What are the main causes of erosive esophagitis. How is erosive esophagitis diagnosed. What are the most effective treatments for erosive esophagitis. Can erosive esophagitis lead to complications. How can erosive esophagitis be prevented.

Understanding Erosive Esophagitis: An In-Depth Overview

Erosive esophagitis is a condition characterized by inflammation and damage to the lining of the esophagus. This common digestive disorder can cause significant discomfort and, if left untreated, may lead to more serious complications. To fully grasp the nature of this condition, it’s essential to explore its causes, symptoms, and available treatment options.

What Exactly is Erosive Esophagitis?

Erosive esophagitis occurs when the lining of the esophagus becomes inflamed and damaged, often due to prolonged exposure to stomach acid. This condition is typically a severe form of gastroesophageal reflux disease (GERD), where stomach contents frequently flow back into the esophagus, causing irritation and erosion of the esophageal tissue.

Common Causes and Risk Factors of Erosive Esophagitis

Several factors can contribute to the development of erosive esophagitis. Understanding these causes can help in prevention and management of the condition.

• Gastroesophageal reflux disease (GERD)
• Hiatal hernia
• Obesity
• Pregnancy
• Smoking
• Excessive alcohol consumption
• Certain medications (e.g., NSAIDs, bisphosphonates)
• Infections (viral, bacterial, or fungal)

Are certain individuals more prone to developing erosive esophagitis? Yes, some people are at higher risk. Those with weakened immune systems, chronic health conditions, or a history of GERD are more susceptible to this condition.

Recognizing the Symptoms of Erosive Esophagitis

Identifying the symptoms of erosive esophagitis is crucial for early diagnosis and treatment. While symptoms can vary from person to person, there are several common signs to watch out for:

• Heartburn or chest pain
• Difficulty swallowing (dysphagia)
• Painful swallowing (odynophagia)
• Regurgitation of food or sour liquid
• Persistent cough or sore throat
• Nausea and vomiting
• Sensation of food sticking in the throat or chest

How can you differentiate between occasional heartburn and erosive esophagitis? The key difference lies in the frequency and severity of symptoms. While occasional heartburn is common, persistent symptoms that occur multiple times a week and interfere with daily activities may indicate erosive esophagitis.

Diagnosing Erosive Esophagitis: Tests and Procedures

Accurate diagnosis of erosive esophagitis is essential for proper treatment. Healthcare providers typically use a combination of methods to diagnose this condition:

1. Medical history and physical examination
2. Upper endoscopy (esophagogastroduodenoscopy or EGD)
3. Biopsy of esophageal tissue
4. pH monitoring
5. Barium swallow study
6. Manometry

What is the gold standard for diagnosing erosive esophagitis? Upper endoscopy is considered the most reliable method for diagnosing erosive esophagitis. This procedure allows direct visualization of the esophageal lining and enables the physician to assess the severity of inflammation and erosion.

Treatment Approaches for Erosive Esophagitis

The treatment of erosive esophagitis aims to relieve symptoms, heal the esophageal lining, and prevent complications. The approach may vary depending on the severity of the condition and its underlying cause.

Medications

• Proton pump inhibitors (PPIs)
• H2 receptor blockers
• Antacids
• Prokinetics
• Sucralfate

Lifestyle Modifications

• Dietary changes (avoiding trigger foods)
• Weight loss
• Smoking cessation
• Limiting alcohol consumption
• Elevating the head of the bed
• Avoiding lying down immediately after meals

Surgical Interventions

In severe cases or when conservative treatments fail, surgical options may be considered:

• Fundoplication
• LINX device implantation
• Endoscopic therapies (e.g., Stretta procedure, TIF)

What is the most effective treatment for erosive esophagitis? Proton pump inhibitors (PPIs) are generally considered the most effective treatment for erosive esophagitis. They work by reducing stomach acid production, allowing the esophageal lining to heal.

Potential Complications of Untreated Erosive Esophagitis

If left untreated, erosive esophagitis can lead to several serious complications:

• Esophageal strictures (narrowing of the esophagus)
• Barrett’s esophagus (precancerous changes in the esophageal lining)
• Esophageal ulcers
• Bleeding
• Perforation of the esophagus
• Increased risk of esophageal cancer

Can erosive esophagitis lead to permanent damage? Yes, if left untreated, erosive esophagitis can cause permanent changes to the esophageal lining, including scarring and the development of Barrett’s esophagus, which increases the risk of esophageal cancer.

Prevention Strategies for Erosive Esophagitis

While not all cases of erosive esophagitis can be prevented, there are several strategies that can help reduce the risk of developing this condition:

• Maintaining a healthy weight
• Eating smaller, more frequent meals
• Avoiding trigger foods (e.g., spicy, acidic, or fatty foods)
• Quitting smoking
• Limiting alcohol consumption
• Wearing loose-fitting clothing
• Managing stress
• Avoiding lying down immediately after meals
• Elevating the head of the bed

How effective are lifestyle changes in preventing erosive esophagitis? Lifestyle modifications can be highly effective in preventing erosive esophagitis, especially when combined with appropriate medical treatment. Many patients experience significant improvement in symptoms and a reduced risk of complications by implementing these changes.

