Erosive esophagitis: how to identify and what is required for its treatment. Erosive esophagitis Esophagitis code according to ICD 10 in adults

Esophagitis refers to inflammation of the mucous membrane of the lower esophagus. It often occurs due to frequent or prolonged reflux of aggressive juice from the stomach.

The erosive form is one of the most dangerous, because with it the mucous membrane begins to become covered with ulcers. If left untreated, they can bleed or lead to more serious consequences.

Erosive reflux esophagitis - what is it?

This is a disease that affects the entire lining of the esophagus or part of it. According to ICD-10, the disease belongs to group K20-K31. These are stomach diseases and duodenum.

The disease may for a long time proceed without symptoms or have the same symptoms as gastritis. If left untreated, this disease can affect not only upper cells esophagus, but also deeper layers. Therefore, treatment is carried out under the strict supervision of a doctor.

The erosive form often occurs not only with the progression of the catarrhal type of the disease, but also in patients who have undergone gastrectomy or gastrectomy.

According to statistics, 2% of adults have reflux esophagitis. It is detected twice as often in men. The erosive form is a consequence of the progression of the catarrhal type of the disease.

Causes

Erosive esophagitis can appear for various reasons:

overweight,
smoking,
excessive physical activity,
errors in diet,
emotional overstrain,
wearing tight clothes,
hernia in the esophageal opening of the diaphragm.

Erosion may appear due to taking medications. Especially when it comes to anti-inflammatory and sedatives.

The erosive form can result from acute or chronic inflammation of the esophagus. Erosion also forms after chemical burns with acids, alkalis and various technical liquids.

The prerequisite for the disease may be severe viral, bacterial or fungal infections, regular use of glucocorticosteroids and non-steroidal drugs.

Classification

There are several main forms of esophagitis:

spicy,
chronic,
surface,
ulcerative,
distal.

Spicy

This form is the most common. Accompanied by superficial or deeper inflammation of the mucous membrane. The disease develops gradually, so with timely treatment it can resolve without complications.

Chronic

Occurs when negative impact on the walls of the esophagus was constant. Develops over a long period of time. Therefore, it sometimes causes irreversible consequences that can affect all layers of the mucosa and other parts of the digestive tract.

Surface

Sometimes it is called catarrhal. This form is characterized by inflammation and swelling of the esophageal mucosa. Under influence negative factors with this form there are only superficial layers. Therefore, the disease does not cause significant tissue destruction.

Ulcerative

This is a condition in which inflammation not only penetrates the lining of the esophagus, but also when it causes the formation of ulcers. This disease requires a serious approach to treatment.

The formation of lesions may begin both with prolonged contact with the irritating factor and with short-term contact.

Distal

The erosive form can be detected if only the lowermost part of the esophagus was affected by ulcers. It connects to the stomach.

Degrees

The erosive form has several forms:

1st degree. It is characterized by the manifestation of a separate type of erosion. They don't touch each other. Sometimes erythema is detected at this stage. It is most often found in the distal esophagus.
2nd degree. An erosive lesion in which the erosions have a merging nature. Despite this fact, the lesion does not affect the entire mucous membrane.
3rd degree. Its peculiarity is that ulcers form in and in the lower part of the esophagus. It turns out that the entire mucous membrane is one large ulcer with a certain amount of healthy tissue.
4th degree. It includes not only the appearance of erosions, but is also accompanied by stenosis. This form usually has a chronic course.

Symptoms

Characteristic of the disease are pains that occur in different areas of the esophagus. They may appear while eating. Patients report frequent heartburn, a burning sensation in the chest, and regurgitation of food or mucus. Belching with blood may occur.

TO general symptoms refers to weakness, anemia, which occurs due to chronic blood loss or for dizziness. If the pathological process is complemented by infection, this can lead to inflammation of neighboring organs.

Signs of the disease include:

Pain different intensity. Mainly appears behind the sternum. May worsen with eating, at night, or with physical activity.
Heartburn. Occurs when exposed to acidic environment from the stomach to the esophagus. The condition can occur when the body is in a horizontal position and during physical activity.
Belching. It indicates insufficient functioning of the cardia. In some cases it is so strong that it resembles vomiting.
Dysphagia. Appears in severe forms of esophagitis. For serious condition characteristic sensations of food retention in the area of the xiphoid process.

Diagnostics

It is necessary to detect diseases in a timely manner. Based on the results of the study, it is possible to determine not only the severity of the pathology and its degree, but also the appropriateness of the treatment.

One of effective methods– fibrogastroduodenoscopy. During the procedure, the mucous membrane is examined using an endoscope. The method allows you to identify the presence of redness, the degree of motor impairment and inflammatory process. If there are ulcers, narrowings or scars, the method will help identify them.

Morphological assessment is given after studying the material under a microscope. Cells are taken in the same way as during a biopsy. It allows you to exclude malignant degeneration and identify signs of pathology.

X-ray with contrast agent. Before using an x-ray, a barium suspension is injected. During the examination, erosions are revealed. The patient is viewed in both horizontal and vertical positions. This also makes it possible to determine the presence of reflux or diaphragmatic hernia.

How to treat erosive reflux esophagitis?

To cope with the disease, a person is advised to reconsider his lifestyle and make some adjustments to it.

You should definitely quit smoking and avoid serious physical activity that involves bending over. This will provoke the reflux of stomach contents into the esophagus.

Drugs

Two tactics are used for treatment. The first includes powerful medications. with time intensive reception medications are reduced. The second principle is that drugs that have minimal effectiveness are prescribed first. As treatment progresses, the pharmacological effect increases.

One of the effective methods is taking secretolytics. These are drugs necessary to reduce gastric secrecy. Reducing acidity reduces the harmful effects on the delicate esophageal mucosa.

