Acute esophagitis

Acute esophagitis is divided into inflammation of infectious and inflammatory traumatic nature, the first - to nonspecific and specific, the latter - to chemical burns and mechano-traumatic injuries (perforations, ruptures, gunshot wounds).

Read also: Chronic esophagitis

[1], [2], [3], [4]

What causes acute esophagitis?

Acute esophagitis nonspecific is most often secondary, induced by inflammatory processes occurring in neighboring anatomical regions, in the upper and lower respiratory tract, and at a distance. Pathogenetically acute esophagitis nonspecific can be divided:

1. on the descending, arising from ingestion of infected secretions from the paranasal sinuses in chronic purulent sinusitis, as well as in chronic pharyngitis and tonsillitis;
2. on the ascending, localizing in the lower third of the esophagus and resulting from the throwing of acidic stomach contents into the esophagus in chronic hyperacid gastritis;
3. on esophagitis, arising from infection of the esophagus from inflammatory foci that are localized but adjacent (adenites, strumites, near-esophageal phlegmon, pleurisy);
4. on esophagitis, caused by hematogenous or lymphogenous path from foci located at a distance located in the lungs, abdominal organs, kidneys;
5. on posttraumatic acute nonspecific esophagitis arising as a result of infection of abrasive microbiota abrasions and wounds of the mucosa of the esophagus caused by foreign bodies;
6. on a special form of esophagitis arising from HIV infection caused by activated cytosgaloviruses and manifested by ulceration of the mucosa of the esophagus; this form is usually combined with cytomegalovirus colitis, gastritis and enteritis.

Clinical forms of acute esophagitis

Acute nonspecific esophagitis is divided into several forms, which is determined by the depth and area of the inflammatory process. The latter can be confined only to the mucosa and the submucosa or spread to the entire thickness of the esophageal wall. In the process may be involved and okopischevodnaya cellulose. If only the mucous membrane is affected, the esophagitis ends with the rejection of the necrotic epithelium, followed by the restoration of it. The torn mucosa is eliminated outward in the form of flaps or a tube resembling a cast of the esophagus. The more severe esophagitis occurs in the form of phlegmonous or necrotic inflammation, the process spreads to deeper layers - submucosal and muscle tissue with the formation of ulcers and a scab, purulent foci and the development of a demarcation process. After sequestration, a reparative process begins with the phenomena of granulation and scarring. Scars and circular cell infiltration are formed in the muscular layer of the esophagus. In perepishchevodnoy cellulose, if it is involved in an aseptic inflammatory process, sclerosing also develops, and if septic inflammation occurs in it, peri-esophagitis is complicated by purulent mediastinitis. Distinguish the following clinical forms of acute nonspecific esophagitis.

[5], [6], [7], [8], [9], [10], [11], [12], [13]

Catarrhal esophagitis

Catarrhal esophagitis is manifested by mild dysphagia and a burning sensation behind the sternum. In the first days of the patient complains of pain when swallowing, pain in the neck or behind the breastbone, thirst, secretion of ductile mucus or saliva. Sometimes there is vomiting with a small amount of blood. When esophagoscopy is determined diffuse hyperemia and edema of the mucous membrane, sometimes superficial islet ulceration of it. Inflammation, if not supported by a pathogenic factor, can last several days. As a remedy apply bismuth preparations, sour-milk products, sulfonamides, sedatives and anesthetics, liquid food.

[14], [15], [16], [17], [18]

Ulcerative necrotic esophagitis

Ulcerative necrotic esophagitis is a rare disease that occurs as a complication of banal infections of the upper respiratory tract. The general condition of the patient is severe: high temperature (38-39 ° C), severe spontaneous pain in the esophagus, unbearable when swallowing the food lump and liquid, which is why the swallowing act is almost completely broken.

The patient is in a forced position (lying on his side with his knees clenched or sitting forward with inclination). The mucous membrane of the esophagus is covered with a gray coating; in places deep ulceration and necrotic areas are revealed. Treatment includes the elimination of the source of primary infection, the appointment of antibiotics, sulfonamides, parenteral nutrition in the acute stage, then liquid food, timely prevention of the formation of cicatricial stenoses by bougie. In severe cases of ulcerative necrotic esophagitis, gastrostomy for nutrition is indicated.

Phlegmonous esophagitis

Phlegmonous esophagitis manifests itself in two forms - localized and diffuse.

Localized phlegmonous esophagitis

The localized form is manifested by a ring-shaped limited submucosal abscess. Symptoms: constant spontaneous pain in the sternum, intensifying with a deep breath or attempting to swallow a portion of the fluid irradiating into the back (interscapular space); Dysphagia, reaching the full obstruction of the esophagus; symptoms of a common infectious disease (high body temperature, tachycardia, leukocytosis, increased ESR). When the abscess is located in the cervical region of the esophagus, it manifests itself as a swelling in the supraclavicular area, which is painful during palpation and when the head moves. When localized in the thoracic esophagus, the pains are diffuse chestiness with irradiation to the back and the epigastric region. In the latter case, there may be a tension in the muscles of the anterior abdominal wall, simulating the acute abdomen. The abscess most often breaks through the lumen of the esophagus, which is the most favorable outcome of the disease, but can also be emptied into the pleural cavity, the trachea with the formation of the esophageal-tracheal fistula, and also into the mediastinum, which leads to the inevitable death of the patient.

Treatment of abscess of the esophagus with its thoracic localization and growing clinical phenomena is surgical, by endoscopic dissection of its capsule and suction of purulent contents. In the cervical localization of the esophagus abscess, it is opened from the external access, blocking the entry of pus into the mediastinum by gauze tampons. In the presence of pronounced edema in the area of the entrance to the esophagus, which spreads on the threshold of the larynx, and the appearance of the first signs of suffocation, an urgent tracheotomy is shown, since such edemas possess the insidious property of an avalanche-like build-up.

Diffuse phlegmonous esophagitis

Diffuse phlegmonous esophagitis from the very beginning is manifested by a severe general toxic (septic) inflammatory syndrome, manifested by a high body temperature (39-40 ° C), shortness of breath due to edema of the mediastinal fiber, cyanosis. Swallowing is impossible not only because of strong spontaneous pains, but also as a result of edema of the muscular tissue of the esophagus and the toxic paresis of the neuromuscular apparatus providing the motor function of the esophagus. The patient takes a forced position, often falls into a delusional state with disorientation in space and time, at the height of the process falls into a co-existing state. Esophagoscopy with diffuse phlegmonous esophagitis is contraindicated because of the danger of damage to the esophageal wall, which becomes sharply edematous, loose and easily perforated.

The evolution of the process is extremely difficult; patients die within a few days as a result of putrefactive gangrene of the esophagus and mediastinum.

Treatment is ineffective: massive doses of broad-spectrum antibiotics, detoxification therapy, immunomodulatory treatment. Some authors recommend endoscopic dissection of the mucosa throughout its extent, but this procedure with a developed clinical picture does not contribute to recovery.

[19], [20], [21], [22]