Author/Professor Gao Qilong, Deputy Director of the Department of Integrated Traditional Chinese and Western Medicine, Henan Provincial Cancer Hospital
| Chronic esophagitis, or reflux esophagitis, is an inflammatory lesion caused by the reflux of gastric or duodenal contents into the esophagus, typical of which are acid reflux, heartburn, chest pain. The study found that in areas with a high incidence of esophageal cancer, the incidence of chronic esophagitis is particularly high, and the incidence of esophagitis is 10 years earlier than that of esophageal cancer. At the same time, most cases of esophageal cancer are often accompanied by esophagitis, so it is believed that esophagitis is related to esophageal cancer and is a precancerous disease of esophageal cancer. |
What is reflux esophagitis?
Reflux esophagitis refers to the regurgitation of gastric contents into the esophagus, staying in the esophagus for a long time, the gastric contents contain stomach acid, pepsin, bile acid and other attack factors, causing self-digestion and damage to the esophageal mucosa, and symptoms such as acid reflux, heartburn, and retrosternal pain occur, often occurring 1 to 2 hours after meals.
Heartburn refers to the burning sensation radiating from the back of the sternum to the neck, and reflux refers to the regurgitation of gastric contents to the pharynx or mouth. Reflux symptoms mostly occur after a full meal, and when the reflux is severe at night, it affects the patient's sleep. Heartburn and nausea are often associated with posture, which can be exacerbated by postures such as bending over, coughing, straining to defecate, lying flat, or lying on your side. In addition, chest pain may occur. The site of pain is behind the sternum, under the saberoid process, or in the upper abdomen, often radiating to the chest, back, shoulders, neck, jaw, ears, and arms.
In addition, reflux esophagitis can also cause esophageal spasm or esophageal scar narrowing, ulceration, causing difficulty swallowing, and even painful swallowing, and in severe cases, chronic esophageal bleeding.
In addition to typical symptoms, patients with reflux esophagitis may present with cough, sputum production, and some patients may even develop asthma symptoms. However, it is different from cough caused by colds and lung diseases. The cough caused by reflux esophagitis is mainly choking cough, similar to drinking water choking cough, because food in the stomach or chycodylosis regurgitates to the throat, irritates the respiratory tract, causes a severe irritating cough, and long-term reflux can lead to the occurrence of chronic pharyngitis.
Why does reflux esophagitis cause?
Reflux esophagitis, looking for the root cause, only blame the "floodgates" can not be closed.
There is a "one-way gate" at the junction of the esophagus and the stomach – the subesophageal sphincter. When the "gate" is open, food is allowed to enter the stomach from the esophagus; when the "gate" is closed, it can prevent the contents of the stomach and duodenum from flowing into the esophagus. Once various factors make the "gate" not tightly closed, the stomach and duodenal contents flow into the esophagus in reverse, which will cause inflammation and erosion of the esophageal mucosa and develop reflux esophagitis.
Hypothetical sphincter pressure and increased intra-abdominal pressure do not cause a sphincter contraction response, causing pathological reflux. Certain hormones (such as cholecystectin, glucagon, etc.), food (high fat, strong tea, coffee, chocolate), drugs (cholinergic and β-adrenergic agonists, α-adrenergic antagonists, dopamine, diazepam, calcium receptor antagonists, etc.) can affect the function of the subesophageal sphincter.
In addition, being in bad moods such as mental tension, anxiety, and depression for a long time; obesity, pregnancy, weight-bearing labor, etc. can increase intra-abdominal pressure, which can easily lead to regurgitation of gastric contents and cause reflux esophagitis.
Can reflux esophagitis become cancerous?
Reflux esophagitis is generally not cancerous, but does not rule out the possibility of cancer.
Reflux esophagitis, although a benign esophageal disease, generally does not develop into a malignant tumor. However, reflux esophagitis, if not treated actively for a long time, is likely to become cancerous. Long-term chronic gastroesophageal reflux replaces the squamous epithelium of the lower part of the esophagus with metaplasia of the columnar epithelium, forming a peptic ulcer that forms Barrett's esophagus. Barrett's esophagus is primarily the most precancerous lesion of esophageal cancer. Therefore, reflux esophagitis can cause cancerous if it causes Barrett's esophagus.
Drug treatment of reflux esophagitis
1. Acid suppressants: drug treatment of reflux esophagitis, mainly using acid suppressants. Commonly used are proton pump inhibitors (various "pazoles"), histamine H2 receptor antagonists (various "tidins"), and novel potassium-ion competitive acid blockers (P-CAB). It can inhibit gastric acid production, alleviate symptoms, and promote the recovery of damage to the mucosa of the esophagus.
2. Drugs to promote gastrointestinal motility: These drugs are mainly by increasing the pressure of the esophageal sphincter, improving the peristalsis function of the esophagus, promoting gastric emptying, reducing food in the stomach, and reducing esophageal pressure. Such as domperidone, moszapride, itopride.
3. Drugs to protect the gastric mucosa: gastric mucosal protectors such as sucralfate, bismuth potassium citrate, etc., can quickly attach to the surface of the gastric mucosa after oral administration, forming a protective film, so that the local area is no longer infringed, playing an isolation role.
Life prevention of reflux esophagitis
1. Quit smoking and abstain from alcohol: tobacco contains nicotine, which will reduce the pressure of the lower sphincter of the esophagus, so that it is in a relaxed state and aggravate reflux; ethanol is the main component of alcohol, which will not only stimulate gastric acid secretion, but also relax the lower sphincter.
2. Weight loss: excessive obesity will increase intra-abdominal pressure and promote gastric fluid reflux.
3. Small number of meals: a small number of meals, low-fat diet can reduce the frequency of reflux symptoms after eating. A high-fat diet promotes the release of gallbladder tokinin from the mucosa of the small intestine, which can easily lead to regurgitation of gastrointestinal contents.
4. Avoid night food: reflux esophagitis is prone to occur at night, so do not eat 3 hours before going to bed, and do not over-eat.
5. Raise the head of the bed: the flat lying position is easy to induce acid reflux, raise the head of the bed, or raise the pillow to raise the head and neck by about 10 cm, which can alleviate the symptoms.
6. Avoid irritating diets: Avoid eating chocolate, coffee, spicy and other irritating diets and high-fat foods.