Diseases of the esophagus

Esophagus is an anatomical tube for communication of the oral cavity with the stomach and food transport. Has a mucous membrane, "lubricating" its secret passing contents, the muscle layer.

From the upper and lower end of the muscle form sphincters( pulp) to "lock" the transport corridor. Together with the cardiac department of the stomach, they prevent, during normal operation, reverse casting( reflux).

The mechanism of swallowing is passive, regardless of the will of the person. But all the functions of the esophagus are under constant control of the nerve fibers of the parasympathetic system, hormones. Diseases of the esophagus disrupt the worked out connections, make it difficult to deliver nutrients, therefore cause significant damage to the entire digestive system.

Classification of diseases of the esophagus

The entire list of diseases of the esophagus is divided into groups depending on the nature of the pathology:

• congenital malformations - diseases are detected in childhood, include absence of esophagus and doubling, atresia, stenosis, joint fistulae with trachea, shortening and widening, diverticula,cystic formations;
• functional disorders( neuromuscular dysfunction) - paralysis, atony, cardiac spasm, achalasia;
• inflammatory lesions - esophagitis and their consequences, peptic ulcer, stenosis - nonspecific and specific for tuberculosis, syphilis;
• vascular - varicose veins of the esophagus, angioma, hemorrhagic angiomatosis;
• tumors are benign and malignant, precancerous diseases;
• traumatic injuries, including external and internal injuries, burns and their consequences, ingress of foreign bodies.

In the structure of diseases of the esophagus 60% falls on tumors, 10.8% - on functional disorders, diverticula, scars after burns, only 0.4% - esophagitis.

Causes of

The causes of the pathology of the esophagus are differentiated depending on the main effect factor. Congenital - are associated with a violation of the laying of the tube and its separation into the trachea and esophagus, caused by the pathology of heredity, complicated by the mother's pregnancy, the diseases of the mother's body, are formed at the stage of embryonic development of the fetus.

Mechanical - caused by swallowing of sharp objects by children, adults accidentally or with suicidal purpose, fish bones, dry and hard crusts, insufficient chewing food when eating hastily or lacking good dentures in old age.

Chemicals - include frequent alcohol abuse( poisoning with surrogates, acetic acid, technical liquids), spicy foods, salted and pickled foods, strong coffee and chocolate, getting a nicotine dose when smoking and inhaling smoke from tobacco, the use of drugs of irritant effect.

Infectious - the infection gets into the esophagus during ingestion of excretions from the maxillary sinuses with chronic inflammation, from the palatine tonsils, untreated carious teeth. Thermal - the same action has both excessively hot dishes, and too cold.

Symptoms of esophagus diseases

Esophageal diseases have common clinical symptoms, according to which the doctor judges the localization of the lesion. Let us analyze the main manifestations, their mechanism of occurrence. Heartburn - burning sensation behind the sternum, radiating to the neck. It is caused by ingestion of acidic contents on the mucous membrane of the cardial department from the stomach.

Patients report "rolling the hot wave" from the upper abdomen. Decreases after drinking water, swallowing saliva, taking drugs that neutralize the hydrochloric acid of gastric juice. It accompanies dysfunction, esophagitis, gastroesophageal reflux disease( GERD).

Odonophagy - this is the name of the manifestation of soreness behind the sternum when food is ingested. Symptom is caused by damage to the surface of the inner shell. It must be distinguished from painful spastic contractions of the muscles of the esophagus. Observed with infectious esophagitis( herpetic and fungal), cancer, ulceration, chemical burns. The pain becomes permanent, painful for the patient.

Pain in muscle spasm is a sign of impaired motor function. Appear both immediately after a meal, and independently( spontaneously).The intensity and consistency of pain sensations leads the patients to refuse food, fear, severe depression, mental changes.

Regurgitation( eructation) - is caused by the back intake of the food lump in the oral cavity. It is not accompanied by contraction of the muscles of the diaphragm, as with vomiting, accompanies heartburn.

Observed with a narrowing of the esophageal tube due to spasm, scars, diverticula.

If caused by gastroesophageal reflux due to weakness of the sphincter, the patient feels an acidic or bitter aftertaste. The danger of regurgitation is the high risk of ingesting food particles in the trachea and bronchi. Patients develop a severe cough with a gasp of asthma. Further development of aspiration pneumonia is not excluded.

