Therapy | Gullet inflammation


The therapy of an inflammation of the oesophagus is based on several stages, which make more or less sense depending on the extent of the inflammation and the type of cause. In the case of mild symptoms caused by a reflux of stomach contents, one should first of all pay attention to the correct diet and a healthier lifestyle. The aim here is to prevent a persistent irritation of the mucous membrane of the oesophagus by reducing the reflux of stomach contents.

Without this damaging effect, a simple inflammation of the oesophagus heals by itself. Especially carbonated drinks or fruit juices contain a lot of acid and favour the backflow of gastric juice into the oesophagus. Caffeine, nicotine and also alcohol directly increase the production of hydrochloric acid in the stomach, so dispensing with these substances can be an effective measure.

The last food intake, which should be low-fat and not too opulent, should be at least one or two hours before going to bed. If shortly before going to bed the hydrochloric acid production in the stomach is increased, the flat position of the body during sleep favours an overflow into the oesophagus, which further maintains the inflammation. In this way it is possible to sleep with a slightly elevated upper body for some time.

If these measures are not sufficient, the next step is to use medication. First choice drugs for the inflammation of the esophagus are proton pump inhibitors (PPIs). These directly inhibit certain proteins in the stomach that produce hydrochloric acid.

Thus, the most potent damaging stimulus is missing. Usually, treatment over 2-4 weeks with one tablet of a PPI per day is usual. These drugs are well tolerated and have relatively few side effects.

Other medicinal measures are agents that increase the tone of the lower sphincter muscle or neutralize the hydrochloric acid in the stomach. However, these are in the back of the queue. If conservative and drug therapies cannot treat the inflammation of the oesophagus sufficiently, surgery must be considered in rare cases.

This is particularly indicated if the lower sphincter muscle is structurally damaged and can no longer close the stomach entrance, or if protrusion of parts of the stomach into the chest is the cause. The standard surgery here is the so-called laparoscopic fundoplication according to Nissen or Toupet, in which a kind of cuff is placed around the lower esophagus, which prevents backflow of stomach contents. However, the conservative therapy of a reflux-induced inflammation of the esophagus has pushed surgical approaches into the background.

The therapy of non-reflux-induced inflammation consists either in the avoidance of the chemical or physical noxae or in the causal therapy of the triggering pathogen. Fungi are treated with Amphotericin-B or Fluconazole, viruses with Aciclovir or Ganciclovir. As mentioned above, pathogens are only causative in existing severe underlying diseases, which is why the therapy of this underlying disease is an indispensable part of it.

At the beginning of the diagnosis there is an exact inquiry of the patient’s complaints. The typical symptoms of inflammation of the esophagus, such as acid burping, heartburn and pain behind the breastbone, are groundbreaking at the beginning. Especially if the complaints occur after a meal or in certain body positions such as lying down or overhead, the doctor should consider reflux-induced inflammation of the esophagus.

For mild and not long lasting complaints this is sufficient to start a therapy with a PPI. If the symptoms are severe or resistant to therapy, further diagnostic methods follow. In order to clearly confirm the inflammation of the esophagus and to assess the extent of the inflammation, an endoscopy is first performed.

A thin, flexible tube with a camera at its end is inserted into the oesophagus through the mouth or nose under local anaesthetic and possibly sedative medication. This enables the examiner to assess the entire mucous membrane of the oesophagus with regard to mucous membrane damage or fungal plaque. In addition, a small tissue sample or a smear can be taken with forceps to check for pathogens and examined in the laboratory.

To complete the diagnosis of oesophagitis, a 24-hour measurement of the acidity in the oesophagus can be carried out. A small probe, usually inserted nasally, is placed in the lower esophagus and continuously measures the pH value, i.e. the acidity. This examination is particularly useful if no cause could be found during the endoscopy in case of complaints.