Inflammation of the esophagus

introduction

The esophagus, in medicine from Latin Esophagus called, is the Part of the digestive tractwho the Mouth and throat area with the stomach connects.

It is a matter of some kind of hosefrom a outer muscle layer and one inner, final to the cavity of the tube Mucous membrane consists.

By exactly coordinated contraction the musculature becomes the pulp on the mucous membrane pushed to the stomach. At the transition to the stomach, as at the upper end, there is a annular sphincterthat ensures that stomach contents not back into the esophagus can arrive.

A Inflammation of the esophagus, in technical language Esophagitis, is not a rare disease in Germany. About 1% of the population suffers from this clinical picture.
The inflammation of the esophagus can various causes have and is mostly through a Weakness of the lower sphincter of the esophagus (lower esophageal sphincter) on the floor of the Reflux disease conditionally, with the stomach contents back to the esophagus got. Here one speaks of one Reflux esophagitis.
An inflammation of the esophagus can also by viruses or fungi be evoked.

Symptoms

In most cases, a Inflammation of the esophagus a row classic complaintswhich, taken as a whole, lead relatively quickly to the correct diagnostic path.

Especially with the reflux-related inflammation the esophagus is the first thing patients notice uncomfortable heartburnthat lasts for a long time and above all after eating or lying down occurs. There is heartburn in this case not a symptom of inflammation in itselfbut expression of the causal problemnamely, a weakness of the lower sphincter.
It should be said that mild heartburn after high-fat and very voluminous meals is quite normal, but becomes a symptom if it is also after light meals or permanent complaints power.

A leading symptom in all types of inflammation of the esophagus Painthat special behind the breastbone specified and by stinging or burning character are. The pain can also increase a little deeper in the area of ​​the upper abdomen to make noticable. This pain can be caused by inflammation of the esophagus especially worse when swallowing become.

Besides that you can difficulty swallowing in the course of the disease with swallowing and the Feeling of "getting stuck" occur in the throat. In addition to this, a increased belching or burping observed what besides the heartburn first signs inflammation of the esophagus.

In rare cases, patients complain Difficulty breathing.

In addition, in most cases, the inflammation of the esophagus causes one clearly noticeable bad breath.

causes

A Inflammation of the esophagus means nothing else than that Mucous membranethat lines the esophagus through a disturbing factor attacked and damaged becomes. This gets in addition to the direct damage inflammatory reactions and causes the above complaints.

The main cause of an inflamed esophagus is by far one reflux-related damage the mucous membrane. It flows Stomach acid from the stomach back into the esophagus and leads to irritation here as the lining of the esophagus not designed for this acidic environment is. Mainly responsible for this is hydrochloric acid, which largely makes up gastric secretions and directly attacks the mucous membrane. Come next Protein-breaking enzymes that attack the tissues of the esophagus
Hike in response the body's own defense cells into the affected area and try to repair the damage. This along with the demise of cells triggers a Inflammation of the esophagus out.

Usually prevents the lower sphincter However, there are a number of reasons why it can cause it to develop in the esophagus Can no longer fulfill the task and insufficiency occurs. One distinguishes primary from secondary causes a malfunctioning lower sphincter.

Primary direct causes are especially congenital or acquired malformations respectively Misalignments of the stomach and esophagus, whereby the stomach and thus the lower part of the esophagus from the abdomen a little way or all the way into the chest slips. This bothers them nerve supply of the sphincter.

Are more common secondary causesthat through the Sphincteric insufficiency lead to inflammation of the esophagus. Typically lead Obesity or one pregnancy to a increased pressure in the abdomen, which exceeds the normal closing pressure of the sphincter and thus forces stomach acid into the esophagus.

Read more about this at: Heartburn during pregnancy

But also systemic diseases how Diabetes mellitus, neurological diseases or previously performed operations on the affected area potentially cause sphincter insufficiency.

It is also possible that through persistently wrong diet and lifestyle too much acid is produced in the stomach and, if the sphincter muscle is intact, reflux and inflammation of the esophagus still occur. Especially fat containing food, caffeine, alcohol and Cigarette smoke promote the Production of gastric juice.

As Contrasted with reflux esophagitis, caused by gastric acid reflux, can be a Inflammation of the esophagus also directly through those working on site Pathogens and substances to be triggered. However, these causes are significantly less often. Almost exclusively in patients who have a weakened immune system may cause inflammation of the esophagus Mushrooms how Candida albicans evoked what the so-called Thrush esophagitis has the consequence. In doing so, the esophagus is associated with this Colonized by pathogenscausing the inflammation.
Also known viruses as the Herpes virus or the rarer Cytomegaly virus are known to be the cause of esophageal inflammation. These diseases caused by pathogens are, however very rare and practically do not affect healthy people. In patients who e.g. because of a HIV infection or one leukemia are immunocompromised, they play a role.

Last should be considered rare causes of esophagitis chemical or physical damage how acid burns or Burns to be named.

therapy

The Therapy of inflammation of the esophagus is based on several stages, depending on Degree of inflammation and make more or less sense depending on the nature of the cause.

