Esophagus reflux esophagitis

M. Menges, M. Muller and M. Zeitz, Increased acid and bile reflux in Barrett s esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy. Am. J. Gastroenterol., 2001, 96(2), 331. 

Shaheen, N. and Ransohoff, D.F., Gastroesophageal reflux, Barrett esophagus, and esophageal cancer scientific review, JAMd, 287,1972-1981,2002. 

Esophageal reflux (esophagitis)— This type of irritation, also known as esophagitis, results from regurgitation of stomach acid into the esophagus. 

O GERD can be divided into three distinct categories erosive esophagitis, non-erosive reflux disease, and Barrett s esophagus. 

The lower esophageal sphincter is a manometrically-defined zone of the distal esophagus with an elevated basal resting pressure. The sphincter is normally in a tonic, contracted state, preventing the reflux of gastric material from the stomach. It relaxes on swallowing to permit the free passage of food into the stomach. 

Many patients with GERD produce normal amounts of acid, but the acid produced spends too much time in contact with the esophageal mucosa. The contact time is dependent on the rate at which the esophagus clears the noxious material, as well as the frequency of reflux. The esophagus is cleared by primary peristalsis in response to swallowing, or by secondary... 

The PPIs are superior to H2RAs in patients with moderate to severe GERD. This includes not only patients with erosive esophagitis or complicated symptoms (Barrett s esophagus or strictures), but also those with non-erosive reflux disease who have moderate to severe symptoms. Symptomatic relief is seen in approximately 83% of patients and healing rates at 8 weeks as judged by endoscopy are 78%.1... 

Most infants have physiologic reflux with no clinical consequence.26 Complications, although rare, include distal esophagitis, failure to thrive, esophageal strictures, and Barrett s esophagus.27... 

Peppermint oil is widely advocated it acts as an antispas-modic agent due to its ability to relax gastrointestinal smooth muscle. However, it also relaxes the lower esophageal sphincter, which could allow reflux of gastric contents into the esophagus. The usual dose is 1 to 2 enteric-coated capsules containing 0.2 mL of peppermint oil two to three times daily. 

Esophageal stricture Narrowing of the esophageal lumen. Esophageal strictures are usually benign and caused by acid refluxing into the lower esophagus. 

Stipa F., Stein H.J., Feussner H., Kraemer S., Siewert J.R., Assessment of non-acid esophageal reflux comparison between long-term reflux aspiration test and fibeoptic bilirubin monitoring, Dis. Esophagus 1997 10 1. 

Esophagus (Big Blue FI lad transgenic rats) Increased duodeno-gastric-esophageal reflux Significant increase in lad mutations 43... 

Proton pump inhibitors are the most effective agents for the treatment of nonerosive and erosive reflux disease, esophageal complications of reflux disease (peptic stricture or Barrett s esophagus), and extraesophageal manifestations of reflux disease. Once-daily dosing provides effective symptom relief and tissue healing in 85-90% of patients up to 15% of patients require twice-daily dosing. 

---