Refluxesofagitis

Refluxesofagitis is inflammation of the esophageal mucosa caused by exposure to stomach contents, most often in gastroesophageal reflux disease (GERD). It is commonly referred to as reflux esophagitis. Chronic reflux irritates the squamous lining of the esophagus and can lead to erosions; long-standing disease may be associated with metaplastic changes such as Barrett's esophagus.

Risk factors include obesity, hiatal hernia, pregnancy, smoking, and medications or foods that lower lower esophageal sphincter tone. Diagnosis is usually made from the combination of clinical features and endoscopic findings. Endoscopy can assess mucosal injury, which is graded by the Los Angeles (LA) classification, ranging from minimal breaks to extensive erosions. Biopsies may be taken to evaluate for complications, such as Barrett's esophagus or eosinophilic esophagitis. When symptoms are typical but mucosal breaks are not seen, or when surgery is considered, pH monitoring or impedance testing and esophageal manometry may be used.

Treatment emphasizes lifestyle measures and acid suppression. Lifestyle changes include weight loss, elevating the head of the bed, avoiding late meals and trigger foods, and smoking cessation. Pharmacologic therapy usually starts with proton pump inhibitors (PPIs) such as omeprazole or esomeprazole for about eight weeks; many patients heal, while some require higher PPI doses or addition of H2 receptor antagonists for partial response. If symptoms persist despite optimized medical therapy, surgical or endoscopic anti-reflux procedures may be considered.

Complications can include esophageal ulcers, strictures, and Barrett's esophagus, which carries a risk of esophageal adenocarcinoma. Most patients respond to treatment, but symptoms and disease activity may recur, necessitating ongoing management and follow-up.