Barrett's esophagus (BE) is a disease in which an area of stratified squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium, resembling the lining of the stomach or small intestine. This condition in medicine is called dysplasia, and its main danger is the high risk of malignancy, i.e. turning into cancer.
- Symptoms
- Forms of Barrett's esophagus
- Causes
- Diagnostics
- Treatment of Barrett's esophagus
- Complications
- Prevention
- Forecast
Symptoms
The symptoms of Barrett's esophagus are similar to gastroesophageal reflux disease, since it is the reflux of gastric contents that is the main cause of the development of this pathology. The patient may be concerned about:
- Heartburn. It can occur after eating, active physical activity, or bending the body. It should be noted that metaplastic epithelium is less sensitive to the action of gastric juice, so in such patients the symptoms of heartburn are mild. But upon questioning, it turns out that previously these symptoms in the patient were more pronounced.
- Belching.
- A burning sensation or pain behind the sternum.
- Dry cough.
- Feeling of heart failure.
- With severe metaplasia, dysphagia may develop - a violation of swallowing and the passage of a food bolus through the esophagus.
- Anemia. It develops rarely when BE is accompanied by erosive changes with hidden chronic bleeding.
Esophageal neurosis: symptoms
Neurosis is provoked by psychological disorders. This is a disease of the esophagus, the symptoms of which appear most often in women from 20 to 40 years old. They are most often exposed to stress. The disease is also provoked by fatigue, chronic lack of sleep, and depression. Symptoms of neurosis include:
- burning in the chest;
- heartburn;
- heaviness in the esophagus;
- pressure behind the sternum;
- retention of food in it (feeling of lump obstruction).
How is this disease of the stomach and esophagus treated? Treatment is aimed, first of all, at eliminating the cause of the neurosis. At the same time, medications with a mild sedative effect and vitamin complexes are prescribed. Problems with the esophagus (the symptoms are obviously varied) recede after the psychological state normalizes. At the same time, all negative symptoms disappear.
Forms of Barrett's esophagus
The following morphological variants of Barrett's esophagus are distinguished:
- Cardiac type. It is characterized by a surface in the form of pits (foveolar surface), the cellular composition contains mucin-producing cells.
- Fundal type. With this type of pathology, in addition to mucin-producing cells, there is the presence of cells characteristic of the gastric epithelium - chief and parietal cells.
- Cylindrical cell type. This variant of the pathology histologically resembles the intestinal mucosa, since the epithelium forms folds and, in addition to mucin-producing cells, contains goblet cells.
It is the latter variant of BE that is most susceptible to dysplastic changes and transformation into cancer. Therefore, many authors suggest that only metaplasia containing goblet cells be classified as Barrett's esophagus.
In addition, the disease is classified depending on the extent of the altered area. Here, a distinction is made between short Barrett's esophagus, when the length of the altered section does not exceed 3 cm, and long esophagus, when the length exceeds 3 cm.
