Esophagitis is inflammation, which causes damage to the tissues of the esophagus due to a variety of reasons. Esophagus is a muscular tube whose function is to deliver food from the mouth to the stomach. The symptoms of esophagitis comprise of difficult and painful swallowing along with chest pain. Esophagitis occurs due to regurgitation of stomach acids back into the esophagus, oral medications, infection and allergies.
Treatment depends on the underlying cause and the severity of the damage to the tissue. If esophagitis is not treated, then it can damage the lining, disturbs the normal function and leads to other complications, such as stricture, scarring and difficulty in swallowing.
Causes & Types of Esophagitis
Esophagitis is classified into the conditions which cause it. There are some cases where there is more than one cause of esophagitis.
Lower esophageal sphincter is a valve-like structure, which helps in keeping the acidic contents of the stomach from entering back into the esophagus. If this valve doesn't close properly or remains open, then there is backflow of stomach contents into the esophagus. This condition is known as gastroesophageal reflux. A complication of this condition is chronic inflammation and damage to tissue in the esophagus.
Eosinophils are the white blood cells, which play an important role in allergic reactions. When the concentration of these white blood cells increases in the esophagus, then it causes eosinophilic esophagitis. This often happens in response to an allergen or acid reflux or both.
Majority of the times, individuals who have allergic esophagitis have allergy to one or more foods. Foods which can cause eosinophilic esophagitis include eggs, milk, wheat, peanuts, soy, beans, beef and rye. People suffering from eosinophilic esophagitis can have other nonfood allergies, such as inhaled allergens like pollen etc. can also cause allergic esophagitis.
There are many oral medications, which cause tissue damage if they continue to remain in contact with the esophageal lining. If a person swallows a pill with a little amount of water or no water at all, then the pill or its residue continues to remain in the esophagus and causes inflammation. Medicines which have been linked to esophagitis include: Pain-relievers (ibuprofen, aspirin), antibiotics (tetracycline, doxycycline), potassium chloride, bisphosphonates, quinidine etc.
Any type of infection, such as bacterial, viral or fungal in the tissues of the esophagus can cause esophagitis. Infectious esophagitis is a relatively rare condition and commonly occurs in those individuals who have poor immune system, such as people with cancer or HIV/AIDS.
Risk Factors for Esophagitis
The following are the risk factors for different types of esophagitis:
- Having excessively large and fatty meals.
- Eating immediately before sleeping.
- Excessive consumption of chocolate, caffeine, alcohol, and mint-flavored foods.
- Eating hot, spicy, citrus based foods worsens the symptoms of GERD or reflux esophagitis.
- Having history of allergic reactions, such as asthma, allergic rhinitis and atopic dermatitis.
- A family history of eosinophilic esophagitis increases the risk of having it.
- Taking a pill/medicine with little or no water.
- Taking medicines right before sleeping. This causes esophagitis due to decreased production of saliva and swallowing during sleep.
- Taking medicines when lying down.
- Older age, as it can cause decreased production of saliva and cause age-related changes to the esophageal muscles.
- Large or oddly shaped pills.
Taking medications, such as steroids and antibiotics for infections increase the risk for esophagitis. Patients having diabetes are also more susceptible to especially developing candida esophagitis. Weakened immune system also increases the risk for infectious esophagitis. Certain cancer treatments, such as taking immunosuppressants can also increase the risk of infectious esophagitis.
Signs & Symptoms of Esophagitis
- Swallowing difficulties.
- Pain when swallowing.
- Pain in the chest, especially behind the sternum (breastbone) when eating.
- Food impaction, i.e. food which is swallowed gets stuck in the esophagus.
- Heartburn and acid regurgitation.
- Symptoms in young children comprise of failure to thrive and feeding difficulties.
Consult a Doctor Immediately if the Symptoms:
- Do not subside even after a few days.
- Are so severe that patient finds it difficult to eat.
- Do not improve after taking over-the-counter antacids.
- Are accompanied by chest pain or shortness of breath after some time of eating.
- Are accompanied by signs and symptoms of flu, such as fever, headache and muscle aches.
Investigations for Esophagitis
- Barium x-ray: patient is given a barium solution to drink or told to take barium coated pill. The lining of the esophagus and stomach gets coated with barium, which makes the organs more obvious. X-rays are then taken to help identify any esophageal narrowing, structural changes, tumors, hiatal hernia or any abnormality which is causing these symptoms.
