What Is the Difference Between Acid Reflux and Indigestion?

Reflux esophagitis (RE) is an esophageal inflammatory lesion caused by the influx of the contents of the stomach and duodenum into the esophagus. Endoscopic manifestations of esophageal mucosa damage, namely esophageal erosion and / or esophageal ulcer. Reflux esophagitis can occur at any age, and the incidence of adults increases with age. Incidence rates are high in Western countries and low in Asia. This regional difference may be related to genetic and environmental factors. But in the past two decades, the global incidence has been increasing. Middle-aged and elderly people, obesity, smoking, alcohol consumption, and high mental stress are the high incidence groups of reflux esophagitis.

Basic Information

nickname

Gastroesophageal reflux disease

English name

reflux esophagitis, RE

Visiting department

Gastroenterology

Multiple groups

Middle-aged and elderly people, as well as those who are obese, smoke, drink, and are stressed

Common causes

Related to the destruction of the anti-reflux barrier, dysfunction of esophageal acid clearance, etc.

Common symptoms

Burning sensation (heartburn), reflux and chest pain

Causes of reflux esophagitis

1. Anti-reflux barrier damage

The lower esophageal sphincter (LES) is a high-pressure region in the range of 3 to 5 cm above the esophagus-gastric junction. The resting pressure here is 15-30mmHg, which constitutes a pressure barrier and plays a physiological role in preventing gastric contents from flowing back into the esophagus. Increased intra-abdominal pressure in normal people can cause LES contractile reflexes through the vagus nerve, doubling LES pressure to prevent GER. LES can cause GER if the LES pressure is too low and the intra-abdominal pressure does not cause a strong LES contractile response. Cholinergic and beta-adrenergic agonists, alpha-adrenergic antagonists, dopamine, diazepam, calcium receptor antagonists, morphine and fat, alcohol, caffeine, and smoking can affect a variety of food factors LES function, induces GER. In addition, during pregnancy, oral progesterone-containing contraceptives, and late menstrual cycles, plasma progesterone levels increased, and the incidence of GER increased accordingly.

2. Disorders of esophageal acid clearance function

Normal esophageal acid clearance includes esophageal emptying and saliva neutralization. When the acidic gastric contents are refluxed, it takes only 1 to 2 times (10 to 15 seconds) for the secondary esophagus to evacuate almost all of the reflux. A small amount of acid remaining in the esophageal mucosa pit can be neutralized by saliva (normal people have 1000-1500ml per hour, saliva with a pH of 6-8 enters the stomach through the esophagus). The function of esophageal acid clearing is to reduce the time period of esophageal mucosa immersion in gastric acid, so it has the effect of preventing reflux esophagitis. Saliva secretion almost stopped during nighttime sleep, secondary esophageal peristalsis was rare, and esophageal acid clearance was significantly delayed at night, so the harm of GER at night was more serious.

3. Impairment of anti-reflux barrier function of esophageal mucosa

When the defense barrier is damaged, esophagitis can be caused even under normal reflux conditions. Studies have found that esophageal epithelial cell proliferation and weakened repair capacity is one of the important causes of reflux esophagitis.

4. Gastroduodenal Dysfunction

(1) Abnormal gastric emptying.

(2) Gastroduodenal reflux When the pyloric sphincter tone and LES pressure are low at the same time, hydrochloric acid and pepsin in gastric juice, bile acid, pancreatic juice, and hemolyzed lecithin in the duodenal fluid can all flow back simultaneously. The esophagus erodes the keratinized layer of esophageal epithelial cells and makes them thin or shed. H + and pepsin in the reflux flow through the new squamous epithelial cell layer and penetrate into the esophageal tissue, causing esophagitis.

5. hiatal hernia

Common is a sliding hernia. The esophagogastric junction moves up with the stomach and into the thorax. The rise of the stomach separates the lame feet and the fissures become enlarged. When the hernia sac is small, it slides up and down with position, exertion, and cough. After the hernia sac enlarges, it no longer slides, changing the normal anatomical relationship near the hiatus and causing incomplete closure of the esophagogastric junction. A hernia in the stomach disappears the His angle of the esophagus into the stomach, the esophagus membrane is stretched, thinned, and the abdominal esophagus moves upward, further worsening the closure function of the joint. Reflux esophagitis occurs in more than half of patients with hiatal hernias.

6. Pregnancy vomiting

A hiatal hernia due to increased intra-abdominal pressure during pregnancy can cause reflux esophagitis, but it can be recovered after delivery without any treatment. Vomiting and prolonged hiccups can also make the cardia often open and cause reflux esophagitis, which can return to normal after removing the cause.

