Acute esophagitis

Acute esophagitis is divided into inflammations of infectious and inflammations of traumatic nature, the former - into non-specific and specific, the latter - into chemical burns and mechanical-traumatic injuries (perforations, ruptures, gunshot wounds).

Read also: Chronic esophagitis

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What causes acute esophagitis?

Acute non-specific esophagitis is most often secondary, induced by inflammatory processes occurring in adjacent anatomical areas, in the upper and lower respiratory tract, and at a distance. Pathogenetically, acute non-specific esophagitis can be divided into:

1. descending, arising from swallowing infected secretions from the paranasal sinuses in chronic purulent sinusitis, as well as in chronic pharyngitis and tonsillitis;
2. ascending, localized in the lower third of the esophagus and arising as a result of the acidic contents of the stomach being thrown into the esophagus during chronic hyperacid gastritis;
3. for esophagitis, which occurs when the esophagus is infected from inflammatory foci localized in the vicinity (adenitis, struma, periesophageal phlegmon, pleurisy);
4. for esophagitis arising by hematogenous or lymphogenous routes from distant foci located in the lungs, abdominal organs, and kidneys;
5. for post-traumatic acute non-specific esophagitis resulting from infection with purulent microbiota of abrasions and wounds of the esophageal mucosa caused by foreign bodies;
6. a special form of esophagitis that occurs with HIV infection, caused by activated cytomegaloviruses and manifested by ulcerations of the esophageal mucosa; this form is usually combined with cytomegalovirus colitis, gastritis and enteritis.

Clinical forms of acute esophagitis

Acute non-specific esophagitis is divided into several forms, which is determined by the depth and area of the inflammatory process. The latter may be limited to the mucous membrane and submucous layer or spread to the entire thickness of the esophageal wall. The periesophageal tissue may also be involved in the process. If only the mucous membrane is damaged, then esophagitis ends with the rejection of dead epithelium with its subsequent restoration. The rejected mucous membrane is eliminated to the outside in the form of flaps or a tube resembling a cast of the esophagus. More severe esophagitis occurs in the form of phlegmonous or necrotic inflammation, the process spreads to deeper layers - submucous and muscle tissue with the formation of ulcers and scabs, purulent foci and the development of the demarcation process. After sequestration, the reparative process begins with granulation and scarring. Scars and round cell infiltration also form in the muscular layer of the esophagus. In the periesophageal tissue, if it is involved in the aseptic inflammatory process, sclerosis phenomena also develop, and if septic inflammation occurs in it, periesophagitis is complicated by purulent mediastinitis. The following clinical forms of acute nonspecific esophagitis are distinguished.

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Catarrhal esophagitis

Catarrhal esophagitis is manifested by mild dysphagia and a burning sensation behind the breastbone. In the first days, the patient complains of pain when swallowing, pain in the neck or behind the breastbone, thirst, secretion of viscous mucus or saliva. Sometimes vomiting with a small admixture of blood appears. Esophagoscopy reveals diffuse hyperemia and edema of the mucous membrane, sometimes superficial insular ulcerations. Inflammation, if not supported by a pathogenic factor, can last for several days. Bismuth preparations, fermented milk products, sulfonamides, sedatives and painkillers, and liquid food are used as therapeutic agents.

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Ulcerative necrotic esophagitis

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

The patient is in a forced position (lying on his side with his knees drawn up or sitting with a forward lean). The mucous membrane of the esophagus is covered with a gray coating; deep ulcers and necrotic areas are revealed in places. Treatment includes elimination of the source of primary infection, prescription of antibiotics, sulfonamides, parenteral nutrition in the acute stage, then liquid food, timely prevention of the formation of cicatricial stenosis by bougienage. 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 manifests itself as a ring-shaped limited submucous abscess. Symptoms: constant spontaneous pain in the sternum, increasing with a deep breath or an attempt to swallow a portion of liquid, radiating to the back (interscapular space); dysphagia, reaching complete obstruction of the esophagus; symptoms of a general infectious disease (high body temperature, tachycardia, leukocytosis, increased ESR). When the abscess is localized in the cervical esophagus, it manifests itself as swelling in the supraclavicular region, painful on palpation and with head movements. When localized in the thoracic esophagus, the pain is diffuse retrosternal in nature with irradiation to the back and epigastric region. In the latter case, tension of the muscles of the anterior abdominal wall may be observed, simulating an acute abdomen. An abscess most often breaks through into the lumen of the esophagus, which is the most favorable outcome of the disease, but it can also empty into the pleural cavity, trachea with the formation of an esophageal-tracheal fistula, as well as into the mediastinum, which leads to the inevitable death of the patient.

Treatment of esophageal abscess in the thoracic region and increasing clinical manifestations is surgical, by endoscopic dissection of its capsule and suction of purulent contents. In case of cervical localization of paraesophageal abscess, it is opened from external access, blocking the entry of pus into the mediastinum with gauze tampons. In the presence of pronounced edema in the area of the entrance to the esophagus, spreading to the vestibule of the larynx, and the appearance of the first signs of suffocation, urgent tracheotomy is indicated, since such edemas have the insidious property of avalanche-like growth.

Diffuse phlegmonous esophagitis

Diffuse phlegmonous esophagitis manifests itself from the very beginning as a severe general toxic (septic) inflammatory syndrome, manifested by a high body temperature (39-40 ° C), difficulty breathing due to edema of the mediastinal tissue, and cyanosis. Swallowing movements are impossible not only because of severe spontaneous pain, but also as a result of edema of the muscular tissue of the esophagus and toxic paresis of the neuromuscular apparatus that ensures the motor function of the esophagus. The patient assumes a forced position, often falls into a delirious state with disorientation in space and time, and at the height of the process falls into a soporous state. Esophagoscopy in diffuse phlegmonous esophagitis is contraindicated due to the risk 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 mucous membrane along its entire length, but this procedure does not promote recovery in the advanced clinical picture.

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