Esophagitis is a condition because of an inflammation of the lining of the lower end of the oesophagus. Esophagus or gullet is a hollow muscular tube about 2 cms in diameter that acts as the ‘swallowing pipe’ leading to the stomach. Muscles of the esophagus contract in a coordinated fashion in one direction to push the food down through a valve like muscle called the lower esophageal sphincter.
Reflux esophagitis is usually caused when the digestive juices containing acids from the stomach, repeatedly move upwards into the lower esophagus (reflux).
- If there is a suspected diagnosis of esophagitis, then an endoscopy examination will have to be done.
- A narrow, flexible tube, with a light, is passed through the mouth and throat and on to the esophagus.
- Any injury or ulceration in the esophagus can be seen by this procedure.
- A small bit of the lining may be taken for biopsy, to check for any abnormalities.
- A white fluid containing barium (barium swallow) is swallowed, this enables the doctor to observe the passage of the fluid on X-ray.
- It can be studied whether the esophagus is ulcerated or narrowed.
- Diagnosis by barium meal X-ray may also show evidence of hiatus hernia.
3. 24 hour testing
- This can be used for measuring the acid levels in the esophagus
- In this procedure a fine tube is passed into the esophagus and left there for 24 hours.
- A special tip at the end of the tube measures the acidity at frequent intervals.
- This will give an indication of how often and how long the reflux episodes last.
4. Diagnostic Enigma
Reflux or heartburn when associated with chest pain can be a cause of anxiety as many conditions like angina or heart attacks can also mimic similar pain. There are many physicians the world over, who have treated heart attacks as reflux erroneously and paid a heavy price. Hence it is important to get the diagnosis of reflux right so that more serious conditions are not missed.
Some of the conditions that can mimic heartburn include the following:
- Myocardial Infarction or heart attack
- Cholecystitis – Inflammation of Gallbladder
- Peptic Ulcer Disease
Reflux is very common and practise of simple measures may bring enough relief.
The more the stomach is stretched by food, the higher the tendency to reflux. Eating fatty meals as fat delays gastric emptying also increases the tendency to reflux.
- Eat small meals
- Eat regularly, this helps in reducing the pressure on the upper part of the stomach caused by large meals.
- Avoid large rich meals, particularly in the evening this reduces the tendency to reflux.
- Avoid eating late at night so as to keep the stomach relatively empty at bedtime.
- Avoid alcohol, if it is being taken, it should be in moderation with meals.
- Smoking should be avoided. Tobacco prevents the esophageal sphincter from working properly, reduces the rate at which the stomach empties and increases stomach acid production.
- Bending should be kept to a minimum, especially after meals.
- Loose clothing is preferable instead of tight clothes especially around the waist and belt.
- Being overweight can cause upward pressure on the base of the esophagus, so losing weight may relieve symptoms.
- The tendency to reflux increases when you are lying down. This is mainly due to gravity. A simple way to change that is to use a pillow under the mattress or to raise the head of your bed to help to keep stomach contents from rising into the esophagus.
3. Drug treatment
- Usually only needed for a short period, although sometimes it may need to be prescribed again.
- Medication, which can enhance the normal movements of the esophagus, can also be prescribed and can be helpful.
4. Surgical treatment
- This can be done by laparoscopy, by this procedure the tissue around the lower oesophagus can be tightened thereby decreasing or preventing reflux.
- If the oesophagus has become narrow, then it may be widened by an endoscopic procedure or, occasionally, by way of surgery.