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Esophagitis

Eosinophilic Esophagitis

Esophagitis is a condition, characterized by inflammation of the esophagus. It can either be acute, or chronic in nature.


Presentation

The condition of esophagitis, presents with the following signs and symptoms [7]:

  • Swallowing becomes difficult and very painful
  • Development of heartburn and regurgitation 
  • Experiencing pain in chest during eating
  • Food impaction, which occurs when food gets stuck in the esophagus during swallowing
Weight Loss
  • Can be associated with weight loss, heartburn, regurgitation (especially with lying flat), and aspiration pneumonias. Eosinophilia is thought to be due to a reactive process from stasis of esophageal contents.[online.epocrates.com]
  • . • Lose weight if needed — a five- or 10-pound weight loss can help. • Stop smoking. Carey Stites is a certified personal trainer, group fitness instructor and a Registered Dietitian with a master’s degree in nutrition.[kdhnews.com]
  • loss Chest pain (aggravates with swallowing) Sore throat ‘Tough’ voice due to construction Acid reflux (GERD) Abdominal pain Heartburn Fever Muscle Ache Headache Shortness of breath Particularly if these conditions last for a couple of days and seem[torrancegastro.com]
  • loss While many of these symptoms may mimic those of gastroesophageal reflux disease (GERD), there is an important distinction to keep in mind.[nutritionbyerin.com]
  • Symptoms are dominated by diarrhea and weight loss. Laboratory testing demonstrates evidence of malabsorption, including iron deficiency and loss of fat soluble vitamins. Osteopenia is a complication of vitamin D deficiency.[clinicaladvisor.com]
Collapse
  • CASE PRESENTATION: A 52 year-old diabetic woman collapsed at her home in front of an acquaintance. "Bloody vomit" was noted. Despite resuscitation efforts, the patient died. A complete autopsy was performed.[ncbi.nlm.nih.gov]
Hoarseness
  • Symptoms may include: Cough Difficulty swallowing Painful swallowing Heartburn (acid reflux) Hoarseness Sore throat Treatment depends on the cause.[nlm.nih.gov]
  • Other mouth and throat symptoms sometimes occur such as gum problems, bad breath, sore throat, hoarseness, and a feeling of a lump in the throat. Severe chest pain develops in some cases (and may be mistaken for a heart attack).[cgpsl.org]
  • Other mouth and throat symptoms sometimes occur, such as gum problems, bad breath, sore throat, hoarseness and a feeling of a lump in the throat. Severe chest pain develops in some cases (and may be mistaken for a heart attack).[patient.info]
Vomiting
  • It presents with failure to thrive, nausea, and vomiting in children and is a common reason for dysphagia and food impaction in adults.[ncbi.nlm.nih.gov]
  • Presenting symptoms may vary from feeding refusal, gagging, and/or vomiting in the younger population, dysphagia, chest pain, and abdominal pain in adolescents, as well as emergent food impactions.[ncbi.nlm.nih.gov]
  • In children, EoE symptoms vary with age and include vomiting, abdominal pain, and dysphagia.[ncbi.nlm.nih.gov]
  • An eleven-year girl presented with uncontrolled type I diabetes mellitus and recurrent epigastric pain with vomiting. Her oral intake was satisfactory. There was no dysphagia and odynophagia. Physical examination was normal with good oral hygiene.[ncbi.nlm.nih.gov]
  • […] large amounts, often have forceful vomiting, have trouble breathing after vomiting or have vomit that is yellow or green, looks like coffee grounds, or contains blood Causes Esophagitis is generally categorized by the conditions that cause it.[mayoclinic.org]
Dysphagia
  • This rare disorder should be considered in patients presenting with sudden-onset retrosternal pain in addition to dysphagia and odynophagia.[ncbi.nlm.nih.gov]
  • The disease is characterized by esophageal symptoms, primarily dysphagia in adult patients, and esophageal eosinophilic infiltration.[ncbi.nlm.nih.gov]
  • Eosinophilic esophagitis (EoE) is a unique form of non-IgE-mediated food allergy characterized by esophageal eosinophilic infiltration that commonly causes dysphagia and food impaction in children and adolescents.[ncbi.nlm.nih.gov]
