ulcer of the esophagus. - Acute or chronic ulceration of the distal esophagus, caused by exposure to gastric juice with gastroesophageal reflux. Clinically, the disease is manifested and psevdostenokarditicheskimi retrosternal pain, dysphagia and dyspepsia. Pathology Diagnosis includes FEGDS with biopsy, x-ray of the esophagus, esophageal manometry, pH meter intraesophageal, fecal occult blood. Treatment begins with conservative measures (dietary changes, antacids, H2 blockers, histamine receptors, IPP, and antireflux prokinetic drugs), after failure of fundoplication surgery is performed.
ulcer of the esophagus.
gastric ulcer and ulcer 12P. intestine. Approximately a quarter of patients peptic ulcer, localized in the esophagus, is combined with the same defects in the stomach and duodenum. Isolated esophageal ulcers occur in 50 times less than the ulceration of the digestive tube at other sites. Almost always the basis for the formation of a defect of the esophagus is the cardiac sphincter insufficiency, accompanied by gastroesophageal reflux. Much less ulceration is not associated with exposure to acidic gastric contents on the mucosa of the esophagus and is caused by radiation therapy, tumor process, taking certain drugs. These sores are called symptomatic. The first mention of esophageal ulcers dating back to 1879. This pathology occurs in men more often than women.
hiatal hernia, GERD, secondary (as a result of any pathology) or iatrogenic (after surgery on the stomach) deficiency cardia of the stomach, systemic scleroderma (atrophy of myofibrils cardiac sphincter and esophagus), decreased tone of the gastric wall at GIT comorbidity (gastric and duodenal disease, cholelithiasis, severe vomiting and others.).
At the heart of the esophagus ulcer formation mechanism based on three main pathogenetic factors: disturbance of the neuroendocrine regulation of digestion with an increase in the stimulating effect of gastrointestinal hormones; hyperproduction of hydrochloric acid in the stomach; heterotopia sites of the gastric mucosa in the esophagus.
Symptomatic esophageal ulcers in patients diagnosed gastroenterology department is much less common than peptic. This diagnosis should be made if during the examination did not reveal any organic disease, gastroesophageal reflux disease is absent. The causes of symptomatic esophageal ulcers can serve as a tumor stenosis or esophageal diverticulum accompanied by stagnation of food in the lumen; influenza viruses, herpes, CMV, HIV; syphilis and tuberculosis. The most common viral ulcer of the esophagus diagnosed in drug addicts, homosexuals and HIV-positive. Against the background of serious diseases of the nervous system, extensive and deep burns, sepsis stress ulcers are formed. Medication toxic ulcer of the esophagus may occur in patients receiving NSAIDs, cytostatics, antibiotics. Dekubitalnye esophageal ulcers formed due to prolonged standing stomach tube in critically ill patients. Sjogren's syndrome (systemic autoimmune connective tissue disorders), and Behcet's syndrome (systemic vasculitis with ulceration of the mucous membranes) may also be accompanied by ulcers of the esophagus.
In addition, isolated acute ulcers of the esophagus (formed in the postoperative period, against the background of the diseases accompanied by frequent vomiting acidic contents of the stomach) and chronic (on the background of other organic and systemic disease).
angina pectoris. Dysphagia associated mainly with swelling and inhibition of esophageal motility in the background ulceration. If esophageal ulcers exist for a long time and is accompanied by the formation of stenotic narrowing, then to the clinic joins regurgitation just eaten food.
Heartburn worried virtually all patients with peptic ulcer of the esophagus. There heartburn on the background cast of acidic gastric contents into the esophagus lumen. The intensity of heartburn often expressed, causes patients to constantly take soda. At the height of heartburn and chest pain may occur vomiting, bringing significant relief. The vomit often contain streaks of blood. Furthermore, bleeding esophageal ulcers may be associated with melena.
In the long esophageal ulcers, especially against the background of lack of treatment, the patient begins to lose weight comes cachexia. Suffice rare complication of esophageal ulcer perforation into the mediastinum is the formation of mediastinitis, pleural cavity (with the development of pleurisy), peritoneal cavity (for this condition is characterized by clinic "acute abdomen"). There are anecdotal cases of perforation of the esophagus ulcer in the aorta ended almost instantaneous death from profuse bleeding. Probably bleeding into the lumen of the esophagus: acute (develops profuse vomiting bright red blood, weakness, hypotension, tachycardia) or chronic (it is characterized by symptoms such as iron deficiency anemia, a positive test for occult blood in the stool).
gastroenterologist. Close cooperation with this expert endoscopist typically allows a short time to make a correct diagnosis. Ulcerative defect provoked them esophageal dysmotility are found in the upper GI endoscopy, esophageal radiography. During endoscopic examination must be conducted edge biopsy esophageal ulcers with histological and morphological analysis of the sample. Thus, the differential diagnosis is carried out with esophageal cancer, ulcer-specific (tuberculous, syphilitic etiology), viral infection.
There are three types of endoscopic ulcers. The first of these (alopecia esophageal ulcer) is described as a defect of 10 mm in diameter, not affecting the motility and peristalsis of the esophagus. For the second type of esophageal ulcers (depth) is characterized by larger dimensions (30 mm) deep bottom, and the edges extend above the mucosa. In esophageal peristalsis this type of ulcer is also not affected. The third type (ploskoinfiltrativnaya esophageal ulcer) does not rise above the wall of the esophagus, ulcers, bloodshot border, the bottom is covered with fibrin.
Identify gastro-oesophageal reflux, cardiac sphincter insufficiency, esophageal hernia axial help intraesophageal pH monitoring carried out during the day (celebrated persistent or episodic acidification in the esophageal lumen); esophageal manometry (register the cardiac sphincter relaxation). If you suspect a bleeding ulcer is shown holding a series of stool tests for occult blood (the same method can be used to monitor the treatment of ulcers and scarring).
fundoplication with proximal selective vagotomy. The effectiveness of the operation is stored in the long term by more than 80% of patients.
Prediction and prevention of esophageal ulcers
Prognosis of esophageal ulcers favorable provided timely access to medical care and undertake a full course of treatment. When detection of chronic peptic ulcer of the esophagus is recommended long-term and annual medical check-up of anti-treatment. Prevention esophageal ulcer is in compliance with a healthy lifestyle, timely treatment of disease, which can lead to the formation of ulcers.