Diseases of the esophagus

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

Esophageal spasm (spastic dyskinesia) is a disease of the esophagus characterized by periodically occurring spasms. A distinction is made between primary esophageal spasm, which is a consequence of cortical dysfunction or a consequence of general convulsions, and secondary (reflex), which develops as a symptom of esophagitis, ulcerative 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 excruciating pain behind the breastbone, a feeling of a lump, fullness and compression, usually there is regurgitation with food entering the mouth, or even the respiratory tract (Mendelson's syndrome). Complications of esophageal spasm include the occurrence of pulsion diverticula and sliding hernia of the esophageal opening. Diseases of the esophagus are confirmed by X-ray and FGS. In all cases, it is necessary to exclude gallbladder pathology using ultrasound.

Strictures are diseases of the esophagus, which are characterized by its cicatricial narrowing, developing 4-6 weeks after a chemical burn. Accompanied by dysphagia and clinical esophagitis, hemorrhagic syndrome often occurs. Depending on the level of stricture, determined by X-ray and FGDS, the patient is sent for inpatient treatment to the ENT or thoracic department.

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

By location, there are cervical (Zenker), thoracic (bifurcation) and supradiaphragmatic (epiphreneal) diverticula. They can be single or multiple. By pathogenesis - pulsion (as a result of increased intraesophageal pressure), traction (as a result of cicatricial stretching of a section 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 mucous membrane prolapsing into the defect between muscle fibers.

The clinical picture of this esophageal disease appears late when diverticula have already formed and complications have developed in them: discomfort in the chest area, a feeling of food getting stuck, pressure behind the breastbone, 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 a delay in the cavity of food masses, saliva, foreign bodies.

Accompanied by pain behind the breastbone, a feeling of soreness and compression. Diverticulitis can give its own complications in the form of bleeding, periesophagitis, perforations with the development of mediastinitis, the formation of esophageal-tracheal and esophageal-bronchial fistulas.

These diseases of the esophagus are confirmed by X-ray examination and FGDS.

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

Very rarely, elderly people may develop multiple false diverticula (Barshon-Teschendorf syndrome), which are accompanied by transient dysphagia and chest pain simulating angina. Confirmation of the diagnosis by fluoroscopy. Treatment of the esophagus disease is conservative by a therapist.

Esophagitis is an inflammatory disease of the esophagus: acute, subacute, chronic, reflux esophagitis as a separate form. According to the nature of the changes in the wall, the following are distinguished: catarrhal, erosive, hemorrhagic, pseudomembranous, necrotic esophagitis; abscess and phlegmon.

Catarrhal esophagitis is the most common. It is accompanied by heartburn, a burning sensation behind the breastbone, a soreness or a lump when food passes. The symptoms quickly disappear after the cessation of the factor that caused esophagitis: hot food, irritants and acids. X-ray does not reveal changes in the walls, FGS is the main diagnostic method, but there should always be alertness for tumors. Treatment of esophageal disease is conservative on an outpatient basis by a therapist.

Erosive esophagitis often develops with acute infectious diseases of the pharynx or the action of irritants. The clinical picture of the esophagus disease is the same as that of catarrhal esophagitis, but is expressed more vividly, often accompanied by bloody vomiting (hematemesis), a positive Grigersen reaction, feces for occult blood). FGS is carried out with caution. The course is conservative, better in a hospital, aimed at correcting the underlying pathology. In case of bloody vomiting, emergency care is sent to surgery or an endoscopist surgeon is involved in the treatment.

Hemorrhagic esophagitis occurs in acute infectious and viral diseases (typhus, flu, etc.). Accompanied by pain when swallowing, bloody vomiting, melena. Referral to a hospital for the underlying pathology or to a surgical department. Confirmation of the diagnosis of FGS with measures to stop bleeding.

Pseudomembranous esophagitis develops with diphtheria and scarlet fever. It manifests itself as sharp pain behind the breastbone when swallowing, severe dysphagia, and coarse fibrin films in the vomit. Treatment of the esophagus disease is carried out inpatiently, then as complications develop (stenosis, diverticulum formation), the patient is transferred for surgical treatment to a thoracic or specialized surgical department.

Necrotic esophagitis is observed in severe cases of scarlet fever, measles, typhoid fever, as well as candidiasis, agranulocytosis, etc. The pain may not be particularly pronounced, but dysphagia develops quite powerfully. Bleeding, perforation with the development of mediastinitis may occur. The outcome of the esophagus disease, as a rule, is the formation of cicatricial stenosis. Treatment in each case is individual, inpatient according to the underlying pathology, but with the obligatory involvement of a surgeon and endoscopist.

An esophageal abscess is formed when a foreign body (usually a fish or chicken bone) penetrates the wall. The general condition is almost not affected, a sharp pain behind the sternum when swallowing is disturbing. The diagnosis is confirmed by FGS, in which it is possible to open the abscess and remove the foreign body. In this case, treatment is carried out conservatively, on an outpatient basis, by a therapist. A breakthrough of the abscess into the mediastinum is possible, but it is extremely rare and is accompanied by the development of mediastinitis, which requires hospitalization in the thoracic department.

Phlegmon also develops around the implanted foreign bodies, but it spreads along the wall and into the mediastinum. The condition is severe from the very beginning, increasing intoxication syndrome, pronounced aerophagia, pain behind the sternum, especially with swallowing movements and movements: neck. Emergency hospitalization in a thoracic or specialized department is indicated, where treatment of the esophagus disease will be carried out.

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