I feel like food is going down the esophagus. What is dysphagia? Treatment of patients suffering from gastric obstruction

The woman who came to see the doctor was in despair, not understanding what was happening to her. IN Lately Not only can she not go on a visit, but even during a break she cannot have lunch with the employees in the canteen. And that's why. When she sits down at the table and starts to eat, the food literally gets stuck in her throat and pain immediately appears behind the sternum. And burping at the most unexpected moments puts her in an awkward position. There is simply no escape from embarrassment.

Such symptoms indicate impaired motility of the esophagus. The results of the X-ray examination confirmed the assumption: the woman was diagnosed with achalasia cardia - a violation of the transition of food masses from the esophagus to the stomach.
This disease occurs due to the lack of peristalsis of the esophagus or when the cardia (the junction of the esophagus into the stomach) does not open reflexively during swallowing. Food masses accumulate in the esophagus, causing its significant expansion.

Of course not always similar symptoms indicate the development of the disease. But still, at the first sign of difficulty passing food through the esophagus, be sure to consult a doctor. Do not resort to self-medication or advice from ignorant friends! Only the attending physician can understand the totality of the manifestations of the disease and outline a plan for examination and treatment.

The basis of this disease is a violation of the central nervous regulation motor function esophagus, caused by prolonged experiences, severe emotional stress, or infectious-toxic damage to its nerve plexuses, caused either by poisoning or burn. And here, as a rule, a kind of vicious circle arises. Anxiety and negative emotions intensify the manifestations of the disease - regurgitation, chest pain, difficulty passing food through the esophagus, which, in turn, further traumatizes the patient’s psyche.

Therefore, if you have been diagnosed with achalasia cardia, first of all, avoid situations and experiences that traumatize the psyche. Try, for example, to eat in an environment that does not cause embarrassment. Indeed, to pass a bolus of food through the esophagus, patients use certain techniques: they bend their torso back and periodically inhale deeply. But with strangers this is not always convenient.

You need to eat often - 4-5 times a day and little by little. This will reduce the frequency of regurgitation, which occurs mainly when the esophagus is full. Eat slowly, chew your food thoroughly, and do not talk while eating. After eating, be sure to drink a glass or half a glass of warm boiled water to remove food debris from the esophagus. A few sips of water push the retained food bolus into the stomach, protecting the esophagus from the development of congestive inflammation. Mineral waters are also useful, since by releasing large amounts of carbon dioxide, they increase pressure in the esophagus, thereby pushing food into the stomach faster.

Food should not be too hot or too cold. On low temperature muscle fibers the esophagus responds with additional spasm, and the patency of the cardia worsens. High temperature increases inflammatory process in the wall of the esophagus.

Hot seasonings, spices, sauces, fatty, smoked foods, and alcohol contribute to the development of inflammation. In some patients, apples, persimmons or kefir, soft bread or boiled potatoes, hard-boiled eggs. They will have to be abandoned.
With achalasia cardia, there are all the prerequisites for retention of foreign bodies in the esophagus. Therefore, be especially careful when there are bony fish or poultry on the table.

I recommend weak meat broths, pureed soups, pureed meat dishes, side dishes made from coarse fiber - carrots, beets, green peas, boiled and pureed. In the morning you can eat pureed porridge: semolina, oatmeal, buckwheat, rice. Eggs are better in the form of steam omelettes. Include dairy products in your diet: milk, sour cream, pureed cottage cheese. Drink non-acidic juices. Rosehip decoction and fresh fruit jelly are very useful.

Perhaps I will surprise you now by saying that with this disease, infrequent (once every one or two weeks) deviations from a strict diet are possible: favorite dish, eaten with appetite, passes through the esophagus better than those that the patient eats without pleasure. Obviously, this is due to the influence of the central nervous system.

Often achalasia cardia is combined with other diseases of the digestive system. Then coordinate the diet with your doctor additionally.

“GERD occurs when a person, as a result of constant reflux of very caustic stomach contents (acidic) or small intestine(alkaline) back into the esophagus, its mucous membrane becomes inflamed lower section. – Says gastroenterologist Oleg Vasilchenko.

The symptoms of GERD are familiar to many. This is heartburn, belching sour or bitter, a feeling of a lump behind the sternum, increased salivation, discomfort when swallowing up to pain in the esophagus, and sometimes even retrosternal pain like angina pectoris.

Today it is known that GERD can cause serious complications in the form of ulcers (sometimes bleeding), narrowing of the esophagus and precancerous changes in the esophageal mucosa. The disease aggravates and provokes attacks of asthma, angina pectoris, and can cause severe caries and pneumonia.

What happens inside a person can be described as follows. During normal operation of the esophagus, food passes through it into the stomach gradually and sequentially. And if intestinal motility (contraction of the muscles of the esophagus, which helps food move from the pharynx to the stomach) is disrupted, the esophagus contracts so that pieces of food dangle back and forth along it and reach the stomach much later than they should.

Insufficiency of the cardia (sphincter of the lower part of the esophagus) is expressed in the fact that the “passage” from the stomach to the esophagus is not always closed for those pieces of food that “ask” back and, as a result, part of the lunch again ends up in the esophagus, which should not happen.

The motor activity of the esophagus and sphincter tone are adversely affected by many foods (alcohol, fats, coffee, chocolate, citrus fruits) and some medications (nitrates, barbiturates, tranquilizers, theophylline, calcium channel blockers, etc.).

The mucous membrane of the esophagus is damaged when:

The stomach is stretched by food due to overeating or as a result of aerophagia (overflow with air);

Peptic ulcer or cholelithiasis is present;

Pregnancy is present and fetal growth increases intra-abdominal pressure;

The person suffers from mental instability.

A patient with GERD needs to give up smoking, wearing tight clothes, lifting heavy objects, alcohol, fats, coffee, and dinners before bedtime. After eating, it is equally harmful to do exercises and go to bed.

You need to replace your waist belt with suspenders, sleep in bed with the head of the bed raised, preferably on your left side, lose excess weight, adjust your chair and eat in moderation.

Experience shows that drug treatment for GERD is more effective than surgery. But even when cured with drugs, the disease returns in 85-90% of patients after six months, usually due to the fact that people do not want to change their lifestyle.

Fibroesophagogastroscopy can detect and confirm the diagnosis of GERD - you swallow a flexible hose, at the end of which there is a light bulb and a lens that allows you to examine the esophagus and stomach from the inside.

Food does not pass into the stomach

Either you are worried about your health, or your health will worry you!

Achalasia cardia. If food doesn't pass.

This disease occurs due to the lack of peristalsis of the esophagus or when the cardia (the junction of the esophagus into the stomach) does not open reflexively during swallowing. Food masses accumulate in the esophagus, causing its significant expansion.

You need to eat often, once a day and little by little. This will reduce the frequency of regurgitation, which occurs mainly when the esophagus is full. Eat slowly, chew your food thoroughly, and do not talk while eating. After eating, be sure to drink a glass or half a glass of warm boiled water to remove food debris from the esophagus. A few sips of water push the retained food bolus into the stomach, protecting the esophagus from the development of congestive inflammation. Mineral waters are also useful, since by releasing large amounts of carbon dioxide, they increase pressure in the esophagus, thereby pushing food into the stomach faster.

With achalasia cardia, there are all the prerequisites for retention of foreign bodies in the esophagus. Therefore, be especially careful when there are bony fish or poultry on the table.

