Disease: Esophagitis

    What is esophagitis?

    Esophagitis is a term used to describe inflammation of the esophagus, which is the tube that connects the throat to the stomach. There are several types of esophagitis depending on the cause. Esophagitis can be caused by infection, irritation of the esophagus, or inflammation of the lining of the esophagus.

    What causes esophagitis?

    Esophagitis can be caused by infection or irritation of the esophagus.

    Infections of the esophagus can be caused by bacteria, viruses, or fungi, including:

    • Candida, a yeast infection. This is more common in patients with weakened immune systems, such as those with diabetes, HIV/AIDS, patients undergoing chemotherapy, or people who are taking antibiotics or steroids.
    • Herpes, a viral infection. It may develop in the esophagus when the body's immune system is weak.

    One of the main causes of esophageal irritation is reflux of stomach acid. There are several causes for reflux:

    • GERD (gastroesophageal reflux disease): weakness or dysfunction of the muscle that keeps the stomach closed (sphincter) can allow stomach acid to leak into the esophagus (acid reflux), causing irritation of the inner lining. Also called GERD esophagitis - in severe cases it can become erosive esophagitis.
    • Vomiting: when vomiting is frequent or chronic it can lead to acid damage to the esophagus. Excessive or forceful vomiting may cause small tears of the inner lining of the esophagus, leading to further damage.
    • Hiatal hernia: This abnormality occurs when a part of the stomach moves above the diaphragm producing a small abnormal pouch, or hiatal hernia, which can lead to excess acid refluxing into the esophagus.
    • Achalasia: This is a disorder where the lower end of the esophagus does not open normally, and as a result food can get stuck in the esophagus or is regurgitated. People with achalasia have a higher than normal risk of esophageal cancer.

    Medical treatments for other problems can also cause esophageal irritation.

    Surgery, including certain types of bariatric (weight loss) surgery, can lead to increased risk of esophagitis. Medications such as aspirin and other anti-inflammatory drugs can irritate the lining of the esophagus, and also cause increased acid production in the stomach that can lead to acid reflux. Large pills taken with too little water or just before bedtime can dissolve or get stuck in the esophagus, causing irritation. Radiation to the chest (thorax), for cancer treatment can cause burns leading to scarring and inflammation of the esophagus.

    Other causes of esophageal irritation:

    • Swallowing of foreign material or toxic substances
    • Diets high in acidic foods or excessive caffeine
    • Smoking

    What are the types of esophagitis?

    There are several types of esophagitis.

    • Reflux esophagitis is caused by a reflux of stomach acid into the esophagus.
    • Infectious esophagitis is caused by bacteria, viruses, or fungus.
    • Barrett's esophagus results from untreated inflammation of the esophagus that can cause changes in the type of cells that make up the inner lining (mucosa) of the esophagus. Barrett's esophagus increases the risk for esophageal cancer.
    • Eosinophilic esophagitis is inflammation of the esophagus due to an increase in the number of a type of white blood cells (eosinophils) in the lining of the esophageal wall. This leads to dysmotility of the esophagus (the muscles do not work properly to move food through) and difficulty in swallowing. Causes of eosinophilic esophagitis include food allergies, gastroesophageal reflux disease (GERD), parasitic diseases, or inflammatory bowel diseases.
    • Behçt's syndrome (also called Behçet's disease) is a form of vasculitis that can cause ulcers in the mouth, esophagus and other parts of the body. This disease is rare in the U.S.
    • Graft-versus-host disease is a complication that can occur after a transplant (usually bone marrow transplant) when the newly transplanted cells attack the recipient's body. Esophagitis may occur in this condition.
    • Cancer esophagitis may be a symptom of cancer of the esophagus, or metastatic cancer (cancer that started in another part of the body and then spreads to the esophagus).

    What are the symptoms of esophagitis?

