Reflux esophagitis

What is heartburn?

It is a symptom felt asa burning sensation in chest. Many patients describe this symptom like indigestion, dyspepsia, or hyper-acidity. About 20% of population may suffer from heartburn. It is more common in pregnancy, obesity and smokers.

Is this to do any thing with heart?

No, despite the name ‘heartburn’ it has nothing to do with heart, and usually this symptom arises from your esophagus. Because the esophagus and heart are located near each other, many people mistake this symptom arising from heart. However,if you are not sure if it’s heartburn or pain arising from your heart, seek medical attention right away. Your doctor will be the best judge to ascertain whether your symptom is from your heart or esophagus.

What are causes of heartburn?

Usually the symptom of heartburn occurs when the acid present in the stomach refluxes back into the food pipe (esophagus) and irritates the esophageal lining.

The causesof this reflux of acid leading to heartburn are given below:

How common is heartburn?

Heartburn is a very common symptom and it is estimated that approximately one-third of general population have heartburn at least once a month, with 10% experiencing it nearly every day.

What are conditions that can cause chest pain or chest discomfort?

There are many causes of chest pain or chest discomfort. The most important is related to heart called ‘angina’. It is a condition when heart gets less blood supply. Beside this, problems of heart valve (mitral valve prolapse), heart covering (pericarditis) or heart muscles (hypertrophic cardiomyopathy) can cause chest pain. Lung condition (like pneumonia pleurisy), stomach condition (ulcers, reflux esophagitis, hiatus hernia), problems of gall bladder or pancreas, problems of ribs, rib muscles and infections like herpescan also cause chest pain.

Is heartburn same as ‘gastro-esophageal reflux disease’ (GERD)?

GER (gastroesophegeal reflux) is a normal phenomenon, which happens in all individuals, more frequently after a meal. When this results in significant distress and retrosternal pain it is referred to as GERD (gastroesophegeal reflux disease). Heartburn is the most common symptom ofgastro-esophageal reflux disease. But besides heartburn, GERD can cause many other symptoms, like chest pain, sour eructation, chronic cough, and painful or difficult swallowing.

Is heartburn related to lifestyle of person?

Yes, it is more common in persons who areoverweight, smokersor alcoholics. It is also related to the type of diet one takes.

Can heartburn be due to food?

Yes, certain foods like citrus fruits, chocolates, spicy-foods, tomatoes, onions and fizzy drinkscan also causeheartburn.

Can medicines also cause heartburn?

Yes, many medicines can be associated with heartburn symptoms. The common examples are pain-killers (like ibuprofen, aspirin), sedatives, medicines for high blood pressure, corticosteroids and certain antibiotics.

Howdoes pregnancy cause heartburn?

Many women have symptoms of heartburn when they are pregnant. The reasons are hormonal changes that occur during pregnancylowers the pressure of lower esophageal sphincter (LES). The other cause of regurgitation of acid into food pipe is thegrowing fetus that puts pressure over the stomach.

How does smoking cause heartburn and GERD?

Smoking cause heartburn by many mechanism as given in diagram below

What is reflux esophagitis?

Reflux esophagitis is basically injury to esophageal lining due to acid exposure. This is a pathological or morphologic term. This injury mostly occurs in distal part of esophagus, near gastro-esophageal junction because this part is maximally affected with acid reflux. Clinically, disease is known as gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD). The American College of Gastroenterology defines GERD as “chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus”. GERD can be erosive or non-erosive. Non erosive reflux disease is more common where symptoms of heartburn and retrosternal pain occur but erosions (minute ulcers) or ulcers don’t occur in esophageal lining. Reflux esophagitis is differentiated from other types of esophagitis like eosinophic esophagitis, infectious esophagitis and pill esophagitis by clinical history, endoscopic findings and mucosal biopsies.

Why does reflux esophagitis occur?

Esophageal mucosa or inner lining is protected normally against acid damage. A competent valve between esophagus and stomach and angle between esophagus and stomach prevents reflux of gastric contents into esohagus in healthy individuals. In addition to this, tightly apposed cells in esophageal mucosa, mucus adhered over it and submucosal blood flow forms a three layer barrier to protect against acid induced damage. When excessive acid leads to damage to these defensive mechanisms erosions occur in esophageal mucosa, known as reflux esophagitis. This can happen due to incompetent valve (which happen in hiatus hernia), abnormally increased opening of valve (decreased lower esophageal sphincter pressure) or excessive acid production in stomach.

How common is reflux esophagitis?

Reflux esophagitis or GERD is very common. According to an estimate sixty percent of the adult population will experience some type reflux esophagitis symptoms within a one year period and twenty-five percent will have symptoms at leat once a week.

What are the factors responsible for esophagitis?

Excessive intake of alcohol, smoking and citrus drinks are responsible for esophagitis. Certain medications mainly pain killers, aspirin etc. can lead to damage to esophageal mucosa. Obesity is an important factor responsible for GERD. GERD occurs with increase frequency in pregnancy due to hormonal changes and increased intra-abdominal pressure. Certain diseases like scleroderma has high association with reflux esophagitis.

What are the symptoms of reflux esophagitis ?

Heartburn is the most common symptom of reflux esophagitis, which is present in more than 80% of patients. Other symptoms include regurgitation, abdominal pain, chronic cough, difficulty in swallowing, hoarseness of voice, recurrent belching, and a sensation of lump in throat.

What are the complications of esophagitis ?

Esophagitis can lead to narrowing of esophageal lumen leading to difficulty in swallowing. It produces large ulcers which might bleed. Barrett’s esophagus is a complication of long standing GERD where esophageal mucosa turn into intestinal type mucosa. This condition is pre-cancerous and may lead to development of esophageal cancer.

How to prevent reflux esophagitis?

Life style modification is important for avoidance of reflux esophagitis. For example:

• Smoking cessation
• Abstinence from alcohol
• Avoidance of citrus drinks and spicy meal
• Avoidance of excessive tea and coffee
• Maintaining atleast two to three hours gap between last meal and sleep
• Avoidance of pain killers and other drugs which leads to esophageal injury

What if reflux esophagitis is not treated?

Apart from causing troublesome symptoms, untreated long standing reflux esophagitis can lead to ulcers and strictures which might cause bleeding and difficulty in swallowing. Barrett’s esophagus (pre-cancerous condition) and esophageal cancer are serious consequences of reflux esophagitis, albeit seen in minority of patients.

What is hiatus hernia?

Hiatus hernia is a condition in which a portion of stomach bulges up into the chest. Normally stomach is in abdominal cavity. Hiatus hernia leads to decreased functioning of lower esophageal sphincter (LES) that may result into GERD. Hiatus hernia may occur without symptoms or with symptoms of GERD including heartburn.

Does symptoms of GERD also affects quality of life?

Yes, persistent symptoms impair the quality of life. They can cause absenteeism, poor sleep quality, chronic cough, chronic bronchitis, less productivity and chronic pain in abdomen.