Many people experience burning or uncomfortable sensations in their chest and upper abdomen, often attributing it to simple stress or indigestion. However, persistent or severe symptoms, especially those disrupting sleep or causing difficulty swallowing, could indicate esophagitis, an inflammation of the esophagus. While common in modern society, esophagitis should not be dismissed, as recurrent episodes and lack of treatment can potentially lead to serious complications, including an increased risk of esophageal cancer.
Internal medicine specialist Dr. Kim Kyung-joon from W+ Internal Medicine emphasizes the importance of managing esophagitis, stating, "Esophagitis can often be prevented and its symptoms alleviated through proper lifestyle management. However, neglecting it can negatively impact the esophageal tissue." Dr. Kim provides a detailed explanation of the risks and management strategies for reflux esophagitis.
Q. What is esophagitis, and what are its causes?
Esophagitis is a general term for inflammatory conditions affecting the esophagus. While it can be triggered by medications or infections from viruses or fungi, the most common type is reflux esophagitis, caused by the backflow of stomach acid into the esophagus.
Stomach acid is highly acidic, and the stomach lining is equipped to withstand this environment. However, the esophagus is far more sensitive to acid. When stomach acid refluxes into the esophagus, it can damage the lining, leading to inflammation – this is reflux esophagitis.
Q. What are the main symptoms of esophagitis?
The most frequent symptoms are heartburn and chest pain. Patients may describe the pain as burning or a dull, aching sensation. Other common symptoms include a feeling of a lump in the throat, excessive mucus, and frequent sour burping. Hoarseness or a chronic cough lasting for more than three to four weeks can also be indicators of esophagitis. Some individuals may also experience nausea, vomiting, or a bitter taste in the mouth. In severe cases, difficulty swallowing (dysphagia) or pain upon swallowing (odynophagia) can occur, sometimes accompanied by unintended weight loss.
Q. The symptoms seem similar to indigestion. How can we differentiate them?
Indigestion is a broad term with various causes, affecting not only the stomach and esophagus but also organs like the liver, gallbladder, and pancreas. Mental health issues like depression and systemic diseases such as thyroid problems or diabetes can also manifest as indigestion. It's challenging to distinguish these conditions based on symptoms alone, often requiring endoscopic, ultrasound, or CT scans for accurate diagnosis.
However, if you experience classic esophagitis symptoms like heartburn, a burning sensation in the chest, chest pain, and a lump in the throat, esophagitis becomes a primary consideration. If symptoms are severe or indigestion persists for over four weeks, it's crucial to consult a specialist for proper evaluation and diagnosis.
Q. How is esophagitis treated?
Treatment primarily involves lifestyle modifications and medication. Esophagitis is closely linked to daily habits. We advise against:
Overeating
Late-night meals
Lying down immediately after eating
A high-fat diet
Excessive caffeine intake
Alcohol consumption and smoking
Wearing tight-fitting clothing
Weight management is also essential for individuals with abdominal obesity.
Medication is usually the first line of treatment, and most patients respond well. Proton pump inhibitors (PPIs), which reduce stomach acid production, are commonly prescribed. While effective, medication alone is often insufficient for long-term relief. Lifestyle changes and dietary adjustments are crucial to prevent recurrence after treatment.
Q. Are there foods that are good or bad for esophagitis?
For overweight individuals, weight control is paramount. While adequate protein intake is beneficial, it's best to limit high-fat foods. Regardless of the type of food, avoid overeating and late-night snacking. Particular attention should be paid to carbonated drinks, coffee, acidic juices, chocolate, greasy foods, alcohol, and tobacco.
While some foods like cabbage and seaweed are often cited for their potential to protect the stomach and esophageal lining, focusing on avoiding trigger foods is more critical. Identifying individual food sensitivities and keeping a food diary can be helpful in managing symptoms. Some commonly reported trigger foods include spicy foods, citrus fruits, tomatoes and tomato-based products, peppermint, and garlic.
Q. Why is lying down immediately after eating so harmful?
When we are standing or sitting, the esophagus is positioned above the stomach. While reflux can occur with overeating or increased abdominal pressure, it's less frequent. However, when lying down, the esophagus and stomach are at a similar level. If the sphincter between the esophagus and stomach is slightly relaxed and food remains in the stomach, it's easier for stomach contents to flow back into the esophagus. This increased exposure to stomach acid can readily damage the esophageal lining. Elevating the head of the bed can help mitigate this issue by using gravity to keep stomach acid down.
Q. Can esophagitis lead to complications if left untreated?
While most cases of esophagitis improve with lifestyle changes and medication, neglecting it for an extended period can lead to esophageal ulcers. Repeated healing and inflammation of these ulcers can cause esophageal strictures, making eating difficult. Furthermore, the esophageal tissue can undergo histological changes, leading to a condition called Barrett's esophagus. This is a precancerous condition that significantly increases the risk of esophageal adenocarcinoma, a type of esophageal cancer. Therefore, timely and appropriate management is crucial. Chronic inflammation from untreated esophagitis can also contribute to chronic pain and discomfort, impacting the overall quality of life. In rare cases, severe esophagitis can lead to esophageal perforation (a tear in the esophageal wall), a life-threatening condition requiring immediate medical attention.
Q. What are some ways to prevent recurrence after esophagitis treatment?
As mentioned earlier, lifestyle modifications are key to preventing recurrence. Managing weight and avoiding lying down immediately after meals are crucial. It's also important to avoid late-night meals, overeating, alcohol, and smoking. Elevating the upper body during sleep and lying on the left side can also be helpful. The stomach is positioned slightly to the left of the body's midline. Lying on the left side naturally places the stomach below the esophagus, making reflux less likely. While sleeping posture can change throughout the night, using functional pillows or bedding that helps maintain an elevated upper body position can be beneficial for those experiencing persistent discomfort. Regular follow-up with a healthcare professional is also important to monitor for any signs of recurrence and adjust management strategies as needed.
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