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Reflux Esophagitis (Heartburn)

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
occuring, 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 recom-
mended. This is uncommon. More than 90% of patients will
improve without surgery.

JGianfranciscoMD@aol.com