7. Other diseases

During the development of newborns and infants, reflux occurs due to poor esophageal sphincter function. Most of them can be relieved as the child develops. Primary inferior esophageal sphincter dysfunction causes insufficiency, and organic diseases such as tumors in the lower esophagus and cardia, scleroderma, and various pyloric obstructions can cause reflux esophagitis.

Therefore, reflux esophagitis is usually the result of reflux bile and gastric acid acting on the esophageal mucosa. Before bile causes esophageal damage, there must be pyloric and LES dysfunction; reflux esophagitis is often accompanied by gastritis . Sliding esophageal hiatal hernia is often complicated by LES and pyloric dysfunction; duodenal ulcers are often accompanied by high gastric acid secretion, which can easily cause gastric antrum spasm and pyloric dysfunction, so this disease is also complicated. Factors such as obesity, a large amount of peritoneal effusion, late pregnancy, increased intragastric pressure, and alcohol and tobacco drugs can induce the disease.

Clinical manifestations of reflux esophagitis

1. There is no correlation between the severity of esophagitis and reflux symptoms. Reflux esophagitis patients have the typical symptoms of gastroesophageal reflux, but they can also be free of any symptoms of reflux and only show symptoms of indigestion such as upper abdominal pain and discomfort. The clinical manifestations of patients with severe esophagitis are not necessarily severe.

2. Typical symptoms are post-sternal burning (heartburn), reflux, and chest pain. Heartburn refers to the burning sensation radiated from the back of the sternum to the neck, and reflux refers to the reflux of gastric contents to the pharynx or mouth. Symptoms of reflux often occur after a full meal and affect patients' sleep when the nighttime reflux is severe.

3. Esophageal scar formation becomes narrow in the late stage of the disease, and the burning sensation and burning pain gradually decrease, but permanent dysphagia occurs, which can cause blockage or pain when eating solid food.

4. Severe esophagitis may cause bleeding from esophageal mucosa erosion, mostly chronic small amount of bleeding. Long-term or heavy bleeding can cause iron deficiency anemia.

Reflux esophagitis

1. X-ray examination of upper barium meal

Note the presence of gastro-esophageal reflux, hiatal hernia, or esophageal stricture, and understand the condition of the stomach and duodenum.

2. Endoscopy and biopsy

Endoscopy is the gold standard for the diagnosis of reflux esophagitis. Endoscopy can confirm reflux esophagitis and assess its severity and grade. At the same time, organic diseases of the upper digestive tract such as esophageal cancer and gastric cancer can be excluded.

3. Nuclide gastroesophageal reflux examination

Use the isotope-labeled liquid to observe the supine position and abdominal pressure, and observe whether there is excessive gastroesophageal reflux.

4. Esophageal drip acid test

The patient took a sitting position, inserted the nasogastric tube and fixed it at a distance of 30 to 35 cm from the incisors, and then infused 5 to 10 ml of saline for 15 minutes. After the pain or burning sensation was positive.

5. ECG

An electrocardiogram should be performed during the onset of pain to distinguish it from angina.

Reflux esophagitis diagnosis

Diagnosis can be made based on the above symptoms, signs, and laboratory tests.

Differential diagnosis of reflux esophagitis

Reflux esophagitis is often confused with:

Esophageal cancer

Esophageal microscopy and X-ray barium swallowing can be used for identification.

2. Peptic ulcer

Chronic, rhythmic, seasonal and periodic attacks, X-ray barium meal and gastroscopy can show ulcers in the stomach or duodenum

3. Angina Pectoris

Post-sternal pain and angina pectoris of esophagitis can exist separately and sometimes at the same time, and both can be alleviated with nitroglycerin, which is difficult to distinguish.

4. Hysteria

It means that the patient complained of a foreign body sensation in the throat, unable to start swallowing, a feeling of blockage, and no organic lesions were found in clinical examination. It is thought that the upper reflux of the stomach caused the stimulation of the upper esophagus. Misdiagnosis is sometimes the only symptom of a few patients.

Complications of reflux esophagitis

In addition to esophageal strictures, bleeding, ulcers and other complications, the reflux of gastric juice can invade the pharynx, vocal cords and trachea and cause chronic pharyngitis, chronic vocal cord inflammation and bronchitis. It is clinically called Delahunty syndrome. Gastric reflux and aspiration into the respiratory tract can still cause aspiration pneumonia. Recent studies have shown that GER is associated with some recurrent asthma, cough, nocturnal apnea, and angina-like chest pain.

