Esophagitis
Esophagitis is the inflammation of the esophagus, the muscular tube that connects the mouth to the stomach. Commonly associated with conditions such as gastroesophageal reflux disease (GERD), it can lead to complications like strictures, ulcers, and in rare cases, esophageal cancer. Various risk factors contribute to the development of esophagitis, including obesity, pregnancy, smoking, and certain foods and medications. Symptoms typically include heartburn, upper abdominal discomfort, nausea, and in some cases, difficulty or pain when swallowing.
Diagnosis often involves patient history, diagnostic tests like endoscopy and barium swallow studies, or ambulatory acid monitoring to assess reflux severity. Treatment focuses on alleviating symptoms, healing the esophagus, and preventing complications. Over-the-counter medications, dietary changes, and proton pump inhibitors are common management strategies, while infectious or immune-mediated esophagitis may require specific treatments like antibiotics or glucocorticoids. Most cases respond well to therapy, although some individuals, particularly those with radiation-induced esophagitis, may experience long-term effects. Understanding the causes and treatment options for esophagitis is essential for effective management and improved patient outcomes.
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Esophagitis
ALSO KNOWN AS: Inflammation of the esophagus
RELATED CONDITIONS: Gastroesophageal reflux disease (GERD), Barrett esophagus, heartburn (pyrosis), difficulty swallowing (dysphagia), painful swallowing (odynophagia)
DEFINITION: Esophagitis is a general condition in which the esophagus, the muscular tube connecting the mouth to the stomach, is inflamed. Different medical conditions are associated with esophagitis, including GERD, in which the stomach contents flow backward into the esophagus, and non-erosive reflux disease (NERD). Serious gastrointestinal complications of esophagitis include a narrowing of the esophagus (strictures), ulcers, and, in rare cases, a risk of esophageal cancer.
Risk factors: Factors that may increase the risk of developing esophagitis include pregnancy, obesity, scleroderma, smoking, alcohol, caffeine, chocolate, fatty or spicy foods, spinal cord injury, and certain medications (such as nonsteroidal anti-inflammatory drugs, or NSAIDs, including aspirin and ibuprofen).
Etiology and the disease process: The etiology of esophagitis differs depending on the cause of the inflammation. In GERD-associated esophagitis, a backflow (reflux) of acidic fluid from the stomach (containing gastric acid, pepsin, and sometimes bile) to the esophagus irritates the epithelium (the cells lining the esophagus). Sometimes, a premalignant condition called Barrett's esophagus can develop, which can increase the risk of developing esophageal cancer. However, the risk of esophageal cancer in patients with Barrett esophagus is relatively small—estimates range from 2 to 20 percent of Barrett esophagus patients a year.
Nonreflux esophagitis may be caused by infection (viral, bacterial, fungal, or parasitic organisms), chemicals (ingestion of a caustic chemical or medication), radiation therapy (physically damaging the lining of the esophagus leading to inflammation and ulceration), or in rare instances immune-mediated disorders (eosinophilic esophagitis).
Incidence: Esophageal reflux symptoms occur in up to 60 percent of the general population every month, with up to 20 percent having weekly symptoms. Radiation esophagitis occurs in up to 80 percent of patients receiving radiation therapy to the esophagus. Patients at the highest risk include those who receive high doses of radiation or radiation with concurrent chemotherapy.
Symptoms: The most common symptom is heartburn (pyrosis). Other common symptoms of esophagitis include upper abdominal discomfort, nausea, bloating, and fullness. Less common symptoms of esophagitis include dysphagia, odynophagia, cough, hoarseness, wheezing, and vomiting of blood (hematemesis).
Screening and diagnosis: A physician can establish a diagnosis of GERD based on patient history alone. However, if symptoms are severe or do not respond to treatment, the physician may order diagnostic tests designed to determine mucosal injury, amount of reflux, and pathophysiology, including barium X-ray series, endoscopy, an ambulatory acid (pH) probe test, and an esophageal impedance test.
During a barium X-ray series, the patient drinks a barium solution that, through a series of X-rays, provides a picture of the shape and condition of the esophagus, stomach, and upper intestine (duodenum). X-rays can also reveal a hiatal hernia, an esophageal narrowing, or a growth.
During an endoscopy, or an esophagogastroduodenoscopy (EGD), a flexible tube with a light and camera (endoscope) is inserted down the throat and can reveal inflammation of the esophagus or stomach. A may also be taken during an EGD to test for Barrett esophagus, esophageal cancer, or the presence of a bacterium that may cause peptic ulcers.
An ambulatory acid (pH) probe test can identify when and how long stomach acid flows back into the esophagus. A flexible tube (catheter) is inserted through the nose into the esophagus to position a probe just above the stomach. The other end of the catheter is attached to a small computer that records acid measurements. The probe remains in place to record measurements for one or two days.
The esophageal impedance test is similar to the ambulatory acid probe test except that it measures whether gas or liquids reflux back into the esophagus.
Treatment and therapy: Treatment goals are to relieve symptoms, heal ulcerations, and prevent complications. Reflux esophagitis is managed with over-the-counter agents, such as H2-receptor antagonists (cimetidine, ranitidine, famotidine, nizatidine), and with lifestyle changes such as altering eating habits (for example, avoiding alcohol, caffeine, carbonated beverages, chocolate, fatty foods, or overly large meals), ceasing to smoke cigarettes, and sleeping with the head of the bed elevated by about four to six inches. Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole, or rabeprazole) are frequently prescribed and appear highly effective at relieving symptoms and healing erosive esophagitis.
Infectious esophagitis is treated with antibiotics, whereas glucocorticoids are effective in patients with immune-mediated esophagitis. Radiation esophagitis treatment involves symptom management (like reflux esophagitis) and prevention (radioprotectors, varying treatment doses and schedules). For severe cases, a temporary feeding tube can be inserted into the stomach, or surgery may be required to treat the injuries. A prescription analgesic can be gargled with and swallowed to treat pain associated with esophagitis.
Prognosis, prevention, and outcomes: Though the response to therapy may differ depending on the specific cause of the esophagitis, the disorders that cause esophagitis usually respond to treatment. For individuals with radiation esophagitis, most symptoms resolve in two to four weeks, but long-term repercussions occur for some.
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