Food does not pass into the stomach

In diseases of the esophagus, the main complaints will be difficulty passing food through the esophagus (dysphagia) and pain along the esophagus (behind the sternum). Already at the first complaint of this kind, you should consult a doctor and conduct an examination.

It is advisable to remember the term “reflux esophagitis”. Reflux is a reverse reflux, in our case the reflux of gastric contents into the esophagus; normally this should not happen, since there is a muscular valve between the esophagus and the stomach. Esophagitis is inflammation of the esophagus. Thus, reflux esophagitis is an inflammation of the esophagus due to the reflux of acidic gastric contents into it (see diagram).

Esophageal cancer occurs more often in people with risk factors for the disease. These include systematic contact with carcinogenic substances, chronic radiation exposure, excessive consumption of rough, very hot, spicy foods that irritate the mucous membrane of the esophagus, alcohol abuse, and smoking. Precancerous diseases include inflammation of the esophagus, polyps and papillomas of the esophagus, scars after chemical burns. Local signs of esophageal cancer include dysphagia, chest pain, a feeling of fullness behind the sternum, regurgitation of food, and increased salivation. Along with these signs, increasing weakness and weight loss are noted.

A functional disorder of the esophagus is a violation of its motor function without visible organic (inflammatory, tumor) changes. Most often this is manifested by periodically occurring spasms of the esophagus. The causes of this type of violation are mostly associated with emotional disorders - an increased level of human anxiety, persistent depression of mood (depression), household and work-related psychotraumatic factors. In some cases, the reasons cannot be determined.

Hiatal hernia - chronic illness, in which through the hole in the diaphragm in chest cavity the esophagus, stomach, and rarely intestinal loops are displaced (see diagram). A hiatal hernia contributes to the development of inflammation of the esophagus (reflux esophagitis). A common sign hiatal hernia are pain behind the sternum, in the epigastric region, in the left half chest. Pain appears after eating, when physical activity, in a horizontal position, when coughing, against the background of bloating. Relieves pain after belching, regurgitation, vomiting, and drinking soda. We must remember that pain with a hiatal hernia requires special attention because they are similar to the pain of angina pectoris, peptic ulcer, chronic pancreatitis. A hiatal hernia is often combined with these diseases. Patients also complain of heartburn, pain when swallowing, and disturbances in the movement of food through the esophagus. In some patients with hiatal hernia, gastric contents from the esophagus enter the Airways. A cough appears, there may be shortness of breath, bronchitis and pneumonia occur. A hiatal hernia is recognized using x-ray examination. It is necessary to examine the patient not only “standing”, as is usually done, but always in the “lying” position. Treatment of a hiatal hernia is aimed primarily at preventing an increase in intra-abdominal pressure. It is necessary to avoid heavy lifting, frequent bending forward, and tightening the belt. You should sleep with the head of the bed raised. Dietary measures are important. Meals should be at least 4 times a day, dinner 2-3 hours before bedtime, eat slowly. It is necessary to limit the consumption of hot, spicy foods, foods that reduce the tone of the lower esophageal sphincter - coffee, chocolate. Drug treatment is the same as for reflux esophagitis. In cases severe course surgical intervention is used for the disease. A patient with a hiatal hernia should be observed by a gastroenterologist.

Esophageal diverticula are limited sac-like protrusions of the esophageal wall, facing outward (see diagram). Diverticula can be single or multiple. They are formed in people with greater compliance of the walls of the esophagus than in healthy people as a result of increased pressure inside the esophagus or “pulling” of the esophagus from the outside by adhesions. Very often, diverticula of the esophagus do not manifest themselves; they are detected by chance during an X-ray examination. With high-lying diverticula, there may be a cough, a feeling of dryness in the throat and foreign body along the esophagus during swallowing. In patients with very large diverticula, there are disturbances in the movement of food through the esophagus, regurgitation, night cough. After recognizing diverticula, a gastroenterologist decides on the method of treatment. Great importance has a regime and diet. The food you eat should be crushed, you should eat slowly, in small portions. After eating, it is advisable to drink a few sips of water. You should sleep with the head of the bed raised. Before eating, it is advisable to take one teaspoon of vegetable oil. An inflammatory process called diverticulitis can occur in diverticula. In these situations, antibiotics are prescribed for a course of 5-8 days with a break of 10 days. When not enough effective treatment indications for surgery are given.

Achalasia is an enlargement of the esophagus that develops due to a decrease or inability of the lower esophageal sphincter to relax during the act of swallowing, combined with a decrease in the force of contraction of the esophagus. Among the causes of esophageal achalasia are the consumption of very cold food, cold drinks, vitamin B1 deficiency, as well as frequent stressful situations and psychoemotional disorders. On initial stages the disease can be considered as purely functional, but over time persistent changes are detected in the nerve cells of the middle and lower thirds of the esophagus. The main symptom of achalasia is difficulty swallowing. They vary in severity and intensity, and it is equally difficult to swallow both liquid and solid food. Patients also complain of chest pain. Pain can occur directly during swallowing, as well as outside of eating. Typical of achalasia is regurgitation. Esophageal achalasia is recognized using x-ray and esophagoscopy. More complex diagnostic methods are also used. In most cases, treatment of achalasia begins with general measures, especially in the initial stages of the disease. Should be avoided if possible stressful situations, negative emotions. Food should be mechanically and chemically gentle, i.e. crushed, not spicy, with enough proteins and vitamins. Food should be taken 6 times a day, in small portions. Drug treatment is carried out with prolonged nitrates and calcium antagonists (verapamil and nifedipine). The course of treatment is usually 1 month; if it is insufficiently effective, instrumental expansion of the lower esophagus is performed.

What to do if food gets stuck in the throat and does not pass into the stomach?

It is necessary to consult a gastroenterologist and undergo an examination of the esophagus - x-ray, endoscopic - to exclude various tumor diseases. Quite often, with these complaints we are talking about achalasia cardia - a violation of the transition of food mass from the esophagus to the stomach.

The cardia is the junction of the esophagus and the stomach. If the peristalsis of the esophagus is impaired and the cardia does not open reflexively during swallowing, then the food mass is forced to linger in the esophagus itself, causing its expansion. This leads to regurgitation and pain in the sternum.

The causes of the disease associated with a violation of the central nervous regulation of the motor function of the esophagus are prolonged nervous overloads, stressful situations, and sometimes burns of the esophagus.

Food should not be too hot or too cold. Spicy seasonings and sauces are excluded from the diet.

If the disease worsens, the attending physician may advise introducing weak meat broth and side dishes of pureed vegetables - carrots, beets, cauliflower - into the diet for a certain period; various porridges - semolina, rice, Hercules; meat and fish - in minced form (boiled meat minced through a meat grinder, cutlets, dumplings, soufflé). Various vegetables and fruit juices, compotes, jelly.

Caution must be exercised if there is bony fish or chicken on the dinner table. Swallowed bones can linger in the esophagus and cause inflammation or even damage to the mucous membrane of the esophagus.

Sometimes, to facilitate the passage of food through the esophagus, deep holes can be made several times. breathing movements, bend the shoulder part of the body back.

Difficulty passing food through the esophagus

A condition in which a person experiences pain when food passes through the esophagus, or other discomfort associated with swallowing, is called dysphagia. This is not an independent nosological unit, but only a symptom, and quite a formidable one, of several diseases at once.