Living with Erosive Esophagitis: Management and Coping Strategies

For individuals diagnosed with erosive esophagitis, managing the condition and coping with its effects can be challenging. However, with the right approach, it’s possible to maintain a good quality of life:

• Adhering to prescribed treatment plans
• Keeping a food diary to identify trigger foods
• Practicing stress-reduction techniques
• Joining support groups or seeking counseling
• Regular follow-up with healthcare providers
• Being prepared for potential flare-ups
• Educating family and friends about the condition

What role does diet play in managing erosive esophagitis? Diet plays a crucial role in managing erosive esophagitis. Avoiding trigger foods, eating smaller meals, and not eating close to bedtime can significantly reduce symptoms and promote healing of the esophageal lining.

Recent Advances in Erosive Esophagitis Research and Treatment

The field of gastroenterology is continually evolving, with new research and treatment options emerging for erosive esophagitis:

• Novel pharmaceutical approaches
• Improved endoscopic techniques for diagnosis and treatment
• Personalized medicine based on genetic factors
• Minimally invasive surgical options
• Probiotics and microbiome research
• Alternative and complementary therapies

What are some promising areas of research in erosive esophagitis treatment? Emerging research areas include the development of new classes of acid suppressants, targeted therapies for specific subtypes of esophagitis, and the exploration of the gut microbiome’s role in esophageal health.

Erosive esophagitis is a complex condition that requires a comprehensive approach to diagnosis, treatment, and management. By understanding its causes, recognizing its symptoms, and implementing appropriate treatment strategies, individuals with this condition can effectively manage their symptoms and prevent complications. As research continues to advance, we can expect even more effective treatments and management options in the future, improving the quality of life for those affected by erosive esophagitis.

Esophagitis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Esophagitis refers to inflammation or injury to the esophageal mucosa. One of the most common causes is gastroesophageal reflux, which can lead to erosive esophagitis. Other etiologies include radiation, infections, local injury caused by medications, pill esophagitis, and eosinophilic esophagitis (EoE). The most common symptoms in patients with esophagitis are chest pain, odynophagia, and dysphagia. Patients with EoE may present with food impaction. If the esophagitis is severe and leads to strictures, fistulization, and perforation, patients may present with symptoms related to those entities.

Objectives:

• Contrast the typical history and physical exam findings in eosinophilic esophagitis, erosive esophagitis, infective esophagitis, and pill esophagitis.

• Describe the presentation of patients with potential complications of esophagitis such as food impaction, strictures, fistulas, and perforation.

• Review the etiology-specific management of esophagitis.

• Outline the importance of enhancing care coordination among the interprofessional team to ensure proper evaluation and management of esophagitis.

Access free multiple choice questions on this topic.

Introduction

Esophagitis refers to inflammation or injury to the esophageal mucosa. There are many causes of esophagitis and essentially the presentation is similar which include retrosternal chest, heartburn, dysphagia or odynophagia.[1][2]

One of the most common causes is gastroesophageal reflux, which can lead to erosive esophagitis. Other etiologies include radiation, infections, local injury caused by medications, pill esophagitis, and eosinophilic esophagitis (EoE). The most common symptoms in patients with esophagitis are chest pain, odynophagia, and dysphagia. Patients with EoE may present with food impaction. If the esophagitis is severe and leads to strictures, fistulization, and perforation, patients may present with symptoms related to those entities.

Etiology

Multiple etiologies for esophagitis have been identified such as reflux esophagitis, Medication (Pills) induced esophagitis, infectious , eosinophilic and radiation esophagitis.[3] 

• Reflux or erosive esophagitis that occurs because of the reflux of gastric contents into the stomach leading to mucosal injury is one of the most common causes of esophagitis.

• Infection esophagitis can be caused by bacteria, viruses, fungal and parasitic microorganisms with the least common being bacteria and the most common being fungal.

• Pill induced esophagitis is most commonly associated with oral bisphosphonates like alendronate, some antibiotics like tetracycline, doxycycline, and clindamycin. NSAIDs, aspirin, ferrous sulfate, potassium chloride, and mexiletine has also been reported as a cause of pill-induced esophagitis.

• Eosinophilic esophagitis (EoE) is now thought to be a chronic immune antigen-related esophageal disease with almost similar symptoms of esophagitis but histologically have squamous mucosal inflammation caused by predominant eosinophilic infiltration. [4]

• Radiation-induced esophagitis is associated with radiotherapy related toxicity and can present as both in acute and chronic forms.

Epidemiology

Epidemiology varies depending on the subset to which one refers.[5][6][7]

• Professionals estimate that 1% of the population suffers from erosive esophagitis.

• Medication-induced esophagitis has an estimated incidence of 3.9 per 100,000 population per year with a mean age at diagnosis of 41.5 years.

