Reflux Esophagitis

What is reflux esophagitis?

Reflux esophagitis is inflammation of the lower part of the esophagus. The esophagus is the tube that carries food from your throat to your stomach. Esophagitis causes heartburn, which is a burning pain or warmth in your chest or throat, usually close to the bottom of the breastbone.

Over time reflux esophagitis can cause changes in the lining cells of the esophagus, causing a condition called Barrett’s esophagus. These changes can increase your risk of cancer of the esophagus.

What is the cause?

Reflux esophagitis happens when acids in your stomach flow back into your esophagus. Normally, when you swallow, food and liquids flow down the esophagus. There is a ring of muscle around the lower end of this food pipe. This ring, called a sphincter, opens up and lets the food go into your stomach. Normally, it then closes and keeps stomach contents from going back into the esophagus. If the sphincter is weak or too relaxed, it doesn’t stay closed all of the way and stomach acid and food can flow back into the esophagus. (This backward movement of acid and food is called reflux.) Because the esophagus does not have the protective lining that the stomach has, the acid irritates it and can cause pain.

Reflux esophagitis can happen because of:

• overweight
• pregnancy
• hiatal hernia, which is a condition in which part of the stomach pokes through the diaphragm up into the chest
• frequent vomiting
• nasogastric tubes, which are tubes passed through your nose down into your stomach for treatment of some medical problems
• eating large meals or eating close to bedtime
• lying down right after you eat
• scleroderma (a disease that causes thickening and tightness of the skin)

What are the symptoms?

Symptoms include:

• heartburn, which is a burning pain or warmth in your chest or throat, usually close to the bottom of the breastbone
• cramping, severe pain, or pressure below the breastbone
• bitter or sour taste in your mouth
• unexplained dry coughing
• shortness of breath

You may have symptoms when you lie down after eating and you may feel better when you sit up. Heartburn, the most common symptom, usually happens 30 to 60 minutes after you eat and may be severe. The pain may spread to your neck, jaw, arms, and back. It may be hard to tell it from a heart attack. Get emergency care if your heartburn does not get better within 15 minutes after treatment or if you have chest discomfort (pressure, fullness, squeezing or pain) that goes away and comes back or chest discomfort that goes to your arms, neck, jaw or back. These symptoms may be signs of a heart attack.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have the following tests:

• a barium swallow X-ray exam, which can show swallowing problems or signs of abnormal areas in the esophagus
• a test to measure pressure in the esophagus
• endoscopy (a way for your provider to look at your esophagus and stomach with a scope)

If you have endoscopy, you will be given medicine to relax you and then a thin flexible tube with a tiny camera will be placed in your mouth and down into your stomach. If your provider sees abnormal areas on the esophagus walls, samples of tissue (biopsies) may be taken. The samples will be examined in the lab for infection, cancer, or precancerous changes.

Often no tests are necessary. Instead, your provider may first see if taking medicine relieves your symptoms. In some cases, depending on your medical history and your symptoms, you may need tests to make sure the pain is not caused by heart disease.

How is it treated?

Your healthcare may recommend some lifestyle changes and antacids to control reflux. If this doesn’t relieve your symptoms, your healthcare provider may prescribe medicine. There are different types of medicine for GERD and they work in different ways to decrease stomach acid and help stomach emptying.

Repeated inflammation and scarring may narrow your esophagus. If this happens, your healthcare provider may dilate (widen) your esophagus, using an endoscope to stretch the scarred tissue. In some cases you may need surgery to correct the narrowing.

Repeated or chronic inflammation increases your risk of cancer of the esophagus. Your healthcare provider may recommend that you have an endoscopy on a regular schedule, for example, once a year. This can allow abnormal areas to be removed before they become cancer or for cancer to be found at an early stage.

How can I take care of myself help prevent reflux esophagitis?

To feel better and prevent problems:

• Follow your healthcare provider’s treatment plan. Carefully follow your provider’s instructions for taking your medicines. Ask your healthcare provider what you should do if your treatment isn’t helping or your symptoms get worse. Keep your follow-up appointments with your provider.
• Take nonprescription antacids after meals and at bedtime, according to your provider’s recommendation.
• Take medicines with plenty of liquid. Swallowing medicine without enough liquid can irritate the esophagus.
• Eat smaller, more frequent meals. Avoid overeating and late-evening snacks or meals before bedtime.
• Avoid drinking alcohol and eating foods that can make reflux worse, such as chocolate, mint-flavored foods, fatty foods, citrus foods, caffeine, or tomato products.
• Lose weight if you are overweight. Extra weight puts pressure on your stomach. This can cause stomach contents to push up into your esophagus.
• Don't smoke. Smoking can increase stomach acid. The air you swallow while smoking may also increase the pressure in your belly. This can cause stomach contents to push up into your esophagus. Smoking also increases the risk for cancer of the esophagus.
• Wear loose fitting clothing without belts.

It may also help if you:

• Avoid vigorous activity after meals.
• Sit up during meals and wait at least an hour after eating before you lie down. It’s best to not eat for 2 to 3 hours before you go to bed.
• Raise the head of your bed 6 to 8 inches by putting the frame on wood blocks. If you cannot raise the frame of the bed, try placing a foam wedge under the head of your mattress. Sleeping on your left side may also help. Just using extra pillows will not help.
• Chew sugarless gum after meals. Some studies have shown that this decreases reflux.
• Don't smoke. Smoking can increase stomach acid. The air you swallow while smoking may also increase the pressure in your belly. This can cause stomach contents to push up into your esophagus. Smoking also increases the risk for cancer of the esophagus.
• Do things to help your mood and emotions. If you start to feel depressed or anxious, talk to your provider about your feelings.

Ask your healthcare provider:

• how and when you will hear your test results
• how long it will take to recover from this illness
• what activities you should avoid and when you can return to your normal activities
• how to take care of yourself at home and what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.