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"description": "Эзофагит - заболевание пищевода, сопровождающееся воспалением его слизистой оболочки, представляет одно из очень распространенных заболеваний пищеварительного тракта. \r\n\r\nРефлюкс-эзофагит представляет собой воспаление слизистой оболочки пищевода, обусловленное забросом желудочного содержимого в пищевод (желудочно-пищеводный рефлюкс). ",
"etiology": "<p>Причины острого эзофагиты: </p>\r\n<ul>\r\n<li>острые инфекционные процессы; </li>\r\n<li>физическое повреждение (ожог, травмирование при введении зонда, повреждение инородными телами); </li>\r\n<li>химический ожог; </li>\r\n<li>аллергическая реакция на пищевые продукты. </li>\r\n</ul>\r\n<p>Причины развития хронических эзофагитов: </p>\r\n<ul>\r\n<li>алиментарный эзофагит (употребление очень горячей, острой пищи, крепкого алкоголя); </li>\r\n<li>профессиональный эзофагит (работа, связанная с вдыханием паров едких химических веществ); </li>\r\n<li>застойный эзофагит (раздражение слизистой остатками скопившейся пищи при разного рода затруднениях эвакуационной функции пищевода); </li>\r\n<li>аллергический эзофагит); </li>\r\n<li>дисметаболический эзофагит (связан с нарушениями обмена – гиповитаминозами, недостаточностью микроэлементов и тканевой гипоксией, продолжительной интоксикацией организма и т. п.).</li>\r\n</ul>\r\n<p>Рефлюкс-эзофагит развивается вследствие гастроэзофагеального рефлюкса (заброса желудочного содержимого в пищевод). Рефлюкс из желудка в пищевод может возникать по следующим причинам: </p>\r\n<ul>\r\n<li>недостаточность кардии (нижнего пищеводного сфинктера); </li>\r\n<li>грыжа пищеводного отверстия диафрагмы; </li>\r\n<li>недостаточная длина пищевода. </li>\r\n</ul>",
"pathogenesis": "<p>Механизм развития эзофагита обусловлен непосредственным раздражающим химическим, термическим, токсическим или пептическим (при недостаточности кардии и рефлюкс-эзофагите) воздействии на слизистую оболочку пищевода, в редких случаях - бактериальным, токсическим или токсико-аллергическим поражением.</p>\r\n<p> </p>",
"diagnostics": "<p>Диагностика эзофагита включает: </p>\r\n<ul>\r\n<li>Рентгенологическое исследование с контрастным веществом. Наблюдаемый заброс контрастного вещества из желудка в пищевод свидетельствует о выраженном рефлюксе.</li>\r\n<li>Эзофагоскопия - эндоскопическое исследование пищевода.</li>\r\n<li>Эзофагоманометрия — фиксирует различные по характеру нарушения моторики пищевода. </li>\r\n<li>Мониторная рН-метрия пищевода - измерение кислотности в просвете пищевода и желудка; содержимое пищевода будет кислым из-за заброса кислого содержимого из желудка.</li>\r\n</ul>",
"treatment": "<p> Консервативное лечение показано больным с неосложненным течением заболевания. Оно включает в себя: </p>\r\n<p>Общие рекомендации: </p>\r\n<ul>\r\n<li>после принятия пищи избегать наклоны вперед и не ложиться в течение 1,5 часов </li>\r\n<li>спать с приподнятым не менее чем на 15 см головным концом кровати, </li>\r\n<li>не носить тесную одежду и тугие пояса, </li>\r\n<li>ограничить потребление продуктов, агрессивно действующих на слизистую оболочку пищевода (жиры, алкоголь, кофе, шоколад, цитрусовые и т.п.), </li>\r\n<li>отказаться от курения. </li>\r\n</ul>\r\n<p>Медикаментозная терапия: </p>\r\n<ul>\r\n<li>Приём антацидов и производных альгиновой кислоты - препараты снижающие кислотность посредством её нейтрализации. </li>\r\n<li>Антисекреторные препараты - препараты, снижающие кислотность посредством подавления её образования. </li>\r\n<li>Прокинетики - препараты, которые увеличивают тонус нижнего пищеводного сфинктера. </li>\r\n<li>Антибиотикотерапия - применяется для подавления инфекционного процесса. </li>\r\n</ul>\r\n<p>Физиотерапевтическое лечение: </p>\r\n<ul>\r\n<li>при рефлюкс-эзофагите хороший результат дает амплипульстерапия; </li>\r\n<li>снижение болевого синдрома электрофорезом; </li>\r\n<li>грязелечение и бальнеотерапия. </li>\r\n</ul>\r\n<p>При тяжелом течении рефлюкс-эзофагита со стриктурами, язвами и стенозом физиотерапия противопоказана. Операции при стенозе пищевода заключаются в эндоскопическом рассечении стриктур, расширении или бужировании пищевода. По показаниям проводится резекция и пластика пищевода. </p>",