• Many studies have tried to identify the most accurate incidence and prevalence of eosinophilic esophagitis. The estimated incidence is 0.35 per 100,000 population with a prevalence of 55 per 100,000 population has been associated with food allergies, asthma, and eczema. It appears to be more common in males who usually present with symptoms in their 2nd or 3rd decade. 

• Radiation esophagitis is a relatively frequent complication of radiation therapy. Acute injury invariably occurs at doses of 6000 cGy given in fractions of 1000 cGy per week. Lower doses or longer schedules are associated with lower rates of radiation esophagitis.  

• For infectious esophagitis, the numbers are not very easy to define. One thing that is certain is that is way more prevalent in patients who are immunocompromised such as HIV-infected patients and patients with hematological malignancies.

Pathophysiology

The pathophysiology also depends in large part on the subset of esophagitis to which one refers.[8][9][10]

• Reflux esophagitis: Abnormal amount and frequent reflux of gastric content into the esophagus lead to mucosal injury. Several mechanisms take place in the pathophysiology of reflux. See more information in the Gastroesophageal Reflux Disease (GERD) chapter. Briefly, the lower esophageal sphincter (LES) seems to have decreased tone and increased transient relaxations. These factors facilitate the anterograde flow of acid. Also, patients with large Hiatal hernias seem to have a higher incidence of reflux since they contribute to a decreased tone in the LES. In contrast, any conditions that decrease esophageal peristalsis or affects saliva content can affect the protective mechanisms in place to prevent esophageal injury, contributing to the development of reflux esophagitis.

• Medication-induced esophagitis: The pathogenesis of medication-induced esophagitis involves a direct irritant effect and disruption of cytoprotective barriers. Researchers hypothesize that prolonged contact of irritants with the esophageal mucosa can lead to damage. Medications like doxycycline, tetracyclines, and ferrous sulfate can cause local caustic injury as they have a pH of less than three once dissolved in water or saliva. Other medications such as potassium chloride can cause tissue destruction and vascular injury due to its hyperosmolar nature.

• Eosinophilic esophagitis: The pathogenesis of EoE is incompletely defined. Considerable evidence suggests that eosinophilic esophagitis is an allergic disorder induced by antigen sensitization either through foods and/or aeroallergens. Eotaxin, interleukin 5 (IL-5) and STAT6 may play important roles. Some patients have at least partially improved symptoms with acid suppression therapy suggesting that acid reflux may be a contributor.

• Radiation esophagitis: The pathophysiology involves DNA damage and cell death from high-energy electrons leading to the formation of volatile oxygen-free radicals. The radiation injury can be acute or chronic. In the acute phase, radiation destroys epithelial cells and interferes with proliferation. Small doses can lead to villous blunting and minor alterations in mucosal formation, but larger doses can denude extensive regions of the mucosa. The chronic injury seems to involve small vessel ischemic injury. Endothelial inflammation coupled with smooth muscle and fibroblast proliferation compromise blood flow into the small vessels. Excessive fibrosis and the presence of atypical fibroblasts characterizes chronic radiation injury. Progressive injury can lead to strictures, ulceration, fistula formation and even perforation.

• Infectious esophagitis: Infection esophagitis can be caused by bacterial, fungal, parasitic and viral micro-organisms. Bacterial esophagitis is the least common of all. Candida albicans infection is the most common cause of infectious esophagitis. The first step in the pathophysiology involves colonization with mucosal adherence and proliferation. The second step involves impairing the host defense mechanisms. C. Albicans is a normal component of oral flora, but it can become a problem if their number increases (e.g., with the use of antibiotics) or if the patient is immunosuppressed (e.g., by therapy with corticosteroids). Herpes simplex virus (HSV) is the most common cause of viral esophagitis. It infects the squamous epithelium leading to vesicles and then ulcerations. Cytomegalovirus (CMV), Epstein-Barr (EBV) and varicella-zoster (VZV) are other viral causes of viral esophagitis.

Histopathology

Reflux esophagitis histopathology usually not very specific. common findings are dilation of intercellular space and neutrophils and eosinophils infiltration. Eosinophilic infiltration if present in GERD esophagitis can mimic eosinophilic esophagitis however it also responds to treatment with proton pump inhibitors in contrast with eosinophilic esophagitis

Eosinophilic esophagitis histopathology shows intraepithelial eosinophils and usually requires at least 15/HPF eosinophils in at least one biopsy sample to diagnose EoE.

Multinucleated giant cells with ballooning and degeneration of squamous cells with Cowdry type A inclusion is pathognomonic diagnosis finding for HSV esophagitis and Large cells with both intracytoplasmic inclusions and amphophilic intranuclear inclusions are seen in CMV esophagitis.[11][5]

History and Physical

The most common symptoms and signs are retrosternal chest pain, Heartburns, odynophagia or dysphagia. Patients with EoE can present with food impaction and more often seen in young adults or children with some history of asthma, food allergy or atopy. Reflux esophagitis symptoms may include Globus sensation, regurgitation and sometimes wheezing or chronic cough. History should be included regarding commonly known medicine ingestion which can cause pill-induced esophagitis. History of cancer and radiation therapy can provide a clue regarding radiation esophagitis.

