EZOFAGYT (oesophagitis; Greek oisophagos a gullet + - itis) — an inflammation of a gullet.
One of the most often found diseases of a gullet. Distinguish acute, chronic and subacute E. Vydelyayut also ref...............
The acute esophagitis arises owing to impact on a mucous membrane of a gullet of hot food, chemicals (to - t, alkalis, etc.), ionizing radiation, at acute inf. diseases (scarlet fever, diphtheria, etc.), acute pharyngitis and gastritis. Depending on the nature of inflammatory changes allocate a catarral, erosive, hemorrhagic, pseudomembranous, necrotic esophagitis, and also abscess and phlegmon of a gullet.
An endoesophagitis — the most common form acute E. It is characterized by puffiness and a hyperemia of a mucous membrane of a gullet; it is shown by heartburn, easy burning behind a breast, a sadneniye in a gullet or feeling of passing of a food lump on a gullet, sometimes there are pains amplifying during the passing of food. At rentgenol. a research usually do not reveal any changes. At acute E. the ezofagoskopiya (see) is not recommended to be made in connection with danger of a perforation of a wall of a gullet. Often symptoms catarral E. disappear independently after cancellation of a disturbing factor. If process does not abate, to the patient appoint mechanically, thermally and chemically sparing diet, the knitting and enveloping means (drugs of bismuth, 1% solution of a tannin, starch, etc.), at pains — inside anaesthesin, solution of novocaine, at the expressed spasm — antispasmodics (Nospanum, a papaverine, etc.).
The erosive esophagitis develops at acute inf more often. diseases or action on a wall of a gullet of the irritating substances. At erosive E. the mucous membrane is hyperemic, numerous erosion of the different sizes are defined on its surfaces. The surface of erosion is covered with hemorrhagic exudate, pus, a fibrinous plaque and crusts. In on affairs from isty to a basis and a muscular coat hypostasis and leukocytic infiltration are noted. Symptoms of an eroznvny esophagitis are similar to manifestations of catarral, the hematemesis is quite often observed (see the Hematemesis), in Calais it is possible to find traces of blood. Treatment is same, as at an endoesophagitis. At the hemorrhagic phenomena appoint styptic means (Calcium chloratum, Vikasolum, aminocaproic to - that, etc.).
The hemorrhagic esophagitis meets at acute infectious and viral diseases — a sapropyra (see the Sapropyra epidemic), flu (see), etc. At this form E. hemorrhages in a mucous membrane and the subject layers of a wall of a gullet prevail. The wedge, a case is characterized by pains during the swallowing, a hematemesis, a melena (see). Hemorrhagic E. can be complicated by massive bleeding from a gullet. Treatment is directed to a basic disease. Appoint also knitting, enveloping, anesthetizing, antispasmodics (see above), intramusculary enter Vikasolum, intravenously kapelno aminocaproic to - that, by means of the endoscope make laser photocoagulation, diathermocoagulation (see). At massive bleedings carry out transfusion of fresh blood or blood substitutes. On 1 — 3 day appoint hunger, water with ice, then the cold wiped food.
Pseudomembranes about z y y the esophagitis is observed by N at diphtheria (see) and scarlet fever (see). On a mucosal surface of a cover there is a considerable exudate of fibrin forming easily dischargeable film of gray-yellow color. Clinically pseudomembranous E. it is shown by severe pain during the swallowing and other signs of a dysphagy (see). In emetic masses it is possible to find films of fibrin. At a heavy current of this form E. formation of a cicatricial stenosis of a gullet is possible (see). Treatment is same, as at catarral E. At a cicatricial stenosis of a gullet bougieurage is shown (see).