"prevention": "<p>Профилактика эзофагитов подразумевает избегание причин его развития – ожогов горячей пищей, химическими веществами, повреждений инородными телами и т. п. </p>\r\n<p>Профилактика хронического эзофагита – регулярное диспансерное обследование у гастроэнтеролога и при необходимости – лечение. Больным хроническим эзофагитом в качестве профилактики обострений показано санаторно-курортное лечение.</p>",
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},
"code": "K21",
"name": "Гастроэзофагеальный рефлюкс",
"icd_name": "Гастроэзофагеальный рефлюкс",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"3"
],
"periodicity": 1,
"slug": "k21_gastroezofagealnyy_reflyuks",
"lead": "Нарушение здоровья, относящееся к группе болезни пищевода, желудка и двенадцатиперстной кишки",
"description": "<p>Гастроэзофагеальная рефлюксная болезнь – хроническое рецидивирующее заболевание пищевода, обусловленное забросом агрессивного желудочного или желудочно-кишечного содержимого в просвет пищевода и характеризующееся пищеводными и внепищеводными симптомами.</p>",
"etiology": "<p>Развитию гастроэзофагеальной рефлюксной болезни способствуют следующие причины: </p>\r\n<ul>\r\n<li>Снижение тонуса нижнего пищеводного сфинктера (НПС). </li>\r\n<li>Снижение способности пищевода к самоочищению. </li>\r\n<li>Повреждающие свойства рефлюктанта, то есть содержимого желудка и/или двенадцатиперстной кишки, забрасываемого в пищевод. </li>\r\n<li>Неспособность слизистой оболочки противостоять повреждающему действию рефлюктанта. </li>\r\n<li>Нарушение опорожнения желудка. </li>\r\n<li>Повышение внутрибрюшного давления.</li>\r\n</ul>\r\n<p>На развитие гастроэзофагеальной рефлюксной болезни влияют и особенности образа жизни, такие как стресс, работа, связанная с наклонным положением туловища, ожирение, беременность, курение, факторы питания (жирная пища, шоколад, кофе, фруктовые соки, алкоголь, острая пища), а также приём повышающих периферическую концентрацию дофамина препаратов (фенамин, первитин, прочих производных фенилэтиламина). </p>",
"pathogenesis": "<p> Основным фактором развития гастроэзофагеальной рефлюксной болезни является недостаточность нижнего сфинктера пищевода. У здоровых людей это мышечное циркулярное образование в обычном состоянии держит в сомкнутом состоянии отверстие между пищеводом и желудком и препятствует обратному движению пищевого комка (рефлюксу). </p>\r\n<p>В случае недостаточности сфинктера отверстие открыто и при сокращении желудка происходит обратный заброс его содержимого в пищевод. Агрессивная желудочная среда вызывает раздражение стенок пищевода и патологические нарушения в слизистой вплоть до ее глубокого изъязвления. У здоровых людей рефлюкс может возникать при наклоне туловища, физических упражнениях, ночью.</p>",
"diagnostics": "<p>Диагностика ГЭРБ включает: </p>\r\n<ul>\r\n<li>Суточный внутрипищеводный рН-мониторинг – основной метод исследования, подтверждающий у больного ГЭРБ. В ходе этого исследования определяется количество и длительность рефлюксов в течение суток, а также продолжительность времени, в течение которого уровень рН падает ниже 4. </li>\r\n<li>Тест с ингибитором протонного насоса. Пациенту на 2 недели назначается прием препарата из группы ингибиторов протонной помпы (омез, нексиум) в стандартной дозе. Эффективность терапии является подтверждением заболевания. </li>\r\n</ul>\r\n<p>Помимо этих методов диагностики больному могут назначаться и другие исследования. Обычно они необходимы для оценки состояния пищевода и других органов пищеварительной системы, выявления сопутствующих заболеваний, а также для исключения болезней, с похожей клинической картиной: </p>\r\n<ul>\r\n<li>ЭФГДС (эзофагогастродуоденоскопия) с уреазным тестом; </li>\r\n<li>хромэндоскопия пищевода; </li>\r\n<li>рентгенологические исследования