  • It presents with failure to thrive, nausea, and vomiting in children and is a common reason for dysphagia and food impaction in adults.[ncbi.nlm.nih.gov]
  • Presenting symptoms may vary from feeding refusal, gagging, and/or vomiting in the younger population, dysphagia, chest pain, and abdominal pain in adolescents, as well as emergent food impactions.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Presenting symptoms may vary from feeding refusal, gagging, and/or vomiting in the younger population, dysphagia, chest pain, and abdominal pain in adolescents, as well as emergent food impactions.[ncbi.nlm.nih.gov]
  • In children, EoE symptoms vary with age and include vomiting, abdominal pain, and dysphagia.[ncbi.nlm.nih.gov]
  • EoE is characterized by eosinophilic inflammation of the esophagus causing gastrointestinal symptoms such as abdominal pain, vomiting, reflux, dysphagia, and food impactions.[ncbi.nlm.nih.gov]
  • Eosinophilic gastroenteritis Patients often have GI symptoms not directly attributed to the esophagus such as abdominal pain, nausea, weight loss, GI bleeding, diarrhea, malabsorption, or protein-losing enteropathy.[online.epocrates.com]
  • Eosinophilic Esophagitis Esophagus Dysphagia Chest or upper abdominal pain Food stuck in the esophagus Heartburn that doesn’t respond to medication Regurgitation In children: vomiting, poor weight gain or failure to thrive Unknown Overview Eosinophilic[nm.org]
Nausea
  • It presents with failure to thrive, nausea, and vomiting in children and is a common reason for dysphagia and food impaction in adults.[ncbi.nlm.nih.gov]
  • Abdominal pain, nausea, regurgitation, vomiting, trouble swallowing, food getting stuck, and heartburn are all possible symptoms of esophagitis.[nicklauschildrens.org]
  • Symptoms of EoE include nausea, vomiting, and abdominal pain after eating. A person may also have symptoms that resemble acid reflux from the stomach.[aarda.org]
  • Because this condition inflames the esophagus, someone with EoE may experience difficulty swallowing, pain, nausea, regurgitation, and vomiting.[gikids.org]
  • Eosinophilic gastroenteritis Patients often have GI symptoms not directly attributed to the esophagus such as abdominal pain, nausea, weight loss, GI bleeding, diarrhea, malabsorption, or protein-losing enteropathy.[online.epocrates.com]
Odynophagia
  • This rare disorder should be considered in patients presenting with sudden-onset retrosternal pain in addition to dysphagia and odynophagia.[ncbi.nlm.nih.gov]
  • There was no dysphagia and odynophagia. Physical examination was normal with good oral hygiene.[ncbi.nlm.nih.gov]
  • Pill-induced esophagitis may be underreported by patients, when symptoms are mild and unrecognized and/or underdiagnosed by the clinicians as a cause of retrosternal pain, odynophagia, or dysphagia.[ncbi.nlm.nih.gov]
  • From the 39th day of CRT onwards, he presented with a sustained fever and severe odynophagia that was resistant to antibiotic therapy.[ncbi.nlm.nih.gov]
  • It is characterized by odynophagia in immunocompromised patients, particularly patients with AIDS.[radiopaedia.org]
Chest Pain
  • Presenting symptoms may vary from feeding refusal, gagging, and/or vomiting in the younger population, dysphagia, chest pain, and abdominal pain in adolescents, as well as emergent food impactions.[ncbi.nlm.nih.gov]
  • A 21-year-old man was admitted to our outpatient clinic with retrosternal chest pain, dysphagia, and odynophagia complaints, which occurred within 2 weeks after starting dexketoprofen trometamol.[ncbi.nlm.nih.gov]
  • pain Experience pain in your mouth or throat when you eat Have shortness of breath or chest pain that occurs shortly after eating Vomit large amounts, often have forceful vomiting, have trouble breathing after vomiting or have vomit that is yellow or[mayoclinic.org]
  • KEYWORDS: Chest pain; Computed tomography; Esophagitis; Esophagogastroduodenoscopy[ncbi.nlm.nih.gov]
  • While you can treat esophagitis at home in many cases, see a doctor if you notice symptoms lasting for more than a few days or severe symptoms like choking, vomiting blood, or chest pain that lasts longer than a few minutes.[wikihow.com]

