Esophagitis

ESOPHAGITIS

Esophagitis is any inflammation or irritation of the esophagus. The esophagus is the tube that sends food from the mouth to the stomach. Common causes will include acid reflux, side effects of certain medications, and bacterial or viral infections. Reflux is when the stomach's contents and acids comes back up into the esophagus.

This disorder can cause a variety of symptoms that include:

• Heartburn
• Trouble swallowing
• Sore throat

If not treated, esophagitis can lead to ulcers, scarring, and severe narrowing of the esophagus, all of which can be a medical emergency.

The treatment options and outlook will depend on the cause of the condition. However, most healthy people improve within two to four weeks especially with proper treatment. Recovery may take longer for people with a weakened immune system or infection.

TYPES OF ESOPHAGITIS

Eosinophilic esophagitis:-

Eosinophilic esophagitis is caused by too many of a type of disease-fighting white blood cell (eosinophils) in the esophagus. This occurs when the body over responds to an allergen. This can make eating difficult among people with vulnerabilities (e.g. children and the aged). Common triggers include:

• Peanuts
• Milk
• Soy
• Tree nuts
• Shellfish
• Eggs
• Wheat

Allergens that can be inhaled, (e.g. Pollen), can also contribute to this form of esophagitis.

Reflux esophagitis:-

Usually due to a condition known as gastro esophageal reflux disease (GERD). Reflux esophagitis occurs when stomach contents like acids, frequently back up into the esophagus. This causes chronic inflammation and irritation of the esophagus.

Drug-induced esophagitis:-

Drug-induced esophagitis can occur when an individual takes certain medications without enough water. This makes the medications linger in the esophagus for too long.

These medications may include:

• Potassium chloride
• Drugs that prevent bone loss (Bisphosphonates)
• Pain relievers
• Antibiotics

Infectious esophagitis:-

This is a rare type which can be due to bacteria, viruses, fungi, or parasites. One is at increased risk for this type of esophagitis if he/she has a weakened immune system due to disease or medications. This happen to be a type that is common in people with HIV or AIDS, cancer, and diabetes.

CAUSES

Generally, this condition is categorized by its causes. However, in certain cases, more than one factor may be causing esophagitis.

Reflux esophagitis:-

The lower esophageal sphincter, a valve-like structure usually keeps the acidic contents of the stomach out of the esophagus. If this valve does not close properly or opens when it should not, the contents of the stomach may back up into the esophagus (gastro esophageal reflux). A condition in which this backflow of acid is a frequent or ongoing problem is called a Gastro esophageal reflux disease (GERD). A complication of GERD is characterized by chronic inflammation and tissue damage in the esophagus.

Eosinophilic esophagitis:-

Eosinophils are white blood cells that play a key role in fighting allergies. Whenever there is a high concentration of these white blood cells in the esophagus (most likely in response to an allergy-causing agent) or acid reflux or both, Eosinophilic esophagitis occurs. In a lot of cases, this type of esophagitis may be triggered by foods such as milk, eggs, wheat, soy, peanuts, beans, rye and beef. However, these foods are not reliably identified by conventional allergy testing.

It is possible that people with Eosinophilic esophagitis may have other nonfood allergies. For example, sometimes airborne allergens such as pollen if inhaled, could be a cause.

Lymphocytic esophagitis:-

Lymphocytic esophagitis (LE) is a highly uncommon esophageal condition in which there are an increased number of lymphocytes in the lining of the esophagus. LE may be related to Eosinophilic esophagitis or to GERD.

Drug-induced esophagitis:-

Several oral medications can cause tissue damage if they remain in contact with the lining of the esophagus for too long. For instance if one swallows a pill with little or no water, the pill itself or its residue from the pill may remain in the esophagus.

The following drugs have been linked to esophagitis:

• Quinidine (used to treat heart problems)
• Potassium chloride (e.g. used to treat potassium deficiency)
• Pain-relievers (e.g. aspirin, ibuprofen and naproxen sodium).
• Antibiotics (e.g. tetracycline and doxycycline)
• Bisphosphonates (alendronate etc.), a treatment for osteoporosis

Infectious esophagitis:-

An infection, be it bacterial, viral or fungal in tissues of the esophagus may cause esophagitis. Infectious esophagitis is relatively uncommon and occurs more among people with poor immune system function, such as people with HIV/AIDS or cancer.

A fungus that is normally present in the mouth called Candida albicans is a common cause of infectious esophagitis.

SYMPTOMS

Common signs and symptoms of esophagitis include:

• Acid regurgitation
• Heartburn
• Chest pain that occurs with eating
• Swallowing difficulties
• Pain when swallowing
• Swallowed food getting stuck in the esophagus

In infants and young children, especially those too young to explain their discomfort or pain, the signs may include:

• Feeding difficulties
• Failure to grow well

WHEN TO SEE A DOCTOR

• Individuals should report sudden worsening of chest pain, shortness of breath or fever to their doctor immediately. Occasionally an injured esophagus can develop a hole, causing the above symptoms.
• Whenever one is unable to eat or drink due to pain during swallowing, they should contact their doctor. Dehydration which is life-threatening can develop quickly if one cannot drink liquids.
• If the symptoms do not respond to initial treatment, one should consult their doctor. Occasionally, some scarring in the esophagus will cause persistent swallowing difficulty that might require dilation therapy that is done through the endoscope.

People should get emergency care if they:

• Experience pain in the mouth or throat when eating
• Experience shortness of breath or chest pain that occurs especially after eating
• Experience pain in the chest that lasts more than a few minutes
• Suspect that food is stuck in the esophagus
• Have a history of heart disease and experience chest pain
• Vomit large amounts, often have forceful vomiting, have trouble breathing after vomiting or have vomit that is yellow or green, looks like coffee grounds, or contains blood

RISK FACTORS

Risk factors for esophagitis vary, and will depend on the causes of the disorder.

Reflux esophagitis:-

Factors in reflux esophagitis are the same factors that increase the risk of gastro esophageal reflux disease (GERD). They include the following:

• Smoking
• Large and fatty meals
• Eating immediately before going to bed
• Excess alcohol, caffeine, chocolate and mint-flavored foods
• Extra weight, including from pregnancy

A number of foods may also worsen symptoms of GERD or reflux esophagitis:

• Alcohol
• Chocolate
• Tomato-based foods
• Mint-flavored foods
• Citrus fruits
• Caffeine
• Spicy foods
• Garlic and onions

Eosinophilic esophagitis:-

Risk factors for allergy-related esophagitis, may include:

• A history of certain allergic reactions, including allergic rhinitis, asthma and atopic dermatitis
• A family history of Eosinophilic esophagitis

Drug-induced esophagitis:-

The factors that may increase the risk of drug-induced esophagitis are related to issues that prevent quick and complete passage of a pill into the stomach. These factors include:

• Swallowing drugs while lying down
• Swallowing drugs right before sleep
• Swallowing a pill with little or no water at all
• Older age (because of age-related changes to the muscles of the esophagus)
• Large or oddly shaped pills

Infectious esophagitis:-

Risk factors for infectious esophagitis relate closely to medications. In particular, people with diabetes also are at increased risk of candida esophagitis.

Poor immune system function may also be related to causes of infectious esophagitis. This may be due to an immune disorder, HIV/AIDS or certain cancers.

POSSIBLE COMPLICATIONS

If left untreated, esophagitis can lead to changes in the structure of the esophagus.

Possible complications include:

• Tearing of the esophagus lining tissue from retching (food gets stuck) or during Endoscopy (due to inflammation)
• Stricture (Scarring or narrowing) of the esophagus
• Changes to the cells lining the esophagus, increases the risk of esophageal cancer

DIAGNOSIS

The doctor or specialist will most likely make a diagnosis based on answers to questions, a physical exam, and one or more tests.

The tests may include:

• Barium X-ray

A solution containing a compound called barium or a pill coated with barium will be taken. Barium coats the lining of the esophagus and stomach and makes the organs visible. These images can help identify narrowed portions of the esophagus, or other abnormalities that could be causing symptoms.

• Endoscopy

Doctors will guide a long, thin tube equipped with a tiny camera at its end (endoscope) down the throat and into the esophagus. With this instrument, the doctor can look for any unusual appearance about the esophagus and even remove small tissue samples for testing. Depending on the cause of the inflammation, the esophagus may look different. The patient will be lightly sedated for this test.

• Laboratory tests

Small tissue samples that is removed (biopsy) during an endoscopic exam will be sent to the lab for testing. Depending on the suspected cause of the disorder, the tests may be used to:

• Diagnose a fungal, bacterial or viral infection
• Determine the concentration of white blood cells related to allergy (eosinophils)
• Identify abnormal cells which would suggests esophageal cancer or precancerous changes.

TREATMENT FOR ESOPHAGITIS

Treatment normally depends on the cause.

Medications may include:

• Oral steroids
• Pain relievers
• Proton pump inhibitors (medications that block production of stomach acid)
• Antiviral medications
• Antifungal medications
• Antacids

If food allergies is the cause of the condition, trigger foods must be identified and eliminated from diet.

The top food allergens include:

• peanuts
• milk
• soy
• eggs
• wheat
• shellfish

Avoiding spicy and or acidic foods and drinks, and raw or hard foods can also ease the symptoms. Petty things like taking smaller bites and chewing food well will also help ease symptoms. Tobacco and alcohol must be avoided as well.

If the symptoms are due to medication, there may be the need to drink more water, take a liquid version of the medication, or try a different medication. The patient may need to remain upright and refrain from lying down for 30 minutes after taking medication in pill form.

THE LONG-TERM OUTLOOK

Chronic esophagitis can cause stricture (narrowing of the esophagus) or tissue damage it not treated. The chances of developing esophageal cancer are higher if the cells lining the esophagus have changed due to persistent exposure to acids.

One's personal outlook will depend on the cause and on his/her overall health. Most people improve with treatment. Healthy people often recover within three to five days, sometimes even without treatment. Recovery may take longer if you have a weakened immune system.

PREVENTION

Acid reflux, the most common cause of esophagitis sometimes can be prevented by some very simple measures like:

• Avoiding heavy meals, especially within several hours of bedtime
• Cutting out cigarettes and alcohol
• Avoiding large amounts of caffeine, chocolate, peppermint and high-fat foods.
• Controlling your weight.

If heartburn persists despite these measures, the doctor may suggest preventative medications that decrease stomach acid.

All prescription and non-prescription pills should be taken while in upright positions and should be swallowed with water. This is especially important for the medicines that frequently cause esophagitis.