At slight discomfortthat through a Backflow of stomach contents are conditional, one should first refer to the right nutrition and one healthier lifestyle respect, think highly of. The goal is to create a persistent irritation the mucous membrane of the esophagus by reducing the Prevent backflow of stomach contents. Without these harmful effect, heals a simple inflammation of the esophagus by itself out.
Especially Carbonated drinks or fruit juices contain a lot of acid and encourage gastric juice to flow back into the esophagus. Caffeine, nicotine and also alcohol directly increase the production of hydrochloric acid in the stomach, so that renouncing these substances one effective measure can be.
The last food intakethat should be low in fat and not too opulent at least an hour or two before bed respectively. If just before going to bed the Hydrochloric acid production in the stomach increased the flat body position during sleep favors passage into the esophagus, which further sustains the inflammation. So you can be with for some time slightly raised upper body sleep.

Should this Measures are not enough, come as the next level Medication for use. Means of first choice for inflammation of the esophagus Proton pump inhibitors (PPIs). This directly inhibit certain proteins in the stomachthat produce the hydrochloric acid. So that is missing most potent damaging stimulus. Treatment is common over 2-4 weeks with one tablet of a PPI per day. These funds are well tolerated and have relatively few side effects.
Further medicinal measures are means that the Increase the tone of the lower sphincter or the Neutralize hydrochloric acid in the stomach. However, these are behind the scenes.

if the conservative and drug therapies the inflammation of the esophagus not treat adequately in rare cases must be sent to a surgery be thought. This is especially indicated when the lower sphincter muscle structurally damaged and can no longer close the stomach entrance, or a Eversion of parts of the stomach in the rib cage is causative.
The standard operating room here is the so-called laparoscopic fundoplication after Nissen or Toupee, in which one species Cuff around the lower esophagus to prevent backflow of stomach contents.

However, conservative therapy for reflux-related inflammation of the esophagus has that surgical approaches pushed into the background. Therapy for non-reflux inflammation consists of either Avoidance of chemical or physical noxae or in the causal therapy of the causative agent. Mushrooms are made with Amphotericin-B or fluconazole treated viruses with Acyclovir or ganciclovir.
As said above are pathogens only with existing serious underlying diseases Cause why the therapy of this underlying disease is an indispensable part of it.

diagnosis

At the beginning of the diagnosis there is one exact inquiry the patient's complaints. The typical symptoms of inflammation of the esophagus like acid regurgitation, heartburn and Pain behind the sternum are groundbreaking at the beginning. Especially when the Discomfort after eating or in certain body positions like that Lie or over head occur, the doctor should contact one inflammation caused by reflux think of the esophagus.
In the case of mild and not long-lasting complaints, this is sufficient to deal with a Therapy with a PPI to start.

With strong or therapy resistant complaints close other diagnostic methods on.
In order to clearly confirm the inflammation of the esophagus and to be able to assess the extent of the inflammation, an Endoscopy carried out. This is a thin flexible hoseat the end of which there is a camera, through the mouth or nose under local anesthesia and possibly sedative medication inserted into the esophagus. This allows the examiner to view the entire esophageal lining Damage to the mucous membrane or fungal deposits judge. Additionally can with a pair of pliers a small tissue sample or a smear on pathogens and examined in the laboratory become.

To the Diagnosis of inflammation of the esophagus to complete one can 24-hour measurement of acidity be made in the esophagus. A small, mostly nasally inserted probe comes to lie in the lower esophagus and measures continuously adjust the pH, so the acidity. This examination is especially useful when there are complaints in the endoscopy no cause proven could be.

forecast

The forecast inflammation of the esophagus caused by reflux mainly depends on how long the complaints have existed and how strong you are.

The vast majority of cases have very good prognosis and can be achieved with general measures mentioned above and a PPI to treat well. Inflammation of the esophagus then heals by itself in a few days or weeks.
It is important to take care of the disease won't come back.

However, it can be caused by gastric juice Inflammation of the esophagus in some cases too malignant changes in the mucous membrane lead, which is why one with existing complaints definitely to the doctor have to go. Through the lasting stimulus can spread to the bottom of the inflammation tumor which are far more complicated to deal with.

The simple inflammation The esophagus, however, is with adequate treatment no reason to worry. Immunocompromised patients with a Fungal or viral esophagitis however, they usually have difficult processes and require one Treatment by experts.

Possible consequences of a narrowing of the esophagus

One possible consequence of inflammation of the esophagus is narrowing of the esophagus, usually in the lower part.
This is characterized, among other things, by a more difficult transport of food to the stomach, as well as by heartburn.

prophylaxis

To avoid inflammation of the esophagus The main thing to do is to prevent Lifestyle changes on. Of the Avoid eating excessively high-fat meals such as alcohol and nicotine come first. To do this one makes conscious diet with adequate servings sense.

A Weight loss has in the long run as well positive effects. In addition, the Avoiding stress not insignificant too.

One through pathogenic agents caused inflammation of the esophagus can be difficult to prevent, because here this weakened immune system is the reason for the onset of the disease. Care must be taken here, high hygienic standards to meet the infection with e.g. prevent a fungus and treat the underlying disease.