Evaluation

Diagnosis of esophagitis can be made based on history and clinical examination however to differentiate subtypes of esophagitis requires endoscopy and biopsy examination. In suspected acid reflux esophagitis if symptoms are mild to moderate then an endoscopy may not be required and can be reserved if poor or failed response to proton pump inhibitors. Similarly, if the history is very suggestive of medication-induced (pill) esophagitis, endoscopy may not be initially required. 

The endoscopic appearance of the mucosal lesions can help with diagnosis. In patients with suspected eosinophilic esophagitis, endoscopy may reveal white exudates or papules, red furrows, corrugated concentric rings, and strictures; but endoscopy may be normal in up to 10% of patients. Endoscopic signs of candidiasis are small, diffuse, linear, yellow-white “cheese-like” plaques adherent to the mucosa. CMV esophagitis is characterized by several large, shallow, superficial ulcerations. HSV esophagitis results in multiple small, deep ulcerations.

Endoscopic biopsy of esophageal lesion histology study can differentiate and confirm different esophagitis etiology. Patients with eosinophilic esophagitis on histology will have a characteristic eosinophilic infiltration (> 15 eosinophils per high-power field). Histology can also be helpful in the diagnosis of infectious etiologies. Multinucleated giant cells with ballooning and degeneration of squamous cells are diagnostic of HSV esophagitis with Cowdry type A inclusions being pathognomonic. Large cells with both intracytoplasmic inclusions and amphophilic intranuclear inclusions are suggestive of CMV esophagitis.[11][5]

Treatment / Management

Treatment depends on the etiology but core principles of treatment in addition to etiology specific treatment include acid suppression with PPI or h3 blockers, lifestyle modification, liquid to soft or puree diet to allow adequate time for healing and dietary modification. If the etiology appears to be acid reflux based on history then the use of h3 blockers twice a day or proton-pump inhibitors daily is indicated initially. Patient should also be advised of lifestyle and dietary modifications which include weight loss, elevating the head end of bed (patient with nocturnal symptoms of cough, hoarseness, sore throat), elimination of some dietary triggers such as fatty food, chocolate, carbonated drinks, spicy food, smoking, and alcohol. If the etiology is medication-induced esophagitis, the medication should be stopped if possible and if necessary then should be switched to any other alternatives. The patient should be instructed to take pills with 4 oz of water and remain upright for 30 min after taking the pills. For eosinophilic esophagitis treatment include acid suppression, topical or systemic steroids either topical budesonide or fluticasone and dietary modification if a food allergy is suspected. If etiology is infectious, target therapy is indicated. For C.  Albicans, oral fluconazole is the drug of choice. For HSV esophagitis, treatment is oral or intravenous acyclovir and Foscarnet for those who are non-responders. CMV esophagitis is treated with Gancyclovir or Valganciclovir. Treatment of complications like stenosis or stricture may require endoscopic dilation. Addition of topical anesthesia like topical lidocaine (e.g. GI cocktail) and opioids may help in ulcers related pain. NSAIDs must be avoided as it may exacerbate symptoms.[12][13][14]

Differential Diagnosis

In general, all types of esophagitis can mimic each other as the initial clinical presentation is usually similar and will require further detailed history and further diagnostic test including endoscopy and histopathology examination. Histologically Reflux esophagitis can closely mimic eosinophilic esophagitis. In these cases, usual clinical practice is to prescribe Proton pump inhibitors (PPI) for 8 weeks. Acid reflux esophagitis usually responds well to PPI treatment with a resolution of eosinophilic infiltration but the persistence of clinical symptoms or eosinophilic infiltration on repeat endoscopy confirms EoE. Endoscopy appearance of the esophageal lesion with histology also confirm different types of infectious esophagitis. 

Because retrosternal chest pain and dysphagia or odynophagia are common symptoms are shared by many other diseases differential diagnosis is usually broad. 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.

Radiation Oncology

Irradiation therapy for treatment of  thoracic ,head and neck or abdominopelvic malignancy can cause radiation induced esophageal injury .  Treatment 

Complications

Complication of chronic and untreated esophagitis includes 

Consultations

Gastroenterology service is required in the comprehensive management of esophagitis including diagnosis and treatment of esophagitis related complications. Dietary consultation can be useful in-patient education regarding dietary modification

Deterrence and Patient Education

Lifestyle and dietary modifications are important parts of treatment and further prevention of esophagitis. Patient with Acid reflux esophagitis who are overweight should try for weight loss. Common dietary triggers and habits which include fatty and spicy meals, coffee, carbonated drinks, spicy food, chocolate, alcohol, smoking and not keeping enough time between dinner and bedtime should be avoided. The elevating head end of the bed to 30-45 degree can help with nocturnal symptoms of acid reflux include night cough, sore throat and voice hoarseness. Patient diagnosed with EoE should avoid foods they are allergic to. Maintenance of small meals, clear liquid or soft puree diet during treatment can help with symptoms and accelerate healing time.[15] 

