Reflux Esophagitis

Heartburn is frequently due to reflux esophagitis. This common illness occurs when the valve between the stomach and the esophagus (the tube running from the mouth to the stomach) malfunctions. Malfunction of the valve allows acid to damage the sensitive lining of the esophagus. This can lead to pain and blood loss. This blood loss can make a person anemic (lower the blood count) and can make a test for blood in the stool positive.

Diagnosis is suspected from the patient's symptoms and can often be proven by endoscopy. Endoscopy is a procedure under sedation involving a flexible tube with a lens system which allows the damaged esophagus lining to be viewed and biopsied. Biopsy will show inflammation when acid injury is occurring, and in severe cases may show a tendency for cell changes in the lining. If cell changes are found (dysplasia), endoscopy will need to be repeated intermittently to monitor an uncommon, but possible change to cancer.

Treatment begins with changes in the diet. Foods which make reflux worse contain fat, caffeine, chocolate and mint flavors. Alcoholic beverages are also avoided. Nicotine from cigarettes will worsen the condition. Citrus fruits and tomatoes can cause direct injury to the lining. Food should not be taken less than 3 hours before sleeping or napping. Small frequent meals are better than large meals.

Tight fitting clothes should be avoided as well as prolonged activities causing abdominal muscle straining. Elevating the head of the bed on 4 inch wooden blocks allows gravity to keep acid in the stomach overnight.

Antacids are tried for symptoms. Prescription medicines are the next form of treatment.

If all else fails, surgery to make a new valve may be recommended. This is uncommon. More than 90% of patients will improve without surgery.