What Is Reflux Esophagitis?

Have you ever exercised directly after eating or gone for a lie down straight after a big meal? If you have, you might have quickly experienced a burning sensation in your chest or throat, or even had a few acidic burps. That’s because some of the contents of your stomach — food, digestive enzymes, and acid — have come back up into your esophagus. When this happens, even if it’s not that much or that far, the lining of the esophagus (the mucosa) can be damaged. The process of coming back up is called reflux and if it happens too often, you can develop a condition called reflux esophagitis.

Is Reflux the Same as Vomiting?

Reflux is more like a leak — the physiological mechanisms that should keep the stomach open to “downwards” traffic and closed to “upwards” traffic have failed in some way and something has come back up. Your body can usually clear the esophagus again by peristalsis (the muscle movements that push food through the digestive system) and, provided it’s not a case of reflux esophagitis, can neutralize the acidity by causing you to swallow alkaline saliva.

Vomiting occurs when a whole set of muscles, including the diaphragm, intercostal, and abdominal muscles, contract simultaneously one or more times, squeezing the stomach and forcing its contents up and out of the body. The body will not attempt to use peristalsis to stop vomiting or clear things “downwards” again.

Does Reflux Happen in Babies?

We all know that most infants can spit up small amounts of milk or food after a feed — the image of a parent with a towel on their shoulder, infant in their arms, “burping” the baby is very familiar! This is actually reflux. It occurs in babies because their esophagus is not fully developed, and it is generally not dangerous.

Current medical advice is to contact a healthcare provider if reflux starts after 6 months or starts earlier but persists to 1 year. A consultation is also recommended if your baby is spitting up large amounts of food, frequently spitting up food, refusing to eat, coughing or gagging while feeding, crying while feeding, getting frequent ear infections, or not gaining weight.

How Common Is Reflux Esophagitis and What Are the Symptoms?

Reflux esophagitis is a very common condition. In fact, it’s so common and often presents with such typical symptoms that primary care providers can usually diagnose it without an endoscopy, barium X-ray, tissue sampling, or other investigations —unless, of course, there are atypical symptoms (see below).

The typical symptom is heartburn: That’s the burning feeling that starts behind the sternum but spreads as high as in the back of the throat. A sense of having a lump in one’s throat, acid in the throat, increased salivation, and dysphagia (difficulty swallowing) are also symptoms that a doctor or nurse would count as typical.

In more unusual cases, symptoms like chronic chest pain, chronic throat ache, asthma, tooth damage, or spasms in the esophagus may occur — and are more likely to prompt an investigation, since they are also symptoms of other conditions.

How Serious Is Reflux Esophagitis?

If you regularly experience any of the typical symptoms, you should talk to a healthcare provider. While reflux isn’t dangerous short-term, a damaged esophagus and difficulty swallowing are only two of the risks of unmanaged reflux. Ulcers with associated bleeding, increased cancer risk, and even breathing problems can occur, among other things.

Current medical advice is to seek an appointment with a healthcare provider if the symptoms last more than a few days, can’t be relieved by a short period of using over-the-counter antacids, make eating uncomfortable, or are accompanied by unexpected weight loss. Emergency care is essential if the pain in your chest lasts more than a few minutes, you have a history of heart disease, or have shortness of breath or chest pain directly after eating. You should also seek emergency care if you vomit large amounts or frequently or have pain in your mouth or throat while eating.

What Is the Study about?

The study described in the paper “Saliva Secretion Is Significantly Lower in Female Patients with Mild Reflux Esophagitis than in Female Healthy Controls” is interesting because it discusses salivation. As mentioned above, secreting and swallowing saliva, which is alkaline, can help with neutralizing the acid that has leaked into the esophagus during reflux. Therefore, it’s important to investigate the patterns of saliva secretion in patients with reflux issues. This study focuses on the differences between male and female patients and healthy subjects.

Why Study the Differences between Male and Female Patients?

Reflux esophagitis is more common in male subjects. Female subjects are more prone to having symptoms without erosion of the esophageal mucosa. Note that these differences do not automatically mean that there’s a physiological difference between male and female bodies — socioeconomic and behavioral factors also play a part in the progression of reflux esophagitis and the likelihood of seeking treatment.

Differences have been shown that the level of saliva secretion is lower in healthy female subjects than in healthy male subjects. This was in an experiment where saliva secretion was stimulated with chewing gum. Such a difference could be significant in examining differences in the progression of reflux esophagitis in male and female patients. Therefore, in this study, the authors looked at stimulated saliva secretion in 25 male patients with mild reflux esophagitis, 25 female patients, 25 healthy male subjects, and 25 healthy female subjects.

What Did the Researchers Find?

They found that the level of stimulated saliva secretion was significantly lower in female patients than in healthy female controls. Such a difference was not found between male patients and male healthy controls. The subject requires further study before anything definitive can be said. It might explain — or at least be part of the explanation — why there is a difference in the presentation and progression of reflux esophagitis in male and female patients.

At present, this information isn’t useful for a patient talking to their physician, but it’s definitely worth keeping an eye on developments in this area. Anything that helps against this common and painful condition will be good news.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.