Diagnosis of chronic esophagitis

Diagnosis of chronic esophagitis is based on instrumental research methods and clinical examination of the patient.

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X-ray of the esophagus

Characteristic signs of chronic esophagitis are swelling of the folds of the mucous membrane, uneven contours of the esophagus, and the presence of a large amount of mucus. In the presence of erosions of the mucous membrane of the esophagus, round or oval strips of barium "depot" measuring 0.5-1.0 cm are detected.

When a peptic ulcer develops, a flow of contrast medium into the ulcer crater is detected, and a "niche" symptom appears, which is a round or triangular protrusion on the contour of the esophagus shadow. The folds of the esophageal mucosa converge, converge to the niche (symptom of convergence of folds). Sometimes an esophageal ulcer is manifested not by a "niche", but by a persistent contrast spot on the inner surface of the esophagus. It disappears after taking 1-2 sips of water and is then again determined after taking each portion of barium.

Esophagoscopy

Esophagoscopy reveals hyperemia of the mucous membrane, exudate in the esophageal cavity, erosions, and small-point hemorrhages. The diagnosis of " chronic esophagitis " is clarified by targeted biopsy of the esophageal mucous membrane with subsequent histological examination.

Endoscopically, 4 degrees of esophagitis are distinguished.

• Stage I - swelling, hyperemia of the mucous membrane, large amount of mucus.
• Stage II - the appearance of isolated erosions against the background of edema and hyperemia of the esophageal mucosa.
• Stage III - multiple erosions and mild bleeding of the esophageal mucosa against the background of severe edema and hyperemia of the esophageal mucosa.
• Stage IV - erosions spread throughout the esophagus, contact (when touched by the endoscope) bleeding, edema, hyperemia of the esophageal mucosa, the presence of viscous mucus in the form of plaque, sometimes with a yellowish tint.

The severity of reflux esophagitis is classified according to Savary-Miller

In addition, stages of reflux esophagitis are distinguished.

• Stage A - moderate hyperemia of the esophageal mucosa.
• Stage B – formation of visible defects (erosions) with fibrin deposition.

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Esophagomanometry and 24-hour intraesophageal pH-metry

These methods can detect the presence of gastroesophageal reflux.

Bernstein acid perfusion test

Used to diagnose chronic esophagitis. The test is considered positive and indicates the presence of esophagitis if a burning sensation and pain behind the breastbone occurs 15-20 minutes after pouring 0.1 M hydrochloric acid solution into the esophagus through a thin tube at a rate of 15-20 ml per minute.

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Complete blood count

With the development of erosions or peptic ulcers of the esophagus, occult prolonged bleeding is possible, which leads to the development of chronic iron deficiency anemia in the general blood test.

Differential diagnosis of chronic esophagitis

Differential diagnosis of chronic esophagitis essentially comes down to differential diagnosis of the main symptoms - dysphagia and chest pain, belching and vomiting.

Dysphagia is observed not only with esophagitis, but also with a number of other diseases: esophageal cancer, achalasia cardia, esophageal diverticula (with diverticulitis), foreign bodies in the esophagus, esophageal strictures, scleroderma (systemic), hysteria, inflammatory diseases of the pharynx, larynx; lesions of the nervous system and muscles involved in swallowing.

All of the above diseases are accompanied by certain symptoms. Esophageal cancer is a common pathology and accounts for about 80-90% of all esophageal diseases. Chronic esophagitis, as well as diverticula, cicatricial strictures of the esophagus (after chemical burns), Plummer-Vinson syndrome (sideropenic dysphagia) are precancerous diseases.

Symptoms of esophageal cancer can be divided into three groups: primary, secondary, and general.

Primary symptoms include:

• dysphagia;
• pain when swallowing (located behind the sternum);
• feeling of fullness behind the breastbone;
• regurgitation;
• increased salivation.

The most constant and first of the named symptoms is dysphagia. With advanced esophageal cancer and tumor decay, dysphagia decreases and may disappear.

Pain is observed in 1/3 of patients and can be intermittent (during meals) or constant (usually indicating a late stage of the disease).

Secondary symptoms of esophageal cancer include:

• hoarseness of voice (damage to the recurrent nerve);
• Horner's triad (miosis, pseudoptosis, exophthalmos) - damage to the sympathetic ganglia;
• enlargement of local lymph nodes;
• bradycardia (due to irritation of the vagus nerve);
• coughing fits;
• vomit;
• dyspnea;
• stridor breathing.

Common symptoms of the disease include:

• general weakness;
• progressive weight loss;
• anemia.

These symptoms indicate an advanced, even terminal stage of the disease.

For the purpose of correct diagnosis, it is necessary to pay attention to the clinical forms of esophageal cancer:

• Esophageal - the most common form (in 50% of patients), characterized by dysphagia, pain when food passes through the esophagus;
• Gastritis - imitates chronic gastritis and is manifested by heartburn, nausea, belching, vomiting; dysphagia may be absent (tumor of the lower segments of the esophagus);
• Neuralgic - characterized by the predominance of pain in the neck, shoulder, arm, and spine;
• Cardiac - pain in the heart area comes to the forefront in the clinical picture;
• Laryngotracheal - characterized by hoarseness, aphonia, barking cough;
• Pleuropulmonary - manifested by shortness of breath, cough, attacks of suffocation;
• Mixed - combines the manifestation of various forms.

Verification of the diagnosis of esophageal cancer is carried out using X-ray examination of the esophagus and esophagoscopy with targeted biopsy.

X-ray examination of the esophagus reveals the following characteristic signs:

• filling defect;
• absence of esophageal peristalsis at the site of tumor localization;
• disruption of the relief structure of the esophageal mucosa.

To determine the spread of the tumor process to neighboring organs, X-ray diagnostics of chronic esophagitis in conditions of pneumomediastinum and computed tomography are used.

Esophagoscopy is performed on absolutely all patients with suspected esophageal cancer. With exophytic tumor growth, lumpy tumor masses protruding into the lumen of the esophagus are visible; they bleed easily when touched with an endoscope. With the endophytic form, local rigidity of the esophageal wall, discoloration and ulceration of the mucous membrane (an ulcer of irregular shape with uneven lumpy edges) are noted.

During esophagoscopy, a biopsy of the esophageal mucosa is performed, followed by a histological examination of the biopsy.

It is also advisable to conduct a cytological examination of esophageal lavage water for the presence of tumor cells.

Pain behind the sternum caused by chronic esophagitis requires differential diagnosis of chronic esophagitis with ischemic heart disease. IHD is characterized by the occurrence of pain at the height of physical exertion, clear irradiation of pain to the left arm, shoulder blade, shoulder; localization of pain mainly in the upper third of the sternum; ischemic changes in the ECG. With esophagitis, pain is often localized behind the xiphoid process, is directly related to the act of swallowing, is quickly relieved by taking antacids, and is not accompanied by ischemic changes in the ECG. However, in some cases, pseudo-ischemic changes in the ECG are possible.

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