Acute esophagitis is an acute inflammatory lesion of the esophageal mucosa, which is caused by a strong, but short-term effect of any damaging factor. Such an inflammatory process can last from several days to 3 months.
Development reasons, pathogenesis
The causes of acute esophagitis can be divided into 4 subgroups:
– exposure to an infectious agent (these include scarlet fever, fungal infections, tuberculosis, cytomegalovirus, influenza, diphtheria, syphilis, herpes);
– exposure to various physical factors (such as high or low temperature, traumatism during instrumental methods of examining the esophagus or other parts of the gastrointestinal tract, as well as when foreign bodies enter the esophagus);
– exposure to chemical factors (acid, alcohol, alkaline burns), as well as exposure to various other chemicals;
– various manifestations of food allergies.
The development of esophagitis occurs either against the background of severe damage due to chemical or physical exposure, or with a decrease in immunological reactivity, when favorable conditions are created for the introduction of an infectious agent into the esophageal mucosa. In other cases, the development of esophagitis is unlikely, since the esophageal mucosa is resistant
to damaging factors. This is due to the fact that it is represented by stratified squamous epithelium (there may be up to 29 layers), which in turn is covered with thick mucus.
According to various sources and authors, there are a number of classifications of esophagitis, in this regard, there is no single classification. The following classification is possible:
1. By etiological factor: exposure to an infectious agent, various physical factors, chemical factors, food allergies.
2. According to the stages of development: edema and redness of the mucous membrane, the appearance of single erosive lesions in the area of edema, a significant increase in edema and hyperemia of the mucosa, which has foci of bleeding and erosion in places. “Weeping” mucous membrane – there are multiple diffusely located foci of erosion, and the mucous membrane is prone to bleeding even with the slightest mechanical damage.
3. By morphology: erosive, catarrhal, pseudomembranous, membranous, hemorrhagic, phlegmonous, necrotic.
Some aspects of certain forms of acute esophagitis
Catarrhal esophagitis. The most common form associated with acute esophagitis. This form of acute esophagitis develops against the background of inaccuracies in nutrition (such as eating cold or hot foods, spicy foods); alcohol burns, minor mechanical injuries. In the clinic, such patients have chest pain and severe burning. Because of these manifestations of the disease, patients cannot eat for several days. With instrumental methods of examination, a specific picture is found in such patients. X-ray examination reveals esophageal hyperkinesia, and endoscopic examination reveals stage 1–2 esophagitis.
Erosive esophagitis. The emergence of this type of esophagitis occurs against the background of an infectious disease and the introduction of an infectious agent in scarlet fever, fungal infections, tuberculosis, cytomegalovirus infection, influenza, diphtheria, syphilis, herpes, allergies. Also, erosive esophagitis in some cases is possible with traumatic injury to the esophagus and chemical burns. We can say that erosive esophagitis in its own way is the next phase of catarrhal esophagitis. The clinical picture is primarily dominated by the symptoms of the underlying disease, against which the development of erosive esophagitis occurred. In the clinic of developed esophagitis, significant chest pains are noted that appear during or after eating. Belching, heartburn, increased secretion of the salivary glands, and bad breath are observed. Endoscopic examination will reveal areas of edema, redness, hemorrhage, erosion, which will correspond to the 2-3rd stages of esophagitis. Radiographically, there will be a significant amount of mucus, hyperkinesia of the esophageal walls, as well as a change in relief, as a result of which flat “pockets” will form.
Hemorrhagic esophagitis. It is a rather rare type of erosive esophagitis. The onset of hemorrhagic esophagitis is possible against the background of an infectious disease and, accordingly, the introduction of an infectious agent in scarlet fever, fungal infections, tuberculosis, cytomegalovirus infection, influenza, diphtheria, syphilis, herpes, allergies. Also, hemorrhagic esophagitis is observed in some cases with traumatic injury to the esophagus and with chemical burns. In the clinical picture, such patients are characterized by the appearance of intense chest pains, as well as bloody vomiting. With endoscopic examination of the esophagus, a picture of the 3-4th stages of esophagitis will be observed. Bleeding will occur. Exfoliation of the mucous membrane of the esophagus is possible in the form of “narrow ribbons”.
Pseudomembranous esophagitis. The development of this form of acute esophagitis is possible due to a number of diseases, which include diphtheria, radiation sickness, scarlet fever, fungal diseases, blood diseases. The clinical picture is marked by the presence of intense pain, dysphagia, vomiting, nausea. An increase in clinical manifestations after eating is possible. In the vomit, fibrin films may appear, as well as blood impurities. During endoscopic examination of the esophagus in the affected area, there are fibrinous plaques that have a gray or yellow-gray color. Fibrinous deposits are formed due to detrin and fibrin, which normally cover the lining of the esophagus.
