Reflux esophagitis (reflux disease, GERD) – causes, symptoms and treatment
Reflux esophagitis, also known by doctors as gastroesophageal reflux disease (GERD), is a common disease. About 20 percent of the German population for example shows symptoms of reflux disease. Lifelong therapy for the disease is usually necessary, sometimes even with surgery. The following text explains how reflux oesophagitis develops, what symptoms it manifests and how it is treated.
What is reflux esophagitis?
Reflux esophagitis, or gastroesophageal reflux disease (from “gaster” = stomach, “esophagus” = esophagus and “reflux” = reflux), is a disease caused by the reflux of gastric acid into the esophagus.
The transition from the esophagus to the stomach is usually closed by a sphincter (lower esophageal sphincter). This occlusion opens when ingested food enters the stomach from the esophagus. With reflux esophagitis, the function of this sphincter is disturbed. So stomach acid can overcome the occlusion and rise from the stomach into the esophagus. In contrast to the stomach, the lining of the esophagus has no natural acid protection and is damaged by the acid.
How does reflux esophagitis?
The function of the lower esophageal sphincter is restricted in patients suffering from reflux esophagitis. How exactly this loss of function comes about is still not fully understood. However, some factors have been identified which can lead to the development of reflux disease.
- Overweight: Obese patients are more likely to have reflux esophagitis. It is assumed that the mobility of the stomach (motility) is changed in this patient group and that, as a result, the naturally prevailing pressure in the abdominal cavity is increased. The combination of these factors can trigger reflux disease
- Eating habits: Increased production of stomach acid can damage the lower esophageal sphincter and cause more stomach acid to enter the esophagus. In addition, increased consumption of coffee, alcohol and cigarettes increases the production of stomach acid. Spicy and greasy dishes can produce similar effects
- Diaphragmatic hernia: Diaphragmatic hernia, also referred to as hiatal hernia in medical terminology, also favors the occurrence of reflux disease. When the hernia occurs, part of the stomach moves over the diaphragm, where normally only the esophagus is located. Gastric acid can accumulate in this part of the stomach and attack the lining of the esophagus
What are the symptoms of reflux disease?
Not every patient who is affected by reflux disease shows symptoms. Especially mild forms of the disease often do not cause any symptoms and are therefore not noticed by patients and doctors.
When reflux esophagitis triggers symptoms, they can be divided into two groups. The main group summarizes the main symptoms. These occur in almost every patient who develops symptoms. The second group includes **unspecific symptoms **that affect all patients. Unspecific symptoms alone do not provide clear evidence of the presence of reflux disease.
|Main symptoms||Unspecific symptoms|
|Heartburn||Pain behind the sternum (sometimes listed under “heartburn”)|
|Burning or feeling of pressure in the chest|
Tab.1: Symptoms of reflux esophagitis
Heartburn, a major symptom of reflux disease, occurs most often after eating. In the morning the symptoms are often the most pronounced, as lying for a long time makes it easier for gastric acid to flow back into the esophagus. Coughing and hoarseness can be caused, among other things, by irritation of the larynx by the acid.
A** feeling of pressure or tightness** in the chest is a rarer symptom of reflux esophagitis. It mainly occurs when a diaphragmatic hernia (hiatal hernia) is the cause of the symptoms. A diaphragmatic hernia can also affect the natural expansion of the heart and thus its beating function.
Are there different degrees of severity of reflux disease?
Doctors divide reflux disease into different degrees. Such a classification of diseases is common in order to determine the severity of the disease and the need for therapy. The most common classification of reflux disease is the Savary and Miller classification:
- Degree I: The first degree of reflux disease describes the mildest form of this disease. It is characterized by isolated damage to the mucous membrane of the esophagus, which is particularly noticeable as reddening and mild inflammation
- Degree II: In the second degree of the disease, the damage is larger and more pronounced, but does not yet cover the entire circumference of the esophagus
- Degree III: The third degree is characterized by damage to the mucous membrane that covers the entire circumference of the esophagus
- Degree IV: In the fourth degree, there are serious changes in the mucous membrane such as mucosal ulcers, mucosal adhesions (strictures) and so-called Barrett's esophagus, which can represent the preliminary stage of cancer of the esophagus
How does a doctor diagnose reflux disease?
If the main symptoms of reflux esophagitis appear in a patient, this gives an important indication of the presence of the disease. The combination of the main symptoms and unspecific symptoms can further reinforce this suspicion.
To confirm the diagnosis, the doctor will perform a gastroscopy, during which he can look at the esophagus at the same time (esophagogastroduodenoscopy, EGD). As part of this examination, he can see the damage to the mucous membrane and measure the extent of the reflux disease.
The doctor may also carry out long-term pH monitoring. The pH in the lower esophagus is measured over 24 hours in order to determine the acid load in these areas.
X-ray examinations of the esophagus only provide little information about the disease and therefore are not recommended.
How is reflux disease treated?
The treatment of reflux disease is based on three main measures: Change in eating habits, medical therapy for the symptoms, and surgical treatment of acid reflux.
Change in eating habits:
The mildest form of therapy for reflux disease is a change in eating habits. By avoiding greasy and spicy foods a slight improvement in symptoms can be achieved. Also refraining from drinking alcohol and smoking cigarettes can help relieve the symptoms of reflux disease. However, these measures have only had an effect on mild forms of reflux oesophagitis, and their influence is limited to alleviating the symptoms and leaves the degree of the disease in itself unchanged
Medical therapy for symptoms
Reflux disease can be effectively treated with medication. A group of drugs is used here, which are called** proton pump inhibitors** (PPI). These drugs inhibit transporters in the lining of the stomach that are involved in the production of stomach acid (so-called proton pumps). By inhibiting these transporters, the amount of gastric acid produced is reduced, thus eliminating the cause of the symptoms. Omeprazole and pantoprazole are two examples of PPIs.
Therapy with proton pump inhibitors leads acomplete decrease in symptoms in a short time with most patients. After four to eight weeks in most cases thedamage to the esophagus is decreased significantly.
Surgical treatment of acid reflux
Surgical treatment of acid reflux is useful in few cases. Studies have shown that treatment with PPIs provides similarly good or better long-term results in most patients. Especially when the reflux esophagitis is caused by a diaphragmatic hernia (Hiatal hernia), surgery may be beneficial. With a so-called fundoplicatio, part of the upper stomach is used as an artificial sphincter that prevents acid from flowing back from the stomach into the esophagus.
Reflux esophagitis is a common disease that leads to a significant reduction in the quality of life for many sufferers. Since the symptoms are mostly very characteristic, in most cases the disease can be recognized quickly. Treatment of the disease with proton pump inhibitors shows good effectiveness. In severe cases, patients can be helped by surgery, improving their quality of life again.