Z\u00e1n\u011bty j\u00edcnu zp\u016fsobuj\u00ed zna\u010dnou \u010d\u00e1st symptomatologie tohoto org\u00e1nu. Vznikaj\u00ed bu\u010f samostatn\u011b, nebo jako n\u00e1sledek jin\u00fdch poruch j\u00edcnu. Mnoho z\u00e1n\u011bt\u016f se projev\u00ed jen necharakteristick\u00fdmi p\u0159\u00edznaky, nap\u0159. neur\u010dit\u00fdmi epigastrick\u00fdmi a dyspeptick\u00fdmi obt\u00ed\u017eemi, nechutenstv\u00edm, krv\u00e1cen\u00edm, a na ezofagitidu se v\u016fbec nemysl\u00ed. Teprve roz\u0161\u00ed\u0159en\u00ed fibroendoskopie uk\u00e1zalo v cel\u00e9 \u0161\u00ed\u0159i v\u00fdznam t\u00e9to nemoci. P\u0159edm\u011btem z\u00e1jmu chirurga je p\u0159edev\u0161\u00edm refluxn\u00ed ezofagitida, kter\u00e9 je v\u011bnov\u00e1na kapitola 9, a ezofagitida zp\u016fsoben\u00e1 polept\u00e1n\u00edm, o kter\u00e9 je pojedn\u00e1no v kapitole 14. P\u0159edev\u0161\u00edm pro pot\u0159eby diferenci\u00e1ln\u00ed diagnostiky je t\u0159eba alespo\u0148 z\u00e1kladn\u00edch znalost\u00ed o cel\u00e9 \u0161\u00ed\u0159i t\u00e9to problematiky. Bli\u017e\u0161\u00ed pou\u010den\u00ed o t\u011bchto typech z\u00e1n\u011bt\u016f je mo\u017eno nal\u00e9zt p\u0159edev\u0161\u00edm v gastroenterologicky zam\u011b\u0159en\u00fdch publikac\u00edch [1\u20139].<\/p>\n
Etiologie a patogeneze ezofagitid. \u0160kodliviny p\u016fsob\u00ed na sliznici p\u0159\u00edmo z lumen nebo okol\u00ed krevn\u00ed a lymfatickou cestou. P\u0159ehled etiopatogenetick\u00fdch faktor\u016f uv\u00e1d\u00ed tab. 10.1.<\/span><\/p>\n .<\/span><\/p>\n Pl\u00eds\u0148ov\u00e9 a virov\u00e9 ezofagitidy postihuj\u00ed nej\u010dast\u011bji pacienty s naru\u0161enou imunitou, vyskytuj\u00ed se po l\u00e9\u010db\u011b antibiotiky a kortikosteroidy. D\u0159\u00edve byly tyto z\u00e1n\u011bty z\u0159ejm\u011b vz\u00e1cn\u00e9. Dnes se s nimi setk\u00e1v\u00e1me hlavn\u011b u nemocn\u00fdch s imunosupresivn\u00ed l\u00e9\u010dbou, po transplantac\u00edch, b\u011bhem protin\u00e1dorov\u00e9 chemoterapie a p\u0159i AIDS. V\u00fdznamn\u011b mohou ovliv\u0148ovat morbiditu a mortalitu t\u011bchto nemocn\u00fdch.<\/p>\n Nej\u010dast\u011bj\u0161\u00edm p\u0159\u00edznakem ezofagitidy je dysfagie a odynofagie. P\u0159\u00edtomnost refluxn\u00ed ezofagitidy asi nen\u00ed predisponuj\u00edc\u00edm faktorem infek\u010dn\u00edho z\u00e1n\u011btu. Slizni\u010dn\u00ed l\u00e9ze po radiaci a chemoterapii se mohou st\u00e1t vstupn\u00ed branou infekce.<\/p>\n Etiologie a patologick\u00e9 n\u00e1lezy. Etiologick\u00fdm agens je Candida albicans, vz\u00e1cn\u011bji C. crusei, C. tropicalis a Torulopsis glabrata. P\u0159\u00edtomnost pl\u00edsn\u011b na sliznici nemus\u00ed b\u00fdt z po\u010d\u00e1tku prov\u00e1zena z\u00e1n\u011btem. Projevuje se nejprve b\u011blav\u00fdmi n\u00e1lety na sliznici, kter\u00e9 lze zprvu spl\u00e1chnout, pozd\u011bji spl\u00fdvaj\u00ed ve vyv\u00fd\u0161en\u00e9 ostr\u016fvky a\u017e membr\u00e1ny. Sliznice mezi nimi je nejprve zarudl\u00e1, pak