These medications include:

proton pump inhibitors,
H-blockers,
M-anticholinergics.

The duration of taking medications depends on the degree of the disease and the number of erosions.

The minimum course is about a month. Among soft medicines There are various antacids that neutralize the effect of hydrochloric acid. To increase the resistance of the esophageal mucosa, doctors may additionally prescribe medications for treatment.

Folk remedies

Patients with the erosive form are prescribed decoctions of herbs that have wound-healing, anti-inflammatory and bactericidal effects. These include nettle, calendula, chamomile, mint and sage.

Among the popular recipes is a collection of flowers pharmaceutical chamomile or flax seeds. Take two large spoons of these components. They add motherwort, licorice root and lemon balm leaves. The prepared mixture is infused for several hours after it is poured with boiling water. Drink ¼ glass three times a day.

Freshly squeezed water can be used to combat heartburn. potato juice, dry raspberry or blackberry leaves. The latter can simply be chewed.

Diet

With the erosive form, pain can occur even with an insignificant, at first glance, imbalance in food. The diet should be gentle.

Products that enhance gas formation processes should be excluded. Cold and hot dishes are excluded. Foods that reduce the tone of the lower sphincter should be excluded from the menu. That is, you should not overuse chocolate, onions, garlic, pepper and coffee.

Before eating, drink a glass of still water. This will help protect your esophageal lining. During the day, you can eat a couple of pieces of raw potatoes. This will reduce the occurrence gastric juice. Potatoes can be replaced with several nuts.

Prognosis and prevention

The erosive form requires more treatment. If there are no complications, then the prognosis is favorable, and life expectancy does not decrease. If the disease is not treated, then there is a high probability of developing precancerous and cancerous conditions.

Prevention erosive reflux esophagitis consists of constant dieting. It is important to sleep on an extra pillow so that your head is always higher than your feet. This will not allow, in case of disruption of the cardia, to provide Negative influence on the functioning of the digestive tract.

The inflammatory process that covers the mucous membrane of the esophagus with the formation of erosions and ulcers on it is called erosive esophagitis. This disease occurs equally often in men and women. By international classification ICD-10 diseases, the pathology is coded K 22.1, and when GERD is added - K 22.0.

The erosive form requires immediate treatment, as it can cause serious complications, including malignant neoplasms. Therefore, if heartburn and burning behind the sternum appear, you need to contact a gastroenterologist to receive special treatment.

We found out what erosive esophagitis has ICD 10 code, we follow further. Esophagitis causes inflammation of the mucous membrane of the esophagus and develops in an acute and chronic type. An acute course occurs when:

fungal infections;
alkalis;
acids;
salts of heavy metals;
hot food or steam;
alcohol.

Also discomfort in the form of heartburn causes overeating, physical work immediately after eating. In addition, esophagitis can be caused by reflux, that is, the reflux of stomach contents back into the esophagus. The hydrochloric acid contained in gastric secretions irritates the epithelium of the esophageal tube. When affected by these factors, the mucous membrane of the esophagus becomes inflamed, red and swollen. So what are the typical symptoms? Erosive esophagitis causes the patient to:

heartburn;
burning in the chest;
sore throat.

This condition is treated by using a gentle diet, and if the disease is caused by an infectious factor, then antibiotic therapy is added.

If treatment is not started in time, erosions will appear on the mucous membrane in addition to hyperemia, hence the name erosive esophagitis. It develops when chronic course diseases.

Necrotizing esophagitis

This is a form of acute disease, which does not occur very often and occurs in people with reduced immunity due to infectious diseases (scarlet fever, sepsis, measles, mycosis). The disease is characterized by severe inflammation of the esophageal mucosa, forming necrotic (dead) areas, which, when rejected, form deep ulcerative lesions. During the healing of ulcers, the epithelium of the esophagus becomes covered with purulent or bloody exudate.

Against the background of symptoms corresponding to the underlying disease, the following are observed:

chest pain;
vomiting mixed with necrotic tissue;
dysphagia (impaired swallowing).

This form of the disease often causes complications in the form of bleeding, acute purulent inflammation of the mediastinum, and substernal abscess.

Treatment of necrotizing esophagitis takes a long time and requires the patient to be patient and strictly follow all the doctor’s instructions. After the ulcers heal, scarring forms in the esophagus, which brings discomfort to the patient.

Chronic erosive esophagitis of the esophagus

The chronic course of the disease occurs due to the following reasons:

Gastroesophageal reflux disease leads to chronic inflammation esophageal epithelium. Due to insufficient closure of the sphincter muscle ring separating the esophagus and stomach, food can flow back into the esophageal tube, irritating the mucous membrane. Hyperemia and swelling of the epithelium of the walls of this internal organ is determined first stage diseases. Symptoms during this period are not pronounced, mainly heartburn. If GERD is not treated, the membrane will not only turn red, but erosions will form on it. This second stage diseases.

This is what doctors diagnose when patients come to them with complaints of heartburn and burning along the esophagus. During an endoscopic examination of the walls of the internal organ, the presence of single or multiple erosions is noted on the epithelium of the walls, which do not merge and form defects on the mucosa in the area of one fold. The walls of the esophagus are covered with fibrous plaque.

Third stage characterized by the degeneration of erosions into ulcers. This is already erosive ulcerative esophagitis. At this stage, not only the surface layer of the epithelium is affected, but also the underlying tissue. The defects extend beyond one fold and can be observed around the esophageal mucosa. With further progression, damage occurs muscle tissue esophageal tube. The condition worsens as persistent cough, vomit mixed with blood pain along the esophagus, occurring regardless of food intake.

This stage is dangerous due to the development of complications:

bleeding;
stenosis;
Barrett's esophagus.