Enhancing Healthcare Team Outcomes

There are many causes of esophagitis and healthcare workers in many disciplines will encounter these patients. To avoid delay in diagnosis, an interprofessional approach is necessary. The prognosis for most patients is good with prompt treatment, but ultimately the outcomes depend on the underlying cause. When esophagitis is recurrent, it can lead to anxiety and absenteeism from work because of the need to rule out other more serious causes of chest pain. Untreated esophagitis can lead to stricture formation and malnutrition. Both bleeding and perforation are also relatively common complications. Some patients may aspirate and develop pneumonitis or worsening of asthma. In most patients who do not change their lifestyle, recurrences are common, and thus life long therapy is required. In immunocompromised patients, both candida and herpes can lead to severe pain, dysphagia, and weight loss. Patient education is key when a diagnosis of esophagitis is made. The patient should be told to sleep with the head of bed elevated, avoid lying supine after a meal and lose weight. The patient should also avoid caffeinated beverages, alcohol and discontinue smoking. Finally, the patient should be told to avoid NSAIDS.[16][17]

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• Comment on this article.

Figure

Candida esophagitis. Image courtesy S Bhimji MD

Figure

Eosinophilic esophagitis. https://commons.wikimedia.org/wiki/File:Multi_ring_esophagus.jpg
Samir at the English language Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)]

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Ishimura N, Sumi S, Okada M, Mikami H, Okimoto E, Nagano N, Araki A, Tamagawa Y, Mishiro T, Oshima N, Ishihara S, Maruyama R, Kinoshita Y. Is Asymptomatic Esophageal Eosinophilia the Same Disease Entity as Eosinophilic Esophagitis? Clin Gastroenterol Hepatol. 2019 Jun;17(7):1405-1407. [PubMed: 30144524]

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Disclosure: Catiele Antunes declares no relevant financial relationships with ineligible companies.

Disclosure: Ashish Sharma declares no relevant financial relationships with ineligible companies.

Esophagitis Causes, Symptoms, Treatments

Written by WebMD Editorial Contributors

• What Is Esophagitis?
• Esophagitis Symptoms
• Esophagitis Causes and Risk Factors
• Esophagitis Diagnosis
• Esophagitis Treatments
• Esophagitis Prevention
• Esophagitis Outlook
• More

Esophagitis is an inflammation of the lining of the esophagus, the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers, and scarring of the esophagus.

Symptoms of esophagitis include:

• Difficult or painful swallowing
• Acid reflux
• Heartburn
• A feeling of something of being stuck in the throat
• Chest pain
• Nausea
• Vomiting

If you have any of these symptoms, you should contact your doctor as soon as possible.

Causes

Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include:

Candida. This is a yeast infection of the esophagus caused by the same fungus that causes vaginal yeast infections. The infection develops in the esophagus when the body’s immune system is weak, such as in people with diabetes or HIV. It is usually very treatable with antifungal drugs.

Herpes. Like candida, this viral infection can develop in the esophagus when the body’s immune system is weak. It is treatable with antiviral drugs.

Irritation leading to esophagitis can come from 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
• Swallowing a toxic substance
• Hernias
• Radiation treatment for cancer

Risk factors

Some lifestyle choices can make esophagitis more likely, including:

• Eating right before you go to sleep
• Too many large meals with high-fat foods
• Smoking
• Heavy alcohol use
• Carrying extra weight, including when you’re pregnant

Some foods can also give you a higher chance of esophagitis if you eat them. These include:

• Caffeine
• Citrus
• Spicy foods
• Garlic
• Onions
• Chocolate
• Mint

Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:

Upper endoscopy. A test in which a long, flexible lighted tube, called an endoscope, is used to view the esophagus.

Biopsy. During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope.

Upper GI series (or barium swallow). During this procedure, X-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an X-ray. This characteristic enables doctors to view certain abnormalities of the esophagus.

Treatment for esophagitis depends on the type of esophagitis you have.

Reflux esophagitis is when the contents of your stomach back up into your esophagus. If it happens a lot, your doctor may tell you that you have a condition called GERD (gastroesophageal reflux disease). To treat this, you might use:

• Over-the-counter drugs like antacids, or medications that block acid production like lansoprazole (Prevacid) and omeprazole (Prilosec)
• Prescription drugs that can block acid production or help clear your stomach
• Surgery to strengthen the valve that separates your stomach and your esophagus

Eosinophilic esophagitis is when a large number of white blood cells called eosinophils come together in your esophagus. Usually, this happens because of an allergy. It can be triggered by pollen or some foods.

To treat this, you might take:

• Prescription medicines to block acid production
• Steroids like budesonide (Pulmicort) and fluticasone (Flovent)
• Monoclonal antibodies like dupilumab (Dupixent) work by stopping the action of inflammation-causing proteins. You get it in a weekly injection.  

Your doctor may also suggest an elimination diet. This is where you stop eating common food allergens for a while, then slowly add them back in. This can help you and your doctor figure out which foods might cause your esophagitis.

