Gastroenterology - Reflux Oesophagitis

What is oesophagitis?

Oesophagitis is an inflammation of the lining of the gullet (oesophagus).

In most people it is caused by the digestive juices from the stomach, repeatedly moving upwards (reflux) into the lower oesophagus producing redness and ulceration. Muscle contractions normally keep the lower end of the oesophagus closed, but reflux occurs when the muscle is weak.

The reason why the muscle becomes weak is not fully understood.

What are the symptoms of reflux?

Reflux causes a burning sensation in the upper abdomen and lower chest, sometimes moving upwards towards the throat.

The oesophagus does not have the same protective lining as the stomach, to protect against acid, therefore the acid normally produced by the stomach causes a burning sensation.

It is usually worse at night or can be brought on by bending or physical exercise, particularly after a meal. The sensation or discomfort is often referred to as heartburn.

What causes reflux?

Once the muscle becomes weak, several factors can promote reflux, such as smoking or drinking too much alcohol. Being overweight or wearing tight clothing can also increase the pressure within the stomach.

Some people will notice that certain foods cause reflux, particularly acidic, rich, spicy or fatty foods. In some cases, reflux is caused by a hiatus hernia (protrusion of a small part of the stomach, above the diaphragm into the chest). This prevents the muscle at the base of the oesophagus from working properly.

What are the symptoms of oesophagitis?

Sufferers may experience a burning sensation in the lower chest immediately after swallowing hot fluids, e.g. tea or soup. A similar discomfort may be felt after meals, especially hot fatty foods such as bacon and eggs.

Food may come up into the mouth (regurgitation), especially on stooping or lying in bed at night. If this is severe, the person may wake up coughing or with a choking sensation.

How is oesophagitis diagnosed?

Your doctor may diagnose the presence of oesophagitis and reflux based on your symptoms.

If acid reflux is not treated, the oesophagus may become sore and inflamed. This is called oesophagitis and may require a short course of treatment to settle it down.
 
Your doctor may refer you for an examination called gastroscopy in which a narrow, flexible tube with a light at the end is passed through the mouth, throat and oesophagus into the stomach.  This allows the endoscopist (the doctor or nurse carrying out the procedure) to examine the oesophagus for any reddening or ulceration.

Occasionally sophisticated tests such as 24 hour ambulatory pH study is required to diagnose reflux disease.

What treatments are available?

Reflux is very common. However taking simple measures can help. These include:

• Small meals, eaten regularly will help reduce the pressure into the upper part of the stomach caused by eating large meals
• Eating later at night should be avoided in order to ensure that the stomach is empty at bedtime
• A change in diet such as reducing caffeine intake (coffee and tea), fatty foods and a reduction or avoidance of acidic drinks
• Alcohol should only be taken in moderation with meals
• Smoking should be avoided
• Loose clothing is better than tight waistbands and belts. Bending should be kept to a minimum, especially after meals
• Avoid stooping by using long handled tools when gardening or doing housework
• Being overweight can cause upwards pressure on the base of the oesophagus, so loosing weight may relieve symptoms
• At nightime, raising the head end of the bed by 6 to 9 inches can help to keep stomach contents from rising into the oesophagus

Medicines available to help with your reflux range from antacids to stronger drugs. Antacids neutralise any acid in the oesophagus and the stronger drugs reduce, or actually stop the production of acid in the stomach.

What will happen if the oesophagitis is not treated?

If the oesphagitis is not treated severe inflammation and ulceration can, over a period of time, lead to narrowing (stricture) of the oesophagus which in turn can cause difficult swallowing.