Reflux esophagitis what is the treatment. Symptoms and treatment of reflux esophagitis

Erosive reflux esophagitis is an inflammation that occurs in the lining of the lower esophagus. It develops as a result of prolonged and frequent back emissions into this section of the contents of the stomach. This pathology is considered one of the stages of gastroesophageal reflux disease. The disease is common among the adult population. Erosive reflux esophagitis occurs twice as often in men. Let's consider this pathology in more detail.

General information

Gastric contents include digestive enzymes, hydrochloric acid, and in some cases pancreatic juice and bile acids. The process of reverse ejection into the esophagus can also be observed in absolutely healthy people. In this case, no more than 2 episodes occur during the day, the duration of which is about five minutes. As a rule, this phenomenon is observed during the day, after eating, as a rule. Most of these episodes go unnoticed.

Defense mechanisms

IN healthy body There are several factors that can help prevent more frequent reflux of stomach contents into the esophagus. These include, in particular:

Causes of pathology

Erosive esophagitis can be caused by a number of provoking factors that completely or partially eliminate the effectiveness of the above protective mechanisms. These include:

Classification

Reflux esophagitis can be of two types. With more easy course pathology in the process of endoscopic examination, only swelling and redness are noted. This is how the non-erosive form of pathology manifests itself. In a more severe course, mucosal defects of varying length are noted. In this case, erosive esophagitis is diagnosed. When a second form of pathology is detected, experts often indicate its degree. In particular, distal erosive esophagitis can have from 1 to 5 tbsp. It is determined by the area and number of defects on the mucous membrane, as well as the presence of complications (Barrett's esophagus, strictures, and others).

Disease development

At the initial stage, active stomach enzymes (pepsin), hydrochloric and bile acids, lysolecithin simply irritate the esophageal mucosa. As a result, the first signs of pathology appear. Further, inflammation gradually develops. With prolonged and extensive contact of the mucous membrane with irritating compounds, the condition becomes more complicated. This is how erosive esophagitis begins. In the absence of a therapeutic effect, mucosal defects are transformed. The inflammation turns into ulcerative erosive esophagitis. These defects can cause strictures (scar deformities) and bleeding. Prolonged ulcerative erosive esophagitis can provoke precancerous changes, and subsequently adenocarcinoma (their malignant transformation).

Clinical picture

How does erosive esophagitis manifest? Symptoms of pathology can be hidden or pronounced. The manifestations of pathology are divided into two groups: esophageal and extraesophageal. The first category is considered a classic manifestation of the clinical picture. In some cases, esophageal signs are sufficient to reveal distal erosive esophagitis. Extraesophageal manifestations are much more difficult to associate with pathology. Patients in such cases are forced to undergo various specialists and take many tests before erosive reflux esophagitis is detected. Treatment in this case may begin late, when complications occur.

Esophageal manifestations of pathology

Often they are caused by late meals, overeating, errors in the diet, the action of carbonated or alcoholic beverages, physical or psycho-emotional stress. Symptoms appear when a person takes a horizontal position, lifting weights, bending over, at night. The classic signs include:

Extraesophageal manifestations

Feeling of a lump or prolonged discomfort in the throat.
Hoarseness of voice.
Suffocation.
Damage to the vocal cords.
Prolonged cough without expectoration.
Damage to tooth enamel.
Laryngeal pillomatosis.
Inflammation of the gums.
Neck soreness.
Periodic heart rhythm disorders.
Pain in the lower jaw.
Stench from the mouth.

Diagnostics: general information

It is important to timely identify erosive reflux esophagitis. Treatment of pathology in advanced stages can be very long. Therefore, it is highly discouraged to delay the visit to the doctor. It should be borne in mind that the severity of the manifestations of pathology does not in all cases correspond to the severity of mucosal lesions. The results of the diagnostic materials carried out will reveal the nature and stage in which erosive esophagitis occurs. Treatment will be effective only with timely referral to a specialist.

Fibrogastroduodenoscopy

During this diagnostic procedure, a highly informative examination of the esophageal mucosa is carried out using an endoscopic apparatus. During the examination, a specialist assesses the condition of the shell. In particular, the presence of redness, the degree of motor disorder and inflammation, the presence of narrowings, scars, ulcers, erosions are determined. With the help of special biopsy spines, tissue can be taken from all affected areas.

Morphological assessment

This study involves the analysis of material under a microscope. Morphological assessment allows to exclude malignant transformation and to establish signs of pathology. In particular, to assess the degree of inflammation, swelling of the mucous membrane, detect microbleeds.