HETEROTOPY OF THE STOMACH MUCOSA INTO THE ESOPHAGUS
Simonova E.V., Nikishaev V.I. *, Shchudro S.A. ** State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” Kiev City Clinical Hospital of Emergency Medical Care *, Ukraine State Institution “Regional Children's Clinical Hospital”
Introduction Heterotopia (from the Greek Heteros - other and topos - place), atypical localization of tissues or parts of organs, i.e. their presence in an unusual place for them (Virchow R.). An example of heterotopia is the identification of the gastric mucosa in the esophagus, elements of the pancreas in the stomach and intestines, the gray substance of the cerebral cortex in its white matter, etc. M. Borst et al. It is believed that heterotopia is the result of damage or changes in tissue differentiation in the early stages of development, but not a consequence of the transformation of one tissue into another (metaplasia) after the final formation of the organism. Heterotopy occurs as a result of migration of cells from one germ layer to another, displacement of cells within a given germ layer, or secondary displacement of organs. Ectopia (from the Greek ektopos - displaced), displacement of an organ into adjacent body cavities or outward due to a congenital defect (developmental defect) or traumatic damage to the walls of the cavity, congenital or acquired displacement of an organ or tissue to an unusual place. In the literature, heterotopia and ectopia are often combined into the concept of dystopia. Ectopic (heterotopic) gastric mucosa (GM) can be found in any part of the gastrointestinal tract. The condition in which it is localized in the upper part of the esophagus is called “heterotopia of the gastric mucosa in the esophagus” (“inlet patch”, “ectopic/heterotopic gastric mucosa in the upper esophagus”). In 1897, pathologist Shaffer J. reported cases of the presence in the proximal esophagus of glands containing parietal cells located above the muscle plasticity [5]. The frequency of heterotopia of the coolant in the esophagus, detected at autopsy, according to the literature, ranged from 0.7 to 70% [4, 5, 10, 12]. The frequency of endoscopically identified heterotopia of the coolant in the upper part of the esophagus ranges, according to the literature, from 0.1 to 10% [1, 2, 5, 10, 12]. Variend S., Howat AJ (1988) conducted a prospective analysis of the esophageal mucosa of 300 children aged 0 to 14 years who died for various reasons; gastric heterotopia was detected in 21% of cases [11]. According to Williams SM [12], this pathology is more common than is believed. The discrepancy between the frequency of ectopia according to autopsy and endoscopy can be explained, according to some authors, by the fact that the lesion can regress with age [10]. According to most researchers, the frequency of this pathology does not depend on the gender and age of patients [5], although according to H. Takeji et al. this pathology is more common in men[10].
Causes
The main cause of esophageal metaplasia is gastroesophageal reflux - the reflux of gastric contents back into the esophagus. At the same time, aggressive gastric juice irritates the mucous membrane and provokes the replacement of stratified squamous epithelium with columnar epithelium that is more resistant to such effects, i.e. metaplasia occurs - the replacement of one type of tissue with another. Further irritating action leads to the fact that the metaplastic epithelium forms a clone of cells with a violation of the system of programmed death (apoptosis). This condition is called dysplasia and subsequently leads to cancer.
Additional risk factors are:
- Esophageal-diaphragmatic hernia. They lead to constant disposition of the stomach and, as a consequence, to constant reflux.
- Obesity. Firstly, obesity leads to increased intra-abdominal pressure, which provokes reflux. Secondly, in this condition there is an increase in the volume of peri-esophageal fiber, which releases pro-inflammatory cytokines that negatively affect the esophageal mucosa.
- Smoking.
- Metabolic syndrome.
Retrograde prolapse
Let us dwell in more detail on the varieties of the disease being studied that may occur currently. With retrograde prolapse of the gastric mucosa into the esophagus, the cardiac part of the stomach transitions to the abdominal segment. In this case, a scalloped formation may appear, but it will not be in the stomach itself, but in its vestibule.
A layer of contrast agent forms between the prolapsed mucous membrane and the walls of the esophagus, which in the image resembles a narrow ring in appearance. If at this time the esophagus is inserted into the cardiac part of the stomach, its corolla becomes as clear as possible in the photographs.
Variability in X-ray images is typical for retrograde prolapse of the gastric mucosa. Note that such changes should not be confused with a hernia in the esophageal opening of the diaphragm.
Diagnostics
To make a diagnosis, an endoscopic examination with a biopsy and subsequent morphological examination of a fragment of suspicious tissue is necessary.
Endoscopy involves examining the wall of the esophagus using a tube equipped with a video camera, a light source and manipulation instruments. The camera transmits an enlarged image to the monitor, which allows the doctor to examine the mucous membrane in more detail. Metaplastic epithelium looks like foci of hyperemia against the background of pearly white normal epithelium of the esophagus. They are also called tongues of flame. Upon closer examination, it is clear that the metaplastic zones are atrophic; blood vessels running in the longitudinal direction are visualized in them.