Dysphagia is characterized by difficulty or inability to swallow

The esophagus is part of the digestive canal, which is a muscular tube somewhat flattened from front to back. Food enters it from the pharynx and, after passing through it, enters the stomach. Its length in adults is about thirty centimeters. It begins as a continuation of the pharynx, passes through the chest cavity and ends in the abdominal cavity.

Etiology of this problem

The reasons why food cannot pass through the esophagus normally are quite varied. They may be associated with damage:

Throats.
Esophagus.
Stomach.
Tissues surrounding the esophagus.
The presence of foreign bodies in these formations.

From the oral cavity and the initial part of the esophagus, the main causes of dysphagia can be oral candidiasis, tonsillitis with severe enlargement of the tonsils, as well as a previous cerebral stroke. Sometimes it can be one of the symptoms of Parkinson's disease, pseudobulbar palsy, or polio.

Thus, the etiological factors are extremely diverse, as in the case of snoring during pregnancy, its causes may be associated with disruption of the activity of many organs and their systems.

Classification of dysphagia

There are several criteria by which dysphagia is divided into types. For example, based on the location of the pathological process that caused it, the following types of this symptom are distinguished:

There is also a division of dysphagia into organic, that is, caused by objective pathological changes in organs and tissues, and functional, in which the cause of difficulty swallowing is transient disorders of the nervous regulation of the muscular apparatus of the esophagus.

They also consider the division into a paroxysmal, or attack-like form, the causes of which lie in a disorder of the nervous regulation of esophageal motility, and a constant form, which occurs in patients with organic lesions of this organ.

Clinical picture

Thus, unpleasant process swallowing indicates that a person has a pathology of one of the gastrointestinal tract organs, and it is necessary to consult a doctor. In parallel with the feeling that food is not passing well through the esophagus, patients may develop a number of accompanying symptoms that help establish the diagnosis. They experience pain when swallowing, after which coughing attacks or even suffocation may develop. Their voice becomes hoarse and hoarse.

Patients with dysphagia may experience a lump in the throat

Many patients complain of increased salivation. Between meals, people with dysphagia may experience a feeling of fullness behind the sternum or a feeling of a lump in the throat. Initially, people experience these unpleasant sensations if the food they eat is hard and rough. However, as the disease progresses, the condition worsens, and patients cannot eat even soft and then liquid foods normally.

When swallowing impairment is a consequence of paralysis of the pharyngeal muscles, or esophageal fistula, patients experience severe regurgitation, in which food enters the nose and trachea. With lesions of the lower esophagus (achalasia cardia, esophagitis, reflux disease, stricture), severe vomiting is observed, after which the discomfort disappears or its intensity noticeably decreases.

The voice of such patients becomes hoarse or even hoarse, which indicates damage to the larynx or pharynx. They lose body weight. Its rapid decline should alert doctors, as it may be a sign of esophageal cancer, which prevents food from passing into the stomach.

Dependence of the clinical picture on the location of the obstruction to the passage of food

With the first type of dysphagia, food accumulates in the mouth of the patient, who cannot swallow it. If the act of swallowing occurs, then subsequent unpleasant sensations arise almost instantly, no more than one second passes. Aspiration of food (its entry into the upper respiratory tract) is very often observed, resulting in coughing and suffocation.

In the case of esophageal dysphagia, people feel that food stops somewhere behind the breastbone, and these sensations arise only after a few sips.

From the moment of the last of them, two seconds pass (obstacle at the level cervical spine) up to 4-5s (pathological process in the middle third). If the obstacle is in the lower part of the esophagus, the clinic develops in 8-9 seconds.

Diagnostics

The scope and nature of examinations are determined by the attending physician

Since the causes of disruption of the passage of food through the esophagus are extremely diverse, the diagnosis must be multifaceted. Correct collection of anamnesis of the disease plays a very important role. This stage must be approached responsibly, since even small parts can play an important role.

When the information is collected, doctors move on to an objective examination. At this stage, it is important to correctly assess the general status of the patient, which may change with systemic diseases. Oral examination also plays an important role. It allows you to identify stomatitis, as well as inflammatory diseases, such as sore throat.

Of the instrumental diagnostic methods, the most informative is fibrogastroduodenoscopy.

This is an endoscopic research method that allows you to assess the condition of the mucous membrane throughout the esophagus, as well as the stomach and duodenum. In this case, one can not only consider pathological formation, but also to collect biological material for analysis, which is very useful if a neoplasm is suspected.

X-ray diagnostic methods are very useful for assessing the condition of the mediastinum. With their help, you can also study the structural features of the patient’s esophagus, evaluate its size and shape, as well as the condition of the mediastinal tissues. During an X-ray examination, it is easy to identify external tumors that develop outside the esophagus and lead to its mechanical compression, which makes it difficult for food to pass through it.

If a disorder of the nervous regulation of esophageal tone is suspected, a detailed neurological examination should be carried out, which can also be combined with laboratory and radiological techniques, for example, computed tomography or magnetic resonance imaging.

In order to clarify the possibility of esophagitis and reflux disease, a pH-metry technique is used to determine the acidity of gastric juice.

Therapeutic tactics

Treatment is aimed at the underlying disease that caused dysphagia

Since this disorder has extremely diverse causes and development options, there is no single scheme for its treatment. Help should be based on correct and complete diagnosis and treatment of the underlying disease. You also need to take into account that the process may be functional in nature and require a completely different approach.

If the process is functional, you should only explain to the patient the causes and pathogenesis of his problem, and recommend avoiding unnecessary stress, mental and physical strain, and normalizing sleep and diet.

If there is a spastic nature of dysphagia, the use of a number of muscle relaxants is indicated, which help normalize muscle tone and improve the patient’s condition.

If it is determined that the cause of impaired swallowing is a third-party pathology, it should be treated. For example, adequate therapy should be prescribed for GERD or esophagitis.

Diseases of the esophagus

The esophagus is of invaluable importance in the human body. It is thanks to him that we receive everything we need for the functioning of other organs, because the food we consume gives us energy for life. But this organ, like our entire body, is subject to diseases that not only bring pain, but are also psychologically difficult to bear, as they are accompanied by belching, heartburn, and an unpleasant odor. Such diseases affect not only the health of the whole organism, but also daily life sick. The most common diseases of the esophagus are caused by impaired motility of the organ or neoplasms, such as cysts and benign tumors, and cancer. The main diseases of the esophagus, their symptoms, diagnosis and treatment will be discussed further.

Diseases of the esophagus and their symptoms

Motility disorders of the esophagus include diseases such as achalasia cardia, esophageal spasm of the esophagus, peptic esophagitis, chalasia cardia and diaphragmatic hernia. These diseases have several different character courses and symptoms.

Achalasia cardia, or cardiospasm, is a neuromuscular disease. This is a violation of the reflex opening of the lower esophageal sphincter during the passage of food. The reasons for the development of this disease of the esophagus are not known; it manifests itself in adulthood, more often in women. Complications of this disease are most often caused by prolonged retention of food in the esophagus. In adults, a common complication is inflammation of the esophagus, which in turn can cause cancer of both the esophagus itself and the upper part of the stomach. Children more often experience complications such as bronchopneumonia, lung abscesses and other respiratory diseases caused by food getting into them.