Workup

The following tests would be employed, for diagnosing the condition of esophagitis:

  • Physical examination: A preliminary physical examination, which includes a question and answer session to understand the symptoms, is carried out.
  • Barium X-ray: In this test, the individual is given solution of barium to drink, or is given a pill coated with barium. Barium evenly coats the esophageal lining, and the stomach, which makes it possible to clearly view the abnormalities inside the organs. An X-ray is conducted, which helps in analyzing the esophagus.
  • Endoscopy: Endoscope is used for viewing the internal of the esophagus, to determine any unusual development. During this process, a sample of the tissue is also taken for biopsy. The sample is tested for viral agents, or presence of any abnormal cell development [8].

Treatment

The goal of treatment involves effective management of the symptoms, and treating the underlying disease conditions. Methods for treating esophagitis, depend on the cause of the condition. Following methods are employed to treat esophagitis:

  • Reflux esophagitis is usually treated with over the counter medications that would help control gastrophageal reflux. If these do not work, then prescription strength medications, that include H2-receptor blockers, can be administered. When other modes of treatment fail to show any positive effect then surgery is the last resort [9].
  • Eosinophilic esophagitis is treated with proton pump inhibitors, that would help reduce the allergic reactions [10]. Topical swallowed steroids can also be used, along with the 6–food elimination diet, in which individuals are asked to abstain from certain foods triggering allergies [11]. Surgical procedures, such as fundoplication may be employed, for correcting esophagitis.
  • In the case of infectious esophagitis, antibiotics are administered to treat the causative agent. Various causative agents such as bacteria, virus, fungi and parasite can be effectively treated with medications.
  • Drug-induced esophagitis is treated by avoiding medications, which cause damage, and irritation to the tissues of the esophagus. Administration of alternative drug, or taking liquid form of the same pill, can be considered. Individuals are also advised to stand, or sit for 30 minutes, after ingestion of the pill.

Prognosis

The prognosis of the condition is usually favorable, and patients usually respond to treatment. For individuals with compromised immunity, recovery period will be pretty long. However, if esophagitis has induced significant changes in the cells of the esophagus, then chances of developing cancer in the future increases [6].

Etiology

In majority of the cases, back flow of the stomach acids into the esophagus, is the major cause of esophagitis. In addition, other factors such as infections, underlying disease conditions, allergies and medications, can also predispose an individual to develop the condition. The nature of the causative factor gives rise to a specific type of esophagitis.

Back flow of acidic contents of stomach into the esophagus, causes gastrophageal reflux to develop. This in turn, leads to inflammation of the esophagus, causing esophagitis. Certain medications, if not gulped with enough water, can cause its remnants to remain in the lining of the esophagus, irritating the tissues. Such a condition is termed as drug-induced esophagitis [2].

Epidemiology

Esophagitis is a common occurrence amongst adults, children are seldom affected [3]. Reflux esophagitis and candida esophagitis are the most common forms of esophagitis. Symptoms of esophageal reflux occur in about 33 – 44% of population. Infectious esophagitis is majorly caused due to Herpes virus, and commonly occurs in those individuals with an underlying disease conditions, such as AIDS, lymphoma and leukemia [4].

