What exactly is erosive esophagitis? What is the usual treatment and overall prognosis for it?

S.C.

Erosive esophagitis is part of the spectrum of gastroesophageal reflux disease (GERD). The cause of this disease is abnormal reflux of gastric juices and acid back into the esophagus due to abnormal relaxation of the lower esophageal sphincter, which separates the stomach from the esophagus.

GERD is very common, and most people who have it do not see a doctor because their symptoms are mild. All they may require is occasional over-the-counter medications, such as antacids, or drugs such as cimetidine (Tagamet) that prevent acid production in the stomach.

People with more frequent or severe symptoms of reflux are more likely to see a doctor. Many of these are referred to gastroenterologists who frequently perform diagnostic tests to diagnose GERD. One of these tests is an upper endoscopy, commonly called an EGD, in which a doctor uses a flexible tube-shaped instrument called an endoscope to view the esophagus, stomach, and upper intestine, or duodenum.

When EGD is used to look for evidence of GERD, a grading system is assigned to the appearance of the esophagus. Most people with GERD will have a normal-looking esophagus. This is Grade 0, in which the only changes that can be found are seen on biopsy specimens under the microscope. In Grade 1, the endoscopist sees some redness or swelling in the lining of the esophagus. In Grades 2-4, progressively worse damage is seen, ranging from erosions (superficial breaks in the lining of the esophagus associated with inflammation) to deep ulcers. The term erosive esophagitis can be used when referring to Grades 2-4.

Without seeing your endoscopy pictures or report, I'm not able to comment on the severity of the erosive changes. However, most gastroenterologists agree that the therapy for erosive esophagitis should include a proton-pump inhibitor drug. These medications are the most potent inhibitors of acid production available. The two currently on the market are omeprazole (Prilosec) and lansoprazole (Prevacid).Proton-pump inhibitors have been found to heal erosive esophagitis in 85 to 100 percent of cases in medical research trials.

Overall, the prognosis for people with erosive esophagitis is excellent. Keep in mind that most patients get relief from their symptoms within weeks of using these medications, but relapse if they don't stay on a maintenance dose for the long term. I recommend that you discuss the details of the treatment with your doctor, who can provide the appropriate medication and dose for your condition.