Endoscopic signs of esophagitis

Esophagitis is a lesion of the mucous membrane of the esophagus of an inflammatory-degenerative nature with subsequent involvement of the deep layers of the esophagus wall. Primary is rare, more often secondary and accompanies diseases of the esophagus and other organs.

Acute esophagitis. Occurs with direct exposure of the mucous membrane to thermal, chemical or mechanical factors, inflammatory processes can spread from the oral cavity, etc. Endoscopically, the diagnosis is beyond doubt: the mucous membrane is hyperemic, edematous, easily vulnerable, can bleed when touched, ulcers are possible. The Z-line is blurred.

Degrees of acute esophagitis (Basset).

1. Edema and arterial hyperemia of the mucous membrane, abundance of mucus).
2. The appearance of isolated erosions on the tops of edematous folds of the mucous membrane.
3. Edema and hyperemia are more pronounced, large areas of eroded and bleeding mucous membrane appear.
4. "Crying" mucous, diffuse erosion. Bleeds at the slightest touch. The mucous may be covered with viscous mucus or a yellowish fibrin coating. In reflux esophagitis, fibrin acquires a yellowish-greenish tint.

Acute esophagitis may pass within a few days. At stage IV there may be perforation and bleeding, in the remote period - cicatricial stenosis of the esophagus.

Certain types of acute esophagitis

Fibrinous (pseudomembranous) esophagitis. Occurs in childhood infections. A grayish-yellowish coating appears, after its rejection - long-term non-healing erosions.

Corrosive esophagitis. Occurs when taking chemically aggressive substances (alkalis, acids, etc.). Currently, endoscopy is not contraindicated, as was previously thought, but a pediatric fibroendoscope of the smallest caliber should be used for the examination. During examination, pronounced hyperemia and significant edema of the mucosa up to complete obstruction of the esophagus are revealed. The esophagus loses its tone. It is complicated by massive bleeding. Fibrous strictures develop from 3-6 weeks, often after a longer period of time. Usually, inflammatory and cicatricial changes are most pronounced in the area of physiological constrictions. There are 4 stages of endoscopic changes in the esophagus:

1. Hyperemia and swelling of the swollen mucous membrane.
2. The presence of white or yellow plaques with the formation of pseudomembranes.
3. Ulcerated or bleeding mucosa covered with viscous exudate.
4. Chronic stage: the mucosa is patchy with cicatricial structures, scarring leads to the formation of a short stricture or tubular stenosis.

Chronic esophagitis.

Causes: prolonged irritation of the mucous membrane by alcohol, spicy, hot food, excessive smoking, inhalation of harmful vapors and gases.

1. Ingestive chronic esophagitis (not associated with reflux) - descending esophagitis.
2. Reflux esophagitis (peptic esophagitis) is ascending esophagitis.

It occurs as a result of retrograde reflux of stomach contents into the esophagus.

Ingestive esophagitis is localized in the middle third of the esophagus or diffusely, characterized by the presence of leukoplakia. Reflux esophagitis is characterized by a distal location with gradual spread proximally and the formation of peptic ulcers.

Endoscopic criteria for chronic esophagitis (Kabayashi and Kasugai)

1. Hyperemia of the mucous membrane is diffuse or in the form of stripes.
2. The presence of erosions or acute ulcers, less often chronic ones.
3. Increased bleeding of the mucous membrane.
4. Rigidity of the esophageal walls.
5. The presence of leukoplakia - whitish callused seals with a diameter of 0.1 to 0.3 cm - is an increase in the layers of the epithelium by 6-7 times; the epithelium acquires a cubic shape and increases in size. The degree of these changes depends on the severity of the esophagitis.

Severity of chronic esophagitis

• Stage I. Mild degree: hyperemia of the mucous membrane in the form of longitudinal stripes, edema, presence of viscous mucus. Sometimes expansion of the arterial and venous vascular pattern.
• Stage II. Moderate severity: pronounced diffuse hyperemia of the mucous membrane, thickening of folds, pronounced edema of the mucous membrane, decreased elasticity, pronounced contact bleeding, there may be isolated erosions.
• III st. Severe degree: presence of ulcers.

Peptic esophagitis (reflux esophagitis). This is the most common type of chronic esophagitis. It occurs due to the constant reflux of gastric juice, sometimes bile, etc. into the esophagus.

There are 4 degrees of reflux esophagitis (according to Savary-Miller):

• Stage I (linear form). More or less pronounced diffuse or spotty reddening of the mucosa in the lower third of the esophagus with isolated defects (with a yellow base and red edges). There are linear longitudinal erosions directed from the Z-line upwards.
• Stage II (confluent form). Defects of the mucous membrane merge with each other.
• Stage III (circular esophagitis). Inflammatory and erosive changes occupy the entire circumference of the esophagus.
• IV st. (stenotic). Resembles the previous form, but there is stenosis of the lumen of the esophagus. Passage of the endoscope through the narrowing is impossible.

Peptic (flat) ulcer of the esophagus. First described by Quincke in 1879 and named after him. Most often solitary, but can be multiple and confluent. Located mainly in the lower third of the esophagus, in the area of the cardioesophageal junction, on the posterior or posterolateral wall. The shape is different: oval, slit-like, irregular, etc. The size is usually up to 1 cm. Most often elongated along the axis of the esophagus, but can be annular. The edges of the ulcer are flat or slightly protruding, uneven, dense on instrumental palpation, surrounding the ulcer in the form of a hyperemic rim. In some cases, the edges can be bumpy - suspected cancer. The bottom is covered with a white or gray fibrin coating. After washing with a stream of water, easily bleeding dark red tissues are visible. As recovery proceeds, epithelialization occurs from the edge to the center, the bottom is cleared, and there is usually no convergence of folds. After healing, a linear or serrated scar is formed, a rough diverticulum-like deformation of the wall and stricture of the esophagus may form.

A biopsy is very helpful in determining the process. Since the pieces obtained during a biopsy are small, more must be taken.

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