Reflux oesophagitis (Heart burn)

Etio-pathology


Movement of gastric contents in the oesophagus is called gastro-oesophageal reflux. It is common after meals and increases with belching. The inflammatory oesophageal epithelial changes due to reflux is called as Reflux oesophagitis. 


Factors promoting reflux include unconsciousness, hyperemesis, mental retardation, pregnancy,anesthesia, progressive systemic sclerosis and delayed gastric emptying. Hiatus hernia may also be one of the underlying abnormalities. Direct tissue injury may be caused by the presence of acid, pepsin, bile acids and pancreatic enzymes in the refluxate. Abnormally delayed oesophageal clearance will aggravate the injury still further.


Clinical features 


Heart burn(pyrosis) is the commonest symptom. Water brash, regurgitation, dysphagia, increased salivation may also occur. The symptoms may not correlate with the severity of oesophagitis. Transient remissions and relapses are common. Common complication may be chronic peptic stricture in distal oesophagus. Rarel, bleeding may occur from acute oesophagitis. Other effects of reflux disease may be gastro pulmonary reflux, chest pain, cardiac symptoms etc.,