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 and pain in the area below the breastbone.

How does it occur?

Reflux esophagitis happens when the acid contents of the stomach flow back into your esophagus and cause heartburn. This back flow of acid is called reflux, or gastroesophageal reflux. Your esophagus may become red and inflamed if the reflux of acid happens often.

Reflux esophagitis can occur with:

• overweight
• pregnancy
• hiatal hernia, which is a condition in which part of the stomach protrudes through the diaphragm up into the chest
• recurrent vomiting
• nasogastric tubes, which are tubes passed through your nose down into your stomach
• eating large meals
• lying down right after you eat
• scleroderma (a disease that causes thickening and tightness of the skin).

What are the symptoms?

Symptoms include:

• heartburn
• cramping, severe pain, or pressure below the breastbone
• pain, often in the chest
• acid taste, especially at night
• coughing
• shortness of breath.

Symptoms may occur when you lie down after eating and may be relieved when you sit upright. Heartburn, the most common symptom, usually occurs 30 to 60 minutes after you eat and may be severe. The pain may spread to your neck, jaw, arms, and back.

How is it diagnosed?

Your healthcare provider will review your symptoms and examine you. Your provider may order the following tests:

• X-rays
• endoscopy, a procedure in which a thin flexible tube with a tiny camera is placed in your mouth and down into your stomach so your provider can see your esophagus and stomach
• esophageal manometry (a test to measure pressure in the esophagus).

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 provider may recommend or prescribe:

• antacids to take after meals and at bedtime
• medicine that decreases the amount of acid your stomach makes
• medicine that helps food and acid move down through your digestive tract
• weight loss to decrease the pressure on your stomach
• eating smaller meals
• avoiding late-evening snacks or meals before bedtime
• raising the head of your bed about 4 to 6 inches to help the acid stay in your stomach.

Repeated inflammation and scarring may make your esophagus become narrower. If this happens, your healthcare provider may:

• dilate (widen) your esophagus
• use surgery to repair a hiatal hernia if you have one
• use surgery to create a new segment of esophagus.

In severe cases of esophagitis, in which symptoms continue in spite of treatment, a surgical procedure called fundoplication may be considered. This surgery makes the sphincter work better. The sphincter is a ringlike muscle at the bottom of the esophagus. When it's working normally, it acts like a valve, letting food pass into the stomach and then closing before stomach acid can back up into the esophagus.

How long will the effects last?

The duration of symptoms and response to treatment vary from person to person. It is important to keep your follow-up appointments with your healthcare provider, especially if your symptoms are not getting better. Severe reflux esophagitis can eventually cause changes in the cells that line the esophagus, resulting in a condition called Barrett's esophagus. These changes increase your risk of cancer of the esophagus.

How can I take care of myself?

Follow these guidelines:

• Take medicines with plenty of liquid. Swallowing medicine without enough liquid can irritate the esophagus.
• Avoid smoking.
• Avoid drinking alcohol.
• Avoid eating chocolate, peppermint, fatty foods, citrus foods, caffeine, or tomato products. These foods make reflux worse.
• Wear loose fitting clothing without belts.
• Avoid heavy meals.
• Avoid lying down right after you eat.
• Sleep with your head elevated at least 4 to 6 inches. (It's usually most comfortable to put the head of your bed on blocks.)
• Maintain your proper weight.
• Keep your follow-up appointments with your healthcare provider.
• Tell your healthcare provider if your symptoms get worse.

How can I help prevent reflux esophagitis?

Follow these guidelines:

• Avoid smoking and alcohol.
• Maintain a healthy weight.
• Eat smaller meals. Avoid overeating.
• Eat foods that don't cause symptoms.
• Avoid lying down for at least 3 hours after meals.