Associated symptoms | Reflux esophagitis

Associated symptoms

The main symptoms of reflux esophagitis are heartburn, pain behind the sternum, as well as a feeling of pressure and pain when swallowing. The symptoms depend on the time of day and physical activity. When lying down, these pains are often worsened because the acid can rise even more easily into the esophagus.

After meals, the symptoms also become more severe because the acid production in the stomach increases reflexively for digestion. Burping and choking, as well as nausea and vomiting can also be added to the symptoms. As a consequence, the respiratory tract may become involved, which manifests itself in a chronic irritable cough.

Duration

The duration of reflux esophagitis can vary greatly. An important factor here is the frequency with which the symptoms occur and recur. The frequency allows a prognosis on the previous damage and the success of therapy.

Simple symptoms such as initial heartburn can subside within a few hours. They often occur only temporarily after eating fatty foods or at night. If there is already inflammation of the esophagus, the symptoms are almost permanent.

With the start of drug therapy, the symptoms should subside within a few days. In most cases, the therapy is carried out for 2 weeks to give the mucous membrane the necessary time to heal completely. Recurring or therapy-resistant complaints can take on chronic progressions. In these cases, the complaints often persist for months to years.

Stages of reflux esophagitis

Many inflammations of the esophagus and acid complaints of the stomach occur without direct damage to the mucous membrane. This is in contrast to erosive reflux esophagitis, in which an inflammation of the esophagus can be seen with the naked eye during gastroscopy. The erosive reflux esophagitis can be divided into four different degrees.

Grade 1 still represents the lowest stage of the disease, but the mucous membranes have already suffered microscopic or already visible damage. In gastroscopy, small damages can be seen, but not larger than 5mm. At this stage, a therapy by dietary modification is useful but no longer sufficient.

Acid-inhibiting drugs often have to be used in order to allow a complete healing. After the classification of erosive reflux esophagitis follows grade 2, which already describes more severe damage to the mucous membranes.Here, several abrasions, so-called “erosions”, may have already occurred, which are more than 5mm in size. Nevertheless, most of the esophageal mucosa is still intact, in contrast to the remaining 2 degrees.

Grade 2 requires urgent drug therapy and immediate change in dietary habits. In progressive stages, extensive and very painful damage can occur, which is sometimes irreversible and poses a risk of further diseases of the stomach and esophagus. The erosive-ulcerous form of reflux esophagitis represents a further stage of damage to the mucous membranes.

In addition to the protrusions and visible damage to the wall of the esophagus, ulcerous changes are now added. An ulcer describes an ulcer and damage that penetrates deep into all other wall layers of the organ below the mucous membrane. This is already a highly advanced form of damage that is no longer limited to the mucous membrane.

The symptoms of an ulcer also worsen. The pain can sometimes be sharp while eating. In this stage of reflux esophagitis, immediate therapy is necessary to prevent worse consequences and also to prevent esophageal cancer.

The reflux esophagitis has a strong tendency to become chronic. This is due to the progressive slackening of the sphincter muscle at the entrance to the stomach. This allows the acid to rise uninhibitedly into the esophagus, irritating and inflaming the sensitive mucous membrane there.

Often there is a permanent irritation of the mucous membranes despite therapy, so that even small amounts of acid are sufficient to trigger the inflammation again. Chronic reflux esophagitis is an enormous and underestimated problem in the western world. Even heartburn, which occurs twice or more often a week, can cause severe damage to the esophagus for years.

The mucosal cells in the esophagus can change and transform over years of irritation. These transformations result in a so-called “Barrett’s oesophagus” at a final stage of the disease. This represents the pathological, complete acid-induced transformation of the lower esophagus and is an enormous risk factor for the development of esophageal cancer. People who already have erosive reflux esophagitis must undergo repeated gastroscopies at short intervals in order to detect and stop the progression of the disease and the development of malignant cells at an early stage.