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The gullet has invaluable value in a human body. Exactly thanks to it we receive all necessary for work of other bodies, the food consumed by us gives us energy for life. But this body, as well as all our organism, is exposed to diseases which not only bring pain, but also are psychologically hard transferred as are followed by an eructation, heartburn, an unpleasant smell. Such diseases influence not only health of all organism, but also everyday life of the patient. The most widespread diseases of a gullet are caused by disturbances of motility of body or new growths, both cysts and benign tumors, and cancer. About the main diseases of a gullet, their symptoms, diagnosis and treatment, the speech will go further.
Diseases of a gullet and their symptoms
Such diseases as a cardia achalasia, a gullet esophagism, a peptic esophagitis, a halaziya of the cardia and difragmental hernias belong to disturbances of motility of a gullet. These diseases have a little different character of a current and symptoms.
The cardia achalasia, or cardiospasm belongs to neuromuscular diseases. This disturbance of reflex opening of the lower sphincter of a gullet when passing food. The reasons of development of this disease of a gullet are not known, it is shown at the age of 20-40, is more often at women. Complications of this disease are most often caused by a long delay of food in a gullet. At adults frequent complication is the inflammation of a gullet which in turn can become the reason of cancer both the gullet, and upper part of a stomach. Children have such complications as bronchial pneumonia, the abscesses of lungs and other respiratory diseases caused by hit of food in them more often.
Symptoms of an achalasia have character of a triad. The first display of this disease of a gullet – swallowing disturbance, or a dysphagy. This symptom can arise suddenly or gradually, amplifying after nervous excitement. The paradoxical dysphagy when the rigid and dense food passes normally is in certain cases observed, and liquid is not. Swallowing disturbance can depend also on food temperature. The second symptom of an achalasia are a vomiting, they happen at overflow of a gullet when there is a sharp reduction of muscles. The third symptom is the pain caused by a spasm of muscles of a gullet at its overflow. Pain behind a breast passes after passing of food to a stomach. Nausea, an eructation air, burning in a gullet, the increased salivation also join these symptoms.
The gullet esophagism – the spasm of walls of a gullet which is not followed by disturbances of functions of the lower food sphincter arises owing to nervous disturbance. The esophagism is more often shown at men of middle and advanced age, maybe by a symptom of other disturbances of a digestive tract.
Symptom of an esophagism of a gullet is pains behind a breast which often are accepted to displays of stenocardia. Pains can arise not only during meal, but also in an interval between receptions. They are different intensity and duration. Except pain this disease is characterized by disturbance of swallowing of paradoxical character, inconstancy of this symptom distinguishes a gullet esophagism from other diseases and new growths of a gullet.
The peptic esophagitis, or reflux esophagitis of a gullet is caused by insufficiency of the lower food sphincter that leads to throwings of contents of a stomach back in a gullet. Also the cardia halaziya has the same current, but it is caused more often by hernias of an esophageal opening of a diaphragm. Due to such emissions of a gastric juice, bile, pancreatic juice the mucous membrane of a gullet suffers. There is an inflammation, ulcers when which scarring the gullet is lent. This disease of a gullet proceeds very slowly, in frequent cases it can be found in babies.
Symptoms a reflux esophagitis – burning behind a breast, heartburn, pain, an eructation. Some symptoms amplify at a trunk inclination, in lying situation, during the smoking or alcohol intake. The eructation can become the reason of development of aspiration pneumonia. It happens at hit of gastric contents in respiratory tracts, especially at night vomiting which are followed by cough. Bleedings and cicatricial changes can be complications of a disease.
Phrenic hernias – movement by body from an abdominal cavity in a chest cavity. Hernias can be the inborn, acquired or traumatic defects, most often at patients hernias of a food opening of a diaphragm are observed, they can be sliding or paraezofagealny. This disease has very scanty symptomatology. The main symptoms of phrenic hernia — anemia and the concealed hemorrhages.
High-quality new growths of a gullet grow slowly and almost asymptomatically. Most often they are found accidentally, in certain cases the patient can feel the accruing disturbance of swallowing which develops within several years.
Unlike benign tumors and cysts the cancer of a gullet has more expressed symptoms and is diagnosed many times more often than other diseases of a gullet. Cancer occupies 60-80% from all diseases of a gullet, this disease, the sixth on frequency, at the age of 50-60, meets at men of this age the groups abusing smoking and alcohol more often. Here some more reasons which cause a gullet cancer: complications of disturbance of motility of body, namely an achalasia, Barret's gullet, papillomas and hems which can be also after a gullet burn caustic substances.