Symptoms of achalasia are triadic. The first manifestation of this disease of the esophagus is a swallowing disorder, or dysphagia. This symptom can occur suddenly or gradually, intensifying after nervous excitement. In some cases, paradoxical dysphagia is observed, when hard and dense foods pass normally, but liquids do not. Swallowing problems may also depend on the temperature of the food. The second symptom of achalasia is regurgitation, which occurs when the esophagus is full, when a sharp muscle contraction occurs. The third symptom is pain caused by spasm of the esophagus muscles when it is full. Pain behind the sternum goes away after food passes into the stomach. These symptoms are also accompanied by nausea, belching of air, burning in the esophagus, and increased salivation.

Esophageal spasm - spasm of the walls of the esophagus, not accompanied by dysfunction of the lower alimentary sphincter, occurs due to a nervous disorder. Esophagospasm occurs more often in middle-aged and elderly men, and may also be a symptom of other disorders digestive tract.

A symptom of esophageal spasm of the esophagus is chest pain, which is often mistaken for manifestations of angina pectoris. Pain can occur not only during meals, but also in the interval between meals. They come in varying intensity and duration. In addition to pain, this disease is characterized by a paradoxical swallowing disorder; the inconstancy of this symptom distinguishes esophageal spasm from other diseases and neoplasms of the esophagus.

Peptic esophagitis, or reflux esophagitis of the esophagus, is caused by insufficiency of the lower alimentary sphincter, which leads to the reflux of stomach contents back into the esophagus. Chalazia cardia has the same course, but it is more often caused by hiatal hernia. Due to such emissions of gastric juice, bile, and pancreatic juice, the mucous membrane of the esophagus suffers. Inflammation and ulcers occur, with scarring of which the esophagus narrows. This disease of the esophagus proceeds very slowly, in frequent cases it can be found in infants.

Symptoms of reflux esophagitis are burning behind the sternum, heartburn, pain, belching. Some symptoms worsen when bending over, lying down, smoking or drinking alcohol. Belching can cause aspiration pneumonia. This happens when gastric contents enter the respiratory tract, especially during night regurgitation, which is accompanied by coughing. Complications of the disease may include bleeding and scarring.

Diaphragmatic hernia is the movement of an organ from the abdominal cavity into the chest cavity. Hernias can be congenital, acquired or traumatic defects; most often, patients experience hernias food opening diaphragms, they can be sliding or paraesophageal. This disease has a very scant symptoms. The main symptoms of a diaphragmatic hernia are anemia and hidden bleeding.

Benign tumors of the esophagus grow slowly and are practically asymptomatic. Most often they are discovered by chance; in some cases, the patient may experience an increasing difficulty in swallowing, which develops over several years.

Unlike benign tumors and esophageal cancer cysts have more severe symptoms and is diagnosed many times more often than other diseases of the esophagus. Cancer occupies 60-80% of all diseases of the esophagus, it is the sixth most common disease among adults, and is more common in men of this age. age groups smoking and alcohol abusers. Here are a few more reasons that cause esophageal cancer: complications of impaired motility of the organ, namely achalasia, Barrett's esophagus, papillomas and scars, which can also occur after a burn of the esophagus with caustic substances.

First, esophageal cancer manifests itself as a feeling of discomfort and chest pain in the patient, dysphagia, increased salivation, and weight loss. For the first one or two years, symptoms of esophageal cancer are practically not observed, until the tumor begins to narrow the esophagus, dysphagia gradually increases, and pain intensifies.

Diagnosis of esophageal diseases

Diagnosis of esophageal diseases in the early stages is carried out using esophagotonocymography. The esophagus is examined using a multi-channel probe with balloons or open catheters, which record contractions of the esophagus and changes in pressure in it. Most often, such a study is performed when symptoms of achalasia are detected.

X-ray examination makes it possible to detect deformations of the esophagus due to spasm of its muscles. Such studies are prescribed for suspected esophagospasm, reflux esophagitis of the esophagus, diaphragmatic hernia and neoplasms of the esophagus. For symptoms of reflux esophagitis, intraesophageal pH-metry and esophagomanometry are prescribed, which makes it possible to establish the pH level in the lower esophagus and dysfunction of the lower esophageal sphincter. To detect gastroesophageal reflux, a barium x-ray is sometimes prescribed, with the patient in a supine position with the leg end elevated.

Of course, an important role in diagnosing diseases of the esophagus is played by a patient interview, which the attending physician must conduct before prescribing any examination. Many symptoms of esophageal diseases can be a manifestation of other diseases. Therefore, it is very important to make sure that these are not diseases of the digestive system that require urgent surgical intervention.

Treatment of esophageal diseases

Conservative treatment of esophageal diseases is prescribed in the initial stages of diseases such as achalasia cardia, reflux esophagitis and uncomplicated diaphragmatic hernia Oh.

For achalasia, nitro drugs, ganglion blockers, nifedipine and others are prescribed similar drugs calcium antagonists. But the main method of treating this disease is cardiolatation. This method involves widening the narrowed area in the esophagus using a balloon pneumatic cardiodilator. This treatment of achalasia is contraindicated in patients with portal hypertension, which is accompanied by varicose veins of the esophagus, in patients with severe esophagitis and blood diseases. In case of contraindications, alternative methods are used.

Conservative treatment of esophagospasm consists of a gentle diet, prescription of nitro group drugs, sedatives and antispasmodics. If there is no positive effect, surgical treatment is performed, which consists of cutting the muscular layer of the esophagus. It is important to start treatment as soon as the first symptoms of esophageal spasm appear, since in this case the likelihood of avoiding surgical treatment is much higher.

Treatment of reflux esophagitis is aimed at reducing intra-abdominal pressure, manifestations of esophagitis, reducing body weight to age norm. IN mandatory a mechanically and chemically gentle diet is prescribed, fractional meals. H2-receptor drugs are prescribed: ranitidine, famotidine, which reduce the acidity of gastric juice, and antispasmodics are also prescribed and enveloping agents. Prokinetics are used to increase the force of compression of the lower esophageal sphincter and the time of evacuation of gastric contents. Surgical treatment prescribed for axial hiatal hernia, bleeding and stenosis.

Treatment of sliding diaphragmatic hernias is carried out conservatively, reducing the manifestations of the gastroesophageal reflex. Surgical treatment is performed for complications such as bleeding, narrowing of the esophagus, or ineffectiveness of conservative treatment. The latter complication is more common in patients with congenital defects and lower esophageal sphincter insufficiency.

There is no need to talk about conservative treatment of esophageal cancer. This happens due to the diagnosis of the disease at those stages when it does not produce a positive effect. Radical treatment is carried out directly as preparation before surgery. In the early stages of the disease, pure radiation treatment or surgical intervention, in later cases only a combination of both.

The use of chemotherapy and radiation therapy before surgery improves treatment results several times. Irradiation is carried out several weeks before surgical treatment, the method of remote gamma therapy is used. Surgical intervention depends on the location of the malignant tumor. If the lower part of the esophagus is affected, it is removed along with the upper part of the stomach, sewing the remaining part of the esophagus into the stump of the stomach. If the middle section is affected, the esophagus is completely removed; the stomach wall is first sutured to abdominal wall and create an anastomosis for introducing nutrition through the probe.

One to two years after removal of the esophagus, provided there is no relapse, the esophagus is restored by replacing it small intestine. Relapse of the disease can occur if radiation therapy is ineffective. The lethality of this disease is associated not so much with metastasis as with the depletion of the body due to the primary tumor. Therefore, the earlier a malignant disease of the esophagus is detected and surgery is performed, the more successful the treatment prognosis.