Drug-induced esophagitis happens when medicines touch the lining of your esophagus for too long. For this, your doctor might:

• Change your medication
• Give it to you in liquid form, if possible

They might also advise you to take your medicine with a full glass of water or ask that you stand or sit for at least 30 minutes after you take it.

Infectious esophagitis happens when the tissues of your esophagus are infected. This can happen if you have cancer or HIV. To treat it, you’ll take a medication to clear up your infection.

If your esophagus is very narrow or food is stuck in it, your doctor may perform a procedure called esophageal dilation, which will expand your esophagus.

Some people turn to alternative treatments to ease symptoms. These aren’t used in place of medical treatments, but in addition to them.

They can include:

• Herbal remedies like licorice, chamomile, and marshmallow
• Relaxation practices like progressive muscle relaxation or guided imagery
• Acupuncture

Make sure you talk with your doctor before you start any alternative treatments.

While you have treatment for esophagitis, there are certain steps you can take to help yourself feel better:

• Avoid spicy foods such as those with pepper, chili powder, curry, and nutmeg.
• Stay away from hard foods such as nuts, crackers, and raw vegetables.
• Try not to eat right before bedtime.
• Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits, and their juices. Instead, try imitation fruit drinks with vitamin C.
• Add more soft foods to your diet such as applesauce, cooked cereals, mashed potatoes, custards, puddings, and protein shakes.
• Try to stay clear of meals with a lot of fatty foods.
• Keep caffeine, chocolate, and mint-flavored foods to a minimum.
• Take small bites and chew food thoroughly.
• Drink liquids through a straw to make swallowing easier.
• Avoid alcohol and tobacco.
• When you take medication, take it with plenty of water.
• Don’t take medicine lying down or right before you go to sleep.

It’s very important that you follow your doctor’s treatment plan for your esophagitis. If you do, you should get relief.

However, if esophagitis goes untreated, it can lead to:

• Scarring of your esophagus. Your doctor might call this “stricture.” It can make swallowing very difficult.
• Something doctors call “esophageal perforation.” That’s a tearing of the tissue that lines your esophagus. It can come from gagging when food gets stuck there or when you have an upper endoscopy. This can also make swallowing difficult. It can also make it hard to breathe.

You may get a condition known as Barrett’s esophagus. Barrett’s esophagus can lead to esophageal cancer.

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What is esophagitis – causes, symptoms, treatment and prevention

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The effectiveness of the treatment of esophagitis in the Hadassah Medical Moscow clinic is due to the use of the best European protocols. Comfortable conditions, individual attitude to each patient, all types of diagnostic tests in one clinic. Our own laboratory allows you to quickly make analyzes and get accurate results. The doctors of the gastroenterology department are highly qualified and have extensive experience in the treatment of esophagitis and other gastrointestinal diseases.

Esophagitis is an inflammation of the mucous membrane of the esophagus, the most common disease among all pathologies of the gastrointestinal tract. Many factors lead to the defect, which must be considered for primary and secondary prevention. The condition is accompanied by pain and characteristic symptoms, but it must be differentiated from other pathologies, for example, a malignant neoplasm of the stomach, peptic ulcer. Esophagitis itself can cause malignant degeneration of tissues, so its timely diagnosis and adequate treatment is the prevention of gastrointestinal cancer.

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Anaida Valerievna

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Benefits of treating esophagitis, gastrointestinal pathologies in the Hadassah clinic

Extensive diagnostic capabilities, own laboratory

Hadassah performs all types of laboratory and hardware research. In the diagnosis of esophagitis, endoscopic techniques, contrast radiography, cytological, microscopic laboratory studies are used. The latest equipment, our own laboratory allow you to perform diagnostics quickly and accurately.

High international level medical services in Moscow

Hadassah Medical Gastroenterology Department provides highly qualified assistance with the choice of the most optimal and effective treatment option. The best treatment protocols, effective original drugs, consultations of expert doctors from other countries, without going abroad.

Interdisciplinary approach of clinic doctors, medical consultations

Unique treatment regimens, original drugs, interdisciplinary approach of clinic specialists help to solve a problem of any complexity. The medical decision does not depend on the opinion of one specialist, because several doctors of different specializations participate in the treatment to develop an objective professional view.

Rehabilitation of patients – continuation of the treatment program with medical support

Rehabilitation, recovery is an important part of the treatment, so doctors control this process, developing an individual rehabilitation program for each patient. If necessary, the patient will be cared for with all necessary medical procedures.

An integrated approach in the treatment of esophagitis, gastrointestinal pathologies

In addition to therapeutic, surgical treatment, the patient will be prescribed a program of diet therapy, herbal medicine, physiotherapy treatment with full medical support, tracking results. Hadassah is consulted by a nutritionist.

Unique surgical treatment with high efficiency

Operations at Hadassah are performed by world-class professionals. During any operation, modern high-tech equipment is used. The uniqueness of the treatment lies in the presence of an interdisciplinary team. With us you will receive a specialized consultation with an objective assessment of prescriptions made in other medical institutions.

