Endoscopic signs of esophagitis

Esophagitis is a lesion of the mucosa of the esophagus of an inflammatory-degenerative nature with the subsequent involvement of deep layers of the esophagus wall. Primarily occurs rarely, more often secondary and accompanies diseases of the esophagus and other organs.

Acute esophagitis. There is a direct effect on the mucous membrane of thermal, chemical or mechanical factors, inflammatory processes from the oral cavity can spread, etc. Endoscopically the diagnosis does not cause doubts: the mucous membrane is hyperemic, edematous, easily vulnerable, it can bleed when touched, ulceration may occur. Z-line is vague.

Degrees of acute esophagitis (Basset).

1. Edema and arterial hyperemia of the mucous membrane, an abundance of mucus).
2. The appearance of single erosions on the tops of edematous folds of the mucous membrane.
3. Edema and hyperemia are more pronounced, large foci of erosive and bleeding mucous membranes appear.
4. "Crying" mucous, diffuse erosion. Bleeding at the slightest touch. The mucous membrane can be covered with viscous mucus or a yellowish coating of fibrin. With reflux-esophagitis, fibrin acquires a yellowish-greenish shade.

Acute esophagitis can occur for several days. At the fourth degree there can be perforation and bleeding, in the distant period - cicatricial stenosis of the esophagus.

Specific types of acute esophagitis

Fibrinous (pseudomembranous) esophagitis. Occurs during childhood infections. There is a grayish-yellowish plaque, after its rejection - long-lasting non-healing erosion.

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

1. Hyperemia and swelling of the swollen mucosa.
2. Presence of plaques of white or yellow color with the formation of pseudomembranes.
3. Ulcer or bleeding mucosa, covered with viscous exudate.
4. Chronic stage: mucous spotted with scar structures, scarring leads to the formation of short strictures or tubular stenosis.

Chronic esophagitis.

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

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

It occurs as a result of retrograde casting 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 arrangement with a gradual proliferation proximally and the formation of peptic ulcers.

Endoscopic criteria of chronic esophagitis (Kabayashi and Kazugai)

1. Hyperemia of the mucosa diffuse or in the form of bands.
2. The presence of erosions or acute ulcers, less often chronic.
3. Increased bleeding of the mucous membrane.
4. Stiffness of the esophagus.
5. The presence of leukoplaky - calloused whitish-colored densities from 0.1 to 0.3 cm in diameter is an increase in the layers of the epithelium 6-7 times; The epithelium acquires a cubic form, increases in size. The degree of these changes depends on the severity of the esophagitis.

The severity of chronic esophagitis

• I Art. Light degree: hyperemia of the mucosa in the form of longitudinal bands, edema, the presence of viscous mucus. Sometimes the expansion of the arterial and venous vascular pattern.
• II century. Of moderate severity: pronounced diffuse hyperemia of the mucous membrane, thickening of the folds, pronounced edema of the mucous membrane, decreased elasticity, pronounced contact bleeding, there can be single erosions.
• III century. Heavy: the presence of ulcers.

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

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

• I Art. (linear form). More or less pronounced diffuse or patchy 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 to the top.
• II century. (draining form). Defects of the mucous membrane fuse with each other.
• III century. (circular esophagitis). Inflammatory and erosive changes occupy the entire circumference of the esophagus.
• IV century. (stenosing). Reminds the previous form, but there is stenosis of the lumen of the esophagus. Passage of the endoscope through constriction is impossible.

Peptic (flat) ulcer of the esophagus. It was first described by Quincke in 1879 and bears his name. More often solitary, but can be plural and drained. They are located mainly in the lower third of the esophagus, in the zone of cardioesophageal junction, on the posterior or posterolateral wall. The shape is different: oval, slit, irregular, etc. Dimensions are often up to 1 cm. It is often elongated along the axis of the esophagus, but can be annular. The edges of the ulcer are flat or slightly protruding, uneven, dense with instrumental palpation, surrounding the ulcer in the form of a hyperemic corolla. In some cases, the edges may be bumpy - a suspicion of cancer. The bottom is covered with a white or gray coating of fibrin. After washing with a stream of water, bleeding dark red fabrics are easily visible. As you recover, it epithelizes from the edge to the center, the bottom clears, convergence of the folds usually does not. After healing, a linear or dentate scar is formed, a coarse diverticuloid-like deformity of the wall and esophageal stricture can form.

Biopsy helps in determining the process. Since the pieces obtained by biopsy are small, one must take more.

[1], [2], [3], [4], [5], [6], [7]