WordNet

an abnormal backward flow of body fluids
inflammation of the esophagus; often caused by gastroesophageal reflux (同)oesophagitis

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/03/29 20:29:28」(JST)

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Esophagitis (or oesophagitis) is inflammation of the esophagus. It may be acute or chronic. Acute esophagitis can be catarrhal or phlegmonous, whereas chronic esophagitis may be hypertrophic or atrophic.

Symptoms

Heartburn (pain in chest - retrosternal)
Nausea
Postprandial worsening of symptoms

Symptoms may be relieved by antacids. Esophagitis causes symptoms of abdominal pain and vomiting. If not treated, it causes discomfort and scarring of the esophagus. This makes swallowing food more difficult.^[1]

Causes

Infectious

Forms of infectious esophagitis are typically seen in immunocompromised people. Types include:

Fungal
- Candida (Esophageal candidiasis)
Viral
- Herpes simplex (Herpes esophagitis)
- Cytomegalovirus

Endoscopy can be used to distinguish among these conditions.^[2]

Other

The most common cause is gastroesophageal reflux disease (GERD, or GORD in British English). If caused by GERD, the disease is also called reflux esophagitis.
Chemical injury by alkaline or acid solutions may also cause esophagitis, and is usually seen in children, or in adults who attempt suicide by ingestion of caustic substances.^[3]
Physical injury resulting from radiation therapy or by nasogastric tubes may also be responsible.
Pill esophagitis
Hyperacidity
Alcohol abuse
Eosinophilic esophagitis is a poorly understood form of esophagitis, which is thought to be related to food allergies.
Crohn's disease – a type of IBD which is also an autoimmune disease where the immune system inflames the gastrointestinal tract – can cause esophagitis if it attacks the esophagus.
Certain medications, including doxycycline may cause esophagitis if taken incorrectly.^[4]

Grading of severity

The severity of reflux esophagitis is commonly classified into four grades according to the Los Angeles Classification:^[5]^[6]

Grade A	One or more mucosal breaks < 5 mm in maximal length
Grade B	One or more mucosal breaks > 5mm, but without continuity across mucosal folds
Grade C	Mucosal breaks continuous between > 2 mucosal folds, but involving less than 75% of the esophageal circumference
Grade D	Mucosal breaks involving more than 75% of esophageal circumference

References

^ MedlinePlus Encyclopedia Esophagitis
^ Classen, Meinhard; Tytgat, Guido N. J.; Lightdale, Charles J. (2010). Gastroenterological Endoscopy. Thieme. p. 490. ISBN 978-3-13-125852-6.
^ Tierney, Lawrence M., Jr; McPhee, Stephen J.; Papadakis, Maxine A. (2007). Current Medical Diagnosis & Treatment 2007 (46 ed.). McGraw-Hill. ISBN 0-07-147247-9.
^ "Oesophogagitis with Doxycycline".
^ Farivar M. "Los Angeles Classification of Esophagitis". webgerd.com. In turn citing: Lundell LR, Dent J, Bennett JR, et al. (August 1999). "Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification". Gut. 45 (2): 172–80. doi:10.1136/gut.45.2.172. PMC 1727604. PMID 10403727.
^ Laparoscopic bariatric surgery, Volume 1. William B. Inabnet, Eric J. DeMaria, Sayeed Ikramuddin. ISBN 0-7817-4874-7.^{[page needed]}

UpToDate Contents

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1. 成人における難治性胃食道逆流症へのアプローチ approach to refractory gastroesophageal reflux disease in adults
2. 成人における胃食道逆流症の内科的マネージメント medical management of gastroesophageal reflux disease in adults
3. 成人における胃食道逆流症の臨床症状および診断 clinical manifestations and diagnosis of gastroesophageal reflux in adults
4. 乳児の胃食道逆流 gastroesophageal reflux in infants
5. 小児や青年の胃食道逆流症のマネージメント management of gastroesophageal reflux disease in children and adolescents

English Journal

Laparoscopic Sleeve-Collis-Nissen Gastroplasty: a Safe Alternative for Morbidly Obese Patients with Gastroesophageal Reflux Disease.