If the visual picture is in doubt, the doctor can use chromoendoscopy, in which suspicious areas are stained with special dyes, for example, Lugol's solution, methylene blue, 1% acetic acid, etc.
In addition, during endoscopy the following characteristics are described:
- Length of transformed mucosa.
- Relation of the transformation zone to the gastroesophageal junction.
- Level of the proximal border and its position relative to the incisors.
- Presence of strictures.
The main point in diagnosing BE is a morphological study, in which a fragment of the obtained tissue is examined under a microscope. In this case, not only the presence of metaplasia and goblet cells is noted, but also a search is conducted for foci of dysplasia and possible adenocarcinoma of the esophagus. As a rule, a biopsy is used to obtain material, in which a piece of tissue is split off using manipulation instruments.
It became clear how a precancerous condition of the esophagus occurs - Barrett's syndrome
Rice. 1.
Schematic representation of the epithelium at the junction of the esophagus (Oesophagus) and stomach (Stomach), in which epithelial cells of different types are found. Transitional epithelium is formed by basal layer and luminal layer cells, which are characterized by different levels of expression of three marker proteins (p63, KRT5 and KRT7). Reflux caused by bile acids or abnormal gene expression can cause the border region epithelium to become abnormal - similar to intestinal epithelium - with inclusions of goblet cells, and a proliferating structure called Barrett's oesophagus is formed. Drawing from a popular synopsis for the article under discussion
Scientists were able to understand the mechanism of occurrence of a precancerous condition at the junction of the esophagus and stomach - Barrett's syndrome. They were able to characterize the epithelium in this border region in detail and showed in laboratory mice that basal cells with a specific set of markers can become the precursors of intestinal-like tissue that replaces the normal epithelium of this region. Cells with similar properties are found at the border of the esophagus and stomach in humans, so this research should help improve methods for early diagnosis and treatment of cancer.
It is well known that the earlier cancer is diagnosed and treated, the easier the treatment itself can be and the higher the chances of recovery. For some types of cancer, so-called precancerous conditions have been identified - tissue changes that are not malignant in themselves, but increase the likelihood of cancer developing in these tissues. Such conditions are currently known for a relatively small number of cancers. Therefore, on the one hand, it is necessary to try to expand the list of correspondences between malignant tumors and precancerous conditions, and on the other hand, to clarify the mechanisms of occurrence of these conditions in order to increase the effectiveness of cancer prevention.
One of the types of precancerous conditions is metaplasia, in which cells of one type are replaced by cells of another (usually reversible). Metaplasias often occur at the boundaries between different types of epithelium and can in such cases give rise to carcinomas - malignant tumors of epithelial cells. Epithelium is the tissue that lines the surface of the body (that is, roughly speaking, the skin), internal cavities and mucous membranes of organs. In Russian medicine, two main types of epithelium are distinguished: stratified squamous epithelium (skin, mucous membranes, esophagus) and single-layer columnar epithelium (stomach, intestines). Particularly distinguished are the epithelium lining organs that undergo strong stretching (for example, in the urinary system), the so-called transitional one. In Western medicine, a more detailed classification of epithelium has been adopted (see Epithelium).
The most common and actively studied form of metaplasia is Barrett's esophagus (Barrett's syndrome). This is a dangerous complication of reflux disease - the reflux of stomach contents into the esophagus, in which the stratified squamous epithelium normally characteristic of the esophagus in the border area of the junction of the esophagus with the stomach is replaced by a cylindrical one (characteristic of the stomach) interspersed with goblet cells characteristic of the intestines - “single-cell glands” that secrete moisturizing mucus (see Fig. 1). The frequency of occurrence of the syndrome with reflux is 10%, and in the general population - 1%. Over the past 40 years, the incidence of Barrett's esophagus has increased almost 8-fold. It is considered a precancerous condition because highly lethal adenocarcinoma of the lower esophagus occurs 10 times more often in it than in the normal esophagus.
