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Esophagitis is inflammation of the esophagus, the muscular tube that carries food from the mouth to the stomach.
Painful, burning sensations, chest pain, and difficulty swallowing can all be symptoms of esophagitis. Esophagitis can be brought on by a number of factors. Backflow of stomach acids into the esophagus, infections, oral medications, and allergies are a few prominent causes.
The following are the different types of esophagitis.
- Reflux esophagitis: When the acidic contents of your stomach and digestive flow back and reflux into the esophagus, the mucous lining (mucosa), which lines the esophagus, becomes irritated and erodes. This is the most frequent type of esophagitis. If the patient frequently experiences acid reflux or frequently throws up, this could occur.
Causes of reflux esophagitis including gastroesophageal reflux disease (GERD), bile reflux, and bulimia nervosa.
- Eosinophilic esophagitis: Eosinophilic esophagitis is a type of immune hypersensitivity reaction characterized by an exaggerated response of the immune system. In this condition, the immune system mobilizes an excessive number of eosinophils to combat a perceived threat, such as an infection or an allergy. However, even after the initial threat has been resolved, these eosinophils continue to accumulate in the esophagus, leading to persistent inflammation. This condition is more commonly observed in individuals with diverse allergies, who are more susceptible to its occurrence.
- Drug-induced esophagitis: Pill esophagitis can occur when oral medications come into prolonged contact with the lining of the esophagus, leading to tissue damage. This can happen when a patient swallows a pill with inadequate water or fails to swallow it completely, causing the tablet or pill residue to remain in the esophagus. In such cases, the prolonged presence of medication in the esophagus can cause irritation and injury to the esophageal tissues, resulting in pill esophagitis.
Examples of such medications include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, antibiotics, potassium chloride, bisphosphonates, and chemotherapy drugs.
- Infectious esophagitis: Esophageal infections are uncommon unless an individual has a compromised immune system, which makes them more susceptible to frequent and severe infections overall. Typically, infections in the esophagus originate from other parts of the body and subsequently spread to the esophagus. Among these infections, viral and fungal infections are the most commonly encountered types.
- Lymphotic esophagitis (LE): Lymphocytes, a type of white blood cell, increase in the lining of the esophagus in lymphocytic esophagitis. LE could be connected to GERD or eosinophilic esophagitis.
- Autoimmune esophagitis: In addition to eosinophilic esophagitis, some other autoimmune diseases can also result in esophagitis as a complication. These conditions include Behçet’s disease, inflammatory bowel disease (IBD), and graft vs host disease.
- Radiation esophagitis: Radiation mucositis, an inflammation of the mucosa in the esophagus, may result from radiation therapy that targets the esophagus, chest, or throat. Although it happens seldom, some persons who have received radiation can develop chronic esophagitis.
The treatment approach for esophagitis depends on its underlying cause and the extent of damage to the esophageal tissue lining. If left untreated, esophagitis can negatively impact the ability of the esophagus to efficiently transport food and liquids from the mouth to the stomach. Additionally, esophagitis may lead to complications such as esophageal scarring or narrowing, unintended weight loss, and dehydration. Therefore, it is important to address esophagitis promptly to prevent these potential complications.
Symptoms
The following are typical signs and symptoms of esophagitis:
- Difficulty or painful swallowing
- Heartburn
- Food impaction, which is the condition in which swallowed food becomes lodged in the esophagus.
- Chest pain
- Acid regurgitation or reflux
- Nausea and vomiting
- Blood in the vomit
- Mouth sore
- Feeding difficulties in children
- Chest or abdominal pain in children
The majority of esophagitis symptoms can be brought on by a few distinct digestive disorders. It is crucial to seek immediate medical attention if you experience symptoms that persist for more than a few days, do not improve with over-the-counter antacids, make eating difficult, or are accompanied by flu-like symptoms such as headache, fever, and muscle aches. Similarly, if you are experiencing unexplained weight loss, it is important to consult a healthcare provider promptly.
