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Reflux OesophagitisHeartburn (reflux oesophagitis) is an inflammation of the oesophagus (gullet) resulting from a failure of the valve (lower oesophageal sphincter) between the oesophagus and the stomach. In health, the valve prevents the back flow of gastric juices.
The symptoms of heartburn are common, often considered trivial, and frequently managed by simple home remedies or over-the-counter antacids. Untreated it can progress to serious disease in some people.
This fact sheet provides information on the causes, symptoms, treatment, and longer-term complications of heartburn (reflux oesophagitis).
What is heartburn and reflux?Gastro-oesophageal reflux is the back flow of stomach contents into the oesophagus.
Normally the lower oesophageal sphincter opens to allow food and fluid to pass into the stomach and then closing to prevent food and acidic gastric juices flowing back into the oesophagus. Reflux occurs when the lower oesophageal sphincter is either weak or relaxes inappropriately allowing corrosive gastric contents to flow backcausing inflammation of the oesophagus.
Does reflux occur in healthy people?A small tube which measures acidity when placed in the oesophagus shows that everyone has short periods of reflux. These are usually of short duration lasting a minute or two, with a total time of less than half an hour in a 24 hour period.
Inflammation occurs when the exposure to stomach contents is prolonged and the stomach juices refluxed have a high acid and pepsin content.
Why does the oesophagus become inflamed and not the stomach?An important function of the stomach is to produce and store very strong acids. Acid have roles in breaking down food for digestion, and killing unwanted infectious organisms. In order to store the juices which would digest other organs and tissues, the stomach evolved a very effective barrier layer which protects it almost as well as if it were ceramic bowl. The uniqueness that in spite of this remarkable protective layer it is still able to allow passage of those foods and fluids required by the body.
The barrier layer over the oesophagus is much weaker and not designed to resist the aggressive stomach juices. The barrier is sufficient to provide temporary protection but long exposure results in inflammation with swelling, redness and sometimes pain - the hallmarks of oesophagitis.
What causes heartburn & reflux oesophagitis?
The causes may be divided into two groups - those with a normal lower oesophageal sphincter and those with poorly functioning oesophageal sphincter.
Increases in the pressure in the abdomen can overcome the strength of a normal valve. Such pressure increases may be associated with pregnancy, obesity, bending when the stomach is full, large amounts of free fluid in the abdomen (ascites), physical exertion including coughing, vomiting, or straining, and sometimes very tight clothing.
What is the role of hiatus hernia?
When the upper part of the stomach moves up into the chest through the diaphragm, the person is said to have a hiatus hernia. In its normal position the gastro-oesophageal valve has additional support from the muscles of the diaphragm. When the stomach is not in its preferred position with loss of diaphragmatic support there is lowering of the pressure available to prevent reflux.
What are the symptoms of heartburn & reflux oesophagitis?
Heartburn is the characteristic symptom. Described as a burning pain behind the breastbone, it most commonly occurs after eating. It can, however, occur on bending, lying down, straining, after coffee, and even with emotional stress. It may last up to two hours and is often relieved by taking an antacid.
How is reflux oesophagitis diagnosed?
Endoscopy is the gold standard for diagnosis. The appearance can be photographed and a biopsy obtained.
What is the treatment for heartburn & reflux oesophagitis?
Treatment should consider lifestyle factors, consideration of drug treatment, and surgery.
What lifestyle changes?
What drug options are available?
Antacids taken regularly can neutralise acid in the oesophagus and stomach. For very mild symptoms this is the simplest satisfactory medication. Usually the relief is temporary and too much antacid can have its own side effects.
What about surgery?
Surgery for reflux oesophagitis has been controversial. Surgeons have always had a place in the management of disease unresponsive to drug treatment and disease with complications. The recent advances in laproscopic surgery techniques - a less invasive procedure than open surgery - have renewed interest in surgery for the less severe forms of the disease. A procedure known as fundoplication, modifies the angle between the oesophagus and the stomach, making it more acute thus creating a valve action which closes when pressure in the stomach is increased.
What are the complications of heartburn & reflux oesophagitis?
Sometimes serious complications develop. Bleeding may occur. Ulcers can develop leading to scarring and narrowing (stricture) of the oesophagus. Cancer is a remote possibility which cannot be ignored.
Reflux oesophagitis is a disorder with a wide spectrum of symptom intensity which spoils quality of life and which, for a few, can cause severe life threatening illness. Because of the potential for serious complications the symptoms should never be ignored as trivial. The treatment options usually advance along the lifestyle, pharmaceutical drugs and finally to the surgical options. Laparoscopic fundoplication surgery is being considered earlier than in the recent past.
|Last Updated ( Wednesday, 14 November 2007 )|
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