Clinical and endoscopic picture of acute esophagitis
Acute inflammation of the esophageal mucosa is accompanied by pronounced symptoms that are extremely uncomfortable for the patient. The leading clinical manifestations include complaints of intense pain and a burning sensation localized directly behind the sternum. A specific sign of the pathology is odynophagia—severe pain that occurs at the moment of swallowing a food bolus.
During an endoscopic examination, the specialist visualizes the classic signs of acute mucosal inflammation. The severity of changes directly depends on the damaging factor. In the most severe clinical cases, in addition to standard edema and hyperemia, deep foci of esophageal tissue necrosis may be detected.
Etiology of inflammatory esophageal lesions
The causes of acute esophagitis are usually classified into several broad groups depending on the nature of the damaging agent:
- Chemical factors: damage occurs as a result of burns from aggressive chemical compounds (concentrated acids and alkalis), as well as due to the use of certain specific medications.
- Iatrogenic and traumatic factors: the inflammatory process develops as a direct consequence of previous surgical operations on the gastrointestinal organs or as a result of prolonged gastric tube intubation.
- Neurogenic factors: the pathology manifests against the background of severe comorbid diseases of the central nervous system.
- Infectious factors: specific viral (herpes simplex virus, cytomegalovirus) and fungal infections. This type of esophagitis is extremely rare in healthy individuals and usually occurs as a complication against the background of pronounced immunosuppression. A characteristic example is the development of infection in cancer patients undergoing treatment with cytostatics.
Therapy for infectious forms requires a specific approach: targeted antiviral agents (e.g., acyclovir) are used, and parenteral analgesia is prescribed to relieve severe pain.
Mechanisms of development and morphology of GERD
The pathogenesis of gastroesophageal reflux disease is based on regular pathological reflux—the uncontrolled backflow of contents from the lower digestive tract into the esophageal lumen. In the vast majority of cases, the aggressive agent is acidic gastric juice. Much less frequently, clinical practice records the reflux of alkaline contents coming from the small intestine.
Morphologically, the continuous aggressive effect of the refluxate causes chronic inflammation of the esophageal wall. With a prolonged course of the disease and the absence of adequate therapy, surface erosions and deeper ulcer defects inevitably form on the mucosa.
Reflux complications: Barrett's esophagus
One of the most formidable complications of long-standing GERD is the development of Barrett's esophagus. The essence of this severe pathological process is cellular metaplasia of the epithelium. The normal stratified squamous epithelium that physiologically lines the lower third of the esophagus is pathologically replaced by columnar epithelium of the gastric or intestinal type.
The prognosis for Barrett's esophagus is always guarded. This metaplasia is officially recognized as a precancerous condition, since the altered epithelium is capable of transforming into a malignant tumor—esophageal cancer—with a high probability.
Hiatal hernia
Hiatal hernia has a direct pathogenetic connection with GERD, being one of the most frequent causes of chronic reflux esophagitis. The disruption of the anatomical barrier promotes the unhindered reflux of gastric juice.
The symptoms of the disease and its complications are quite diverse. Patients complain of pronounced dyspeptic phenomena and classic manifestations of reflux. In addition, a characteristic feature is recurrent minor bleeding originating from the damaged vessels of the inflamed mucosa. For instrumental confirmation and precise verification of a hiatal hernia diagnosis, the primary method is an X-ray examination of the esophagus and stomach.
Briefly: answers to topical questions
What groups of medications are used for the baseline medical therapy of GERD?
For the baseline medical therapy of gastroesophageal reflux disease, a comprehensive pharmacological approach is used, including several main groups of drugs. These include:
- Proton pump inhibitors—drugs of choice and first-line therapy;
- Potassium-competitive acid blockers;
- Alginates—create a mechanical barrier;
- Antacids—used for an enveloping effect;
- Prokinetics—used to normalize peristalsis and sphincter tone.
What are the main extraesophageal (atypical) manifestations of gastroesophageal reflux disease?
Extraesophageal manifestations of gastroesophageal reflux disease are divided into those reliably associated with it and those suspected. Reliably associated ones include:
- Chronic cough;
- Chronic laryngitis;
- Bronchial asthma;
- Erosion of hard dental tissues.
A suspected association is noted for the following pathological conditions:
- Pharyngitis;
- Sinusitis;
- Pulmonary fibrosis;
- Otitis media.
What specific radiological signs make it possible to verify a hiatal hernia?
Specific radiological signs directly depend on the anatomical type of hiatal hernia.
- Type 1 (sliding)—contrast fluoroscopy visualizes folds of the cardia of the stomach above the diaphragm; an associated Schatzki ring (Schatzki ring) may also be detected.
- Type 2 (paraesophageal)—the gastroesophageal junction remains in place, but the gastric fundus herniates into the thoracic cavity.
- Type 3 (mixed)—the gastroesophageal junction is located above the esophageal hiatus.
- Type 4 (intrathoracic stomach)—the stomach is almost entirely located in the thoracic cavity.
According to which endoscopic classification is the severity of reflux esophagitis assessed?
The severity of reflux esophagitis is assessed using the Los Angeles classification. The sources indicate grades A–B, as well as stages B, C, and D of erosive esophagitis according to EGD data.
Class and exam questions
What is odynophagia, and in which condition does it occur?
Odynophagia is severe pain upon swallowing food. In propaedeutics of internal diseases, this symptom is one of the leading manifestations of acute inflammation of the esophageal mucosa.
What is the pathogenesis of gastroesophageal reflux disease?
The main mechanism of GERD development is pathological reflux of aggressive contents into the esophagus. Most often this is acidic gastric juice, and less commonly, alkaline contents of the small intestine.
Why is Barrett's esophagus considered a dangerous complication?
In this condition, metaplasia occurs: the normal epithelium of the lower third of the esophagus is replaced by the gastric or intestinal type. This is a precancerous condition capable of transforming into esophageal cancer.
What is the primary diagnostic method for hiatal hernia?
X-ray examination, which allows visualization of structural displacement, is recognized as the primary method for the instrumental verification of a hiatal hernia diagnosis.
What else to study on this topic
- Mechanisms of mucosal necrosis formation during chemical burns with acids and alkalis
- Features of the development of immunosuppression in cancer patients receiving cytostatics
- Detailed endoscopic picture of erosive and ulcerative lesions of the esophageal wall in GERD
- Pathophysiology of recurrent bleeding from mucosal vessels in hiatal hernia
- Differential diagnosis of dyspeptic symptoms in various forms of reflux disease
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