Why does an ulcer form?
The lining of the esophagus is designed to allow food to pass through, not to come into contact with acid. When the lower esophageal sphincter does not work well, stomach contents regularly rise up and the protective mechanisms fail. First, inflammation appears, then erosion, and with continued damage, an ulcer. A separate mechanism for tablet ulcers: a capsule or tablet, taken without enough water or lying down, lingers in narrow places of the esophagus and releases a concentrated substance directly onto the mucous membrane.
- Gastroesophageal reflux disease
- Hiatal hernia
- Damage from tablets: potassium supplements, some antibiotics, bisphosphonates
- Infections in people with weakened immune systems: candida, herpes, cytomegalovirus
- Consequences of radiation therapy and chemotherapy
- Chemical burn
- Rare conditions with increased acid secretion
Symptoms
The most characteristic symptom is odynophagia, that is, pain precisely at the moment of swallowing, which is felt behind the sternum and can radiate to the back, neck and jaw. It is often accompanied by heartburn, sour belching and a burning sensation, aggravated by lying down and after a heavy meal. With a deep defect, difficulty swallowing occurs. Hidden bleeding does not manifest itself for a long time as anything other than increasing weakness and pallor due to anemia. Sometimes the pain behind the sternum is so pronounced that it is confused with heart pain.
- Pain when swallowing behind the sternum
- Heartburn and sour belching
- Burning sensation that gets worse when lying down
- Difficulty passing food
- Weakness and pallor with hidden blood loss
- Belching and nausea
Diagnostics
Endoscopy is the only way to see the ulcer, assess its size, depth, and signs of recent bleeding. During the study, a biopsy is necessarily taken: it allows you to exclude a tumor, as well as identify an infectious or eosinophilic lesion. Additionally, a complete blood count is assessed to detect anemia and determine H. pylori infection, since stomach treatment affects the course of the disease. If an infectious nature is suspected, special studies of the biopsy specimen are performed.
- Endoscopy of the esophagus and stomach with biopsy
- Complete blood count, ferritin
- Test for H. pylori
- Examination of a biopsy specimen for suspected infection
- X-ray of the esophagus if narrowing is suspected
- Daily pH-metry in difficult cases
Treatment
The basis of therapy is powerful and long-term acid suppression with proton pump inhibitors, usually for 8 weeks or more, with control endoscopy. At the same time, the cause is eliminated: the offending drug is discontinued or replaced, the infection is treated with antifungal or antiviral agents, and if H. pylori is detected, eradication is carried out. In case of bleeding, endoscopic hemostasis is performed. Surgical treatment is rarely required for perforation or severe complications. All medications and timing are determined by the doctor; you cannot interrupt the course on your own.
- Long-term proton pump inhibitors
- Discontinuation or replacement of the offending drug
- Treatment of infection based on biopsy results
- Eradication of H. pylori when detected
- Endoscopic bleeding control
- Control endoscopy after treatment
Lifestyle and prevention
Changes in regimen noticeably speed up healing. You should have dinner no later than three hours before bedtime, sleep with the head of the bed raised 15 centimeters, and avoid tight belts and bending over after eating. Limit alcohol, strong coffee, very spicy and sour foods, and carbonated drinks. Quitting smoking reduces acid reflux. Any tablets should be taken standing or sitting with a full glass of water, and do not lie down immediately afterward. If you are overweight, even a moderate reduction will reduce the frequency of castings.
- Last meal 3 hours before bedtime
- Raised headboard
- Quitting smoking and limiting alcohol
- Less spicy, sour, carbonated
- Take the tablets with a glass of water in an upright position
- Losing body weight if you are overweight