What Is Esophagitis? How Is Esophagitis Treated?

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Main Category: Acid Reflux / GERD
Also Included In: GastroIntestinal / Gastroenterology
Article Date: 25 Nov 2011 - 0:00 PST

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Esophagitis (UK: Oesophagitis) is inflammation of the esophagus. The esophagus is a muscular tube from the pharynx to the stomach through which food and drinks pass. Esophagitis damages esophagus tissue. Patients may experience problems swallowing, as well as chest pains (heartburn). It is much more common in adults than in children.

In some cases, untreated esophagitis can lead to alterations in the structure and function of the esophagus.

According to a review of the Swedish National Rergister, esophagitis rates (diagnosed by endoscopy) are less than 5% among people aged 55 years. Other studies have estimated the prevalence in the same age group at around 2%.

If diagnosed rapidly and treated properly, the prognosis for esophagitis is usually good. Prognosis also depends on the underlying disease process.


Food and drink go down the esophagus

What are the signs and symptoms of esophagitis?

What is the difference between a sign and a symptom? A symptom is something the patient feels and describes, such as dizziness, pain, or anxiety. A sign is something other people, apart from the patient, can also detect, such as a rash, pallor, or weight loss.

The signs and symptoms most commonly linked to esophagitis include:

• Abdominal pain
• Adynophagia - pain when swallowing
• Dysphagia - difficulty swallowing
• Food gets stuck in the esophagus
• Lack of appetite
• Nausea, and possibly vomiting
• Cough
• Pain when eating, heartburn
• Mouth sores
• Feeding difficulties, and subsequently possible failure to thrive in young children and babies. At this age, most patients are too young to describe their symptoms

What are the causes of esophagitis?

Several conditions can cause esophagitis. It is most commonly caused by GERD (gastroesophageal reflux disease, GORD in British English). Sometimes the condition may be caused by more than one factor.

Esophagitis may be caused by:

• GERD - known as reflux esophagitis. There is a valve which stops acids from seeping back up into the esophagus, it is called the esophageal sphincter. If it is faulty - does not flap closed and open properly, stomach contents can reflux; make their way back up into the esophagus, effectively GERD. GERD can irritate the esophagus, leading to esophagitis.
• Allergies - they can cause eosinophilic esophagitis, triggered by an allergic reaction, usually to one or two foods. An eosinophil is a type of white blood cell (leukocyte). When there is an allergic reaction or a parasitic infection, the numbers of eosinophils in the blood usually rise. If eosinophils crowd the esophagus it will become inflamed.
• Some medications - known as drug-induced esophagitis - if in contact with the esophagus lining for too long, some oral medications can cause inflammation. This can happen if an oral medication is swallowed without washing it down with enough water. Residue from the tablet, pill or capsule may stay in the esophagus. Most commonly, it can occur with some painkillers, antibiotics, drugs to treat potassium deficiency (potassium chloride), and certain drugs for the treatment for osteoporosis, such as Fosamax (alendronate).
• Some infections - known as infectious esophagitis. People who are immunocompromised (have weakened immune systems) are more susceptible. Infectious esophagitis can be caused by candida (esophageal candidiasis), herpes simplex, and cytomegalovirus. With the help of endoscopy, a trained doctor (with the help of a pathologist) can identify the source of the infection.
• Other causes - such as alcohol abuse, radiation therapy, nasogastric tubes, and chemical injury from ingested alkaline or acid solutions can also cause esophagitis. Chemical injury may occur if a child drinks something from a kitchen cupboard they shouldn't, or an adult when swallowing caustic substances during a suicide attempt.

What are the risk factors for esophagitis?

A risk factor is something, such as a circumstance, genetic characteristic, lifestyle, bodyweight, etc., that can have an impact on the risk of developing a disease or condition. For example, being obese is a risk factor for diabetes type 2; it raises the risk of becoming diabetic.

The following are risk factors for GERD, which raises the chances of developing reflux esophagitis:

• Being overweight or obese
• Hiatal hernia
• Pregnancy
• Smoking
• Consuming certain foods and drinks in large quantities regularly, such as tomato-based ones, citrus fruits, chocolate, garlic, onions, spicy foods, alcohol, and caffeine.