пищевода и желудка с использованием контраста; </li>\r\n<li>ЭКГ и суточное мониторирование ЭКГ; </li>\r\n<li>ультразвуковое исследование органов брюшной полости. </li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Пациентам, страдающим ГЭРБ, рекомендуется: </p>\r\n<ul>\r\n<li>Нормализация массы тела. </li>\r\n<li>Необходимо исключить из своего рациона жирную, жареную, острую пищу, шоколад, кофе, крепкий чай, газированные напитки, цитрусовые, лук, чеснок. </li>\r\n<li>Важно не переедать, принимать пищу малыми порциями, с перерывом в 15-20 минут между блюдами, не есть позже, чем за 3-4 часа до сна. </li>\r\n<li>Исключение нагрузок, связанных с повышением внутрибрюшного давления, а также ношение тесных поясов, ремней и т. п. </li>\r\n<li>Приподнятое положение (15-20 см) головного конца кровати ночью. </li>\r\n</ul>\r\n<p>Медикаментозная терапия ГЭРБ направлена, в основном, на нормализацию кислотности и улучшение моторики. Для лечения ГЭРБ применяются антисекреторные средства (ингибиторы протонного насоса, блокаторы H2-гистаминовых рецепторов), прокинетики и антациды. </p>\r\n<p>Для нормализации моторики принимают прокинетики - специальные лекарственные препараты, которые усиливают перистальтику желудочно-кишечного тракта. </p>\r\n<p>Хирургические вмешательства при гастроэзофагеальной рефлюксной болезни: эндоскопическая пликация гастроэзофагиального соединения (накладываются швы на кардии), радиочастотная абляция пищевода (повреждение мускульного слоя кардии и гастроэзофагеального соединения, с целью рубцевания и уменьшения рефлюкса), гастрокардиопексия и лапароскопическая фундопликация по Ниссену. </p>",
"prevention": "<p>Профилактикой развития ГЭРБ является ведение здорового образа жизни, исключающего факторы риска, способствующие возникновению заболевания (отказ от курения, злоупотребления алкоголем, жирной и острой пищей, переедания, подъема тяжестей, продолжительного нахождения в наклонном состоянии и др.). Также способствуют профилактике своевременные меры по выявлению нарушений моторики верхних отделов пищеварительного тракта и лечение грыжи диафрагмы.</p>",
"clinical_picture": "<p>Пищеводные (эзофагеальные) проявления ГЭРБ: </p>\r\n<ul>\r\n<li>изжога (чувство жжения за грудиной) – основной симптом; она может принимать разнообразный характер: как возникать несколько раз в течение дня, так и быть постоянной. Отличительная особенность – связь эпизодов изжоги с изменением положения тела (с наклоном вперед, в положении лежа), употреблением провоцирующих продуктов питания или лекарственных препаратов. </li>\r\n<li>отрыжка кислым, горьким, едой (срыгивание) или воздухом; </li>\r\n<li>разнообразные нарушения глотания; </li>\r\n<li>одинофагия (ощущение боли или неприятные ощущения при прохождении пищи по пищеводу, что обычно встречается при выраженном поражении слизистой пищевода); </li>\r\n<li>боли в области желудка или в проекции пищевода; </li>\r\n<li>рвота, упорная икота; </li>\r\n<li>ощущение кома за грудиной. </li>\r\n</ul>\r\n<p>Внепищеводные проявления: </p>\r\n<ul>\r\n<li>легочной синдром [кашель, одышка, эпизоды спонтанной остановки дыхания (апноэ), рефлекторный бронхоспазм, у некоторых пациентов развиваются аспирационная пневмония, бронхиальная астма]; </li>\r\n<li>отоларингологический синдром, так называемая отоларингологическая маска ГЭРБ (грубый лающий кашель, осиплость голоса по утрам, першение, рецидивирующие отит, ринит); </li>\r\n<li>стоматологический синдром (разрушение зубной эмали); </li>\r\n<li>анемический синдром (снижение количества эритроцитов и гемоглобина вследствие микрокровотечений из изъязвлений слизистой оболочки пищевода); </li>\r\n<li>кардиальный синдром (загрудинные боли, имитирующие стенокардию). </li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 111,
"standards": [
4990
]
},
{
"id": 6661,
"symptoms": [
{
"id": 3149,
"synonyms": [
{
"name": "Боль при глотании"
},
{
"name": "Непроходимость пищи"
},
{
"name": "Пищевод болит"
},
{
"name": "Больно глотать"
}
],
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