It feels like there's a fire inside... Could it be reflux esophagitis?

Many people experience heartburn, chest discomfort, or a sensation of a foreign object caught in the throat at least once in their lives. These are the main symptoms of gastroesophageal reflux disease, also known as reflux esophagitis, a condition where stomach acid repeatedly flows back into the esophagus, causing damage and inflammation of the esophageal lining. Here, we learn about reflux esophagitis with the help of Dr. Choi Yu-a, a specialist at Daejeon Sun Hospital's Gastroenterology Center.

 

When the sphincter between the stomach and esophagus weakens, food can flow back up.

 

Between the stomach and the esophagus, there is a sphincter. This sphincter has a constricting function, opening only when food entering through the mouth moves downward into the stomach, and in a healthy state, contents in the stomach cannot rise up into the esophagus. However, if the sphincter's constricting function weakens, contents in the stomach can reflux, and the stomach acid mixed with these contents gradually damages the mucous membrane of the esophagus. The gas that is expelled through the mouth when burping after eating also passes through this sphincter, and frequent burping is a reason to visit a hospital.

 

▲ Heartburn, chest burning, sensation of a foreign body in the throat, throat burning, voice changes, chest pain, etc.

 

The main symptoms include heartburn, chest burning, foreign body sensation in the throat, throat burning, voice changes, chest pain, nausea, and dizziness that appear within about 30 minutes after eating. Major causes include greasy foods, beverages containing caffeine such as coffee, alcohol consumption, and smoking, which weaken the sphincter muscle. Obesity, pregnancy, and ascites (accumulation of fluid in the abdomen) are also known causes of reflux esophagitis. Symptoms can be classified based on the substances that trigger them. When bile refluxes, it is classified as biliary; if digestive juices from the intestinal mucosa are the cause, it is classified as alkaline. If ulcers (sores or erosions on the mucous membrane that bleed easily or are bleeding) are observed on the esophageal mucosa, it is classified as ulcerative.

 

Approximately half of the patients are diagnosed with endoscopy... Esophageal pH testing is also performed.

 

The basic diagnostic method for gastroesophageal reflux disease is endoscopy, and about half of the patients are diagnosed with reflux esophagitis during the endoscopy stage. When it is difficult to make a definitive diagnosis with endoscopy alone, esophageal pH monitoring is performed. Esophageal pH monitoring involves inserting a small device into the lower esophagus and measuring the pH level for 24 hours to check for acid reflux. It is also called 24-hour ambulatory pH monitoring. Additionally, reflux esophagitis can be diagnosed through esophageal endoscopy, upper gastrointestinal contrast studies, and esophageal manometry.

 

▲ Treatment with acid secretion inhibitors... Surgery may be necessary if complications occur

 

If diagnosed with reflux esophagitis, treatment usually begins with the use of proton pump inhibitors (PPIs) to suppress stomach acid secretion, often combined with gastrointestinal motility agents. Complete healing typically takes several months. However, if complications such as esophageal narrowing or obstruction (esophageal stricture) occur, esophageal dilation may be necessary. There is also a complication called Barrett's esophagus. Barrett's esophagus is a condition where the middle-layer squamous epithelial cells of the lower esophagus transform into metaplastic columnar epithelium, and individuals with Barrett's esophagus are known to have about a 30-fold higher risk of developing esophageal cancer compared to those without it. Therefore, if diagnosed with Barrett's esophagus, it is recommended to undergo an endoscopic examination once a year, which is currently considered the most accurate method for diagnosing gastric cancer.

 

▲ Avoid overeating and do not lie down immediately after meals

 

The most basic way to prevent gastroesophageal reflux disease is to change your lifestyle habits. Following the lifestyle guidelines below will be very helpful in preventing reflux esophagitis.

 

Avoid overeating and late-night snacking.

 

Do not lie down immediately after eating.

 

▲ Avoid alcohol, cigarettes, coffee, and black tea as much as possible.

 

▲ Manage your weight to prevent obesity.

 

▲ New fruit juices and carbonated drinks directly irritate the esophageal mucosa, so reduce them.

 

▲ Sleep aids and gout medications can lower the pressure of the sphincter muscle, so consult with a doctor before taking them.