Esophagitis

What Is It?

The esophagus is the muscular tube that carries food through the chest, from the mouth to the stomach. Normally you don't feel it except when you are swallowing. However, if the inside lining of your esophagus becomes inflamed, you may experience pain or problems swallowing. This inflammation of the esophagus is called esophagitis.

Esophagitis has several common causes:

• Acid reflux By far the most common cause of esophagitis, acid reflux (also called gastroesophageal reflux disease or GERD) is a backflow of digestive acid from the stomach, resulting in a chemical burn of the esophagus.
• Eating disorders Like acid reflex, frequent vomiting can cause acid burn in the esophagus. Esophagitis sometimes is seen in people with eating disorders who make themselves vomit.
• Medications Some common medications also can cause a chemical burn in the esophagus. Pills that are most likely to cause esophagitis include potassium, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or aspirin, osteoporosis medications such as alendronate (Fosamax) or risedronate (Actonel), iron supplements and quinidine (sold under several brand names).
• Chemotherapy and radiation therapy for cancer Some of these treatments can injure the esophagus lining, resulting in esophagitis.
• Infections Infections in the esophagus also can cause esophagitis. Only a few types of infection are common in the esophagus, and they usually do not occur if your immune system is normal. If your immune system is weakened, you may develop esophagitis from yeast (candidal esophagitis) or from viruses such as cytomegalovirus (CMV) or herpes. Even in someone who already has a herpes infection, herpes rarely causes esophagitis if the immune system is normal. Esophagitis from infections is common in people who have HIV infection, use steroid medicines for a long time, have had organ transplants, and have been treated with chemotherapy for cancer.

Symptoms

The main symptoms of esophagitis are:

• Pain in the chest (behind the breastbone) or throat that can be burning, heavy or sharp If acid reflux is the cause of esophagitis, the pain may be worse after meals or when you lie flat. Pain from esophagitis may be constant or may come and go.
• Swallowing problems including worsening of the chest pain when you swallow or a feeling of food sticking in your chest after you swallow
• Bleeding, seen as blood in vomit or as darkening of the stools

Diagnosis

The diagnosis often is made based on your symptoms. The most accurate way to check for esophagitis is for a gastroenterologist to look directly at the inside of the esophagus with a video camera called an endoscope. The endoscope has a camera at the end of a flexible, plastic-coated tube. This tube is long enough to reach through the stomach to the first portion of the intestine (duodenum), so the procedure is sometimes called esophagogastroduodenoscopy or EGD. Using the endoscope, the gastroenterologist can see evidence of injury from esophagitis, such as areas where the lining of the esophagus has worn away (called erosions or ulcers), blisters or scarred areas. Some infections leave a deposit on the esophagus walls that can be sampled through the endoscope by using a remote-controlled brush. In some cases the doctor will do a biopsy of the esophagus by snipping a small sample of the inside lining through the end of the endoscope. This tissue is examined under a microscope.

Since esophagitis is only one of the things that can cause symptoms of chest pain or swallowing problems, your doctor may order other tests to evaluate your heart, lungs or digestive tract.

Expected Duration

How long symptoms last depends on how easily their cause can be eliminated. Bad cases of reflux or resistant viruses, for example, might require several tries before the right medicine or treatment is found. In most cases, symptoms begin to improve within a few days of starting the right treatment, but it can take weeks for symptoms to go away completely. Esophagitis from infections is harder to cure if the immune system is severely weakened.

Prevention

The most common cause of esophagitis, acid reflux, sometimes can be prevented by some very simple measures:

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

If you have heartburn despite these measures, your doctor may suggest you take a preventative acid-blocking medicine.

All prescription and nonprescription pills should be taken while you are upright and should be swallowed with water. This is especially important for the medicines that frequently cause esophagitis.

Treatment

Treatment depends on the cause of esophagitis.

• Acid reflux Acid-blocking medications, including H2-blockers and proton-pump inhibitors, may be used. For a few difficult cases, a type of stomach surgery can also help prevent reflux.
• Medications Drinking a full glass of water after taking a pill can help. For severe esophagitis, it is sometimes better to stop the medicine and find alternative treatment. Since acid can worsen esophagitis caused by medications, your doctor also may prescribe an acid-blocking medication to speed healing.
• Infections These are treated with specific antibiotics. Some esophagus infections are difficult to treat with swallowed pills or liquids, so medicines may be given intravenously (into a vein).

While your esophagus is recovering, your doctor can ease your pain symptoms by prescribing pain relievers or a local anesthetic that can be swallowed in a thick liquid form to coat the esophagus lining.

When To Call A Professional

If you are unable to eat or drink due to pain during swallowing, you should contact your doctor. Life-threatening dehydration can develop quickly if you cannot drink liquids.

Occasionally an injured esophagus can develop a hole, causing sudden worsening of chest pain, shortness of breath or fever. Report these symptoms to your doctor immediately, because bacteria from your digestive tract can contaminate your chest cavity and cause a serious infection.

If your symptoms do not clear up with initial treatment, consult your doctor. Occasionally, scarring in the esophagus will cause persistent swallowing difficulty that might require treatment by a gastroenterologist.

Prognosis

Almost all cases of esophagitis can be cured. Some causes, such as acid reflux, may require long-term treatment.

Additional Info

American College of Gastroenterology (ACG)

P.O. Box 3099

Arlington, VA 22302

http://www.acg.gi.org/

American Gastroenterological Association

4930 Del Ray Ave.

Bethesda, MD 20814

Phone: (301) 654-2055

Fax: (301) 654-5920

http://www.gastro.org/

Centers for Disease Control and Prevention (CDC)

1600 Clifton Road

Atlanta, GA 30333

Phone: (404) 639-3534

Toll-Free: (800) 311-3435

http://www.cdc.gov/