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Inflammation of the esophagus (reflux disease, reflux esophagitis)

Inflammation of the lining of the esophagus (esophagus) is called esophagitis.

Symptoms and definition of reflux esophagitis

Gastro-oesophageal reflux disease, also known as reflux oesophagitis or reflux inflammation, manifests itself primarily through symptoms such as heartburn or a feeling of pressure in the middle chest or upper abdominal area, caused by increased stomach acid load in the esophagus.

The most common symptoms of esophagitis include:

  • Pain, burning, or pressure, predominantly behind the breastbone and in the upper abdomen
  • heartburn
  • acid regurgitation
  • difficulties swallowing
  • salty or soapy taste in the mouth after burping
The symptoms usually occur after a large meal, carbonated or alcoholic beverages or at night. In some sufferers, gastric juice that flows back enters the airways and can lead to asthma and other chronic diseases there.
The following symptoms can be associated with an inflammation of the esophagus:
  • Bad breath
  • chronic cough
  • hoarseness
  • chronic laryngitis
  • Bronchial asthma
  • Tooth enamel changes

How does an esophagitis develop?

If the mucous membrane is often or permanently exposed to this acidic stimulus, small injuries or rough areas arise that soon become inflamed.
If the inflammation persists, this irritation can lead to an inflammatory reaction that can cause deep damage to the mucous membrane (ulcers), scarring and the resulting narrowing of the organ. Recurring inflammation can also lead to an increase in connective tissue (fibrosis) in the esophageal wall. As a result, it loses its elasticity and can no longer contract or relax properly in order to transport chyme into the stomach or to allow it to pass through.


Esophagitis affects 15-25 percent of the population, and esophageal reflux disease is on the increase.
About 30 percent of those affected see their doctor.
Around 60 percent have a mild form of reflux disease in which no inflammation can be detected endoscopically, but which can cause symptoms similar to those of the endoscopically detectable, sometimes severe inflammation of the esophagus.


Reflux oesophagitis as reflux inflammation of the esophagus caused by acidic gastric juice usually occurs (in about 90 percent of cases of reflux oesophagitis) in connection with the presence of a hiatal hernia (gap in the diaphragm).
The cause of the acid reflux is the frequent or prolonged slackening of the lower esophageal sphincter.
In addition to this very common cause of esophagitis, there are also rare causes of esophagitis such as: B. Viral infections or infections with Candida fungi. An allergic reaction e.g. In rare cases, e.g. food components can trigger esophagitis (eosinophilic esophagitis). The latter causes are independent of the acid reflux.


In about 10 percent of cases of long-lasting acid reflux inflammation, changes occur in the lower area of ​​the esophageal mucosa. This is called columnar epithelial metaplasia, also called Barrett's epithelium or Barrett's esophagus. These changes carry the risk that in a few cases (in about 7-10 percent of patients with Barrett's epithelium) a special form of esophageal cancer can develop in the lower part of the esophagus: Barrett's carcinoma.
Regular endoscopic monitoring of patients with these changes in risk is therefore necessary.

Diagnosis and examination procedures

The suspected diagnosis is made by the doctor based on the symptoms. The attending physician and the patient make a decision on further measures and therapy based on the symptoms.
The most important diagnostic measure is the esophagus and gastroscopy (esophago-gastro-duodenoscopy), during which tissue samples can also be taken, and in some cases also the acid measurement in the esophagus (ph-metry). Only a tissue sample is capable of distinguishing between (harmless) changes in the mucous membrane and (dangerous) malignant changes in the mucous membrane. If there are only small areas of the mucous membrane that have been transformed in the sense of this epithelial metaplasia, the risk of cancer is relatively low. However, this risk is higher for epithelial metaplasias that affect the entire part of the lower esophagus (Barrett's esophagus). Endoscopic checks should therefore be carried out at individually different intervals.


As a rule, esophagitis can be treated well. Surgical intervention is only necessary in very rare cases.
  • Avoid triggers
    Treatment of inflammation of the esophagus consists primarily of avoiding triggers and other stimuli. It usually helps to stop eating solid food in the late afternoon. Avoiding acidic and irritating foods such as desserts, spicy foods, fried foods and alcohol usually reduces the symptoms. If the inflammation is caused by rising gastric juice, sleeping with the upper body elevated can alleviate the symptoms.
  • Medical therapy
    Drugs, so-called acid binders (antacids) or proton pump inhibitors, which reduce the production of acid in the stomach lining, often help. The acid blockers reduce the production of stomach acid, but not the reflux. Often very low doses of these drugs are sufficient, in some cases higher and very rarely very high doses of these drugs are required. Then gastric juice still flows back into the esophagus, but it is no longer so acidic and therefore no longer damages the esophagus. It is assumed that consistent treatment that leads to freedom from symptoms can also lower the risk of cancer; this has not yet been proven. Since reflux disease has a "mechanical defect" that causes the acid reflux due to the inadequate action of the locking mechanism and maintains reflux oesophagitis, reflux problems can be expected in most cases after reducing or skipping treatment. Therefore, treatment of reflux oesophagitis is often required long-term.
  • Surgical intervention
    If the cause of the esophagitis is clearly a defect in the closure mechanism, in some cases minimally invasive surgery can be used to stop the inflammatory backflow of gastric juice. The attempt is made to alleviate the symptoms by surgically restoring the locking mechanism. A decision on the surgical treatment of reflux esophagitis depends on the circumstances in the individual case. The postoperative results are favorable in the short term; in a period of more than 5 years, however, less well, since after this time a certain proportion of the patients have to take proton pump inhibitors again in order to be symptom-free.
    If the esophagus has been irritated by swallowed objects, these must be removed immediately. If scar tissue or tissue thickening forms, it may be necessary to remove them through an operation.


When is a doctor's visit absolutely advisable?
  • Despite taking antacids for a week, the symptoms are not better.
  • The pain radiates into the arms.
  • The chyme reaches the mouth (regurgitation).
  • The reflux symptoms are long-lasting (chronic).
  • The symptoms increase.
  • Heartburn or acid regurgitation in children.
  • If you have difficulty swallowing.
What can I do myself to make the symptoms go away?
  • Weight normalization
  • Small, low-fat meals
  • No meals right before bed
  • No chocolate or other desserts
  • No nicotine
  • No acidic drinks
  • Coffee only with milk
  • Instead of coffee, rather tea
  • No alcohol
  • No carbonated drinks
  • Walk for 30 minutes after eating
  • Sleep with your upper body raised up to 45 ° and lying on your right side
Caution: The symptoms can be aggravated by bending over, pressing, lying on your back, or exertion