Dysphagia - difficulty in swallowing food especially dry, rich in fiber. Some patients have a paradoxical sign - liquid food passes with greater difficulty than solid.

Symptoms of diseases of the esophagus have their own peculiarities for each pathology. These are added: prolonged hiccough, increased salivation, putrefactive odor. We will look at them using the example of the most common diseases.

. Basic diseases

The following are the main pathological conditions, their pathogenesis, symptoms and peculiarities of the course.

Achalasia of the cardia

The disease is also called "cardiospasm".The reason is unknown. In pathogenesis, attention is drawn to the broken connection of the muscles of the esophagus and the dysfunction of nervous regulation.

In childhood, nedorazvitie neural apparatus of the esophageal tube. As a result, the opening of the lower sphincter and food lump is delayed.

Patients complain of a feeling of heaviness behind the breastbone and in epigastrium, raspiranie, regurgitation. To push food helps to wash down food with water. Symptoms are fickle.

Occur after swallowing products that contain a significant amount of fiber. Sometimes dry food causes a less painful reaction than liquid. The pain behind the breastbone is very similar to angina in cardiopathy, so patients of the middle and old age are tested ECG.

Dyskinesia

Functional disorders of the muscular tone of the esophagus are manifested in the form of dyskinesia. It accompanies an organic lesion, accompanies esophagitis, ulcers, but is possible without any anatomical damage. Inefficient motor activity is manifested by a disturbed process of food transport. The reason is a change in the regulatory role of the nervous system.

Signs such as an eructation of air, heartburn, unstable chest pains in this case occur in persons suffering from neuroses. The patients themselves indicate the connection of well-being with the transferred stresses.

Description of symptoms accompanied by vivid imagery: "something jerks in the throat", a feeling of a lump. Massage of the reflexogenic zone, restorative procedures, a clear mode of rest and work help.

Gastroesophageal reflux disease

Another name for the disease is "reflux esophagitis".Chronic inflammation of the esophageal mucosa is caused by throwing food with gastric juice back way out of the stomach.

The main reason is the weakness of the lower esophageal sphincter due to the effects of spicy food, caffeine, nicotine, and vagal nerve damage. It is observed with diaphragmatic hernia, stomach ulcer, cholecystitis. It is provoked by pregnancy.

Distinguish:

• esophageal manifestations - heartburn, belching, difficulty in swallowing, lonely phagia, vomiting, hiccough;
• extra-arteries - a tendency to frequent colds, bronchial and lung diseases, stomatitis, ENT diseases, caries, anemia.

Hernia of the esophagus of the diaphragm

The disease is caused by the displacement of the lower part of the esophagus( possibly also part of the stomach, intestinal loops) through the enlarged ring of the muscles of the diaphragm from the abdominal cavity to the thoracic. The cause is a stretching of connective tissue structures of the muscular apparatus of the diaphragm, an increase in pressure inside the abdominal cavity( with ascites), inflammatory diseases of the esophagus.

occurs in 0.5% of adults. It is important that in half the cases the disease occurs without symptoms. The main manifestations do not differ from the common esophageal signs, but the chest pains are of particular importance. Unlike cardiac, they are provoked by eating, leaning forward, lying position of the patient. Relief occurs after vomiting, belching.

Esophagitis

Esophagitis is rare. They accompany other lesions of the esophagus and stomach, traumas, hypovitaminosis, iron deficiency. The disease is considered acute if it lasts up to 3 months. More half-yearly manifestations refer to the chronic course. Interim periods are called subacute.

Specific inflammation occurs in syphilis, tuberculosis, fungal infection. It shows all the above esophageal symptoms. With regurgitation or vomiting, it is typically the detection of food that has just been eaten. Typical relationship of chest pain with nutrition.

Diverticulum of the esophagus

Diverticula are saccular formations within the esophageal wall. By origin can be pulsion( caused by increased internal pressure) and traction( with cicatricial changes in the esophagus and neighboring lymph nodes).

Wall protrusion is able to reach considerable dimensions and squeezing the tube to disrupt the passage of food. Is manifested:

• gradual strengthening of dysphagia;
• putrefactive odor from the decomposition of food stuck in the diverticulum;
• burping air and food;
• swelling on the neck immediately after the start of the meal and the inability to continue swallowing until the evacuation of the diverticulum.

