1. Can reflux esophagitis be prevented?
The prevention of reflux esophagitis can be achieved mainly in the following aspects.
(1) prevention of dietary management: the diet is based on the principles of high protein, high fiber, low fat, quit smoking and alcohol, avoid greasy food, minimize the intake of sweets, strong tea, chocolate, coffee and other foods, and avoid overfull dinner.
(2) Environmental adaptation: improve their own resilience and avoid gastrointestinal symptoms caused by environmental stress.
(3) Sleep quality adjustment prevention; develop a good biological clock, ensure sufficient sleep, and medication intervention if necessary; avoid eating within 3 h before bedtime to reduce gastric acid secretion, and prevent gastric contents reflux when lying on the back.
(4) Prevention of mental and psychological adjustment; release psychological burden and relieve anxiety.
(5) Prevention of drug application; for poor gastrointestinal motility, take acid suppressants and gastrointestinal motility drugs as needed, and stop using them when the symptoms are relieved; apply acid suppressants or motility drugs prophylactically to effectively reduce reflux symptoms; constipated patients can apply laxatives to keep the stool open.
(6) Standardized treatment, timely consultation and treatment according to treatment norms.
2.What is reflux esophagitis?
Refluxe sophagitis (RE) is an inflammatory esophageal lesion caused by the reflux of gastric and duodenal contents into the esophagus, which endoscopically manifests as a break in the esophageal mucosa, i.e. esophageal erosion or esophageal ulcer. The clinical symptoms are heartburn, acid reflux, and retrosternal burning pain. Some patients may experience changes in the mucosal epithelium of the lower esophagus, where the original squamous epithelium is replaced by hyperplastic columnar epithelium, which is called Barrett’s esophagus, a precancerous lesion.
3.What are the signs and symptoms of reflux esophagitis or what are the discomforts of the body?
The clinical manifestations of reflux esophagitis are diverse and vary in severity, with the following three main areas of manifestation.
(1) Esophageal symptoms: Heartburn and reflux are characteristic symptoms of typical reflux esophagitis, often appearing 1h after a meal, and can be aggravated when lying down, bending over or when abdominal pressure increases. Heartburn is a burning sensation in the retrosternal region. Reflux is a sensation of regurgitation of gastric contents into the mouth or hypopharynx. Other atypical related symptoms include one or more of the following, such as epigastric pain, chest pain, belching, abdominal distension, epigastric discomfort, foreign body sensation in the throat, painful swallowing, and dysphagia.
(2) Extra-esophageal symptoms: such as pharyngitis, chronic cough, asthma, mainly due to irritation or damage to tissues or organs outside the esophagus by refluxed material. Some studies have shown that up to one-third of patients with chronic and persistent pharyngitis have GERD, but less than 10% have typical symptoms such as acid reflux and burning sensation in the epigastrium. In addition, reflux esophagitis may be a triggering factor for asthma, suggesting that extraesophageal irritation is not uncommon in patients with reflux esophagitis. Some patients complain of pharyngeal discomfort, foreign body sensation, cotton ball sensation or blockage, but no real swallowing difficulty, called hysterical ball syndrome.
(3) Complications: Common complications include esophageal stricture, upper gastrointestinal bleeding, and Berrett’s esophagus, which can occur on the basis of reflux esophagitis or without reflux esophagitis and is a precancerous lesion of esophageal adenocarcinoma.
4.What factors can cause reflux esophagitis?
The pathogenesis of reflux esophagitis is very complicated, but the following factors are currently considered to be involved.