Additionally, if you have chest pain lasting more than a few minutes or difficulty breathing after eating, immediate medical attention is necessary. Recognizing the severity of these symptoms and seeking timely medical care is vital for proper diagnosis and appropriate treatment.
Causes
Inflammation of the esophageal tissues can occur when your immune system is mobilized to combat an infection, during an allergic reaction, or as a result of corrosive damage inflicted on the tissues.
- Acid reflux such as GERD
- Allergies to food, pollens, or air
- Infections, either bacterial, viral, or fungal.
- Medications such as pain-relieving medications, antibiotics, potassium chloride, and quinidine (heart problem medication)
- Radiation therapy
- Autoimmune diseases.
Risk factors
The different types of the condition can affect the risk factors for esophagitis.
- Reflux esophagitis: The following are risk factors for gastroesophageal reflux disease (GERD), which are also risk factors for reflux esophagitis:
- Eating just before going to bed
- Eating large and fatty meals.
- Smoking.
- Having extra weight and that also include pregnancy.
Food such as fatty food, chocolate, caffeine, alcohol, and peppermint can worsen symptoms of reflux esophagitis.
- Eosinophilic esophagitis: The following risk factors for eosinophilic esophagitis, or allergy-related esophagitis may includes:
- Family history of eosinophilic esophagitis.
- History of allergic reactions, that includes asthma, atopic dermatitis and allergic rhinitis.
- Drug-induced esophagitis: Drug-induced esophagitis risk factors are typically linked to conditions that impede a quick and complete passage of a tablet into the stomach. These factors consist of:
- Ingesting a tablet without any or little water.
- Aging, maybe as a result of changes to the esophageal muscles brought on by aging or a decrease in salivation.
- Pills with unusual shapes or sizes
- Taking drugs while lying down.
- Using medicines just before bed, which is probably related to the fact that people tend to swallow less and produce less saliva while they sleep.
- Infectious esophagitis: Medications like steroids or antibiotics are frequently linked to risk factors for infectious esophagitis. Diabetes also increases the risk of certain infections, particularly candida esophagitis.
Immune system dysfunction may be a factor in further infectious esophagitis causes. An immunological illness, AIDS or HIV, or specific malignancies could be responsible for this. Additionally, several cancer therapies and medications known as immunosuppressants, which prevent immune responses to transplanted organs, may raise the chance of contracting infected esophagitis.
Diagnosis
The presence of esophagitis can be determined through the following diagnostic tests:
- Physical examination: Healthcare providers often diagnose esophagitis based on the presence of typical symptoms. To determine its effectiveness, a healthcare provider may prescribe an acid-blocking medication and observe the response. If the symptoms improve, they can make a reasonable assumption that the individual has reflux esophagitis.
- Barium X-ray: The patient is given the option to consume a solution or a tablet containing the substance barium. The lining of the stomach and esophagus is coated with barium, which also makes the organs visible. With the use of these images, it may be possible to spot esophageal constriction, other structural changes, a hiatal hernia, tumors, or other irregularities that may be contributing to symptoms.
- Endoscopy: A long, thin tube with a tiny camera on it is inserted down the neck and into the esophagus during this procedure. The name of this device is an endoscope. A healthcare provider can examine the esophagus with an endoscope to check for any odd features. Depending on the underlying cause of the inflammation, such as medication usage or acid reflux, the esophagus may seem differently. This test will be performed while the patient is under sedation.
- Esophageal sponge: One method for assessing the level of inflammation in the esophagus without resorting to an endoscopy involves the use of a capsule attached to a string. The individual ingests the capsule, which eventually dissolves in the stomach. By pulling on the string, the healthcare provider can retrieve a sponge that used to sample the esophageal tissues during its removal. This technique allows the healthcare provider to evaluate the degree of esophageal inflammation.
