Reflux esophagitis is a disease that has been increasing in recent years. According to statistics, at least 10% of the population of industrialized countries suffer from this form of esophagitis.
What is reflux esophagitis?
In reflux esophagitis, the mucous membrane in the lower part of the esophagus is inflamed. This inflammation is caused by a backflow (reflux) of digestive juices from the stomach into the esophagus (gullet). For meanings of maxillary sinusitis, please visit bestitude.com.
If hydrochloric acid, pepsin or bile acids act on the esophagus for a longer period of time, they irritate and damage its mucous membrane. In 65% of those affected, no signs of inflammation are discovered during an esophageal endoscopy, despite major and distressing symptoms. This type of reflux esophagitis is called non-erosive reflux esophagitis (NERD). “Erosive” here refers to a visible, superficial and inflammatory change in the esophageal lining.
35% of patients suffer from “erosive reflux esophagitis” (GERD). An endoscopy shows clear signs of inflammation. Reflux esophagitis is also referred to as reflux disease.
Causes
In principle, the assumed causes of reflux oesophagitis only refer to the reasons which lead to an increased reflux of gastric acids etc.
It is not yet known why this ultimately leads to inflammation of the esophagus in some cases and not in others. These causes are divided into direct (primary) and indirect (secondary) causes and affect the closing mechanisms of the esophagus and stomach. The wave-like transport movement of the esophagus muscles (peristalsis) can also be affected.
The direct causes include certain foods such as fats, stimulants such as alcohol or irritating food components such as caffeine, theine and peppermint. In addition, there are changes in the hormone level, such as can occur during pregnancy, for example. Psychological stress, age-related muscle weaknesses, changes in the pressure conditions in the abdominal cavity due to constipation, pregnancy, etc.
The secondary causes of reflux oesophagitis are based on other diseases, such as pathological or surgical changes at the entrance to the stomach or surgical damage to the lower esophageal sphincter (a type of sphincter). In premature babies, this muscle is often not yet properly developed. Chronic, inflammatory diseases such as scleroderma or nerve diseases due to diabetes are also among the indirect causes of reflux esophagitis.
In general, obesity or a diaphragmatic hernia, through which part of the stomach protrudes, are considered risk factors.
Symptoms, Ailments & Signs
The leading symptom of the disease is heartburn, a burning pain behind the breastbone and in the upper abdomen. It feels like something sharp is flaring up in the stomach area and esophagus. There is also a feeling of pressure and heat in the chest, which is often wrongly associated with heart disease.
Heartburn initially occurs after meals, later also without food intake. It worsens when lying down or bending over. In addition, those affected often have acidic gasps and air and stomach acid rise up into the mouth. Bad breath develops.
Constant contact with acid irritates and inflames the lining of the esophagus. This manifests itself in difficulty swallowing and pain in the throat. For some patients, the throat feels extremely dry, but even drinking a lot cannot get rid of this feeling of dryness.
For others, the inflammation causes a feeling like they have something stuck in their throat, leading to constant throat clearing and a dry cough at night. Hoarseness can also occur. Because of the difficulty in swallowing and the pain in the esophagus, patients often eat less. If the disease persists, weight loss may occur. If left untreated, the inflammation can spread to the larynx and lungs.
Diagnosis & History
The diagnosis of reflux esophagitis is made by esophagoscopy, an examination of the esophagus using a camera tube, and gastroscopy, an examination of the stomach.
If changes in the mucous membrane become visible, they enable the disease to be classified. There is also the option of taking a small tissue sample during these examinations. A 24-hour acid measurement, a pH measurement, is carried out and allows statements to be made about the duration and strength of the acid reflux within a day.
Esophageal manometry, a muscle function measurement, is rarely performed these days. Reflux esophagitis leads to Barett esophagus in a small percentage of cases.
The mucosa of the esophagus changes, its structure is similar to that of the gastric mucosa. Ulcers or esophageal cancer can develop from this altered mucosa.
Complications
The symptoms of reflux esophagitis are very uncomfortable and can lead to serious complications. For this reason, this condition must be diagnosed and treated early. Those affected primarily suffer from severe heartburn. The heartburn itself occurs mainly after eating acidic or salty foods and has a very negative effect on the quality of life of those affected.