Obstruction of food through the esophagus

Of the three parts of the human esophagus, the thoracic section suffers from obstruction. It is more often susceptible to tumor damage and trauma. Pathological process accompanied by dysphagia, that is, impaired swallowing function. This occurs due to an abnormal narrowing of the lumen of the esophagus, which prevents the normal passage of solid foods and liquids.

Injuries chest area may cause obstruction of the esophagus.

Description of the pathology

Obstruction is the appearance of a barrier that causes narrowing or blocking of the esophageal lumen. Poor permeability makes it difficult for food and liquid to enter the stomach. In most cases, the pathology develops after damage to the esophagus.

When a wound, crack or scratch heals, connective tissue forms on the walls of the digestive tract, forming a seal. This scarring causes narrowing of the lumen.

Less commonly, obstruction of the esophagus occurs against the background of the development of cancer in its wall. External compression of the tract by nearby pathological tissues is also possible.

Stages

a person feels discomfort when swallowing. Unpleasant, poorly expressed sensations arise behind the sternum;
It becomes difficult to swallow pieces, solid food does not pass well. Relief occurs when drinking water;
it is difficult to eat pureed, pureed and porridge-like food, it also does not pass well;
pain when swallowing occurs when drinking any liquids and drinking water;
the critical stage, when complete obstruction occurs, not allowing even water to be consumed.

Forms

Narrowing of the esophagus of benign origin. Appears against the background of chemical burns, intentional or accidental use of cauterizing liquids, untreated ulcers in the deep layers of the mucous membrane of the esophageal walls.
Stenosis of malignant origin. Appears with esophageal cancer.

These two forms have 4 degrees:

1st degree, when the size of the narrowing in diameter is 9-11 mm;
2nd, when the diameter is 6-8 mm;
3rd - 3-5 mm;
4th - 1-2 mm.

Causes

Causal factors for obstruction can be caused by organ diseases and injuries. The most common cases:

development of deep ulcers in the epithelium of the esophagus;
the presence of saccular protrusions in the walls of the organ - diverticula;
the appearance of cardiospasm, that is, narrowing of the alimentary tract in the area of its connection with the stomach;
development of benign and malignant tumors with a cell type not different or different from those that form the organ;
the onset of gastroesophageal reflux, characterized by the release of gastric contents back into the esophagus;
development of ulcerative esophagitis, that is, inflammation of the mucous membrane with the appearance of deep defects;
consumption of aggressive liquid chemicals (acids, alkalis), hot food and drinks that cause burns with stenosis;
ingress of foreign particles;
open wounds and closed injuries;
mechanical damage;
consequences severe infections, such as tuberculosis, fungal mycosis;
presence of systemic diseases connective tissue, for example, with damage blood vessels, different organs and tissues, due to which fibrous tissue grows with a decrease in the esophageal lumen.

Obstruction of the esophagus can form in utero. This pathology is congenital.

Symptoms

Dysphagia - main feature pathology. It manifests itself as difficult, painful and incomplete swallowing. Various degrees are possible - from mild discomfort to choking even with water.
Odynophagia, manifested as severe pain when swallowing with a location behind the sternum. Pain may appear on the left under the scapula, at the bottom of the jaw apparatus. Sometimes the symptoms become similar to a heart attack.
Vomiting previously eaten food containing blood.
Belching with a strong unpleasant odor, like rotten eggs.
Weight loss due to reduced food portions, but maintaining appetite.

Diagnostics

Pathology is diagnosed by using imaging (optical) detection methods, such as:

Eophagogastroduodenoscopy is an instrumental technique for assessing the condition of the esophageal lumen, the structure of the epithelium, and taking a biopsy;
Ultrasound is a method that detects any pathology of the esophagus;
CT and MRI are techniques that allow one to differentiate pathology, confirm the diagnosis and identify related problems.

Obstruction of the esophagus causes changes in clinical parameters, so additional tests such as:

grade color index blood and the degree of decrease in hemoglobin in red blood cells;
determination of total hemoglobin, protein;
conducting research feces for occult blood.

Treatment

Therapeutic tactics depend on why the pathology arose, as well as on the degree of its development. When a foreign particle gets stuck in the esophagus, it is removed through an esophagoscope with bougienage (expansion) of the narrowed lumen. For esophageal dysfunction due to the development of oncology, they are used surgical methods. The affected part is removed, and the remains are attached directly to the stomach. Additionally, radiation, chemical or photodynamic therapy is prescribed.

Medication

antacids;
prokinetics;
astringents;
regeneration stimulants;
proton inhibitors.

Surgical

Most often used for esophageal cancer. There are several popular techniques:

surgery with complete excision of the esophagus and its replacement with other tissues;
chemotherapy with anticancer drugs;
radiation combined with chemotherapy to shrink the tumor so that it can be removed.

If the obstruction is caused by a benign neoplasm, the pathology is eliminated by bougienage, that is, dilation of the esophagus with special instruments. When treating cardiospasm, surgery is not necessary; conservative methods are used.

Traditional methods

The combination of conservative methods with folk remedies gives a positive result in the treatment of esophageal obstruction. But the use of alternative medicine recipes must be agreed with your doctor.

Oak bark decoctions

You need to take 30 g of cinquefoil bark and root, 40 g of walnut and St. John's wort leaves, 20 g of oregano. The mixture should be crushed, take 30 g and pour 700 ml of chilled water. The drink is infused for 3 hours. After the time has passed, the tincture is brought to a boil and cooked for 5-10 minutes. After filtering, the medicine should be drunk 100 g 30 minutes before meals.

Wormwood collection

Together with wormwood, arnica and ground femoris root are used, taken in a ratio of 50: 75: 100, respectively. After thorough mixing, 45 g of the mixture is selected, placed in a thermos, into which 400 ml of boiling water is added. The drink is filtered after 10 hours. You should drink it in small sips of half a glass four times before meals (30 minutes before).

Other settings

When treating pathology with folk remedies, tinctures are used:

with lemongrass;
marshmallow root;
ginseng;
alder cones and quince seeds;
Rhodiola extract.

Diet therapy

The diet is based on the individual characteristics of the body, the degree of stenosis and provoking causes. Three widely used dietary tables:

No. 1, suggesting a full menu including pureed dishes, steamed or boiled. Hot and cold foods are excluded. You should eat small portions up to 6 meals.
No. 1a, which involves the consumption of warm liquid and semi-liquid dishes up to 6 times a day with breaks of 2.5 hours. The amount of salt is limited, the volume of water is increased to 1.5 liters. Additionally, foods high in vitamins are introduced: A, B6, B12, C. It is not allowed to eat bread, baked goods, vegetables, sausages, smoked meats, fatty meats, canned food, sweets, sour fruits with berries, coffee with strong tea, soda.
No. 1b, suggesting a complete low-calorie menu with a limitation of chemically, thermally, and mechanically irritating foods to the mucous membrane. Food should be ground and boiled. Consistency - liquid, mushy. Meals are fractional.

In all three cases, a snack is allowed 3 hours before a night's rest.

Who treats the disease?

If you experience the first difficulties and discomfort when swallowing food or water, you should contact a specialist - a gastroenterologist.