Reflux esophagitis treatment

Medical treatment

The purpose of medical treatment is to reduce reflux and reduce the irritation and corrosion of gastric secretions. Sliding hernias without complaints generally do not require treatment. Patients with mild reflux esophageal inflammation or medical treatment due to age, other diseases, and unwillingness to surgery. For obese patients, weight loss can reduce intra-abdominal pressure and reflux. Avoid heavy movements, bending over, etc. Do not wear tights. Raise the head of the bed 15cm during sleep, do not eat 6 hours before bedtime, avoid alcohol and tobacco, can reduce the incidence of esophageal reflux.

In terms of drug treatment, antacids can be used to neutralize gastric acid and reduce the activity of pepsin. For prolonged gastric emptying, gastric motility drugs such as domperidone (morpholine), itopride, etc. can be used. H ₂ receptor antagonists or proton pump inhibitors can reduce gastric acid and protease secretion. The combination of acid-suppressing drugs and prokinetic drugs can improve the efficacy of some patients.

2. Promote emptying of the esophagus and stomach

(1) Dopamine antagonists These drugs can promote emptying of the esophagus and stomach and increase the tension of LES. Such medications include metoclopramide (Metoprolol) and domperidone (Mordomline), taken before bedtime and before meals. If the former is overdosed or taken for a long time, it can cause extrapyramidal neurological symptoms, so it should be used with caution in elderly patients; the latter can cause hyperprolactinemia with long-term administration, which can cause adverse reactions such as breast hyperplasia, lactation and amenorrhea.

(2) Cisapride Through the intestinal plexus nerve can release acetylcholine to promote peristalsis and emptying of the esophagus and stomach, thereby reducing gastroesophageal reflux.

(3) Uranylcholine, a pseudocholinergic drug, can increase the tension of LES, promote esophageal contraction, and accelerate the emptying of acidic food in the esophagus to improve symptoms. This mouth can stimulate gastric acid secretion, so take it cautiously for a long time.

3. Reduce stomach acid

(1) Antacid can neutralize gastric acid, thereby reducing the activity of pepsin and reducing the damage of acidic gastric contents to the esophageal mucosa. Alkaline drugs also have the effect of increasing LES tension. Aluminum hydroxide gel and magnesium oxide. Alginic acid foam contains alginic acid, sodium alginate and antacids, which can float on the surface of gastric contents and prevent reflux of gastric contents.

(2) Histamine H2 receptor antagonists Cimetidine, furazidine, and famotidine can be used. This class of drugs can strongly inhibit gastric acid secretion and improve acid reflux in the gastroesophagus. If the above symptoms cannot be improved, the dose can be increased to 2 to 3 times.

(3) Proton pump inhibitors These drugs can block the H + -K + -ATPase of parietal cells, such as omeprazole and lansoprazole have been widely used in clinical practice.

3. Combined use

Promoting the combination of esophagus, gastric emptying drugs and antacids has a synergistic effect and can promote the healing of esophagitis. Dopamine antagonists or cisapride may also be used in combination with histamine H2 receptor antagonists or proton pump inhibitors.

4. Surgical treatment

The purpose of surgical treatment is to repair hernia holes and anti-reflux to correct esophageal stenosis.

5. Chinese medicine treatment

(1) Body Acupuncture The main acupuncture point is Neiguan, Zusanli.

(2) Ear acupuncture Take the Shenmen, stomach, esophagus, and stimulate the needle moderately.

Reflux esophagitis prevention

1. Avoid alcohol and quit smoking: Because tobacco contains nicotine, it can reduce the pressure of the lower esophageal sphincter, make it relax and increase reflux; the main component of alcohol is ethanol, which can not only stimulate gastric acid secretion, but also relax the lower esophageal sphincter Is one of the causes of gastroesophageal reflux.

2. Pay attention to a small number of frequent meals and eat a low-fat diet, which can reduce the frequency of reflux symptoms after eating. In contrast, a high-fat diet can promote the release of cholecystokinin from the mucosa of the small intestine, which can easily cause gastrointestinal reflux.

3. Don't overeat at dinner, avoid lying flat after meals.

4. Obese people should lose weight. Increased abdominal pressure in obese people can promote gastric reflux, especially in the supine position, and should actively reduce weight to improve reflux symptoms.

5. Maintain a comfortable mood and increase appropriate physical exercise.

6. When going to bed, the bed head as a whole should be raised by 10 to 15 cm, which is an effective way to reduce nighttime reflux.

7. Minimize activities that increase intra-abdominal pressure, such as excessive bending, wearing tights, and tightening belts.

8. Drugs should be used under the guidance of a doctor to avoid side effects of taking the drug indiscriminately.