Reflux Esophagitis

Esophageal reflux is considered the most common disease encountered by gastroenterologists and general practitioners. It contributes to a large proportion of cases treated by general practitioners (primary care physicians). In Western countries, the prevalence of the disease is approximately 10% to 20%, and severe disease is observed in 6% of the population; in Asian countries, the prevalence is approximately 5%. Esophageal reflux disease is defined as a condition in which the stomach contents reflux into the esophagus or beyond (oral cavity, larynx, or the lungs), causing troublesome symptoms and or complications. Risk factors contributing to the development of esophageal reflux include age over 50, body mass index above 30, smoking, anxiety, depression, and decreased physical activity. Medicines that modulate the lower esophageal sphincter pressure, including nitrates, calcium blocker agents, anticholinergics, play a role. Recently, non-alcoholic fatty liver disease has been reported to increase the risk of developing reflux esophagitis. The disease is primarily a disorder of the lower esophageal sphincter and can be classified on the presence of symptoms without erosions on endoscopic examination (non-erosive disease, NERD) or symptoms plus esophageal erosions (erosive reflux disease, ERD). While the disease is particularly more common in men, when it occurs in women, it is more likely to be NERD. The diagnosis is usually established based on a combination of presenting symptoms, objective testing with endoscopy, ambulatory reflux monitoring, and response to a proton pump inhibitor (PPI) therapy. Based on the clinical picture, particularly when patients are presenting with typical symptoms, investigations are not needed in these patients. Investigations are usually recommended in patients presenting with atypical symptoms and patients developing complications. Esophageal reflux may result in several complications, including esophagitis, upper gastrointestinal bleeding, anemia, peptic ulcer, peptic stricture, dysphagia, cancer of gastric cardia, and Barrett esophagus. The reflux may also result in extra-gastrointestinal complications, including dental erosions, laryngitis, cough, asthma, sinusitis, and idiopathic pulmonary fibrosis. Reflux esophagitis frequently occurs during pregnancy at any trimester. Usually, these patients do not have heartburn before pregnancy, and in these patients, reflux and heartburn usually resolve after the delivery. The management goals are (i) reduction of weight in patients with obesity and changes in dietary habits to decrease the effects of reflux, (ii) treatment of reflux with PPI, (iii) exploring alternative management plans for patients not responding to PPI, and (iv) management of esophageal reflux complications.