X-ray with contrast agent

The study is carried out using a suspension of barium. During the examination, changes of an inflammatory nature, narrowing, ulcers are revealed. The patient is examined both horizontally and vertically. This allows you to verify duoenogastric and gastroesophageal refluxes, hernia of the diaphragm. X-rays are well tolerated by patients.

Erosive esophagitis: treatment

If a pathology is detected, a specialist can recommend the following measures:

Operation.
Medication (antisecretory agents "Pantoprazole", "Nizatidin", "Platyphyllin" and others).
Lifestyle correction.
Diet therapy.

Most patients receive outpatient therapy. Those who have a complicated course of the disease are hospitalized and all the previously used methods have not yielded results. In this case, surgery is often prescribed.

Erosive esophagitis: diet

To enhance the drug effect, patients are advised to adjust the diet. In particular, it should:

Refrain from overeating. The recommended number of meals is 4 times / day, while portions should be small.
Do not eat at night. At least two hours should pass between bedtime and dinner.
To exclude from the diet too cold or hot, spicy dishes that can damage the esophageal mucosa.
Eliminate from the diet all foods that can weaken the tone of the esophageal sphincter. These include chocolate, coffee, fat milk, margarine, fried foods, red fish, tomatoes, citrus fruits.

Inflammation of the esophageal mucosa, resulting from the constant throwing of stomach contents into the esophagus, the morphological feature of which is the presence of a large number of erosions of various sizes, is called erosive reflux esophagitis.

The main reason for the development of this pathology is the constant throwing of the contents of the stomach into the esophagus, which has an irritating effect on its mucous membrane and eventually leads to the formation of erosions.

The provoking factors for the occurrence of erosive reflux esophagitis are:

ulcer of the duodenum and stomach;
hernia of the esophageal opening of the diaphragm;
mechanical damage to the esophagus (for example, after the introduction of the probe);
inaccuracies in nutrition (abuse of spicy, fatty or salty foods);
bad habits;
getting into the esophagus of various chemicals (gasoline, alkali, acid and a number of others);
some infections;
operations on the esophagus and other organs of the gastrointestinal tract.

Types of erosive reflux esophagitis

According to the form of manifestation, acute, subacute and chronic reflux esophagitis are distinguished. There are four degrees that characterize the clinical development of this pathology:

Erosive reflux esophagitis of the first degree. It is characterized by the development of erythema in the lower part of the esophagus. Isolated erosions appear on the mucous membrane.
Erosive reflux esophagitis of the second degree. At this stage of the disease, erosion begins to merge with each other, but the affected area does not yet cover the entire mucous membrane of the esophagus.
Erosive reflux esophagitis of the third degree. In this case, inflammation covers the entire mucous membrane of the esophagus, erosion merges with each other, turning into ulcers.
Erosive reflux esophagitis of the fourth degree. It is manifested by the development of stenosis (narrowing of the lumen) and chronic ulcers of the esophagus.

Erosive reflux esophagitis symptoms

There are several main clinical signs of erosive reflux esophagitis, which play a decisive role in the diagnosis of the disease:

dysphagia (difficulty swallowing) - manifested by the feeling that food is stuck in the esophagus or the inability to swallow any food;
belching - usually due to dysfunction of the distal esophageal sphincter;
heartburn - most often appears after eating, during physical exertion, performing work associated with bending;
chest pain - aggravated by physical exertion and at night, when the patient takes a horizontal position.

The general symptoms of the disease include dizziness, anemia, and weakness. If the course of reflux esophagitis is complicated by infection, then complications such as phlegmon and mediastinitis may develop.

The most serious complication of erosive reflux esophagitis is the development of Barrett's esophagus, as this disease is a precancerous condition.

Diagnosis of erosive reflux esophagitis

The diagnosis is made on the basis of anamnesis data, clinical signs of the disease (dysphagia, belching, heartburn, chest pain), X-ray and esophagoscopy data.

X-ray reveals a slight expansion of the lumen of the esophagus, which indicates a decrease in its tone. The mucous membrane of the esophagus is thickened and edematous.

With esophagoscopy, it is determined that the mucous membrane of the esophagus is hyperemic and covered with hemorrhagic, purulent or serous exudate. On its surface, erosions of various sizes are visible, sometimes small cell hemorrhages are found.

Erosive reflux esophagitis treatment

Most often, patients are treated on an outpatient basis. Hospitalization is indicated only when conservative methods of treatment fail and surgery is required.

