Reflux Disease

Gastroesophageal reflux disease is a very common condition that can sometimes cause serious damage to the esophagus resulting in many complications. It should be emphasized that the severity of symptoms is not always proportional to the damage of esophageal mucosa.


Gastroesophageal reflux is related to return of the acidic gastric content back into the esophagus. The esophagus is normally separated from the stomach by a sphincter muscle and in addition, small amounts of gastric juice are neutralized by swallowed saliva. However, the sphincter is not properly functional in some people. Anatomical disorder of the sphincter may be caused by hiatus hernia and its functional disorder may occur due to nicotine, alcohol and caffeine.


Reflux disease


The scheme shows backflow of the gastric juice into the esophagus.



The stomach acid irritates the lining of the esophagus and damages it. This is accompanied with symptoms such as belching, chest pain and heartburn. The problems worsen after meals. The pain in heartburn may be very severe and it can even mimic the myocardial infarction. The gastric juice may sometimes even get into the mouth and nasopharynx and leak into the respiratory tract. Gastric acid is aggressive; it irritates the lower airways and causes episodes of dry cough and hoarseness. Returning gastric contents may be related to bad breath and bitter taste in the mouth.


The complications occur due to chronic damage of the esophageal mucosa. Acidic contents can cause occurrence of esophageal ulcer, which is similar to gastric and duodenal peptic ulcers. The ulcer may hurt when swallowing, it can bleed and sometimes it can even burst. The rupture is a life-threatening condition. Chronic inflammation of the esophagus may cause local scarring and strictures that manifest with eating disorders and troubles when swallowing. Some cells may react to acid reflux by changing their attributes to become more similar to cells of intestinal mucosa. This condition is known as Barrett's esophagus. Barrett's esophagus should be regularly monitored as it can turn into esophageal cancer.


The treatment is very important. Acute problems may be solved by swallowing baking soda. This substance neutralizes the acid and brings a quick relief. The patient should sleep with elevated head (which reduces the risk of leakage of gastric juice into the lungs), smoking cessation is also advisable. The doctors can prescribe modern and effective medicines, for example the proton pump inhibitors that directly reduce the production of acid in the stomach. A more detailed and comprehensive overview of medication used against the reflux disease can be found here.


The most serious cases of complicated reflux disease non-responding to pharmacological therapy may be solved by a surgical intervention, which aims to improve the function of the lower esophageal sphincter.


Patients with confirmed Barrett's esophagus should be regularly monitored by upper GI endoscopy with regular biopsy check-ups. When the risk of esophageal cancer is too high, endoscopic removal of the mucosa or even surgical solution is needed.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources