Only complex therapy will help get rid of reflux esophagitis, so it will be useful for every person who suffers from this disease to know how this disease should be properly treated with the help of a competent doctor.
So let's get started.
Symptoms of reflux esophagitis
In adults, the disease is characterized by vivid symptoms; the presence of the disease can be missed only in the initial stage. First of all, the patient has the following symptoms:
- heartburn;
- nagging pain in the retrosternal space;
- difficulty swallowing (dysphagia);
- frequent belching;
- odynophagia (pain in the esophagus when swallowing);
- bad breath.
In severe cases of pathology, vomiting with blood is possible. Children may also experience changes in voice timbre and loss of appetite. In addition, there may be accompanying symptoms from various body systems presented in the table.
| System | Symptoms |
| Cardiac | Cardialgia; extrasystoles |
| Respiratory | Shortness of breath, dry cough, short-term breath holdings during sleep |
| Otorhinolaryngological | Sore throat, sore throat, redness due to inflammation |
| Hematopoietic | Anemia |
| Dental | Glossitis, stomatitis, caries |
An extrasystole is a contraction of the heart that occurs ahead of the main beat.
Causes
The occurrence of reflux esophagitis can be caused by any factors that reduce or completely eliminate the effectiveness of the listed protective mechanisms. They may be:
- Chemical, nutritional factors;
- Nervous tension;
- Increased pressure in the peritoneum.
Often reflux esophagitis accompanies gastrointestinal diseases such as:
- stomach ulcer or cancer;
- damage to the vagus nerve;
- violation of duodenal patency of the esophagus;
- chronic pancreatitis, cholecystitis;
- pyloroduodenal stenosis;
- hiatal hernia.
Causes of reflux esophagitis in adults
The disease is associated with the penetration of gastric juice with digested food into the esophagus, but this does not explain what reflux esophagitis is in adults and what is the root cause of its occurrence. Normally, the reflux of stomach contents into the esophagus is resisted by its lower (cardial) sphincter, which opens when food moves down. The rest of the time it is closed, although its rare and short-term openings are not considered a pathology. But when this becomes a constant phenomenon, accompanied by characteristic symptoms, this indicates the presence of the disease. A weak gastric sphincter is the most common cause of reflux esophagitis.
A sphincter is a muscular structure that controls the flow of fluid or gas through an organ cavity. In the body there are both sphincters of the digestive tract and others, some of which a person can control, others work independently of his will.
Weakening of the lower esophageal sphincter is not a clear-cut phenomenon, and factors such as alcohol abuse, smoking and addiction to coffee can reduce its locking ability. People who are overweight often suffer from reflux esophagitis, which is associated with the pressure of the abdomen on the diaphragm. Eating too hot food and drinks can also weaken the lower sphincter. In addition, reflux can be caused by diseases such as:
stomach ulcer;- stomach cancer;
- pyloroduodenal stenosis;
- pancreatitis;
- hiatal hernia;
- cholecystitis;
- pathology of the vagus nerve.
There are also often cases of the development of reflux esophagitis after surgical operations on the stomach and esophagus.
Why is inflammation of the esophagus dangerous?
Inflammatory diseases can lead not only to surgery or disability, but can even threaten the patient’s life if you do not consult a doctor in time - this is why inflammation of the esophagus is dangerous.
Of course, catarrhal and erosive forms of esophagitis, after eliminating the causes that caused them, go away on their own and rarely cause complications. With more severe esophagitis, the following consequences are possible:
- Narrowing of the esophageal opening (stenosis) is most often the result of chemical burns or severe infections (tuberculosis, diphtheria, typhus); a massive deposition of connective tissue forms at the site of narrowing, which significantly complicates the peristalsis of the esophagus. Above the site of narrowing, as a result of the constant accumulation of food, the wall of the esophagus stretches and bulges, diverticula of the esophagus appear, which often become infected. Post-burn stenoses have a large extent.
- Perforation of the esophagus is a serious complication requiring urgent surgical care. The causes of perforation can be burn esophagitis, esophagitis due to severe infections, and peptic ulcers. The first symptom of perforation may be vomiting, first of scarlet blood, and then of “coffee grounds”. The clinical picture of shock increases very quickly (blood pressure drops sharply, against the background of tachycardia, followed by arrhythmia).