When erosive reflux esophagitis is detected, patients are prescribed complex treatment, including:

diet therapy;
treatment with folk methods;
drug therapy;
surgical intervention.

Diet

If the patient is diagnosed with the initial stage of reflux esophagitis, then changing the composition and diet can help him.

The basic rule is to eat often, but little by little. Eating large amounts of food at a time causes an increased production of gastric juice and provokes the reflux of stomach contents into the esophagus, which further exacerbates the problem.

It is necessary to exclude foods that can cause abdominal pain or heartburn in the patient.

The diet should be dominated by foods containing fiber and complex carbohydrates (potatoes, pasta, bran bread, cereals).

It is necessary to stop eating fatty and fried foods, as when eating fat, a lot of gastric juice is released, which leads to increased reflux.

Alcohol and smoking are also prohibited as they increase heartburn and reflux.

Treatment with folk remedies

Medicinal herbs cannot completely cure erosive reflux esophagitis. They are used in the treatment of the disease as symptomatic agents, for example, to get rid of heartburn.

Folk remedies in the form of herbal preparations, decoctions and infusions must be consumed regularly. The course of treatment for erosive reflux esophagitis is on average two months.

Below are a few folk recipes reflux esophagitis treatments:

Potato juice... Helps get rid of heartburn. It is taken within 14 days, in a quarter of a glass, 15 minutes before meals.

Flaxseed kissel... For its preparation, take three tablespoons of flax seeds, pour boiling water and insist for three hours, then filter and take two tablespoons 15 minutes before each meal.

Drug treatment

The basis of drug therapy for reflux esophagitis is considered to be antisecretory drugs that reduce the production of gastric juice. The drugs in this group include:

M-anticholinergics (Platyphyllin, Metacin);
blockers of histamine receptors (Ranitidine, Famotidine, Nizatidine);
proton pump inhibitors (Esomeprazole, Rabeprazole, Omeprazole).

The choice of the drug and the duration of the course of treatment is determined by the doctor, depending on the severity of the pathological process, the nature of erosion, the presence of a precancerous condition.

In the treatment of erosive esophagitis, prokinetics are used, which help to normalize the motor function of the gastrointestinal tract. These include:

Domperidone (Motilak, Motonium, Motilium);
Itoprid (Ganaton);
Metoclopramide (Cerucal, Raglan).

If bile is present in the gastric contents that are thrown into the esophagus, the use of drugs such as Ursofalk, Ursosan is indicated.

To neutralize the hydrochloric acid produced in the stomach, various antacids (Almagel, Rutacid, Gastal, Fosfalugel, Rennie) and alginates (Topaal, Gaviscon) are used.

In case of erosive reflux esophagitis, after the end of the course of treatment, a control endoscopic examination is required to make sure that the therapy is effective.

Surgery

Treatment of reflux esophagitis by surgery is carried out in the following cases:

ineffectiveness of the conducted conservative treatment;
aspiration pneumonia;
strictures of the esophagus;
barrett's esophagus.

The main surgical method of treatment is Nissen fundoplication. The goal of surgery is to restore the function of the cardiac sphincter. For this, a cuff is formed around the distal esophagus during the operation from the fundus of the stomach, due to which the reflux into the esophagus stops.

Prognosis for erosive reflux esophagitis

With erosive reflux esophagitis, the prognosis in most cases is favorable. When the causes of the disease are eliminated, the patient is completely cured. In the case of the development of complications such as mediastinitis, the prognosis worsens.

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Esophagitis is an inflammation of the inner mucous wall of the lining of the esophagus. Esophagitis is of two forms - acute and chronic.

Esophagitis symptoms

The main symptomatic picture with esophagitis is as follows - a constant feeling of discomfort, a burning sensation in the sternum, which may increase when eating or swallowing saliva. Constant heartburn and belching and belching, leaving a sour aftertaste. With esophagitis of the erosive form, vomiting may occur, which is accompanied by bloody clots, as well as bloody discharge from the stool. With illness, a feeling of "lump in the throat" may develop. Chest pain can often radiate to the back or neck area. The patient has increased salivation.

Reflux esophagitis

Reflux esophagitis is an inflammatory process on the mucous membrane of the esophagus, which is characterized by the ingress of stomach contents into the esophagus. The main reason for the development of the disease is a hernia, which develops on the esophageal diaphragm. The main symptom of the disease is, which becomes stronger after eating, often accompanied by belching or hiccups. The patient feels pain in the area chest, which gives off to the region of the heart. Quite often, the symptoms of the disease are reduced only to pain. The launched process of treating the disease can lead to the development of an esophageal ulcer or even to tumor processes.

