Hospital therapy. Diagnosis, treatment of chronic esophagitis (the most important)

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Hospital therapy. Diagnosis, treatment of chronic esophagitis (the most important)

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37. Diagnosis, treatment of chronic esophagitis

Diagnosis and differential diagnosis. The most valuable research method for this pathology is endoscopy, during which hyperemia, edema, and thickening of the mucosal folds are noted.

It is necessary to differentiate reflux esophagitis with peptic ulcer of the stomach and duodenum, coronary heart disease, chronic cholecystitis and pancreatitis. The leading symptom in the differential diagnosis is pain. Differentiation with peptic ulcer is helped by the absence of late and "hungry" pains in esophagitis, as well as data obtained from endoscopy of the esophagus and stomach. Coronary pain, in contrast to esophagitis, is characterized by a connection with physical and emotional stress, the effect of nitrates, signs of ischemia on the ECG, including those according to bicycle ergometry. Ultrasound data of the abdominal organs help to exclude the pathology of the gallbladder and pancreas as the cause of the pain syndrome.

Treatment. Therapy of reflux esophagitis includes the treatment of diseases that caused it, and the appointment of antireflux therapy.

Patients are advised to avoid lifting weights, bending over. It is necessary to take the correct position during rest and sleep (the headboard is raised by 15-20 cm, at an angle of 30-50). It is recommended to normalize body weight, eat fractionally (the last meal - 3 hours before bedtime). Alcohol and spicy foods are excluded from the diet.

Assign adsorbents and alkalizing drugs that have a protective effect on the mucous membrane. These substances include Venter, which is administered orally at a dose of 1 g (preferably in the form of a suspension) 30-40 minutes before meals 3 times a day and the 4th time on an empty stomach at bedtime. The course of treatment is 8-10 weeks. Almagel, phosphalugel, maalox, gastal have a similar effect. These drugs are used in the interdigestive period (1/2-2 hours after meals and at night) until complete remission occurs. Phosphalugel and Maalox are prescribed 1-2 packets 2-3 times a day, gastal - 2-3 tablets a day. Tea soda, a mixture of Bourget, white clay due to insufficient efficiency is not advisable to use. Enveloping and astringent action has bismuth nitrate 1 g 3-4 times a day. A high antireflux activity of a new antacid, topalkan, was noted. Mineral waters - "Borjomi", "Essentuki No. 4", "Jermuk", "Smirnovskaya" have an alkalizing effect.

To reduce acidic gastric secretion, histamine H2 receptor blockers (cimetidine, ranitidine, famotidine), Ka-K-ATPase inhibitors (omeprazole), a selective blocker of M-cholinergic receptors of parietal cells, and its analogue buscopan are prescribed.

Forecast and prevention. The prognosis for life and work is favorable. In a complicated course, the prognosis is determined by the timeliness and quality of medical care. Patients with a severe course are assigned a disability group. Patients with chronic reflux esophagitis should be under the supervision of a gastroenterologist. At least 2 times a year, endoscopic and morphological studies are indicated due to the possibility of malignancy.

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