- Barrett's esophagus – This condition is most often the result of GRD. As a result of constant exposure to the acidic contents of the stomach on the mucous membrane of the esophagus, the cells of the mucous membrane are damaged and changed. Such metaplastic cells often give rise to adenocarcinoma.
- Purulent complications of esophagitis. When the esophagus is damaged by foreign bodies (fish bones, accidentally swallowed sharp objects), abscesses and phlegmon of the esophagus occur.
Diagnostics
Primary information for diagnosis is provided by anamnesis and external examination, with special attention paid to the oral cavity. Dental caries, together with inflammation of the mucous membrane, are characteristic signs of reflux esophagitis. Next, the patient undergoes instrumental examinations.
- Fibrogastroduodenoscopy is mandatory and allows not only to confirm the presence of the disease, but also to determine the features of further treatment. The essence of the method is to insert a special probe into the esophagus, which transmits to the screen the condition of the mucous membranes of the stomach and esophagus.
- Esophagomanometry is performed to assess the contractility of the lower sphincter.
- X-rays are used to trace the path of food through the esophagus. To do this, the patient is asked to swallow a portion of barium sulfate, a special drug that is visible using x-rays. The drug is tasteless and harmless to humans.
Additional methods of differential diagnosis also include a cardiogram, chest x-ray and tests for esophageal acidity. Such methods are carried out in order to exclude the likelihood of some other pathologies.
In childhood, reflux esophagitis develops quite rarely; adults are mainly affected by this disease, with men 2 times more likely than women.
Types of disease
- Chronic reflux inflammation of the esophagus is accompanied by periodic painful sensations behind the sternum. Symptoms intensify when running, lifting weights, or eating.
- Acute reflux esophagitis is characterized by inflammatory changes directly in the esophageal wall. When a person takes food, he feels that the movement of the food bolus stops behind the sternum. At the same time, the temperature rises, salivation increases, and swallowing problems occur. Belching is observed in the final stage of the disease.
Non-erosive reflux esophagitis
What is non-erosive reflux esophagitis? This complex term refers to one of the types of GERD, characterized by specific clinical symptoms, in the absence of damage to the tissues of the esophagus. Serious therapy is usually not needed. As a rule, patients recover after normalizing their diet and eliminating spicy, fatty and salty foods.
Erosive reflux esophagitis
The erosive form is one of the most dangerous, because with it the mucous membrane begins to become covered with ulcers. If left untreated, they can bleed or lead to more serious consequences. The worsening of the disease is provoked by dietary errors, which include the consumption of various types of acidic foods, caffeine and alcohol.
Often the course of the disease is aggravated by medications, even such harmless ones, at first glance, as paracetamol, analgin, aspirin, etc. The disease can occur without symptoms for a long time or have the same symptoms as gastritis.
If left untreated, this disease can affect not only the upper cells of the esophagus, but also the deeper layers. Therefore, treatment is carried out under the strict supervision of a doctor.
Classification
Depending on the research data, the patient is diagnosed with the degree of damage to the esophagus.
- The disease in the initial stage does not have pathological changes in the cellular structure of the mucous membrane.
- Reflux esophagitis of the 2nd degree is characterized by diffuse changes in the mucous membrane of the esophagus.
- The third degree of the disease is considered erosive esophagitis.
- At grade 4 we are talking about erosive-ulcerative esophagitis.
Complicating factors include adenocarcinoma of the esophagus, bleeding, and Barrett's esophagus.
Symptomatic treatment
If other gastrointestinal pathologies are associated with GERD or reflux was caused by one of them, the disease is treated symptomatically, according to the type of underlying disease:
- Stress or neurosis as the root cause of reflux esophagitis. Prescription of sedatives (valerian, motherwort) and consultation with a psychotherapist are required.
- Peptic ulcer disease. De-Nol should be additionally prescribed. For bacterial ulcers, antibiotics are taken.
- Weak immunity with low tissue regeneration. It is recommended to take immunostimulants.
How to treat gastroesophageal reflux esophagitis
Traditionally, the fight against the disease begins with medications, and if they are ineffective, the word remains with surgical methods.
Treatment of reflux esophagitis with medication
Drug treatment of reflux esophagitis is carried out over a course of 5 to 8 weeks, in conjunction with certain nutritional standards. The patient is prescribed several types of drugs, among which antisecretory agents play an important role. With their help, the activity of gastric juice is suppressed, which is necessary to quickly reduce the effect on the esophageal mucosa. Based on the type of effect, there are two types of these drugs.
