Diseases of the esophagus

Esophageal syndrome is a symptom complex that causes diseases of the esophagus. The main manifestation of changes in it is dysphagia. Traumatic injuries lead to the development of mediastinitis.

Esophagospasm (spastic dyskinesia) - diseases of the esophagus, characterized by recurrent spasms. There are primary esophagospasm, which is a consequence of cortical violations of the regulation of the function or a consequence of general seizures and secondary (reflex), which develops as a symptom in esophagitis, ulcer and cholelithiasis, cancer, etc. Attacks can be rare (1-2 times a month) or almost after every meal. These diseases of the esophagus are accompanied by painful pains behind the sternum, a feeling of clot, overflow and compression, usually there is regurgitation with ingestion of food masses in the mouth, and even in the respiratory tract (Mendelssohn syndrome). Complications of esophagospasm are the occurrence of pulsatile diverticula and a sliding hernia of the esophageal opening. Diseases of the esophagus are confirmed by fluoroscopy and FGS. In all cases, it is necessary to exclude the pathology of the gallbladder with ultrasound.

Strictures are diseases of the esophagus, which are characterized by scar scarring, which develops 4-6 weeks after a chemical burn. It is accompanied by dysphagia and clinic of esophagitis, often there is hemorrhagic syndrome. Depending on the level of stricture, determined by fluoroscopy and FGS, the patient is referred for inpatient treatment in the ENT or thoracic department.

Diverticula - diseases of the esophagus, characterized by hernial protrusions of its wall with the formation of a sac.

The location distinguishes cervical (tsikerovskie), pectoral (bifurcation) and supra-diaphragmatic (epiphrenic) diverticula. They are single and multiple. By pathogenesis - pulsion (as a result of increased intra-esophageal pressure), traction (as a result of cicatricial stretching of the wall) and pulsion-traction. By morphology - complete, when there is a protrusion of all layers of the wall, and incomplete if their wall consists only of the mucosa that prolapses into the defect between the muscle fibers.

The clinic of this disease of the esophagus appears late with already formed diverticula and the development of complications in them: unpleasant sensations in the chest, a sense of food "stuck", pressure behind the sternum, dysphagia, regurgitation, salivation, pain in the neck, behind the breastbone, in the back. The most common complication of diverticula is their inflammation - diverticulitis - catarrhal, erosive, rarely purulent or gangrenous, developing with delay in the cavity of food masses, saliva, foreign bodies.

It is accompanied by pain behind the sternum, a sense of sadness and constriction. Diverticulitis can give its own complications in the form of bleeding, pereezophagitis, perforations with the development of mediastinitis, the formation of esophageal-tracheal and esophageal-bronchial fistulas.

These diseases of the esophagus are confirmed with the help of fluoroscopy, FGS.

Tactics: referral to a thoracic or specialized department for surgical treatment.

Very rarely elderly people can develop multiple false diverticula (Barshnya-Teschendorf syndrome), which are accompanied by transient dysphagia and chest pain simulating angina pectoris. Confirmation of diagnosis by fluoroscopy. Treatment of esophageal disease conservative therapist.

Esophagitis - inflammatory diseases of the esophagus: acute, subacute, chronic, reflux esophagitis as a separate form. By the nature of the changes, the walls are distinguished: catarrhal, erosive, hemorrhagic, pseudomembranous, necrotic esophagitis; abscess and phlegmon.

Catarrhal esophagitis occurs most frequently. It is accompanied by heartburn, a burning sensation behind the sternum, a sore or lump in the passage of food. The phenomena quickly disappear after the cessation of the factor that caused esophagitis: hot food, irritants and acids. X-rays do not reveal changes in the walls, FGS is the main method of diagnosis, and there must always be caution in relation to tumors. Treatment of esophageal disease conservative ambulatory therapist.

Erosive esophagitis often develops in acute infectious diseases of the pharynx or the action of irritants. The clinic of the disease of the esophagus is the same as that of catarrhal esophagitis, but is more pronounced, often accompanied by bloody vomiting (hematemesis), a positive reaction of Grigersen, feces to occult blood). FGS is conducted with caution. The course is conservative, better in the hospital, aimed at correcting the underlying pathology. When bloody vomiting for emergency care is sent to surgery or attracted to the treatment of an endoscopic surgeon.

Hemorrhagic esophagitis occurs in acute infectious and viral diseases (typhus, influenza, etc.). It is accompanied by pain during swallowing, bloody vomiting, melena. Referral to the hospital according to the main pathology or to the surgical department. Confirmation of the diagnosis of FGS with the implementation of measures to stop bleeding.

Pseudomembranous esophagitis develops with diphtheria and scarlet fever. It manifests a sharp pain behind the sternum when swallowing, expressed by dysphagia, in the vomit masses of coarse fibrin films. Steady-state treatment of the disease of the esophagus, then, as complications develop (stenosis, formation of the diverticulum), they are transferred for surgical treatment to the thoracic or specialized surgical department.

Necrotic esophagitis is observed in severe scarlet fever, measles, typhoid fever, as well as in candidomycosis, agranulocytosis, etc. Pain may not be particularly pronounced, but dysphagia develops quite powerful. There may be bleeding, perforation with the development of mediastinitis. The outcome of esophageal disease, as a rule, is the formation of cicatricial stenosis. Treatment in each case individually, stationary for the main pathology, but with the mandatory involvement of a surgeon and endoscopist.

Esophageal abscess is formed by the introduction of a foreign body into the wall (more often fish or chicken bone). The general or common status is not disturbed almost, disturbs a sharp pain behind a breast bone at a swallowing. Confirms the diagnosis of FGS, in which it is possible to open the abscess and remove the foreign body. In this case, the treatment is conservative, outpatient, therapist. The breakthrough of the abscess into the mediastinum can be, but it is extremely rare and accompanied by the development of mediastinitis, which requires hospitalization in the thoracic department.

Phlegmon also develops around ingrained foreign bodies, but it spreads along the wall and into the mediastinum. The condition from the very beginning is a serious, increasing syndrome of intoxication, pronounced aerofagia, pain behind the sternum, especially with swallowing movements and movements: the neck. An emergency admission to the thoracic or specialized department is indicated, where the treatment of esophageal disease will be performed.

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