da Silva LE1, Alves MM, El-Ajouz TK, Ribeiro PC, Cruz RJ Jr.
Obesity surgery.Obes Surg.2015 Jul;25(7):1217-22. doi: 10.1007/s11695-014-1523-4.
BACKGROUND: Some studies have recently suggested that laparoscopic sleeve gastrectomy may exacerbate gastroesophageal reflux disease (GERD) symptoms or even increase the risk of "de novo" post-operative GERD. We herein describe and evaluate the initial response of an alternative technique of sleeve
PMID 25528566

A relation between cell cycle and intestinal metaplasia in oesophageal biopsies using optical and digital microscopy.

Máté M1, Molnár B.
Pathology oncology research : POR.Pathol Oncol Res.2015 Jul;21(3):669-73. doi: 10.1007/s12253-014-9873-8. Epub 2015 Mar 5.
Protein expression changes in relation to cell cycles provide important information, and it may represent a new method for an early diagnosis of metaplasia - dysplasia - adenocarcinoma sequence. We investigated potential changes in cell cycle genes such as protooncogenes (PCNA, EGFR), tumour suppres
PMID 25740071

Barrett's esophagus: recent insights into pathogenesis and cellular ontogeny.

Kapoor H1, Agrawal DK2, Mittal SK3.
Translational research : the journal of laboratory and clinical medicine.Transl Res.2015 Jul;166(1):28-40. doi: 10.1016/j.trsl.2015.01.009. Epub 2015 Jan 31.
Esophageal adenocarcinoma (EAC) has increased 6-fold in its incidence in the last 2 decades. Evidence supports the hypothesis of stepwise progression from normal squamous epithelium → reflux esophagitis → metaplasia (Barrett's esophagus, BE) → dysplasia → adenocarcinoma. The precurso
PMID 25701368

Japanese Journal

Optimal acid suppressive treatment for adequate symptom relief and prevention of the complications of gastroesophageal reflux disease : differences in long-term clinical course and pathophysiology among disease subtypes

Esophagus : official journal of the Japan Esophageal Society 14(2), 113-121, 2017-04
NAID 40021166161

Increase of transient lower esophageal sphincter relaxation associated with cascade stomach

Ｊｏｕｒｎａｌ　ｏｆ　Ｃｌｉｎｉｃａｌ　Ｂｉｏｃｈｅｍｉｓｔｒｙ　ａｎｄ　Ｎｕｔｒｉｔｉｏｎ 60(3), 211-215, 2017
NAID 130005631985

胃管再建術後吻合部位置が術後逆流性食道炎発生に与える影響

日本気管食道科学会会報 68(2), 143-145, 2017
NAID 130005612035

Related Pictures

Reflux Gastroesophageal Reflux Disease (GERD) - Gastrointestinal Disorders - MSD Manual reflux esophagitis Esophagitis - Causes & Treatment for Eosinophilic, Reflux & Erosive Reflux Esophagitis - Wikipedia Reflux esophagitis | definition of reflux esophagitis by Medical dictionary

★リンクテーブル★

リンク元	「逆流性食道炎」
関連記事	「reflux」「refluxed」

「逆流性食道炎」

Esophagitis
	Micrograph of herpes esophagitis. H&E stain.
Classification and external resources
Specialty	gastroenterology
ICD-10	K20
ICD-9-CM	530.10
DiseasesDB	9182
MedlinePlus	001153
MeSH	D004941
	[edit on Wikidata]

　　[★]

英: reflux esophagitis
同: peptic esophagitis
関: 胸骨下痛、食道炎、バレット食道、胃食道逆流症 GERD

概念

胃食道の逆流防止機構が十分に作動せず、胃・小腸内容液の逆流から粘膜傷害をきたした状態(IMD)。
上位の疾患概念に胃食道逆流症 GERDがある。

分類

ロサンゼルス分類：(内視鏡的な分類)
Savary-Miller分類
食道疾患研究会による分類：色調変化型、びらん型、潰瘍型、隆起肥厚型

リスク

肥満、妊娠(腹腔内圧上昇、エストロゲン・プロゲステロンによるLES圧低下)、過食、高カロリー食(チョコレート、和菓子、高脂肪食、餅)・刺激物、食後臥位(3時間以内)、喫煙、アルコール、薬剤(Ca拮抗薬、硝酸薬、テオフィリン)
滑脱型食道裂孔ヘルニア、LES機能不全、胃切除後