In addition, when an infectious factor is added against the background of erosive esophagitis, purulent inflammation esophagus. Such conditions lead to deterioration general condition patient, and in case of bleeding require emergency hospitalization. Erosive fibrinous esophagitis should not be allowed to develop.

Therapeutic measures

Therapy for the erosive form of the disease is similar in treatment principles to other types of esophagitis and GERD. It consists of:

drug treatment;
dietary nutrition;
preventive measures.

Drug therapy

Drugs that reduce gastric acidity - antacids. In combination with them, medications are prescribed that create a protective film on the surface of the gastric mucosa, as well as on the food bolus, which reduces harmful effects hydrochloric acid on the walls of the esophagus - alginates. The drugs of choice are Rennie, Gaviscon, Phosphalugel.
Prokinetics- medications that help food move faster through the esophagus into the stomach and thereby reduce the irritating effect of food on the lining of the esophageal tube ( Tsirukal, Metaclopramide, Motylium).
If erosions occur as a result of reflux caused by insufficient function of the cardia, then prescribe IPP. These are medications that increase the contractility of the sphincter that separates the esophagus and stomach ( Omez).
For better regeneration of epithelial cells of the esophageal mucosa, it is prescribed Solcoseryl, Alanton.
In the presence of infectious inflammation added to the above drugs vitamins And antibiotics.

If complications arise or drug therapy turned out to be ineffective, then carry out surgery. This can be a traditional technique (incision into chest or abdomen) or by laporoscopy, which is less traumatic.

Diet

Diet plays a big role. Diet for erosive esophagitis is aimed at reducing irritating effect food products to the esophageal mucosa. The following dishes are excluded from the diet:

And also products:

fresh vegetables;
sour fruits;
legumes;
black bread;
mushrooms.

Alcohol and smoking are strictly prohibited.

Patients should eat small meals at least 5-6 times a day so as not to overload the stomach and cause reflux. After eating, you should not lie down to rest, but you should walk around a little, but not do physical work, especially one that requires bending your torso forward. After last appointment There should be at least 3 hours between eating and going to bed.

Patients can use steamed dishes, baked or boiled. Also, do not take very hot or cold food. During meals, you need to chew food well and do not eat rough food, so as not to injure the esophageal mucosa.

When GERD with erosive esophagitis is diagnosed, the diet must be followed.

Useful video

A bit more useful information You can learn how to properly treat yourself and eat in this video.

Prevention

After treatment, patients need to monitor not only their diet, but also change their lifestyle. Such people should not engage in strenuous sports. abdominals. You also need to reduce physical and emotional stress. If the work is related to the position - bending the body forward, then this type of activity needs to be changed. You should not wear tight clothing, tight belts or corsets.

Gives good results hiking before bed, as well as drinking tea ( mint, lemon balm, calendula,chamomile), which has a sedative and anti-inflammatory effect.

It must be remembered that when the first signs of the disease appear, you need to consult a doctor, since self-medication or use traditional methods will not be able to completely cure the disease, and in some cases leads to exacerbations. Once a year, such patients need to visit a gastroenterologist with mandatory endoscopic examination. If the patient's condition worsens, consultation is needed immediately.

Erosive esophagitis is a pathological condition in which the mucosa of the distal and other parts of the esophageal tube is affected. Characterized by the fact that under the influence of various aggressive factors(mechanical impact, eating too hot food, chemicals that cause burns, etc.) the mucous membrane of the organ gradually becomes thinner, and erosions form on it.

Most often, the formation of pathological areas is observed in the distal esophagus. This is due to the fact that gastric contents in some pathologies can be thrown into the cavity of the organ, thereby affecting its mucosa. This is usually observed with. This condition requires timely diagnosis and treatment, as it is dangerous due to the development of complications. It is not difficult for an experienced gastroenterologist to identify the progression of GERD. The most informative way to make a diagnosis is to conduct an endoscopic examination of the esophagus. At this study in the distal esophagus, the doctor will be able to detect erosions indicating progression of GERD. He will also have the opportunity to assess the extent and depth of tissue damage.

Erosive esophagitis in the International Classification of Diseases (ICD-10) has its own code – K22.1. If esophagitis develops simultaneously with GERD, then the code will be different – K21.0. It is worth noting that the symptoms erosive lesion esophageal problems can occur in people of different age categories. Most often, the disease is diagnosed in middle-aged and older people. age group. It is important, when the first symptoms indicating this disease appear, to immediately contact a qualified gastroenterologist, and not self-medicate (for example, using folk remedies). Only after a comprehensive diagnosis will the doctor be able to confirm the diagnosis and identify concomitant pathologies (for example, GERD).

Treatment of erosive esophagitis should only be comprehensive. Drug therapy, physiotherapeutic treatment, as well as a special diet (gentle) are prescribed. Diet plays an important role in the treatment of pathology. The diet will need to be followed not only during treatment, but also after it, in order to avoid relapses (especially if a chronic type of esophagitis has been diagnosed).

Etiology

The priority reason due to which erosive-ulcerative esophagitis progresses is GERD. When this condition develops, contents are periodically dumped gastric cavity into the distal esophagus. Due to such aggressive effects, the mucous membrane is destroyed and erosions form on it. To completely eliminate erosive esophagitis, you will need to first treat GERD. Therapy for GERD is also prescribed by a gastroenterologist after preliminary diagnosis.

Other reasons due to which such damage to the esophagus may occur include:

passion for spicy food;
performing surgical interventions on the esophageal opening of the diaphragm;
regular consumption of alcoholic beverages;
, and ;
progression of infectious pathologies in the human body;
the distal esophagus may be injured during insertion of a probe or during radiation therapy;
thermal or chemical burn mucous membrane of the esophagus.