Although Barrett's syndrome has been extensively studied since its description in 1950, the key processes involved in its development have remained unknown: how does the replacement of squamous epithelium with columnar epithelium (metaplasia) occur? from which cells does the newly formed columnar epithelium of the esophagus originate? How does the subsequent transformation into malignant neoplasms proceed?
Five main theories have been proposed to explain metaplasia (they are schematically shown in Fig. 2): 1)
direct conversion of squamous epithelium to columnar epithelium is possible - damage can cause the transformation of one type of tissue into another (Fig. 2, a);
2)
the precursors of columnar epithelium are stem cells circulating in the bloodstream that are capable of differentiating into columnar epithelium (Fig. 2, b);
3)
the precursors of the cylindrical epithelium are the cells of the submucosal (mucosal) glands localized under the squamous epithelium (Fig. 2, c);
4)
expansion into the border region of columnar epithelial cells of the stomach is possible (Fig. 2, d);
5)
the precursors of the cylindrical epithelium are residual embryonic cells localized near the border region (Fig. 2, e).
Rice. 2.
Hypotheses for the occurrence of Barrett's esophagus, proposed earlier.
a
— redifferentiation of the squamous epithelium of the esophagus;
b
— differentiation of bone marrow stem cells circulating in the blood;
c
— expansion of cells of the mucous glands of the esophagus and their transformation into Barrett’s epithelium;
d
— transformation of stem cells of mucous glands;
e
- expansion and differentiation of dormant residual embryonic cells of the border region of the esophagus/stomach.
Figure from the discussed article in Nature
But none of these theories has received strict experimental confirmation. And none explained the appearance of inclusions of goblet cells characteristic of the intestines (and not the esophagus or stomach).
A large team of scientists from Columbia University Medical Center and other scientific institutions in the USA and China conducted a comparative analysis of the expression of genes characteristic of the epithelium. They showed that in mice the border epithelium, consisting of basal and luminal (facing the lumen of the esophagus) cells, is characterized by different expression of three markers in these cells. Basal cells express two cytokeratins, Krt5 and Krt7, as well as the transcription regulatory factor p63. Only Krt7 is expressed in cells of the luminal layer. This distinguishes the border region from the superior region of the esophagus, in which neither the basal cells nor the squamous epithelium express Krt7 (Fig. 1). None of these markers are expressed in the gastric epithelium.
Rice. 3.
Diagram of the anastomosis between the duodenum and esophagus of a mouse, resulting in bile acids (
red arrows
) entering the esophagus.
Figure from the discussed article in Nature
In the next series of experiments, the authors performed delicate surgery on mice and made an anastomosis between the esophagus and duodenum (Fig. 3). As a result, bile acids entered the esophagus, which made it possible to simulate reflux.
Eighteen weeks after surgery, exposure of the border region to bile acids resulted in the formation of Barrett's esophagus cells that expressed the characteristic marker CDX2, and goblet cells appeared in this region. Notably, no such cells were observed in the superior portion of the esophagus, even though it was also exposed to bile acids.
Scientists decided to exclude the possibility of replacing the epithelium in the border area of the esophagus with migrating cells from neighboring tissues. To do this, using genetic engineering methods, they obtained mice in which the expression of the Krt7
in epithelial cells of the border region was associated with the expression of the red fluorescent protein
Tomato
.
Experiments have shown that columnar epithelial cells of Barrett's esophagus express Tomato
, that is,
Krt7
.
And as already mentioned, the Krt7
is expressed in the epithelium of the border region, but is not expressed in the upper region of the esophagus and in the stomach. Consequently, the columnar epithelial cells of Barrett's esophagus are derived exclusively from the basal cells of the border region (Fig. 4).
Rice. 4.
Precursors of basal cells (expressing p63 and KRT7 genes) and luminal cells (KRT7+) of the epithelium of the esophagus/stomach border in mice.