k\u0159ehk\u00e1, krv\u00e1civ\u00e1, objevuj\u00ed se eroze a v\u0159\u00eddky. Vz\u00e1cn\u011bj\u0161\u00ed jsou v\u0159edy hlubok\u00e9, zasahuj\u00edc\u00ed a\u017e do svaloviny, s tvorbou striktur. Mikroskopicky se povlaky skl\u00e1daj\u00ed z fibrinu, granulocyt\u016f a erytrocyt\u016f. P\u0159i barven\u00ed hematoxylinem-eozinem nebo p\u0159i speci\u00e1ln\u00edm barven\u00ed lze prok\u00e1zat pl\u00eds\u0148ov\u00e9 hyfy a pseudohyfy.<\/span><\/p>\n Klinick\u00fd obraz.<\/em> Kandid\u00f3za typicky postihuje oslaben\u00e9 nemocn\u00e9 s imunodeficitem. Podp\u016frn\u00fdm faktorem je porucha vyprazd\u0148ov\u00e1n\u00ed j\u00edcnu. Sou\u010dasn\u011b, ne v\u0161ak v\u017edy, mohou b\u00fdt posti\u017eena i \u00fasta. Pr\u016fb\u011bh m\u016f\u017ee b\u00fdt asymptomatick\u00fd, ale typicky se objevuje dysfagie, odynofagie a n\u011bkdy retrostern\u00e1ln\u00ed bolest. Hore\u010dka a t\u0159esavka jsou zn\u00e1mkou pl\u00eds\u0148ov\u00e9 sepse.<\/span><\/p>\n Diagnostika.<\/em> Endoskopicky zjist\u00edme d\u0159\u00edve popsan\u00e9 zm\u011bny na sliznici. Pl\u00edse\u0148 lze prok\u00e1zat v biopsii a ve st\u011bru. Rentgenov\u00e1 pas\u00e1\u017e zejm\u00e9na ve dvoj\u00edm kontrastu m\u016f\u017ee odhalit i \u010dasn\u00e9 zm\u011bny, dla\u017edicov\u00fd reli\u00e9f p\u0159ipom\u00ednaj\u00edc\u00ed varixy, slizni\u010dn\u00ed ulcerace a samoz\u0159ejm\u011b v\u0159edy a striktury v pokro\u010dil\u00e9m stadiu.<\/span><\/p>\n Diferenci\u00e1ln\u00ed diagn\u00f3za.<\/em> Jin\u00e9 mykotick\u00e9 infekce ezofagu jsou vz\u00e1cn\u00e9. Aspergil\u00f3zu lze od kandid\u00f3zy n\u011bkdy t\u011b\u017eko odli\u0161it a spolu s n\u00ed je nej\u010dast\u011bj\u0161\u00ed infekc\u00ed u nemocn\u00fdch s n\u00e1dory. Je t\u0159eba na ni myslet p\u0159i l\u00e9\u010den\u00ed rezistentn\u00ed kandid\u00f3zy. P\u0159i l\u00e9\u010db\u011b se u\u017e\u00edv\u00e1 amfotericin B.<\/span><\/p>\n L\u00e9\u010dba.<\/em> V\u00fdb\u011br antimykotika z\u00e1vis\u00ed na klinick\u00e9m stavu a imunologick\u00e9m profilu nemocn\u00e9ho. Podle mo\u017enost\u00ed je t\u0159eba p\u0159eru\u0161it agresivn\u00ed l\u00e9\u010dbu cytostatiky a imunosupresivy. U stabilizovan\u00fdch a imunokompetentn\u00edch nemocn\u00fdch jsou posta\u010duj\u00edc\u00ed nevst\u0159ebateln\u00e1 peror\u00e1ln\u011b pod\u00e1van\u00e1 m\u00edstn\u011b p\u016fsob\u00edc\u00ed antimykotika, nap\u0159. nystatin, kter\u00fd je mo\u017eno podat i u AIDS. V t\u011b\u017e\u0161\u00edch p\u0159\u00edpadech je t\u0159eba podat peror\u00e1ln\u011b resorbovateln\u00e9 a syst\u00e9mov\u011b p\u016fsob\u00edc\u00ed antibiotika, nap\u0159. ketokonazol (200 mg denn\u011b), flukonazol (100 a\u017e 200 mg denn\u011b, p\u0159i AIDS a\u017e 400\u2013800 mg denn\u011b). Chronick\u00e9 pod\u00e1v\u00e1n\u00ed m\u016f\u017ee v\u00e9st ke vzniku rezistence, m\u016f\u017ee doj\u00edt k poru\u0161e biosynt\u00e9zy steroid\u016f a k blok\u00e1d\u011b