Esophageal Ulcer - Causes, Symptoms, and Management

Introduction

Peptic ulcers are lesions or sores which form in the upper digestive tract area. The most common peptic ulcers are gastric ulcers which are formed in the stomach area, and duodenal ulcers, which are formed in the upper area of the small intestines. Peptic ulcers formed in the esophagus are called esophageal ulcers.

What Is Esophageal Ulcer?

An esophageal ulcer is a painful sore found in the lining of the esophagus, between the junction of the esophagus and the stomach. The esophagus is a tube that connects the throat to the stomach. Esophageal ulcers occur when the mucosal layer that lines the gastrointestinal tract wears away. The wearing of the mucous cell line allows acid and other gastric juices of the stomach to irritate the esophagus wall, forming ulcers.

What Causes Esophageal Ulcers?

• Esophageal ulcers are formed from bacterial infections, mainly the Helicobacter pylori bacteria.

• The bacteria damage the mucosal lining, making it more prone to stomach acid damage. The stomach acids move up to the esophagus, cause erosion to the esophagus, and form an ulcer.

• Viral infections like human immunodeficiency virus (HIV), cytomegalovirus, herpes simplex virus, and fungal infections like candida overgrowth can also cause esophageal ulcers.

• Gastroesophageal reflux disease (GERD) is another condition that causes an esophageal ulcer. The lower esophageal sphincter muscle is weak or damaged in gastroesophageal reflux disease. This muscle usually undergoes tightening and prevents food in the stomach from moving back to the esophagus (preventing the reflux of gastric content). However, when the muscle is damaged, frequent acid reflux occurs, and this reflux causes the stomach's contents to move back into the esophagus, causing an esophageal ulcer.

• In patients with bulimia nervosa (eating disorder), continuous vomiting can expose the mucus of the esophagus to gastric contents, thereby causing sores on the esophageal mucosa.

• Habits like excessive consumption of alcohol, smoking, and regular use of nonsteroidal anti-inflammatory drugs (NSAID) like Ibuprofen can cause damage to the mucosal lining of the esophagus leading to the formation of an ulcer.

• Pills like potassium irritate the esophagus and cause an ulcer when it is taken without enough water or if the patient lies down immediately after consumption of the pill. Whenever a pill is taken, it is important to swallow them with enough water, and patients are advised not to lie down immediately after taking the pill.

What Are the Symptoms Seen in Esophageal Ulcers?

The main symptom found in esophageal ulcers is a burning pain in the chest region. This pain can be either mild or severe. Other symptoms include sore throat, nausea, vomiting, bloating sensation, indigestion, heartburn or acid reflux, sour taste inside the mouth, pain during swallowing, lack of appetite, and dry cough. However, esophageal ulcers can also be asymptomatic in some people.

What Are the Complications of an Esophageal Ulcer?

Untreated esophageal ulcers can cause serious complications like esophageal perforations or bleeding ulcers. It can also cause scarring of the esophagus. If symptoms like fevers, chills, difficulty in breathing, increased heart rate, vomiting of blood, or sudden chest pain develop, it is important to seek immediate medical attention.

How Are Esophageal Ulcers Diagnosed?

The healthcare provider will diagnose esophageal ulcers by taking a detailed medical history and physical examination. An endoscopic examination is also done. Here, an endoscope will be inserted through the mouth into the esophagus. If ulcers are detected, doctors might also take samples of the ulcer for further examination.

How Are Esophageal Ulcers Healed?

1. Treatment of esophageal ulcers aims to suppress the stomach acid, control the secretion of acid, promote peristalsis (contractions to move food through the gastrointestinal tract), and heal the mucosal wall.

2. If bacterial infections cause esophageal ulcers, antibiotics are given to destroy the bacteria. Antibiotics include Amoxicillin, Metronidazole, and Clarithromycin.

3. Antifungal or antiviral medications are given if a viral or fungal infection causes the ulcer. Cytomegalovirus infection is treated with Ganciclovir, and Fluconazole is a treatment option for candida overgrowth.

4. If the prolonged use of NSAID is the causative factor, the doctor will stop the drug and prescribe a different one.

5. Proton pump inhibitor drugs like Lansoprazole, Esomeprazole, Pantoprazole, Rabeprazole, or Omeprazole are given to treat esophageal ulcers. These medications work differently and will stop the production of acids in the stomach. Proton pump inhibitors show a better and long-term effect on ulcers than H2 receptor blockers.

6. H2 receptor antagonists include Ranitidine, Cimetidine, Famotidine, and Nizatidine. These drugs neutralize acids and reduce their delivery to the duodenum region. H2 blockers only provide temporary relief.

7. Severe cases of esophageal ulcers are managed by several methods like intravenous administration of fluids, analgesics given for pain relief, nasogastric tube intubation, and also treated with H2 receptor antagonists and proton pump inhibitors.

8. Severe cases of esophageal ulcers can also undergo surgical intervention. Surgery is done to tighten the lower esophageal sphincter muscle valve or insert a magnetic device to help the lower esophageal sphincter muscle valve function.

How Long Does It Take for Esophageal Ulcers to Heal?

Symptoms of esophageal ulcers will go away within a few days of treatment. However, it is important to continue medications until the doctor stops them.

Are There Any Recovery Tips for Esophageal Ulcers?

A few healthy changes in lifestyle, along with medications, can speed up recovery. They include:

• Reduce stress by attending a yoga class or by exercising.

• Get enough sleep.

• Avoid habits like drinking alcohol or smoking.

• Include a diet that contains fruits, whole grains, vegetables, and low-processed or sugary foods.

• Drink lots of water.

• Eat frequent small meals and avoid overeating.

• Try chewing gum after meals. This will increase saliva, which will help keep stomach acid out of the esophageal region.

• Try to stay upright for a few hours (about three hours) after eating.

• If overweight, it is recommended to lose weight.

What Are the Dietary Recommendations for Esophageal Ulcers?

Doctors recommend dietary changes as a part of the treatment of esophageal ulcers. Certain foods will help reduce the condition, and certain foods will trigger the condition. They are given below.

• Recommended Foods - A high-fiber diet benefits people with esophageal ulcers. Foods that contain a high-fiber diet include whole grains, legumes, flax seeds, fruits like bananas and apples, nuts, oats, lean protein, and vegetables like sweet potato, carrot, spinach, broccoli, and kale.

• Foods to Avoid - Foods that can worsen the condition include caffeinated beverages, coffee, tea, sodas, alcohol, chocolate, citrus fruits, tomatoes, mint, spicy foods, and greasy, fatty, or fried foods.

Conclusion:

Esophageal ulcers can cause significant pain and discomfort for patients. Some symptoms include difficulty swallowing, heartburn, a sour taste inside the mouth, and loss of appetite. It can either be caused due to a bacterial, viral, or fungal infection or a condition like gastrointestinal reflux disease. The condition can be easily diagnosed and treated by understanding the underlying factor causing esophageal ulcers. Esophageal ulcers get healed within a few days with the help of adequate medical intervention.