Squamous epithelium - flat epithelium of the esophagus. Transitional epithelium - epithelium of the border region of the esophagus. Cardia - stomach. Figure from the discussed article in Nature
In conclusion, the authors decided to check how similar the structure of the border region between the esophagus and stomach is in humans and in mice. They analyzed the expression of human epithelial markers and showed their similarity to mouse ones. In this region in humans, basal cells with expression of the p63, KRT5 and KRT7 genes were found, as well as luminal cells in which KRT7 was expressed, but there was no expression of the p63 gene. In basal cells belonging to the superior region of the esophagus, KRT7 was not expressed (Fig. 5).
Rice. 5.
In the border area of the human esophagus and stomach, a specific transitional epithelium is localized, which grows in Barrett's esophagus.
a
- microscopic image of basal cell precursors (marked
by arrows
) and luminal epithelial cells, stained with hematoxylin and eosin.
The length of the scale bar
is 50 µm.
b
— basal cells of the epithelium of the border region express the p63, KRT5 and KRT7 genes (expression products are marked
with triangles
).
Esophageal squamous basal cells do not express KRT7 (marked with arrows
).
Immunohistological staining with various fluorescent dyes. The length of the scale bar
is 50 µm.
c
- diagram of the structure of the epithelium of the border region of the human esophagus/stomach, symbols as in Fig.
4. Figure from the discussed article in Nature
Using flow cytometry, two types of basal cells of the human esophagus (with markers p63+KRT7− and p63+KRT7+) were separated. From these cells in vitro
Three-dimensional cultures of organoids were obtained and it turned out that organoids obtained from p63+KRT7+ cells and originating from the border region of the esophagus are capable of forming epithelial cells similar to intestinal epithelium. Organoids obtained from p63+KRT7− cells taken from the upstream region did not have this property.
Thus, scientists were able to use a model of laboratory mice to characterize the epithelium of the border region between the esophagus and stomach, which gives rise to a precancerous condition - Barrett's esophagus, and also to verify that in humans everything is structured similarly. It turned out that this epithelium is more sensitive to damaging factors than the epithelium of the higher areas of the esophagus or the epithelium of the stomach. The results obtained are in best agreement with the previously put forward hypothesis of the origin of Barrett's esophagus about the direct transformation of epithelial tissues of the border region: it was shown that the basal cells of the border epithelium can be the precursors of epithelium similar to the intestinal one, which includes goblet cells.
At the same time, the genetic markers of border zone epithelial cells identified during the study as such are unlikely to be the cause of the formation of Barrett's esophagus and the further development of cancer. There are likely other factors involved, such as acid reflux, other chemical irritants, hormonal imbalances, or viral infections.
Despite remaining questions, the work discussed provides a detailed picture of the formation of Barrett's esophagus. Since precancerous conditions and malignant tumors especially often occur in the border areas of the epithelium of different organs (uterus, esophagus, rectum), we can hope that similar mechanisms operate there. However, further research will have to clarify this issue, as well as whether the border epithelium is the only site of occurrence of this metaplasia and its further transformation into cancer. After all, it has long been shown that a structure similar to Barrett’s esophagus can also arise in patients in whom the border region of the esophagus has been removed (SR Hamilton, JH Yardley, 1977. Regnerative of cardiac type mucosa and acquisition of Barrett mucosa after esophagogastrostomy). So the results obtained can contribute to the development of methods for diagnosing, preventing and treating these conditions not only in relation to the esophagus, but also to other organs.
Sources:
1) Ming Jiang, Haiyan Li, Yongchun Zhang, Ying Yang, Rong Lu, Kuancan Liu, Sijie Lin, Xiaopeng Lan, Haikun Wang, Han Wu, Jian Zhu, Zhongren Zhou, Jianming Xu, Dong-Kee Lee, Lanjing Zhang, Yuan -Cho Lee, Jingsong Yuan, Julian A. Abrams, Timothy C. Wang, Antonia R. Sepulveda, Qi Wu, Huaiyong Chen, Xin Sun, Junjun She, Xiaoxin Chen & Jianwen Que.