    Symptoms of esophagitis include:

    • Difficult and/or painful swallowing
    • A feeling of food getting stuck on the way down
    • Heartburn, acid reflux
    • Unpleasant taste in mouth
    • Sore throat, hoarseness, or cough
    • Mouth sores
    • Nausea, vomiting
    • Abdominal pain or indigestion
    • Chest pain, in the middle of the chest, often radiating to the back, usually associated with swallowing or occurring soon after a meal
    • Bad breath (halitosis)

    How is esophagitis diagnosed?

    A gastroenterologist (a doctor who specializes in treatment of disorders of the gastrointestinal tract) may order specialized tests to look for the cause and extent of the esophagitis. These tests include:

    • Esophagogastroduodenoscopy (EGD): An endoscope is used to directly examine the esophagus, stomach and first part of the intestines. In addition, tissue samples can be obtained (biopsy) to assess the severity of the damage to the esophagus.
    • Esophageal manometry: this test is used to measure the pressure inside the lower part of the esophagus. A thin, pressure-sensitive tube is passed through the mouth or nose and into the stomach, which is then pulled slowly back into the esophagus. Patients are asked to swallow, and the pressure of the muscle contractions is measured along several sections of the tube.
    • Upper GI series or barium swallow is a test where X-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and appears white on an X-ray, and can show the location and extent of damage to the esophagus.

    How is esophagitis treated?

    Treatment for esophagitis depends on its cause.

    • If esophagitis is caused by an infection, it is treated with medications to eliminate the infection.
    • If esophagitis is caused by acid reflux it is treated with medications to reduce or block acid production, for example, heartburn drugs.
    • If esophagitis is due to a medical procedure the patient may need to be on acid-blocking medications for a long time.
    • If the cause of esophagitis is due to taking medications, the patient may need to change those medications. Always consult a doctor before stopping or changing medication.

    If esophagitis is diagnosed early enough, medications and dietary or lifestyle changes are often enough to allow the body to heal. If the damage is severe or leads to scar tissue causing difficulty swallowing, more invasive treatments may be necessary.

    • Endoscopy can be used to remove any lodged pill fragments, food or foreign bodies stuck in the esophagus. Stretching (dilatation) of the esophagus can also be done as part of the endoscopy procedure.
    • Surgery may be necessary to remove any damaged portions of the esophagus. In the case of Barrett's esophagus, where the risk of cancer is increased, surgery might be the treatment of choice.
    • Eosinophilic esophagitis is treated with gentle stretching of the esophagus (dilatation) and medications to decrease white blood cells (eosinophils) in the lining of the esophagus.
    • Achalasia may be treated with stretching of the esophagus (dilatation) when oral medications fail to improve symptoms.

    Lifestyle changes that may alleviate symptoms of GERD and esophagitis include:

    • Stop smoking
    • Remain upright while eating and for a time (about 2-3 hours) afterwards
    • Take small bites and chew food slowly
    • Avoid eating within 3 hours of bedtime or laying down
    • Raise the head of the bed by 4 to 6 inches (put blocks or a foam wedge under the head of the bed; don't use pillows as this can put pressure on the abdomen)
    • Lose weight
    • Wear loose clothing
    • Avoid aspirin or ibuprofen

    What about esophagitis and diet?

    Diet is often a key to reducing the symptoms of esophagitis. The GERD diet is aimed at reducing acid reflux, the main cause of esophagitis.

    • Eat low fat, high protein meals
    • Avoid fatty foods
    • Avoid spicy foods
    • Avoid acidic foods and beverages such as citrus and tomatoes
    • Avoid foods that may trigger or worsen heartburn including chocolate, mint, onions or garlic
    • Eat smaller meals, more frequently
    • Eat soft foods that are easily digested
    • Stop eating before you feel full
    • Avoid coffee or tea (even decaffeinated), alcohol, and soda

    What options are there for pain relief for esophagitis?

    Many over-the-counter medications can help neutralize stomach acid and provide short-term relief for the pain of esophagitis caused by acid reflux. Do not take these medications long-term. See a doctor if symptoms persist for more than two weeks.

    Pain medications and medications that decrease inflammation such as corticosteroids can be used as adjuncts in the treatment of any inflammatory cause of esophagitis.