(1) lower lower esophageal sphincter pressure is an important cause of reflux esophagitis, such as some foods (high fat, sweets, chocolate, coffee, etc.), drugs (calcium antagonists, diazepam, etc.), increased intra-abdominal pressure (pregnancy, ascites, weight-bearing labor, etc.) or increased intragastric pressure (delayed gastric emptying) can cause lower lower esophageal sphincter pressure and lead to GERD; (2) transient lower (3) decreased acid removal ability of the esophagus: when the peristaltic amplitude of the esophagus decreases, disappears or becomes pathologically peristaltic, its ability to eliminate reflux decreases, resulting in prolonged residence time of reflux in the esophagus, resulting in damage to the mucosa caused by reflux, especially at night; (4) damage to the esophageal mucosal barrier: such as long-term smoking, alcohol consumption, mental stress, depression can reduce the barrier of the esophageal mucosa, making it unable to resist reflux. (4) damage to the esophageal mucosal barrier: long-term smoking, alcohol consumption, mental stress and depression can all reduce the esophageal mucosal barrier, making it unable to resist the damage caused by reflux; (5) attack by gastric acid and duodenal reflux: gastric acid and pepsin are important factors in esophageal damage caused by reflux of gastric contents. The lower the pH and the longer the acid exposure, the more severe the mucosal damage; (6) abnormal gastroduodenal function: delayed gastric emptying dilates the proximal stomach and induces transient lower esophageal sphincter relaxation, leading to gastroesophageal reflux. When duodenal lesions occur, incomplete closure of the pyloric sphincter leads to duodenogastric reflux. Duodenogastric reflux can increase the risk of RE due to the increase in gastric volume, and the refluxed material containing bile and pancreatic enzymes also has a damaging effect on the esophageal mucosa. (8) Esophageal visceral hypersensitivity; (9) Other factors: H. pylori infection, genetic factors, autonomic dysfunction, psychological factors, mental factors, etc.
5.Why does reflux esophagitis occur?
(1) lifestyle plays a role in GERD, poor lifestyle habits such as high-fat diet, smoking, alcohol, chocolate, coffee, strong tea, sweets, etc. can reduce the pressure of the lower esophageal sphincter, is an important cause of reflux esophagitis, obesity, fatigue, mental factors, bowel difficulties, etc. are considered high-risk factors for reflux esophagitis; (2) organic lesions: gastric diseases cause gastric emptying disorders or (2) organic lesions: gastric diseases resulting in impaired gastric emptying or incomplete closure of the pyloric sphincter in duodenal lesions leading to duodenogastric reflux, duodenogastric reflux can increase the risk of GERD due to increased gastric volume, and reflux containing bile and pancreatic enzymes can cause damage to esophageal mucosa.
6.How to diagnose reflux esophagitis? How do I determine if I have reflux esophagitis?
Foreign scholars believe that as long as the symptoms of typical reflux esophagitis are present, the diagnosis of RE can be considered, and proton pump inhibitors (PPI) can be used as experimental treatment, and if the effect is obvious, the diagnosis is established. Domestic scholars also generally believe that the role of symptoms, especially typical symptoms, should be emphasized in the diagnosis of RE, but RF must be differentiated from other etiologies of esophagitis and peptic ulcer, so the diagnosis of RE also depends on the comprehensive judgment of clinical manifestations and ancillary tests.
In the case of typical symptoms of heartburn and reflux without evidence of GI obstruction, reflux esophagitis can be clinically considered. If there are extra-esophageal symptoms and reflux symptoms, it can be considered as reflux-related or possibly related extra-esophageal symptoms, such as reflux-related cough and asthma. If there are only extraesophageal symptoms without typical heartburn and reflux symptoms, the diagnosis of reflux esophagitis cannot be made yet. Further information on the timing of the onset of symptoms, the relationship with meals and body position, and other triggers is desirable. Endoscopy and 24-h esophageal pH monitoring are the “gold standard” combination for the diagnosis of RE, and experimental PPI therapy is an important tool for the diagnosis of RE. In cases of atypical symptoms, a combination of endoscopy, 24-hour esophageal pH test and experimental treatment is often needed to make a comprehensive analysis.
7.Which diseases are easily confused with GERD or which diseases need to be differentiated?
(1) Esophageal lesions: fungal esophagitis, drug esophagitis, esophageal cancer, pancreatic dystocia, etc.
(2) Differentiate chest pain as the main manifestation from cardiogenic chest pain or non-cardiogenic chest pain caused by other causes.
(3) Functional lesions such as functional heartburn, functional chest pain, functional dyspepsia, etc.
8.What tests can help to confirm the diagnosis of reflux esophagitis?
(1) Gastroscopy: It is the main diagnostic method for reflux esophagitis, and it is a routine test for patients with recurrent symptoms, severe degree, alarm signs or family history of tumor, and the presence or absence of reflux esophagitis and its complications can be diagnosed according to the microscopic performance, which helps in differential diagnosis.