Catarrhal esophagitis

Catarrhal - inflammation of the esophageal mucosa, chronic and acute forms. Often, catarrhal esophagitis can occur due to the constant use of food that is too hot or, conversely, too cold, as well as excessive consumption of spicy foods, pickles, pickles, and rough foods. Acute catarrhal esophagitis can result from an excessive love of foods that contain large amounts of acid, alkali and iodine. A hernia of the alimentary diaphragm can also cause the development of the disease. Catarrhal esophagitis symptoms are persistent pain in the esophagus, especially when swallowing food. After eating, there is severe heartburn and belching with an unpleasant aftertaste. Pain in the chest, sometimes radiating to the region of the heart. Less often, pain is shifted to the interscapular region. the disease requires immediate treatment, as it can subsequently develop into erosive esophagitis.

Erosive esophagitis

Erosive esophagitis is an inflammation of the mucous membrane of the esophagus with the appearance of erosion on it. The main reason for the onset of the disease is a previous catarrhal inflammation of the esophagus. Erosion on the mucous membrane can be the result of a burn chemicals, acids. Viral infections, the causative agents of which are fungi or bacteria, can also be the cause of the disease. Long-term use of certain drugs can cause erosion on the walls of the mucous membrane. The main symptom of erosive is pain when swallowing and passing food through the esophagus, constant, persistent heartburn, belching, which is accompanied by coughing up of a blood clot, regurgitation of food particles or mucus, less often nausea and vomiting, which can also be accompanied by a small amount of blood.

Esophagitis treatment

Esophagitis is best treated in a hospital setting. Treatment includes complex therapy, which involves not only taking medications, but also a special therapeutic diet. When treating reflux esophagitis, it is prohibited to take medications that reduce the tone of the esophageal sphincter. The patient needs to normalize his weight if there are such problems. During treatment, it is necessary to refrain from physical exertion, especially on the abdominal cavity, to minimize the tilt of the torso, to refrain from wearing belts and belts. A therapeutic diet excludes the intake of foods that lead to intense gas formation, refrain from drinking alcohol, sweets and coffee. Avoid eating spicy foods, and avoiding excessive overeating. Drug treatment is prescribed by a doctor individually for each case. Surgical intervention is allowed only in very advanced cases of the disease.

Treatment for catarrhal esophagitis is mainly based on diet # 1. When pain occurs, use no-shpu or. Astringents are accepted medications - venter or den-nol. To maintain the body, a vitamin complex is prescribed, and sea buckthorn oil is also taken internally. In the treatment of catarrhal esophagitis, anti-inflammatory decoctions from or calendula are taken. Treatment is carried out with medicinesbelonging to the group of antacids, for example Almagel. It is imperative to take anti-inflammatory drugs and decoctions that will help soothe irritated esophageal mucosa. Depending on the stage of the disease, prokinetics are prescribed, for example, motilium. Treatment must be accompanied by a mandatory diet No. 1.

Erosive esophagitis is a pathoanatomical form that is much more common in clinical practice than other forms this disease.

Sometimes the pathological process is complicated by suppuration, bleeding, mediastinitis and perforation.

Fortunately, after curing the underlying disease, erosive esophagitis disappears without a trace.

The causes of erosive esophagitis

As a rule, the disease develops due to acute or chronic inflammation of the esophagus.

Often, erosion on the mucous membrane occurs after burns with technical fluids, alkalis or acids. At the same time, such a disease can result from severe bacterial, viral or fungal infections, and it can also develop in patients taking glucocorticoids and non-steroidal anti-inflammatory drugs for a long time.

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Reasons for the development of erosive reflux esophagitis

Erosive reflux esophagitis is inflammatory processwhich develops in the distal part of the esophagus due to reflux (reflux) of acidic stomach contents. The reason for this condition is gastroesophageal reflux disease, which occurs due to the insufficiency of the obturator mechanism of the cardia.

As a rule, the pathological process occurs after the formation of sliding hernias of the diaphragm (its esophageal opening), and it can also develop with severe vomiting, ulcerative stenosis of the outlet of the stomach and with a short esophagus.

Classification of the pathological process by the degree of damage

By the nature of the course of the disease, erosive esophagitis is acute, subacute and chronic.

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Acute esophagitis

The most common form of the disease is acute erosive esophagitis, accompanied by superficial or deep inflammation of the esophageal mucosa. In this case, the ailment develops suddenly, and, with adequately prescribed treatment, also quickly passes without complications and serious consequences.

