Reflux esophagitis is a disease that has become increasingly common in recent years. According to statistics, at least 10% of the population of developed countries suffer from this form of esophagitis.
What is reflux esophagitis?
Schematic diagram showing the anatomy involved in reflux disease or heartburn. Click to enlarge. In reflux esophagitis, the mucosa in the lower part of the esophagus is inflamed. This inflammation is caused by reflux of digestive juices from the stomach into the esophagus. If hydrochloric acid, pepsin or even 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 detected during an esophagoscopy (endoscopy), despite great and agonizing discomfort. 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 mucosa. “Erosive reflux esophagitis” (GERD) affects 35% of sufferers. Clear signs of inflammation can be seen on endoscopy. Reflux esophagitis is also referred to as reflux disease.
Causes
The assumed causes of reflux esophagitis refer in principle only to the reasons that lead to increased reflux of gastric acids, etc.. Why these then ultimately lead to inflammation of the esophagus in some and not in others is not yet known. These causes are divided into direct (primary) and indirect (secondary) causes and influence the closure mechanisms of the esophagus and stomach. The undulating transport movement of the esophageal muscles (peristalsis) may also be affected. Direct causes include certain foods such as fats, stimulants such as alcohol, or irritating food components such as caffeine, teein, and peppermint. In addition, there are changes in hormonal status, such as may occur during pregnancy. Psychological stress, age-related muscular weaknesses, changes in abdominal pressure due to constipation, pregnancy, etc.
The secondary causes of reflux esophagitis 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 muscle). In premature infants, 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 hiatal hernia, which causes part of the stomach to bulge out, are considered risk factors.
Symptoms, complaints, and signs
The leading symptom of the condition is heartburn, a burning pain behind the breastbone and in the upper abdomen. It feels as if something sharp is flaring up in the stomach area and esophagus. In addition, there is a feeling of pressure and heat in the chest, which is often mistakenly associated with diseases of the heart. Heartburn occurs initially after meals, and later without prior food intake. It intensifies when lying down or bending over. In addition, sufferers often experience acid regurgitation, and air and stomach acid rise to the top of the mouth. Bad breath develops. Due to the constant contact with acid, the mucous membrane of the esophagus is irritated and becomes inflamed. This manifests as difficulty swallowing and pain in the throat. For some patients, the throat feels extremely dry, but they cannot get rid of this dry feeling even by drinking a lot. For others, the inflammation causes them to feel as if they have something stuck in their throat, resulting in constant throat clearing and a nighttime irritating cough. Hoarseness may also occur. Because of the difficulty swallowing and the pain in the esophagus, patients often eat less. If the disease lasts longer, weight loss may occur. If left untreated, the inflammation can spread to the larynx and into the lungs.
Diagnosis and course
Diagnosis of reflux esophagitis is made by esophagoscopy, an examination of the esophagus with the aid of a camera tube, and gastroscopy, a reflection of the stomach. If mucosal changes become visible during this procedure, they allow the disease to be classified.In addition, there is the possibility of taking a small tissue sample during these examinations. A 24-hour acid measurement, a pH-metry, is performed and allows statements to be made about the duration and strength of acid reflux within a day. Esophageal manometry, a muscle function measurement, is rarely performed nowadays. Reflux esophagitis leads to beretta esophagus in a small proportion of cases. The mucosa of the esophagus changes, its structure resembles that of the gastric mucosa. Ulcers or esophageal cancers can develop from this altered mucosa.
Complications
The symptoms of reflux esophagitis are very unpleasant and can lead to serious complications. For this reason, this disease must be diagnosed and treated early. Those affected suffer first and foremost from severe heartburn. The heartburn itself occurs mainly after eating sour or salty foods and has a very negative effect on the quality of life of the affected person. A permanent belching or a strong cough can also occur due to the disease. In severe cases, patients suffer from shortness of breath. If the disease is not treated, in the worst case it can also lead to the development of ulcers and further also to 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 particular complications or other discomforts. Especially the heartburn can be alleviated. Furthermore, many sufferers rely on surgical interventions that can permanently relieve the discomfort and limit the acid production of the stomach.
When should you see a doctor?
As a rule, reflux esophagitis should always be treated by a physician. There is no self-healing in this disease, and in most cases it also leads to further worsening of symptoms. 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 affected person suffers from severe heartburn. In this case, the heartburn may occur sporadically or after eating various meals and have a negative impact on the quality of life of the affected person. Furthermore, a strong bad breath of the affected person can also indicate reflux esophagitis. It is not uncommon for patients to experience pain in the throat or even difficulty swallowing, resulting in coughing or hoarseness. Furthermore, the larynx of the affected person may also become inflamed. Reflux esophagitis can be treated by a general practitioner or by an internist. In this case, there are usually no particular complications.
Treatment and therapy
Treatment of reflux esophagitis is conservative or surgical. In most cases, conservative treatment with the administration of certain medications is sufficient. Proton pump inhibitors decrease the acidity of the stomach contents by not producing as much hydrochloric acid in the stomach. Antacids, do not interfere with acid production, but neutralize the existing acidity. Prokinetics have a supportive effect by increasing the closing force of the lower esophageal sphincter and promoting emptying of the stomach. Conservative therapy must be lifelong, as reflux esophagitis recurs after discontinuation of medication. In the rare cases where conservative treatment is unsuccessful, a surgical procedure called a “fundoplicatio” may be performed. The upper part of the stomach is placed over the lower esophageal sphincter like a cuff, reinforcing the closure of the esophagus.
Prevention
Preventive measures for reflux esophagitis include weight loss, eating smaller, more frequent meals, and avoiding foods that are too fatty or irritating. Sleeping with the upper body elevated, wearing loose clothing, avoiding stress and excessive alcohol consumption also have a preventive effect.
Aftercare
Aftercare for reflux esophagitis is varied and highly individualized. First and foremost, the elimination of the cause of reflux must be prioritized. This often cannot be done adequately. In reflux esophagitis, long-term or even lifelong therapy with gastric acid reducers is necessary.Follow-up care here primarily refers to alleviating and ultimately suppressing and healing the esophagitis by preventing the stomach acid from flowing back into the esophagus. Usually, this can only be done with medication or even surgery. The specialist, a gastroenterologist, monitors the course of treatment and the severity of the disease. Follow-up care in this case is primarily based on regular check-ups. Since the disease progresses individually and can be based on various causes, as well as surgical consequences, there is no standardized aftercare and also no firmly definable statement about the course and cure. Reflux esophagitis must be treated in the long term, especially if the patient has persistent symptoms. If the stomach does not close properly, reflux can occur even in certain positions, which irritates the esophagus again and causes reflux esophagitis to flare up. Individual patient counseling and treatment is essential in this case.
What you can do yourself
To prevent reflux esophagitis, patients can do many things themselves. First, there is a change in diet. If possible, no spicy foods should be eaten, as they can aggravate the symptoms of reflux esophagitis. Likewise, hot or acidic foods should be avoided. The patient should also avoid alcohol or coffee (or caffeine in general) during the period, as they can cause gastric acid reflux, which is the main cause of reflux esophagitis. As a countermeasure, soothing substances can also be eaten or drunk. Chamomile tea, for example, can be helpful in this regard. To lower the pH of the stomach acid and thus reduce its aggressiveness, the patient can take medications in the form of proton pump inhibitors, such as omeprazole or pantoprazole. Likewise, medications that inhibit inflammation, such as ibuprofen or acetaminophen, can be helpful. A positive side effect of the medications is an alleviation of the pain that can be caused by reflux esophagitis. If the patient continues to notice discomfort, such as stabbing pain behind the sternum or more frequent belching, indicating worsening symptoms, the patient should see a physician, who may prescribe an endoscopy. In general, the patient should see a physician for regular checkups, as reflux esophagitis can be a precursor to aggressive esophageal cancer.
