Hospital therapy. Peptic ulcer of the esophagus (most important)

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Hospital therapy. Peptic ulcer of the esophagus (most important)

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38. Peptic ulcer of the esophagus

Peptic ulcer of the esophagus is an acute or chronic disease characterized by ulceration of the mucosa of the distal segment of the esophagus under the influence of active gastric juice.

Etiology and pathogenesis. Chronic peptic ulcers of the esophagus are complications of reflux esophagitis and hiatal hernia. Their occurrence is facilitated by the internal short esophagus, focal metaplasia of the mucosa, heterotopia of the gastric mucosa into the esophagus, reflux disease with cardia insufficiency, diseases accompanied by frequent vomiting (post-vagotomy syndrome, afferent loop syndrome, chronic alcoholism).

Clinical picture. Symptoms of a peptic ulcer of the esophagus resemble the clinical picture of peptic esophagitis: persistent heartburn, worsening after eating, when bending the body, in a lying position, regurgitation, pain when swallowing, and impaired passage of solid food occur.

The clinical symptoms of perforation are indistinguishable from the symptoms of acute penetrating and non-penetrating mechanical injury by foreign bodies. Approximately 14% of esophageal ulcers penetrate into the surrounding tissues.

Diagnosis and differential diagnosis.

Based on clinical symptoms, it is extremely difficult to suspect a peptic ulcer. The diagnosis is verified in the course of instrumental and laboratory research. The most informative X-ray and endoscopic examination.

The most reliable information in the verification of peptic ulcer of the esophagus is provided by endoscopy and multiple biopsy from the edges of the ulcer. When advancing the endoscope to the peptic ulcer, signs of stage I-IV esophagitis, motor dysfunction of the esophagus, perifocal edema and hyperemia of the mucous membrane are revealed.

It is necessary to differentiate peptic ulcers of the esophagus with ulcerations of a specific nature (with tuberculosis, syphilis). In these situations, specific serological tests, the results of histological and bacteriological studies significantly help. The combination of the pathology of the esophagus with damage to the lungs and other organs makes it necessary to purposefully examine the patient in relation to a specific process.

Treatment. Treatment includes the appointment of a diet: mechanically and chemically sparing food is recommended, which is taken in small portions 5-6 times a day. To prevent reflux of contents from the stomach into the esophagus, the position of the patient in bed should be with a raised headboard. Medicines are taken lying down. Assign monotherapy with a drug of one of the following pharmacological groups: antisecretory, including antacids and adsorbents, stimulants of the motor-evacuation function of the stomach (prokinetics), drugs - mucus simulators. Therapy is carried out for a long time - 1,5-3 months.

Indications for surgical treatment - lack of healing within 6-9 months, complicated course (perforation, penetration, stenosis, bleeding).

Forecast and prevention. The prognosis for life and work is favorable.

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