What is reflux esophagitis?

Reflux esophagitis is an inflammatory condition of the esophagus that occurs when stomach acid, and sometimes other stomach contents such as pepsin and bile, back up into the esophagus, causing damage to its lining. In a healthy person, the lower esophageal sphincter (LES), located between the esophagus and the stomach, normally acts as a valve to prevent stomach contents from backing up into the esophagus. If this sphincter is not working properly or is weakened, stomach acid can cause irritation and inflammation of the esophagus.

Reflux esophagitis is one of the manifestations of gastroesophageal reflux disease (GERD), which is a chronic and common disease. GERS can affect people of any age, but is more common in adults. Although many people experience mild reflux symptoms, prolonged and repeated acid exposure can lead to more serious complications such as esophageal erosions, strictures, and even Barrett's esophagus, a precancerous condition.

Patients with reflux esophagitis can suffer from a variety of complaints, ranging from mild discomfort to severe pain that significantly affects their daily life. Symptoms are often associated with meals and after meals, which can lead to reduced quality of life. Therefore, it is important to understand the causes and symptoms of this condition in order to provide effective treatment and prevent potential complications.

Causes of reflux esophagitis

Reflux esophagitis develops when stomach acid regularly backs up into the esophagus, damaging its lining. This phenomenon can be related to several factors that affect the lower esophageal sphincter or increase the level of stomach acid.

One of the most common causes is a hiatal hernia, in which part of the stomach enters the chest cavity through the diaphragm. This anatomical deviation can weaken the sphincter, allowing acid to more easily back up into the esophagus. In addition, obesity is a significant risk factor because increased abdominal pressure can cause acid to back up into the esophagus. Obesity also increases intra-abdominal pressure, which can impair LES function.

Dietary habits are an important factor in the development of reflux esophagitis. For example, fatty foods, chocolate, caffeine, and alcohol can relax the LES, promoting reflux. Eating large portions and lying down immediately after eating also increases the risk of reflux, as the horizontal position encourages acid to return to the esophagus. Smoking is another risk factor because nicotine relaxes the sphincter and increases stomach acid production.

Symptoms of reflux esophagitis

The symptoms of reflux esophagitis can vary, and their intensity can range from mild to severe. The most typical and characteristic symptom is burning behind the sternum, known as heartburn. Heartburn is usually worse after eating, especially after consuming fatty, spicy foods or alcohol. They may be associated with a burning sensation that spreads from the sternum to the neck.

In addition to heartburn, patients often complain of regurgitation, the return of acid or food into the mouth. It can create an unpleasant sour taste and cause throat irritation. Some patients may have difficulty swallowing (dysphagia), often associated with esophageal strictures or scar tissue, or a feeling that something is stuck in the throat.

Other symptoms may include chest pain or discomfort, which can sometimes be mistaken for heart problems, especially if the pain radiates to the back or shoulders. Some patients report a chronic cough, hoarseness, or chronic sore throat associated with acid exposure to the upper respiratory tract. These symptoms can also affect the larynx, causing laryngopharyngeal reflux.

At night, symptoms can be particularly unpleasant, as the lying position encourages acid to back up into the esophagus. Patients may wake up with heartburn, chest pain, or regurgitation, which can cause sleep disturbances and daytime fatigue. It is important to recognize these symptoms at an early stage to prevent complications and improve the patient's quality of life.

Diagnostic methods

In order to effectively diagnose reflux esophagitis, several diagnostic methods are needed, which help determine the severity of the disease, exclude other pathologies and determine the most appropriate course of treatment.

Endoscopy

Endoscopy is an essential diagnostic method that allows direct assessment of the condition of the esophageal mucosa. During the procedure, using a flexible tube with a camera (endoscope), the doctor can view the esophagus, stomach, and duodenum. Endoscopy allows to identify signs of inflammation, erosions or strictures, and to take biopsy samples to rule out malignancy or other diseases, such as Barrett's esophagus.

pH monitoring

pH monitoring is a procedure that measures the level of acid in the esophagus over a period of time. This method helps determine the frequency and duration of acid reflux. During the procedure, a small probe is inserted into the patient's esophagus to record the pH level. Data are analyzed to assess the nature of reflux and its relationship to symptoms. This method is particularly useful when symptoms are not typical or when endoscopy does not show obvious lesions.

Esophageal manometry

Esophageal manometry is an additional diagnostic method that evaluates esophageal muscle function and sphincter functionality. This test helps determine whether the esophagus is adequately transporting food and liquids to the stomach and whether the sphincter is working properly. It is an essential technique when surgical intervention is being considered, as it helps to determine LES pressure and the efficiency of esophageal peristalsis.

Treatment options

Reflux esophagitis treatment is tailored to each patient, taking into account the severity of the symptoms and the causes. The goals of treatment are to relieve symptoms, heal inflammation, and prevent complications.

Surgical intervention

Lifestyle changes and prevention

Lifestyle changes are an important aspect in the treatment and prevention of reflux esophagitis. Patients are advised to avoid foods and drinks that can cause reflux, such as fatty and spicy foods, coffee, chocolate and alcohol. It is also recommended to avoid eating large portions and eating right before going to bed.

Special attention should be paid to weight control, as excess weight increases pressure on the abdominal cavity and contributes to reflux. Quitting smoking is essential because nicotine can weaken the sphincter and increase acid production. Smoking cessation not only improves LES function, but also reduces gastric acid secretion.

Patients are advised to sleep with their head elevated to reduce the number of reflux episodes at night. Physical activity and stress management can also help reduce symptoms. Exercise, such as walking or light aerobics, can improve gastric emptying and reduce reflux. Stress management techniques such as yoga or meditation can help reduce the intensity of gastrointestinal symptoms.

Potential complications

If reflux esophagitis is not treated in time, it can lead to several serious complications. Esophageal erosions and ulcers are common complications that can cause bleeding and pain. Blood loss from erosions can lead to anemia and the need for medical intervention.

Stricture formation is another possible complication where the esophagus becomes narrowed as a result of scar tissue formation. This may interfere with swallowing and require endoscopic dilation. Strictures may be recurrent and may require multiple endoscopic procedures.

Barrett's esophagus is a precancerous condition in which the lining of the esophagus changes, increasing the risk of esophageal cancer. This condition requires regular monitoring, which includes endoscopic examinations and biopsies, in order to detect early development of malignant formations and implement the necessary treatment strategies. Early detection and monitoring of Barrett's esophagus can help prevent the development of esophageal adenocarcinoma.

Conclusions