Esophagitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 26, 2016
StartDiseasesEsophagitis

Esophagitis is a typically short-term digestive condition that affects the esophagus, the canal that connects the throat (pharynx) to the stomach. While it is associated with ailments that can progress and cause severe problems, esophagitis is usually more of an uncomfortable annoyance that makes it painful to swallow rather than a serious health concern. However, the severity is entirely dependent on the extent of tissue damage, which should be investigated as swiftly as possible.

Contents

Definition & Facts

Esophagitis is defined as the experience of inflammation in the esophagus, which is the tube comprised of muscle that is responsible for delivering chewed food from the mouth to the stomach for digestion. The symptoms and causes of this condition vary significantly from person to person.

Symptoms & Complaints

This condition can manifest itself in a variety of ways. However, there are recurring symptoms that should prompt one to book an appointment with the doctor. Typical symptoms of esophagitis include: heartburn, trouble with and/or pain when swallowing, chest pain behind the breast bone, coughing, and acid reflux.

Less common symptoms may also be present and include nausea, vomiting, abdominal pain, and fever. An appointment should be set up after symptoms have lasted more than three days, have increased in severity, or have not improved with the consumption of over-the-counter antacids

Causes

A variety of factors may contribute to the development of esophagitis, making it challenging to properly diagnosis in some cases. An infection, whether bacterial, viral infection, or fungal infection, is one of the more common causes. These types of infections are commonly caused by poorly functioning immune system and thereby are commonly found in people afflicted with HIV and/or different types of cancers.

The back-flowing of stomach acid is another common explanation for esophagitis, and it occurs when the lower esophageal sphincter (the valve connecting the esophagus and the stomach) fails to keep the acidic contents of the stomach from rising up the esophagus. Chronic gastroesophageal reflux can lead to complications including chronic inflammation and extreme tissue damage.

Some foods and medicines may contribute to esophagitis and can attack the esophagus in a manner similar to an allergic reaction. The most common food allergens that initiate this type of response include soy, milk, eggs, nuts, and seafood. Antibiotics, aspirin, and ibuprofen have also been found to act as esophageal irritants. 

Diagnosis & Tests

Doctors have developed several methods for diagnosing esophagitis. An endoscopy, which is perhaps the most common, involves anesthetizing the patient before inserting a thin, flexible tube down the throat to examine the esophagus and collect cell samples for a biopsy from within. This allows doctors to not only examine a real-time image of the esophagus but also to identify abnormal cells.

A special X-ray called a barium swallow may also be utilized. For this process, the patient will be required to drink a chalk-like barium solution, as the compound will then coat the lining of the esophagus and stomach and allow the organs to show up on the X-ray image.

Treatment & Therapy

Patients diagnosed with esophagitis will typically be referred to a gastroenterologist, a doctor who specializes in this area of the body. Treatment strategies will depend entirely on the causes, severity, and circumstances unique to each individual. For example, treatment for allergen-induced esophagitis would be to simply avoid the triggering food or medication and reduce the risk of reaction with proper allergen medication, such as a steroid inhalant. The same would be true in the event that the condition was caused by a bacterial or fungal infection: the doctor would prescribe an antibiotic or antifungal drug to combat it.

Over-the-counter antacids, such as Maalox® and Mylanta®, acid production blockers (H2 antagonists), and proton pump inhibitors such as Prevacid® and Prilosec®, may suffice for some, while other cases will require prescription-strength medications. Baclofen®, for example, may be prescribed to decrease instances of gastroesophageal reflux by decreasing the rate of relaxations in the lower esophageal sphincter.

There are several approaches that aim to mitigate and reduce symptoms as well as manage complications of other types of esophagitis too. A gastroenterologist may, in some cases, deem it necessary to perform esophageal dilation which expands the esophagus using endoscopic devices, such as inflatable tubes or balloons to prevent painful swallowing and the chance of food becoming lodged in the throat.

Surgery is another option, though it would only be suggested in severe cases and when other interventions have failed. Nissen fundoplication is a surgical procedure that involves wrapping a portion of the stomach around the lower esophageal sphincter in attempt to strengthen it and prevent stomach acid from backing up into the esophagus.

The FDA has also approved a new device called the Linx® that similarly works to strengthen the lower esophageal sphincter. In this procedure, a ring of small magnetic titanium beads is implanted using a minimally invasive surgery method.

Prevention & Prophylaxis

While some types of esophagitis may not be preventable, lifestyle changes will certainly make a great difference in a patient's health. Smoking is a habit that only worsens an irritated throat, so this should be one of the first changes to occur. Knowing one's allergies and/or sensitivities and abiding by them will reduce the risk of reaction, as will good oral hygiene.

A healthy diet is also a major factor in preventing esophagitis. Avoiding foods high in fats, spices, and acids and replacing them with easily-digestible foods will help to regulate stomach acid and thus reduce the risk of the harmful and unpleasant back-flow involved in gastroesophageal reflux; caffeine, alcohol, and carbonated beverages should also be avoided or consumed in moderation for the same purpose.

The habits that follow eating are equally as important as what is being eaten. Enabling the body to gently and organically digest is a huge part of preventing esophagitis. Laying down directly after eating should be avoided; the gastrointestinal tract performs most optimally when left in a natural upright position. When the time does come to go to sleep, elevating the head to avoid compressing the esophageal tract may reduce the chance of esophagitis or mitigate unpleasant symptoms associated with the condition.