Gastro-oesophageal reflux disease

This is a condition which typically presents with heartburn, acid brash and food or fluid regurgitation. It is caused by the reflux of gastric contents into the oesophagus from the stomach.

This occurs when the difference between the pressure inside the stomach and the pressure in the oesophageal body is greater than the pressure exerted by the lower oesophageal sphincter, at the lower end of the gullet which is designed to prevent reflux whilst at the same time allowing passage of food during swallowing (by relaxing transiently). The lining of the stomach is covered in a layer which secretes both acid and a layer of mucus which contains bicarbonate, which resists damage that would otherwise be caused to the stomach lining by the acid it produces. The lining of the oesophagus is much more like skin and is not resistant to the action of acidity. As a consequence when it is exposed to excess acid it becomes inflamed – resulting in appearences known as oesophagitis. However only a proportion of patients with acid reflux in excess of that which would be considered normal have appearances of oesophagitis at upper GI endoscopy. Many patients, particularly younger ones presenting with typical symptoms of reflux are treated with drugs to supress acid known as proton pump inhibitors without further  investigation, however in those where prolonged treatment is being considered or who have symptoms of food sticking in the oesophagus or weight loss endoscopy is indicated to rule out other causes.

Oesophagitis is a descriptive term used to describe the appearances of inflammation within the lining of the oesophagus. The commonest cause of oesophagitis is gastro-oesophageal reflux, however numerous other conditions may lead to inflammation within the oesophagus, including infection with fungi (candidal oesophagitis), viruses (Cytomegalovirus or herpes virus) or ingestion of caustic soda (chemical oesophagitis).