Esophagitis is the inflammation of the esophagus, a muscular tube that connects and brings food from the mouth to the stomach (food pipe). If not treated, the condition can cause difficulty in swallowing, ulcers or scarring of the esophagus. It may lead to more severe conditions such as Barrett's esophagus which is a risk factor for cancer of the esophagus.
The common cause of esophagitis is the continual exposure to stomach acid that flows back into the esophagus and can cause damage through continued inflammation or gastroesophageal reflux. High levels of a type of white blood cells that react to allergic reactions and regulate inflammation (called eosinophils) can also cause esophagitis - a condition called eosinophilic esophagitis. Additionally, prolong use of certain medications can cause damage to the linings of the esophagus, particularly when taking the drugs with no water. These drugs include: antibiotics, vitamin C supplements, bisphophates, aspirin and other nonsteroidal ant-inflammatory drugs (NSAIDs) and potassium chloride. Too much alcohol intake, smoking, caffeinated drinks, spicy food, radiation therapy or surgery, trauma or spinal cord injury may also lead to esophagitis. Bacteria, fungi (such as Candida albicans) and viruses (cytomegalovirus and herpes simplex, for example) can also infect the esophagus.
The following symptoms may be experienced by a person with esophagitis:
- Sore throat
- Loss of appetite
- Nausea and vomiting
- Difficulty in swallowing (dysphagia)
- Water brash
- Mouth sores or oral thrush (lesion caused by candida albicans)
- Chest pain when eating
- Odynophagia (painful swallowing)
- Abdominal pain
The doctor starts by conducting a physical examination followed by several tests.
Endoscopy is one common test that can directly detect inflammation in the esophagus. If this procedure is used, an endoscope (a long flexible tube with a small camera) is inserted through the mouth to the esophagus. Endoscopy also allows the doctor to remove small esophageal tissues for biopsy.
Barium X-ray uses a barium solution that the patient will swallow. This will provide contrast to obtain images of the esophagus and stomach in order to detect abnormalities.
Skin tests may also be performed to check if the cause of the inflammation is of an allergic nature.
Treatment of esophagitis depends on its cause. The treatments will help prevent complications, decrease acid production and relieve symptoms. The treatments include:
- Analgesics to reduce pain.
- Histamine-2 receptor antagonists (cimetidine, ranitidine hydrochloride, famotidine) to reduce stomach acid production.
- Antivirals, antibiotics or antifungal to fight organisms that cause infection.
- Proton pump inhibitors (rabeprazole, lansoprazole, pantoprazole, omeprazole, esomeprazole magnesium) to reduce gastric acid production.
- Corticosteroids to reduce inflammation.
- Gastrointestinal coating agents (sucralfate) to protect the stomach wall.
- Surgery: surgical procedure is necessary when the patient fails to respond to the primary treatments for esophagitis. The surgical procedure is called fundoplication. This is done by covering a small part of the stomach onto the valve to separate the stomach from the esophagus. This method prevents backflow of gastric acids to the esophagus.
Although clinical data is controversial, use of probiotics for the medical management and prevention of esophagitis might be recommended. Antioxidant treatment with natural herbs might also provide relief. Extracts of Artemisia Asiatica have been shown to protect against oxidative damage which is known to be involved in the development of some cases of esophagitis.
The prognosis for people with esophagitis is good since there are available treatments that can help alleviate the symptoms and can treat the fundamental disease. On the other hand, for people having intermittent episodes of gastric reflux, they may need to follow a maintenance treatment.
Diet-related esophagitis may be prevented by avoiding certain foods, beverages or activities that can cause or aggravate the condition. These include: alcohol, smoking, caffeinated drinks and spicy food. Avoidance of these agents may also be beneficial in reducing the severity of symptoms in esophagitis of different etiology (such as viral or eosinophilic esophagitis).
Living with esophagitis might be difficult in advanced cases where severe complications could arise. However, if the condition is treated and followed by a doctor, the outlook is generally very good.
Research focuses on the development of novel and improved agents for the medical management of esophagitis, such as new proton pump inhibitors with delayed release properties. Efforts are also being developed to better describe the pathophysiology of eosinophilic esophagitis. Increased attention has been recently given to eosinophilic esophagitis due to the higher incidence of this condition.