Varieties

Erosive esophagitis is classified according to several criteria - the degree of damage, the nature of inflammation, the localization of erosions, the nature of the course, the severity of the damage.

According to the nature of its course, erosive esophagitis can be:

sharp;
subacute;
chronic.

Depending on the location of erosion:

proximal;
total (in this case, the ulcers are located over the entire surface of the esophagus).

Classification by degree of damage:

Only the upper part of the mucosa is affected. There are no visible defects;
the thickness of the mucous membrane is affected. Defects are formed, covered with fibrinous plaque, as well as necrotic areas;
the lesion also covers the submucosal layers. This stage is the most dangerous, as perforation of the organ wall may occur.

According to the intensity of organ damage:

erosions can merge with each other;
the mucous membrane is hyperemic, no erosions are observed;
several erosions on the mucous membrane;
ulcerative lesion and.

Degrees

This disease develops gradually. In the first stages of its development, symptoms may not appear at all, or the person will only be bothered by periodic symptoms. As it progresses pathological process the clinical picture becomes more and more pronounced. Erosive-ulcerative esophagitis has four degrees of development:

1st degree– single erosions form on the mucous membrane. Hyperemia is noted in the distal esophagus. The symptoms are not pronounced;
2nd degree– at this stage, there is a fusion of individual erosions, but not the entire surface of the organ is affected. The affected areas are covered with fibrinous plaque;
3rd degree– erosions degenerate into ulcers. Localized in the distal part of the organ;
4th degree– characterized by chronic ulcers and stenosis. Treatment is aimed at reducing the manifestation of symptoms, as well as prolonging the period of relapse. The person will need to adhere to a strict diet at all times.

Symptoms

Symptoms of erosive esophagitis are expressed gradually - at first there may be no signs at all, but later a characteristic clinical picture appears. The patient has:

pain when swallowing food;
a dry cough occurs at night;
hoarseness of voice;
after eating food, nausea occurs - a characteristic symptom;
pain localized behind the sternum;
in the area of the projection of the stomach, the appearance of painful sensations is noted;
severe heartburn;
A characteristic symptom of the pathology is vomiting with blood inclusions.

If this symptom appears, you must immediately visit a qualified gastroenterologist to conduct a comprehensive diagnosis and prescribe an optimal treatment plan, including medication, diet and physiotherapeutic procedures.

Diagnostics

If erosive esophagitis is suspected, the gastroenterologist prescribes a set of measures that will allow him to confirm the diagnosis. The most informative are the following methods:

radiography with the use of a contrast agent;
endoscopic examination;
esophagomanometry;
histological examination of part of the esophageal mucosa;
measuring pH in the esophagus.

Treatment

Treatment of esophagitis can be quite lengthy, since it is necessary for the affected mucosa to fully recover. Doctors usually resort to drug therapy. Prescribe antacids, proton pump blockers, antispasmodics, sedatives and others. If conservative therapy does not bring the desired effect, then in this case they resort to surgical intervention.

It is important to follow a diet during and after treatment. All food products must undergo gentle cooking. The diet involves eating boiled, steamed or stewed food. Irritating foods should be avoided. The diet will need to be followed for a long time. From the diet you need to completely exclude raw vegetables, smoked meats, dried fruits, seeds, cocoa, alcoholic drinks. During the diet, preference is given to enveloping dishes.

Traditional therapy

You can use folk remedies to treat pathology only with the permission of your doctor. In no case should they be the only method of treatment. It is best to combine folk remedies and traditional medicine methods.

Folk remedies that can be used to treat erosive esophagitis:

dandelion flower syrup. This folk remedy is one of the most effective and at the same time easy to prepare at home;
infusion of chamomile, licorice root, lemon balm leaves and motherwort;
infusion of calendula flowers, oregano, white damselfish, peppermint and calamus. This folk remedy has analgesic and anti-inflammatory properties.

Similar materials

Distal esophagitis is a pathological condition that is characterized by the progression of the inflammatory process in the lower part of the esophageal tube (located closer to the stomach). This disease can occur in both acute and chronic forms, and is often not the main, but a concomitant pathological condition. Acute or chronic distal esophagitis can develop in any person - neither age category nor gender do not play a role. Medical statistics are such that pathology most often progresses in people of working age, as well as in the elderly.

Candidal esophagitis is a pathological condition in which there is damage to the walls of this organ by fungi from the genus Candida. Most often, they first affect the oral mucosa (the initial part of the digestive system), after which they penetrate the esophagus, where they begin to actively multiply, thereby provoking the manifestation of characteristic clinical picture. Neither gender nor age category affects the development of the pathological condition. Symptoms of candidal esophagitis can appear in both young children and adults from the middle and older age groups.

Catarrhal esophagitis– a pathological condition in which inflammation of the esophageal mucosa is observed, accompanied by its hyperemia and edema. Most often, this pathology progresses due to aggressive mechanical or thermal effects on the organ, the proliferation of infectious agents, and also due to certain ailments of the digestive system. Catarrhal esophagitis is concomitant disease with cardia insufficiency. The main symptoms that express the pathology are: a burning sensation in the chest, discomfort in this area, pain when eating. It is important to identify in a timely manner this disease to prevent complications from developing.

Esophagitis is a disease characterized by the occurrence of an inflammatory process in the mucous membrane and walls of the esophagus. It develops in the inner wall, but as it progresses it can affect the deeper layers of the organ. Among all diseases of the digestive system, it is the most common. A characteristic feature is that such a disorder can occur for a long time without the manifestation of any symptoms, which is why it is diagnosed completely by accident. It affects people of any age group, regardless of gender. Quite often this diagnosis is made to women during pregnancy and to children. In the international classification of diseases (ICD 10), this disease has its own code – K20.