Chronic esophagitis

It is also a fairly common form of the pathological process, which is characterized by prolonged inflammation of the walls of the esophagus. Developing for a long time, it can be the result of irreversible changes in the structure and work of the esophagus.

Peptic esophagitis

This disease develops due to the penetration of gastric juice into the esophagus (gastroesophageal reflux).

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Superficial (catarrhal) esophagitis

With this form of the pathological process, there is not a strong inflammation of the esophageal mucosa (only its surface layer, without significant tissue destruction).

Ulcerative esophagitis

Erosive-ulcerative esophagitis is a condition in which inflammation penetrates into the deep layers of the esophageal mucosa and causes ulcers (erosions) to form on it.

Distal esophagitis

The common symptoms of erosive esophagitis include weakness, anemia due to chronic blood loss, and dizziness.

If an infection joins the pathological process, it can provoke such serious complications as mediastinitis (inflammation of the mediastinum), phlegmon and perforation of erosions, followed by profuse bleeding. The most formidable complication of erosive esophagitis is a precancerous condition (intestinal metaplasia of the mucous membrane of the esophagus, or Barrett's esophagus).

In clinical practice, the disease is divided into 4 degrees by severity:

With the development of hyperemia and edema, we are talking about 1 degree of the disease.
If fibrous overlays and superficial ulcers are found on the mucous membrane of the esophagus, erosive esophagitis of the 2nd degree of severity is diagnosed.
If fibrosis is noted, shortening of the esophagus, as well as chronic ulcers are found on the mucous membrane - this is the 3rd degree of the pathological process.
Erosive esophagitis of grade 4 is accompanied by progressive fibrosis, narrowing of the esophagus and the formation of penetrating ulcers of the esophagus.

Signs of erosive reflux esophagitis

Note: With peptic esophageal stricture, persistent dysphagia is noted.

Diagnostics of the erosive esophagitis

The disease is diagnosed based on the patient's complaints. However, fibrogastroscopy with targeted biopsy and radiography of the esophagus are preliminarily performed. During fibrogastroscopy, severe inflammation and different kind erosion (bleeding and healed).

X-ray images show incomplete closure of the lower part of the esophagus and increased peristalsis.

In the study of biopsy material, the structure of the esophageal mucosa is assessed (lesions, metaplasia, or).

Without fail, to confirm the degree of anemia, the patient is assigned a blood test. Also, a blood test is carried out to identify Helicobacter.

Treatment method

Treatment of erosive esophagitis of the esophagus is carried out similarly to the treatment of other forms of esophagitis. However, first of all, the actions of specialists are aimed at eliminating the root cause (the pathology that provoked its development).

Note: a prerequisite for successful treatment is adherence to a diet for erosive esophagitis. In this case, spicy and fatty foods, tomatoes, chocolate, citrus fruits and coffee are excluded from the diet of patients. Also, patients with this form of the disease are strongly advised to completely quit smoking.

In order to accelerate the healing of erosions, the use of antacids, alginates and histamine receptor blockers is indicated. At the same time, drug therapy involves the appointment of anti-inflammatory and enveloping agents.

When diagnosing erosive reflux esophagitis, treatment includes taking prokinetics that prevent the esophageal sphincter from relaxing and refluxing gastric contents.

Recommendation: When treating erosive esophagitis, in order to avoid an increase in symptoms, patients are advised to lift their upper body in a supine position using an additional pillow. This helps reduce heartburn and sternum pain.

The treatment of erosive esophagitis has proven itself well folk remedies... At the same time, patients are prescribed to take decoctions of medicinal herbs with wound healing, hemostatic, anti-inflammatory and bactericidal effects (nettle, calendula, chamomile, oak bark, mint, sage).

Published: 17 July 2015 at 15:46

In terms of localization, erosive reflux esophagitis exists in distal, total and proximal forms. The total form is characterized by a lesion of the entire esophagus; during the proximal form, the lesion occurs only in the upper part. The distal form of this disease affects the lowermost part of the esophagus, which connects to the stomach.

Meanwhile, chronic erosive reflux esophagitis (like gastritis) is characterized by prolonged inflammation of the walls of the esophagus with the appearance of erosions on them. This form develops over a long period of the disease, which leads to irreversible pathologies in the functioning and structure of the esophagus.

