Esophageal ulcer

Esophageal ulcer - 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 amoxil-info.net. 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.

Esophageal ulcer - a pathology, is closely associated with 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.

All esophageal ulcers are divided into true (peptic) and symptomatic. To develop true esophageal ulcers cause axial 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), decrease the tone of the gastric wall at GIT comorbidity (stomach ulcer and duodenum, gall stones, vomiting, etc..).

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).

Ulcer of the esophagus is inherent in a particular characteristic for her symptom: chest pain, dysphagia, heartburn, vomiting, emaciation. Pain behind the breastbone usually occur immediately after a meal, are located mostly in the area of ​​the xiphoid process, at least in the epigastric (esophageal ulcer localization in the vicinity of the cardiac sphincter) may resemble an attack of angina pain. 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).