As with any other disease of the digestive tract, with esophagitis of the esophagus in mandatory you need to follow a gentle diet. This is necessary for several reasons at once - to reduce the load on the digestive system, reduce the negative impact of incoming food on the walls of the esophagus and stomach, and reduce acidity (especially important for gastritis). The diet for esophagitis is prescribed by the attending gastroenterologist together with a nutritionist. It should be observed not only during the period of exacerbation, but also during the period of subsidence of symptoms (remission).

The inflammatory process that covers the mucous membrane of the esophagus with the formation of erosions and ulcers on it is called erosive esophagitis. This disease occurs equally often in men and women. According to the international classification of diseases ICD-10, the pathology is coded K 22.1, and when GERD is added - K 22.0.

Erosive esophagitis: what is it?

We found out what erosive esophagitis has ICD 10 code, we follow further. Esophagitis causes inflammation of the mucous membrane of the esophagus and develops in acute and chronic types. An acute course occurs when:

fungal infections;
alkalis;
acids;
salts of heavy metals;
hot food or steam;
alcohol.

Also, unpleasant sensations in the form of heartburn are caused by overeating and physical work immediately after eating. In addition, esophagitis can be caused by reflux, that is, the reflux of stomach contents back into the esophagus. The hydrochloric acid contained in gastric secretions irritates the epithelium of the esophageal tube. When affected by these factors, the mucous membrane of the esophagus becomes inflamed, red and swollen. So what are the typical symptoms? Erosive esophagitis causes the patient to:

heartburn;
burning in the chest;
sore throat.

This condition is treated by using a gentle diet, and if the disease is caused by an infectious factor, then antibiotic therapy is added.

If treatment is not started in time, erosions will appear on the mucous membrane in addition to hyperemia, hence the name erosive esophagitis. It develops during the chronic course of the disease.

Necrotizing esophagitis

Against the background of symptoms corresponding to the underlying disease, the following are observed:

chest pain;
vomiting mixed with necrotic tissue;
dysphagia (impaired swallowing).

This form of the disease often causes complications in the form of bleeding, acute purulent inflammation of the mediastinum, and substernal abscess.

Chronic erosive esophagitis of the esophagus

The chronic course of the disease occurs due to the following reasons:

Gastroesophageal reflux disease leads to chronic inflammation of the esophageal epithelium. Due to insufficient closure of the sphincter muscle ring separating the esophagus and stomach, food can flow back into the esophageal tube, irritating the mucous membrane. Hyperemia and swelling of the epithelium of the walls of this internal organ is determined first stage diseases. Symptoms during this period are not pronounced, mainly heartburn. If GERD is not treated, the membrane will not only turn red, but erosions will form on it. This second stage diseases.

Third stage characterized by the degeneration of erosions into ulcers. This is already erosive ulcerative esophagitis. At this stage, not only the surface layer of the epithelium is affected, but also the underlying tissue. The defects extend beyond one fold and can be observed around the esophageal mucosa. With further progression, the muscle tissue of the esophageal tube is damaged. The condition worsens as persistent cough, vomit mixed with blood pain along the esophagus, occurring regardless of food intake.

This stage is dangerous due to the development of complications:

bleeding;
stenosis;
Barrett's esophagus.

In addition, when an infectious factor is added to the background of erosive esophagitis, purulent inflammation of the esophagus can develop. Such conditions lead to a deterioration in the general condition of the patient, and in case of bleeding require emergency hospitalization. Erosive fibrinous esophagitis should not be allowed to develop.

Therapeutic measures

Therapy for the erosive form of the disease is similar in treatment principles to other types of esophagitis and GERD. It consists of:

drug treatment;
dietary nutrition;
preventive measures.

Drug therapy

Drugs that reduce gastric acidity - antacids. In combination with them, medications are prescribed that create a protective film on the surface of the gastric mucosa, as well as on the food bolus, which reduces the harmful effects of hydrochloric acid on the walls of the esophagus - alginates. The drugs of choice are Rennie, Gaviscon, Phosphalugel.
Prokinetics- medications that help food move faster through the esophagus into the stomach and thereby reduce the irritating effect of food on the lining of the esophageal tube ( Tsirukal, Metaclopramide, Motylium).
If erosions occur as a result of reflux caused by insufficient function of the cardia, then prescribe IPP. These are medications that increase the contractility of the sphincter that separates the esophagus and stomach ( Omez).
For better regeneration of epithelial cells of the esophageal mucosa, it is prescribed Solcoseryl, Alanton.
In the presence of infectious inflammation, add to the above drugs vitamins And antibiotics.

If complications arise or drug therapy is ineffective, then surgery is performed. This may be a traditional technique (an incision in the chest or abdomen) or laparoscopy, which is less traumatic.

Diet

Diet plays a big role. The diet for erosive esophagitis is aimed at reducing the irritating effect of foods on the esophageal mucosa. The following dishes are excluded from the diet:

And also products:

fresh vegetables;
sour fruits;
legumes;
black bread;
mushrooms.

Alcohol and smoking are strictly prohibited.

Patients should eat small meals at least 5-6 times a day so as not to overload the stomach and cause reflux. After eating, you should not lie down to rest, but you should walk around a little, but not do physical work, especially one that requires bending your torso forward. There should be at least 3 hours between your last meal and bedtime.

Patients can use steamed dishes, baked or boiled. Also, you should not eat very hot or cold food. During meals, you need to chew food well and do not eat rough food, so as not to injure the esophageal mucosa.

When GERD with erosive esophagitis is diagnosed, the diet must be followed.

Useful video

You can find out some more useful information about how to properly treat yourself and eat in this video.

