Symptoms and manifestations of esophagitis How to treat esophagitis?
oesophagitis
1. What kind of organ is esophagus?
Esophagus is a tubular organ with muscle as the main component, about 25cm long, connecting the upper mouth and pharynx, passing through the neck and chest, and connecting with the stomach of the upper abdomen. Its main function is to transport the food in the mouth to the stomach for further digestion.
Esophagitis is inflammation caused by edema, congestion and erosion of esophageal mucosa caused by abnormal stimulation.
2. What is the main cause of esophagitis?
Esophagitis is inflammation caused by edema, congestion and erosion of esophageal mucosa caused by abnormal stimulation. The most common cause is reflux esophagitis caused by reflux of stomach contents to stimulate esophagus, and patients often feel acid reflux and heartburn. Others include drug-induced esophagitis, fungal esophagitis, corrosive esophagitis and radiation esophagitis.
3. Is gastroesophageal reflux esophagitis?
There is a muscle at the junction of human esophagus and stomach-esophageal sphincter, which can tightly bind the upper mouth of the stomach, so that gastric contents such as gastric acid, pepsin and food in the stomach rarely flow back to the esophagus to prevent them from stimulating the esophagus. Once this muscle is relaxed or the pressure in the stomach cavity is too high, the contents of the stomach and even bile will flow back to the esophagus, causing symptoms such as acid reflux, heartburn and belching. Reflux esophagitis is only one kind of gastroesophageal reflux disease; There is also a non-erosive gastroesophageal reflux disease with no inflammation in the esophagus, but it is confirmed by examination that there is gastric content reflux, and the patient has symptoms such as gastric acid reflux and heartburn; The other is Barrett's esophagus, where the mucosa is replaced by the mucosa of the stomach or intestine.
4. What drugs or foods can cause or aggravate reflux esophagitis?
An important pathogenic factor of esophagitis is the relaxation of lower esophageal sphincter leading to reflux.
Common drugs that can cause relaxation of lower esophageal sphincter are antihypertensive drugs (such as verapamil and nitrendipine), sleeping pills (diazepam), epilepsy drugs (phenobarbital) and asthma drugs (theophylline). When taking related drugs, please inform the doctor in time and adjust the drugs.
Common foods that can cause relaxation of lower esophageal sphincter are: fat, chocolate, alcohol and mint. Patients with these foods should try to avoid them.
5. What are the manifestations of reflux esophagitis?
The typical symptoms of reflux esophagitis are acid reflux and heartburn, but in fact, the symptoms caused by reflux esophagitis are diverse, which may include:
① Esophageal symptoms: pain in the heart, obvious pain behind the sternum when drinking hot water or eating irritating food, food reflux, mostly sour or bitter, sometimes choking at night, and acidic water spouting from the nose and mouth. Poststernal discomfort and even dysphagia after swallowing food may indicate symptoms of esophagitis;
② Sometimes there are other seemingly unrelated extraesophageal symptoms, such as chest pain, chest tightness, cough and asthma.
6. Why do patients with reflux esophagitis have cough, asthma and aspiration pneumonia?
(1) Gastric contents such as gastric acid enter the esophagus, causing nerve stimulation and cough reflex.
(2) When the reflux is serious, the reflux can be directly inhaled into trachea, which will stimulate the upper respiratory tract, cause local mucosal congestion and edema, and even cause aspiration pneumonia in severe cases (especially for the elderly and the infirm).
(3) Reflux can act on airway chemoreceptor and cause bronchoconstriction.
7. Have symptoms of heartburn and acid reflux. Must be esophagitis? What should I do?
Not necessarily.
If the symptoms of acid reflux and heartburn last for a short time and there are no other accompanying symptoms, they can be left untreated.
If you have heartburn and acid reflux symptoms for a long time, you should first find out the inducement, whether you have overeating, whether you often take acidic drinks, sweets and spicy food, whether you have bad eating and living habits such as smoking and drinking, whether you have constipation, whether you take drugs for a long time, and whether you are overly nervous and angry. If there are the above incentives, they should be corrected as soon as possible.
If the symptoms continue to improve after correction, you should go to the hospital for gastroscopy to see if there are esophageal lesions.
8. What tests can I do if I suspect reflux esophagitis?
(1) Endoscopy is the main method, which can directly observe whether there is esophagitis, and can grade the severity of reflux esophagitis according to the situation observed under endoscope.
(2) The detection of esophageal pH value is helpful to understand the acid reflux in esophagus.
(3) The tension of lower esophageal sphincter can be known by esophageal manometry.
(4)X-ray barium meal examination, can understand the situation of esophageal peristalsis and esophageal mucosa.
9. What are the methods for treating reflux esophagitis?
(1) First, adjust lifestyle and mood, eat less and eat more meals, and give priority to light and digestible food.
(2) followed by drug therapy, mainly proton pump inhibitors, such as omeprazole, pantoprazole and esomeprazole.
(3) Finally, surgical treatment. Those patients who are seriously ill, stubborn and ineffective in drug treatment need surgery.
