Sudden pain in the throat or chest

When people have symptoms of getting angry, they often experience inflammation in the throat, that is, tonsils become inflamed, and eating becomes more difficult. However, if the throat and chest suddenly become hard and painful, it is not caused by getting angry, but rather a problem of reflux esophagitis should be considered. If you have problems such as gastritis, gastroduodenitis, etc., you should seek medical treatment promptly. These are diseases that are prone to recurrence, and the earlier the treatment, the better.

What is reflux esophagitis?

Reflux esophagitis is a disease in which the contents of the stomach and duodenum flow back into the esophagus, causing erosion and ulcers of the esophageal mucosa. Under normal circumstances, the contents of the stomach and duodenum will not enter the esophagus. Even if they occasionally enter the esophagus, the peristalsis and clearance function of the esophagus itself will expel these abnormal gastroduodenal contents. If the esophagus's own defense mechanism is damaged, the gastric acid and pepsin that reflux from the stomach into the esophagus can easily cause erosion or ulcers of the esophageal mucosa, forming reflux esophagitis.

Is reflux esophagitis common?

Reflux esophagitis is a common disease with a high prevalence in Western Europe and North America, and its incidence in my country is also increasing year by year.

Are reflux esophagitis and gastroesophageal reflux disease the same thing?

Reflux esophagitis is a type of gastroesophageal reflux disease, which refers to gastroesophageal reflux disease that has reflux symptoms such as acid reflux and heartburn, and is clearly found to have esophageal inflammation through gastroscopy. Approximately half of untreated GERD cases are reflux esophagitis.

What are the common symptoms of reflux esophagitis?

Typical symptoms of reflux esophagitis include heartburn and regurgitation. Heartburn refers to a burning sensation behind the sternum (from the throat to the chest), and reflux refers to the feeling of gastric contents flowing toward the pharynx or mouth. In addition, reflux esophagitis may also have atypical symptoms such as chest pain, upper abdominal pain, upper abdominal burning sensation, and belching.

What is most easily overlooked is that reflux esophagitis can also cause extra-esophageal symptoms, including cough, throat symptoms, asthma, and tooth decay problems.

What are the serious consequences of reflux esophagitis?

Reflux esophagitis can cause esophageal erosion or ulcer bleeding, esophageal stricture, or Barrett's esophagus.

When the amount of esophageal bleeding is large, it can cause vomiting blood, black stools, and even shock; when the esophagus is narrow, it can cause difficulty in swallowing and inability to eat; Barrett's esophagus is a precancerous lesion of the esophagus, which causes the incidence of esophageal adenocarcinoma to be 10 to 20 times higher than that of normal people. The risk of cancer varies in different countries and regions. Barrett's esophagus patients in European and American countries may be more likely to develop cancer than Asians.

Why does reflux esophagitis occur?

Under normal circumstances, there is a special muscle structure at the junction of the lower esophagus and the stomach, called the lower esophageal sphincter (LES), which acts like a valve to prevent food in the stomach from flowing back into the esophagus. It is currently known that the cause of reflux esophagitis is that multiple factors work together to relax this muscle and lose its valve function, allowing food and gastric juice in the stomach to reflux into the esophagus and damage the esophageal mucosa. When this damage exceeds the esophagus's ability to repair itself, reflux esophagitis occurs.

Who often suffers from reflux esophagitis?

Reflux esophagitis is common in the elderly, men, Caucasians, smokers, obese people, excessive drinkers, manual laborers, etc.

Is reflux esophagitis contagious or hereditary?

Reflux esophagitis is not contagious or hereditary.

I suspect I have reflux esophagitis. What tests should I do?

If you suspect you have reflux esophagitis, you need a gastroscopy to confirm the diagnosis. If no signs of esophageal inflammation are seen under gastroscopy, reflux esophagitis cannot be diagnosed, but gastroesophageal reflux disease cannot be ruled out. At this time, 24-hour esophageal pH monitoring, esophageal pressure measurement and other tests can be performed to further determine whether the patient has acid reflux.

What is the use of gastroscopy?

Gastroscopy is the most accurate method for diagnosing reflux esophagitis. It can directly observe changes in the esophagus and gastric mucosa. In addition to determining whether reflux esophagitis exists, it can also determine the severity of the disease, such as whether there are complications such as bleeding, esophageal stenosis, Barrett's esophagus, etc.

At the same time, for suspicious lesions, samples can be taken directly for pathological examination under gastroscopy. That is, the removed lesions are specially treated and then observed under a microscope to identify whether there are other diseases such as esophageal cancer.

During the gastroscopy, there may be reactions such as nausea and vomiting. If it is unbearable, and the patient's physical condition allows, painless gastroscopy is recommended, which is a gastroscopy under general anesthesia to reduce discomfort during the examination.

What diseases can easily be confused with reflux esophagitis?

Depending on the manifestations of reflux esophagitis, it may be confused with different diseases.