Achalasia is a neuromuscular disease manifested by persistent impairment of the reflex opening of the lower esophageal sphincter when swallowed food approaches it. The first symptoms of the disease often appear at the age of 20-40 years, women are more often affected. The reasons for the development of the disease are not known.

Manifestations of the disease

Achalasia is characterized by a triad of symptoms: dysphagia (impaired swallowing), regurgitation (return of food, regurgitation), pain.

Dysphagia is the main and most often the first symptom of the disease. In some cases it occurs suddenly in the midst of complete health, in others it develops gradually. Increased dysphagia is usually observed after nervous excitement, during a hasty meal, when swallowing dense, dry and poorly chewed food. Sometimes paradoxical dysphagia is observed: dense food passes into the stomach better than liquid and semi-liquid food.

People suffering from achalasia gradually find ways to facilitate the passage of food into the stomach (walking, gymnastic exercises, swallowing air and saliva, taking large amounts warm water and so on).

The degree of dysphagia may depend on the temperature of the food: warm food passes with difficulty or does not pass, and cold food passes without difficulty.

Regurgitation with a slight expansion of the esophagus occurs after several sips. With a greatly dilated esophagus, regurgitation occurs less frequently, but becomes abundant. Regurgitation occurs due to a sharp contraction of the muscles of the esophagus when it is full.

Chest pain may be associated with spasm of the esophageal muscles. It can be eliminated by taking Nitroglycerin, Atropine, Nifedipine (Corinfar). However, more often pain occurs when the esophagus is full and disappears after regurgitation or passage of food into the stomach.

Manifestations

The main symptoms of esophageal cancer are: a feeling of discomfort behind the sternum when swallowing food, dysphagia, pain behind the sternum, increased salivation, weight loss.

The onset of the disease is asymptomatic, this period can last 1-2 years. When the tumor reaches a significant size and begins to narrow the esophagus, the first signs of disruption of food passage appear. Cancer is characterized by a progressive increase in dysphagia. IN initial period dysphagia occurs when swallowing dense or insufficiently chewed food. It feels like it is sticking to the wall of the esophagus or there is a temporary delay at a certain level; a sip of water helps the food pass into the stomach. Then even well-chewed food stops passing through, and you have to take semi-liquid and liquid food.

You can find symptoms of all diseases on our website in the section

Occurrence

Among all neoplasms of the upper digestive tract, esophageal cancer occupies a special place: it usually manifests itself early and is, it would seem, diagnosed in a timely manner, but a relatively small percentage of patients can undergo radical treatment. At least 80% of patients are hospitalized in stages III-IV of the disease.

Types of esophageal cancer

Esophageal cancer is the most frequent illness This organ accounts for 80-90% of all diseases of the esophagus. Among all malignant tumors, esophageal cancer ranks eighth, and malignant tumors of the digestive tract - 3rd after stomach and rectal cancer. There are three sections in the esophagus: cervical (5-6 cm), thoracic (15-18 cm) and abdominal (1-4 cm). In the thoracic esophagus, the upper third (about 5 cm), corresponding to II-IV, is distinguished thoracic vertebrae, middle (5-7 cm), located at the TV-TVII level, and the lower third (5-7 cm), corresponding to the TVII-TX level. The middle third is most often affected thoracic esophagus (40-60%), less often the tumor is localized in the upper thoracic (10-15%) and lower thoracic (20-25%) parts. From a clinical point of view, segmental division of the esophagus is convenient, based on its anatomical relationships with neighboring organs. According to this scheme, 9 segments are distinguished in the esophagus: tracheal segment - from the entrance to the esophagus to the upper edge of the aortic arch, aortic - corresponds to the diameter of the aortic arch, bronchial - the projection of the left main bronchus, interaortobronchial - from the lower edge of the aortic arch to the upper edge of the left main bronchus , subbronchial - from the bifurcation of the trachea to the left atrium, retropericardial (retrocardial) - projections of the left atrium and ventricle, supradiaphragmatic - to the height of the dome of the diaphragm on the right, intradiaphragmatic, subphrenic (abdominal). Macroscopically, three forms of cancer are distinguished: scirrhous or infiltrative cancer, when the tumor uniformly infiltrates the wall of the esophagus and passes into normal tissue without a clear boundary; ulcerative or cerebral cancer - grows into the lumen of the esophagus, easily disintegrates, early metastasizes to regional and distant lymph nodes; nodular or wart-papillomatous cancer - has exophytic growth, easily disintegrates and bleeds; mixed forms of tumor.

Morbidity

The occurrence of esophageal cancer is associated with dietary habits, as well as with alcohol consumption and tobacco smoking. Among the indigenous peoples of the North, Siberia and the Far East, the use of very hot “brick” tea, frozen fish and meat, hard cakes, which winter time sometimes they are also stored frozen. Such a diet with irregular nutrition, as well as abuse of pure or weakly diluted alcohol, leads to permanent injury to the esophagus and a predisposition to cancer. There is an area of high incidence of esophageal cancer. It covers Northern Iran, Central Asia, Kazakhstan, Yakutia, some areas of China and Mongolia. In addition to these territories, very high incidence is observed in a number of countries South Africa. The incidence of esophageal cancer has increased in France and Brazil. India, as well as in the USA among the black population. In the majority European countries the tumor is relatively rare (men - 4-7, women 1-2 per 100,000 population). In high incidence areas, esophageal cancer is 5 to 10 times more common in Indigenous people than in non-Indigenous people. Such significant differences may be associated with dietary patterns, but the influence of genetic factors cannot be ruled out.

Share of esophageal cancer among others oncological diseases is about 2%. At the same time, over the course of a number of years, there has been a downward trend in its share in the overall cancer incidence among both men and women. The proportion of deaths from esophageal cancer among total number deaths from various forms of cancer. It is distributed very unevenly throughout Russia. Among the economic regions, the most cases are in the Northern Economic Region (incidence in men is 13.1 and in women 2.4 per 100 thousand population). The lowest incidence is among men in the North Caucasus region (3.9), among women in the Central Chernozem region (0.45).
Among the administrative territories, the highest incidence of esophageal cancer is in the republics of Sakha (men 33.1 and women 7.7 per 100 thousand population) and Tyva (23.1 and 22.3, respectively), Magadan (19. 0 and 1.4) and Arkhangelsk (15.1 and 3.1) regions, Buryatia (15.0 and 3.6). The lowest incidence rate among men is in the Republic of Adygea (4.0), among women - in the Kursk region (0.20) and in North Ossetia (0.31), despite the fact that in the Jewish Autonomous Region and Chukotka District the incidence rate among women is not at all registered.

Contributing Factors

Various factors contribute to the occurrence of esophageal cancer. On the territory with low level Smoking and alcohol abuse play the largest role in morbidity.
In areas with high incidence rates, the carcinogenic effect is associated with eating too hot food and drinks, eating small-boned fish and hard frozen meat. A monotonous diet with insufficient consumption of fruits and vegetables is important, as a result of which a deficiency of vitamins A, C and riboflavin is created in the body.

Risk factors for the development of esophageal cancer are recognized as systematic contact with carcinogenic substances, chronic radiation exposure, excessive mechanical, thermal, chemical irritation of the esophageal mucosa, cicatricial narrowing of the esophagus after chemical burns, its achalasia, hiatal hernia, reflux esophagitis.