cytochromu P 450. K \u00fa\u010dinku je t\u0159eba kysel\u00e9 prost\u0159ed\u00ed \u017ealudku. U nemocn\u00fdch s neutropeni\u00ed vznik\u00e1 b\u011bhem pod\u00e1v\u00e1n\u00ed imunosupresiv riziko disseminace kandid\u00f3zy. Je zde indikov\u00e1n amfotericin B v d\u00e1vce 0,5\u20130,6 mg\/kg\/den, hlavn\u011b jsou-li pot\u00ed\u017ee s polyk\u00e1n\u00edm. L\u00e9\u010dba m\u00e1 trvat 1\u20132 t\u00fddny. Zejm\u00e9na u nemocn\u00fdch s posti\u017eenou imunitou jsou \u010dast\u00e9 relapsy a je t\u0159eba myslet na mo\u017enost rezistence a jin\u00e9 infekce.<\/span><\/p>\n V\u00fdskyt a etiologie. Herpetick\u00e1 ezofagitida je nej\u010dast\u011bj\u0161\u00ed virovou ezofagitidou, co do v\u00fdskytu druhou infek\u010dn\u00ed po kandid\u00f3ze. Zp\u016fsobuje ji herpetick\u00fd virus typu I. Vznik\u00e1 p\u0159ev\u00e1\u017en\u011b vzplanut\u00edm latentn\u00ed virov\u00e9 infekce v gangliov\u00fdch bu\u0148k\u00e1ch. K aktivaci doch\u00e1z\u00ed zejm\u00e9na u t\u011b\u017ece nemocn\u00fdch a imunodeficitn\u00edch pacient\u016f.<\/span><\/p>\n Klinick\u00fd obraz a diagnostika.<\/em> P\u0159ed n\u00e1hl\u00fdm vznikem odynofagie a dysfagie a p\u0159\u00edpadn\u011b i hematemeze m\u016f\u017ee m\u00edt pacient projevy herpes labialis, gingivostomatitidy \u010di jin\u00e9ho virov\u00e9ho onemocn\u011bn\u00ed. U nemocn\u00fdch s norm\u00e1ln\u00edm stavem imunity trv\u00e1 onemocn\u011bn\u00ed 1\u20132 t\u00fddny. U nemocn\u00fdch s poru\u0161enou imunitou, nap\u0159. AIDS, m\u016f\u017ee b\u00fdt pr\u016fb\u011bh t\u011b\u017ek\u00fd, se vznikem hlubok\u00fdch slizni\u010dn\u00edch ulcerac\u00ed, hemoragi\u00ed a perforac\u00ed.<\/span><\/p>\n Endoskopicky nal\u00e9z\u00e1me v po\u010d\u00e1te\u010dn\u00edm stadiu na sliznici drobn\u00e9 vezikuly, pozd\u011bji se v doln\u00edm j\u00edcnu objevuj\u00ed po\u010detn\u00e9 mal\u00e9 v\u0159\u00eddky s vyv\u00fd\u0161en\u00fdm \u017elutav\u00fdm ohrani\u010den\u00edm, kter\u00e9 \u010dasto spl\u00fdvaj\u00ed. V <\/span>histologick\u00e9m obraze jsou typick\u00e9 velk\u00e9 a\u017e gigantick\u00e9 v\u00edcejadern\u00e9 bu\u0148ky s eozinofiln\u00edmi inkluzemi (tzv. Cowdryho t\u011bl\u00edska A) mezi epitelov\u00fdmi bu\u0148kami. Kultivace viru je mo\u017en\u00e1 ve f\u00e1zi vezikul, ale tehdy je nemocn\u00fd zpravidla je\u0161t\u011b bez p\u0159\u00edznak\u016f. V ulcerac\u00edch b\u00fdv\u00e1 soub\u011b\u017en\u011b i n\u00e1lez kandid\u00f3zy. <\/span>Rentgenov\u00e9 vy\u0161et\u0159en\u00ed m\u016f\u017ee zn\u00e1zornit hv\u011bzdicov\u00e9 ulcerace nebo dla\u017edicov\u00fd reli\u00e9f sliznice.<\/span><\/p>\n L\u00e9\u010dba.<\/em> U imunosuprimovan\u00fdch nemocn\u00fdch se pod\u00e1v\u00e1 acyklovir v d\u00e1vce<\/span> 250 mg\/m2 <\/span>ka\u017ed\u00fdch 8 hodin intraven\u00f3zn\u011b po dobu 7\u201310 dn\u00ed. U nemocn\u00fdch s norm\u00e1ln\u00ed imunitou je posta\u010duj\u00edc\u00ed symptomatologick\u00e1 l\u00e9\u010dba (tekut\u00e1 strava, antacida) a pop\u0159. acyklovir peror\u00e1ln\u011b 5\u00d7 200 mg denn\u011b.