- Endoscopy: In this procedure, the doctor directs a long, thin tube (endoscope) which is equipped with a tiny camera down the throat and into the esophagus. With the help of this instrument, the doctor checks for any unusual appearance of the esophagus and may also take a biopsy (tissue sample) for testing. The appearance of the esophagus may be different depending on the cause of inflammation, such as reflux esophagitis or drug-induced esophagitis. Patient will be slightly sedated during this test.
- Laboratory Tests: Tests such as biopsy, are taken during the endoscopic exam and the tissue sample is sent to lab for testing. Depending on the cause, further tests, such as blood tests may be ordered to diagnose the type of infection, to determine the concentration of eosinophils and to look for any abnormal cells, which would indicate cancer of the esophagus or precancerous changes
Treatment for Esophagitis
Treatment depends on the underlying cause and the aim of the treatment is to reduce the symptoms and manage any complications. Treatment for underlying causes comprises of:
- Over-the-counter antacids, such as Maalox and Mylanta.
- H-2-receptor blockers are the medications, which help in reducing acid production, such as cimetidine and ranitidine.
- Proton pump inhibitors are the medications, which block the acid production and heal the esophagus, such as lansoprazole and omeprazole.
- Prescription-strength H-2-receptor blockers include medications, such as famotidine, nizatidine and ranitidine.
- Prescription-strength proton pump inhibitors, include esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole and dexlansoprazole.
- Baclofen is a medication, which helps in reducing the frequency of relaxation of the lower esophageal sphincter and thereby decreasing gastroesophageal reflux.
- Surgical procedures, such as Fundoplication, may be done if the above interventions do not work. This procedure helps in improving the condition of the esophagus. A portion of the stomach is wrapped around the lower esophageal sphincter, which helps in strengthening the sphincter and prevents the backflow of the acid into the esophagus.
- A newer device, known as Linx, is a procedure where a ring of tiny magnetic titanium beads is wrapped around the junction of the esophagus and stomach to strengthen the lower esophageal sphincter. The Linx procedure can be done using minimally invasive surgery techniques.
- Treatment for this type of esophagitis is avoiding the allergen and trying to reduce the allergic reaction with medications.
- For this, the doctor will prescribe a proton pump inhibitor, such as lansoprazole, esomeprazole, omeprazole, pantoprazole, rabeprazole, or dexlansoprazole.
- Inhaled steroids are used to manage asthma. According to studies, swallowed steroids may act similar to topical steroids in the esophagus and are beneficial in treating eosinophilic esophagitis.
- 6-food elimination diet is where the culprit foods are eliminated to avoid esophagitis. There are no tests, as of now, to pinpoint the main culprit food. For this reason, the doctor recommends removing the common food allergens from the diet. Under the direction of the doctor, foods are gradually added back into the diet and the patient is observed for reappearance of symptoms upon starting a particular food item.
Treatment for drug-induced esophagitis comprises of avoiding the drug, which is causing problem and to replace them with other medicine and to adopt better pill-taking habits. For this, the doctor recommends:
- Taking a substitute drug which is less likely to cause drug-induced esophagitis.
- Drinking a complete glass of water with the pill, unless the doctor has advised the patient to restrict his/her fluid intake because of other medical problems, such as kidney disease.
- Trying to take a liquid version of the medicine if possible.
- Avoiding lying down immediately after taking the pill and sitting or standing for at least half-an-hour.
Medications for treating viral, bacterial, fungal or parasitic infections which are causing infectious esophagitis are prescribed by the doctor.
Lifestyle Modifications for Esophagitis
- Patient should try to avoid foods which will increase reflux. Excessive amounts of foods which will worsen the gastroesophageal reflux symptoms should be avoided and these include caffeine, chocolate, alcohol and mint-flavored foods.
- Adopt good pill-taking habits, such as always taking the pill with lot of water and not lying down for at least 30 minutes after taking a pill.
- Losing excess weight through proper diet and exercise helps with this condition and patient should try to maintain a healthy weight.
- Smokers should quit smoking.
- Certain medications should be avoided, such as pain killers and antibiotics.
- Try to avoid stooping or bending immediately after eating.
- Do not lie down immediately after eating. Wait for a minimum of three hours after eating before lying down or going to bed.
- Elevate the head of the bed by placing wooden blocks under the bed. Raise the bed by at least 6 to 8 inches. Avoid placing pillow under your head, as this will raise only your head and not your entire body and can also lead to other problems.