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Esophagitis

  • Hole in the esophagus

Definition

Esophagitis is an inflammation of the lining of the esophagus. The esophagus is the tube that carries food from the mouth to the stomach.

What is going on in the body?

The lining of the esophagus becomes inflamed because of an infection or an irritation of the lining. Esophagitis is called acute when it occurs suddenly. It is called chronic when it lasts for a long time.

Risks

What are the causes and risks of the disease?

Causes of esophagitis include:
  • infections by organisms such as Candida (yeast), cytomegalovirus (CMV), or herpes simplex (HSV)
  • diseases and conditions that weaken the immune system, such as HIV, poorly controlled diabetes, immunodeficiency disorders, chemotherapy, chronic steroid use, or malnutrition
  • chemicals that are swallowed
  • pills that become stuck in the esophagus
  • gastroesophageal reflux disease (GERD), a condition in which stomach acid splashes back up into the esophagus
  • medications and supplements such as nonsteroidal anti-inflammatory drugs (NSAIDs); bisphosphonates (that are used to treat osteoporosis, like alendronate <i.e., Fosamax>, risedronate <i.e., Actonel>; doxycycline (i.e., Adoxa, Doryx, Vibramycin); iron; and potassium

Prevention

What can be done to prevent the disease?

Maintaining a healthy weight, avoiding smoking, and limiting alcohol intake may decrease the risk of esophagitis. Other ways to decrease the risk include:
  • eating a nutritious diet based on the food guide pyramid
  • getting adequate rest
  • practicing safer sex
  • getting proper treatment for GERD
Esophagitis caused by toxic substances can be avoided by:
  • storing chemicals in properly labeled containers and keeping them out of the reach of children
  • always taking pills with adequate amounts of liquid and at least 15 minutes before lying down
Prevention of esophagitis is not always possible.

Diagnosed

How is the disease diagnosed?

After a complete history and physical, tests ordered may include the following::
  • endoscopy, which uses a scope, or long tube, to see the esophagus and look for possible causes of symptoms. Biopsies may also be done with the endoscope.
  • upper GI series, in which the person swallows liquid barium, and X-rays are taken to follow the course of the barium through the esophagus and into the stomach.
  • blood tests, including a complete blood count (CBC), to check for infection
  • esophageal motility tests, to evaluate the movement of food through the esophagus
  • pH tests, to measure the acid content of the esophagus

Long Term Effects

What are the long-term effects of the disease?

If the cause of the esophagitis is an infection, and the infection is treated, the inflammation may improve. If a toxic chemical, such as lye, bleach, or gasoline is ingested, the esophagus can perforate, or rupture. This esophageal perforation can be fatal.
Conditions such as GERD can irritate and narrow the esophagus causing an esophageal stricture.
Chronic GERD can result in Barrett's esophagus. In Barrett's esophagus, a condition in which the lining of the esophagus is so badly damaged that a new lining is formed. The changes in the cells lining the esophagus pose an increased risk for esophageal cancer.

Other Risks

What are the risks to others?

Esophagitis itself is not contagious and poses no risk to others. If the cause is an infection, such as herpes simplex, the infection may be contagious.

Treatments

What are the treatments for the disease?

Treatment of esophagitis is directed at the cause. Treatment may include:
  • antibiotics, antiviral, or antifungal medications for infections
  • medications to treat underlying conditions, such as GERD or diabetes
  • maintaining a healthy lifestyle
  • surgery to repair the esophagus

Side Effects

What are the side effects of the treatments?

Medications used to treat infections may cause allergic reactions, stomach upset, and headache. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

After Treatment

What happens after treatment for the disease?

Treatment with antacids, diet changes, and activity recommendations may control mild, intermittent symptoms. Recovery from surgery may be a few days to several weeks depending on the procedure used.

Monitor

How is the disease monitored?

Any new or worsening symptoms should be reported to the healthcare provider. Careful attention to symptoms that recur is important so that early treatment can begin.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al. The Merck Manual of Medical Information, 1997.

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