<\/p>\n Etiologie a patologick\u00e9 n\u00e1lezy.<\/em> Prim\u00e1rn\u00ed infekce cytomegalovirem vznik\u00e1 obvykle v d\u011btstv\u00ed a u mlad\u00fdch lid\u00ed. V\u011bt\u0161ina dosp\u011bl\u00fdch m\u00e1 pozitivn\u00ed s\u00e9rologii. Ve v\u011bt\u0161in\u011b org\u00e1n\u016f je mo\u017eno identifikovat virovou CMV-DNA v latentn\u00ed form\u011b. K reaktivaci infekce m\u016f\u017ee doj\u00edt u t\u011b\u017ece nemocn\u00fdch a imunodeficientn\u00edch stav\u016f. Pak se m\u016f\u017ee onemocn\u011bn\u00ed manifestovat i jako ezofagitida. Velmi vz\u00e1cn\u011b vznik\u00e1 u nemocn\u00fdch s norm\u00e1ln\u00ed imunitou. Zdrojem infekce m\u016f\u017ee b\u00fdt transfuze od d\u00e1rce s latentn\u00ed infekc\u00ed nebo org\u00e1n d\u00e1rce p\u0159i transplantaci. Infekce postihuje hlavn\u011b fibroplasty a endotelov\u00e9 bu\u0148ky, dla\u017edicov\u00fd epitel neb\u00fdv\u00e1 posti\u017een.<\/span><\/p>\n Histologicky<\/em> se nach\u00e1zej\u00ed velk\u00e9 bu\u0148ky s intranukle\u00e1rn\u00edmi a cytoplazmatick\u00fdmi inkluzemi se sv\u011btl\u00fdm dvorcem perinukle\u00e1rn\u011b. Biopsie se doporu\u010duje odebrat ze spodiny v\u0159ed\u016f.<\/span><\/p>\n Klinick\u00fd obraz a diagnostika.<\/em> Vedouc\u00edm p\u0159\u00edznakem je odynofagie, \u010dast\u00e9 jsou relapsy onemocn\u011bn\u00ed. <\/span>Endoskopick\u00fd obraz se v po\u010d\u00e1tku p\u0159\u00edli\u0161 neli\u0161\u00ed od ezofagitidy zp\u016fsoben\u00e9 virem herpes simplex. Drobn\u00e9 po\u010detn\u00e9 ulcerace v doln\u00edm j\u00edcnu v\u0161ak \u010dast\u011bji p\u0159ech\u00e1zej\u00ed ve v\u011bt\u0161\u00ed pod\u00e9ln\u00e9 v\u0159edy obklopen\u00e9 makroskopicky t\u00e9m\u011b\u0159 norm\u00e1ln\u00ed sliznic\u00ed. Hojen\u00edm se mohou vytvo\u0159it striktury.<\/span><\/p>\n L\u00e9\u010dba.<\/em> Pod\u00e1v\u00e1 se gancyklovir v d\u00e1vce 2,5 a\u017e 5 mg\/kg ka\u017ed\u00fdch 12 hodin v infuzi po dobu 10 dn\u00ed. V klinick\u00e9m zkou\u0161en\u00ed je foskarnet, pyrofosf\u00e1tov\u00fd analog inhibuj\u00edc\u00ed virovou DNA polymer\u00e1zu a reverzn\u00ed transkript\u00e1zu.<\/span><\/p>\n Pacienti s AIDS mohou b\u00fdt posti\u017eeni n\u00e1hl\u00fdm vznikem dysfagie a odynofagie, jej\u00ed\u017e p\u0159\u00ed\u010dinou je infek\u010dn\u00ed ezofagitida. Nej\u010dast\u011bj\u0161\u00ed je kandidov\u00e1 ezofagitida, \u010dast\u00e9 jsou i infekce cytomegalovirem a herpes simplex. Mnohdy jde o kombinovanou infekci. M\u00e9n\u011b \u010dastou p\u0159\u00ed\u010dinou infekce m\u016f\u017ee b\u00fdt aspergil\u00f3za a histoplazm\u00f3za, virus Epstein\u016fv-Barrov\u00e9 a varicella-herpes zoster. Bakteri\u00e1ln\u00ed infekce m\u016f\u017ee sekund\u00e1rn\u011b infikovat i \u010dasto p\u0159\u00edtomnou refluxn\u00ed ezofagitidu. Zn\u00e1m\u00e9 jsou infekce vyvolan\u00e9 zlat\u00fdm stafylokokem a viriduj\u00edc\u00edm streptokokem. Je pops\u00e1na i tuberkul\u00f3za ezofagu a parazit\u00e1rn\u00ed infekce Pseudocystis carini <\/i>a kryptosporid\u00f3za.