Esophagitis

Introduction to esophagitis Esophagitis is inflammation caused by edema and congestion of the esophageal mucosa due to abnormal stimulation of the superficial or deep tissue of the esophageal mucosa. These stimuli include stomach acid, bile, vomiting, bile, spirits, peppers, too hot soups, too hot tea, and so on. Can be divided into primary and secondary esophagitis. There are many reasons for esophageal inflammation, such as long-term placement of nasogastric tubes or taking aspirin, strong acid and alkali, non-steroidal anti-inflammatory drugs or patients receiving chemotherapy or radiation therapy or the patient's own resistance after severe vomiting. Elevated and infected with tuberculosis or Candida or virus causes esophagitis. Mainly to "burn heart", swallowing pain, difficulty and post-sternal pain. When esophagitis is severe, it can cause esophageal fistula and esophageal stricture, and swallowing food feels "frustration" and even vomiting. General esophagitis bleeding is mild, but it may also cause hematemesis or melena (tar). Esophagitis caused by different causes may be accompanied by corresponding clinical manifestations. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: aspiration pneumonia esophageal ulcer iron deficiency anemia

Cause of esophagitis

Physical factors (25%):

Swallowing hot food, sharp foreign bodies or chewing bones, ingesting corrosive agents and other direct damage to the esophageal mucosa cause inflammation. Esophagitis caused by overheated food can quickly heal itself. The stomach tube is often used to stimulate the esophagus and can also cause esophagitis.

Drug factors (15%):

Drugs such as quinidine, tetracycline, potassium chloride, iron, etc. stimulate the esophageal mucosa, especially tablets that are stagnant in the esophagus, can also cause esophagitis. Antibiotics are used for too long, causing infection of the esophageal mucosal fungi.

Disease factors (20%):

Physical or chemical esophagitis: Esophagitis caused by radiation exposure is called radiation esophagitis.

Lower esophageal sphincter function (15%):

The lower toe of the esophagus in normal people has a high pressure area to prevent gastric contents from flowing back to the esophagus. There are many reasons for the weakening of the lower esophageal sphincter function, including hiatal hernia, which can easily cause the stomach and intestinal contents to flow back into the esophagus, which is the main cause of inflammatory lesions in the esophagus.

Increased abdominal pressure (10%):

Such as a large amount of ascites, pregnancy, resulting in increased abdominal pressure, easy to form reflux.

Esophageal motility disorder (5%):

Usually, when the contents of the stomach flow back into the esophagus, the peristalsis is caused by the tension, and the reflux is returned to the stomach. Esophagitis can slow the esophageal peristalsis, prolong the residence time of the reflux in the esophagus, aggravate the original esophagitis, and esophagitis weakens the function of the lower esophageal sphincter, aggravates reflux, and forms a vicious circle.

Esophagitis prevention

Esophagitis is mostly caused by reflux, you can take Jin Aokang + porphyrin, can inhibit reflux, while eating a gastric mucosal protective agent: such as sucralfate. Usually the diet should be light, do not eat greasy food, so as not to aggravate reflux and illness. Should be chewed slowly, avoid overeating, avoid drinking tea, spirits, espresso and fasting spicy, too cold, overheated and rough food.

Esophagitis complications Complications, aspiration pneumonia, esophageal ulcer, iron deficiency anemia

Esophagitis complications

Serious complications can occur in the Barrett's esophagus, including benign esophagitis, esophageal stricture, ulcers, perforation, hemorrhage, and aspiration pneumonia. Common complications are:

Ulcer

The incidence of ulcers caused by Barrett's esophagus is 2% to 54%. The esophageal columnar epithelium can be ulcerated after being corroded by acidic digestive juice. Symptoms resembling gastric ulcers can be radiated to the back and can cause perforation, hemorrhage, infiltration, ulceration. Stenosis occurs after healing, and symptoms of poor pharyngeal symptoms appear. It can even penetrate the aorta and cause massive bleeding and quickly die. There are two pathological types of Barrett's ulcers, the most common of which are superficial ulcers that occur in the squamous epithelium, which is similar to ulcers caused by reflux esophagitis. Another rare form of deep ulcer that occurs in the columnar epithelium is similar to peptic ulcer.

Stenosis

Esophageal stricture is the most common complication of Barrett's esophagus, with an incidence of 15% to 100%. The stenosis site is more than the squamous-columnar epithelial junction in the upper and middle esophagus, and the stenosis caused by gastroesophageal reflux is mostly located in the lower esophagus. The incidence of reflux esophagitis is 29% to 82%. The lesion may involve the columnar epithelium alone or both the squamous and columnar epithelium.

3. Malignant

The incidence of cancer in the Barrett's esophagus is not well defined, and long-term reflux into the Barrett's esophagus may be malignant. However, studies have shown that patients with Barrett's esophagus have undergone anti-reflux surgery, and these columnar epithelium cannot be resolved, and the risk of malignant transformation is not reduced. The phenotypic hyperplasia can occur in the columnar epithelial zone of Barrett's esophagus, ranging from low to high. Sometimes low dysplasia is not easily distinguished from normal columnar epithelium. Highly dysplasia is sometimes difficult to distinguish from carcinoma in situ and can progress to invasive carcinoma. . These malignant tumors are adenocarcinomas. It should be pointed out that endoscopic findings of the cardia adenocarcinoma with benign columnar epithelium, and columnar epithelial dysplasia is different from adenocarcinoma. The dysplasia of the Barrett's esophagus is pre-cancerous and has been recognized by most people.