- Proton pump inhibitors reduce the amount of acid produced by blocking the proton pump. The most famous of them are Rabeprozole, Omeprazole, Pantoprazole and Lanzoprazole.
- H2-receptor blockers block histamine receptors and also reduce the effect of acid on the mucosa. These are such well-known drugs as Ranitidine, Nizatidine, Roxatidine and others.
The use of some drugs has serious contraindications, so their use should be agreed with the attending physician.
Antacids do not reduce acid secretion, but neutralize its effect. Since long-term use of such drugs is undesirable, the course of treatment should not exceed 2 weeks. For reflux, it is recommended to take medications containing aluminum and magnesium:
- Phosphalugel;
- Maalox;
- Almagel;
- Gastal.
Prokinetics for reflux esophagitis are used to enhance gastric motility and increase the tone of the lower esophageal sphincter, the main cause of the disease. Taking these drugs not only affects the problem organ, but also helps relieve heaviness in the stomach and nausea. Among them are:
- Motilium;
- Domperidone;
- Itopride;
- Tegaserod.
In addition, complex treatment includes taking cytoprotectors that increase the protective properties of the esophagus and stomach, due to their ability to improve blood circulation in problem areas and increase mucus production. These include:
- Dalargin;
- Misoprostol.
If necessary, immunostimulating drugs, antibiotics and antidepressants are prescribed as additional drugs. During treatment, the patient is under outpatient observation, and, depending on the current results, the attending physician may replace some drugs with others or change the general course of treatment.
Surgical methods
Surgical intervention is used if drug therapy has not brought the expected results within six months. But the decision to perform surgery is made immediately after diagnosis if there are complications such as hiatal hernia, aspiration pneumonia, Barrett's esophagus or bleeding. A particular danger is the situation when, due to a rupture of the esophagus, there is a communication between its cavity and the pulmonary space.
An operation called fundoplication restores the functions of the lower esophageal sphincter. It can be used either by an abdominal or thoracic incision or a minimally invasive method using laparoscopy. When using the latter, the patient's postoperative hospital stay is reduced to 4 days.
IPP
Treatment of gastroesophageal reflux disease is not complete without the use of powerful antisecretors. The most powerful are PPIs. Advantages:
- minimal number of side effects;
- work of the active ingredient relative to the parietal cell without deep absorption;
- effective inhibition of Na+/K±ATPase activity;
- rapid blockade of the last stage of hydrochloric acid production with its complete inhibition in the stomach.
The best effective PPIs are: Omeprazole, Pantoprazole, Lanzoprazole, Rabeprazole (Pariet). A single dose of 40, 30, 40, 10 (20) mg, respectively, can completely block the synthesis of hydrochloric acid for 24 hours.
An analogue of Omeprazole is its modified subtype - Losek. Advantages:
- absence of allergic fillers (lactose, gelatin);
- smaller dragee size;
- special coating for easier swallowing;
- soluble in water for use through a nasopharyngeal tube.
Another effective remedy is “Nolpaza” - an antiulcer, acidity-reducing, generic pantoprazole. Nolpaza is recommended when taking other drugs simultaneously due to its 100% compatibility. Take 20 or 40 ml 1 time per day.
Diet for reflux esophagitis
In order to reduce the load on the sphincter, in this disease, a fractional diet is recommended with a preference for dishes with a puree-like consistency. Such food reduces the secretion of gastric juice and alleviates the patient’s condition.
What not to do
All products that in any way contribute to irritation of the mucous membrane or increase the secretion of gastric juice are subject to a ban. It is necessary to exclude:
- spicy;
- fat;
- smoked;
- too salty;
- hot dishes.
Carbonated and alcoholic drinks, canned food, citrus fruits and strong tea or coffee will also not be beneficial for this disease.
Menu for reflux esophagitis for every day
The ban on some products may upset some particularly passionate gourmets, but the list of permitted products is also quite wide, and allows you to choose a worthy replacement for your favorite dishes.
| Products and dishes | Examples |
| First | Vermicelli soups, preferably dairy, vegetable with the addition of lean meat, without frying |
| Second | Chicken, rabbit, veal, fish - perch, bream, pollock, hake. Side dish - porridge and vegetable stews (except legumes). |
| Sauces | Based on milk, flour and vegetable oils |
| Dairy | All fermented milk products are healthy, not exceeding 10% fat content. |
| Eggs | Various foods are allowed, but not fried and no more than 3 times a week |
| Dessert | The baked goods are preferably unsweetened; desserts containing natural honey are healthy; All non-acidic fruits are allowed. |
| Beverages | Green or weak black tea; compotes; mineral water without gas. Tea with the addition of chamomile and rose hips is beneficial. |
Following a diet is necessary not only during drug treatment, but also in the postoperative period. Moreover, the causes of reflux esophagitis in adults are often associated with eating disorders. Strictly following the rules of nutrition, in conjunction with medical prescriptions, will allow you to restore your health much faster and forget about the unpleasant symptoms of reflux esophagitis forever.
