What is reflux esophagitis? Reflux esophagitis is one of the most common types of diseases of the digestive system. It is an inflammatory lesion of the esophagus caused by the reflux of stomach and duodenal contents into the esophagus, which endoscopically manifests as congestion, edema, erosion and even ulcer formation in the mucosa of the lower esophagus. Reflux esophagitis can occur in people of any age, with the incidence increasing with age in adults. The incidence is higher in Western countries than in Asian regions and may be related to genetic and environmental factors. There is a global trend of increasing incidence in the last two decades. Middle-aged and elderly people, obesity, smoking, alcohol consumption and mental stress are the high prevalence of reflux esophagitis. What causes gastroesophageal reflux? 1, the destruction of the anti-reflux barrier lower esophagus and the junction of the stomach there is a ring-shaped muscle, called the lower esophageal sphincter, when not eating in a tight or closed high-pressure state, plays a role in preventing the reflux of gastric contents, including stomach acid, bile, etc. into the esophagus. It acts as an important barrier, protecting the internal environment of the esophagus. When the lower esophageal sphincter pressure is too low and intra-abdominal pressure increases, gastric contents (including stomach acid, bile, food, etc.) can break through the sphincter and enter the esophagus, causing changes in the environment of the lower esophagus, and prolonged irritation can lead to inflammation of the lower esophagus and reflux esophagitis. Some drugs such as cholinergic and β-adrenergic agonist drugs, α-adrenergic antagonists, dopamine, valium, calcium receptor antagonists, morphine, etc. can affect the pressure of the lower testicular sphincter, while food factors such as fatty foods, alcohol, coffee and smoking can also trigger reflux esophagitis. Pregnancy, oral progesterone-containing contraceptives and late menstrual cycle can also increase the incidence of reflux esophagitis due to increased plasma progesterone levels. 2, esophageal acid contouring dysfunction esophageal acid contouring function includes two parts: esophageal emptying and saliva neutralization. Normal people will have small amounts and short periods of reflux. When acidic gastric contents reflux, the esophagus will immediately experience peristaltic contractions, and it only takes 1 to 2 times, about 10 to 15 seconds to empty almost all of the refluxed material. Even if a small amount of acid remains in the mucosal trap of the esophagus, it can be quickly neutralized by the swallowed saliva. Therefore, it has the effect of preventing reflux esophagitis. However, since salivary secretion almost stops during nighttime sleep and secondary peristalsis of the esophagus rarely occurs, esophageal contouring function at night is significantly delayed. 3, damage to the anti-reflux barrier function of the esophageal mucosa when the defense barrier is damaged, even under normal reflux conditions can cause esophagitis. It has been found that the weakened ability of esophageal epithelial cells to proliferate and repair is one of the major causes of reflux esophagitis. Gastroduodenal malfunction includes abnormal gastric emptying and gastroduodenal reflux. When the pyloric sphincter (gastric outlet) tone and lower esophageal sphincter pressure are both low, the gastric outlet and lower esophageal sphincter are simultaneously relaxed, and the hydrochloric acid and pepsin in gastric juice and duodenal fluid can simultaneously reflux into the esophagus, causing esophagitis. 5.Esophageal hiatal hernia is commonly seen clinically as sliding esophageal hiatal hernia. Due to the change of normal anatomical relationship, the closure of the esophagogastric junction is incomplete. Reflux esophagitis can occur in more than half of the patients. 6. Pregnancy vomiting can cause reflux esophagitis due to the increased intra-abdominal pressure of pregnancy, but it can recover after delivery without any treatment. Vomiting and prolonged erratic reflux can also cause reflux esophagitis to occur due to frequent opening of the cardia, which can return to normal after removing the cause. 