Barrett's esophagus

The disease is considered precancerous because it is caused by a change in the cells of the inner layer of the esophagus( metaplasia).Typical cell composition is replaced by areas of the intestinal epithelium. The exact cause is not established, but there is a connection with a prolonged inflammatory process with esophagitis, reflux disease, diaphragmatic hernia.

Patients complain:

• for persistent sore throat and behind the sternum;
• hoarseness of voice;
• belches acidic contents;
• heartburn;
• persistent cough.

Benign tumors

Benign neoplasms of the esophagus arise from epithelial and other wall cells. They grow slowly, do not last long. The most frequent are leiomyomas and cysts.

The main symptoms begin to worry patients with a significant increase in the tumor and difficulty in swallowing food. The sensation of a foreign body that causes nausea and vomiting is characteristic.

Malignant neoplasms

Any of the above causes can lead to a cancerous esophagus. The initial period lasts up to two years and proceeds without symptoms. The first signs are violations during the passage of food, which is caused by a fairly large tumor size.

Dysphagia grows gradually: at first the patient can not swallow hard food, then there are difficulties in feeding with liquid dishes, increased salivation. There are common signs of intoxication: weakness, lack of appetite, weight loss.

Pain behind the breastbone is significantly worse when swallowed, sometimes given in the back. Constant, painful, they become in a serious stage of the disease. Alcoholism and smoking increases the risk of esophageal cancer by 12 times.

Wounds of the esophagus

Burns and injuries of the esophagus occur in case of accidents, mistaken use of acids or alkalis, technical liquids in a state of intoxication, or for the purpose of suicide. Children without supervision swallow sharp objects.

Chemical burn causes necrotic changes in the wall. The degree of damage depends on the patient's condition. At the expressed fast necrosis the patient is in a shock, simultaneously signs of an internal bleeding are observed. Swallowing is impossible. Swelling of the tissues causes complete obstruction of the lumen.

Traumatic damage can occur with the use of endoscopic methods in the diagnosis of other diseases. Wounds of the esophagus should be excluded in cases of traumatization of the chest.

Malformation of

Anomalies of the esophagus are caused by impaired fetal development in the first trimester of pregnancy. At this time, the common tube of the esophagus and trachea is laid, and then divided. Therefore, vice is often connected. Discovered in early childhood. Immediately after the beginning of feeding, esophageal atresia is detected: the child suffocates because of the ingress of milk into the respiratory tract.

Diagnosis

Diseases of the esophagus can not be detected only on the basis of clinical signs. Modern conditions allow for an accurate examination. The complex of information received is important.

Radiography with ingestion of contrast medium and a series of images helps to make an inference in the production of roentgenograms in oblique projections. The front and back view does not give an opportunity to view the esophagus, as it is closed by the mediastinum shadow.

The method is important in diagnosing diaphragmatic hernia, determining the location, the size of the lumen, the presence of filling defects, narrowing with diverticula, tumors, cardiopathy. In the direction of movement of the contrast, gastroesophageal reflux can be confirmed.

In the course of the study, the patient is changed from a vertical position to a horizontal position. Cardiospasm is confirmed by a picture of the narrowing of the sphincter and enlargement in the upper parts.

Esophagoscopy is a method that allows you to visually inspect all parts of the esophagus. If necessary, a fibrogastroscope perform a targeted biopsy, remove foreign bodies. The condition of the mucosa( presence of inflammation, ulcers, tumors), sphincters, the size of the lumen and patency, is assessed for any dysphagia.

Biopsy is a method of intravital early diagnosis of a tumor, metaplasia of the epithelium. Specialists of cytology study the morphological picture of changes, the degree of degeneration, the type of tumor.

Daily pH-meter - used to record the role of acid transfer to the lower esophagus in pathology. A special pH-probe records the acid-base balance during the day. Computer and magnetic resonance tomography - used for suspected tumors, enlarged lymph nodes.

Esophagotho-kymography - includes simultaneous use of several instruments( kymograph, Marey capsules, pressure sensors, ECG).It is used to study the motility of the esophagus in functional disorders. Identifies areas of impaired tone.

Functional testing - is important in identifying gastroesophageal reflux. Apply standard kits that help control acidity, pressure inside the esophagus. Radioisotope technique - necessary for tumor diagnosis, uses isotope 32R, which accumulates in the affected cells, then is visible during scanning.

