Esophagitis is inflammation of the lining of the esophagus that is diagnosed by a barium X-ray or endoscopy. Generally, it is not a diagnosis that can be made by a doctor in the office through a history or physical examination. The inflammation is usually caused by reflux of acid that burns, damaging the esophagus. However, medications can sometimes cause esophagitis, for example, aspirin or over-the-counter pain relievers, iron pills, potassium pills, some antibiotics, and certain drugs used to treat osteoporosis such as alendronate sodium. Rarely, infections of the lining of the esophagus such as yeast (Candida) or certain viruses can cause esophagitis. But again, generally most esophagitis is caused by acid reflux disease.
Symptoms of esophagitis are heartburn, occasionally chest pain, and/or difficulty swallowing. Treatment involves taking medication that suppresses acid production by the stomach, such as proton pump inhibitors like omeprazole (Prilosec) or a class of medications called histamine-2 receptor antagonists (or blockers) such as ranitidine (Zantac). Patients generally need 8 weeks of treatment to heal esophagitis, but most require some type of longer-term medication to maintain healing because there is a high risk of the inflammation returning after medication has been discontinued.
In an endoscopic examination, a spectrum of inflammation can be seen and several grading scales are used to describe the severity of esophagitis. For example, the most commonly used scale is the Los Angeles Esophagitis Grading Scale. This ranges from LA Grade A, which is mild redness at the bottom of the esophagus or mild esophagitis, to LA Grade D, which is severe inflammation with loss of some of the esophageal lining and severe ulceration. Despite the varying severity, the symptoms most patients experience are about the same. On rare occasions, patients with severe esophagitis can have nausea and vomiting. Very rarely, severe esophagitis can result in bleeding and anemia or low blood counts. Bleeding can manifest as vomiting frank blood or material that looks like coffee grounds, to passing blood in the stool that may look black and tarry. These symptoms warrant an urgent visit to the doctor or the closest emergency room because bleeding can be serious and requires immediate treatment.
Thankfully, most patients, even those with severe inflammation, heal readily when they take H2 blockers or PPI treatment. Sometimes severe esophagitis can heal but leave behind scarring and narrowing called strictures. Other times, when the esophagus heals, a new lining forms that is more resistant to acid damage; this condition is called Barrett’s esophagus. Strictures and Barrett’s esophagus present other problems that may require treatment and follow-up that are discussed later.
What is esophagitis? References
By Mortin - Copyright 2009
Last modification 31/12/2009