    What are the complications of esophagitis?

    If untreated, esophagitis caused by GERD can lead to bleeding, ulcers, and chronic scarring. This scarring can narrow the esophagus, eventually interfering with the ability to swallow.

    A major complication, which occurs in a significant portion of people with chronic or longstanding GERD, is Barrett's esophagus, which increases the risk of esophageal cancer. A very few of those who develop Barrett's esophagus will develop esophageal adenocarcinoma.

    Severe esophagitis may lead to difficult or painful swallowing, and malnutrition.

    What are the types of esophagitis?

    There are several types of esophagitis.

    • Reflux esophagitis is caused by a reflux of stomach acid into the esophagus.
    • Infectious esophagitis is caused by bacteria, viruses, or fungus.
    • Barrett's esophagus results from untreated inflammation of the esophagus that can cause changes in the type of cells that make up the inner lining (mucosa) of the esophagus. Barrett's esophagus increases the risk for esophageal cancer.
    • Eosinophilic esophagitis is inflammation of the esophagus due to an increase in the number of a type of white blood cells (eosinophils) in the lining of the esophageal wall. This leads to dysmotility of the esophagus (the muscles do not work properly to move food through) and difficulty in swallowing. Causes of eosinophilic esophagitis include food allergies, gastroesophageal reflux disease (GERD), parasitic diseases, or inflammatory bowel diseases.
    • Behçt's syndrome (also called Behçet's disease) is a form of vasculitis that can cause ulcers in the mouth, esophagus and other parts of the body. This disease is rare in the U.S.
    • Graft-versus-host disease is a complication that can occur after a transplant (usually bone marrow transplant) when the newly transplanted cells attack the recipient's body. Esophagitis may occur in this condition.
    • Cancer esophagitis may be a symptom of cancer of the esophagus, or metastatic cancer (cancer that started in another part of the body and then spreads to the esophagus).

    What are the symptoms of esophagitis?

    Symptoms of esophagitis include:

    • Difficult and/or painful swallowing
    • A feeling of food getting stuck on the way down
    • Heartburn, acid reflux
    • Unpleasant taste in mouth
    • Sore throat, hoarseness, or cough
    • Mouth sores
    • Nausea, vomiting
    • Abdominal pain or indigestion
    • Chest pain, in the middle of the chest, often radiating to the back, usually associated with swallowing or occurring soon after a meal
    • Bad breath (halitosis)

    How is esophagitis diagnosed?

    A gastroenterologist (a doctor who specializes in treatment of disorders of the gastrointestinal tract) may order specialized tests to look for the cause and extent of the esophagitis. These tests include:

    • Esophagogastroduodenoscopy (EGD): An endoscope is used to directly examine the esophagus, stomach and first part of the intestines. In addition, tissue samples can be obtained (biopsy) to assess the severity of the damage to the esophagus.
    • Esophageal manometry: this test is used to measure the pressure inside the lower part of the esophagus. A thin, pressure-sensitive tube is passed through the mouth or nose and into the stomach, which is then pulled slowly back into the esophagus. Patients are asked to swallow, and the pressure of the muscle contractions is measured along several sections of the tube.
    • Upper GI series or barium swallow is a test where X-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and appears white on an X-ray, and can show the location and extent of damage to the esophagus.

    How is esophagitis treated?

    Treatment for esophagitis depends on its cause.

    • If esophagitis is caused by an infection, it is treated with medications to eliminate the infection.
    • If esophagitis is caused by acid reflux it is treated with medications to reduce or block acid production, for example, heartburn drugs.
    • If esophagitis is due to a medical procedure the patient may need to be on acid-blocking medications for a long time.
    • If the cause of esophagitis is due to taking medications, the patient may need to change those medications. Always consult a doctor before stopping or changing medication.

    If esophagitis is diagnosed early enough, medications and dietary or lifestyle changes are often enough to allow the body to heal. If the damage is severe or leads to scar tissue causing difficulty swallowing, more invasive treatments may be necessary.

