Chest Pain (cont.)
The 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.
- Elevating the
head of the bed allows gravity to keep acid from refluxing.
- Smaller meal sizes
can limit stomach distention.
- 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 cough.
Aspiration pneumonia can be caused by acid and food particles inhaled into the
lung. For more, please read the GERD article.
Next: Referred abdominal pain »
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