With erosive distal reflux esophagitis, the process of inflammation penetrates into the deeper layers of the mucous membrane of the esophagus, and therefore ulcers and erosions occur. This form of the disease requires urgent treatment. Particles of the exfoliated mucous membrane can come out during vomiting. In addition, healed ulcers subsequently lead to stenosis or simply narrowing of the esophageal tube.

During the onset of symptoms of erosive reflux esophagitis, it is necessary to consult a gastroenterologist in order to clarify the diagnosis.

Distal erosive reflux esophagitis is often associated with gastritis, hernia of the diaphragm, and gastric ulcer.

The main reasons for the occurrence of such reflux esophagitis are stomach overflow, decreased immunity, chemical burns, excessive consumption of alcoholic beverages.

The main clinical manifestations diseases are the strongest burning sensation that occurs immediately after eating, in a lying position, soreness during swallowing, a feeling of nausea, vomiting, a feeling of fullness in the abdomen, night cough, hoarse voice.

The distal form of reflux esophagitis is superficial, as in gastritis. In this case, the inflammatory process in the mucous membrane occurs without pathological destruction of the epithelium. If, in this case, you undergo a course of treatment in a timely manner, then the disease will go away completely and will not pose a threat to the body.

Erosive-ulcerative reflux esophagitis is diagnosed very quickly, depending on external signs, as well as the results of esophagoscopic and X-ray studies.

If this diagnosis is confirmed, then a special diet is prescribed, which is aimed at eliminating the causes, treating the disease and relieving symptoms. This diet is prescribed by a specialist at the first visit.

The most common complication of the disease (grade 2) is a peptic ulcer in the esophagus (grade 3 - perforated). At grade 1, only deep defects are formed in the walls of the esophagus, which entail complex scarring, as well as possible shortening of the esophageal tube.

Chronic erosive reflux esaphogitis

The chronic form of erosive and ulcerative reflux esophagitis implies the course of the disease for more than 6 months. In this case, as a rule, the signs of the disease are less pronounced. However, the treatment is more complex.

In addition, the distal form can also be chronic. Immediate symptoms are expressed in less soreness and a more rare occurrence of heartburn. As for the appearance of erosion during such a course, their prevalence is no less than during acute form... Often this form is combined with gastritis, but not necessarily. As a rule, in 80% of cases, this form occurs only 1 degree.

Also, the chronic form of the disease has periodic exacerbations. Exacerbations are characterized by severe pain and aggravation common symptoms... During this period, you need a two-day fast, followed by a diet.

In most cases, reflux esophagitis does not need serious treatment. As a rule, patients recover immediately after the normalization of their diet. Diet implies the elimination of the main factors of irritation (including spicy and fatty foods, as well as bad habits, etc.). If the damage to the esophagus is more severe, then it is necessary, in order to comply, with the appointment of antacids and analgesics. In addition, in some cases, it is necessary to eliminate the causes of reflux esophagitis, this will avoid many consequences. but correct treatment can only be prescribed by a gastroenterologist.

Basically, this is the appointment of antacids to get rid of heartburn, pain relievers, as well as prohistamines to reduce acid secretion of gastric juice. In general, drugs for treating this disease are not much different from those used in the case of reflux gastritis.

Grades of erosive reflux esophagitis

According to the classification, this disease has several degrees. 1st is characterized by manifestations of separate, non-coalescing erosions in the lower esophagus. With the 2nd erosive lesions, a large area of \u200b\u200bthe esophageal mucosa is captured. At the third, peptic ulcer of the esophagus develops, accompanied by gastritis.

In medicine, the degree of the disease is determined in relation to the morphological changes that are detected during the endoscopic examination.

Erosive reflux esophagitis of the 1st degree is characterized by focal and mild erythema. That is, the mucous membrane of the esophagus is loose. In this case, the folds of the mucous membrane are slightly smoothed. Treatment with drugs is not necessary, but requires medical advice.

Stage 2 disease involves the formation of single or multiple defects, usually elongated. The presence of exudate is also possible. Erosion is mainly located on the very surface of the folds. However, the area of \u200b\u200bsuch lesions is no more than 10% of the total surface of the esophagus. Treatment is required.

At the third, unlike the second, the degree of reflux esophagitis, erosion begins to merge, as a rule, the entire surface is covered with exudate. The area of \u200b\u200bdefects in comparison with the 2nd stage is 40% larger. Treatment is urgently needed.

In the fourth, most difficult stage, erosion merges, exudative-necrotic pathologies are already formed, defects are located circularly, and this lesion extends more than 5 cm from the sphincter. Treatment should be urgent and in the hospital.