Treatment

The choice of treatment tactics for diseases of the esophagus is individual for each specific case. Common is the need to support the normal mental state of patients, as a violation of swallowing dramatically changes mood, causes severe depression, suicidal attempts.

diet. For severe pain and heartburn, esophagitis is applied for fasting for no more than two days. Then they switch to sparing food. The patient is recommended to feed 6 times a day, in small portions. Dishes should contain enough protein, vitamins, carbohydrates, a reduced amount of fat.

Use grated meat mincer scrolls, semi-liquid porridges. Dairy products are used depending on the concomitant lesions of the stomach. Soups and soups should not contain irritants, seasonings. When esophagitis, ulcers cold drink is recommended.

Vegetables and fruits are allowed after removal of the inflammation, first in the garbled form. Prepare steam casseroles, scrambled eggs. The patient is strictly prohibited: alcoholic beverages, strong coffee and cocoa, citrus, spicy and fried dishes with crust, fresh pastry, fatty culinary products.

Changing the regime requires the exclusion of smoking, the transition to work without occupational hazards, heavy physical exertion. It is recommended to sleep with the raised head end of the bed.

Medical treatment

In order to calm the patient, sedatives are prescribed. In cardiopathy, antispasmodics are used, seizures are removed with nitrates, a group of calcium antagonists. Disturbance of sphincter motility is treated with drugs with anticholinesterase action.

With increased acidity, antacids are mandatory( Maalox, Fosfalugel).Almagel-A with anesthesin is used for local anesthesia. With reflux esophagitis, drugs that promote the blocking of H2-histamine receptors( famotidine, ranitidine), improving the sphincter state( Cisapride, Cerucal) are indicated.

are used. Antibiotics and anti-inflammatory drugs are prescribed for all conditions to combat infection. Specific esophagitis is treated with anti-tuberculosis drugs, antisyphilitic drugs.

Shock condition for esophagus burn is treated in the intensive care unit by intravenous administration of Reopoliglyukin, cardiovascular agents. Antibiotics are mandatory for preventing inflammation of the lungs. When anemia is shown, transfusion of blood substitutes.

Surgical methods

Surgical treatment is prescribed for patients with achalasia if it is not possible to medically act on the sphincter. The muscles are dissected or the course of cardiodilation procedures is carried out with a special balloon. The introduction of a probe with a balloon for squeezing the veins is used for esophageal variceal bleeding.

Esophageal diverticula is treated only promptly, if they are large and violate patency. When the hernia of the esophageal region of the diaphragm is performed fundoplication operation( form an artificial valve), strengthen the muscle ring with plastic tissue. In the case of cancer of the esophagus, remove the tumor and completely or partially - the esophagus with the lymph nodes. Simultaneously, cytostatics and radiation therapy are used.

Congenital anomalies operate in early childhood, since it is necessary to create conditions for feeding the baby. Usually, the intervention consists of two stages: first create the stoma( outlet) of the stomach on the surface of the abdomen, then, after several months, conduct the plasty of the esophagus, connect its ends with each other, with the stomach.

With burns, special attention is paid to the bougie technique for stretching the scars. The method is also used in the postoperative period to prevent stenosis. The patient under the local anesthesia inserts dense rubber probes( buhs) of different sizes, starting with a small diameter. Simultaneously, all drugs are used to improve muscle elasticity.

People's Councils

People who have problems with the esophagus have to stick to their diet and diet for the rest of their lives. Treatment with folk remedies is shown outside of exacerbation. It does not replace medicines. Assists the collection of herbs with anti-inflammatory effect, relieving spasm, protecting the mucosa of the esophagus and stomach.

In herbal medicine, the following are recommended:

• herb of St. John's wort, yarrow, celandine;
• flowers of chamomile, calendula;
• leaves of plantain;
• seeds, roots and leaves of forest angelica;
• rose hips.

To protect the surface of the esophagus and stomach, use a decoction of flax seeds, oats. To remove persistent hiccups, lubricate the throat with oil of oregano, do with it inhalations.

Prevention of

To prevent diseases of the esophagus it is possible, if:

• observe the proper power mode;
• avoid overeating and periods of hunger;
• comply with safety regulations when working with toxic substances;
• future mothers have more to think about the health of the offspring.

Symptoms of esophageal injury begin with minor symptoms, which later develop into severe forms of disorders. So do not try to heal yourself. Early treatment to a doctor helps to pass the examination in a timely manner, avoid problems, stop the disease with the help of a diet.