Esophagitis - Symptoms, Causes, Risk Factors, Diagnosis, Treatment, and Complications

Introduction:

The esophagus is the tube that delivers food from the mouth to the stomach. It is also called the food pipe. Esophagitis is the inflammation that damages the tissue of the esophagus. If untreated, esophagitis can be very uncomfortable and cause difficulty in swallowing.

What Are the Symptoms of Esophagitis?

The signs and symptoms of esophagitis include:

• Difficult swallowing.

• Painful swallowing.

• Chest pain on eating.

• Heartburn.

• Sore throat.

• Hoarse voice.

• Nausea and vomiting.

• Acid reflux.

• Food getting stuck in the esophagus.

In infants and young children, symptoms of esophagitis include:

• Feeding difficulties.

• Difficulty to thrive.

• Difficulty gaining weight.

What Are the Causes of Esophagitis?

Many reasons cause esophagitis, including:

• Reflux Esophagitis: Gastroesophageal reflux disease (GERD) is a condition in which stomach acid backflow into the esophagus. The lower esophageal sphincter muscle prevents the flow of acidic contents from the stomach into the esophagus. If the valve is not functioning properly, it results in reflux disease. A complication of gastroesophageal reflux disease is the chronic inflammation of the esophagus.

• Eosinophilic Esophagitis: Eosinophils are white blood cells that play a key role in allergic reactions.Eosinophilic esophagitis occurs when there are high numbers of eosinophils in the esophagus due to allergies or acid reflux. This type of esophagitis is triggered by milk, eggs, soy, wheat, peanuts, beans, beef, and sometimes inhaled pollen.

• Lymphocytic Esophagitis: The lymphocyte is another type of white blood cell. Lymphocytic esophagitis is an uncommon condition with an increased number of lymphocytes in the esophagus.

• Drug-Induced Esophagitis: Drug-induced esophagitis can occur when certain medications are taken without enough water. This causes the medication to stay long in the esophagus. Some oral medications are associated with esophagitis, including: --Painkillers such as Aspirin, Ibuprofen, and Naproxen sodium. -Antibiotics such as Tetracycline and Doxycycline. Potassium chloride, bisphosphonates, and quinidine.

• Infectious Esophagitis: A bacterial, viral, or fungal infection in the esophagus can cause esophagitis. This is rare and is seen in people with weak immune systems. Candida albicans is a fungus present normally in the mouth. This is the most common cause of infectious esophagitis. Viral infections such as herpes simplex or cytomegalovirus can also cause esophagitis.

What Are the Risk Factors of Esophagitis?

Risk factors of esophagitis depend on the various causes of esophagitis.

Reflux Esophagitis:

• Going to bed immediately after eating.

• Large fatty meals.

• Excess alcohol, caffeine, and chocolate.

• Smoking.

• Excess weight.

The foods which worsen the symptoms of reflux esophagitis include:

• Citrus fruits.

• Alcohol.

• Tomato-based foods.

• Spicy foods.

• Caffeine.

• Chocolate.

• Garlic and onions.

Eosinophilic Esophagitis:

• A family history of eosinophilic esophagitis.

• History of allergic rhinitis and asthma.

Drug-Induced Esophagitis:

• Swallowing a pill with little or no water.

• Taking drugs while lying down.

• Large pills.

• Older age.

Infectious Esophagitis:

• Medications such as steroids and antibiotics.

• People with diabetes.

• Cancer.

• Human immunodeficiency virus or acquired immunodeficiency syndrome.

How Can We Diagnose Esophagitis?

The following tests are done for the diagnosis of esophagitis:

• Barium X-Ray: The patient drinks a solution containing barium, and x-rays are taken. The barium highlights the lining of the esophagus and the stomach. This test is used to identify structural changes, narrowing of the esophagus, hiatus hernia, tumors, or other abnormalities of the esophagus.

• Endoscopy: A long, thin tube inserted into the esophagus with a camera. During the procedure, the doctor looks for any abnormalities of the esophagus and also takes a tissue sample for analysis in the laboratory.

• Laboratory Tests: They are performed to identify:

• Bacterial, viral, or fungal infections.

• Eosinophilic count.

• Identify abnormal cells that indicate precancerous changes or esophageal cancer.

What Is the Treatment of Esophagitis?

Treatment depends upon the cause of esophagitis. Treatment involves eliminating the cause of inflammation and avoiding trigger foods and allergens.

Treatment for Reflux Esophagitis:

• Medications: These include antacids, H2 receptor blockers that reduce acid production, such as Cimetidine, and proton pump inhibitors that block acid production and heal the esophagus, such as Lansoprazole, Pantoprazole, Esomeprazole, and Omeprazole. Prokinetics such as Bethanechol and Metoclopramide are also prescribed.

• Surgery: If medications do not improve the symptoms, fundoplication surgery is done. A portion of the stomach is wrapped around the lower esophageal sphincter muscle. This strengthens the sphincter and prevents the backflow of acid from the stomach into the esophagus.

Treatment for Eosinophilic Esophagitis:

• Treatment primarily avoids the allergen and treats the allergic reactions with medication. If foods cause allergies, identify the triggering foods and eliminate them from the diet.

• Medications: Proton pump inhibitors such as Pantoprazole, Esomeprazole, Omeprazole, and Lansoprazole are prescribed. Some swallowed steroids like Fluticasone and Budesonide act topically in the esophagus and treat eosinophilic esophagitis.

Treatment of Drug-Induced Esophagitis:

• Take an alternative drug that does not cause esophagitis.

• Take a liquid version of a drug.

• Drink an entire glass of water with the pill.

• Sitting or standing for 30 minutes after taking the pill.

Treatment for Infectious Esophagitis:

• A suitable medication is prescribed for bacterial, viral, fungal, or parasitic infections.

If medications do not help, a procedure is performed to dilate the esophagus if there is persistent narrowing.

What Are the Complications of Esophagitis?

If untreated, esophagitis can cause changes in the structure of the esophagus.

• Scarring or narrowing of the esophagus.

• Tearing of the esophagus lining.

• Barrett's esophagus, in which there are changes in the cells lining the esophagus. This condition has an increased risk of esophageal cancer.

What Are the Lifestyle and Home Remedies for Esophagitis?

• Avoid foods that can increase acid reflux like caffeine, chocolate, and alcohol.

• Take a pill with plenty of water.

• Avoid lying down for 30 minutes after taking the pill.

• Maintain a healthy weight.

• Avoid smoking.

• Avoid bending soon after eating.

• Raise the head of the bed.

• Avoid spicy foods.

• Avoid acidic foods such as tomatoes, oranges, grapes, and juices.

• Take small bites of food and chew the food well.

Conclusion:

Most people improve with treatment. However, recovery takes a longer time in patients with weakened immune systems. The outlook of the disease depends upon the cause and the overall health of the patient.