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Chest Pain (cont.)

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Esophagus and reflux esophagitis

The esophagus is a muscular tube that carries food from the mouth to the stomach. The lower esophageal sphincter (LES) is a specialized band of muscle at the lower end of the esophagus that functions as a valve to keep stomach contents from spilling back into the esophagus. Should that valve fail, stomach contents, including acidic digestive juices, can reflux back and irritate the lining of the esophagus. While the stomach has a protective barrier lining to protect it from normal digestive juices, this protection is missing in the esophagus.

Reflux esophagitis (also referred to as GERD, gastroesophageal reflux disease) can present with burning chest and upper abdominal pain that radiates to the throat and may be associated with a sour taste in the back of the throat called waterbrash. It may present after meals or at bedtime when the patient lies flat. There can be significant spasm of the esophageal muscles, and the pain can be intense. The pain of reflux esophagitis can be mistaken for angina, and vice versa.

The physical examination is usually not helpful, and a clinical diagnosis is often made without further testing. Endoscopy may be performed to look at the lining of the esophagus and stomach. When symptoms are long-standing, they may be associated with, or cause, precancerous changes in the cells lining the lower esophagus. Manometry can be done to measure pressure changes in the esophagus and stomach to decide whether the LES is working appropriately. Barium swallow or gastrograph with fluoroscopy is a type of X-ray where the swallowing patterns of the esophagus can be evaluated.

Treatment for reflux esophagitis includes:

  • Dietary and lifestyle changes to limit the amount of acid that can backsplash from the stomach into the esophagus.
  • Elevating the head of the bed allows gravity to keep acid from refluxing.
  • Smaller meal sizes can limit stomach distention.
  • Caffeine, alcohol, anti-inflammatory medications, and smoking are irritants to the lining of the stomach and esophagus and should be avoided.
  • Acid blockers like omeprazole (Prilosec) or lansoprazole (Prevacid) can decrease the amount of stomach acid that is produced, and antacids like Maalox or Mylanta can help bind excess acid.

The complications of acid reflux depend upon its severity and its duration. Chronic reflux can cause changes in the lining of the esophagus (Barrett's esophagus) which may lead to cancer. Reflux may also bring acid contents into the back of the mouth into the larynx (voice box) and cause hoarseness or recurrent cough. Aspiration pneumonia can be caused by acid and food particles inhaled into the lung. For more, please read the GERD article.


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