Practice diagnosis and treatment of reflux esophagitis

2021-03-25 12:00 AM

Pain worsens when lying down or leaning forward. Standing up straight can alleviate the pain, mainly by gravity.

Define

Reflux esophagitis (reflux oesophagitis) is a condition caused by inflammation of the oesophagus containing gastric acid from the stomach reflux into the oesophagus. In rare cases, reflux esophagitis may be seen in post-operative patients (such as gastric bypass) when bile from the stomach backs up into the oesophagus creates an alkaline environment that causes inflammation. This is usually more severe and more difficult to treat.

Reflux esophagitis usually occurs after a slit hernia (hiatus hernia). Prolonged esophagitis in severe chronic cases can narrow the oesophagus. Then, it is necessary to dilate the oesophagus or be treated with surgery.

In fact, the oesophagus can also be inflamed by swallowing chemicals that cause burns and burning, but this is not called reflux esophagitis.

Causes

The direct cause is that the sphincter between the oesophagus and stomach is not doing well with its " one-way operation " function. Normally, this sphincter opens up for food from the oesophagus to enter the stomach and contracts to prevent the stomach from flowing back (a reflux phenomenon) when the stomach contracts.

There are many different causes of sphincter not contracting or contracting not enough. The most common causes are:

Diet: more foods work to make the sphincter contract weaker or not to contract, causing the " reflux phenomenon " that we have mentioned. Foods that do this effect are chocolate, mints, spicy foods, fatty foods, especially animal fats, and sour fruits such as oranges, tangerines, including tomatoes. fruit juice ... Chocolate and mint can stop your sphincter from contracting.

Smoking cigarettes can stop the sphincter from contracting.

This prolonged condition can completely lose the function of the sphincter.

Reduce bowel movements. In this case, reflux esophagitis is often accompanied by many other symptoms.

Pregnant women. This is a natural cause, causing most pregnant women to experience a condition called " morning sickness ", with the most typical symptoms being nausea, vomiting, heartburn ... This condition occurs. This is because as the uterus occupies an increasingly larger volume, it pushes the stomach upwards and begins to compress the sphincter, preventing the muscle from working properly. In addition, the body of a pregnant woman produces a hormone called progesterone, which reduces muscle contraction, and is therefore affected by the sphincter.

People who are obese or overweight may also experience reduced sphincter function due to the pressure of the fat layer that accumulates too much in the abdomen.

When there is a slot herniation, the acid in the stomach also penetrates the oesophagus. The cause of a hernia can be a cough, vomiting, or a straining bowel movement, or a sudden and excessive exertion ... Other causes can be pregnancy, obesity, or old age. Many people over the age of 50 suffer from small cleft hernias. Unless the patient has symptoms of decreased bowel movements or esophagitis that complicates the disease, treatment is not needed.

Diagnose

Diagnosis is mainly based on symptoms

Burning pain in the anterior chest area, usually below the sternum.

A burning sensation in the chest sometimes spreads up the neck and towards the arms. Therefore, severe pain can sometimes be mistaken for a heart attack.

Pain worsens when lying down or leaning forward. Standing up straight can alleviate the pain, mainly by gravity.

The patient feels very sour in the mouth because the acidity of the gastric juice is refluxed with a portion of food. However, the perception of each person can vary depending on the severity of the illness, from very mild cases (only feeling sour after burping, so often called heartburn) to moderate (a sour taste with a strong bitter taste and a burning sensation in your throat) or very severe (with burning pain in your chest, spreading, and a host of other symptoms).

The pain often depends on meals, such as after eating too full, or too fat ...

Several tests can assist with the diagnosis

Esophagoscopy reveals inflammation.

X-rays can show gastric reflux.

Use a flexible tube inserted into the end of the oesophagus to measure the acid concentration here continuously for 24 hours to determine whether the acid is going from the stomach to the oesophagus or not.

Bernstein test : Apply a dilute acid solution in a small, flexible tube up the middle of your oesophagus to determine if you are causing similar symptoms.

Need differential diagnosis from cases accompanied by ulcers.

Treatment

In mild cases, antacids can be used to alleviate symptoms, along with eliminating the cause of the disease.

Instruct the patient on when the headrest is slightly higher than normal.

Pay attention to your diet. For obese or overweight subjects, aim to lose weight. Food ingredients should strongly reduce fat, sour, spicy, stimulating ... and in general, should not eat too full. Monitor your body weight to make sure weight loss is progressing.

Don't eat at bedtime. The last meal of the day should be eaten earlier than usual and reduced in weight, choosing light snacks, liquid dishes, easy to digest ...

No alcohol, no smoking.

Most cases of reflux esophagitis can be completely resolved after a period of dietary adjustment, rest and elimination of harmful agents such as alcohol, tobacco ... However, close monitoring is required. closely to promptly detect unusual symptoms. Persistent esophagitis that becomes chronic can cause narrowing of the oesophagus, requiring surgical treatment or oesophageal dilatation.