Dear Dr. Roach: My brother is 65 years old and was spitting up when eating. He went for an endoscopy yesterday and was diagnosed with Grade 3 esophagitis.
He has been drinking five glasses of wine daily for years. Did this cause his problem?
He said he will stop drinking wine and drink some other, less acidic alcohol.
What is esophagitis and what can he do to get better?
Esophagitis is inflammation of the esophagus, which has many possible causes. The most likely cause, just from total numbers, is reflux esophagitis. That is caused by stomach contents and acid going backward from the stomach into the esophagus. The acid causes chemical damage to the esophagus. The fact that your brother has been “spitting up” — that is, having food contents coming all the way back to the mouth — is strong evidence of esophageal reflux.
Alcohol is a major risk factor for gastroesophageal reflux disease, also called GERD. Alcohol weakens the muscle strength of the lower esophageal sphincter, a muscle between the esophagus and the stomach that acts as a valve preventing food and acid from going backward. Alcohol itself can also damage the esophagus; however, spirits are more likely to do this than wine or beer. Alcohol may also affect the nerves in the esophagus and stomach, keeping them from working properly. It’s the alcohol, not the acid, that generally makes GERD worse, so changing to spirits might actually worsen his condition.
Grade 3 esophagitis is fairly severe (grade 4 is the worst). It’s possible that the doctor performing the endoscopy took biopsies, which would be important to be sure he doesn’t have a less-common cause of esophagitis, such as eosinophilic esophagitis, which appears to be immune-mediated.
Five glasses of wine a day is too much for many body systems. He needs to reduce his drinking for his health. I suspect reducing alcohol will help his esophagitis, but it is critical for many other organs, including the liver, brain, bone marrow and heart.
Dear Dr. Roach: Other than the traditional “BRAT” diet for occasional bouts of diarrhea, is there any OTC medication that you feel works the fastest/most effectively?
Nearly everyone has occasional bouts of diarrhea. Most of the time, these are self-limiting and don’t require treatment. However, the traditional BRAT diet — bananas, (white) rice, (peeled) apples and (white) toast — is an effective diet change to help the gut. In more severe cases, I recommend a clear liquid diet for 24 hours to allow the gut to heal, being sure to get in enough fluid, sugar and sodium. Chicken or vegetable broth and apple juice are traditional for this, but scientifically formulated oral rehydration solutions are available.
When medication is called for, loperamide 2 mg (Imodium) is my first choice. This should not be used in the presence of bloody diarrhea or fever: Please see your doctor in those situations.
I occasionally see someone take so much loperamide that they become constipated, and then reach for a medication to help with that.
Don’t get caught in that vicious cycle. Go easy on the loperamide (i.e., one or two tablets to start, then at most one more after each loose bowel movement, never to exceed eight tablets a day, and never exceeding two days of treatment).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu