Alcohol is a major contributor

Dear Dr. Roach: My brother is 65 years old and was spitting up when eating. He was diagnosed with Grade 3 esophagitis.

He has been drinking five glasses of wine daily for years. Did this cause his problem? What is esophagitis and what can he do to get better? — G.G.

Esophagitis is inflammation of the esophagus, which has many possible causes. The most likely cause 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 that generally makes GERD worse, so changing to spirits may actually worsen.

Grade 3 esophagitis is fairly severe. It’s possible 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.