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Chronic nonspecific esophagitis
Last reviewed: 23.04.2024
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Chronic nonspecific esophagitis, as a rule, develops from acute esophagitis and practically on the basis of the same etiological factors. They can be characterized by the formation of non-healing ulcers. The emergence of a long-term inflammatory process with its cicatricial stenosis, tumors. Chronic esophagitis can be both nonspecific and specific (tuberculosis, syphilis, actinomycosis).
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[What causes chronic nonspecific esophagitis?
Chronic nonspecific esophagitis arises, as a rule, as a result of prolonged irritation of the mucous membrane, its loss of protective properties and infection with its usual pathogenic or conditionally pathogenic microbiota, in rare cases - as a complication of acute esophagitis. In the initial period, the disease is almost asymptomatic and remains unnoticed for a long time. The insignificant but constantly accumulating effects of microtraumas (traumatic genesis), caused by such factors as inadequate chewing process (chewing efficiency, dentistry - less than 40%), tachyphagia, constant use of too cold or hot liquid drinks and spicy dishes, abuse smoking, strong alcoholic beverages, etc.
Infectious lesions constitute the etiological group of chronic nonspecific esophagitis, the same numerous as the group of traumatic chronic nonspecific esophagitis. The cause of these lesions, which occur again, are chronic purulent inflammatory processes in the nasal cavity or pyogenic forms of gum disease, periodontal disease, chronic caseous tonsillitis, in which the infected extracts, together with saliva, enter the esophagus during ingestion and enter the mucous membrane, infecting it . The latter can occur with retrograde infection in the esophagus in inflammatory diseases of the gallbladder, bile ducts, liver, duodenum, stomach, as well as in inflammatory processes in tissues lying outside the esophagus, but closely adjacent to it (pleurisy, mediastinitis, etc.). .).
Obstructive phenomena (strictures, cicatrical stenoses, prolonged functional spasms, tumors, etc.) also contribute to the emergence of chronic nonspecific esophagitis, as they contribute to stagnation of food masses in the esophagus, their decomposition, fermentation and putrefaction, which leads to irritation of the mucosa and her infection.
Chronic nonspecific esophagitis can occur as a result of vegetative-vascular dysfunctions of local and central genesis, as a result of neurotrophic digestion of the whole gastrointestinal tract, as well as as a result of prolonged reflux of acidic gastric contents causing irritation and then peptic ulcers of the mucous membrane (peptic esophagitis). These disorders are especially frequent in gastric ulcers and after resection, after various cardioplastic operations and the imposition of esophageal-gastric anastomoses.
Chronic nonspecific esophagitis can contribute to professional factors associated with the presence in the inspired air of vapors of corrosive liquids, which, when dissolved in the mucus of the oral cavity, are swallowed together with saliva and irritate the mucosa of the esophagus. A similar property is possessed by dust particles formed during the abrasive processing of products made of porcelain, faience, various metals, as well as in the latter, formed during electric welding. It should be noted that "chemical" chronic esophagitis is found in tobacco and alcohol workers, cooks, in the production of cement, gypsum, alabaster, etc.
Symptoms of chronic nonspecific esophagitis
The syndrome that occurs in chronic nonspecific esophagitis is most often characterized by insufficiently clear, often transient symptoms, which due to their uncertainty at the initial stages of the disease are not significant enough to establish a diagnosis of chronic esophagitis with their help. The most frequent symptom is the burning sensation behind the sternum or in the epigastric region, which occurs when the food lump passes through the esophagus, sometimes accompanied by a feeling of slow food movement. This sensation causes the patient to perform additional swallowing movements and forced head movements with the inclination of her forward. To facilitate swallowing, the patient is compelled to consume every sip with a small portion of water while eating dense food.
With the progression of chronic nonspecific esophagitis, spontaneous or functionally dependent pain in the sternum can occur , especially when passing through the esophagus of a dense food lump, often radiating to the back. In peptic esophagitis, straining, torso of the trunk forward or its extension facilitate the ingestion of gastric juice into the lumen of the esophagus, which causes an increase in heartburn and even pain in the region of the xiphoid process (pain symptom of the situation). With "chemical" esophagitis, pain occurs periodically, interrupted by long periods of remission. Another important symptom is the eructation of mucus, sometimes with an admixture of blood, which indicates the appearance in the picture of chronic nonspecific esophagitis of neuromuscular dysfunction and violation of the integrity of the vessels of the mucous membrane (ulcers).
Prolonged course of chronic nonspecific esophagitis, manifested by dysphagia, bleeding, repeated infection of the esophagus leads to deterioration of the general condition of the patient, its emaciation, the appearance of pathomorphological changes in the esophagus tissues (retractile fibrosis of its walls, malignization of the ulcerated mucous membrane).
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Diagnosis of chronic nonspecific esophagitis
The diagnosis is established with the help of esophagoscopy, an x-ray examination of the esophagus and stomach. With esophagoscopy, signs typical for each form of chronic nonspecific esophagitis are revealed. Thus, in the infectious nature of the disease, the mucosa is hyperemic and thickened, covered with mucous or mucopurulent exudate of a greenish-gray color, and individual ulcers are often identified. When esophagitis chemical nature, there are similar changes in the mucous membrane with the only difference being that they are localized in the upper part of the esophagus. In esophagitis caused by food retardation, in addition to the primary cause of stasis (diverticulum, stricture, spasm, etc.), mucosal hyperemia, swelling, hemorrhages into it and spastic contractures are revealed. In chronic peptic esophagitis, the mucous membrane of the lower third of the esophagus is sharply hyperemic, edematic, covered with erosions and hemorrhages; the cardiac part is considerably inflamed and expanded, through it the gastric mucosa can prolapse.
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Treatment of chronic nonspecific esophagitis
Treatment of chronic nonspecific esophagitis is primarily aimed at eliminating the cause of the disease, the detection of which is realized with a comprehensive examination of the patient, including the study of its VNS, the functional and organic state of the gastrointestinal tract and upper respiratory tract. If necessary, resort to probe nutrition, as well as to eliminate the anatomical defects of the esophagus and tumor diseases. Non-surgical treatment of chronic nonspecific esophagitis is in the competence of gastroenterologists, surgical - in the competence of thoracic surgeons.
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