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Esophagitis
Inflammation of the Esophagus

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

Images

WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 3.0
WIKIDATA, CC BY-SA 4.0

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

Entire Body System

  • 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]

    Symptoms can include difficult or painful swallowing, unintentional weight loss or food regurgitation. [ridgedalesurgerycenter.com]

    Symptoms can include difficult or painful swallowing, unintentional weight loss or food regurgitation. https://gastrohealth.com/wp-content/uploads/2017/06/logo.jpg 0 0 Gastro Health https://gastrohealth.com/wp-content/uploads/2017/06/logo.jpg Gastro Health [gastrohealth.com]

    […] if needed — a five- or 10-pound weight loss can help. • Stop smoking. [kdhnews.com]

    Symptoms in children include: Problems feeding or eating Abdominal pain Vomiting Problems swallowing Food getting stuck in the esophagus Poor weight gain or weight loss, poor growth, and malnutrition Symptoms in adults include: Food getting stuck when [ucsfhealth.org]

  • Feeding Difficulties

    EoE is a chronic immune-mediated disorder of the esophagus, which may present as dysphagia, food impaction, heartburn, vomiting, abdominal pain, feeding difficulties, or failure to thrive. [pedsinreview.aappublications.org]

    Children can have feeding difficulties like difficulty advancing to age appropriate foods, coughing when they are trying to swallow solids or liquids. [childrensnational.org]

    In addition, young children with eosinophilic esophagitis may present with feeding difficulties. From Wikipedia This example is from Wikipedia and may be reused under a CC BY-SA license. [dictionary.cambridge.org]

    Esophagitis can also lead to complications such as scarring or narrowing of the esophagus, and difficulty swallowing. [mayoclinic.org]

Respiratoric

  • Hoarseness

    Hoarseness of voice Irritation of vocal cords can cause hoarseness of voice. Hoarseness of voice Irritation of vocal cords can cause hoarseness of voice. Fever Patients with infective esophagitis can have fever. [medicaljoyworks.com]

    Symptoms may include: Cough Difficulty swallowing Painful swallowing Heartburn (acid reflux) Hoarseness Sore throat Treatment depends on the cause. [nlm.nih.gov]

  • Non-Cardiac Chest Pain

    […] of Patients With Non-cardiac Chest Pain Using PillCam Eso - a Wireless Imaging Capsule of the Esophagus. [malacards.org]

    The PPI test has particularly been used in adults to differentiate cardiac from non-cardiac chest pain as well as GERD-related complaints of heartburn, chronic cough, and dyspepsia. [cancertherapyadvisor.com]

Gastrointestinal

  • Vomiting

    […] 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]

    Nausea and or vomiting Patients with esophagitis can have anorexia, nausea and vomiting. Nausea and or vomiting Patients with esophagitis can have anorexia, nausea and vomiting. [medicaljoyworks.com]

    Excessive vomiting: The acid contained in vomit can irritate the esophagus, and excessive vomiting can lead to inflammation. Pills getting stuck: If a pill gets stuck in the esophagus, it can cause burning of the lining. [verywellhealth.com]

    Irritation leading to esophagitis may be caused by any of the following: GERD, or gastroesophageal reflux disease Vomiting Surgery Medications such as aspirin and other anti-inflammatory drugs Taking a large pill with too little water or just before bedtime [webmd.com]

  • 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]

    Symptoms The most common eosinophilic esophagitis symptoms are dysphagia (difficulty swallowing) mostly with solid food. [memorialhermann.org]

    Dysphagia Patients complain of dysphagia which occurs secondary to fibrosis and stricture formation. Some patients complain of odynophagia and sensation of food getting stuck in the mid-esophagus as well. [medicaljoyworks.com]

  • 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]

    Symptoms The most common eosinophilic esophagitis symptoms are dysphagia (difficulty swallowing) mostly with solid food. [memorialhermann.org]