Permanent belching or a strong cough can also occur due to the illness. In severe cases, patients experience shortness of breath. If the disease is not treated, in the worst case it can also lead to the formation of ulcers and cancer in the esophagus. This can also lead to the death of the patient. In most cases, reflux esophagitis can be treated with medication.
There are no special complications or other complaints. In particular, heartburn can be relieved. Furthermore, many of those affected are dependent on surgical interventions that can permanently relieve the symptoms and limit the acid production of the stomach.
When should you go to the doctor?
Reflux esophagitis should always be treated by a doctor. This disease does not heal itself and in most cases the symptoms worsen further. In the worst case, reflux esophagitis leads to inflammation of the esophagus, which can lead to further complications. A doctor should be consulted if the person affected suffers from severe heartburn. The heartburn can occur sporadically or after taking different meals and have a negative effect on the quality of life of those affected.
Furthermore, a strong bad breath of the affected person can indicate reflux oesophagitis. It is not uncommon for patients to have a sore throat or even difficulty swallowing, which can lead to coughing or hoarseness. The larynx of the affected person can also become inflamed. Reflux esophagitis can be treated by a general practitioner or an internist. Usually there are no special complications.
Treatment & Therapy
Reflux esophagitis is treated conservatively or surgically. In most cases, conservative treatment with the administration of certain medications is sufficient.
Proton pump inhibitors reduce the acidity of the stomach contents by reducing the production of hydrochloric acid in the stomach. Antacids do not interfere with acid production, but rather neutralize the acidity present. Prokinetics have a supportive effect, since they increase the closing force of the lower esophageal sphincter and promote gastric emptying. Conservative therapy must be lifelong, since reflux oesophagitis recurs after the medication is stopped.
In the rare cases in which conservative treatment is unsuccessful, surgical intervention, a “fundoplication”, can be performed. The upper part of the stomach is placed over the lower esophageal sphincter like a cuff and thus acts to reinforce the closure of the esophagus.
Prevention
You can prevent reflux esophagitis by losing weight, eating smaller, more frequent meals, and avoiding foods that are too fatty or irritating. Sleeping with a raised upper body, loose clothing, avoiding stress and excessive alcohol consumption also have a preventive effect.
Aftercare
Aftercare for reflux esophagitis is varied and very individual. Above all, the elimination of the cause of the reflux is to be placed in the foreground. This often cannot be done sufficiently. Reflux esophagitis requires long-term or even lifelong therapy with gastric acid reducers.
Follow-up care here is primarily concerned with relieving and eventually suppressing and healing esophagitis by preventing stomach acid from flowing back into the esophagus. As a rule, this can only be treated with medication or even surgically. The specialist, a gastroenterologist, monitors the course of treatment and the severity of the disease.
Follow-up care is primarily designed for regular check-ups. Since the disease progresses individually and can have various causes, as well as surgical consequences, there is no uniform aftercare and no clearly definable statement about the course and healing. Reflux esophagitis requires long-term treatment, especially if the patient’s symptoms persist.
If the stomach does not close properly, certain positions can lead to reflux, which irritates the esophagus again and causes reflux esophagitis to flare up. The individual consultation and treatment of the patient is essential here.
You can do that yourself
To prevent reflux esophagitis, the patient can do a lot himself. On the one hand, there is a change in diet. Spicy foods should be avoided if possible, as they can aggravate the symptoms of reflux oesophagitis. You should also avoid hot or sour food.
The patient should also avoid alcohol or coffee (or caffeine in general) during this time, as they can cause reflux of gastric acid, which is the main reason for reflux oesophagitis. As a countermeasure, soothing substances can also be eaten or drunk. Chamomile tea, for example, can be helpful here.
In order to lower the pH value of the gastric acid and thus reduce the aggressiveness of the gastric acid, the patient can take medication in the form of proton pump inhibitors such as omeprazole or pantoprazole. Medications that inhibit inflammation, such as ibuprofen or paracetamol, can also be helpful. A positive side effect of the medication is that it alleviates the pain that can be caused by reflux oesophagitis.
If the patient continues to experience symptoms, such as stabbing pain behind the breastbone or frequent belching, which indicates worsening symptoms, the patient should see a doctor, who may prescribe an endoscopy. In general, the patient should go to the doctor for regular check-ups, since reflux esophagitis can be a precursor to aggressive esophageal cancer.
