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Esophagitis

Esophagitis

The esophagus is a muscular tube leading from the back of the throat into the stomach. Esophagitis is an inflammation of the lining of the esophagus, caused by infection or irritation of the inner lining (mucosa) of the tube.

 

Common symptoms include heartburn and painful swallowing. If undiagnosed or untreated, esophagitis can cause problems with swallowing, ulcers, scarring of the esophagus, or "Barrett's esophagus", which can be a precursor to esophageal cancer.

 

In general, esophagitis caused by infection or inflammation is very treatable with mediation, dietary or behavioral modification and in some cases, surgical intervention. Most individuals recover fully, some have chronic inflammation that is managed with long-term medical treatment.

 

About 10% to 15% of patients with GERD go on to develop Barrett's esophagus. Less than 1% of patients withe Barrett's esophagus develop cancer, still, they are at an increased risk. Those who have Barrett's esophagus should be monitored closely by a gastroenterologist.

 

The outlook for patients with eosinophilic esophagitis is favorable. It is a chronic, relapsing condition, but not usually one that is life-threatening. Treatments are evolving using different immune modulators to decrease the allergy-like reactions.

 

Achalasia is a progressive, but treatable disorder. Close monitoring by a gastroenterologist is mandatory. A small number of individuals with achalasia may develop squamous cell cancer (carcinoma) as a result.

Symptoms

Symptoms of esophagitis include:

 

  • Difficult and/or painful swallowing, especially if there is a feeling of food getting stuck on the way down.
  • Heartburn, acid reflux, or unpleasant taste in mouth.
  • Sore throat or hoarseness.
  • Mouth sores.
  • Nausea, vomiting, or indigestion.
  • Chest pain, in the middle of the chest, often radiating to the back, usually associated with swallowing or soon after a meal.
  • Bad breath (halitosis).
  • Excessive belching.

Causes

Gastroesophageal reflux disease, or GERD, is the most common cause of esophagitis. When you have GERD, stomach acid and juices flow backward into your esophagus. This can irritate the esophagus.

 

Other causes include:

 

  • A hiatal hernia.
  • Medicines that irritate the esophagus, including:
  1. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve).
  2. Medicines for osteoporosis, such as alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel).
  3. Antibiotics, such as tetracycline or clindamycin.
  4. Other medicines, such as mycophenolate or quinidine.
  • Vitamin and mineral supplements, such as vitamin C, iron, and potassium pills.
  • Infection. People who have a weak immune system are more likely to get esophagitis. This includes people with HIV, diabetes, or kidney problems, as well as older adults and people who take steroid medicine.
  • Radiation therapy.
  • Certain diseases that make it hard to swallow, such as scleroderma.
  • Food allergies, especially to seafood, milk, nuts, soy, or eggs.

Treatment

Treatment for esophagitis depends on its cause.

 

Possible treatments include:

  • Medications that block acid production, like heartburn drugs.
  • Antibiotics, antifungals, or antivirals to treat an infection.
  • Pain medications that can be gargled or swallowed.
  • Corticosteroid medication to reduce inflammation.
  • Intravenous (by vein) nutrition to allow the esophagus to heal and to reduce the likelihood of malnourishment or dehydration.
  • Endoscopy to remove any lodged pill fragments.
  • Surgery to remove the damaged part of the esophagus.

 

While being treated for esophagitis, there are certain steps you can take to help limit discomfort.

  • Avoid spicy foods such as those with pepper, chili powder, curry, and nutmeg.
  • Avoid hard foods such as nuts, crackers, and raw vegetables.
  • 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 such as applesauce, cooked cereals, mashed potatoes, custards, puddings, and high protein shakes to your diet.
  • Take small bites and chew food thoroughly.
  • If swallowing becomes increasingly difficult, try tilting your head upward so the food flows to the back of the throat before swallowing.
  • Drink liquids through a straw to make swallowing easier.
  • Avoid alcohol and tobacco.
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