Sex distribution
Age distribution

Pathophysiology

The pathophysiology of esophagitis depends on the nature of the cause. However, the basic mechanism behind causation of inflammation of the esophagus, remains the same. Due to certain triggering factors, such as infection, drugs or gastrophageal reflux, irritation and damage to the tissues of the esophagus are caused. Such a phenomenon, favors the development of inflammation of the esophagus, which in turn, paves way for development of several unpleasant symptoms [5].

Prevention

It is not always possible to prevent esophagitis. However, affected individuals can prevent its recurrence, by following those methods that have triggered previous bouts of esophagitis. It is necessary to avoid those medications, that can cause irritation in the esophageal lining. Also, avoiding direct contact with individuals, living with Herpes virus is also important.

Summary

Esophagitis is a painful condition, which can cause difficulty in swallowing of food in affected individuals. Some of the common forms of esophagitis include infectious esophagitis, eosinophilic esophagitis, pill esophagitis, reflux esophagitis and candida esophagitis. Of these, candida esophagitis is the most common form. Adults are more prone to develop the condition than children [1].

Patient Information

Definition: Esophagitis is a condition, wherein there is inflammation of esophagus, due to damage to its tissue by certain factors. Such a type of condition is more common amongst the adult population.

Cause: Gastropahgeal reflux, a condition characterized by back flow of the stomach contents to the esopahagus, is the most common cause of esopahgitis. In addition, certain types of drugs, allergic reactions, and infections can also lead to development of esophagitis.

Symptoms: Symptoms of esophagitis include difficulty and pain, while swallowing food, heartburn, chest pain, acid regurgitation and food impaction.

Diagnosis: Various tests will be required to diagnose the condition of esophagitis and also to determine development of future complications. Diagnosis is done through the barium X-ray test, and endoscopy. These procedures help in proper viewing of the internal features of esophagus, to look for the presence of abnormalities.

Treatment: The type of treatment employed, depends on the type of esophagitis that has set in. For reflux esophagitis, over the counter medication are prescribed for preventing gastrophageal reflux. In addition, prescription strength medications, containing H2-receptor blockers are administered. For infectious esophagitis, antibiotics are prescribed for treating the infections.

References

Article

  1. Winstead NS, Bulat R. Pill Esophagitis. Curr Treat Options Gastroenterol. Feb 2004;7(1):71-76. 
  2. Zografos GN, Georgiadou D, Thomas D, et al. Drug-induced esophagitis. Dis Esophagus 2009; 22:633.
  3. Nurko S, Rosen R, Furuta GT. Esophageal dysmotility in children with eosinophilic esophagitis: a study using prolonged esophageal manometry. Am J Gastroenterol. Dec 2009;104(12):3050-7.
  4. Levine MS, Laufer I, Kressel HY, Friedman HM. Herpes esophagitis. AJR Am J Roentgenol. May 1981;136(5):863-6.
  5. Dent J, Dodds WJ, Friedman RH, et al. Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 1980; 65:256.
  6. Nonevski IT, Downs-Kelly E, Falk GW. Eosinophilic esophagitis: an increasingly recognized cause of dysphagia, food impaction, and refractory heartburn. Cleve Clin J Med. Sep 2008;75(9):623-6, 629-33.
  7. Geagea A, Cellier C. Scope of drug-induced, infectious and allergic esophageal injury. Curr Opin Gastroenterol 2008; 24:496.
  8. Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. May 2013;108(5):679-92; quiz 693
  9. Donnellan C, Sharma N, Preston C, Moayyedi P. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database Syst Rev. Apr 18 2005;CD003245.
  10. Schroeder S, Capocelli KE, Masterson JC, et al. Effect of proton pump inhibitor on esophageal eosinophilia. J Pediatr Gastroenterol Nutr 2013; 56:166.
  11. Reuters Health. Elimination diet helps adult eosinophilic esophagitis: study. Medscape Medical News. February 15, 2013. 

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Last updated: 2017-08-09 17:35