(2) Barium esophagogram: combining gastroesophageal imaging and kinetics, it can show the presence of mucosal lesions, strictures, esophageal hiatal hernia, etc., and show the presence or absence of barium reflux in the esophagus.
(3) 24h esophageal pH monitoring: The significance of 24h esophageal pH monitoring is to confirm the presence or absence of reflux, which is characterized by high sensitivity and specificity. 24h esophageal pH monitoring can show in detail acid reflux, diurnal acid reflux pattern, the relationship between acid reflux and symptoms, and the patient’s response to treatment, making treatment individualized.
(4) Esophageal manometry does not directly reflect gastroesophageal reflux, but reflects the barrier function of the gastroesophageal junction (EGJ). It can predict the efficacy of anti-reflux therapy and the need for long-term maintenance therapy. Thus, esophageal manometry can help assess esophageal function, especially in those with poor outcomes.
9. How is reflux esophagitis treated?
The goals of treating reflux esophagitis are to relieve symptoms, improve quality of life, and prevent recurrence and complications.
(1) Lifestyle changes are its basic treatment: develop good lifestyle habits, eat regularly, control diet, avoid high-fat diet, quit smoking and alcohol, reduce the intake of chocolate, strong tea, coffee, sweets and other foods that can lower the pressure of the lower esophageal sphincter, and in addition, studies have found that elevating the head of the bed at least 15 cm can significantly reduce acid contact in the esophagus. Reducing body mass in obese patients can significantly reduce reflux symptoms in patients.
(2) Drug treatment
a. Acid suppression therapy: The current main measures for the treatment of reflux esophagitis are divided into initial therapy and maintenance therapy. The main purpose of initial treatment is to relieve symptoms and cure esophagitis as soon as possible: the preferred proton pump inhibitor PPI class (there are five omeprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole), the recommended standard dose, a course of 8 weeks, some patients with unsatisfactory symptom control can increase the dose or change a PPI. maintenance treatment is mainly aimed at consolidating the efficacy and preventing relapse: there is the original dose or reduced The main purpose of maintenance therapy is to consolidate the efficacy and prevent recurrence: there are three methods: original dose or reduced dose, intermittent dosing and on-demand therapy.
b. Prokinetic therapy: When acid suppression therapy is not effective, prokinetic drugs (such as morpholine, mosapride, etc.) can be applied in combination.
(3) Surgery and endoscopic treatment: laparoscopic anti-reflux surgery is also an option for maintenance treatment. Those who have Barrett’s esophagus with high degree of atypical hyperplasia or those who are considering cancer.
10.What are the precautions in the medication and prevention of reflux esophagitis?
The initial treatment of reflux esophagitis drugs is preferred to the proton pump inhibitors PPI class (there are five types of omeprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole). The H2 receptor antagonist H2RA is not advocated because of the short maintenance of symptoms, the development of resistance in most patients after 4-6 weeks, and the poor long-term efficacy. In the maintenance phase usually severe celiac esophagitis (LA grade C-D) requires adequate maintenance therapy. H2RA is generally not suitable as a long-term maintenance therapy because of the tolerance that can develop with long-term use.
11.What should be the dietary management for the prevention and treatment of reflux esophagitis?
(1) Dietary control: A diet high in protein, high in fiber and low in fat, abstain from smoking and alcohol, avoid greasy foods, minimize sweets, strong tea, chocolate, coffee and other foods that lower the pressure of the lower esophageal sphincter, and reduce the intake of tomato juice, orange juice, cola and other drinks that stimulate acid secretion.
(2)->reduce body mass: overly obese people, due to the increased pressure in the abdominal cavity, easily lead to the reverse flow of food. Therefore, obese people should try to reduce the body mass, avoid bending, squatting and other exercises that increase intra-abdominal pressure.
The head of the bed should be raised 15cm-20cm at night, and avoid lying down after meals to reduce the reflux of gastric contents into the esophagus. Avoid eating within 3 hours before bedtime to reduce the secretion of gastric acid and to prevent reflux of gastric contents when lying on the back.