- Laboratory tests: During an endoscopic examination, small tissue samples are extracted and sent to the lab for analysis. This is referred to as a biopsy.
Tests may be used to diagnose a bacterial, viral, or fungal infection and determine the concentration of eosinophils, or allergy-related white blood cells, depending on the probable underlying cause of the condition.
Treatment
The primary goals of esophagitis treatments are to manage complications, alleviate symptoms, and address the underlying causes of the disorder. Treatment plans vary depending on the specific root cause of the condition.
- Lifestyle changes: Diet modifications by determining the meals and beverages that cause acid reflux and indigestion or that cause an allergic reaction.
- Evening routine: Eat smaller meals, especially at dinner, to lessen acid reflux. Make sure to eat dinner at least three hours before going to bed so it has time to digest.
- Self care: Patient is recommended to stop smoking and alcohol consumption to protect the esophagus.
- Reflux esophagitis: Reflux esophagitis treatment options include:
- Over-the-counter medications. Antacids; H-2-receptor blockers, such as cimetidine; and proton pump inhibitors, which stop acid production and treat the esophagus, including omeprazole and lansoprazole.
- Prescribed medication: These include proton pump inhibitors and H-2 receptor blockers with a prescription.
- Fundoplication: If previous treatments are unsuccessful, this kind of surgery might be done to treat the condition of the esophagus. In this surgery, a section of the stomach is wrapped around the lower esophageal sphincter, the valve dividing the esophagus from the stomach. As a result, the sphincter is strengthened and acid cannot back up into the esophagus.
- LINX: The LINX method is a more recent operation that includes wrapping a ring of small magnetic titanium beads around the lower esophageal sphincter. Since the sphincter is stronger in that position, acid reflux is prevented.
- Eosinophilic esophagitis: Eosinophilic esophagitis is treated by avoiding the allergen and using medications to lessen the allergic reaction. Among the prescribed medications are:
- Proton pump inhibitors: A proton pump inhibitor, such as esomeprazole, lansoprazole, omeprazole, or pantoprazole, will probably be recommended initially by the healthcare provider.
- Steroids: The surface tissue of the esophagus may be affected by swallowed steroids like fluticasone and budesonide, according to several research. To treat eosinophilic esophagitis, the same steroid drugs that are breathed to treat asthma are ingested as a liquid.
- Elimination and elemental diets: Eosinophilic esophagitis is most often brought on by a reaction to a food allergy. Eliminating the offending food could therefore be a successful therapeutic plan.
The patient’s healthcare provider might advise eliminating common food allergies from their diet. Patient should reintroduce foods gradually and track any recurrence of symptoms.
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- Monoclonal antibodies: Dupilumab has just received FDA approval for the treatment of eosinophilic esophagitis in adults and children 12 years of age and older. A monoclonal antibody is a kind of medication that includes dupilumab. It functions to stop the body’s production of certain proteins that lead to inflammation. Dupilumab is injected once a week.
- Drug-induced esophagitis: Drug-induced esophagitis is treated by refraining from using the offending drug and minimizing the risk through improved pill-taking habits. Healthcare provider might advise the patient to use an alternate medication that is less likely to result in esophagitis brought on by medications. To reduce the risk of drug-induced esophagitis, it is advisable to consider the following measures:
- Whenever feasible, opt for a liquid formulation of the medication.
- Consume a full glass of water with the pill, unless instructed otherwise by your healthcare provider due to conditions like kidney disease that require fluid intake restriction.
- Avoid lying down after taking the medication. Maintain an upright sitting or standing position for a minimum of 30 minutes after swallowing the pill.
- Infectious esophagitis: An infectious esophagitis-causing bacterial, viral, fungal, or parasitic illness may be treated with medication by a healthcare provider.
- Treatment for other complications: An esophageal dilation procedure may be carried out by a gastroenterologist. Usually, only very severe narrowing or food that has become caught in the esophagus requires this treatment.