<\/p>\n P\u0159i AIDS se vyskytuje i dysfagie zp\u016fsoben\u00e1 Kaposiho sarkomem, pop\u0159. lymfomem ezofagu. N\u011bkdy se mohou vyvinout velk\u00e9 solit\u00e1rn\u00ed v\u0159edy podobn\u00e9 infekci cytomegalovirem, o kter\u00fdch se p\u0159edpokl\u00e1d\u00e1, \u017ee jsou zp\u016fsobeny samotn\u00fdm HIV.<\/p>\n Vz\u00e1cn\u00e9 je posti\u017een\u00ed j\u00edcnu tuberkul\u00f3zou, aktinomyk\u00f3zou, blastomyk\u00f3zou a histoplazm\u00f3zou. V\u011bt\u0161inou jsou zde p\u0159\u00edtomn\u00e9 i ko\u017en\u00ed p\u0159\u00edznaky.<\/p>\n Ezofagitida v pr\u016fb\u011bhu infek\u010dn\u00edch chorob. U hore\u010dnat\u00fdch infek\u010dn\u00edch chorob v d\u011btsk\u00e9m v\u011bku i v dosp\u011blosti se \u010dasto vyv\u00edj\u00ed z\u00e1n\u011bt j\u00edcnov\u00e9 sliznice, kter\u00fd v\u0161ak neb\u00fdv\u00e1 rozpozn\u00e1n, nebo\u0165 se jeho p\u0159\u00edznaky (bolesti v krku, na hrudn\u00edku, p\u0159i polyk\u00e1n\u00ed) ztr\u00e1cej\u00ed mezi p\u0159\u00edznaky z\u00e1kladn\u00edho onemocn\u011bn\u00ed. Nemocn\u00ed maj\u00ed p\u0159i hore\u010dce odpor k tu\u017e\u0161\u00ed strav\u011b, \u010dasto jen pij\u00ed a polykac\u00ed obt\u00ed\u017ee si uv\u011bdomuj\u00ed sp\u00ed\u0161e jen p\u0159i pit\u00ed kysel\u00fdch ovocn\u00fdch \u0161\u0165\u00e1v. Z\u00e1n\u011bt sliznice je v\u00e1z\u00e1n na akutn\u00ed hore\u010dnat\u00e9 obdob\u00ed a po jeho odezn\u011bn\u00ed se spont\u00e1nn\u011b upravuje.<\/span><\/p>\n R\u016fzn\u00fd stupe\u0148 z\u00e1n\u011btu st\u011bny j\u00edcnu m\u016f\u017ee b\u00fdt vyvol\u00e1n p\u016fsoben\u00edm kyselin, louhu a dal\u0161\u00edch chemik\u00e1li\u00ed. O diagnostice a l\u00e9\u010db\u011b t\u011bchto stav\u016f, kde je \u010dasto pot\u0159ebn\u00e1 \u00fa\u010dast chirurga, je pojedn\u00e1no v kapitole 14.<\/p>\n Dr\u00e1\u017ediv\u00fd vliv na sliznici j\u00edcnu m\u00e1 koncentrovan\u00fd alkohol, tab\u00e1k (p\u0159i \u017ev\u00fdk\u00e1n\u00ed, snad i p\u0159i polyk\u00e1n\u00ed slin s tab\u00e1kov\u00fdm kou\u0159em), ko\u0159en\u00ed, zvl\u00e1\u0161t\u011b pep\u0159, p\u00e1liv\u00e1 paprika, k\u0159en, feferonky, kari a jin\u00e1 orient\u00e1ln\u00ed ko\u0159en\u00ed, d\u00e1le pokrmy a zvl\u00e1\u0161t\u011b n\u00e1poje p\u0159\u00edli\u0161 hork\u00e9. V na\u0161ich podm\u00ednk\u00e1ch snad jen alkohol vyvol\u00e1v\u00e1 z\u00e1va\u017en\u011bj\u0161\u00ed zm\u011bny vedouc\u00ed k ezofagitid\u011b, ale v n\u011bkter\u00fdch zem\u00edch Orientu, nap\u0159. v \u00cdr\u00e1nu a \u010c\u00edn\u011b, byly zji\u0161t\u011bny z\u00e1n\u011btliv\u00e9 zm\u011bny j\u00edcnu u v\u011bt\u0161iny obyvatel, po\u017e\u00edvaj\u00edc\u00edch siln\u011b ko\u0159en\u011bn\u00e9 a hork\u00e9 pokrmy. T\u00edm se vysv\u011btluje vysok\u00fd v\u00fdskyt karcinomu j\u00edcnu v t\u011bchto zem\u00edch. Vlivem dlouhodob\u00e9ho p\u016fsoben\u00ed uveden\u00fdch \u0161kodlivin se nejprve ztlu\u0161\u0165uj\u00ed \u0159asy, vyv\u00edjej\u00ed se lo\u017eiskov\u00e9 hyperplazie epitelu v podob\u011b \u201en\u00e1plasti\u201c a\u017e leukoplakie, vlivem hypersekrece se tvo\u0159\u00ed reten\u010dn\u00ed cysty. Tyto zm\u011bny p\u0159edstavuj\u00ed zv\u00fd\u0161en\u00e9 riziko pro vznik karcinomu.