4. Gastrointestinal bleeding

It can be manifested as hematemesis or blood in the stool, accompanied by iron deficiency anemia, the incidence rate is about 45%, and the source of bleeding is esophagitis and esophageal ulcer.

Esophageal inflammatory symptoms Common symptoms Dysphagia, sore throat, heartburn, burning pain, eating vomiting, esophageal mucosal edema, congestion, phlegm, esophageal reflux symptoms, pain

1. Depressed, loss of appetite or even abolishment. Mucus is attached around the nose and mouth. When chronic esophagitis occurs, the body weight gradually decreases.

2. Dysphagia, painful when swallowing, and a lot of drooling; or vomiting, vomit sometimes with blood. Refuse to eat after swallowing several times.

3. Esophageal palpation is sensitive, the anterior cervical esophagus palpates pain; the front abdomen touches, which can cause food reflux.

4. Upper abdomen or sternal pain burning sensation: the main clinical manifestations of this disease. Pain is especially noticeable when eating a lot, and is related to body position. In severe cases, it can be radiated to the neck, back, chest, and sometimes resembles the symptoms of angina.

5. Reflux: often after the meal, before going to bed at night, there is acidic liquid or food from the stomach and esophagus to the oropharynx. There may be symptoms such as nausea, heating, snoring, heartburn, bloating, discomfort during swallowing, and severe gastrointestinal bleeding due to erosion of the esophagus.

Esophagitis examination

1, esophageal pressure measurement: normal people are quiet, the lower esophageal sphincter has a certain pressure, the pressure of patients with stomach, esophageal reflux is reduced.

2, esophage PH value determination: Determination of esophage PH value, observe its reflux. If necessary, you can do a 24-hour esophageal pH monitoring test to understand the changes in esophageal PH circadian rhythm.

3, acid drop test: through the acid drop test, to stimulate the patient's symptoms, as one of the diagnostic methods.

4, esophageal diet check: esophageal peristalsis weakened, the lower part of the esophagus mucosal wrinkles, sometimes visible small shadow and narrow.

5, endoscopy and biopsy: by endoscopy and biopsy can determine whether there is pathological changes in reflux esophagitis, and whether there is bile reflux, whether there is serious pathology of reflux esophagitis The degree has important value. The inflammatory lesions of standard reflux reflux esophagitis in the Savary and Miller group can be divided into 4 grades: grade I is single or several non-fusion lesions, characterized by erythema or superficial erosion; grade II is a fusion lesion, but not Diffuse or circumferential; Grade III lesions have erosions around the circumference, but no stenosis; Grade IV chronic lesions are characterized by ulceration and fibrosis.

Diagnosis of esophagitis

Diagnostic points

1. Loss of appetite at the beginning of the disease, followed by difficulty swallowing, salivation and vomiting, often occurs after food refusal or swallowing. In patients with acute esophagitis, abnormal applause is emitted due to reflux of gastric juice, and the mucus is adhered to the mouth. The palpation of the esophagus was a chord-like swelling.

2. Esophageal barium meal imaging. The mucosal surface of the esophagus is not smooth and has a banded shadow.

3. Esophageal endoscopy can directly check the inflammatory state of the esophageal mucosa.

Four types of diagnosis of esophagitis

1. Suppurative esophagitis: suppurative esophagitis is the most common mechanical damage caused by foreign bodies. Bacteria multiply on the esophageal wall, causing local inflammatory exudation, varying degrees of tissue necrosis and pus formation, as well as a wider range of cellulitis.

2. Esophageal tuberculosis: Esophageal tuberculosis patients generally have pioneering symptoms of tuberculosis in other organs, especially tuberculosis. Symptoms of the esophagus itself are often confused or concealed by other organ symptoms, so that they cannot be discovered in time. According to the pathological process of tuberculosis, the early stage of infiltration may have symptoms of fatigue such as fatigue, hypothermia, and increased erythrocyte sedimentation rate, but there are also symptoms that are not obvious. Following swallowing discomfort and progressive dysphagia, often accompanied by persistent throat and retrosternal pain, increased when swallowed. Ulcer-type lesions are often characterized by pain during swallowing. Food spills into the airway should take into account the formation of airway esophageal fistula. Dysphagia suggests that lesion fibrosis causes scarring.

3. Fungal esophagitis: The clinical symptoms of fungal esophagitis are mostly atypical, and some patients may have no clinical symptoms. Common symptoms are swallowing pain, difficulty swallowing, upper abdominal discomfort, post-sternal pain, and burning sensation. In the severe sternum, there is a knife-like colic, which can radiate to the back like angina. Candida esophagitis can cause severe bleeding but is not common. Untreated patients may have epithelial shedding, perforation, or even disseminated candidiasis. Perforation of the esophagus can cause mediastinal inflammation, esophageal fistula, and esophageal stricture. Patients with persistent high fever neutropenia should be examined for the presence of disseminated acute candidiasis such as skin, liver, spleen and lung.

4. Viral esophagitis: HSV infection of the esophagus often has nasal and herpes. The main symptom is swallowing pain. Pain often worsens when ingesting food, and the patient descends slowly in the esophagus after swallowing. A small number of patients with dysphagia as the main symptom, mild infection can be asymptomatic.

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