Sample menu for the week
- breakfast: semolina porridge on water with added butter, green tea;
- 2nd breakfast: baked apple;
- lunch: boiled chicken breast, pasta, dried apricot compote;
- afternoon snack: mashed cottage cheese with a teaspoon of honey;
- dinner: vegetable puree soup.
- breakfast: steamed omelet, weakly brewed tea with milk;
- 2nd breakfast: low-fat kefir, pear;
- lunch: steamed chicken cutlet, vegetable stew, fresh fruit jelly;
- afternoon snack: pureed apple;
- dinner: baked hake, green salad with olive oil.
- breakfast: oatmeal with fruit, herbal tea (except mint);
- 2nd breakfast: rice pudding;
- lunch: baked pollock with boiled potatoes, prune compote;
- afternoon snack: fermented baked milk;
- dinner: pumpkin puree soup, beet salad.
- breakfast: rice porridge with butter, weak tea with honey;
- 2nd breakfast: any fruit puree;
- lunch: rabbit stew, zucchini puree;
- afternoon snack: skim milk, savory cookies;
- dinner: carrot casserole with cream sauce.
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- breakfast: baked cheesecakes, sour cream, green tea;
- 2nd breakfast: banana, yogurt;
- lunch: stewed meat with buckwheat porridge, pear compote;
- afternoon snack: curdled milk, biscuits;
- dinner: stuffed zucchini, salad with chicken breast.
- breakfast: rolled oatmeal porridge in water with grated apple;
- 2nd breakfast: any fruit (plums, kiwi);
- lunch: mashed potato soup, baked chicken;
- afternoon snack: jelly, low-fat cheese;
- dinner: chicken noodles, beet salad.
- breakfast: cottage cheese casserole with sour cream;
- 2nd breakfast: fruit smoothie;
- lunch: boiled chicken meatballs, rice, apple compote;
- afternoon snack: savory cookies, pear or apple juice;
- dinner: steamed fish cutlet, carrot salad.
You can cure reflux esophagitis and avoid exacerbations only by putting your diet and lifestyle under control. Avoid smoking and alcohol. Follow simple rules, listen to your body - this will not only relieve pain symptoms, but will also help you defeat the disease completely.
A balanced diet of foods will normalize weight, improve digestion and the general condition of the body, and you will gain vigor and lightness.
Folk remedies
There are many ways to treat reflux esophagitis, even with folk remedies, but before using them it is better to consult a doctor.
- Take a tablespoon each of oregano, calendula, calamus rhizome, anise, fireweed, white marigold, mint. Grind the ingredients. The decoction is prepared as in the previous recipe, but first it is infused and then boiled. Drink the medicine 50 ml up to 6 times a day;
- You need to pour 3 tbsp boiling water. spoons of flax seeds and wait 3 hours, strain, use 2 tbsp. spoons in 20 minutes. before eating. This jelly envelops the mucous membrane.
- A good folk remedy for chronic reflux esophagitis. A medicinal mixture of herbs and celery root juice. The juice of dandelion flowers with sugar will help in treating the disease. Drink 1 tbsp. a spoonful of celery root juice 30 minutes before a meal.
- Papaya contains a special enzyme that helps treat reflux esophagitis naturally and effectively. Just eat this wonderful fruit every day. Additionally, you can use other folk remedies to combat this esophageal disease.
- The disease can be treated with a collection based on marshmallow and linden roots. The collection also includes yarrow, licorice root, horehound herb, centaury herb, wheatgrass rhizome and St. John's wort. Pour a tablespoon of the mixture into a glass of boiling water and cover with a lid. Take the medicine twice a day, half a glass.
Forecast
Reflux esophagitis, as a rule, has a favorable prognosis for work ability and life. If there are no complications, then it does not shorten its duration. But with inadequate treatment and non-compliance with the recommendations given by doctors, new relapses of esophagitis and its progression are possible.