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What is esophagitis?

Esophagitis affects 5-6% of the total population of the Earth, and the pathology is more common in men. Symptoms may be completely absent or make the life of the patient completely unbearable due to the severity of many symptoms. The health risks that this disorder brings with it serve as a serious reason for diagnosis, correction of the condition with medical support.

There are a lot of damaging factors that cause pathological changes, inflammation, ulceration on the walls of the esophagus. But in the vast majority of cases, the reasons lie in the regular reflux of the contents of the stomach into the lumen of the esophagus. The acidity in these sections is different, so the walls of the overlying organ are exposed to aggressive action, which forms inflammatory changes and ulcers.

Damage to the layers of the walls of the esophagus can have different degrees and volumes. On esophagogastroduodenoscopy, characteristic changes in the organ are visualized: thickening and swelling of the walls, areas of ulceration, tissue laxity, altered folding of the esophagus, insufficiency of the esophageal sphincter.

Patients tend to consider the initial signs of esophagitis insignificant, using folk remedies to suppress heartburn or self-treat gastric disorders. This leads to a delay in the pathological process and the early development of complications.

Symptoms of esophagitis

The clinical picture of the disease depends on its type. The most common symptom complex is associated with gastroesophageal reflux disease, when the esophagus becomes inflamed as a result of regular reflux of food masses and gastric juice with high acidity from the stomach.

This disorder is called GERD, it has its own characteristic features:

• constant heartburn, sour, bitter belching;
• bad breath;
• pain behind the sternum, which is considered by many to be cardiac;
• sensation of slow, painful progression of the food bolus through the esophagus;
• pain in the sternum when eating;
• attacks of uncontrollable nocturnal cough.

Inflammation of the esophagus may involve ENT pathologies – pharyngitis, hoarseness. The acidic environment reaches the mouth, which provokes dental problems, deterioration of tooth enamel – erosion, caries, gingivitis, periodontitis. Often patients with GERD have a “geographic” red tongue with a coating.

Symptoms of inflammation of the esophagus of an infectious nature:

• Heartburn, belching.
• Frequent nausea, vomiting. The gag reflex can be manifested in the act of swallowing.
• Pain in the sternum.
• Subfebrile body temperature.
• Fever, signs of general intoxication.

The condition is often accompanied by a sharp weight loss, deterioration of the skin, hair, nails. A common complication is sepsis.

If complications develop, the symptoms for all types of pathology manifest themselves as follows:

• Melena, or black stools with a lot of digested blood.
• Vomiting blood.
• Difficulties with swallowing and moving the food bolus through the organ, up to complete stenosis and inability to eat.
• Signs of anemia, beriberi, malnutrition.
• Significant weight loss, lack of appetite, fear of eating.
• Hoarseness of voice, cough without respiratory cause.

Chronic and acute esophagitis have the same symptoms, the difference in the duration and severity of their manifestation. If the acute course of the disease is accompanied by severe, unbearable pain behind the sternum and a rapid increase in symptoms, then the chronic course has an unexpressed, erased, periodic symptomatology, while pain may not be.

Diagnostic program

When esophagitis is diagnosed, the symptoms and drug treatment depend on the type, stage of the disease, and the presence of complications. Diagnosis is an important stage of treatment; the effectiveness of the methods used depends on the accuracy of the results. First, the doctor gets acquainted with the anamnesis, the patient’s complaints, and examines the nature of the symptoms. Methods most commonly used for diagnosis, differential diagnosis before treatment of inflammation of the esophagus:

Endoscopy

the main base for the diagnosis of esophagitis. A visual examination of the esophageal mucosa is able to give a comprehensive picture of both the localization of the pathological process and its causes (detection of gastroesophageal reflux) and the depth of the wall lesion.

Contrast radiography of the esophagus with barium

allows you to assess the depth and extent of damage to the esophageal wall.

Cytological and microscopic examination

endoscopy biopsy from affected areas. Cytological cell typing can give a clear answer to the question of the cause of the disease and its form (catarrhal, erosive).

The doctor considers comprehensively the results of the diagnosis, the symptoms of esophagitis and prescribes medication.

With the development of complications, surgery is often required to stop life-threatening bleeding and eliminate irreversibly damaged tissues of the organ.

Treatment of esophagitis

Tactics of therapy for inflammatory processes in the esophagus depends on the form of the pathology, severity, the presence of concomitant symptoms and the nature of the disease.

In catarrhal esophagitis, treatment consists of prescribing antacids and agents that have a protective effect on the esophageal mucosa.

Treatment of erosive esophagitis requires combinations of antacids with proton pump blockers. This type of medicine has a long-term acid-suppressing effect on the stomach wall and allows you to more confidently control the concentration of hydrochloric acid, which is necessary for the healing of esophageal erosions.

In severe cases, the patient is transferred to parenteral nutrition with the appointment of local anesthetics.

Bleeding from an eroded esophagus requires the use of endoscopic hemostasis: hemostatic drugs are delivered through a probe to the site of bleeding.

