Diagnosis of chronic esophagitis

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

[1], [2], [3]

X-ray examination of the esophagus

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

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

Esophagoscopy

When esophagoscopy revealed hyperemia of the mucosa, exudate in the cavity of the esophagus, erosion, small-point hemorrhage. The diagnosis of " chronic esophagitis " is specified by a targeted biopsy of the esophagus mucosa followed by a histological examination.

Endoscopically distinguish 4 degrees of esophagitis.

• I Art. - edema, hyperemia of the mucous membrane, a large amount of mucus.
• II century. - the emergence of single erosions on the background of edema, hyperemia of the mucosa of the esophagus.
• III century. - Numerous erosions and slight bleeding of the mucosa of the esophagus against the background of pronounced edema and hyperemia of the mucosa of the esophagus.
• IV century. - widespread erosion throughout the esophagus, contact (at the touch of the endoscope) bleeding, swelling, hyperemia of the mucosa of the esophagus, the presence of viscous mucus in the form of a plaque, sometimes with a yellowish tinge.

The severity of reflux esophagitis is classified by Savary-Miller

In addition, the stages of the flow of reflux esophagitis are distinguished.

• Stage A - moderate hyperemia of the mucosa of the esophagus.
• Stage B - the formation of visible defects (erosion) with the imposition of fibrin.

[4], [5], [6], [7], [8], [9], [10], [11]

Ezofagomanometry and 24-hour intra-esophageal pH-metry

These methods allow us to identify the presence of gastroesophageal reflux.

Acid perfusion test according to Bernstein

It is used for the diagnosis of chronic esophagitis. The test is considered positive and indicates the presence of esophagitis if there is a burning sensation and pain behind the breastbone 15-20 minutes after pouring into the esophagus through a thin probe 0.1 M hydrochloric acid solution at a rate of 15-20 ml per minute.

[12], [13], [14], [15], [16], [17], [18], [19]

General blood analysis

With the development of erosion or peptic ulcer of the esophagus, occult long-term bleeding is possible, which leads to the development of chronic iron-deficiency anemia in a general blood test.

Differential diagnosis of chronic esophagitis

Differential diagnosis of chronic esophagitis essentially reduces to differential diagnosis of the main symptoms - dysphagia and chest pain, eructations and vomiting.

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

All these diseases are accompanied by a certain symptomatology. Esophagus cancer is a common pathology and accounts for about 80-90% of all diseases of the esophagus. Chronic esophagitis, as well as diverticula, scarring strictures of the esophagus (after chemical burns), Plummer-Vinson's syndrome (sideropenic dysphagia) are precancerous diseases.

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

For the primary symptoms include:

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

The most constant and the first among these symptoms is dysphagia. With far-reaching esophageal cancer and tumor disintegration, dysphagia decreases and may disappear.

Pain is observed in 1/3 of patients and is intermittent (at mealtime) and constant (usually indicative of late stage of the disease).

By the secondary symptoms of esophageal cancer include:

• hoarseness of the voice (defeat of the recurrent nerve);
• triad Gorner (miosis, pseudoptosis, exophthalmus) - defeat of sympathetic ganglia;
• increased local lymph nodes;
• Bradycardia (due to irritation of the vagus nerve);
• coughing attacks;
• vomiting;
• dyspnea;
• Stridoroznoe breath.

By common symptoms of the disease include:

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

These symptoms indicate a far-reaching, even terminal stage of the disease.

For the purpose of correct diagnosis, attention should be paid to the clinical forms of esophageal cancer:

• Esophagus - the most common form (in 50% of patients), is characterized by dysphagia, pain while passing through the esophagus;
• Gastritic - simulates chronic gastritis and is manifested by heartburn, nausea, eructation, vomiting; Dysphagia may be absent (swelling of the lower segments of the esophagus);
• Neuralgic - characterized by the prevalence of pain in the clinic in the neck, shoulder, arm, spine;
• Heart - in the foreground in the clinical picture are pain in the heart;
• Laryngotracheal - characterized by hoarseness of voice, aphonia, barking cough;
• Pleuropulmonal - 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 esophageal fluoroscopy and esophagoscopy with targeted biopsy.

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

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

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

Esophagoscopy is performed absolutely for all patients with suspected esophageal cancer. With exophytic growth of the tumor, tuberous tumor masses appear protruding into the lumen of the esophagus, they bleed easily when touched by an endoscope. With endophytic form, local rigidity of the esophagus wall, discoloration and ulceration of the mucosa (ulcer of irregular shape with uneven, tuberous edges) is noted.

During esophagoscopy, a biopsy of the esophagus mucosa is mandatory, followed by a histological examination of the biopsy specimen.

It is also advisable to carry out a cytological study of wash water from the esophagus for the presence of tumor cells.

The chest pain caused by chronic esophagitis requires a differential diagnosis of chronic esophagitis with ischemic heart disease. IHD is characterized by the appearance of pain at the height of physical activity, a clear irradiation of pain in the left arm, shoulder blade, shoulder; localization of pain predominantly in the upper third of the sternum; ischemic ECG changes. With esophagitis, pain is more often localized behind the xiphoid process, is directly related to the swallowing act, is quickly stopped by the use of antacids, and is not accompanied by ischemic changes in the ECG. However, in some cases, pseudo-ischemic ECG changes are possible.

[20], [21], [22], [23], [24], [25], [26], [27]