10. What medicine is used to treat reflux esophagitis?
Drugs used to treat reflux esophagitis mainly include drugs that inhibit gastric acid, promote esophageal motility and gastric motility, and gastric mucosal protective agents.
Acid inhibitors include H2 receptor blockers and proton pump inhibitors.
(1)H2 receptor blocker: It is a drug that inhibits gastric acid secretion. Ranitidine, cimetidine, etc. It is commonly used. These drugs are cheap and can relieve symptoms for mild patients.
(2) Proton pump inhibitor: it is an effective drug to inhibit gastric acid secretion, and omeprazole is commonly used. The inhibitory effect of these drugs on gastric acid is stronger, more lasting and better than that of H2 receptor blockers. They are widely used in clinic, but their prices are relatively high.
(3) The effective drugs for treating reflux esophagitis are also prokinetic drugs, mainly mosapride, because most patients with reflux esophagitis have abnormal esophageal and gastric motility, and when the acid inhibition effect is not good, adding prokinetic drugs can enhance the curative effect.
(4) Mucosal protectants can protect diseases: mainly sucralfate. These drugs can adhere to the surface of esophageal mucosa to provide a physical barrier, reduce the damage of gastric acid to esophageal mucosa and promote mucosal repair.
1 1. Reflux esophagitis, when is the best effect of lazole drugs?
For patients with mild illness, it is enough to take proton pump inhibitors once a day, preferably 30 ~ 60 minutes before breakfast, which has the strongest inhibitory effect on gastric acid; If the illness is a little serious, you need to take it twice a day, and take it again before breakfast 1 time before going to bed at night.
12. How long does it take to treat reflux esophagitis?
(1) proton pump inhibitors and mucosal protectants generally take 4 ~ 8 weeks to treat reflux esophagitis.
(2) After the course of treatment, severe reflux esophagitis needs to be reduced for a long time to avoid persistent esophageal inflammation, leading to esophageal stenosis and canceration;
(3) After the course of treatment, patients with mild and moderate esophagitis whose symptoms are relieved and inflammation is healed can stop taking drugs for observation, and those with recurrent symptoms can be treated for 2-4 weeks.
13. Under what circumstances does reflux esophagitis need surgical treatment?
(1) Severe reflux esophagitis failed after 8 weeks of strict medical treatment.
(2) Patients with severe esophageal erosion and bleeding, patients with repeated reflux aspiration pneumonia, and patients with poor drug treatment effect.
(3) Patients who need long-term maintenance treatment with large doses of acid inhibitors and young patients with reflux esophagitis who are unwilling to take drugs for a long time may also consider surgical treatment.
14. How is the operation to treat esophagitis done?
Surgery is mainly to strengthen the prevention of reflux factors, mainly including the following points:
(1) Endoscopic surgery: Radiofrequency therapy caused a certain degree of burning lesions at the junction of esophagus and stomach, which thickened the local basement after healing, thus enhancing the anti-reflux effect.
(2) Anastomosis of cardia, in which the relaxed cardia is folded and sutured under the endoscope to make it reset, thus tightening the lower esophageal sphincter, increasing the pressure and preventing gastroesophageal reflux.
(3) Traditional thoracotomy and laparoscopic fundoplication. Whether or not each patient needs surgery and which treatment method to choose need to consult a doctor, and the doctor will make the best choice for the patient.
15. Does emotion affect reflux esophagitis?
When people are in a happy mood, the nervous system can control the movement of digestive tract normally and orderly, which is very beneficial to the normal digestion and absorption of food and the rehabilitation of reflux esophagitis. In fact, good emotional activities are good for all systemic diseases.
16. What should we pay attention to in order to avoid reflux esophagitis?
(1) raising the bedside 15 ~ 20cm raising the upper body can reduce the reflux at night.
(2) Pay attention to the diet, don't overeat, and avoid lying flat and squatting after meals.
(3) Try not to eat chocolate, mint, coffee, onions, garlic, etc. Because these foods can reduce the tension of the lower esophageal sphincter.
(4) Choose light, soft and digestible food. Lean meat, chicken and fish can all be eaten properly. Try not to eat greasy fried food, and try to avoid fat meat and sliced meat. Eat less indigestible food, such as zongzi, rice cake, Yuanxiao, fermented grains, etc. Eat less food that has obvious irritation to mucosa. This kind of food mainly refers to being too cold, too hot, too sour and too sweet.
(5) Drink less acidic drinks, quit smoking, and especially avoid hard liquor.
(6) Overweight people should lose weight and reduce the reflux caused by increased abdominal pressure.
(7) keep a good attitude; Keep the stool unobstructed; No tights.
17. What should I do if pregnant women have gastric acid reflux, heartburn or suspected gastroesophageal reflux?
During pregnancy, the level of progesterone is obviously increased, which will reduce the tension of smooth muscle of digestive tract, resulting in heartburn and acid reflux in more than 30% pregnant women. Because of these symptoms during pregnancy, it is not recommended to do gastroscopy and other examinations. You can change some lifestyles first: don't lie flat after meals, don't eat for 2 hours before going to bed, and don't drink coffee or tea. If the symptoms are still very prominent after changing lifestyle, you can take some mucosal protective agents, such as sucralfate and aluminum phosphate gel. These drugs only adhere to the surface of esophageal mucosa, forming a protective film, which will not be absorbed into the blood and affect fetal development.
