Introduction

Reflux esophagitis, sometimes called GERD, happens when the muscle at the base of the esophagus opens at the wrong time and allows the contents of the stomach to splash up into the esophagus. When these acidic stomach juices come into contact with the sensitive lining of the esophagus, a burning sensation results. Heartburn and an “acid mouth” are only some of the symptoms of reflux esophagitis. However, many people consider these sensations normal and don’t seek medical help. Breathing problems such as asthma and recurrent no cardiac chest pains are some other symptoms that can occur.

The Muscle that acts like a fist (lower esophageal sphincter)

The esophagus is a long muscular tube in the chest area that connects the mouth to the stomach. In the lower part of the esophagus, just above the stomach, there is a strong, ring-like muscle that acts like a fist. This muscle tightens to keep stomach contents from moving back up into the esophagus. In this one way system, the esophagus is sealed off from the stomach except during swallowing. Then, the muscle relaxes just enough to allow food into the stomach.

Pressure in the muscle determines whether it will open or stay closed. Increased pressure keeps the muscle tight and protects the esophagus from the stomach’s acidic juices. Less pressure permits the muscle to relax and open. Reflux esophagitis occurs when this muscle relaxes and opens at the wrong time, allowing stomach contents to move back up into the esophagus. The exact cause of malfunctioning of this sphincter is not known, though several things can make reflux symptoms worse. Smoking and caffeine are 2 major contributions that should be limited or avoided.

Other things that cause the “valve” to open more and may worsen reflux are:

Fried and fatty foods
Whole milk
Chocolate
Peppermint/Spearmint
Excessive alcoholic beverages
Cigarette smoking
Lying on your right side
Citrus juices: grapefruit, orange, pineapple, tomatoes

Certain foods that cause the valve to close more and are better tolerated:

Foods high in protein and low in fat
Carbohydrates
Calcium
Nonfat milk

Symptoms to watch for

Heartburn, the most common symptoms of reflux, is a burning sensation or pain that travels upward from the stomach. Heartburn often occurs after meals and can be brought on by eating fried, fatty, or spicy foods. Another common symptoms of reflux is an acidic or bitter taste in the mouth caused by a backflow of stomach acid or food. This usually happens within 1 or 2 hours immediately after eating. Both of these reactions can become worse if you lie down. Less common symptoms of reflux are chest pain and a salty tasting fluid in the mouth.

Complications you need to know about

Chronic reflux can cause such secondary problems as esophageal narrowing (stricture) causing difficulty in swallowing, hoarseness or laryngitis that won’t go away, and damage to vocal cords. Reflux can also cause or worsen respiratory problems, such as asthma and recurrent pneumonia, particularly if stomach contents get into the airways. Barrett’s esophagus (permanent change in the lining) can increase risk of development of cancer and should be evaluated by repeating endoscopy on a periodic basis. Though reflux is a mild condition, in many individuals complications can development when a person is not effectively treated. These can also include bleeding or ulcers in the esophagus.

Diagnosing reflux disease is practically painless

There are a number of possible methods used to diagnose reflux disease. A test known as an upper GI (upper gastrointestinal x-ray) may be performed to confirm a diagnosis of reflux disease, but only provides limited information. A more sensitive procedure is an upper endoscopy, which provides the doctor with a direct view of the esophagus.
A 24 hr. ph monitor is utilized at times also. This test measures the acid content of the stomach and requires patients to wear a battery-powered recorder. During this time, patients can go about normal activities-including sleeping. Additional tests called esophageal motility studies may be performed. These tests are intended to evaluate the movement of food through and the emptying ability of the esophagus.

Treatment can by very effective

The goals of treatment are to control symptoms, speed healing of any damage, and minimize recurrence and complications. The three phases of treatment are: (1) lifestyle adjustment (2) medication (3) surgery. Most often, phases 1 and 2 are so effective that phrase 3 is not required.

Phase 1 Lifestyle Adjustment

Most people with reflux disease can be effectively treated with a combination of lifestyle adjustment and medication. Regardless of other treatment methods, lifestyle adjustment is perhaps the most important. This is something that only you can do to make yourself feel better.

Adjustments in your diet are necessary for phase 1 treatment. You should eat small meals that are high in protein and low in fat. It’s best to eat at equal intervals throughout the day and to not eat anything 3 hours before bedtime. Foods to avoid include chocolate, peppermint and spearmint, excessive alcohol, caffeine, citrus fruits, whole milk and tomato-based products.

It has also been shown that losing weight can have a dramatic effect on reducing reflux esophagitis symptoms since it lessens pressure on the abdomen. Avoid tight fitting clothing and activities that increase abdominal pressure. Smoking should be avoided altogether.

Elevating the head of the bed 6 to 8 inches has been shown to reduce the amount of acid that splashes up into the esophagus. Use blocks under the head of the bed instead of pillows, as pillows may change position during the night. A foam wedge may also be helpful, especially if you sleep on a waterbed.

Some medications can worsen the symptoms of reflux disease. Tell us about any medications you may be taking including over the counter products. We can determine if there is a problem.

Phase 2 Medication

Phrase 2 treatment is the next step for those who don’t respond to lifestyle adjustment. Your doctor will advise you about what medication to take and for how long. It’s important that you follow all dosage instructions and continue to take the prescribed medication until it’s finished, even though you may feel better in a day or so.

Phase 3 Surgery

Despite the fact that phase 1 and 2 treatments can be very effective in treating reflux disease, approximately 5% to 10% of patients with the most sever condition when medication therapy fails to reduce symptoms, when complications such as hemorrhaging need to be prevented, or when reflux disease contributes to pulmonary (lung) disease.

Keeping things in perspective

Reflux disease can be a chronic problem, but it’s important to keep things in perspective. Although the disease is seldom life threatening, it can be a very painful problem. However, the majority of people are effectively treated through lifestyle adjustment and medication. Only if these measures fail does surgery become necessary. Maintaining a positive metal attitude, working with your doctor, and following treatment advice can be the “best medicine” for reflux disease.