Gastroesophageal reflux with esophagitis

GERD with esophagitis is a frequently diagnosed gastroenterological pathology. It is an inflammation of the esophagus, caused by the regular casting into its lumen of the contents of the stomach and duodenum. Under the influence of hydrochloric acid, the distal part of the esophagus is affected and severe complications are formed.

Causes of

Disease Gastroesophageal reflux with esophagitis occurs as a result of insufficiency of the esophageal sphincter. The following factors provoke a similar condition:

• presence in the diet of a large number of spicy / fatty / salty foods;
• the presence of extra pounds;
• diabetes;
• forced long stay in a semi-bent position;
• long-term depression and stress;
• period of bearing the child;
• abuse of strong tea and coffee;
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• smoking and drinking alcohol;
• weight lifting, increased physical activity;
• power failure.

Symptomatic

The clinical picture of the disease is quite specific. Its main symptoms: heartburn, belching, regurgitation( regurgitation), loneliness, dysphagia. It is this strong heartburn that refers to the main manifestations of GERD.The condition is found in the complaints of 75% of patients with this disease. Its cause is the direct contact of the contents of the stomach with the surface of the mucosa of the esophagus.

Feels like a strong feeling of heat behind the sternum. It occurs after taking a certain food - soda, fatty / spicy dishes, alcohol - during exercise, lifting weights, etc. The next sign of the disease becomes a belch with a sour or bitter taste. It develops after eating, carbonated drinks. Can occur in a horizontal position.

Regurgitation( regurgitation) is the spontaneous delivery of stomach contents into the oral cavity. Indicates stagnant esophagitis. Odinophagy( soreness behind the breastbone when swallowing food) and dysphagia( difficulty in swallowing food) are formed during severe GERD.

Extra-oesophageal manifestations of GERD are expressed in the following syndromes:

• Pancreatic. It is accompanied by a cough, attacks of suffocation.
• Otorhinolaryngological. The patient has symptoms of pharyngitis, hoarseness of voice.
• Stomatological. It is characterized by the formation of caries, thinning of the enamel of the dental crown.
• Pronounced kyphosis( specific curvature of the spine).Often combined with diaphragmatic hernia.

Classification of pathology

GERD with esophagitis occurs in 4 stages. For the first( catarrhal esophagitis), it is characteristic to identify local redness and swelling. When the pathology is transferred to the second stage, total hyperemia, the formation of fibrous plaque and erosion zones are diagnosed.

In the third stage, an increase in the total number of erosions occurring at different levels of the esophagus is recorded. The fourth stage is accompanied by the formation of bleeding ulcers, stenosis of the esophageal tube and the development of complications in the form of Barrett's esophagus.

There is also a classification of GERD in terms of:

• 0 degree. Diagnostic signs of the disease are determined exclusively in the course of histological examination.
• 1 degree. A little higher than the lower esophageal sphincter, one or several localized inflammation foci are detected.
• 2 degree. Identified merged erosive foci that do not have common points of contact along the circumference of the esophagus.
• 3 degree. Inflammatory process captures the entire circumference of the esophageal tube.
• 4 degree. There are signs of chronic inflammation - Barrett's esophagus, strictures, peptic ulcers.

Diagnostic measures

In addition to the classical blood test, the patient is assigned various instrumental studies. These are:

• Radiography. Helps identify signs of reflux and complications of GERD, in particular, ulcers, strictures, diaphragmatic hernia.
• Esophagoscopy. Helps to diagnose the current degree of gastroesophageal reflux disease and esophagitis, as well as the development of complications. It allows to exclude a tumor of the esophagus.
• Intraesophageal pH-metry( daily determination of the acidity level of the esophagus).The main method of diagnosing pathology.
• Esophagonomometry. Used to determine the change in the tone of the lower esophageal sphincter, as well as the motor function of the esophageal tube.
• Ultrasound examination of the abdominal cavity organs.

When diagnosing non-esophageal symptoms, the patient is referred for consultation by specialized specialists: cardiologist, pulmonologist, ENT, dentist and others. More details about the current diagnosis of the disease can be found in this article.

Probable complications of

Barrett's esophagus becomes one of the gravest complications of the disease. Pathology is diagnosed in about 10-20% of patients with established gastroesophageal reflux disease. The condition is dangerous with the likelihood of malignancy and the transition to adenocarcinoma. Among the complications of GERD is stridor breathing, fibrosing alveolitis.

Treatment of GERD

Non-pharmacological treatment of gastroesophageal reflux disease is prescribed as an adjunctive therapy. The recommendations are the following: weight normalization, smoking cessation, sleep with a raised head end, refusal to wear corsets and too tight belts, restriction in the intake of medications that can provoke the development of reflux. Observance of the principles of dietary nutrition is one of the stages of the treatment of the disease. The menu should exclude all products capable of provoking an exacerbation of the disease or worsening of the current state.

Drug therapy

The main task is to stop pathological symptoms, scarring of erosions and ulcers, as well as transfer of GERD to a state of remission. To receive prescriptions drugs from several groups:

• Antisecretory - reduce the amount of produced gastric juice. Most often, proton pump inhibitors are prescribed. Treatment of a patient with erosive esophagitis 4-8 weeks. The duration depends on the total number of erosions.
• Antacids. They are used to eliminate heartburn and regurgitation.
• Prokinetics. Appointed as part of complex therapy.

Surgical treatment

Surgical intervention is justified only in the absence of the expected therapeutic result from the previously prescribed regimens. Indications are also the young age of the patient, the absence of a history of severe chronic diseases, complications, GERD, which is accompanied by extra-oesophageal manifestations.

Contraindications are recognized:

• elderly patient;
• severe chronic diseases;
• disorders of esophageal motility.

Surgical treatment of reflux is performed using the method of fundoplication.

Forecast and hospitalization

GERD is a chronic long-lasting disease. Approximately 80% of patients who received adequate treatment, but who stopped taking drugs and do not comply with the diet, often experience a recurrence of GERD.Reflux disease, not accompanied by erosion, and a mild form of reflux esophagitis have a favorable prognosis. They have no influence on the life expectancy of the patient.

In severe forms of the disease, accompanied by the formation of Barrett's esophagus and strictures, the prognosis worsens. Indications for hospitalization are the severe course of the disease, the lack of effect from the prescribed medication, the need for prompt intervention.

Gastroesophageal reflux disease, complicated by the development of esophagitis, is a serious disease that requires the appointment of adequate medication. That is why, when developing a characteristic symptomatology, it is necessary to seek medical advice in the shortest possible time.