Precancerous diseases

Repeated exposure to harmful factors leads to microtrauma or thermal damage to the mucous membrane of the esophagus, causing and maintaining chronic esophagitis. Chronic esophagitis creates conditions for the toxic effect of carcinogenic substances contained in tobacco smoke and arriving as part of food products, which is often accompanied by dysplasia of the epithelium of the esophageal mucosa. Precancerous diseases also include peptic ulcer of the esophagus, polyps and papillomas of the esophagus, cicatricial strictures, sideropenic dysphagia (Plummer-Vinson syndrome).

Diagnostics

"Alarm signals." Making one assume the possibility malignant neoplasm esophagus are:

dysphagia of any severity, occurring regardless of mechanical, thermal or chemical injury to the esophagus;
the sensation of a bolus passing through, pain or discomfort along the esophagus that occurs when eating;
repeated regurgitation or vomiting, especially with blood;
Hoarseness that appears for no reason;
painful cough that occurs when taking liquid.

Instrumental research methods are crucial in recognizing esophageal cancer. X-ray examination of the esophagus reveals:

disruption of the relief structure of the mucous membrane;
detection of filling defect; the presence of a shadow of a tumor node;
lack of esophageal peristalsis.

The possibilities of X-ray examination increase with double contrasting of the esophagus and examination in conditions of pneumomediastinum. Esophagoscopy should be performed at the slightest suspicion of esophageal pathology. This is a direct method for diagnosing a tumor. The level of damage, the shape of the tumor, the degree of narrowing of the esophagus, the presence of decay or bleeding from the tumor are determined. During esophagoscopy, material is taken for cytological and histological examination. The information content of these methods is very high.

Staging of esophageal cancer

There are four stages of esophageal cancer:

Stage I - a clearly demarcated tumor up to 3 cm in diameter, growing only into the mucous and submucosal membrane of the esophagus; The patency of the esophagus is not impaired, there are no metastases.

Stage II - a tumor 3-5 cm in size, growing through all layers of the esophagus, with single metastases to regional lymph nodes.

Stage III - a tumor measuring 5 cm or less, extending beyond the esophagus into the peri-esophageal tissue; the lumen of the esophagus is significantly narrowed; multiple metastases to regional lymph nodes.

Stage IV - the tumor grows into neighboring organs, distant metastases.

Clinical picture

Clinical symptoms of esophageal cancer can be divided into three groups: primary or local symptoms caused by damage to the walls of the esophagus; secondary symptoms resulting from the spread of the tumor process to neighboring organs and tissues; general symptoms caused by intoxication and malnutrition.

Primary symptoms include dysphagia, chest pain, feeling of fullness behind the breastbone, regurgitation of food, increased salivation. Almost all of these symptoms indicate a fairly large spread of the pathological process along the esophagus.

Typical symptoms of esophageal cancer are caused by the obstruction phenomenon. The most striking of them is dysphagia - difficulty passing food through the esophagus. Dysphagia is caused by a narrowing of the lumen of the organ by a growing tumor (mechanical dysphagia), but sometimes it depends on spasm in the overlying parts of the esophagus (reflex dysphagia).

In most cases, dysphagia increases gradually. At first, there are barely noticeable delays in the passage of solid food through the esophagus. The patient seems to feel a hard bolus of food moving through the esophagus. The narrowing progresses, and soon the patient is forced to take solid food with a sip of water or refuse to eat main courses. Subsequently, after a few weeks or months, semi-liquid food stops passing through. and then liquid. Such a consistent development of dysphagia is not always observed. Sometimes, as a result of tumor disintegration or drug treatment, the patency of the esophagus is partially or completely restored. The improvement does not last long, and soon dysphagia begins to progress again.

There are 5 degrees of dysphagia:

I degree - any food passes, but when swallowing solid food, unpleasant sensations occur (burning, scratching, sometimes pain);

II degree - solid food is retained in the esophagus and passes with difficulty, you have to wash down solid food with water;

III degree - solid food does not pass. When trying to swallow it, regurgitation occurs. Patients eat liquid and semi-liquid food;

IV degree - only liquid passes through the esophagus;

V degree - complete obstruction of the esophagus. Patients are unable to swallow a sip of water; even saliva does not pass through.

Important symptoms for diagnosis are food regurgitation and esophageal vomiting. Regurgitation is most often caused by spasm and occurs immediately after eating. Esophageal vomiting occurs with severe stenosis some time after eating. Regurgitation along with others dyspeptic disorders(belching, heartburn, nausea) may be the first symptom of the disease in some patients.

In some cases, excessive salivation (hypersalivation) occurs quite early, but more often it occurs with severe stenosis. Hypervaluation is considered as a protective reflex that makes it easier for food to overcome an obstacle.

Along with the listed signs, esophageal cancer may be accompanied by an unpleasant or even foul odor from the mouth, which depends on the disintegration of the tumor and putrefactive processes above the narrowing and is felt by the patient himself or detected by others.

Secondary symptoms are late manifestations of esophageal cancer. They indicate complications of the disease, due to the process going beyond the walls of the esophagus. Secondary symptoms are hoarseness, Horner's triad (miosis, pseudoptosis, endophthalmos), increased local lymph nodes, bradycardia, coughing attacks, changes in voice sonority, vomiting, shortness of breath, suffocation with stridor breathing.

From common symptoms, inherent in malignant neoplasms of internal organs, with esophageal cancer there is a progressive loss of body weight, up to cachexia, increasing general weakness, fatigue, and anemia.

Treatment

Treatment of patients with esophageal cancer is one of the most challenging tasks in clinical oncology. They use surgical, radiation and combined methods. Chemotherapy as independent method Treatment for esophageal cancer is ineffective.

The choice of treatment depends on the location of the tumor and its extent. Cancer of the abdomen and lower third of the thoracic region is treated surgically. For cancer of the middle third of the thoracic esophagus, both surgical and radiation treatment are used. Cancer of the upper third of the thoracic region and cervical esophagus is subject to predominantly radiation treatment.
Surgical treatment of esophageal cancer consists of subtotal resection or extirpation and subsequent plastic surgery with a gastric, small- or colonic graft.
In order to improve treatment results, radical surgery is supplemented with radiation therapy, often pharmacomodulated (with the simultaneous administration of antitumor chemotherapy drugs).

For inoperable tumors, palliative treatment is used, including some types of surgical interventions (palliative resection of the esophagus, gastrostomy).

General signs of diseasesesophagus

The most important sign of esophageal damage is dysphagia- a feeling of difficulty swallowing, difficulty moving a bolus of food through the esophagus. Dysphagia is caused by both functional (there are no visible changes in the esophagus, only its motor function is impaired) and organic reasons (narrowing of the esophagus after a chemical burn, tumor). Organic lesions are characterized by the appearance of dysphagia, first when taking solid food and then liquid food. At functional disorders ah, or the passage of liquid and solid food is immediately difficult, or swallowing is initially difficult liquid food, then hard.

The second characteristic sign of damage to the esophagus is chest pain, which occur immediately after or during a meal. With functional diseases of the esophagus, chest pain can also occur during emotional stress.

Reflux-esophagitis

The main risk factors for the development of EC are conditions in which, firstly, the tone of the lower esophageal sphincter decreases; secondly, intragastric pressure increases; thirdly, evacuation from the stomach slows down. Often there is a combination of two or three of these reasons. Because of this, hiatal hernia should be considered a risk factor. Peptic ulcers, obesity, and pregnancy contribute to increased intragastric pressure. Intragastric pressure increases with fast and heavy meals, consumption of increased quantity fats, especially refractory ones, flour products, hot seasonings. Alcohol, smoking, chocolate, and coffee significantly reduce the tone of the lower esophageal sphincter. There are a number of widely used medicines, which also contribute to a decrease in the tone of the lower esophageal sphincter: nitrates, calcium antagonists, narcotic drugs.

