Pathologies of the digestive system are common among the population. Reflux-related diseases are common. What are their features?
Reflux esophagitis
The disease is a chronic inflammation of the esophagus, which occurs due to the constant ingestion of acidic stomach contents into it. Pathology is associated with insufficiency of the lower esophageal sphincter, which normally protects the esophagus from the penetration of gastric juice into it.
Acute biliary reflux gastritis
This form is characterized by the development of acute inflammation in the mucous membrane as a result of exposure to bile in the composition of the food bolus. There are several variants of acute gastritis:
- Catarrhal gastritis, the main manifestation of which is a slight hyperemia and swelling of the stomach wall. It thickens and becomes covered with a layer of thick mucus. has petechial hemorrhages and small erosions.
- Fibrinous gastritis, in which zones of necrosis of the epithelium are formed in the wall, infiltrated with fibrinous-purulent exudate. The manifestation of this phenomenon is a thin fibrin film on the surface of the affected areas of the mucous membrane. Superficial gastritis is characterized by the friability of this film, and with deep inflammation, it fuses with the epithelium.
- Necrotizing gastritis, in which, in addition to the epithelium, other layers of the mucous membrane are affected. Necrosis is understood as the death of cells under the influence of aggressive factors.
- Purulent gastritis is the most severe form of inflammation. All layers of the stomach can be involved in the process, which poses a threat of perforation. The manifestation of this variant is the presence of purulent exudate, as well as intensive infiltration of the mucous membrane with leukocytes.
Chronic biliary reflux gastritis
This type is characterized by a combination of inflammatory and dystrophic phenomena. Regular ingestion of bile and pancreatic enzymes into the stomach leads to the development of chronic inflammation. Also, this form may be the outcome of acute gastritis. As a result of alkalization in the mucous membrane, the amount of histamine increases, which makes it edematous and hyperemic.
Pathogenesis
Between the stomach, its antrum, and the duodenum there is a sphincter, which is called the "pylorus". The work of this muscle is aimed at moving the chyme (food bolus) from the stomach to the intestines for further digestion and subsequent absorption of nutrients. Violation of the sphincter can lead to the development of biliary reflux gastritis, the treatment of which requires a combination of medications and proper nutrition. Untimely opening of the sphincter leads to this disease, as a result of which the lump of food, to which the bile produced by the liver is attached, returns back to the stomach. has a detrimental effect on the condition of its mucous membrane. It contains salts, acids and enzymes, which are classified as aggression factors.
Etiology
The causes of the development of biliary reflux gastritis are associated with a violation of the normal functioning of the pyloric sphincter. This can lead to any surgical intervention that affects the motility of the gastrointestinal tract. Also, among the etiological factors, diseases such as hepatitis, cholecystitis and chronic duodenitis can be distinguished. Weakness of the sphincter muscles and increased pressure in the intestines are often the causes of gastritis, and a number of pathologies of the gastrointestinal tract can lead to this. The role of predisposing factors is also important. For example, constant stress reduces the protective properties of the mucous membrane, and it is less resistant to the action of irritating factors. The same applies to that increase the risk of developing gastritis several times. These drugs affect the synthesis of prostaglandins, and they perform an important function - stimulating the formation of mucus by goblet cells, which increases the protective properties of the mucous membrane. Anti-inflammatory drugs block the enzyme cyclooxygenase, as a result of which the amount of prostaglandins decreases, and, consequently, the amount of mucus.
Ascites leads to the formation of reflux esophagitis, which results in increased pressure in the abdominal cavity, narrowing of the pyloroduodenal opening. Additional factors may be malnutrition, tight clothing, medications, stress and smoking. This phenomenon can occur during pregnancy, then it is not associated with pathology.
Biliary reflux gastritis and reflux esophagitis: symptoms
The main symptoms of reflux esophagitis are heartburn and sour belching, which usually occur after eating, as well as when bending forward. In addition to this is discomfort in the epigastric region.
Biliary reflux gastritis is distinguished by a more saturated clinic. Symptoms of this disease include pain and other disorders. Often, patients are concerned about the feeling of fullness and bloating, as well as heaviness usually appear on an empty stomach, and their intensity can be different - from strong acute to aching. Vomiting is often observed.
Diagnostics
Diagnosis of biliary reflux gastritis is carried out after special studies and anamnesis. Complaints alone are not enough for this, they only help to suggest the development of the disease. First of all, the patient is sent for the delivery of feces, in which experts reveal hidden blood. It is also mandatory to conduct EGD, which will help to visually assess the condition of the mucous membrane, to detect pathologically altered foci. An increase in pressure in the duodenum can be detected by manometry.
Reflux esophagitis is diagnosed mainly by X-ray using a contrast agent. This method allows you to track the moment of reflux of the contents of the stomach into the esophagus. It is also recommended to carry out which will allow to assess the condition of the mucosa and take biological material for further research.
Treatment
Biliary reflux gastritis and reflux esophagitis require immediate treatment. This will help improve the patient's condition and avoid possible complications. If esophagitis is detected, bad habits should be abandoned, as well as intense physical exertion on the abdominal zone.
Drug therapy is based on the appointment that will reduce the aggressive effect of gastric juice on the mucosa of the esophagus. Among them, Almagel, Maalox, used by the course, can be distinguished. They envelop the walls of the stomach and reduce acidity.
In addition, it is recommended to use drugs that reduce the secretion of gastric juice ("Omeprazole"). Prokinetics can improve the tone of the sphincter, which is the protection against the reflux of acidic contents. Among such drugs, Motilium and Motilak can be distinguished. If conservative therapy fails, surgery may be required, which is performed using endoscopic equipment.
How is the treatment of such a disease as biliary reflux gastritis carried out? Symptoms and treatment of this pathology are inextricably linked. Patients require a complex of pharmacological and non-drug measures that will improve their condition and relieve clinical manifestations. First of all, you should normalize your lifestyle - giving up bad habits, proper nutrition. Among the medications, histamine receptor blockers are usually prescribed, which will reduce secretion. You can not do without gastroprotectors - they will accelerate the healing of lesions of the mucous membrane. In addition, binding is necessary, which is produced using ursodeoxycholic acid. Drugs such as Domperidone and Metoclopramide will help prevent the reflux of chyme into the stomach.
Prevention
Proper nutrition and timely diagnosis of pathological processes will help prevent the formation of biliary reflux gastritis and esophagitis. It is recommended to carry out regular endoscopic examinations for the purpose of prevention, which will help to identify the disease at an early stage. This will increase the effectiveness of conservative therapy, avoid surgical interventions and the occurrence of severe complications.
In addition, the protective properties of the mucous membrane should be increased. To do this, it is recommended to give up bad habits (or reduce them to a minimum), try to eat healthy food and avoid stressful situations.
Also a predisposing factor is the frequent use of non-steroidal anti-inflammatory drugs, which reduce mucus formation in the stomach, as a result, the mucous membrane becomes vulnerable. An important role is played by the prevention and timely treatment of concomitant diseases.
The problem of the occurrence of biliary reflux gastritis and esophagitis is relevant, since these pathologies can not only worsen the patient's condition, but also cause complications. Timely diagnosis will allow timely start of treatment.