Erosive esophagitis: what is it, Los Angeles classification and treatment
Erosive esophagitis occurs when lesions form in the esophagus due to chronic gastroesophageal reflux. Generally, this condition causes symptoms such as pain when ingesting both solid and liquid foods and the presence of blood in vomiting or in the stomach.
The diagnosis of esophagitis is carried out through the evaluation of symptoms and an endoscopy, in addition to the lesions observed in the esophagus can be cataloged according to the degree of seriousness, under the classification of the Angels.
The treatment of this condition is usually indicated by the gastroenterologist, who may recommend the use of medication to prevent excess gastric yokes or even inhibit production; on the other hand, in the most serious situations, surgery may be suggested. Asimismo, also is necessary the follow-up of a nutritionist, with the purpose of indicating which are the alterations that must be carried out in the eating habits.
The symptoms of erosive esophagitis depend on the degree of injuries in the esophagus, however, the most common include the following:
- Vomiting that may not contain blood;
- Pain al eating solid foods or consuming liquids;
- Bleed en las heces;
- Sore throat;
- Pain in the pecho;
- Chronic Tos.
In addition, when treatment is not received for erosive esophagitis, it is possible that anemia develops due to lack of blood flow and increased risk of an esophageal tumor. Therefore, if there is a suspicion of this condition, it is essential to consult a gastroenterologist so that the diagnosis can be carried out and the appropriate treatment started.
See more details on how to identify esophagitis.
The diagnosis of erosive esophagitis is performed by the gastroenterologist through the evaluation of the symptoms presented and the factors that improve or worsen the intensity of the symptoms.
However, to confirm the diagnosis and determine the severity of the situation, an endoscopy is indicated to observe the size of the lesions and to classify the erosive esophagitis according to the Los Angeles protocol.
Find out how endoscopy is performed.
Los Angeles classification
The Los Angeles classification aims to separate the lesions from erosive esophagitis according to the severity, so that the most suitable treatment for the lesion can be decided.
Grade of seriousness of the injury
1 or more erosions smaller than 5 mm.
1 or more erosions greater than 5 mm, but they are not joined together.
Erosions that unite, the ones that involve less than 75% of the organ.
Erosions that are found in at least 75% of the circumference of the esophagus.
When the lesions of erosive esophagitis are found to be recurrent, there is a greater risk of cancer arising in the esophagus, so it may be necessary that surgical treatment be indicated first, before the use of medicines.
Erosive esophagitis in most cases is a consequence of untreated esophagitis, so that the lesions continue to appear and produce symptoms.
In addition, other situations that favor the development of the esophagitis and the gastroesophageal reflux are due to the fact that the content of the stomach acid reaches the esophagus and promotes irritation in the mucosa, favoring the emergence of lesions.
Erosive esophagitis can also occur more frequently in people who smoke as a result of the consumption of processed and fatty foods.
The treatment for erosive esophagitis depends on the factor that caused it; however, it is normally carried out through the follow-up of a nutritionist, who may indicate to suspend the use of cigarettes, in case the individual is a smoker; reduce the consumption of industrialized and fatty foods, and lose weight in people with the onset of obesity.
Likewise, it may be necessary to use certain medications, such as the following:
- Proton pump inhibitors (PPIs), like omeprazole, esomeprazole and lansoprazole, they inhibit the production of gastric yoke by the stomach, which prevents it from reaching the esophagus;
- H₂ receptor inhibitors of histamine, such as famotidine, cimetidine and nizatidine, used when PPIs have the expected effect, helping to reduce the amount of acid in the stomach;
- prokinetics, such as domperidone and metoclopramide, used to accelerate stomach emptying.
In case the person is under treatment with anticholinergics, such as Artane or Akineton, or calcium channel blockers, such as amlodipine or verapamil, the gastroenterologist can give specific recommendations on how to use the prescribed drugs.
Surgery for erosive esophagitis alone is indicated in case the lesions do not improve or when the symptoms are persistent and all the treatment options before exposed and were used. This surgery consists of rebuilding a small valve that separates the union between the esophagus and the stomach, thus preventing the gastric yoke from returning through this route and causing new injuries.
How is the treatment performed in embarazadas women?
In the case of pregnant women, apart from follow-up with a nutritionist and daily care, it is recommended to use only histamine H₂ receptor inhibitors, such as ranitidine, cimetidine, nizatidine and famotidine, which are safer for them. gestation, in addition to that they are not absorbed by the milk during its production.
Apart from the recommended medical treatment, in order to have a better quality of life and avoid the discomfort caused by the symptoms, it is also necessary to follow the following daily recommendations:
- Raise the head of the bed by 15 to 30 cm;
- Reduce the intake of citrus fruits, carbonated drinks and those containing caffeine or alcohol, and foods such as mint, eucalyptus, tomato, chocolate and hierbabuena;
- Wait two hours to get dressed after the last meal.
These cares are similar to those that should be applied by people with reflux, they can help prevent stomach acid from going up into the esophagus. Find other advice on how to treat reflux.
In the following video, nutritionist Tatiana Zanin shows how to raise the head of the bed and, in addition, shares excellent advice to naturally relieve the discomfort caused by reflux, which is the cause of erosive esophagitis:
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