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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