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Causes of inflammation of the esophageal wall

Knowing about the disease esophagitis, that it is an inflammatory process that captures the superficial or all layers of the esophagus wall, we can assume the main triggers. The causes can be endogenous or exogenous in nature, they can be conditionally divided into main groups.

Exogenous or external factors:

• Infectious agents. As a rule, they affect people with a low immune status, regardless of its causes. The most common pathogens are the herpes virus, Candida fungi.
• Chemical, medicinal. This may be the influence of aspirin, tetracycline, doxycycline, potassium chloride, etc.
• Temperature, radiation, mechanical damaging factors. These can be scratches of the esophagus with rough food, the effects of radiation therapy, trauma, pressure sores or damage from the probe, exposure to very hot food.

Endogenous, or internal factors:

• Reflux esophagitis – reflux of aggressive stomach contents into the esophagus as a result of sphincter failure, high intra-abdominal pressure, dietary habits, etc.
• Autoimmune pathologies, Behçet’s disease.
• Crohn’s disease.

Different influence, duration, strength of damaging agents lead to different course, severity of the disease. Most often, doctors deal with advanced chronic forms of reflux esophagitis, because people tend to consider unpleasant symptoms as natural companions of digestion and first turn to doctors when complications develop.

Types, stages of development of the disease

In the medical classification, esophagitis has the code K20. Since there are a lot of forms of pathologies, there is no generally accepted classification. Doctors use the Chernin table to determine the type of chronic pathology, its volume, stage.

Disease form:

• Acute.
• Chronic.
• Species by reason:
• Exogenous origin.
• Endogenous origin.
• Mixed type.

Type:

• Catarrhal.
• Erosive esophagitis.

By volume:

• Local.
• Common.
• By localization area:
• Proximal.
• Distal.
• Medium.
• Area near the esophageal sphincter.

Downstream:

• Slowly developing.
• With rare relapses (1-2 times a year).
• With frequent relapses (from 3-4 times a year).
• Complicated, severe.

4 degrees of acute pathology according to the H. Basset scale:

• Mucosal edema.
• Single erosions.
• Foci of erosion, bleeding. For example, distal erosive esophagitis.
• Extensive erosions, bleeding of the entire surface.

4 degrees of chronic condition according to the Savary-Miller scale:

• Hyperemic mucosa without erosions.
• Multiple minor erosions.
• Erosion foci.
• Ulcers, stenosis.

Stages of the disease:

• Superficial esophagitis – minor changes in the mucous membrane without compromising its integrity.
• Severe inflammation of the wall.
• Regeneration of once damaged areas of the mucosa.
• In the chronic course of the pathology, even at the stage of remission, complete healing of defects does not occur. Endoscopic diagnostics reveals significant areas of altered tissue, where constant moderate bleeding can be observed.

Prevention and treatment programs for esophagitis, complications in the Hadassah clinic

Gastroenterologists and functional diagnostics doctors will conduct a full examination in the presence of characteristic complaints. After establishing an accurate diagnosis, an individual treatment regimen will be selected and drugs will be prescribed that best eliminate the symptoms and cause of the disease.

The Hadassah clinic doctors in Moscow have at their disposal the most modern means for the treatment of esophagitis that meet the standards of international protocols.

In case of acute situations (bleeding, stenosis of the esophagus), the patient can be provided with the necessary endoscopic and surgical care.

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Egorova
Olga Nikolaevna

Gastroenterologist

Work experience: 17 years

Published: 24.06.2023

reference and cannot serve as a basis for making a diagnosis or prescribing treatment. Internal consultation of the expert is necessary.

sources

• Nasyrov R. A. et al. Morphological features of the esophagus in normal and pathological conditions // University Therapeutic Bulletin. – 2022. – T. 4. – No. 3. – P. 4-13.
• Chernousov A., Khorobrykh T., Vetshev F. Reflux esophagitis. – Litres, 2022.
• Osadchuk AM et al. Gastroesophageal reflux disease and esophagitis associated with the use of drugs: the current state of the problem // Therapeutic archive. – 2019. – T. 91. – No. 8. – S. 135-140.
• Ostroumova O. D., Kachan V. O. Drug-induced esophagitis // Evidence-based gastroenterology. – 2020. – T. 9. – No. 3. – S. 47-54.
• Chechenkova EV et al. Eosinophilic esophagitis is the diagnosis correct? – 2021.
• Akimenko R. I. et al. Microscopic esophagitis: relevance and diagnostic criteria // Ural Medical Journal. – 2019. – No. 11. – P. 128-135.
• Belousov Yu. B. et al. Drug-induced esophagitis: modern pharmacological possibilities for solving a clinical problem.
• Kaibysheva VO et al. Eosinophilic esophagitis: own experience in diagnosis and treatment // Experimental and Clinical Gastroenterology. – 2018. – No. 10 (158). – S. 92-109.
• Kozhemyakina AA Lesions of the upper gastrointestinal tract in Crohn’s disease and ulcerative colitis. – 2021.

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