症状

食道症状：胸焼け、呑酸、嚥下困難
食道外症状：咳嗽、前胸部痛(胸骨後部痛)、嚥下困難、嚥下痛、つまり感

検査

確定診断のために、食道内24時間pHモニター、食道内圧測定、内視鏡検査が重要。特に食道内24時間pHモニターでpHの低下が証明できなければ、胃食道逆流症は否定的。(QB.A-53)
X線造影
胃カメラ
食道内24時間pHモニター

24-hour pH monitoring

pH4以下が一日の10%以上

治療

生活習慣改善指導

食後の就寝禁止、就寝直前の飲食禁止、就寝時Fowler体位
刺激物の制限

薬物療法：

(胃酸分泌抑制)H2受容体阻害薬、プロトンポンプ阻害薬
(胃の逆流阻害)消化管運動促進薬　　←　　本当？
粘膜保護薬 (QB.A-53)
術後胃で十二指腸液の逆流があるばあいには酸分泌抑制薬は無効であり、メシル酸カモスタットが用いられる。

外科的療法：

Nissenの逆流防止手術。腹腔鏡手術が一般的。胃食道逆流症#手術療法
肥満手術

プロトンポンプ阻害薬

hospitalist vol.2 no.3 2014.9 P.741

血液濃度が低い：腸溶コーティングされたPPIが長時間胃に留まると胃の中で溶解してしまい成分が失活して、血液中濃度が十分に上昇しない場合がある。腸管運動の運動改善薬が有効なことがある。
rapid metabolizer：PPIはCYP2C19の代謝を受けるが、遺伝子多形により代謝の速度が異なる(homozygous extensive metabolizer, heterozygous extenstive metabolizer, poor metabolizer)。ランソプラゾールでは多型の影響をうける。エソメプラゾールやラベプラゾールは影響が少ない。
胃内環境が酸性でない：PPIの活性化には酸性環境が必要であるが、食後など胃内に大量の食物がある場合には胃酸が希釈されて酸性環境が得られない場合がある。これに対して腸管の運動改善薬や食前内服が等の対策が必要。

胃酸以外の逆流の可能性

十二指腸液逆流(bile reflux)を考慮して粘膜保護薬(アルロイドG、スクラルファート)や胆汁吸着薬(コレスチミド)、あるいは膵酵素阻害薬(カモスタット)も検討を。
消化管運動亢進のためにプリンペランも考慮。

国試

101A025、097D022、100H016

「reflux」

　　[★]

n.

逆流、還流

v.

逆流する

関: backflush、regurgitate、regurgitation

「refluxed」

　　[★]

adj.

逆流性の

関: regurgitant

[1] MedlinePlus Encyclopedia Esophagitis

[ClassenTytgat2010-2] Classen, Meinhard; Tytgat, Guido N. J.; Lightdale, Charles J. (2010). Gastroenterological Endoscopy. Thieme. p. 490. ISBN 978-3-13-125852-6.

[3] Tierney, Lawrence M., Jr; McPhee, Stephen J.; Papadakis, Maxine A. (2007). Current Medical Diagnosis & Treatment 2007 (46 ed.). McGraw-Hill. ISBN 0-07-147247-9.

[4] "Oesophogagitis with Doxycycline".

[5] Farivar M. "Los Angeles Classification of Esophagitis". webgerd.com. In turn citing: Lundell LR, Dent J, Bennett JR, et al. (August 1999). "Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification". Gut. 45 (2): 172–80. doi:10.1136/gut.45.2.172. PMC 1727604. PMID 10403727.

[6] Laparoscopic bariatric surgery, Volume 1. William B. Inabnet, Eric J. DeMaria, Sayeed Ikramuddin. ISBN 0-7817-4874-7.^{[page needed]}

匿名

検索

案内

案内

reflux esophagitis