Prevention

After treatment, patients need to monitor not only their diet, but also change their lifestyle. Such people should not engage in sports associated with abdominal tension. You also need to reduce physical and emotional stress. If the work is related to the position - bending the body forward, then this type of activity needs to be changed. You should not wear tight clothing, tight belts or corsets.

Walking before bed, as well as drinking tea ( mint, lemon balm, calendula,chamomile), which has a sedative and anti-inflammatory effect.

It must be remembered that when the first signs of the disease appear, you should consult a doctor, since self-medication or the use of traditional methods will not completely cure the disease, and in some cases leads to exacerbations. Once a year, such patients need to visit a gastroenterologist with a mandatory endoscopic examination. If the patient's condition worsens, consultation is needed immediately.

Source: GastrituNet.online

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2010 (Order No. 239)

Gastroesophageal reflux with esophagitis (K21.0)

general information

Short description

GERD (gastroesophageal reflux disease)- complex characteristic symptoms With inflammatory lesion the distal part of the esophagus due to repeated reflux of gastric and, in rare cases, duodenal contents.

Protocol"Gastroesophageal reflux. Other diseases of the esophagus"

ICD-10 codes: K21; K22

K 21.0 Gastroesophageal reflux with esophagitis

K 21.9 Gastroesophageal reflux without esophagitis

K 22.0 Cardiac achalasia

K 22.1 Esophageal ulcer

Classification

Classification of GERD(according to Tytgat as modified by V.F. Privorotsky et al. 1999)

According to endoscopic signs:

1st degree: moderate focal erythema and (or) friability of the mucous membrane of the abdominal esophagus. Moderately expressed motor disorders in the area of the lower esophageal sphincter, briefly provoked subtotal (along one of the walls) prolapse to a height of 1-2 cm, decreased sphincter tone.

2nd degree: signs characteristic of grade 1, combined with total hyperemia of the abdominal esophagus with focal fibrinous plaque. The appearance of focal superficial erosions, often linear in shape, located at the tops of the folds of the esophageal mucosa is possible. Motor disturbances: clear endoscopic signs of gastric valve insufficiency, total or subtotal provoked prolapse to a height of 3 cm with possible partial fixation in the esophagus.

3rd degree: signs characteristic of stage 2, combined with the spread of inflammation to the thoracic esophagus. Multiple, sometimes merging erosions, not located circularly. Increased contact vulnerability of the mucous membrane is possible. Motor disturbances: clear endoscopic signs of gastric valve insufficiency, total or subtotal provoked prolapse to a height of 3 cm with possible partial fixation in the esophagus, there may be pronounced spontaneous or provoked prolapse above the legs of the diaphragm with possible partial fixation.

4th degree: esophageal ulcer. Barrett's syndrome. Esophageal stenosis.

Classification of esophagitis:

1. By origin: primary, secondary.

2. According to the course: acute (subacute), chronic.

3. By clinical form: painful, dyspeptic, dysphagic, asymptomatic.

4. According to the period of the disease: exacerbation, subsidence of exacerbation, remission.

5. According to the presence of complications: uncomplicated, complicated (bleeding, perforation, etc.).

6. According to the nature of changes in the mucous membrane of the esophagus: catarrhal, erosive-ulcerative, hemorrhagic, necrotic.

7. According to the localization of the pathological process: diffuse, localized, reflux esophagitis.

8. By severity: light, moderate, heavy.

Diagnostics

Diagnostic criteria

Complaints and anamnesis
History of pathology of the upper digestive tract: chronic gastritis, gastroduodenitis, peptic ulcer of the stomach and duodenum, etc.
Complaints of pain in the epigastric region, an unpleasant feeling of “soreness, burning” behind the sternum immediately after swallowing food or while eating. With severe pain, children may refuse to eat. Chest pain can occur when walking quickly, running, bending deeply, or lifting heavy objects. Often after eating, there is pain behind the sternum and in the epigastric region, which intensifies when lying down or sitting.

The pathognomonic symptom is heartburn - retrosternal belching and/or cervical (pharyngeal) belching, which usually occurs on an empty stomach, after eating, and during intense physical activity.
Other dyspeptic phenomena: nausea, loud belching, vomiting, hiccups, dysphagia, etc.
“Extraesophageal” manifestations of gastroesophageal reflux disease include reflux laryngitis, pharyngitis, otitis media, and night cough. Symptoms are reported in 40-80% of children with gastroesophageal reflux disease bronchial asthma, developing as a result of microaspiration of gastric contents into the bronchial tree.

Physical examination: painful palpation in the epigastrium.

Laboratory examination: UBC, OAM, stool examination occult blood(may be positive), diagnosis of H. pylori (cytological examination, ELISA, urease test).

Instrumental research: esophagogastroduodenoscopy in the esophagus - focal erythema and (or) friability of the mucous membrane of the abdominal esophagus, the presence of erosions, motor disorders - insufficiency of the cardiac sphincter, reflux of gastric contents into the esophagus.
Biopsy of the mucous membrane of the esophagus - according to indications, x-ray of the esophagus - according to indications.

Indications for consultations:

Neuropathologist;

Dentist;

Physiotherapist.

The required amount of research before planned hospitalization:

1. General analysis blood (6 parameters).

2. General urine analysis.

4. ALT, AST, bilirubin.

5. Scraping for enterobiasis.

List of main diagnostic measures:

1. UAC (6 parameters).

3. Examination of feces for occult blood.

4. Scraping the worm egg.

5. Examination of stool for worm eggs.

6. Esophagogastroduodenoscopy.

7. Cytological diagnostics to determine the degree of damage and inflammatory changes in the gastric mucosa of the esophagus, reflux, diagnosis of H. pylori.