Transitional basal cells at the squamous-columnar junction generate Barrett's oesophagus // Nature.
2017. V. 550. P. 529–533.
2) Lizhe Zhuang & Rebecca C. Fitzgerald. Cancer development: Origins in the oesophagus // Nature.
2017. V. 550. P. 463–464. Synopsis for the article under discussion.
Vyacheslav Kalinin
Treatment of Barrett's esophagus
Drug therapy
As part of drug therapy, long courses of drugs that suppress the secretion of hydrochloric acid are prescribed. First, basic therapy is carried out for 8-12 months, and then they move on to maintenance treatment. The main drugs are proton pump inhibitors, which are prescribed in dosages exceeding recommendations for the treatment of GERD. In addition, antacids that neutralize stomach acid, prokinetics, etc. can be used.
The goal of drug therapy is:
- Control over the secretion of gastric juice, in particular its reduction.
- Reducing the damaging effect of acid on the walls of the esophagus.
- Relieving symptoms and improving the quality of life of such patients.
- Creating conditions for restoration of normal epithelium.
- Reducing the risk of dysplasia and malignant transformation.
Surgery
Antireflux operations are used as part of surgical treatment. They are carried out according to the following indications:
- Presence of a hiatal hernia.
- Insufficiency of the function of the lower esophageal sphincter, proven manometrically and radiologically.
- Ineffectiveness of drug therapy.
The following types of operations are used:
- Fundoplication is the strengthening of the lower esophageal sphincter by creating a cuff around it from the walls of the fundus of the stomach.
- Crurorrhaphy is an operation aimed at suturing the hernial orifice in the diaphragm and strengthening the esophageal-diaphragmatic ligament.
It should be emphasized that surgical treatment does not lead to the abolition of drug therapy. It still has to be continued.
Endoscopic treatment
None of the above methods leads to complete regression of the metaplastic epithelium. Therefore, another stage of treatment is used - endoscopic ablation of the altered mucosa. For this purpose, various technologies are used:
- Argon plasma coagulation.
- Cryoablation.
- Electrocoagulation.
- Photodynamic therapy.
- Laser therapy.
- Radiofrequency ablation.
These methods make it possible to remove not only the metaplastic epithelium, but also its precursor cells - stem cells that have acquired differentiation features characteristic of the intestinal epithelium.
One of the most effective and safe endoscopic treatment technologies is radiofrequency ablation. Its action is based on the thermal effect on the lesions and their destruction. In this case, the doctor can control both the temperature of tissue heating and the depth of exposure. This allows for complete ablation with minimal risks of adverse reactions.
Treatment methods
Note that in most cases, specialized treatment for prolapse of the gastric mucosa into the esophagus is not required. The list of certain therapeutic measures is determined by the presence of a specific list of symptoms in the patient. If acid reflux occurs regularly and heartburn persists, drug treatment is prescribed. It is based on taking medications that block secretions and neutralize the acid found in the gastric juice. In fact, they are designed to relieve the symptoms of heartburn.
When treating prolapse of the gastric mucosa, surgical intervention is required only in cases where conservative therapy does not bring any results. However, he admits that in the vast majority of cases it is not necessary to resort to extreme measures.
Sometimes it is advisable to treat excessive elasticity of the folds of the mucous membrane of the main digestive organ, as well as decreased strength of the diaphragm. This approach is considered reasonable only if the patient experiences severe discomfort.
The list of therapeutic measures in this case is based on taking certain medications. These are proton pump inhibitors (Rabeprazole), antispasmodics (Drotaverine), antacids (Phosphalugel), prokinetics (Domperidone).