Possible complications:
- formation of Barrett's disease;
- high risk of developing a malignant tumor;
- strangulation and development of esophageal ulcers.
Paying attention to your health will help you avoid the dangerous consequences and complications of reflux esophagitis. It is not recommended to try to treat this disease yourself; its complications can be very serious.
Prevention
At the first signs of reflux esophagitis and the appearance of symptoms such as heartburn, discomfort after eating, you should consult a doctor. You may need a slight adjustment to your daily routine, nutrition, and habits. On your own, in order to prevent the development of the disease, you can follow simple rules:
- eat little and often;
- never overeat;
- do not lie down after eating or bend over;
- sleep with the headboard or pillow raised;
- avoid heavy straining and heavy lifting after eating;
- reduce or eliminate the consumption of alcohol, strong tea, coffee, spicy foods;
- stop smoking;
- if you are obese, try to lose weight;
- Avoid stressful situations, infectious viral diseases and weakened immunity.
The most important thing: you should not ignore any initial manifestations of the disease or self-medicate and suppress the symptoms. A timely visit to a specialist will help to avoid many problems and serious complications in the future. Chronic diseases of the esophagus are easier to prevent than to treat. When the first signs of reflux esophagitis appear, you need to reconsider your lifestyle, get rid of bad habits and stick to a healthy diet.
Possible schemes
The first treatment regimen with the same drug. In this case, severe symptoms, the degree of change in soft tissues, and the presence of complications are not taken into account. This approach is not effective and in some cases can be harmful to health.
The second treatment approach is escalation therapy. This means prescribing drugs of different aggressiveness at different stages of the inflammatory process. Treatment consists of following a diet and taking antacid medications. If no effect is observed, the doctor prescribes a combination of similar medications, but stronger in action.
The third scheme is in which the patient begins to take strong proton pump blockers. As soon as severe symptoms subside, weak prokinetics are used. This measure has a positive effect on the health of patients with severe reflux esophagitis.
Prokinetics are used for severe disease
Classic scheme in 4 stages
- Reflux esophagitis, with its mild manifestation (grade 1), is supported by lifelong medication (antacids, prokinetics).
- Moderate severity of inflammation (grade 2) requires regular adherence to proper nutrition. It is also necessary to take blockers that normalize acidity.
- During the period of severe inflammatory process (grade 3), the patient is prescribed receptor blockers, inhibitors together with prokinetics.
- In the latter degree, drugs are powerless, so surgical intervention and a course of supportive treatment are required.
Antacids and alginates
The purpose of using representatives of this subgroup of pharmaceuticals is to quickly neutralize hydrochloric acid in the stomach area. In addition, against the background of their use, a larger volume of bicarbonates is produced, natural protectors of the mucous membrane of the digestive structures. They also bind bile pigments and inactivate pepsin.
In most cases, specialists give preference to non-systemic medications that contain aluminum or magnesium. Modern antacids:
- Almagel
- Phosphalyuge
- Maalox
It is optimal to take them in liquid form, which allows for high-quality distribution over the entire surface of the mucosa.
Antacids are designed specifically to reduce the acidity of gastric contents. The list of contraindications to them is minimal, for example, individual intolerance to active or auxiliary components.
Stages of reflux disease
Symptoms of GERD - their severity and impact on the patient’s general condition - directly depend on the degree of damage to the esophageal mucosa.
The following stages of reflux esophagitis are distinguished:
- Stage 1 - minimal damage to the esophageal mucosa, the diameter of the inflammation is less than 5 mm, limited to one fold;
- Stage 2 - single or multiple lesions exceeding 5 mm in size;
- Stage 3 - inflammation spreads to 2 or more folds, in total less than 75% of the circumference of the esophagus is damaged;
- Stage 4 - large, merging lesions, lesion circumference greater than 75%.
Complications
Without proper and timely treatment, the disease develops into a chronic form, characterized by erosive and ulcerative changes in the structure of the tissues of the esophagus. One of the most serious complications of reflux esophagitis can be esophageal cancer. In addition, a chronic inflammatory process in the esophagus contributes to a decrease in immunity, increasing the risk of diseases such as:
- frequent viral infections;
- sinusitis, sinusitis, tonsillitis and inflammation of the trachea;
- cardiovascular disorders;
- bronchitis, pneumonia, bronchial asthma;
- erosion and tooth decay.