7, other diseases newborns and infants in the development process, due to the lower esophageal sphincter malfunction and reflux, with the development of young children, most can be reduced. Primary lower esophageal sphincter dysfunction makes closure incomplete, and organic diseases such as tumors of the lower esophagus and cardia, scleroderma and various causes of pyloric obstruction, etc. can cause reflux esophagitis. The disease can be triggered by factors such as obesity, large amounts of peritoneal fluid, late pregnancy, increased intragastric pressure, and tobacco, alcohol, and drugs. What are the common symptoms of reflux esophagitis? (a) Burning sensation or pain behind the sternum is the main symptom of the disease, depending on the distribution of the vagus nerve, sometimes radiating to the neck, palate or ear, commonly radiating to both sides of the back between the scapulae. This is due to the fact that walking in an upright position promotes the action of esophageal clearance, and the postural burning pain is aggravated, which is highly suggestive of reflux. In those who lack gastric acid, the burning sensation is mainly caused by bile reflux, and then the effect of taking acid suppressants is not significant. (b) Gastric and esophageal reflux Every time after a meal, when the body is bent forward or when sleeping in bed at night, there is acidic fluid or food reflux from the stomach and esophagus to the pharynx or mouth, this symptom mostly appears before the onset of retrosternal burning sensation or burning pain. (c) Swallowing pain is caused by food mass stimulating the inflamed esophagus or esophageal spasm, spasmodic pain is the same as the distribution and radiation site of heartburn. The spastic pain can also be caused by reflux. (iv) dysphagia can often occur intermittently at the beginning due to secondary esophageal spasm caused by esophagitis, and later it can be replaced by permanent dysphagia due to narrowing of the esophageal scar formation and gradual reduction of burning sensation and burning pain, which can cause blocking sensation or pain at the glabella when eating solid food. (E) regurgitation of stomach acid or bile reflux into the back wall of the mouth indicates gastroesophageal reflux, stomach contents can be spit out or swallowed, leaving a sour or bitter taste in the pharynx and mouth, causing bad breath or taste impairment, chronic irritation of the lips may have a burning sensation, regurgitation can occur after eating, exertion or position change, often accompanied by gastrointestinal distension, erratic reflux, night reflux can also cause cough, aspiration pneumonia or asphyxia Reflux at night can also cause cough, aspiration pneumonia or asphyxia. (F) bleeding and anemia severe esophagitis can occur in the esophageal mucosa erosion and bleeding, mostly chronic small amount of bleeding, long-term or large amount of bleeding can lead to iron deficiency anemia. (vii) other symptoms of reflux through the cricopharyngeal sphincter into the pharynx, can cause laryngeal, tracheal aspiration, inflammatory vocal cord polyps, susceptible patients easily stimulated asthma, diffuse esophagitis or invasive ulcers can occur vomiting blood, chronic blood loss, a few penetrating ulcers can occur esophageal perforation. The aim of medical treatment of reflux esophagitis is to reduce reflux and reduce the irritation and erosion of gastric secretions. Sliding hernias without symptoms usually do not require treatment. In obese patients, weight reduction may reduce intra-abdominal pressure and reflux. Avoid weight holding, bending, and tight clothing and pants. Elevating the head of the bed 15 cm during sleep, not eating 6 h before bedtime, and avoiding alcohol and tobacco can reduce the onset of esophageal reflux. In terms of medication, use acid reducers to neutralize gastric acid and reduce the activity of pepsin. For prolonged gastric emptying, gastrodynamic drugs such as domperidone (morpholine), etopride, etc., H2 receptor antagonists or proton pump inhibitors can reduce gastric acid and protease secretion. The combination of acid-suppressing drugs and prokinetic drugs can improve the efficacy in some patients. How to prevent reflux esophagitis? 1, avoid alcohol and quit smoking: because tobacco contains nicotine, can reduce the lower esophageal sphincter pressure, so that it is in a relaxed state, aggravating reflux; wine is the main component of ethanol, not only to stimulate gastric acid secretion, but also to relax the lower esophageal sphincter, is one of the causes of gastroesophageal reflux. 2, pay attention to a small number of meals, eat a low-fat diet, can reduce the frequency of reflux symptoms after eating. On the contrary, a high-fat diet can promote the release of cholecystokinin from the small intestinal mucosa, which can easily lead to reflux of gastrointestinal contents. 3, dinner should not be eaten too much, avoid lying flat immediately after the meal. 4, obese people should reduce weight. Because excessive obesity increased abdominal pressure, can promote gastric reflux, especially lying position more serious, should actively reduce weight to improve reflux symptoms. 5, keep a relaxed mood, increase the appropriate physical exercise. 6, the head of the bed at bedtime should be raised 10 to 15 cm, to reduce the night reflux is a proven method. 7.Minimize activities that increase intra-abdominal pressure, such as excessive bending, wearing tight-fitting clothes and pants, tightening the belt, etc. 8.Medication should be used under the guidance of a doctor to avoid side effects from indiscriminate use of drugs.