To relieve certain unpleasant sensations that can cause severe discomfort to the patient, as a rule, it is enough to use one of the remedies. To completely get rid of this pathology, surgery will be required. Only thanks to it, the patient will have the opportunity to restore the originally existing anatomical position of the organs. However, surgery is not always considered advisable; it is performed only if there is no response to drug treatment, and also when the hernial sac grows to too large a size.
Complications
The main complication of Barrett's esophagus is malignant transformation into adenocarcinoma secondary to dysplasia.
On average, severe dysplasia is diagnosed in 20-25% of patients within 20-23 years after diagnosis. The likelihood of its development correlates with the length of the affected area and the degree of dysplasia:
- With low-grade dysplasia, the risks of malignancy are 0.8-1.9% per year.
- For severe dysplasia - 6-12.2% per year.
In addition, the number of foci of dysplasia is important. With multiple lesions, the likelihood of malignancy is three times higher than with single lesions.
Prevention
The main point of preventing Barrett's esophagus is timely diagnosis and treatment of reflux. For early detection of BE, it is recommended to perform esophagoscopy with clarifying diagnostics and targeted biopsy in patients with GERD for more than 5 years. Particular attention should be paid to men over 50 years of age, patients with obesity, GERD for more than 10 years and heartburn for more than 5 years.
General preventive measures, although trivial, also have a positive effect:
- Weight reduction to normal.
- To give up smoking.
- A balanced diet with sufficient amounts of fresh vegetables, fruits, vitamins C and E.
- Refusal of alcohol abuse, especially strong alcoholic drinks.
Treatment of esophageal diseases
The choice of treatment tactics for the esophagus is based on diagnostic examination data. It is not possible to cure the esophagus for all diseases. Tumors and varicose veins are practically incurable. The patient is forced to take medications for life and be under the supervision of a doctor. An effective method of combating the disease is surgical treatment. Sometimes only surgery saves and prolongs human life. All tumors must be removed.
The narrowed esophagus is expanded by introducing bougies. The doctor gradually increases the diameter of the device, bringing the lumen of the organ closer to normal. In severe cases, a gastrostomy tube is removed - the opening of a feeding tube through which food enters the stomach. An organ affected by a tumor or scar adhesions can undergo esophagoplasty - the formation of a new esophagus from intestinal tissue.
Chronic reflux is an indication for fundoplication. The fundus of the stomach wraps around the esophagus. A dense cuff is formed, which prevents acid from entering from the stomach. A modified Toupet fundoplication is preferred. It allows natural reflexes to occur - burping and vomiting. The operation is performed by laparoscopy.
A hiatal hernia is eliminated by returning the gastrointestinal tract to its proper place. The esophageal opening of the diaphragm is sutured. The anatomy and physiology of the esophagus, cardia, and stomach are restored.
Drug therapy for esophageal diseases includes the use of the following medications:
- antibiotics that are prescribed for infectious inflammation;
- antacids, proton pump inhibitors, alginates for increased gastric acidity;
- prokinetics and enzymes that improve digestion and evacuation of food into the intestines;
- astringents, hemostatic drugs;
- complex treatment with folk herbal remedies for healing erosions and regenerating mucous membranes.
An important point in the treatment of esophageal diseases is dietary nutrition. Patients take pureed boiled soups, cereals, vegetables, and lean meat. Refusal of smoking and alcohol, carbonated drinks, smoked foods, and marinades is mandatory.
Diseases of the esophagus occur for various reasons in children, adults, and the elderly. The causes of illnesses are injuries, burns, poor diet, bad habits, and infection. Pathologies can be congenital or acquired, have an acute or chronic course. Symptoms of diseases of the esophageal tube are chest pain, heartburn, indigestion. Treatment depends on test data.
The information on our website is provided by qualified doctors and is for informational purposes only. Don't self-medicate! Be sure to consult a specialist!
Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and carries out treatment. Expert of the group for the study of inflammatory diseases. Author of more than 300 scientific papers.
inlet patch - literally translated from English - Spot at the entrance.
I present to you 3 articles on this topic.