The necrotic esophagitis is observed at the heavy course of scarlet fever, measles (see), a typhoid (see), etc., meets also at a candidiasis (see Candidiasis), an agranulocytosis (see). Inflammatory infiltration and necrosis of a mucous membrane and the subject layers of a wall of a gullet with formation of deep ulcers and sloughing is noted. On a mucosal surface of a cover the bloody and purulent discharge appears. The general condition of the patient is defined by weight of a basic disease. At necrotic E. along with the phenomena of the expressed dysphagy such complications as severe bleedings, perforation of a gullet, a mediastinitis often are observed (see). The cicatricial esophageal stenosis happens an outcome of a disease often. Appoint parenteral food (see). Along with enveloping, knitting, anesthetics apply antibiotics in high doses, for a stop of bleeding carry out the same actions, as at a hemorrhagic esophagitis (see above). At perforation of a gullet and a mediastinitis operational treatment — a mediastinotomy is shown (see). At a cicatricial esophageal stenosis make bougieurage.
Abscess of a gullet is most often formed around the gullet of a foreign body which was implemented into a wall (more often than a fish or chicken bone) or other damages. The main symptom is sharp pain behind a breast during the swallowing. Body temperature can increase, the general state is almost not broken. Quite often abscess is independently opened in a gleam of a gullet, together with pus the foreign body is removed and there occurs recovery. If it does not occur, opening of an abscess and removal of a foreign body make by means of the esophagoscope (carefully press the esophagoscope on the basis of abscess or do a section in the field of the maximum protrusion of an abscess). Appoint parenteral food. Within several days to the patient enter antibiotics. At distribution of pus towards a mediastinum an operative measure — a mediastinotomy is shown.
Phlegmon of a gullet also arises around the gullet of a foreign body which was implemented into a wall (see). It is more often observed on a back wall, however unlike abscess inflammatory process is not delimited, and extends along a gullet and deep into, towards a mediastinum. Along with the phenomena of a dysphagy fervescence, disturbance of the general state are noted. The movements by the head are limited because of sharp pain. At rentgenol. a research protrusion of the site of a wall of a gullet, a smoothness of a skladchatost of a mucous membrane come to light. In blood the leukocytosis and acceleration of ROE are noted. The current is heavy, development of a mediastinitis is possible. Treatment operational. The esophagotomy (see) is made via the esophagoscope or outside access and carry out drainage (see) periesophagal cellulose. Appoint parenteral food. Enter high doses of antibiotics, carry out dezintoksika-tsiopny therapy (see).
The forecast at acute E. more often favorable. Accession of complications does the forecast serious.
Prevention consists in treatment of diseases, to-rye can cause acute E., timely removal of foreign bodys of a gullet and elimination of other causes of illness.
The chronic esophagitis arises owing to repeated impacts on a mucous membrane of a gullet various razdrazhit l to it — hot, spicy, rough food, hard alcoholic beverages and their substitutes, and also the nek-ry toxicants which are contained in air of workrooms in the form of vapors and a heat of m. Chronic E. can develop at stagnation and decomposition of food in a gullet at patients with a stenosis or a diverticulum of a gullet, quite often accompanies chronic inflammatory diseases of a nasopharynx and stomach, can be a consequence heavy acute E. Odna from the most frequent reasons chronic E. the throwing in the gullet of a gastric juice (see the Reflux) causing development a reflux esophagitis (see below) is.
At a pathoanatomical research the hyperemia, hypostasis, infiltration of a mucous membrane of a gullet are observed. The mucosal surface of a cover is covered with dense viscous slime, erosion, ulcers, and also a leukoplakia come to light (see) — accurately limited roundish plaques of white color acting over a surface of a wall. At gistol. a research reveal dystrophic changes of an epithelium, an atrophy of glands which are localized in own plate of a mucous membrane in the subject layers — fibrosis of fabric.
A wedge, manifestations are usually poorly expressed. The most frequent complaints are feeling of passing of food on a gullet, the burning sensation, pain behind a breast. There can be vomiting, traces of blood in Calais. Prevalence and the nature of process define by an ezofagoskopiya. Current chronic E., as a rule, high-quality; in some cases the cicatricial stenosis of a gullet can be formed over time.