    • Endoscopy can be used to remove any lodged pill fragments, food or foreign bodies stuck in the esophagus. Stretching (dilatation) of the esophagus can also be done as part of the endoscopy procedure.
    • Surgery may be necessary to remove any damaged portions of the esophagus. In the case of Barrett's esophagus, where the risk of cancer is increased, surgery might be the treatment of choice.
    • Eosinophilic esophagitis is treated with gentle stretching of the esophagus (dilatation) and medications to decrease white blood cells (eosinophils) in the lining of the esophagus.
    • Achalasia may be treated with stretching of the esophagus (dilatation) when oral medications fail to improve symptoms.

    Lifestyle changes that may alleviate symptoms of GERD and esophagitis include:

    • Stop smoking
    • Remain upright while eating and for a time (about 2-3 hours) afterwards
    • Take small bites and chew food slowly
    • Avoid eating within 3 hours of bedtime or laying down
    • Raise the head of the bed by 4 to 6 inches (put blocks or a foam wedge under the head of the bed; don't use pillows as this can put pressure on the abdomen)
    • Lose weight
    • Wear loose clothing
    • Avoid aspirin or ibuprofen

    What about esophagitis and diet?

    Diet is often a key to reducing the symptoms of esophagitis. The GERD diet is aimed at reducing acid reflux, the main cause of esophagitis.

    • Eat low fat, high protein meals
    • Avoid fatty foods
    • Avoid spicy foods
    • Avoid acidic foods and beverages such as citrus and tomatoes
    • Avoid foods that may trigger or worsen heartburn including chocolate, mint, onions or garlic
    • Eat smaller meals, more frequently
    • Eat soft foods that are easily digested
    • Stop eating before you feel full
    • Avoid coffee or tea (even decaffeinated), alcohol, and soda

    What options are there for pain relief for esophagitis?

    Many over-the-counter medications can help neutralize stomach acid and provide short-term relief for the pain of esophagitis caused by acid reflux. Do not take these medications long-term. See a doctor if symptoms persist for more than two weeks.

    Pain medications and medications that decrease inflammation such as corticosteroids can be used as adjuncts in the treatment of any inflammatory cause of esophagitis.

    What are the complications of esophagitis?

    If untreated, esophagitis caused by GERD can lead to bleeding, ulcers, and chronic scarring. This scarring can narrow the esophagus, eventually interfering with the ability to swallow.

    A major complication, which occurs in a significant portion of people with chronic or longstanding GERD, is Barrett's esophagus, which increases the risk of esophageal cancer. A very few of those who develop Barrett's esophagus will develop esophageal adenocarcinoma.

    Severe esophagitis may lead to difficult or painful swallowing, and malnutrition.

    Source: http://www.rxlist.com

    There are several types of esophagitis.

    • Reflux esophagitis is caused by a reflux of stomach acid into the esophagus.
    • Infectious esophagitis is caused by bacteria, viruses, or fungus.
    • Barrett's esophagus results from untreated inflammation of the esophagus that can cause changes in the type of cells that make up the inner lining (mucosa) of the esophagus. Barrett's esophagus increases the risk for esophageal cancer.
    • Eosinophilic esophagitis is inflammation of the esophagus due to an increase in the number of a type of white blood cells (eosinophils) in the lining of the esophageal wall. This leads to dysmotility of the esophagus (the muscles do not work properly to move food through) and difficulty in swallowing. Causes of eosinophilic esophagitis include food allergies, gastroesophageal reflux disease (GERD), parasitic diseases, or inflammatory bowel diseases.
    • Behçt's syndrome (also called Behçet's disease) is a form of vasculitis that can cause ulcers in the mouth, esophagus and other parts of the body. This disease is rare in the U.S.
    • Graft-versus-host disease is a complication that can occur after a transplant (usually bone marrow transplant) when the newly transplanted cells attack the recipient's body. Esophagitis may occur in this condition.
    • Cancer esophagitis may be a symptom of cancer of the esophagus, or metastatic cancer (cancer that started in another part of the body and then spreads to the esophagus).

      Source: http://www.rxlist.com

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