Reflux esophagitis is an esophageal mucosal injury that occurs secondary to retrograde flux of gastric contents into the esophagus, also called gastroesophageal reflux disease (GERD). It is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This causes chronic inflammation and irritation of the esophagus. It also affects the gastroesophageal junctional mucosa.
GERD is classified into two groups on the basis of mucosal changes on endoscopy, which are non-erosive reflux disease (NERD) and erosive esophagitis. NERD is defined as the presence of typical symptoms of GERD in the absence of esophageal mucosal injury on conventional upper gastrointestinal endoscopy. Erosive esophagitis is characterized by mucosal breaks such as erosions or ulcerations on endoscopy.
According to study, “Reflux Esophagitis (Gastroesophageal Reflux Disease) Global Clinical Trials Review, H1, 2018” some of the major companies that are currently working in the reflux esophagitis are Chong kun dang pharmaceutical Corp, Ironwood pharmaceuticals Inc, Takeda pharmaceutical Co Ltd, YuyupharmaInc, Ahn-Gook pharmaceutical Co Ltd,CJ healthcare Corp, Eisai Co Ltd, Wockhardt Ltd, Melinta therapeutics Inc, Sun pharma advanced research company Ltd, Daewoong pharmaceutical Co Ltd, RaQualiapharma Inc.
There are some pathogenesis of GERD such as gastric factors, antireflux mechanisms and esophageal clearance mechanisms. Gastric factors are defined by two terms; irritant potency of the refluxed material and delayed gastric emptying. Irritant potency of the refluxed material is depending on caustic agents such as acid, pepsin, bile & pancreatic enzymes. Delayed gastric, causes gastric distention that can stimulate gastric acid secretion & trigger TLSER (transient lower esophageal sphincter relaxation). Antireflux is a positive pressure gradient between the abdomen and the thorax that tends to promote the reflux of material from the stomach into the esophagus.
Diagnosis of GERD includes two methods such as clinical representation and diagnostic tests. In clinical presentation pyrosis, dysphagia, regurgitation, water brash, odynophagia, chest pain, pulmonary symptoms and night-time GER.
There are many methods for treatment of GERD such as medical treatment, antireflux surgery and endoscopic antireflux procedures. Medical treatment involves lifestyle modifications and pharmacologic therapy. In lifestyle modification smoking, alcohol, fatty meal, tea, spicy food and drugs are involves whereas in pharmacologic therapy, H2 blockers, proton pump inhibitors, antacids, prokinetic drugs and sucralfate are involves. There are a number of different antireflux operations such as nissen, toupet, belesy and fundoplication. Endoscopic antireflux procedures is defined by three system; stretta system, bard endoscopic suturing system and injection of collagen circumferentially at the LES.
There are also some risk factors of GERD; which are scleroderma, alcohol, pregnancy, hiatal hernia, cigarettes and obesity etc. there are also two complications of GERD; peptic stricture formation and barrett’s esophagus. Peptic stricture is a lumen-narrowing lesion that occurs in erosive esophagitis secondary to edema, inflammation or fibrosis of the distal end of esophagi. Barrett’s esophagua is replacement of reflux-damaged squamous epithelium in the distal part of esophagus by metaplastic.
Globally, gastroesophageal reflux disease has been increasing in east due to the socioeconomic development. The prevalence of both GERD and functional gastrointestinal disorders (FGIDs) ranges between 10% and 25% worldwide. Improved medical therapy for GERD might depend on future agents with different therapeutic targets, including GABA inhibitors and nitric oxide modulating drugs in the control of the lower sphincter esophagus and in motility disorders, free radical scavengers in the prevention of mucosal damage and COX-2 specific inhibitors in the prevention of the progression of Barret’s esophagus to adenocarcinoma.
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