    Dysphagia Patients complain of dysphagia which occurs secondary to fibrosis and stricture formation. Some patients complain of odynophagia and sensation of food getting stuck in the mid-esophagus as well. [medicaljoyworks.com]

  • Regurgitation

    Regurgitation is frequent when the patient is in supine position, bending forwards or wearing tight clothes after a heave meal. Regurgitation Regurgitation of acidic gastric contents occurs in reflux esophagitis. [medicaljoyworks.com]

    Inflammation of the esophagus (the tube that carries food from the mouth to the stomach) ICD-9-CM Volume 2 Index entries containing back-references to 530.10 : Esophagitis (alkaline) (chemical) (chronic) (infectional) (necrotic) (peptic) (postoperative) (regurgitant [icd9data.com]

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

    Parents and some medical practitioners confuse vomiting with regurgitation, or use other terms for regurgitation (e.g., spitting up, spitting, or spilling). [cancertherapyadvisor.com]

    Primary esophagitis, caused by physical irritants, causes spasm and obstruction, with pain on swallowing or palpation, profuse salivation, regurgitation of slimy, blood-stained saliva and feed, and may lead to stricture formation. [medical-dictionary.thefreedictionary.com]

  • Nausea

    Nausea and or vomiting Patients with esophagitis can have anorexia, nausea and vomiting. Nausea and or vomiting Patients with esophagitis can have anorexia, nausea and vomiting. [medicaljoyworks.com]

    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]

    In children, symptoms of EoE include abdominal pain, nausea, vomiting, anorexia and dysphagia. [clinicaladvisor.com]

Cardiovascular

  • Chest Pain

    […] in your chest that lasts more than a few minutes Suspect you have food lodged in your esophagus Have a history of heart disease and experience chest pain Experience pain in your mouth or throat when you eat Have shortness of breath or chest pain that [mayoclinic.org]

    […] for evaluation of the chest pain. [healio.com]

    Chest pain Retrosternal or epigastric burning pain is characteristic of reflux esophagitis. Chest pain Retrosternal or epigastric burning pain is characteristic of reflux esophagitis. Water brash Water brash is the increased production of saliva. [medicaljoyworks.com]

    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]

  • Retrosternal Chest Pain

    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]

    REFLUX ESOPHAGITIS The diagnosis of gastroesophageal reflux disease (GERD) is predominantly based on “troublesome” symptoms—when the classic symptoms of heartburn, retrosternal chest pain and dysphagia are no longer simply occasional physiologic issues [archivesofpathology.org]

Musculoskeletal

  • Osteoporosis

    Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995 ;333: 1437 - 1443 2. Siris E, Weinstein RS, Altman R, et al. [nejm.org]

    Pills that are most likely to cause esophagitis include: aspirin doxycycline iron supplements nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) osteoporosis medications such as alendronate (Fosamax [health.harvard.edu]

    Most commonly, it occurs with some painkillers, antibiotics, drugs to treat potassium deficiency, and certain drugs for the treatment for osteoporosis. Infections Infectious esophagitis can occur in people who have weakened immune systems. [medicalnewstoday.com]

    others) and naproxen sodium (Aleve, others) Antibiotics, such as tetracycline and doxycycline Potassium chloride, which is used to treat potassium deficiency Bisphosphonates, including alendronate (Fosamax), a treatment for weak and brittle bones (osteoporosis [mayoclinic.org]

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].

X-Ray

  • Esophageal Motility Disorder

    This condition clinically presents as dysphagia, odynophagia, or an esophageal motility disorder. [51] Rubio et al first introduced LE in 2006 as a novel subset of chronic esophagitis. [52] Histologically, it is characterized by dense intraepithelial [emedicine.medscape.com]

    Some important differential diagnosis which must be considered is acute coronary syndrome with atypical chest pain, malignancy, peptic ulcer disease, rings and webs, pneumonia, pulmonary embolism, achalasia, and esophageal motility disorder. [ncbi.nlm.nih.gov]

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].

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

  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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