8. Endoscopic biopsy.

9. Histological studies.

10. ELISA for H. pylori.

11. Neurologist.

13. Dentist.

14. Physiotherapist.

List of additional diagnostic measures:

1. Determination of cholesterol.

2. Determination of bilirubin.

3. Thymol test.

4. Determination of ALT.

5. Determination of AST.

6. Determination of alpha-amylase.

7. Determination of total protein.

8. Determination of glucose level.

9. Determination of protein fractions.
10. Determination of alkaline phosphatase.

11. Determination of B-lipoproteins.

12. Determination of iron.

13. Determination of diastase.

14. Swab for candida from the throat, pharynx, and tongue.

15. Study on HBs Ag.

16. Ultrasound of the liver, gall bladder, pancreas.

17. X-ray of the esophagus.

Differential diagnosis

Diseases	Clinical criteria	Laboratory indicators
Chronic gastroduodenitis	Localization of pain in the epigastrium, pain in the navel and pyloroduodenal area; severe dyspeptic symptoms (nausea, belching, heartburn, less often - vomiting); combination of early and late pain	Endoscopic changes in the mucous membrane of the stomach and DC (swelling, hyperemia, hemorrhage, erosion, atrophy, hypertrophy of folds, etc.) Presence of H. pylori - cytological examination, ELISA, etc.
Peptic ulcer	The pain is “mostly” late, 2-3 hours after eating. They occur acutely, suddenly, pain on palpation is pronounced, tension in the abdominal muscles, areas of skin hyperesthesia are detected, positive symptom Mendel	At endoscopy - a deep defect of the mucous membrane surrounded by a hyperemic shaft; there may be multiple ulcers
Catarrhal esophagitis	Pain behind the sternum or high in the epigastrium at the xiphoid process of the sternum, squeezing or burning during or after eating, with fast walking, running, deep breathing. Heartburn, worsening when bending over, lying down, or lifting heavy objects	During endoscopy - hyperemia of the mucous membrane of the esophagus, thickening of the folds

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Treatment

Treatment tactics

Purpose of the stage:

1. Relief of exacerbation.

2. Prevention of complications.

3. Selection of adequate therapy.

Treatment tactics:

1. Diet therapy.

2. Elimination causative factor(prokinetics are prescribed to eliminate reflux, and antibacterial drugs are prescribed to eradicate H. pylori).

3. Pathogenetic therapy.

4. Correction of gastric secretory function: for high acidity, antacids, H2 blockers or proton pump blockers, for low acidity - non-absorbable antacids, astringents, enveloping agents, gastric secretion stimulants, replacement therapy).

5. Stimulation of regenerative processes.

6. Elimination of motility disorders of the esophagus, stomach, duodenum.

7. Correction of hypovitaminosis (B vitamins, folic acid, etc.).

8. Elimination of severe pain syndrome(prescription of anticholinergics, myolytics, antispasmodics).

Non-drug treatment: meals 5-6 times a day, in small portions. Elimination of foods that reduce the muscle tone of the cardiac valve: animal fats, coffee, chocolate, citrus fruits, tomatoes, minimize the amount of spicy dishes with spices, vinegar, sauces.

Drug treatment

In accordance with the Maastricht consensus (2000) on methods of treating HP infection, priority is given to regimens based on proton pump inhibitors (PPIs), as the most powerful of the antisecretory drugs. They are known to be able to maintain a pH greater than 3 in the stomach for at least 18 hours a day, which promotes healing duodenal ulcer in 100% of cases.
PPIs, by lowering the acidity of gastric juice, increase the activity of antibacterial drugs and worsen the environment for the life of H. pylori. In addition, PPIs themselves have antibacterial activity.
In terms of anti-Helicobacter activity, rabeprazole is superior to other PPIs and, unlike other PPIs, is metabolized non-enzymatically and excreted primarily through the kidneys. This metabolic pathway is less dangerous in relation to possible adverse reactions when combining PPIs with other drugs that are competitively metabolized by the cytochrome P450 system.

First line therapy- three-component therapy.

Proton pump inhibitor (rabeprazole 20 mg, or omeprazole or lansoprazole 30 mg, or esomeprazole 20 mg) + clarithromycin 7.5 mg/kg (max-500 mg) + amoxicillin 20-30 mg/kg (max 1000 mg) or metronidazole 40 mg/kg (max500 mg); All medications are taken 2 times a day for 7 days. The combination of clarithromycin with amoxicillin is preferable to clarithromycin with metronidazole, as it may help achieve a better outcome when prescribing second-line therapy.

In case of ineffectiveness of first-line drugs, unsuccessful eradication, it is prescribed repeated course of combination therapy (quad therapy) with the additional inclusion of colloidal bismuth subcitrate (de-nol and other analogues) 4 mg/kg (max 120 mg) 3 times a day, for 30 minutes. before meals and the 4th time 2 hours after meals, before bed. Inclusion this drug potentiates the anti-Helicobacter action of other antibiotics.

Rules for the use of anti-Helicobacter therapy:

1. If the use of a treatment regimen does not lead to eradication, it should not be repeated.

2. If the regimen used did not lead to eradication, this means that the bacterium has acquired resistance to one of the components of the treatment regimen (nitroimidazole derivatives, macrolides).

3. If the use of one and then another treatment regimen does not lead to eradication, then the sensitivity of the H. pylori strain to the entire range of antibiotics used should be determined.

4. If bacteria appear in the patient’s body a year after the end of treatment, the situation should be regarded as a relapse of the infection, and not as a reinfection.

5. If the infection recurs, it is necessary to use more effective scheme treatment.

After the end of combined eradication therapy, it is necessary to continue treatment for another 1-2 weeks for duodenal ulcers and for 2-3 weeks for gastric ulcers using one of the antisecretory drugs. Preference is given to PPI, because after discontinuation of the latter (unlike histamine H2 receptor blockers), the so-called secretory “rebound” syndrome is not observed.