At first the cancer of a gullet proves the sensation of discomfort and pains behind a breast at the patient, a dysphagy raised by salivation, weight loss. The first one-two years gullet cancer symptoms are practically not observed, that time so far the tumor does not begin to narrow a gullet, the dysphagy gradually accrues, pain amplifies.
Diagnosis of diseases of a gullet
Diagnosis of diseases of a gullet at early stages is carried out by means of an ezofagotonokimografiya. The gullet is investigated by means of a multichannel probe with barrels or open catheters which register reductions of a gullet and change of pressure in it. Most often such research is conducted when achalasia symptoms are found.
X-ray inspection gives the chance to find deformations of a gullet because of a spasm of his muscles. Such researches are appointed at suspicion to an esophagism, a gullet reflux esophagitis, phrenic hernias and new growths of a gullet. At symptoms the reflux esophagitis is appointed an esophageal rn-metriya and an ezofagomanometriya inside that gives the chance to establish level rn in a lower part of a gullet and dysfunction of the lower esophageal sphincter. For detection of a gastroesophagal reflux sometimes appoint a X-ray with barium, the patient at the same time has to be in lying situation on spin with the raised foot end.
Of course, an important role in diagnosis of diseases of a gullet is played by poll of the patient which the attending physician has to carry out before to appoint any research. Many symptoms of diseases of a gullet can be display of other diseases. Therefore it will very important be convinced that it is not diseases of system of digestion which demand urgent surgical intervention.
Treatment of diseases of a gullet
Conservative treatment of diseases of a gullet is appointed at initial stages of such diseases as a cardia achalasia, a reflux esophagitis and at not complicated phrenic hernias.
At an achalasia nitrodrugs, ganglioblokator, nifedipine and other similar drugs of antagonists of calcium are appointed. But the main method of treatment of this disease is the kardiolatation. This method consists in expansion of the lent place in a gullet by means of a balloon pneumatic cardiodilator. Such treatment of an achalasia is contraindicated to patients with portal hypertensia which is followed by a gullet varicosity, the patient with the expressed esophagitis, blood diseases. At contraindications apply alternative methods.
Conservative treatment of an esophagism consists in a sparing diet, purpose of drugs of nitrogroup, sedative and spasmolytic drugs. In the absence of a positive effect carry out surgical treatment which consists in a rassekaniye of a muscular layer of a gullet. It is important to begin treatment as soon as there were first symptoms of an esophagism of a gullet as in that case probability to avoid operational treatment much above.
Treatment a reflux esophagitis is directed to decrease in intra belly pressure, manifestations of an esophagitis, decrease in body weight to age norm. Also chemically sparing diet, fractional food is without fail appointed mechanically. From drugs are appointed H2 receptors: ranitidine, famotidine which reduce acidity of a gastric juice and also are appointed spasmolytic drugs and the enveloping means. Prokinetics for increase forces of compression of the lower sphincter of a gullet and time of evacuation of contents of a stomach are used. Operational treatment is appointed at axial hernia of an esophageal opening, bleeding and a stenosis.
Treatment of phrenic hernias of the sliding character is carried out conservatively, reducing manifestations of a gastroesophagal reflex. Surgical treatment is carried out at complications, such as bleeding, an esophageal stenosis, inefficiencies of conservative treatment. The last complication meets at patients with inborn defects and insufficiency of the lower sphincter of a gullet more often.
It is not necessary to speak about a conservative cancer therapy of a gullet. It happens because of diagnosis of a disease at those stages when it does not give a positive effect. Radical treatment is carried out directly as preparation before operation. At early stages of a disease purely beam treatment or an operative measure, positively influence later only their combination.
Use himio-and radiation therapy before operation improves results of treatment several times. Radiation is carried out several weeks prior to surgical treatment, the method of a remote gamma therapy is applied. Operational intervention depends on localization of a malignant tumor. If the lower part of a gullet is affected, it is deleted together with upper part of a stomach, sewing the gullet rest in a stomach stump. At defeat of average department, the gullet is removed completely, prepost podshivany walls of a stomach to an abdominal wall and create an anastomosis for input of food through a probe.
In one-two years after removal of a gullet, on condition of lack of recurrence the gullet is recovered, replacing it with a small bowel. Recurrence of a disease can happen on condition of inefficiency of radiation therapy. The lethality of this disease is connected not so much with innidiation how many with organism exhaustion because of primary tumor. On it, the malignant disease of a gullet is revealed earlier and operation is performed, the forecast of treatment is more successful.