Esophagitis

Medical condition
Esophagitis is inflammation of the esophagus. The esophagus is a muscular tube through which food travels from the mouth to the stomach.
Esophagitis most commonly occurs in older individuals. The incidence of this condition is similar in men and women. Esophagitis is rare among children.

Cause of the condition
There are several main causes for inflammation in the esophageal mucosa. The most important pathology causing esophagitis is gastroesophageal reflux disease (GERD). During GERD, due to inadequate closure of the lower esophageal sphincter, acidic stomach contents repeatedly enter the esophagus and irritate its mucosa. Chronic inflammation can damage deeper layers of the esophageal tissues.
Another cause of esophagitis is an autoimmune disease called eosinophilic esophagitis. This condition is characterized by a high number of white blood cells called eosinophils, which are often associated with specific allergies. People with eosinophilic esophagitis are usually allergic to certain foods such as milk, eggs, nuts, etc.
Less commonly, esophagitis can be caused by infectious agents: viruses, fungi, bacteria. Infection-induced inflammation of the esophagus is most commonly found in individuals with weakened immune systems (e.g., those with HIV/AIDS).
The use of certain medications can also be a cause of esophagitis: aspirin, ibuprofen, some antibiotics, bisphosphonates.

Risk factors
Risk factors for esophagitis include: smoking, alcohol consumption, frequent and severe vomiting, chest surgeries or radiation therapy.

Symptoms
The following clinical symptoms are typical for the condition:
Difficulty swallowing food,
Painful swallowing,
Pain, burning sensation behind the breastbone,
Throat clearing, coughing,
Food swallowed seems to “stick” in the esophagus.

Diagnosis
After identifying the signs of the condition, instrumental tests are performed:
X-ray using contrast material. The individual swallows a barium solution, and during the X-ray examination, the movement of the contrast material through the digestive tract is observed. This test can identify the location of esophageal narrowing, various tumor formations.
To diagnose gastroesophageal reflux disease, esophageal 24-hour pH monitoring may be performed (monitoring of pH fluctuations in the esophagus over a 24-hour period). This test is rarely performed.
The main test for diagnosing esophagitis is esophageal endoscopy. During this procedure, mucosal changes are evaluated, and samples can be taken for histological examination.

Treatment
Treatment depends on the cause of the condition. If GERD is the cause of esophagitis, proton pump inhibitors, other acid-reducing or neutralizing medications are prescribed. Eosinophilic esophagitis is treated with steroid medications, as well as a strict diet. In the case of infectious esophagitis, appropriate anti-infective medications are prescribed upon identifying the causative agent of the disease. If esophageal inflammation is caused by medication use, attempts should be made to switch to other non-irritating esophageal medications. If this is not possible, the medications should be taken with a large amount of water and individuals should not lie down for at least half an hour after taking the medications.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology