Esophagitis

Infectious (Herpetic) Esophagitis

Herpetic esophagitis occurs with the direct spread of infection from the mucous membrane of the oropharynx or with the reactivation and migration of the virus into the mucosa of the esophagus through the vagus nerve. The main symptoms are pain when swallowing, dysphagia, pain behind the sternum, weight loss. Multiple oval erosions with hyperemic bottom appear on the mucosa of the esophagus, some of which are covered with fibrinous films. Distal parts of the esophagus are predominantly affected, but in severe cases the mucous membrane of the esophagus is affected along its entire length. Neither esophagoscopy nor radiography with contrasting barium suspension makes it impossible to distinguish between herpetic esophagitis and candidal and radial esophagitis, thermal and chemical burns. However, the cytological and virological study of the material obtained by esophagoscopy, is of great help in the diagnosis.

Type 1 herpes simplex virus occasionally causes esophagitis in people with normal immunity. However, usually herpetic esophagitis occurs with a weakened immunity, the causative agent of it is herpes simplex virus type 1 or herpes simplex virus type 2. Complaints come down to sudden chest pain, odinofagiya and dysphagia. In severe cases, bleeding and disruption of the general condition (nausea, vomiting, fever, chills, mild leukocytosis) are possible. A vesicular rash on the nose and lips makes it possible to immediately assume a diagnosis.

With the help of X-ray examination with a barium suspension, it is impossible to detect early changes in the esophagus and distinguish herpes esophagitis from esophagitis caused by other pathogens. When esophagoscopy is found on the esophagus, vesicles and small erosion with steep edges, often covered with fibrinous films. Subsequently, erosion increases in size and merge with the formation of multiple ulcers of the esophagus. To make a diagnosis, a biopsy is required - normal (from the edge of the ulcer) or brush. Balloon dystrophy of the epithelium and intranuclear eosinophilic inclusions, surrounded by a zone of enlightenment, are characterized by giant epithelial cells in smears. Diagnostic value is virus isolation in cell culture, which takes several days.

Antiviral agents facilitate the patient's condition and accelerate the healing of erosions.

Patients with deep immunodeficiency are prescribed acyclovir, 800 mg orally, 2 times a day or 250 mg / m2 IV every 11 hours for prophylactic purposes. In case of herpetic esophagitis, acyclovir is administered IV at a dose of 250 mg / m2 every 8 hours. dysphagia pass to the drug intake, 200-400 mg 5 times a day. The condition usually improves after 1 week, but large ulcers heal much longer. When the causative agent is resistant to acyclovir, foscarnet is prescribed, 60 mg / kg i / v every 8 h.

Concomitant reflux esophagitis aggravates the course of the disease and increases the risk of complications.

Infectious esophagitis

Infectious esophagitis can be caused by various viruses (most often esophagitis is caused by the herpes simplex virus and cytomegalovirus), in more rare cases, viral esophagitis develops when the varicella virus or Epstein-Barr virus develops, with specific pathogens (mycobacterium tuberculosis, paleopaemone). infection (most often fungi of the genus Candida), parasitic infection.

Infectious esophagitis usually occurs in individuals with various immunodeficiency states.

Risk factors should be considered:

  • use of antibiotics and steroids,
  • chemotherapy and / or radiation therapy,
  • malignant neoplasms,
  • immunodeficiency syndromes, including acquired immunodeficiency syndrome.

Common signs of infectious esophagitis is the presence of an infectious process in other organs and systems. Characterized by the presence of such signs of infection as fever, skin rash, ulcers, aphthae in the mouth and others.

Odinophagy, dysphagia, especially pain and difficulty swallowing when consuming liquid food are observed in clinical symptoms. There may be complaints of shortness of breath and pain behind the sternum. In more rare cases, infectious esophagitis may be asymptomatic.

In infectious esophagitis, the surface layer of the esophageal mucosa is most often involved in the pathological process, and only in exceptional cases does the inflammation spread to the deep layers, which can cause stenosis or fistula.

Candida esophagitis

Candida esophagitis refers to the most common and studied form of infectious esophagitis. The most common cause of candidal esophagitis are the fungi of the genus Candida, in addition, there are isolated information about the identification of cryptococcosis, histoplasmosis, blastomycosis and aspergillosis.

Candidosis of the esophagus is more often detected in patients with hemoblastosis, AIDS, after organ transplantation and in those receiving inhaled steroid pharmacotherapy, in patients with oncological diseases. The absence of oral candidiasis does not exclude the occurrence of isolated esophageal candidiasis.

In general patients, candidal esophagitis occurs in 1–2% of cases, in patients with type 1 diabetes - in 5–10%, in AIDS patients - in 15–30% (some authors believe that up to 50%).

Diagnosis and differential diagnosis

Verification of the diagnosis is usually carried out during esophagoscopy, when white or whitish-yellow plaques and / or confluent linear or nodular plaque-like raids are detected on the hyperemic esophagus mucosa, usually in its middle third. In some cases, the formation of ulcerations. The pathognomonic sign of candidal esophagitis is the fact that the deposit is hardly removed with biopsy forceps and after its removal there are areas of sedimentation of the mucous membrane.

Histological examination of the biopsy material from the affected areas revealed yeast fungi with pseudohyphae, which penetrate into the epithelial layer of the mucous membrane or even into deeper layers.

If it is impossible to conduct an etiological examination of the patient, a quick positive response to etiological therapy may be an additional diagnostic criterion for the disease.

Candida esophagitis must be differentiated from esophagitis of viral genesis, drug and eosinophilic esophagitis.

For the treatment of candidal esophagitis, the prescription of systemic antimycotic drugs that include imidazole is recommended. In the presence of immunodeficiency, the dose of the drug increases significantly.

If the treatment is not effective enough, amphotericin can be given.

Cytomegalovirus esophagitis

Cytomegalovirus and herpetic esophagitis are the second most common. The frequency of cytomegalovirus esophagitis is 10–20% of all infectious lesions of the esophagus and develops only against the background of immunodeficiency in patients undergoing transplantation who are on long-term hemodialysis, HIV-infected, in patients who are receiving steroid therapy for a long time.

Diseases of cytomegalovirus esophagitis in patients without immunodeficiency states are not registered.

Clinical picture

For cytomegalovirus esophagitis is characterized by pronounced singularity, sometimes up to sitofobii. Dysphagia is characterized by difficulty swallowing when consuming liquid food and is the second most common clinical symptom of the disease. In the stage of a developed clinical picture of patients, constant nausea, vomiting, fever, and weight loss are of concern.

Forecast and outcome

Damage to the esophagus in cytomegalovirus esophagitis is often combined with lesions of the retina, lungs, liver, colon. In severe cases, massive necrosis of the epithelium, rupture of the esophagus, bleeding, strictures, tracheobronchial fistulas, and dissemination can occur.

An effective antiviral pharmacotherapy is an important condition for a positive result in the treatment of secondary lesions of the esophagus and the prevention of complications.

Tuberculous esophagitis

The defeat of the esophagus by tuberculosis is observed relatively rarely and, as a rule, is combined with damage to the lungs.

Esophagitis can develop when swallowed sputum infected with mycobacteria, less often in patients with immunodeficiency, hematogenous or lymphogenous from the lungs and mediastinal organs.

Diagnostics and differential diagnostics

The endoscopic picture is variable, ulcers, strictures can be observed, three-dimensional lesions with ulceration are described, which requires a differential diagnosis with malignant tumors. Sometimes the displacement of the esophagus is revealed by enlarged lymph nodes of the mediastinum.

The diagnosis is established according to the biopsy data - the detection of necrotizing granulomas in the biopsy specimens of the esophagus, tuberculosis mycobacteria.

In case of tuberculous esophagitis, complex treatment with anti-tuberculosis drugs is carried out.

Other pathogens that can cause esophagitis

With tertiary syphilis, the mucous membrane of the esophagus may be pale treponema.

Conducting endoscopic examination reveals gumma, syphilitic ulceration, strictures.

Diphtheria can also be accompanied by a lesion of the esophagus, which spreads from the oropharynx.

Endoscopic examination reveals signs of fibrinous inflammation of the esophageal mucosa.

Medicinal esophagitis

Inflammatory changes in the mucous membrane of the esophagus under the influence of drugs can occur in patients of any age group.

One of the identified risk factors is considered to be an insufficient amount of water, which is washed down with medications, as well as the adoption of a horizontal position after taking medications, in violation of the motility of the esophagus or the presence of abnormalities in its development.

Erosions and ulcers of the esophageal mucosa can occur under the influence of pharmaceuticals with high chemical activity (antibiotics, ascorbic acid, iron supplements), which have the ability to cause acid or alkaline burns of the esophageal mucosa.

Another damaging factor is the occurrence of gastroesophageal reflux, which is possible after taking theophylline, anticholinergic drugs, the development of local hyperosmolarity when exposed to potassium chloride. Some pharmaceuticals can cause medicinal damage to the esophagus due to the high concentrations that they are able to create in tissues (doxycycline, nonsteroidal anti-inflammatory drugs).

Exodus and Prevention

Ulcerative defects provoked by medicinal substances, as a rule, heal very quickly, sometimes even without additional treatment, only after the elimination of the damaging agent.

For the prevention of drug damage to the esophagus, especially for elderly people, it is recommended to wash down the pharmaceuticals with enough water and not to take the horizontal position of the body for at least 1 hour after taking the medicine.

Scleroderma

In systemic scleroderma, esophagitis can develop in 70–80% of patients with grade 1 disease activity. With grade 3 activity, the esophagus is affected in 100% of cases.

Replacing the smooth muscle fibers of the lower two-thirds of the esophagus with dense fibrous tissue leads to impaired peristalsis and causes difficulty in the passage of the food bolus through the esophagus. The spread of the pathological process to the lower esophageal sphincter is accompanied by the throwing of stomach contents into the esophagus, which further aggravates the damage to the esophageal mucosa.

Autoimmune lesions

Some skin diseases (acquired epidermolysis bullosa, common pemphigus, cicatricial pemphigoid, lichen planus) can occur with involvement in the pathological process of the esophagus with the onset of esophagitis, which is difficult to treat with drugs.

Such esophagitis most often occurs in women of middle age group.

Esophagus vesicle is a rare disease, the morphological manifestation of which is the large bull, after the destruction of which there are large eroded surfaces.

Conducting adequate timely treatment leads to the rapid healing of erosion.

Diabetes

The pathology of the esophagus in patients with diabetes mellitus is detected in 5-17% of cases, the estimated frequency is much higher.

The leading cause of damage to the esophagus in diabetes mellitus is a violation of visceral innervation (autonomic neuropathy gastrointestinal form) and, consequently, the motor function of the esophagus, reduced tone of the lower esophageal sphincter and expansion of the stomach, which leads to the development of pathological gastroesophageal reflux.

Eosinophilic esophagitis

The disease can be diagnosed in any age group, but it is most often detected in children and in males under 40 years of age. There is a high frequency of combination of eosinophilic esophagitis with atopic and allergic diseases, mainly with bronchial asthma. Eosinophilic esophagitis is considered an immune-mediated disease of the esophagus with the participation of eosinophilic cells, occurring against the background of autoimmune diseases.

Quite often, eosinophilic esophagitis is regarded as gastroesophageal reflux disease.

Burns, foreign bodies

Foreign bodies and burns of the esophagus can cause the development of severe chronic forms of esophagitis. The infectious-inflammatory process joins the consequences of injury and burns.

Chemical burns occupy a leading place among the injuries of the esophagus in childhood.

Traumatization of the esophagus often occurs as a result of mechanical damage to the mucous membrane or deeper layers during various manipulations or operations: installation of a nasogastric probe, endoscopic sclerotherapy, endoscopic ligation of the esophagus veins, as well as damage to the esophagus mucous membranes with food and foreign bodies when swallowed.

Diagnosis of Infectious Esophagitis

The diagnosis is established by the presence of a lesion detected during fibroesophagoscopy. Herpes lesion of the esophagus is manifested in the form of vesicles that can merge and be filled with serous fluid. Then the vesicles are replaced by an ulcer. Similar rashes on a mucous membrane can repeat decreasing, or increasing.

The main methods of diagnosing infectious esophagitis are:

  • Feeling of the abdomen - required to exclude cholecystitis, gastritis and pancreatitis,
  • Fegds is the main survey method using a fiber optic probe equipped with a camera. In this situation, the esophagus and part of the stomach are examined,
  • X-ray
  • Esophagomanometry.

Treatment of infectious esophagitis

Therapy of an infectious form of esophagitis is carried out with antiviral drugs, but most often the flu-like illness passes on its own.

It is mandatory for patients to prescribe a special diet and sweep away the damaging factors. It is very important to exclude from the diet of a patient with infectious esophagitis chocolate, fatty foods and tomatoes.

In addition, during treatment of the disease, enveloping medications and local antispasmodics are prescribed to the patient. Also from the diet should be completely abandoned spicy and coarse food, strong coffee, alcoholic beverages and citrus fruits. At the same time, herbal decoctions that heal wounds and relieve inflammation are considered to be very useful. In the case of a severe form of the infectious process, patients are given infusion therapy, which involves the introduction of a detoxification solution.

Fungal lesion of the esophagus

Most often, in patients with fungal esophagitis, Candida albicans is sown, but other pathogens can be released, for example, Candida tropicalis, Candida parapsi-losis, Candida glabrata, Histoplasma capsulatum, Blastomyces dermati-tidis, Aspergillus spp. and Torulopsis glabrata.

Candida albicans is found in the oropharynx in about 50% of healthy people. In normal immunity, Candida albicans is also found on the skin and in the intestines. In case of violations of cellular immunity or taking antibacterial drugs, the composition of the intestinal microflora can be significantly disturbed, which leads to the reproduction of Candida albicans. Mechanical or chemical damage to the esophageal mucosa, for example during gastroesophageal reflux, is believed to increase the risk of Candida albicans reproduction and subsequent infection. And in fact, in many cases, the most pronounced lesions of the mucous membrane in patients with candidiasis of the esophagus are observed in the distal parts, which are most of all exposed to the acidic gastric contents during reflux. The mechanisms of attachment of yeast fungi to the mucous membranes and the subsequent infection are not fully understood. Candidiasis is the most common infection of the esophagus, and the severity of its manifestation may vary from a random finding during endoscopic examination with no symptoms at all to the most severe lethal outcome. According to one study, 90% of HIV-infected people with candidal stomatitis were diagnosed with endoscopy caused by Candida spp. lesion of the esophageal mucosa. Larger studies have not confirmed this high rate; nevertheless, many of the drugs used to treat candidal stomatitis are also effective for candidiasis of the esophagus. Therefore, endoscopic examination is advisable to carry out only in cases where local antifungal therapy has failed. Candida esophagitis may also have long-term effects. Severe inflammatory reaction leads to exfoliation of the mucous membrane, perforation and esophageal strictures.

Although candidal esophagitis can develop in any patient, there are certain predisposing factors.

Predisposing factors

The development of candidiasis is promoted by HIV infection, neutropenia, hemoblastosis and other malignant neoplasms, organ transplantation, immunosuppressive therapy, including glucocorticoids, antitumor therapy, radiation therapy, alcoholism, exhaustion, old age. In generalized granulomatous candidiasis, in addition to the esophagus, the skin, nails and oral cavity are affected. In such patients, as a rule, cellular immunity is impaired. However, the introduction of highly active antiretroviral therapy into practice has significantly reduced the frequency of opportunistic infections.

Viral esophagitis

Viral esophagitis is also quite common, especially with immunodeficiency, and may show candidiasis in clinical manifestations. Most often, esophagitis is caused by herpes viruses, mainly herpes simplex virus and cytomegalovirus. In AIDS, Epstein-Barr virus, varicella-zoster virus and HIV-1 virus can also be detected in esophagus ulcers.

Esophagitis caused by the herpes simplex virus

Herpetic esophagitis can also develop in healthy people, especially after intense physical exertion or heavy experiences. In most cases, the disease resolves itself in about 7–10 days, which indicates normal cellular and humoral immunity. Persistent infection and relapse may be signs of acquired immunodeficiency, in such cases it is necessary to establish its cause.

Predisposing factors

  1. Malignant neoplasms, mainly of the hematopoietic and lymphoreticular systems.
  2. Transplantation.
  3. Reception of immunosuppressive drugs, glucocorticoids.
  4. Antitumor chemotherapy.
  5. AIDS.

  1. Installation of a nasogastric tube.
  2. Tracheal intubation.
  3. Reflux esophagitis.

Diagnostics

Clinical manifestations. Herpes damage to the esophagus is characterized by a triad of symptoms: fever, pain on swallowing and pain behind the sternum, which is aggravated during the meal. The pain may be in the back. Possible pain on palpation of the xiphoid process of the sternum. Sometimes there is gingivitis. 30% of patients develop a generalized infection. Multiple lesion of a virus (for example, an infection of the stomach and respiratory organs) threatens the life of the patient. Herpes infection is often accompanied by other infections (bacterial, fungal and viral). Severely debilitated patients may not complain of pain, so in such cases, special attention should be paid to dysphagia and lack of appetite.

Endoscopy is the preferred diagnostic method. During the study, take a brush scrapings and perform a biopsy, while biopsy specimens should be taken from the edge of the ulcer.

  • The endoscopic picture depends on the stage of infection: the early stage - vesicles of various sizes, the intermediate stage - small superficial ulcers with steep edges and yellow fibrinous exudate, at a late stage ulcers merge, forming extensive patches of superficial ulceration.
  • On the affected areas, the growth of the Candida yeast fungus and bacteria often begins, so the virus can only be isolated from the vesicles or the edges of the ulcer. A smear from the bottom of the ulcer should definitely be examined for the presence of Candida spp. Histological examination of epithelial cells from the edges of the ulcer visible inclusions. Chromatin in the nuclei of the affected cells is shifted to the periphery, resembling a bezel. Often, giant multinucleated cells are also seen.

Radiocontrast study with a barium suspension. With double contrast radiography, ulcers and plaques can be seen, but the picture is indistinguishable from candidal esophagitis.

Diagnosis of herpetic esophagitis is often difficult, since characteristic intranuclear inclusions and giant multinuclear cells may not be found in mucosal biopsy specimens obtained by endoscopy. In this case, the immunoperoxidase method and in situ hybridization are used (these methods are also used to detect other viruses — cytomegalovirus, Epstein — Barr virus, and HIV-1). Even in this case, the absence in the biopsy of the affected epithelium can cause a diagnostic error. The presence in the exudate of clusters of macrophages with nuclei of irregular shape adjacent to the affected epithelial cells is a characteristic inflammatory reaction in herpetic esophagitis. If such macrophages are seen in the biopsy, and there are no characteristic intracellular inclusions, additional studies are shown to rule out herpes infection.

Sowing brush scrapings and biopsy specimens improves diagnostic accuracy.

Treatment

  • Supportive treatment. For local anesthesia, especially before eating, give the patient a lidocaine gel. With a strong persistent pain when swallowing the patient is transferred to parenteral nutrition.
  • Acyclovir allows you to quickly eliminate the symptoms of the disease. It is usually prescribed at a dose of 6.2 mg / kg i.v./ every 8 hours for 10-14 days. In mild and moderate esophagitis, acyclovir is prescribed orally at a dose of 200 mg 5 times a day. Valaciclovir and famciclovir are as effective as acyclovir, but they can be taken less frequently.

Bacterial esophagitis

In immunodeficiency, bacterial esophagitis can be considered as a separate disease. If neutropenia occurs with fever or bacteremia of unknown origin, the possibility of esophagitis should be considered. In bacteremia, the same pathogen is sometimes found in biopsy specimens taken from the esophagus. Most often, biopsy specimens and blood sow gram-positive cocci and sticks, as well as gram-negative enterobacteria. Antibacterial therapy should be selected taking into account the sensitivity of the isolated pathogen.

Esophagus tuberculosis

Tuberculosis of the esophagus is rare. Disease It may be a consequence of secondary pulmonary tuberculosis, as well as the result of direct penetration of the pathogen from the adjacent bronchopulmonary lymph nodes or lymph nodes of the mediastinum, vertebral bodies, aortic aneurysm, and pharyngeal or laryngeal tissues. With active pulmonary tuberculosis, the defeat of the esophagus can be caused by the ingestion of a large number of bacteria that colonize mucous membranes already affected by another pathogen. However, in most cases of tuberculous esophagitis, chest radiography does not reveal an active tuberculous process in the lungs.

Clinical picture. Characteristic epigastric pain and dysphagia.

However, patients' complaints are often uncertain.

Diagnostics

  1. The results of X-ray studies are varied, including esophageal compression of the lymph nodes, ulcers and strictures, resembling lesions in malignant tumors.
  2. Endoscopy. At endoscopic examination, superficial ulcers with smooth edges, small tuberculous granulomas on the mucous membrane or thickening and fibrosis of the esophagus walls, narrowing of its lumen and stricture can be seen. Biopsy reveals granulomas with caseous necrosis with or without acid-resistant bacteria.
  3. Sowing sputum sometimes makes it possible to isolate Mycobacterium tuberculosis even in the absence of radiographic changes.
  4. The tuberculin test is usually positive, and the results should be compared with the results of the control samples.

Treatment. Assign a 9-month course of combination therapy, including isoniazid, rifampicin and ethambutol.

The degree of acute esophagitis:

Chronic esophagitis - a chronic inflammatory process in the wall of the esophagus.

More often, this is the result of acute esophagitis, which has been started or is not cured to the end. Types of chronic esophagitis

Occupational esophagitis caused by harmful fumes, acids, caustic alkalis, heavy metal salts in production, Congestive esophagitis irritation of the esophageal mucosa with food debris, Allergic esophagitis - occurs when food allergies, bronchial asthma, that is, altered reactivity of the body, Alimentary esophagitis, and body irritation. hot food, Chronic esophagitis is a rare satellite of diseases such as duodenitis and gastritis. Symptoms are dominated by pain in different parts of the abdomen, soreness behind the sternum, burping air, heartburn, hiccups, drooling and many other manifestations.

In chronic esophagitis, exacerbations are not uncommon. Lack of treatment can lead to scarring in the esophagus.

4 degrees of chronic esophagitis:

  1. Hyperemia without erosion in distal regions,
  2. Selected small erosive damage to the mucous membrane
  3. Separate erosive areas merge with each other,
  4. Stenosis and ulcers on the mucous,

Also mentioned are such types of esophagitis as dysmetabolic, idiopathic ulcerous esophagitis (similar to ulcerative colitis), nonspecific regional stenotic esophagitis, peptic esophagitis or reflux esophagitis.

How does the esophagus in chronic esophagitis

Mucus, puffiness, loose and hyperemic surface. Expansion of the veins of the esophagus, erosion, hemorrhagic rashes. Cysts, microabscesses. Atrophy of the mucosa, dysplasia, peptic ulcers of the esophagus. This incomplete list of morphological manifestations of the disease alone can warn all those who are frivolous about their health.

Esophagitis in children

Esophagitis can occur even in newborns. The reason for this is the general physical immaturity of the body.

Older children, able to tell about their problems, report pain in the epigastric region and under the xiphoid process. This occurs during or after a meal, especially intense pain in the prone position or during exercise. Nausea and vomiting in preschoolers, those who are older - heartburn and belching air. It is necessary to immediately pay attention to any complaints of the child in order to timely examine and prevent the transition of the acute to the chronic form, to pay attention to the diet and diet.

Morphological forms of esophagitis

Symptoms characteristic of a) and b) are hyperemia and swelling of the mucous membrane.

Often occurs against the background of exacerbation of infectious diseases or irritation of the esophageal wall with various substances,

Some infections or viral diseases (such as typhus or influenza) become the trigger, causing hemorrhages in the esophagus wall.

e) and f) occur in diphtheria and scarlet fever. Subject tissue soldered to fibrinous exudate.

The reason - severe infectious diseases - typhoid fever, scarlet fever, measles, are also possible with agranulocytosis, candidiasis.

Damage to the wall of the esophagus by a foreign body, followed by purulent inflammation.

There are two stages: acute and chronic.

a) Characteristic symptoms in acute candidal esophagitis - rapid rates of development of the disease, fever. The fungal process spreads to the lower esophagus,

b) The chronic form of esophagitis is usually the result of poor-quality and incomplete treatment of the acute form. Necrotic manifestations and ulceration are also possible.

After describing all the stages, forms and complications of esophagitis, it will not be superfluous to remind once again that the earlier the treatment is started, the more attentively the person treats his body, the alarming symptoms, the diet, the faster recovery will come.

The following types of diagnostics are usually prescribed to determine the stage of the disease, its severity and the purpose of optimal treatment:

  • Esophagoscopy,
  • X-ray
  • Monitor pH-metry of the esophagus,
  • Depending on the severity of the condition and the neglect of the disease, patients are offered conservative or surgical treatment.

    Conservative treatment

    When the disease is not started and proceeds without serious complications, there is enough drug treatment and follow the doctor’s recommendations regarding nutrition, diet, regimen.

  • antacids,
  • prokinetics
  • antisecretory drugs.

    Appointments regarding regimen, diet, dietary habits and behavior

  • denial of clothing, restraining movement,
  • strict restrictions on fat, citrus, chocolate, coffee and other foods that adversely affect the esophageal mucosa,
  • complete smoking cessation
  • Do not lean forward and do not take a horizontal position after eating for at least 1.5 hours.

    If the listed measures are not enough, other methods of treatment are added:

  • endoscopic laser therapy,
  • electrophoresis with novocaine on the epigastric region,
  • hyperbaric oxygenation,
  • direct intraesophageal electrical stimulation of the cardia.

    Surgery

    In those cases when conservative treatment and diet do not bring results, they resort to surgical intervention. The following symptoms may be signs that it cannot be avoided:

  • lack of effect from conservative treatment,
  • esophageal strictures, repeated bleeding,
  • Barrett's esophagus,
  • Frequently repeated aspiration pneumonia.

    Reflux esophagitis

    Reflux esophagitis is a condition in which the contents of the stomach or intestines enter the esophagus. Such unpleasant symptoms as heartburn, a lump in the throat, pain, and a burning sensation behind the sternum bring discomfort to the patient.

    Reflux esophagitis is classified into several degrees:

    The easiest and most reversible stage is with grade 1 esophagitis, when there is only a few minor lesions. Grade 2 - a series of confluent foci of erosion. Grade 3 - ulcers in the lower esophagus, total mucosal lesion. Grade 4 - the transition of the disease into chronic and esophageal stenosis.

    Treatment of folk remedies

    Many people actively use folk remedies in the treatment of esophagitis. Here are just some of them:

    Folk remedies such as these can only alleviate the condition, but not solve the problem in a complex. Of course, all these recipes can improve the dynamics of the disease. But they are only good as preventive methods. Replacing folk remedies full treatment of professional doctors can not. There is no need to joke with health, amateur activities here are unacceptable. The consequences can be too serious, because your life is at stake.

    What triggers / Causes of Esophagitis:

      The most common cause of esophagitis is a gastro-esophageal reflex, resulting in damage to the esophageal mucosa due to exposure to an acid-peptic factor. If esophagitis is caused by reflux, it is called reflux esophagitis.

    Other causes of esophagitis include:

      infections (most often fungi of the genus Candida, herpes simplex virus, cytomegalovirus). These infections are most common in patients with reduced immunity, in particular, those suffering from AIDS or receiving immunosuppressive therapy, glucocorticoids, antitumor chemotherapy drugs. A chemical burn with alkali or acid, a solvent (for example, gasoline, acetone), a strong oxidant such as potassium permanganate can also cause esophagitis. Such esophagitis is usually observed in children after a random sample or in adults after a suicide attempt using an alkali, acid, solvent or oxidizing agent. Often observed in alcoholics - in this case, the damaging factor is ethyl alcohol. Physical damage to the esophagus due to radiation therapy or the insertion of the probe can also cause esophagitis.

    Symptoms of herpes esophagitis

    The symptoms of herpetic esophagitis are similar to the signs of a banal catarrhal esophagitis and are accompanied by symptoms of a common herpes infection (sudden onset, chills, fever, and sometimes seizures). After 24-48 hours, the severity of these phenomena is significantly reduced or they completely disappear. Instead, there are local signs of herpetic lesions on the skin, pharyngeal mucosa and esophagus. The latter are dominated by clinical manifestations - pain during the passage of a food lump in the esophagus, dysphagia, sometimes belching with mucus mixed with blood.

    Diagnosis of herpetic esophagitis

    The diagnosis of herpetic esophagitis is established by the presence of herpetic lesions of the skin, pharyngeal mucosa and with fibroesophagoscopy. Herpes lesions of the esophageal mucosa are manifested in the form of vesicles with scalloped edges, with a tendency to merge, filled with yellowish serous fluid. Vesicles are replaced by ulcers, the bottom of which is covered with a yellowish false-membranous coating. These lesions of the mucous membrane of the esophagus are similar to those that occur on the mucous membrane of the oral cavity and pharynx, which contributes to the diagnosis of influenza esophagitis. Herpes lesions on the mucous membrane of the esophagus can be repeated with small intervals, gradually increasing, and the number of lesions decreases.

    Treatment of Esophagitis:

    Treatment of acute corrosive esophagitis, as well as abscess and phlegmon are carried out in the hospital. In acute and subacute esophagitis, a gentle diet No. 1 is prescribed (in some cases fasting or feeding through a tube is recommended for a few days). With abscess and phlegmon of the esophagus, antibiotics are prescribed. For acute, subacute and chronic esophagitis, astringents are useful (bismuth nitrate basic 1 g or 0.06% silver nitrate solution 20 ml 4-6 times daily before meals).

    Treatment of reflux esophagitis mainly carried out by conservative measures. In order to prevent gastro-esophageal reflux, physical work associated with the torso and tension of the abdominals is prohibited. It is recommended to sleep with a raised upper half of the body. From drugs, astringents and antacids are prescribed (magnesium oxide, calcium carbonate precipitated, aluminum hydroxide 1 g 5 times a day after meals, almagel, etc.). With pronounced concomitant esophagism, antispasmodic and anticholinergic agents are indicated. When corrosive esophagitis in order to avoid the formation of stricture early begin bougienage of the esophagus.

  • failure of conservative treatment,
  • complications of esophagitis (strictures, repeated bleeding),
  • frequent aspiration pneumonia,
  • Barrett's esophagus (due to the danger of malignancy).

    Features of herpes internal organs

    Herpes infection of the internal organs is much less common than the same “fever on the lips” or genital herpes. Most often, internal inflammation causes cytomegalovirus - herpes simplex virus type 5. Symptoms of internal herpes are associated with the appearance of herpetic lesions on the internal organs - trachea, larynx, urethra, bladder, walls of the vagina. And if HSV type 1 and type 2 remains responsible for the damage of the organs described above, herpes esophagitis, pneumonia and hepatitis are caused by type 5 HSV.

    Symptoms of internal herpes are extremely diverse and depend entirely on the damage of a particular organ or system. The most common are three forms of internal herpes: herpetic hepatitis, esophagitis and pneumonia.

    In herpetic esophagitis, the inner lining of the esophagus becomes inflamed. In this case, the patient feels pain when swallowing, the very process of swallowing food is disturbed. Additional symptoms are associated with pain behind the sternum during weight loss. When examined through an endoscope, the doctor finds multiple areas of erosion, which, without appropriate treatment, can lead to loosening of the esophageal mucosa. In most cases, herpes affects only the upper esophagus, but if the disease has gone too far, then changes characteristic of herpes may appear on the intestinal walls.

    With pneumonia of herpes origin, symptoms such as fever, cough, shortness of breath occur, although this form of the disease is usually found in weakened people. The patient feels chest pain and general malaise, in the later stages it becomes difficult to breathe. In general, the symptoms of the disease are blurred, since the disease often proceeds against the background of other bacterial, fungal and protozoal infections of the respiratory organs.

    Herpetic hepatitis is accompanied by a lowered immune status. In its clinical manifestations, it is very similar to other types of hepatitis. The most characteristic symptom of the disease is jaundice, accompanied by yellowing of the skin due to increased activity of bilirubin. At the initial stage of the disease, body temperature rises, general malaise, headache, weakness occur. The liver shell is stretched, which causes pain in the right hypochondrium, irrigating the shoulder or shoulder blade.

    With the defeat of the internal organs, it is sometimes possible to detect the true cause of the disease only after a proper examination and special tests - PCR and ELISA. The first is aimed at detection in the blood of the pathogen itself, and the second - antibodies to it. In the latent stage of PCR, it may not only reveal the presence of virus molecules, but the very first relapse will provoke the appearance of antibodies to the virus, which will remain in the body forever.

    Newborn Herpes

    Of all the groups of patients infected with the herpes virus, newborns are most at risk of contracting herpes type 5. In this case, the disease can affect both internal organs and the central nervous system. The latter is possible if the child does not receive the necessary treatment. Symptoms of generalized infection can be fatal in 65% of cases. And only less than 10% of newborns with CNS damage grow and develop normally. Despite the fact that a herpetic rash is the most common sign of infection, in many newborns the skin is affected only in the later stages of the disease.

    In 70% of cases, the symptoms of HSV type 2 occur in babies after childbirth. This applies to the situation when the child passed through an infected birth canal. Infection with HSV type 1 occurs in the postnatal period, during contact with sick family members. In either case, there is a high risk of developing complications affecting the activity of the central nervous system.

    Herpes infection of internal organs is treated with the same drugs as any herpes virus infection. We are talking about antiviral drugs, immunomodulators and ancillary drugs - antipyretic, analgesic and anti-inflammatory. In some cases, the doctor may decide on drug therapy to support the affected internal organs.

    Herpetic esophagitis, pneumonia and hepatitis are treated with antiviral drugs such as Acyclovir, Famvir, Valaciclovir and others. Viferon, Cycloferon, Isoprinosine and Licopid can be noted from immunomodulators. Cytomegalovirus therapy in people with transplanted internal organs and in patients with AIDS is accompanied by taking Ganciclovir, Tsidofovir, and Foscarnet.

    Treatment of ENT organs and organs of the digestive tract should be supplemented with a special diet, which involves the rejection of fatty, spicy and spicy foods that can irritate the walls of the esophagus and larynx. The patient is advised to maintain an upright posture for 1.5 hours after eating, wear loose clothing and give up bad habits. In the treatment of herpetic pneumonia, often accompanied by a bacterial or fungal infection, antibiotics and expectorants are of great importance. Amoxicillin, Amoxiclav, Augmentin, etc. can be distinguished from antibacterial drugs.

    Treatment of herpetic hepatitis requires the introduction of hepatoprotectors. Although hepatitis in infectious mononucleosis caused by Epstein-Barr virus, usually occurs in a mild form and in most patients is resolved independently. In severe cases, acute hepatic failure develops. In addition, infection with this strain of the virus increases the risk of developing lymphoproliferative diseases after transplantation of internal organs.

    Additional treatment

    Whatever type of herpes virus does not provoke a disease of the internal organs, it is important to maintain the condition of the patient with vitamins and drugs that normalize metabolism. Treatment of herpes infection is associated with taking vitamins A, C, E, group B, rutin. Of particular importance is vitamin therapy during seasonal exacerbation of infection. Great benefits can bring the means of traditional medicine. Treatment is shown infusion viburnum, immortelle, tansy and celandine. And folk healers recommend regularly drinking infusion of lemon balm for several weeks.

    In the process of treatment of herpes with folk remedies, fresh juices are indispensable for people, which can have a huge positive effect on the body's defenses. A good effect can be a mixture of carrot juice, fresh beet tops, parsley and apples. It should be drunk during the day in small sips.

    Esophagitis - inflammation of the esophagus

    Inflammation of the inner lining of the esophagus - a long inflammatory process that affects the deep layers of the body. Inflammation of the esophagus occurs quite often, may occur without visible symptoms. The disease is called esophagitis.

    According to its functions, the esophagus is subject to inflammatory processes.

    The mechanism of the appearance of the disease

    A suitable environment for the work of the esophagus, the stomach is determined by the pH level. An alkaline environment is ideal for the upper digestive system. Diseases of the gastrointestinal tract, infectious diseases, mechanical damage - causes that change the level of acidity. The result is that an increased acid content disrupts the normal functioning of the esophagus. The impact of a constant stimulus on the inner walls is the beginning of the inflammatory process.

    The disease is provoked by local irritants: infectious, common. Inflammation of the mucous membrane of the esophagus provoke the following reasons:

  • Reflux is a common cause of irritated mucous membranes. Acid-peptic factor has a destructive effect on the internal walls of the organ. When confirming the presence of peptic inflammation, the disease acquires the prefix reflux esophagitis.
  • Infection is the second reason. Kandin fungus, herpes, cytomegalovirus, provoke inflammation. Candida esophagitis occurs in people with lowered immune systems. As a rule, candidal esophagitis is a secondary disease and is treated together with the infection.
  • Burn. Effects on mucous acid, gasoline, acetone, solvent, other strong oxidizing agents. The organ is inflamed, the edema is the result of a burn.
  • Mechanical damage during examination, treatment. The result is puffiness, hyperemia, organ inflamed, irritated mucous layer.