Two constant signs of reflux esophagitis are heartburn and pain in the chest during eating, as well as at rest. Both signs arise or intensify when the body is tilted forward, when overeating, severe cough, heavy lifting, sudden muscle tension abdominals. They are also caused by drinking coffee, tomatoes, citrus fruits, chocolate, and alcohol. Helps with heartburn and pain baking soda, milk, antacid agents (Almagel, Maalox, phosphalugel, Rennie) Patients are also concerned about belching, regurgitation; in severe forms, dysphagia may appear.

Treatment of reflux esophagitis is carried out by a gastroenterologist. Before prescribing treatment, it is necessary to undergo an examination to confirm the diagnosis of inflammation of the esophagus.

However, much depends on the patient to achieve the treatment effect. Reducing body weight is of great importance; in patients with increased weight, the diaphragm is high, intragastric pressure increases and reflux into the esophagus increases. The simplest and effective method weight loss - reducing the daily caloric intake of food. The diet should avoid foods that reduce the tone of the esophageal valve or sphincter - coffee, strong tea, chocolate, fatty meats. You should stop smoking and drinking alcohol. The last meal should be 3-4 hours before bedtime. It is recommended to sleep with the head end of the bed raised by 15-20 cm.

Representatives of three groups of drugs are used in modern conditions: H-2 blockers histamine receptors(ranitidine, famotidine), proton pump blockers omeprazole) and motility modulators gastrointestinal tract(metoclopramide, cisapride). The drugs of the first two groups reduce the acidity of gastric juice, the latter increase the tone of the gastroesophageal sphincter. The doctor gives specific recommendations for taking and dosing medications.

Esophageal carcinoma

At the slightest symptoms from the esophagus, you should immediately consult a doctor and undergo necessary research. Early detection of esophageal cancer is the key to successful treatment. The most effective is a combination of surgery and radiation treatment.

Functional disorders of the esophagus

The most common symptom of the disease is dysphagia. It tends to wax and wane over a fairly long period of time. Less often than dysphagia, pain in the sternum is observed, sometimes it occurs clearly during meals, sometimes it is not associated with food.

The appearance of these phenomena requires immediate medical examination and research. This is necessary to rule out more serious diseases of the esophagus, primarily tumors. When this is done, the doctor will prescribe treatment.

In severe forms of functional disorders of the esophagus, consultation with a psychologist or psychotherapist is required, an in-depth study of the psychological status is required to identify the internal, often deep and unconscious conflict that caused functional impairment. Correction of such a conflict can be achieved using psychotherapeutic techniques.

Symptomatic treatment is carried out by a therapist. Patients are advised to eat food in a calm environment, eat slowly, and chew it thoroughly. From medications Long-acting nitrates are effective. The calcium antagonist nifedipine (Corinfar) has a good effect. It is prescribed 10-20 mg three times a day before meals.

Hiatal hernia

A hiatal hernia is a chronic disease in which the esophagus, stomach, and rarely intestinal loops are displaced through a hole in the diaphragm into the chest cavity (see diagram). A hiatal hernia contributes to the development of inflammation of the esophagus (reflux esophagitis). A common sign of a hiatal hernia is pain behind the sternum, in the epigastric region, and in the left half of the chest. Pain appears after eating, during physical activity, in a horizontal position, when coughing, against the background of bloating. Relieves pain after belching, regurgitation, vomiting, and drinking soda. We must remember that pain from a hiatal hernia requires special attention, since it is similar to pain from angina, peptic ulcer, and chronic pancreatitis. A hiatal hernia is often combined with these diseases. Patients also complain of heartburn, pain when swallowing, and disturbances in the movement of food through the esophagus. In some patients with hiatal hernia, gastric contents from the esophagus enter the respiratory tract. A cough appears, there may be shortness of breath, bronchitis and pneumonia occur. A hiatal hernia is recognized using an x-ray. It is necessary to examine the patient not only “standing”, as is usually done, but always in the “lying” position. Treatment of a hiatal hernia is aimed primarily at preventing an increase in intra-abdominal pressure. It is necessary to avoid heavy lifting, frequent bending forward, and tightening the belt. You should sleep with the head of the bed raised. Dietary measures are important. Meals should be at least 4 times a day, dinner 2-3 hours before bedtime, eat slowly. It is necessary to limit the consumption of hot, spicy foods, foods that reduce the tone of the lower esophageal sphincter - coffee, chocolate. Drug treatment is the same as for reflux esophagitis. In cases of severe disease, surgical intervention is used. A patient with a hiatal hernia should be observed by a gastroenterologist.

Esophageal diverticula

Esophageal diverticula are limited sac-like protrusions of the esophageal wall, facing outward (see diagram). Diverticula can be single or multiple. They are formed in people with greater compliance of the walls of the esophagus than in healthy people as a result of increased pressure inside the esophagus or “pulling” of the esophagus from the outside by adhesions. Very often, diverticula of the esophagus do not manifest themselves; they are detected by chance during an X-ray examination. With high-lying diverticula, there may be a cough, a feeling of dryness in the throat and a feeling of a foreign body along the esophagus when swallowing. Patients with very large diverticula experience disturbances in the movement of food through the esophagus, regurgitation, and night cough. After recognizing diverticula, a gastroenterologist decides on the method of treatment. Regime and diet are of great importance. The food you eat should be crushed, you should eat slowly, in small portions. After eating, it is advisable to drink a few sips of water. You should sleep with the head of the bed raised. Before eating, it is advisable to take one teaspoon of vegetable oil. An inflammatory process called diverticulitis can occur in diverticula. In these situations, antibiotics are prescribed - 2-3 courses of 5-8 days with a break of 10 days. If treatment is insufficiently effective, indications for surgery are given.

Esophageal achalasia

Achalasia is an enlargement of the esophagus that develops due to a decrease or inability of the lower esophageal sphincter to relax during the act of swallowing, combined with a decrease in the force of contraction of the esophagus. Among the causes of esophageal achalasia are the consumption of very cold food, cold drinks, vitamin B1 deficiency, as well as frequent stressful situations and psycho-emotional disorders. At the initial stages, the disease can be considered as purely functional, but over time, persistent changes are detected in the nerve cells of the middle and lower thirds of the esophagus. The main symptom of achalasia is difficulty swallowing. They vary in severity and intensity, and it is equally difficult to swallow both liquid and solid food. Patients also complain of chest pain. Pain can occur directly during swallowing, as well as outside of eating. Typical of achalasia is regurgitation. Esophageal achalasia is recognized using x-ray and esophagoscopy. More complex diagnostic methods are also used. In most cases, treatment of achalasia begins with general measures, especially in the initial stages of the disease. If possible, you should avoid stressful situations and negative emotions. Food should be mechanically and chemically gentle, i.e. crushed, not spicy, with enough proteins and vitamins. Food should be taken 6 times a day, in small portions. Drug treatment is carried out with prolonged nitrates and calcium antagonists (verapamil and nifedipine). The course of treatment is usually 1 month; if it is insufficiently effective, instrumental expansion of the lower esophagus is performed.