<\/p>\n Ponech\u00e1-li se v j\u00edcnu del\u0161\u00ed dobu c\u00e9vka zaveden\u00e1 nosem, je nebezpe\u010d\u00ed vzniku z\u00e1n\u011btu p\u0159edev\u0161\u00edm na za\u010d\u00e1tku a na konci j\u00edcnu. Av\u0161ak patogeneze je v obou lokalizac\u00edch rozd\u00edln\u00e1. V oblasti horn\u00edho \u00fast\u00ed vznik\u00e1 z\u00e1n\u011bt mechanicky otlakem, v termin\u00e1ln\u00edm j\u00edcnu b\u00fdv\u00e1 jeho p\u0159\u00ed\u010dinou reflux z poruchy sv\u011bra\u010dov\u00e9ho mechanizmu ze zaveden\u00e9 c\u00e9vky.<\/p>\n Traumatick\u00e9mu mechanizmu lze \u010delit pou\u017eit\u00edm m\u011bkk\u00e9 speci\u00e1ln\u00ed c\u00e9vky pro enter\u00e1ln\u00ed v\u00fd\u017eivu, refluxn\u00edmu po\u0161kozen\u00ed p\u0159\u00edslu\u0161nou medikament\u00f3zn\u00ed l\u00e9\u010dbou. P\u0159i nutnosti dlouhodob\u00e9 v\u00fd\u017eivy sondou je t\u0159eba zv\u00e1\u017eit zalo\u017een\u00ed p\u0159echodn\u00e9 gastrostomie \u010di jejunostomie.<\/p>\n V\u00fdznamn\u00e9 po\u0161kozen\u00ed sliznice j\u00edcnu i hlub\u0161\u00edch vrstev j\u00edcnov\u00e9 st\u011bny m\u016f\u017ee b\u00fdt zp\u016fsobeno tabletou n\u011bkter\u00fdch l\u00e9k\u016f, kter\u00e1 nen\u00ed \u0159\u00e1dn\u011b spolknuta a spl\u00e1chnuta zapit\u00edm. Tableta ulp\u00ed na j\u00edcnov\u00e9 sliznici a p\u016fsob\u00ed lok\u00e1ln\u00ed z\u00e1n\u011btlivou reakci a\u017e nekr\u00f3zu. Nebezpe\u010dn\u00e9 jsou zejm\u00e9na tablety kaliumchloridu, bisfosfon\u00e1ty (alendron\u00e1t) a tetracykliny.<\/p>\n P\u0159\u00edzna\u010dn\u00e1 je akutn\u011b vznikl\u00e1 odynofagie, kter\u00e1 nastupuje b\u011bhem n\u011bkolika m\u00e1lo hodin, v\u00e1znout m\u016f\u017ee i polyk\u00e1n\u00ed slin. M\u016f\u017ee b\u00fdt pocit trval\u00e9 retrostern\u00e1ln\u00ed bolesti \u010di p\u00e1len\u00ed. Nemocn\u00e9, kte\u0159\u00ed u\u017e\u00edvaj\u00ed tyto l\u00e9ky, je t\u0159eba pou\u010dit, \u017ee tabletu mus\u00ed po\u017e\u00edt ve stoje, hodn\u011b zap\u00edt a pokud mo\u017eno ji\u017e neul\u00e9hat. Ulp\u00edvaj\u00edc\u00ed tabletu je mo\u017eno odstranit endoskopicky. Obvykle doch\u00e1z\u00ed k pom\u011brn\u011b rychl\u00e9 spont\u00e1nn\u00ed \u00faprav\u011b. Nezbytn\u00e1 je tekut\u00e1 nebo ka\u0161ovit\u00e1 strava po dobu n\u011bkolika dn\u00ed.