Endoscopy can damage a lower esophageal sphincter

Reflux esophagitis

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Especially when eating, the stomach produces large amounts of acid. This serves on the one hand to kill germs contained in the food and on the other hand to digest the food.

The gastric mucosa is protected against the effects of acids by various mechanisms. In contrast, the esophageal mucosa lacks protective mechanisms against the aggressive gastric juice. In the case of reflux, this can damage the mucous membrane. It creates a Reflux esophagitis (Inflammation of the mucous membrane of the esophagus). In turn, it can lead to bleeding and inflammatory ulcers.

At a chronic reflux esophagitis scarred constrictions of the esophagus develop. If the mucous membrane changes irreversibly (metaplasia), it is called Barrett's mucous membrane. It carries an increased risk of developing esophageal cancer.

To prevent acidic stomach contents from flowing back into the unprotected esophagus, the lower sphincter, the esophageal sphincter (gastric gatekeeper, stomach mouth), must function. Overall, the human organism has three natural antireflux mechanisms in the esophagus and stomach area:

  • The lower sphincter and gastric entrance gate (lower esophageal sphincter) are tense when at rest and prevent the flow of food back into the esophagus
  • The gastric contents are emptied into the duodenum in a timely manner.
  • The esophagus (esophagus) cleans itself through muscle contractions.

If the antireflux mechanisms are not working properly, the lining of the esophagus is exposed to unnatural stress from the backflow of stomach contents. This can be caused by stomach acid (acidic), pancreatic secretions and bile acids (basic). The secretions from the pancreas and bile find their way into the stomach via the duodenum. In combination with stomach acid, they are particularly aggressive.

causes for reflux

  • a dysfunctional lower sphincter and stomach entrance porter: the food flows back into the esophagus.
  • Disturbed gastric motor skills: the stomach is emptied with a delay, which leads to stomach enlargement with an increase in gastric pressure and an overproduction of gastric acid.
  • a disturbed cleaning function of the esophagus: the refluxing chyme remains longer in the esophagus.

The main symptoms of reflux disease are heartburn and acid regurgitation. Heartburn manifests itself as a dull pain or pressure behind the breastbone and often occurs at night as well. Other symptoms may include swallowing difficulties and morning hoarseness, in rare cases also chronic coughing, sore throat, asthma or throat clearing.

Diagnosis

The diagnosis of reflux disease is made endoscopically. For this purpose, the severity of the changes in the mucous membrane is assessed. If the mucous membrane is abnormal, a tissue sample is taken to rule out Barrett's esophagus (severe changes in the mucous membrane with cellular remodeling, metaplasia); sometimes atypia or even a tumor develop.

therapy

Therapy for reflux disease or reflux esophagitis is primarily based on conservative measures such as eating smaller meals, reducing weight or refraining from smoking, alcohol or acidic beverages. Raising the head of the bed at night can improve the symptoms.

If there is no improvement, so-called proton pump inhibitors are drugs of first choice for acute treatment. They inhibit the acid secretion of the stomach and are highly effective and very well tolerated. Acute reflux lesions heal in over 80 percent of cases.

The aim of surgical therapy is always to prevent excessive backflow of stomach contents into the esophagus. Today, this procedure is practically always minimally invasive (laparoscopic).


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