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Peptic ulcer of the esophagus: causes, symptoms, diagnosis, treatment
Last reviewed: 12.07.2025
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Peptic ulcer of the esophagus has much in common with gastric and duodenal ulcers and occurs, according to various authors, in 3.5-8.3% of cases of this disease; it is most often observed in men after 40 years of age, but can occur at any age.
Trophic diseases of the esophagus occur as a result of local or general pathogenic factors and are manifested by various pathomorphological changes in its mucous membrane and deeper layers. They are often combined with vascular diseases of the esophagus and its neuromuscular dysfunctions. Most often, trophic lesions of the esophagus occur secondarily and are caused by trophic diseases of the stomach.
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What causes peptic ulcer of the esophagus?
The mechanism of occurrence of peptic ulcer of the esophagus is unclear. Most authors are inclined to the "theory" according to which peptic ulcer of the esophagus occurs as a result of reflux of hyperacid gastric juice, causing peptic destruction of the mucous membrane of the esophagus, which is not adapted to contact with hydrochloric acid and enzymes contained in the gastric juice. According to another "theory", peptic ulcer of the esophagus occurs in those individuals whose esophagus contains ectopic islets of the gastric mucosa, constantly secreting a secretion unacceptable for the normal state of the mucous membrane of the esophagus. A number of authors believe that peptic ulcer of the esophagus occurs as a complication of acute esophagitis. In any case, when considering the pathogenesis of peptic ulcer of the esophagus and developing a treatment strategy for this disease, one should take into account the state of the central nervous system and autonomic nervous system, disorders of which can cause disorders of the secretory activity of the stomach and organs of the entire gastrointestinal tract in general. In this case, probably, the basic significance is the research of I.P. Pavlov and K.M. Bykov in the field of cortical-visceral reflexes, the distortion of which leads to functional and trophic diseases of the gastrointestinal tract. Thus, K.M. Bykov (1949) put forward the concept of the secretory fields of the stomach, according to which the lesser curvature of this organ is a kind of trigger for the secretory activity of the glands of the stomach. The basis for this theory was a thorough study of the secretory activity of the lesser curvature of the stomach.
In recent years, allergic genesis of gastrointestinal diseases, and in particular of the esophagus and stomach, has been considered, not without reason. At the same time, allergic manifestations from these organs can be observed not only with energy-induced allergization (for example, nutritional allergy), but also with other ways of sensitization of the body.
The vascular “theory” is also considered, according to which a deficiency in blood supply to individual areas of the esophageal mucosa (atherosclerosis, microthrombosis, spasm resulting from psychoemotional stress) can lead to trophic disorders of the esophageal mucosa.
Pathological anatomy of peptic ulcer of the esophagus
Peptic ulcer of the esophagus is localized mainly in the lower third of the esophagus. Macroscopically, it is very similar to a gastric ulcer: esophagoscopy reveals a funnel-shaped depression in the wall of the esophagus with unclear edges; a sclerotic (callous) ridge forms around the ulcer. Basically, a peptic ulcer of the esophagus is single and of varying depth, but multiple ulcers in various stages of development often occur. If they are located around the lumen of the esophagus, then disturbances in its esophageal function may occur.
Symptoms of peptic ulcer of the esophagus
The symptoms of peptic ulcer of the esophagus are defined by the term "esophageal syndrome", which includes such signs as pain, dysphagia and regurgitation. These symptoms are especially pronounced when solid food passes through the esophagus and, to a lesser extent, liquid food. The clinical course is characterized by periods of exacerbations and "clear" intervals. During exacerbations at the initial stages of the disease, minor esophageal bleeding may be observed, which does not require special measures to stop it.
Peptic ulcer of the esophagus is characterized by a progressive clinical course with worsening signs of esophageal syndrome, weakening and emaciation of the patient to a cachexic state. Against this background, which is usually accompanied by a severe stomach disease (peptic ulcer, malignancy of the process), severe esophageal complications may occur: profuse bleeding from the blood vessels of the esophagus, perforation, malignancy.
As a rule, blood from esophageal bleeding is scarlet, but if it gets into the stomach and is then released in the form of vomit, it acquires a dark brown color, due to the color of hydrochloric hematin formed by combining hemoglobin with hydrochloric acid. When blood from the stomach gets into the intestine, melena occurs. Constant esophageal microhemorrhages in combination with stomach disease cause severe anemia. Perforations of the esophagus into the pleura occur in 14% of cases; perforations into the pericardium, mediastinum and other adjacent anatomical structures are also possible, causing severe secondary complications.
Esophageal strictures in peptic ulcers are an almost inevitable phenomenon, manifested by the same pathomorphological and clinical signs as in chemical burns of the esophagus.
Diagnosis of peptic ulcer of the esophagus
The diagnosis is established based on radiographic and esophagoscopic examination of the patient. Radiography using a radiopaque substance on the walls of the esophagus visualizes the area (areas) of contrast medium retention with clear boundaries corresponding to the size and depth of the ulcer. Esophagoscopy determines the localization, number, shape and macrostructure of the ulcer; if its edges and bottom proliferate, or other signs are detected that are suspicious of malignancy of the process, a biopsy is indicated. In all cases without exception, peptic ulcer of the esophagus is accompanied by chronic esophagitis of varying prevalence, which requires appropriate non-surgical treatment.
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Treatment of peptic ulcer of the esophagus
Treatment of peptic ulcer of the esophagus includes medical, endoscopic and surgical methods.
Non-surgical treatment of peptic ulcer of the esophagus is identical to that used for gastric ulcer and is carried out in accordance with the identified gastroscopic and histological data. The drugs of choice can be H2-antihistamines (Ranitidine, Ranigast, Famotidine, Cimetidine), antacids and adsorbents (Almazilat, aluminum phosphate, Carbaldrate, magnesium carbonate, magnesium oxide), antihypoxants and antioxidants (Butylated hydroxytoluene), vitamins and vitamin-like agents (Retinol, Retinol palmitate), proton pump inhibitors (drugs that block the final stage of hydrochloric acid formation - Lansoprazole, Omenrazole, Akrilaize, Lanzap, Lansofed), local anesthetics (Benzocaine), regenerators and reparators (Tykveol), myotropic antispasmodics (Otilonium bromide).
Endoscopic treatment of peptic ulcer of the esophagus using cauterizing, extinguishing and astringent agents is ineffective.
Peptic ulcer of the esophagus is treated surgically only in cases of deep ulcers that are not amenable to non-surgical treatment, pose a risk of perforative complications, and also in cases of esophageal perforations. At the same time, a gastrostomy is applied for nutrition.