<\/p>\n J\u00edcnov\u00e9 varixy se \u010dasto komplikuj\u00ed z\u00e1n\u011btem, jen\u017e se ozna\u010duje jako venostatick\u00e1 ezofagitida. Sliznice v oblasti varix\u016f je rud\u00e1, zdu\u0159el\u00e1, s fibrin\u00f3zn\u011b exsudativn\u00edmi povlaky sm\u00ed\u0161en\u00fdmi se zbytky potravy. N\u011bkdy se p\u0159ipojuje z\u00e1n\u011bt mykotick\u00fd, bakteri\u00e1ln\u00ed nebo peptick\u00fd (refluxn\u00ed). Z\u00e1n\u011btliv\u00e9 zm\u011bny zvy\u0161uj\u00ed riziko krv\u00e1cen\u00ed, je\u017e m\u016f\u017ee poch\u00e1zet z drobn\u00fdch l\u00e9z\u00ed sliznice.<\/p>\n V roz\u0161\u00ed\u0159en\u00e9m j\u00edcnu p\u0159i achal\u00e1zii, nad z\u00fa\u017een\u00edm, nad doln\u00edm j\u00edcnov\u00fdm kruhem, po fundoplikaci pro hi\u00e1tovou k\u00fdlu, nad karcinomem aj. m\u016f\u017ee m\u011bstnaj\u00edc\u00ed strava vyvolat z\u00e1n\u011bt \u2013 stagna\u010dn\u00ed ezofagitidu. <\/i>Av\u0161ak m\u011bstn\u00e1n\u00ed samo b\u00fdv\u00e1 vz\u00e1cn\u011b jedin\u00fdm patogenn\u00edm mechanizmem, v\u00fdznamn\u011bj\u0161\u00ed p\u0159\u00ed\u010dinou z\u00e1n\u011btu u t\u011bchto stav\u016f b\u00fdv\u00e1 reflux.<\/p>\n Akutn\u00ed ezofagitida m\u016f\u017ee vzniknout n\u00e1sledkem poran\u011bn\u00ed, z\u00e1n\u011btu nebo n\u00e1doru mozku (typ Cushing\u016fv), u pop\u00e1lenin (typ Curling\u016fv), po b\u0159i\u0161n\u00edch operac\u00edch a r\u016fzn\u00fdch stavech \u0161okov\u00fdch. Je to analogick\u00fd mechanizmus jako u akutn\u00edho v\u0159edu gastrointestin\u00e1ln\u00ed sliznice (viz tuto kapitolu).<\/p>\n Chronickou ezofagitidu mohou zp\u016fsobit r\u016fzn\u00e9 nemoci vyvol\u00e1vaj\u00edc\u00ed poruchu hybnosti j\u00edcnu, m\u011bstn\u00e1n\u00ed obsahu nebo p\u0159estup z\u00e1n\u011btu z okol\u00ed, nap\u0159. divertikly, striktury, n\u00e1dory, tracheobronchitida, choroby mediastina.<\/p>\n Pemfigus a epidermolysis bullosa se lokalizuj\u00ed nejen na k\u016f\u017ei a v \u00fastech (viz tuto kapitolu), n\u00fdbr\u017e i v dla\u017edicov\u00e9m epitelu j\u00edcnu, a vyvol\u00e1vaj\u00ed z\u00e1n\u011btliv\u00e9 zm\u011bny sliznice, je\u017e mohou vy\u00fastit v jizven\u00ed a strikturu. Striktu\u0159e se sna\u017e\u00edme zabr\u00e1nit pod\u00e1v\u00e1n\u00edm steroid\u016f.<\/p>\n Ze syst\u00e9mov\u00fdch chorob nezn\u00e1m\u00e9 etiologie se v j\u00edcnu vz\u00e1cn\u011b vyskytuje sarkoid\u00f3za, granulomat\u00f3zn\u00ed z\u00e1n\u011bt pokl\u00e1dan\u00fd za Crohnovu nemoc a choroba Behcetova (s v\u0159edy na zevn\u00edm genit\u00e1lu a s uveitidou).<\/p>\n O t\u00e9to nov\u00e9 nozologick\u00e9 jednotce alergick\u00e9ho p\u016fvodu se zmi\u0148ujeme v kap. 9.5.3 na str. 126.<\/p>\n Takov\u00fdm stavem je hemoragick\u00e1 ezofagopatie <\/i>(nevhodn\u011b naz\u00fdvan\u00e1 \u201eerozivn\u00ed ezofagitida\u201c). Je to akutn\u00ed onemocn\u011bn\u00ed nezn\u00e1m\u00e9 etiologie, analogick\u00e9 krv\u00e1civ\u00e9 gastropatii. V\u011bt\u0161inou se projevuje n\u00e1hlou hematemez\u00ed bez j\u00edcnov\u00fdch prodrom\u016f.