    Acute condition

    The mild form does not cause any inconvenience, but if you do not pay attention to the first symptoms in time, it becomes acute. On examination, hyperemia of the esophagus is visible, the passage of food is accompanied by pain. As a rule, parallel to the acute state of the disease of the stomach.

    The nature of the symptoms depends on the degree of inflammation. The catarrhal form proceeds without signs, sometimes there is discomfort when taking hot, cold food, swelling and redness. Severe forms are accompanied by fever, general malaise, edema, acute hyperemia. Patients brings discomfort pain in the neck, behind the sternum, heartburn, difficulty swallowing and increased salivation.

    Extremely complex form is accompanied by vomiting with blood, the patient faces a state of shock. A week after the exacerbation, an imaginary recovery occurs, the symptoms subside, the process of eating is normalized. If the necessary treatment is not carried out, severe foci will start scarring, a consequence of which is dysphagia.

    Chronic condition

    You can call the process lasting more than 6 months. Regular mucosal injury, exposure to acidic conditions, some diseases (syphilis, tuberculosis) cause the development of the chronic form. The mechanism of the disease is the constant impact of harmful factors on the walls of the mucous. In chronic esophagitis, there are several groups:

  • alimentary occurs due to frequent irritation of the walls with hot, spicy food, hard food pieces, smoking, which leads to redness,
  • professional accompanies people who often come across acids, alkalis, salts, which is typical of hard working conditions,
  • dysmetabolic appears in heart failure, low immunity, vitamin deficiency.

    Signs of illness

    Symptoms of inflammation of the esophagus are often not pronounced, are presented by the following symptoms:

  • edema,
  • mucous hyperemic,
  • difficulty swallowing
  • feeling of heaviness in the sternum
  • regurgitation
  • periodic pain, give back, neck, shoulder blades.

    The disease begins gradually. At first there are difficulties when swallowing, after a short period of time there is a belching, then vomiting. Severe vomiting can cause bleeding. The amount of vomit affects the degree of narrowing of the walls of the body. The disease development process is divided into 4 stages:

  • Stage 1 - hyperemia, edema of the mucous membrane increases the amount of secreted mucus. During the meal, there is sometimes discomfort that passes after stopping the meal.
  • Stage 2 - hyperemic mucosa provokes the formation of single erosive ulcers.
  • Stage 3 - the number of erosion increases. Erosive edema provokes bleeding.
  • Stage 4 - the entire esophagus in erosive ulcers. Erosion, esophageal walls are covered with yellowish fibrin.

    Separately, the following types of esophagitis are distinguished: ulcerative (the causes of occurrence are not fully determined), regional (progressive inflammation, which leads to complete obstruction).

    Esophagitis. Cardia failure

    A complication is expressed in the poor functionality of the cardiac sphincter, which is located between the stomach and the esophagus. As a result of insufficient closing of the valve, undigested food particles, gastric juice enter the esophagus from the stomach. Disorders of the sphincter lead to the formation of ulcers of the mucous membrane, which are gradually covered with fibrin. The determination of the degree of difficulty is confirmed by endoscopy. The complication is divided into three degrees:

  • The first - the sphincter does not close completely, is open to 1/3 of the total diameter. Accompany the violation of frequent air belching.
  • The second is closing the valve in half. The number of eructations increases, bringing discomfort.
  • The third is the complete closure of the sphincter.

    Heartburn, nausea, cramps in the esophagus, the stomach is accompanied by cardio-esophagitis.

    Ulcerative esophagitis

    This form is extremely rare. The severity of ulcerative complications, the duration of treatment brings inconvenience to the patient. In the classical form, swelling and redness of the mucous membranes are observed, but if the aggressive environment does not stop it, changes in the structure occur. The long-term influence of irritating factors first leads to thinning of the walls of the mucous membrane, and then to the defeat of the submucosal and muscular layers. The surface covers fibrin plaque. The disease becomes erosive and ulcerative, fibrins completely cover the bottom.

    Symptoms are ambiguous, often confusing specialist:

  • night cough
  • constant heartburn
  • pain when swallowing, in the abdomen,
  • nausea sometimes occurs.

    Medications

    In parallel, a specialist prescribes medications:

  • acidity lowering drugs (astringent antacids)
  • prokinetic drugs, improve the motor processes of the gastrointestinal tract ("Metoclopramide"),
  • medicine that relieves spasms.

    The performed esophagoscopy allows the specialist to treat the patient with a course of detoxification therapy, prescribing a broad-spectrum antibiotic. A positive result is fixed by physiotherapeutic procedures (electrophoresis, treatment with mud, exposure to modulated current). Drug treatment is positive in the absence of serious complications.

    Surgical intervention

    Unsuccessful drug treatment is the signal for the surgical method. Main reasons:

  • ineffective drug treatment,
  • addition of complications.

    The operation is to expand the lumen of the esophagus, with the possible removal of part of the body (if indicated), its plastics.

    Folk preparations

    Faced with the symptoms of esophagitis, it is necessary to change the usual way of life. It is worth starting with a dietary approach to nutrition, giving up bad habits, and complex treatment with folk remedies will give excellent results. Self-treatment folk remedies are not worth it, consult a phytotherapist for a recommendation.

    Preference is given to drugs that treat redness, can relieve irritation, remove fibrin from the walls of the esophagus and restore proper gastric secretion:

  • Flax seeds have astringent properties. Enveloping the walls of the mucous, protect the esophagus from the occurrence of erosion and fibrin. Seeds reduce the level of acidity, thereby leaving heartburn, stomach pain. 1 teaspoon of seeds is poured 0.5 glass of water, left overnight. In the morning on an empty stomach infusion is drunk. The course of treatment is 5 days, break 10 and repeat.
  • Herbal collection of chamomile (2 tbsp.), Licorice root, melissa, motherwort (1 tbsp.) Can soothe the hyperemic mucous layer, relieve puffiness, reduce discomfort. Brew a glass of boiling water, insist on a water bath for 10 minutes, then set aside for a couple of hours. Strain, drink a third cup 4 times a day.
  • Dill tincture is suitable when the wall of the esophagus is hyperemic. Ground seeds (2 tsp.) Pour a glass of boiling water, insist 2 hours. Strained infusion take 1 tbsp. l before meals 4 times a day.

