There are various types of esophagitis, and they are organized categorically by the underlying conditions that cause it. Esophagitis can be drug induced, caused by an allergic reaction, or even result from an infection. The topic of today’s blog, however, is reflux esophagitis. There is a structure called the lower esophageal sphincter (LES) that acts as a valve, keeping stomach contents out of the esophagus. Normally, this structure is relaxed only during swallowing. If the LES opens spontaneously, or if the LES cannot close properly, the acidic contents of the stomach find their way back into the esophagus, causing heartburn and “acid reflux” (also known as gastroesophageal reflux). When the acidic contents of the stomach do this repeatedly, inflammation can occur. If this backflow of stomach acid becomes a recurring problem, one may develop a condition known as GERD (gastroesophageal reflux disease). Complications of this disease include tissue damage due to chronic inflammation in the esophagus.

Those who suffer from reflux esophagitis report experiencing a sour taste in the mouth and a burning pain in the upper abdomen and mid-chest. Other signs and symptoms may include:

• Difficulty or painful swallowing
• Nausea and/or vomiting
• Food becoming lodged in the esophagus (also known as food impaction)
• Decreased appetite

If symptoms last for more than a few days without improvement, or if pain in the chest lasts more than a few minutes, immediate medical attention may need to be sought. You may also want to consider informing your doctor if your symptoms are severe enough to inhibit eating, or if your symptoms are accompanied by other, less easily explained symptoms (e.g., flu-like symptoms or shortness of breath).

There are certain risk factors that can make one more susceptible to developing reflux esophagitis and/or GERD. These factors include obesity, pregnancy, hiatal hernia, and smoking tobacco. Other risk factors include eating too quickly, eating fatty foods, eating acidic foods, and alcohol consumption. If left untreated, esophagitis can lead to structural changes of the esophagus. These structural changes, in turn, can lead to alterations in cell structure and/or function—a major risk factor for the development of esophageal cancer.

Self Help

For those who experience recurring bouts of acid reflux and heartburn, most can find relief by making a few simple lifestyle changes. Some of these changes include:

• Pace yourself while eating
• Elevate your head while sleeping
• Avoid foods that are especially acidic and/or high in fat content
• Stop smoking
• Reduce your alcohol consumption
• Lose weight
• Avoid clothes that are too tight, as they can sometimes inhibit proper circulation
• Avoid late night snacking

Some other ingestible food and drink to consider avoiding are chocolate, citrus juices, and coffee, as all of these are particularly high in acid content.

Western Treatments

Most people who suffer from reflux esophagitis can manage their symptoms on their own. However, when the symptoms persist, medical attention may need to be sought. Your doctor can determine whether you have reflux esophagitis by both gauging your symptoms and performing X-rays and/or an endoscopy. Traditional Western treatment for reflux esophagitis may include prescribing acid-blocking drugs such as proton pump inhibitors. Alternately, your doctor may recommend a surgical procedure called fundoplication. This procedure is only intended for the most severe cases or cases that are caused by a hiatal hernia, and the purpose of the surgery is to help strengthen the LES. As always, there are a slew of potential side effects and complications involved with both of these treatments.

A Case Study in TCM Diagnosis

A 42-year-old woman was suffering from chronic abdominal bloating, heartburn, and excessive belching. She was approximately 100 pounds overweight, admitting to indulging in regular episodes of binge eating. For her, food was used to help her cope with the stresses of everyday life—even going so far as to admit that she would eat the way “an alcoholic drinks.” Traditional Chinese diagnosis found that her pulse was sinking and wiry, and that her tongue was red with a yellow coating. It was explained that any herbal remedy on its own, without the accompanying changes in diet and exercise, would have minimal effect. Once the patient was fully briefed, she was prescribed an herbal mixture containing poria sclerotium, coix seed, barley shen qu, magnolia bark, angelica root, and some other choice herbs. It was also recommended that she include more fruits, vegetables, and whole grains into her diet. Radical dieting was discouraged, as these crash diets can make one feel deprived and therefore more likely to binge. Herbal teas were recommended in place of soda and other carbonated beverages.

After two weeks the patient reported experiencing less heartburn less often, but the bloating and belching were still present. An additional herbal formula containing curcuma tuber, corydalis rhizome, taraxacum herb, and melia fruit was prescribed in order to address food stagnation. While the patient struggled with adhering to her new diet and exercise plan, she did report some improvement. She was reminded that for best results, she was encouraged to stick to her recommended dietary and lifestyle changes.