<\/p>\n Z\u00e1n\u011bty j\u00edcnu zp\u016fsobuj\u00ed zna\u010dnou \u010d\u00e1st symptomatologie tohoto org\u00e1nu. Vznikaj\u00ed bu\u010f samostatn\u011b, nebo jako n\u00e1sledek jin\u00fdch poruch j\u00edcnu. Mnoho z\u00e1n\u011bt\u016f se projev\u00ed jen necharakteristick\u00fdmi p\u0159\u00edznaky, nap\u0159. neur\u010dit\u00fdmi epigastrick\u00fdmi a dyspeptick\u00fdmi obt\u00ed\u017eemi, nechutenstv\u00edm, krv\u00e1cen\u00edm, a na ezofagitidu se v\u016fbec nemysl\u00ed. Teprve roz\u0161\u00ed\u0159en\u00ed fibroendoskopie uk\u00e1zalo v cel\u00e9 \u0161\u00ed\u0159i v\u00fdznam t\u00e9to nemoci. P\u0159edm\u011btem z\u00e1jmu chirurga je p\u0159edev\u0161\u00edm refluxn\u00ed ezofagitida, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":65,"menu_order":50,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-496","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/496","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=496"}],"version-history":[{"count":16,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/496\/revisions"}],"predecessor-version":[{"id":1146,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/496\/revisions\/1146"}],"up":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/65"}],"wp:attachment":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n\n
\n Tab. 10. 1<\/span>
\nP\u0159\u00ed\u010diny z\u00e1n\u011bt\u016f j\u00edcnu<\/span><\/td>\n<\/tr>\n\n Infekce, polept\u00e1n\u00ed<\/td>\n bakterie, viry, pl\u00edsn\u011b, specifick\u00e9 granulomy, kyseliny, louhy, jin\u00e9 chemick\u00e9 l\u00e1tky, l\u00e9ky<\/td>\n<\/tr>\n \n Potravinov\u00e9 vlivy, fyzik\u00e1ln\u00ed vlivy<\/td>\n dr\u00e1\u017ediv\u00e9 po\u017eivatiny, alkohol, nikotin, intubace, endoskopie, teplo, z\u00e1\u0159en\u00ed, ciz\u00ed t\u011blesa, trauma<\/td>\n<\/tr>\n \n Venost\u00e1za<\/td>\n j\u00edcnov\u00e9 varixy<\/td>\n<\/tr>\n \n M\u011bstn\u00e1n\u00ed obsahu<\/td>\n achal\u00e1zie<\/td>\n<\/tr>\n \n Stres<\/td>\n Cushingova nemoc, Curlingova nemoc<\/td>\n<\/tr>\n \n Choroby ko\u017en\u00ed a syst\u00e9mov\u00e9<\/td>\n pemfigus, epidermolysis bullosa, sklerodermie, Crohnova nemoc, Behcetova nemoc<\/td>\n<\/tr>\n \n Reflux<\/td>\n kysel\u00fd, alkalick\u00fd, sm\u00ed\u0161en\u00fd<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n 10.1 Z\u00e1n\u011bty infek\u010dn\u00ed<\/h3>\n
Pl\u00eds\u0148ov\u00e1 ezofagitida (monili\u00f3za, kandid\u00f3za)<\/h6>\n
Herpetick\u00e1 ezofagitida<\/h6>\n
Cytomegalovirov\u00e1 ezofagitida<\/h6>\n
Ezofagitida v r\u00e1mci AIDS<\/h6>\n
Jin\u00e9 infekce j\u00edcnu<\/h6>\n
10.2 Z\u00e1n\u011bty chemick\u00e9<\/h3>\n
10.3 Z\u00e1n\u011bty a v\u0159edy j\u00edcnu jin\u00e9ho p\u016fvodu<\/h3>\n
Jin\u00e9 exogenn\u00ed \u0161kodliviny<\/h6>\n
Trauma<\/h6>\n
Po\u0161kozen\u00ed j\u00edcnu l\u00e9ky<\/h6>\n
Venost\u00e1za<\/h6>\n
M\u011bstn\u00e1n\u00ed obsahu<\/h6>\n
Neurogenn\u00ed vlivy, \u0161ok<\/h6>\n
Jin\u00e9 nemoci j\u00edcnu a okoln\u00edch org\u00e1n\u016f<\/h6>\n
Choroby ko\u017en\u00ed a syst\u00e9mov\u00e9<\/h6>\n
Eozinofiln\u00ed ezofagitida<\/h6>\n
10.4 Stavy nepr\u00e1vem ozna\u010dovan\u00e9 za ezofagitidu<\/h3>\n
Literatura<\/h3>\n
\n