Treatment chronic E. long. It is necessary to remove a cause of illness. The patient make sanitation of the centers hron. infections. The food (sparing, fractional, 4 — 6 once a day) is of great importance. Appoint knitting, enveloping, antispasmodics (see above). Also vitamins are shown. biogenic stimulators, autohemotherapy. At a cicatricial stenosis of a gullet make bougieurage.
Forecast, as a rule, favorable.
Prevention consists in elimination of the reasons causing a disease and also in timely treatment acute E.
The subacute esophagitis differs from chronic E. smaller duration of a current (3 — 6 months). Morphological changes, a clinical picture and treatment same as at chronic E.
Reflyuks-ezofagit arises at throwing (reflux) in a gullet of a gastric juice. The throwing in a gullet of a gastric juice is observed in most cases at the sliding hernias of an esophageal opening of a diaphragm (see the Diaphragm. phrenic hernias). The reflux esophagitis meets also after operations — resections, or damage of an esophageal and gastric sphincter; at the diseases which are followed by an atrophy of muscles of a zone of the cardia, e.g. sclerodermas (see) at the functional incompetence of cardia caused by spastic reduction of the gatekeeper and a hyper tone of a stomach (see) or increase in intragastric pressure owing to a peptic ulcer (see), cholelithiasis (see), etc., in case of substantial increase of intra-belly pressure (see) at pregnancy, big tumors of an abdominal cavity.
At a reflux esophagitis the same are noted morfol. changes, as at a chronic esophagitis (see above). The main symptoms ref are the heartburn, vomiting reminding vomiting, amplifying at an inclination of a trunk and also in horizontal position of the patient are, at an overeating and tension of a prelum abdominale. The retrosternal pains during the swallowing sometimes reminding coronary are quite often observed. During the progressing of process there are complications — bleedings, a cicatricial stenosis of a gullet, education (or increase) hernias of an esophageal opening of a diaphragm.
The main diagnostic method is rentgenol. the research of a gullet allowing to reveal in most cases hernia of an esophageal opening of a diaphragm and to observe a gastroesophagal reflux. The research is conducted not only in vertical, but also horizontal position of the patient, use the special receptions causing increase in vnutribryush-ny pressure (a natuzhivaniye, a tussiculation, tension of a prelum abdominale, pressure a tube of a X-ray apparatus on epigastric area, etc.). Apply also an ezofagoskopiya (see tsvetn. the tab. to St. Gullet, t. 19, Art. 336, fig. 8,9). The incompetence of cardia at a reflux esophagitis is defined by an ezofagokimografiya (see) and ezofagoto legs of a raffia (see). For identification of a gastroesophagal reflux carry out a rn-metriya of a gullet (see the Gullet) and test with methylene blue, solution to-rogo via the probe enter into a stomach, and then, having tightened the probe, pump out contents of a gullet; emergence of the painted liquid confirms existence of a reflux.
At a reflux esophagitis for the purpose of prevention of a pelting of contents of a stomach in a gullet prohibit the physical activity connected with an inclination of a trunk and tension of a prelum abdominale, recommend to sleep with the raised upper half of a trunk. Appoint astringents and alkalis (calcium carbonate, magnesia usta, etc.); at sharply expressed accompanying esophagospasm — spasmolytic and cholinolytic means (atropine, drugs of a belladonna, Methacinum, but - to a shp, etc.), cerucal. In the absence of effect of conservative treatment or emergence of complications carry out operational treatment — bringing down of a hernial bag to an abdominal cavity, fixing of the cardia in an esophageal opening and fundoplication (see the Stomach, operations). In some cases resort to a pyloroplasty (see) or the selection vagisection (see). Patients about a reflux esophagitis in view of danger of emergence of complications shall be under dispensary observation.
Bibliography: See bibliogr. to St. Gullet.
A. L. Grebenev.