When fibrinous deposits are rejected, ulcers or erosions form, which later slowly heal. In some cases, it is possible that membranous stenoses may remain in the esophagus. To eliminate them, use the bougie method.
Membranous esophagitis. By etiology, development is possible against the background of an infectious process (such as herpes, sepsis, smallpox, shingles); chemical damage (burns of various nature). In the clinic, such patients have very diverse manifestations. It is possible to develop both mild forms of membranous esophagitis, when a minimal clinical picture is observed, and severe, when intoxication, bleeding, dysphagia, esophageal perforation, pain syndrome, mediastinitis can be observed. Severe forms of membranous esophagitis often lead to the death of the patient. In endoscopic examination, attention is drawn to the defeat of all layers of the esophagus. In this case, epithelial rejection will be noted. After the inflammation in the esophagus subsides, the formation of rough cicatricial stenosis is possible.
Necrotizing esophagitis. Refers to acute forms of inflammation of the esophagus. It is quite rare. As a result of a number of serious diseases, which include candida mycosis, sepsis, typhoid fever, there is a decrease in immunity in the body. Due to this, the development of necrotic esophagitis occurs. The clinical picture is characterized by the presence of painful dysphagia, weakness, profuse vomiting. Sometimes bleeding occurs, the development of diseases such as pneumonia, pleurisy, mediastinitis is possible. The disease cannot be cured without consequences. After a full course of treatment, strictures may form in the esophagus. Such strictures can be attributed to the initial precancerous changes.
Septic esophagitis. A rare disease of streptococcal nature. Inflammation of the walls of the esophagus in this disease can be both diffuse and local. The occurrence of a disease is possible in violation of the integrity of the esophageal mucosa due to damage by a foreign body. In rare cases, it is possible to develop acute phlegmonous esophagitis, which is a complication of various forms of acute esophagitis, which in turn is a consequence of purulent fusion of the walls of the esophagus. As a result of purulent damage to the walls of the esophagus, pus penetrates into the tissue of the mediastinum, and as a result, a number of complications are possible, which include purulent bronchitis, mediastinitis, pneumonia, pleurisy, spondylitis, aortic rupture. If an anaerobic infection is attached, the patient may develop mediastinal emphysema, as well as the formation of spontaneous pneumothorax. In such patients, the clinical picture will be characterized by the existing intoxication, vomiting, chest pain, pain in the cervical region, high fever.
When examining patients with a diagnosis of septic esophagitis, attention is drawn to the forced position of the head with an inclination to one side, swelling in the neck area, impaired mobility in the cervical spine. Often after septic esophagitis, the formation of purulent mediastinitis occurs. From laboratory data, a general blood test is important, where there is an increase in the erythrocyte sedimentation rate, the number of leukocytes significantly increases. In order to confirm the streptococcal nature of the disease, blood is cultured on nutrient media. X-ray and endoscopic examination in the acute period of the disease is not indicated. During the scarring period, due to the danger of the formation of gross defects that can lead to the development of esophageal stenosis, X-ray examination is mandatory. Treatment of acute esophagitis
is based on principles that include symptomatic, etiotropic and pathogenetic treatment. Etiotropic treatment consists in treating the underlying disease. However, against the background of the addition of acute esophagitis, therapy undergoes certain changes and adjustments. In cases where, against the background of any infectious diseases, acute esophagitis occurs, it is necessary to prescribe parenteral antibiotics. With the existing necrotic, hemorrhagic changes along the esophagus, it is advisable to refuse food intake within 2-3 weeks. For this period, parenteral nutrition is prescribed. Intravenous administration of vitamins, amino acids, protein hydrolysates is carried out. Des-intoxication therapy is prescribed. It is recommended to start regular nutrition after the inflammatory process subsides. It is recommended to start with both chemically and thermally benign foods. It can be vegetable soups, milk, cereals, cream. Reduction of local inflammatory symptoms is achieved through the use of collargol, tannin, novocaine. Astringents are prescribed. In this case, the patient must comply with bed rest, the head must be at the level of the body or below. If no visible changes occur after the application of astringent drugs, then parenteral non-narcotic analgesics are recommended. If there are symptoms of esophageal dyskinesia, then drugs such as raglan, cerucal, cisapride are used before meals. With existing erosions of the esophagus, bismuth preparations are prescribed. In cases of existing bleeding or with hemorrhagic esophagitis, drugs such as dicinone, aminocaproic acid, vicasol are recommended. If there is severe bleeding, then a plasma and blood transfusion is prescribed. With the existing purulent process, the patient is prescribed antibiotic therapy, including several antibiotics, parenteral nutrition; the abscess is being sanitized. In order to prevent stenosis of the esophagus due to the formed strictures, bougienage is performed. A favorable prognosis is possible only in cases of erosive and catarrhal esophagitis. In all other cases, the prognosis is poor. Prevention of the disease must be timely, otherwise there may be complications in the form of acute esophagitis.