What Is an Esophageal Ulcer?

Esophageal ulcers occur on the basis of peptic esophagitis or ectopic gastric mucosa of the esophagus, located near the cardia at the lower end of the esophagus, and can be accompanied by acute bleeding. In esophageal hiatal hernia, the part of the stomach on the palate is prone to ulcers. About 20% of cases have blood and may be severe bleeding, which is manifested by vomiting and melena.

Esophageal ulcers occur more frequently in the lower 1/3 of the esophagus, but they are also common in about 10% of patients. The size of the ulcer also varies greatly from patient to patient, the small one is only a few millimeters, and the large one can surround the esophagus for a week. Esophageal ulcers often occur in patients with reflux esophagitis and sliding hiatal hernias with cardia esophageal reflux. Ulcers can occur in squamous or columnar epithelium, or after esophagogastric anastomosis or esophageal jejunostomy. The prevalence of esophageal ulcers is mostly between 30 and 70 years old. About 2/3 of patients are over 50 years old, but they can also be seen in children.

Visiting department: Gastroenterology
Multiple groups: 30 to 70 years old
Common locations: esophagus

Common causes: Esophageal tuberculosis, esophageal cancer, reflux esophagitis, corrosive esophagitis, etc.
Common symptoms: Difficulty swallowing and pain

Causes of esophageal ulcers and common diseases

The etiology of esophageal ulcers is complex and diverse. Common causes include reflux esophagitis, esophageal foreign body damage, esophageal ulcers caused by long-term placement of gastric tubes, ulcers after esophageal varicose vein treatment, esophageal cancer, Barrett's esophagus, esophageal Crohn's disease, drugs Sexual injury, esophageal infection, idiopathic esophagitis of unknown cause, etc.

Differential diagnosis of esophageal ulcer

Diagnosis mainly depends on X-ray examination and endoscopy, which can determine the location, shape, size and nature of the ulcer.

X-ray characteristics: It usually occurs in the lower part of the esophagus, but it can also be located in the middle part. The size of the ulcer is between several millimeters and 3cm. The front view of the shadow is oval, round, and the edges are smooth and tidy. There are edema bands around, the mucosa can reach the edge of the shadow, and the local tube wall can have different degrees of stenosis. The disease should be distinguished from esophageal diverticulum and ulcerative esophageal cancer. The esophageal diverticulum is a sac-like barium shadow protruding outside the cavity, and the inner mucosal folds are connected to the esophageal mucosal folds. The ulcerative esophageal cancer is irregular irregular shadows in the cavity. .

Esophageal ulcer examination

The main symptoms are difficulty swallowing, a burning sensation in the lower part of the sternum, and high upper abdomen (xiphoid process) pain. Difficulty swallowing is due to esophageal spasm, which can disappear as the inflammation subsides, and then with the subsidence of inflammation and the healing of ulcers, scars can be left, which can cause stenosis and dysphagia. Ulcer pain is characterized by a high location, deep drilling pain behind the xiphoid process, and radiating to the back and interscapular area. Pain often occurs when eating or drinking. It usually occurs within a few seconds after swallowing. It can also occur after an interval of half an hour. It can be induced or exacerbated when lying down or bending down. It can be relieved by taking antacids. Other symptoms are nausea, vomiting, belching, and weight loss. Physical examination showed tenderness at the xiphoid process. The main complications are obstruction, bleeding and perforation to the mediastinum or upper abdomen.

Principles of esophageal ulcer treatment

Including general treatment, etiology treatment, symptomatic treatment and complications treatment.

General treatment of esophageal ulcer

Advocate rest, soothing emotions, avoid irritating diets and excessively fast and hot diets, quit smoking and alcohol, and avoid lying flat after meals.

Esophageal Ulcer Treatment

The etiology of esophageal ulcer is complex, and different treatment methods are adopted for different causes. Esophageal Crohn's disease can be treated with mesalazine or other immunosuppressive agents, esophageal BS can be treated with hormones or immunosuppressive agents alone or in combination, and tuberculosis, viral, and fungal infections can be treated according to the etiology. Most of the esophageal ulcers caused by abortion are acid suppression and improvement of gastrointestinal motility. Most of the esophageal ulcers caused by drugs can be relieved by themselves. Among the drug factors, when aspirin is used in antithrombotic therapy, the prevention and treatment of gastrointestinal damage caused by aspirin can refer to the "Chinese Expert Consensus on the Prevention and Treatment of Gastrointestinal Damage of Antiplatelet Drugs". The relationship between Helicobacter pylori and esophageal diseases is not clear. There is no conclusive conclusion whether H. pylori eradication should be performed in patients with simple esophageal ulcers and H. pylori infection. Recent studies have suggested that gastroesophageal reflux without severe gastric atrophy or hiatal hernia Patients are recommended for eradication.

Esophageal ulcer acid treatment

The idea of "no acid and no ulcer" has been widely accepted. Nowadays research has proved the importance of acidic environment in the pathogenesis of esophageal ulcers, so improving the acidic environment around the mucosa is particularly important for the treatment of esophageal ulcers. The main drugs include acid inhibitors (PPI, H2 receptor antagonists, etc.), stomach acid drugs (aluminum magnesium carbonate, aluminum hydroxide, etc.), drugs that reduce acid reflux (domperidone, mosapride, cisapride, etc.) ), Esophageal mucosal protective agent (colloid pectin bismuth, misoprostol, etc.). In recent years, studies have found that some patients still have heartburn, chest pain and other discomforts after PPI application. The reasons may be eosinophilic esophagitis, high sensitivity of the esophageal mucosa, non-acidic substances flowing back into the esophagus (such as bile salt reflux), CYP2C19 Polymorphism, etc., the application of esophageal electrical impedance test, pH monitoring, esophageal dynamic measurement and other methods can assist judgment.

Treatment of esophageal ulcer complications

The main complications of esophageal ulcer are bleeding, stenosis and perforation. Endoscopic treatment is one of the important methods to control complications. For bleeding, endoscopy can be given under the scope of epinephrine injection or a probe to stop bleeding, if necessary, blood transfusion treatment; for esophageal stenosis, endoscopic balloon dilatation is often used; surgical treatment of esophageal perforation can be selected according to the condition, and endoscopic mulch Stent implantation or conservative treatment (such as intravenous nutrition, application of spectrum antibiotics, CT or ultrasound thoracentesis drainage).