Symptoms such as heartburn and reflux are common, and are easily associated with gastritis and peptic ulcer. Confusion because these diseases are all related to excessive gastric acid secretion and will present similar symptoms, but gastritis and peptic ulcer often have upper abdominal pain, while reflux esophagitis does not often cause abdominal pain.

Reflux esophagitis, which manifests itself as chest pain, is easily confused with coronary heart disease. However, the chest pain caused by coronary heart disease usually occurs when one is tired or emotionally excited, does not last long, and can be relieved after rest. It can be identified through electrocardiogram and gastroscopy. This is why doctors will ask patients to do an electrocardiogram before performing a gastroscopy, in order to rule out heart causes.

Reflux esophagitis, which is manifested by extra-esophageal symptoms such as cough and asthma, is easily confused with respiratory diseases such as chronic bronchitis and bronchial asthma. However, the above-mentioned lung and tracheal diseases are often triggered by weather changes, and are often accompanied by coughing up sputum and fever, and will not cause heartburn and reflux symptoms.

Which department should I visit for reflux esophagitis?

If you have reflux esophagitis, you should see a gastroenterologist. If there is no specialist clinic, you can go to the general internal medicine department for treatment.

What are the treatments for reflux esophagitis?

In addition to taking medicine, some lifestyle changes can also be helpful in treating reflux esophagitis, such as losing weight, quitting smoking, and quitting drinking. In addition, raising the upper body appropriately when sleeping can also effectively reduce reflux.

The main treatment for this disease is oral medication. The first choice is proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, pantoprazole, and rabeprazole to inhibit gastric acid secretion. Effective therapeutic drugs also include gastrointestinal prokinetic drugs such as domperidone, mosapride, and itopride. Drug treatment for at least 8 weeks is generally recommended.

For patients who respond to acid suppression therapy but are prone to relapse after drug discontinuation, surgical treatments such as fundoplication and endoscopic radiofrequency therapy can be considered.

Fundoplication is a surgical procedure that folds part of the tissue of the stomach fundus to the lower esophagus to increase the resistance at the junction of the esophagus and stomach and reduce reflux; endoscopic radiofrequency treatment is a technology that uses special tools under a gastroscope to cause local lesion necrosis through electric cauterization to achieve the treatment goal. The development of these technologies has increased the treatment options for patients with refractory reflux esophagitis.

Can reflux esophagitis be completely cured?

The lesions of reflux esophagitis can be cured. The healing rate of patients who received regular treatment for 8 weeks was 77.5%~94.1%.

Will reflux esophagitis recur after treatment? What should I do if it recurs?

Reflux esophagitis has a tendency to recur chronically. After the symptoms are relieved, it is also necessary to pay attention to changing your lifestyle to eliminate the cause. Once the disease recurs, you can still use drugs that suppress gastric acid and cure it.

It should be noted that if Barrett's esophagus is present, regular gastroscopy should be performed to identify other conditions such as esophageal cancer.

What should patients with reflux esophagitis pay attention to in their diet?

Patients with reflux esophagitis should pay attention to avoiding foods that affect the pressure of the lower esophageal sphincter, such as high-fat foods, chocolate, coffee, strong tea, etc.

In terms of eating habits, you should be careful not to eat too much at one meal, let alone overeating; you should not go to bed immediately after eating during the day, and you should not eat within 2 hours before going to bed.

What should patients with reflux esophagitis pay attention to in their daily life?

The onset of reflux esophagitis is closely related to obesity, and people who are overweight are more likely to develop the disease. Therefore, weight control is an important condition for patients with reflux esophagitis to reduce the onset of the disease. In addition, when resting, the patient can raise the head of the bed slightly.

In daily life, we should pay attention to reducing factors that cause increased abdominal pressure, such as constipation and tight belts.

At the same time, avoid the use of drugs that can reduce the pressure of the lower esophageal sphincter, such as nitroglycerin, atropine, nifedipine, etc. In addition, pay attention to adjusting your mood, because insomnia and anxiety can also aggravate the symptoms.

Can reflux esophagitis be prevented? How?

Reflux esophagitis is preventable. As long as you understand the factors that cause reflux esophagitis, control your weight, avoid excessive drinking, develop good eating habits, and avoid eating high-fat, chocolate, coffee, strong tea and other foods, you can reduce the probability of reflux esophagitis.

Will reflux esophagitis recur? How to prevent recurrence?

Reflux esophagitis can recur, and some believe that symptoms will recur in almost all patients after stopping PPIs.

The most important thing to prevent disease recurrence is to adjust lifestyle and eating habits. By controlling lifestyle factors and taking medication regularly, most patients can alleviate symptoms and avoid serious consequences such as esophageal stenosis and cancer.

However, some patients need to take PPIs orally for a long time to suppress gastric acid in order to maintain treatment and control symptoms. The dosage for maintenance treatment varies from person to person and needs to be adjusted to the minimum dose that is asymptomatic for the patient under the guidance of a doctor.