In the case of GERD not associated with H. pylori, the goal of treatment is to relieve clinical symptoms diseases. The prescription of antisecretory drugs is indicated - proton pump inhibitors (rabeprazole or omeprazole 20 mg 1-2 times a day, lansoprazole 30 mg 2 times a day, esomeprazole 20 mg 2 times a day).

For normalization motor function stomach, duodenum, biliary tract, the use of prokinetics is indicated - domperidone 0.25-1.0 mg/kg 3-4 times a day for 20-30 minutes. before meals, for a duration of treatment of at least 2 weeks.

To reduce the tone and contractile activity of smooth muscles internal organs To reduce the secretion of exocrine glands, hyoscine butyl bromide (buscopan) is prescribed 10 mg 2-3 times a day. If necessary - antacids (Maalox, Almagel, Phosphalugel), cytoprotectors (sucralfate, de-Nol, Ventrisol, Bismofalk), synthetic prostaglandins E1 (misoprostol), mucous membrane protectors (Solcoseryl, Actovegin) vegetotropic drugs (Pavlov's mixture, valerian root infusion) . The duration of treatment is at least 4 weeks.

The effectiveness of treatment is monitored endoscopic method in 8 weeks

Further treatment

Anti-relapse treatment is carried out 2 times a year, its volume and duration are determined by the condition of the mucous membrane of the distal esophagus. The presence of erosive and ulcerative defects is an indication to increase the number of anti-relapse courses of treatment up to 4 times a year. To regenerate the mucous membrane of the esophagus, it is advisable to prescribe water-soluble beta-carotene - Vetoron - to all patients with esophagitis at a dose of 40 mg per day (2 ml, 2 times a day).

List of essential medications:

1. Rabeprazole 20 mg, 40 mg, tab.

2. Omeprazole 20 mg, table.

3. Pantoprazole 20 mg, tab.

4. Clarithromycin, 250 mg, 500 mg, tab.

5. Metronidazole, TB 250 mg

6. Amoxicillin, 500 mg, 1000 mg tablet, 250 mg, 500 mg capsule; 250 mg/5 ml oral suspension

7. Domperidone, 10 mg, tab.

8. Famotidine, 40 mg, tablet, 20 mg/ml injection solution

9. Actovegin, 5.0 ml amp.

10. Bismuth tripotassium dicitrate, 120 mg, tab.

11. Magnesium and aluminum hydroxide (almagel, phospholugel)

12. Metronidazole 250 mg tablet; 0.5% in a bottle, 100 ml solution for infusion

List of additional medications:

1. Hyoscine butyl bromide 10 mg tablets, 1 ml amp.; 10 mg suppositories

2. Pavlova mixture, 200 ml

3. Pancreatin 4500 units, caps.

4. Polyphepam, 100 ml

5. Solcoseryl 2.0 amp.

Indicators of treatment effectiveness:

1. Relief of pain syndrome.

2. Relief of dyspepsia.

3. Relief of inflammatory changes in the mucous membrane of the esophagus.

Hospitalization

Indications for hospitalization (planned):

1. Presence of clinical symptoms, exacerbation of the disease.

2. Lack of effect from outpatient therapy.

3. Complications of the underlying disease, erosion, ulcers.

4. Frequent relapses of the disease.

Prevention

Preventive actions:

Prevention of bleeding;

Prevention of malignancy;

Prevention of the occurrence of erosive-ulcerative esophagitis;

Prevention of Barrett's esophagus.

Information

Sources and literature

Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
1. Prodigy guidance - Dyspepsia - proven DU, GU, or NSAID-associated ulcer. NICE 2004Management of Helicobacter pylori Infection. MOH Clinical Practice Guidelines 9/2004 New Zealand guidelines group/ Management of dyspepsia and heartburn, June 2004.) Management of Helicobacter pylory infection. Ministry of health clinical practice guidelines 9/2004/ Guidelines for clinical care. University of Michigan health system. May 2005. Practice guidelines. Guidelines for the Management of Helicobacter pylori Infection/ THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 93, No. 12, 1998. Clinical guidelines based on evidence-based medicine: Per. from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova. - 2nd ed., rev. - M.: GEOTAR-MED, 2002. - 1248 p.: ill. M.Yu.Denisov. Practical gastroenterology for pediatricians.-M, 1999. Children's gastroenterology / ed. A.A. Baranova - M. 2002, 592 p. Kawacami Y., Akahane T., Yamaguchi M. et al. In vitro activities of rabeprazole, a novel proton pump inhibitor, and its thiother derivative alone and in combination with other antimicrobials againts recent clinical isolates of H. pylori. Antimicrob Agents Chemother, 2000. vol.44, N2.-P.458-461. H. Holtmann, P. Bytzer, M. Metz, V. Loeffler. A randomized, double-blind, comparative study of standard-dose rabeprazole and high-dose omeprazole in gastro-oesophageal reflux disease/ Aliment Pharmacol Ther 2002; 16: 479-485 Diseases of older children, a guide for doctors, R.R. Shilyaev et al., M, 2002 Practical gastroenterology for pediatricians, V.N. Preobrazhensky, Almaty, 1999 Practical gastroenterology for pediatricians, M.Yu. Denisov, M. 2004

Information

List of developers:

Head of the Department of Gastroenterology of the Aksai Children's Clinical Hospital, F.T. Kipshakbaeva.

Assistant at the Department of Childhood Diseases of KazNMU named after. S.D. Asfendiyarova, Ph.D., S.V. Choi.

Doctor of the Department of Gastroenterology of the Aksai Children's Clinical Hospital, V.N. Sologub.

Attached files

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