Peptic Ulcer of the Esophagus: Causes, Symptoms, Diagnosis, Treatment
Last reviewed: 23.04.2024
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Peptic ulcer of the esophagus has much in common with the ulcer of the stomach and duodenum and is found, according to different authors, in 3.5-8.3% of cases of this disease; most often observed in men after 40 years, but can occur at any age.
Trophic diseases of the esophagus arise as a result of the action of local or general pathogenic factors and are manifested by various pathomorphological changes in its mucosa and deeper layers. Often they are combined with vascular diseases of the esophagus and its neuromuscular dysfunction. Most often trophic lesions of the esophagus occur again and are caused by trophic diseases of the stomach.
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What causes peptic ulcer of the esophagus?
The mechanism of peptic ulcer of the esophagus is not clear. Most authors are inclined to the "theory", according to which the peptic ulcer of the esophagus arises from the reflux of hyperacid gastric juice, which causes peptic destruction of the mucosa of the esophagus, which is not adapted to contact with hydrochloric acid and enzymes contained in gastric juice. According to another "theory", the peptic ulcer of the esophagus occurs in those persons in the esophagus of which there are ectopic islets of the gastric mucosa, which constantly secrets the secret unacceptable for the normal state of the mucosa of the esophagus. A number of authors believe that the peptic ulcer of the esophagus arises as a complication of acute esophagitis. In any case, when considering the pathogenesis of peptic ulcer of the esophagus and the development of a treatment strategy for this disease, the condition of the central nervous system and the VNS should be taken into account, the disturbances of which can cause disturbances in the secretory activity of the stomach and, in general, the organs of the whole gastrointestinal tract. In this case, the studies of IP Pavlov and KMBykov in the field of cortical-visceral reflexes, whose distortion leads to functional and trophic gastrointestinal diseases, are probably of fundamental importance. So, KM Bykov (1949) put forward the concept of secretory fields of the stomach, according to which the small curvature of this organ is a kind of trigger device for the secretory activity of the glands of the stomach. The basis for this theory was a thorough study of the secretory activity of a small curvature of the stomach.
In recent years, not without reason is considered the allergic genesis of diseases of the digestive tract, and in particular the esophagus and stomach. At the same time, allergic manifestations from these organs can be observed not only with enerogic allergization (for example, nutritional allergy), but also in other ways of sensitizing the body.
A vascular "theory" is also considered, according to which the deficit of blood supply to certain areas of the esophageal mucosa (atherosclerosis, microthrombosis, spasm resulting from psychoemotional stress) can lead to trophic disorders of the mucosa of the esophagus.
Pathological anatomy of the peptic ulcer of the esophagus
Peptic ulcer of the esophagus is localized mainly in the lower third of the esophagus. Macroscopically very similar to a stomach ulcer: with esophagoscopy, a funnel-shaped depression in the esophagus wall with indistinct edges is revealed; around the ulcer is formed sclerotically (callus) shaft. In general, the peptic ulcer of the esophagus is of a single and different depth, but often there are multiple ulcers that are in different stages of development. If they are located along the circumference of the lumen of the esophagus, then there may be a violation of its esophagus function.
Symptoms of peptic ulcer of the esophagus
Symptoms of peptic ulcer of the esophagus are defined by the concept of "esophageal syndrome", which includes such symptoms as pain, dysphagia and regurgitation. These symptoms are especially pronounced when passing through the esophagus of dense food and to a lesser extent - liquid. In the clinical course, there are periods of exacerbations and "light" gaps. With exacerbations in the initial stages of the disease, small esophageal bleeding may occur, not requiring special stopping measures.
Peptic ulcer of the esophagus is characterized by progressive clinical course with aggravation of signs of esophageal syndrome, weakening and emaciation of the patient to the cachexial state. Against this background, which is usually accompanied by a serious stomach disease (peptic ulcer disease, malignization of the process), severe esophageal complications can arise: profuse bleeding from the blood vessels of the esophagus, perforation, malignancy.
As a rule, the blood is scarlet in the case of esophageal bleeding, but if it enters the stomach and then is released as vomit, it acquires a dark brown color due to the color of the hemaglobin formed with the hydrochloric acid of the hydrochloric acid hematin. When blood gets from the stomach into the intestine, melena appears. Constant esophageal microhemorrhagia in combination with a stomach disease cause the occurrence of severe anemia. Perforation of the esophagus into the pleura occurs in 14% of cases; there may also be perforations in the pericardium, mediastinum and other neighboring anatomical structures that cause severe secondary complications.
Strictures of the esophagus with its peptic ulcers - a phenomenon almost inevitable, manifested by the same pathomorphological and clinical signs as with a chemical burn of the esophagus.
Diagnosis of peptic ulcer of the esophagus
Diagnosis is established on the basis of an x-ray and an esophagoscopic examination of the patient. When radiographing using X-ray contrast material on the walls of the esophagus, the segment (s) of delay of the contrast agent with clear boundaries corresponding to the size and depth of the ulcer is visualized. When esophagoscopy is determined by the localization, number, shape and macrostructure of the ulcer; with the proliferation of its edges and bottom, the detection of other signs that are suspicious of the malignancy of the process, a biopsy is shown. In all cases of peptic ulcer of the esophagus, without exception, esophagitis of various prevalence accompanies , which provides for appropriate non-operative treatment.
What do need to examine?
Treatment of peptic ulcer of the esophagus
Treatment of peptic ulcer of the esophagus includes medicamentous, endoscopic and surgical methods.
Non-operative treatment of peptic ulcer of the esophagus is identical to that used for gastric ulcer and is performed in accordance with the revealed gastroscopic and histological data. As the drugs of choice, H2-antihistamines (Ranitidine, Ranigast, Famotidine, cimetidine), antacids and adsorbents (Almazilate, 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 the formation of hydrochloric acid - Lansoprazole, Omenrazole, Acrylate, Lanzap, Lansofed), local anesthetics ((Benzocaine), egeneratory and reparatory (Tykveol) myotropic spasmolytics (Otiloniya bromide).
Endoscopic treatment of peptic ulcer of the esophagus with cauterizing, stiffening and binding agents is ineffective.
Peptic ulcer of the esophagus is treated by surgical methods only with deep ulcers that do not lend themselves to non-operative treatment, which are dangerous for perforated complications, and also with esophageal perforations. Simultaneously impose gastrostomy for nutrition.