    Soothe irritated esophagus common folk remedies (soda, milk) is not worth it. Folk medicine temporarily reduces the level of acidity, as a result, it will increase.

    Prevention

    A healthy lifestyle is the best disease prevention. Try to avoid irritants:

  • spicy hot food
  • smoking,
  • alcohol,
  • products with high acidity,
  • excess weight,
  • narrow, uncomfortable clothing.

    Watch your health, control the symptoms and do not let the situation develop.

    Lesions of the esophagus with herpes simplex virus

    Rash on the mucous membrane of the esophagus, manifested by the clinic of acute esophagitis (painful esophageal dysphagia, etc.), rarely detected with esophagogastroscopy.

    Electron microscopy of targeted biopsy specimens of the gastric mucosa is of diagnostic importance.

    In the treatment, acyclovir is used (zovirax and other synonyms), which is introduced into the IV on the first day at the rate of 5 mg / kg 3 times a day. then for five days, taken orally 200 mg 5 times a day. Acyclovir with herpes prevents the formation of new elements of the rash, reduces the likelihood of dissemination and visceral complications, reduces pain during the acute phase and has an immunostimulating effect. A similar effect has the drug famciclovir (famvir), administered orally 250 mg 3 times a day for 7 days. Recently, for the treatment of herpes infection, valaciclovir (valtrex), 500 mg 2 times a day, has been used successfully. within 5-7 days.

    Classification of esophagitis

    The extent of the lesion has differences for the acute and chronic course of the disease. Acute esophagitis and burns of the esophagus are divided into three degrees:

  • superficial damage without erosive and ulcerative defects,
  • defeat of the entire mucous membrane with peptic ulcers and necrosis,
  • the lesion extends to the submucous layers, deep defects are formed with the possibility of perforation of the esophagus wall, bleeding. After healing, the formation of cicatricial strictures is possible.
  • Symptoms of esophagitis

    The main clinical manifestations of esophagitis:

  • dysphagia,
  • discomfort,
  • burning and pain in the chest,
  • arising or increasing when swallowing.

    Duodenogastroesophageal reflux manifested:

  • heartburn
  • belching sour or bitterness.

    Erosive and hemorrhagic esophagitis may be accompanied by:

  • bloody vomiting
  • excretion of blood with feces.

    The general condition is determined by the underlying disease, the prevalence of the process (focal or diffuse), its morphological form. It suffers the most from phlegmonous esophagitis.

    Acute Esophagitis may be complicated:

  • massive bleeding
  • an abscess
  • perforation of the esophagus,
  • development of purulent mediastinitis.

    The outcome of acute pseudomembranous and necrotic, as well as chronic esophagitis can be stricture of the esophagus. Focal dysplasia of the mucous membrane of the esophagus is often malignant.

    Esophagitis Treatment

    Treatment of uncomplicated forms of esophagitis is conservative. In case of prolonged unsuccessful conservative therapy, the appearance of complications (strictures, scars, repeated bleeding), the threat of malignancy (Barret's esophagus) and the occurrence of recurrent aspiration pneumonias resort to surgical treatment of esophagitis.

    To achieve success in treatment, the following rules must be followed:

  • After eating, keep your body upright for an hour and a half,
  • Place chumps up to 15 cm high on the side of the head under the legs of the bed,
  • Clothes should not pinch the belly,
  • Stop smoking,
  • To minimize the level of fatty foods, alcohol, citrus fruits, hot spices, chocolate and other foods that irritate the mucous membrane in the diet.

    Medicines

    If the disease passes in an uncomplicated form, its treatment is carried out with medication.

  • Antacid drugs (almagel, smect),
  • Drugs to reduce the production of gastric juice (omeprazole),
  • Prokinetics (improve the locomotor activity of the gastrointestinal tract: cleboprid, metoclopramide, betanecol).

    Treatment will be more effective if, in addition to medications, laser exposure, oxygen or electrophoresis are also used.

    Esophagitis Diet

    In the acute period, fractional feeding is recommended, chemically and thermally sparing food, and later (until the symptoms disappear) - diet No. 1.

    Persons with gastroesophageal reflux are prohibited products that provoke cardia hypotension (chocolate, citrus fruits, tomatoes, tea, coffee), as well as smoking. Afternoon sleep is not recommended.

    For severe back pains, fasting for 2 to 3 days is recommended. Food for this disease should be benign from all points of view. The temperature of the food should not be too high or low, the structure is soft and semi-fluid. In the composition of dishes should not be annoying (sour or sharp substances).

    It is desirable to cook dishes in the form of mashed potatoes, souffles, jellies.

    • Soup without seasonings in vegetable, meat, fish broths,
    • Mush porridge except barley, millet and wheat,
    • Lean meat in the form of souffle or ground boiled meat,
    • Lean boiled milled fish,
    • Eggs in the form of a steam omelet and a soft boil,
    • Sour-milk and dairy dishes,
    • Vegetables boiled or stewed first in the form of mashed potatoes. It should abandon tomatoes in any form and sharp species,
    • Fruits should be abandoned from acidic species, as well as melons and citrus.

    Until improvement, do not eat bread, fatty foods, sauces, mushrooms, pickles, soda, smoked foods, raw fruits and vegetables, nuts, chocolate, strong coffee, tea and cocoa.

    Infectious (Herpetic) Esophagitis

    Published: July 29, 2015 at 10:40

    Herpes type esophagitis is an inflammatory process of the esophagus. Infectious lesion of the esophagus by herpes or shingles is rare. As a rule, it proceeds with parallel damage to different parts of the epithelium and mucous membrane.

    Signs of herpetic esophagitis resemble the manifestation of the catarrhal form of the ailment and are complemented by general symptoms. Usually after a day or two, the severity of symptoms significantly decreases or disappears altogether. They are replaced by lesions of the epithelium and mucous membrane.

    Patients have pain during the passage of food through the esophagus, belching with blood and mucus, dysphagia.

    Watch the video: Histopathology Esophagus --Herpes esophagitis (December 2019).