Definition
The term “reflux esophagitis” describes an inflammation of the lower esophagus caused by contact of the esophageal mucosa with gastric acid. The causes, stages, courses and consequences of this disease can be numerous. Overall, these complaints are a very widespread problem, since up to 20% of the western population suffer from acid-related mucous membrane complaints of the stomach and oesophagus. The mucous membranes of the upper digestive tract are subject to a balanced relationship between the acid that serves the digestion and protective factors such as saliva, a layer of mucus and the slow movements of the muscles. If this balance is disturbed by one of the many causes in favor of the acid, recurrent heartburn, reflux esophagitis and, in the long term, chronic reflux disease and damage to the mucous membranes may occur.
Causes
The cause of reflux esophagitis is an excess of stomach acid on the mucous membranes of the esophagus. The acid attacks the mucous membranes, may initially cause heartburn, and later on may also cause irritation, inflammation, ulcers and long-term damage to the cell structures of the mucous membrane. The reason for the strong acid excess is in most cases a combination of several factors.
One important factor is the slackening of the ring muscle at the transition from the esophagus to the stomach. This normally keeps the acid away from the oesophagus, but in many people it can slacken for unknown reasons. Another important role is played by diet and lifestyle.
They make reflux esophagitis a growing problem, especially in the western world. Thus, high-fat food, alcohol, nicotine, coffee, obesity, lack of exercise and stress are the main causes of reflux esophagitis. More rarely also other basic diseases of the gastrointestinal tract are behind the illness. Operations on the stomach, pregnancy and constrictions in the digestive tract are other important factors in the development.
Diagnosis
The diagnosis begins with a detailed survey of the symptoms and eating and living habits. Typical pain behind the breastbone after eating or while lying down already indicates heartburn. Initially, the diagnosis can be made with the help of an initial attempt at therapy.
For this purpose, so-called proton pump inhibitors are taken for a period of 7-14 days, which reduce the acid production in the stomach. If the symptoms improve as a result, the diagnosis of an acid-related irritation of the mucous membranes is made. However, if the results of the therapy attempt are not clear, a more concrete diagnosis can be made by means of a gastroscopy.
In this procedure, irritation of the mucous membranes can be detected and biopsies of the tissue can be taken. Furthermore, the pH value of the esophagus should be measured for 24 hours using a probe. If the pH is below 4 at several times, this indicates reflux disease and excess acidity.
The gastroscopy and pH measurement can and should also be carried out in cases of long-term complaints, very conspicuous living and eating habits or at the request of the patient. In the case of very advanced complaints and conspicuous features in gastroscopy, a biopsy can be taken so that the mucous membrane can be examined more closely under the microscope. Here, changes and slowly developing damages of the tissue can be diagnosed and a stage of the disease can be estimated.