18. Can esophagitis cause cough?
About 10% of chronic cough is caused by gastroesophageal reflux. Stomach contents such as gastric acid reflux enter the esophagus, which stimulates nerves to cause cough, or a small amount of stomach contents directly enter the trachea to cause cough, which in turn leads to an increase in abdominal pressure and aggravation of reflux, forming a vicious circle.
19. Could my cough be caused by gastroesophageal reflux?
Cough caused by gastroesophageal reflux generally has the following characteristics:
(1) acid reflux and heartburn, cough, asthma, hoarseness;
(2) Cough is mainly dry and lasts for a long time, mainly at night. After a full meal, eating more greasy food and drinking more coffee is easy to get worse.
If you have the above characteristics, the treatment effect in the respiratory department is poor, which may be caused by gastroesophageal reflux. You can go to the gastroenterology department for relevant examination.
20. There is Helicobacter pylori infection. Is this related to reflux esophagitis?
Helicobacter pylori is mainly parasitic in the antrum of stomach. It is related to chronic active gastritis and peptic ulcer, and will not cause or aggravate reflux esophagitis.
2 1. Can reflux esophagitis become cancerous?
Reflux esophagitis is a benign disease, but long-term inflammatory stimulation of esophageal mucosa may lead to pathological progress, atypical hyperplasia and other precancerous lesions, and even lead to esophageal cancer. But the process of canceration lasts for decades, so if you have reflux esophagitis, you don't have to worry too much as long as you actively treat it and check it in time, but as long as you actively treat it and check it in time, you can greatly improve your chances of survival.
22. Is esophagitis as related to bacterial infection or viral infection as pneumonia?
Esophagitis associated with infection also exists, but it is not common. The cause of infection is fungal infection, mainly white rosary infection.
23. What kind of person will get Candida albicans esophagitis?
Normal people rarely get candida albicans esophagitis. When the body's immune function is low, candida albicans infection can be secondary, such as diabetic patients with poor blood sugar control, patients with chronic obstructive pulmonary disease (chronic bronchitis, emphysema), patients with tumor diseases, patients with long-term glucocorticoid use, etc. Patients with reflux esophagitis are prone to candida albicans infection on the basis of esophageal lesions.
24. What are the manifestations of Candida albicans esophagitis?
Generally, on the basis of basic diseases, there are retrosternal pain, heartburn, dysphagia and dysphagia; Some may be accompanied by oral candidiasis (thrush).
25. How to diagnose Candida albicans esophagitis?
The diagnosis of this disease mainly depends on gastroscope and brushing teeth. There are white spots and punctate secretions in the esophageal mucosa under endoscope, and the hyphae and spores of Candida can be found by cell brush examination.
26. How to treat Candida albicans esophagitis?
First of all, we should treat and control the basis of primary disease and improve immunity. At the same time, the application of antifungal drugs, such as oral nystatin, mainly depends on local action and is rarely absorbed through the gastrointestinal tract, so the side effects are also small.
27. What is the effect of taking corrosive liquid by mistake on esophagus?
(1) Mistaking corrosive liquid can cause esophageal burns, and patients will have chest pain, which is obvious when swallowing, dysphagia is also common, and vomiting may also occur. The vomit contains bloody liquid. This time is the acute phase, when the esophageal mucosa is congested, edematous, esophageal ulcer, necrosis, esophageal cavity stenosis or complete obstruction.
(2) About 1 ~ 2 weeks after burn, the acute inflammation subsided and the esophageal cavity reopened to some extent. Patients with dysphagia have improved symptoms and can eat some liquid food.
(3) 2 ~ 4 weeks after burn, due to scar formation, esophageal scar stenosis is formed, and dysphagia cannot be improved or even aggravated.
28. The acute phase of corrosive esophagitis has passed, or what should I do if I have difficulty swallowing?
After the corrosive esophagitis is cured, it is easy to form scar stenosis, which leads to food staying in the esophageal stenosis and unable to reach the stomach for digestion and absorption when swallowing food. In this case, endoscopy, esophageal dilatation or stent placement can be performed. If the curative effect is poor or the situation is serious, the narrow esophagus can be surgically removed.
29. What about dysphagia and dysphagia after radiotherapy for lung cancer?
Radiotherapy for lung cancer inevitably exposes the esophagus to a certain dose of radiation, and some people can form radiation esophagitis, which can be further diagnosed by gastroscopy.
30. How to treat radiation esophagitis?
At present, there is no good treatment for radiation esophagitis, mainly anti-inflammation, analgesia and the application of mucosal protective agent. Low dose dexamethasone and lidocaine diluted with normal saline are taken orally, and mucosal protective agent is taken after meals.
3 1. What's wrong with swallowing the esophagus when taking medicine?
In addition, when taking aspirin, ferrous sulfate and fluorouracil, people are used to swallowing without drinking water and lying down before going to bed, which leads to the drug staying in the esophagus for a long time, so improper long-term use of these drugs can also cause esophagitis.