Allergies - people with allergies, as well as those with a family history of allergies have a higher risk of developing eosinophilic esophagitis.

Medications - the following risk factors may raise the risk of developing drug-induced esophagitis:

• Having to swallow large pills/tablets
• Taking medications when not in an upright position (lying down)
• Taking medications just before going to bed (lying down within thirty minutes of taking medications)

Infections - having a weakened immune system may raise the risk of developing infectious esophagitis, as may occur in individuals..:

• ..undergoing chemotherapy or other cancer treatments
• ..with HIV/AIDS
• ..who have received a transplanted organ and have to take immunosuppressant drugs

How is esophagitis diagnosed?

After asking the patient some pertinent questions regarding symptoms, their medical (and perhaps family) history, and carrying out a physical examination, the doctor may order some further diagnostic tests.

Barium X-ray - the patient either swallows a barium-coated pill or drinks a barium solution. Barium sticks to the lining of the esophagus and stomach and helps provide well-defined outlines in X-ray pictures, which in turn help the doctors determine whether there is any narrowing or structural alteration in the esophagus. Examples of structural changes could be a hernia or a tumor.

Endoscopy - this device allows the doctor to have a good look inside. He/she uses an endoscope, a long, thin tube with a small camera at the end. The endoscope is threaded down the patient's throat and into the esophagus, where the doctor can see if there is anything abnormal. With the endoscope it is also possible to remove some tissue (biopsy) which can be sent to the laboratory for testing. By looking at the esophagus, the physician might be able to determine what caused the inflammation.

Tissue samples - a small amount of tissue may be removed to determine whether the inflammation is caused by an organism (bacterium, fungus, parasite, or virus), allergy (test eosinophil levels), cancer, or a precancerous change.

Allergy - some tests may be performed to find out whether the patient is sensitive to one or more allergens. This may involve a skin-prick test or elimination diet.

What are the treatment options for esophagitis?

Treatment will depend almost entirely on what caused the inflammation.

Reflux (GERD):

• Proton pump inhibitors - these are drugs that have a long-lasting effect on reducing gastric acid production.
• Fundoplication - surgery to treat GERD; it is also used for hiatus hernia. Part of the stomach is wrapped around the lower esophageal sphincter, thus strengthening it and preventing stomach acids from making their way back up to the esophagus.
  
  
  Illustration of a a Nissen fundoplication
  

Allergies:

• Corticosteroids - these oral medications can reduce allergy-related inflammation, resulting in less inflammation in the esophagus, allowing it to heal. Long-term use can affect bone density, stunt growth in children, lead to higher diabetes and/or acne risk, as well as some mood disorders.
• Inhaled steroids - primarily used for the treatment of asthma, inhaled steroids can help reduce the symptoms of eosinophilic esophagitis. In this case, the patient swallows the steroid preparation so that it coats the esophagus.
• Proton pump inhibitors - patients with esophagitis caused by allergies may have good results when prescribed proton pump inhibitors if the doctor suspects there is a certain amount of reflux as well.
• Food allergy - the treatment here is simply to eliminate foods that cause allergies. A good doctor will usually refer the patient to qualified dietician.

Esophagitis caused by certain medications - the doctor may prescribe an alternative medication, change its presentation (from solid to liquid form, for example), encourage the patient to drink plenty of water when taking a tablet/pill, and explain the importance of remaining upright when taking drugs (and perhaps staying upright for a while afterwards).

Esophagitis caused by infections - the doctor will probably prescribe a specific medication, depending on whether the pathogen is a virus, fungus, parasite or bacterium.

Severe narrowing of the esophagus - a procedure may be performed to dilate the esophagus.

What are the possible complications of esophagitis?

Esophagitis that remains untreated can lead to changes in the function of the esophagus, as well as its structure.

Barrett's esophagus - a complication of severe chronic GERD. The cells that line the bottom of the esophagus change. They become irritated due to refluxes. There is a higher risk of cancer (adenocarcinoma) of the esophagus.

Esophageal stricture - the esophagus narrows, making eating and drinking more difficult. Food can get stuck.

Esophageal rings - a ring of tissue in the inside of the lower part of the esophagus develops. This narrows the passage and partly blocks the esophagus.

Written by Christian Nordqvist
Original article date: 08 June 2004
Article updated: 25 November 2011


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