Hospital therapy. Etiology, pathogenesis, clinical picture of chronic esophagitis (the most important)

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Hospital therapy. Etiology, pathogenesis, clinical picture of chronic esophagitis (the most important)

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36. Etiology, pathogenesis, clinical picture of chronic esophagitis

Chronic esophagitis is a chronic inflammation of the mucous membrane of the esophagus lasting up to 6 months. The most common variant is peptic esophagitis (reflux esophagitis), which can be complicated by peptic ulcer of the esophagus.

Etiology and pathogenesis. The main cause of the disease is a constant reflux of gastric contents into the esophagus, sometimes bile and intestinal contents, i.e. peptic esophagitis is an aseptic burn of the esophagus by stomach acid.

In the pathogenesis of reflux esophagitis, regurgitation of acidic contents and a violation of the purification and emptying of the esophagus from it are important. There are five criteria for the pathogenicity of reflux in the genesis of peptic esophagitis: frequency, volume, regurgitation, chemical composition, condition of the esophageal mucosa and sensitivity to a chemical factor (inflammation of the walls reduces sensitivity), emptying rate (clearance), which depends mainly on active peristalsis, alkalizing action saliva and mucus.

The occurrence of reflux esophagitis is promoted by hernia of the esophageal opening of the diaphragm, duodenal ulcer, post-gastroresection disorders, and allergies. Allergic predisposition also matters.

Morphological examination of patients with peptic esophagitis reveals edema, hyperemia of the mucosa, infiltration of the submucosa of the supradiaphragmatic segment of the esophagus.

clinical picture. Typical signs of reflux esophagitis include burning behind the sternum, heartburn, regurgitation, which is aggravated by lying down, dysphagia, and the positive effect of taking antacids. There may be pain behind the sternum after eating, resembling angina pectoris.

The occurrence of pain in reflux esophagitis is associated with peptic irritation of the esophageal wall and its spasms during regurgitation of acidic gastric contents, as well as with infringement of the prolapsed mucosa. Distinctive features of this pain: its long, burning character, localization in the xiphoid process, irradiation along the esophagus, less often to the left half of the chest, no noticeable effect from taking antacids, antispasmodics, increased in a horizontal position, especially after eating.

Particular attention in clinical diagnosis should be given to minor symptoms of dysphagia, such as a feeling of a lump behind the sternum, a feeling of hot food passing through the esophagus. A sign of gradually beginning esophagitis may be salivation and the habit of drinking water with food.

Physical examination of patients with reflux esophagitis does not provide diagnostically significant information.

The complications of reflux esophagitis include bleeding, ulceration, strictures, shortening of the esophagus, and malignancy. Chronic reflux esophagitis can lead to the development of axial hiatal hernia.

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