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Esophagitis

Updated : August 30, 2023





Background

Esophagitis is the damage or inflammation of the esophageal mucosa. Odynophagia, dysphagia, and chest pains are typical signs and symptoms of esophagitis. Patients may exhibit symptoms associated with strictures, perforation, and fistulization if the esophagitis is severe and results in these conditions.

Epidemiology

Food allergies, eczema, and asthma have been linked, with an estimated incidence of 0.35 per 100,000 people and 55 per 100,000 people. Males tend to be more susceptible, and they typically begin to exhibit symptoms in their second or third decade.

Erosive esophagitis affects 1% of the population. The estimated incidence of medication-induced esophagitis is 3.9 per 100,000 people annually, with a mean age at diagnosis of 41.5 years.

The statistics for infected esophagitis are challenging to determine. It is significantly more common among immunocompromised patients, such as those with HIV infection and individuals suffering from hematological malignancies.

Anatomy

Pathophysiology

The pathogenesis also depends on the subgroup of esophagitis addressed.

Medication-induced esophagitis

Direct irritating effects and cytoprotective barrier breakdown are involved in developing medication-induced esophagitis. Repeated exposure to irritants can harm the esophagus mucosa. When dissolved in water or saliva, medications like tetracyclines, ferrous sulfate, and doxycycline have a pH below 3, which can result in local caustic damage. Due to the hyperosmolar character, other drugs like potassium chloride can harm the vascular system and destroy tissue.

Infectious esophagitis

Bacterial, parasitic, viral, and fungal microorganisms can cause esophagitis infection. The least common is bacterial esophagitis. The most common cause of infectious esophagitis is Candida albicans infection. The pathophysiology begins with colonization, followed by mucosal adhesion and proliferation. The second phase is to diminish the host’s defence system. C. Albicans is a natural element of oral flora; however, it may become a concern when antibiotics are used or if the patient is immunocompromised. The most frequent cause of viral esophagitis is the herpes simplex virus. It causes cysts and eventually ulcerations by infecting the squamous epithelium. Other viral causes of viral esophagitis include Epstein-Barr, cytomegalovirus, and varicella-zoster.

Reflux esophagitis

Mucosal damage results from excessive and recurrent reflux of stomach contents in the esophagus. The lower esophageal sphincter’s tone has reduced, and transient relaxations have increased. These elements help the acid to flow antegrade. Additionally, people with significant Hiatal hernias experience more reflux since they contribute to the loss of tone. Contrarily, circumstances that reduce esophageal peristalsis or impact saliva production can disrupt the defenses against esophageal injury, leading to reflux esophagitis.

Etiology

Esophagitis has many etiologies, including reflux disease, medication-induced, bacterial, radiation, and eosinophilic esophagitis. The most frequent cause of esophagitis is reflux, also known as erosive esophagitis, which develops when gastric contents leak into the stomach and cause damage to the mucosa.

Bacteria, viruses, fungi, and parasitic microorganisms can all result in infection esophagitis, with fungi being the most common and bacteria being the least common. Oral bisphosphonates like alendronate and certain antibiotics, including doxycycline, tetracycline, and clindamycin, are the most frequently linked to medicine-induced esophagitis.

Ferrous sulfate, mexiletine, potassium chloride, NSAIDs, and aspirin have also been implicated in pill-induced esophagitis cases. Esophagitis is also caused by radiation therapy and can present in acute or chronic types.

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 
 

sucralfate

Infants > 3 months and children <6 years:

500

mg

Orally 

4 times a day

Children > 6 years: 1000 mg/dose four times a day



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK442012/

Esophagitis

Updated : August 30, 2023




Esophagitis is the damage or inflammation of the esophageal mucosa. Odynophagia, dysphagia, and chest pains are typical signs and symptoms of esophagitis. Patients may exhibit symptoms associated with strictures, perforation, and fistulization if the esophagitis is severe and results in these conditions.

Food allergies, eczema, and asthma have been linked, with an estimated incidence of 0.35 per 100,000 people and 55 per 100,000 people. Males tend to be more susceptible, and they typically begin to exhibit symptoms in their second or third decade.

Erosive esophagitis affects 1% of the population. The estimated incidence of medication-induced esophagitis is 3.9 per 100,000 people annually, with a mean age at diagnosis of 41.5 years.

The statistics for infected esophagitis are challenging to determine. It is significantly more common among immunocompromised patients, such as those with HIV infection and individuals suffering from hematological malignancies.

The pathogenesis also depends on the subgroup of esophagitis addressed.

Medication-induced esophagitis

Direct irritating effects and cytoprotective barrier breakdown are involved in developing medication-induced esophagitis. Repeated exposure to irritants can harm the esophagus mucosa. When dissolved in water or saliva, medications like tetracyclines, ferrous sulfate, and doxycycline have a pH below 3, which can result in local caustic damage. Due to the hyperosmolar character, other drugs like potassium chloride can harm the vascular system and destroy tissue.

Infectious esophagitis

Bacterial, parasitic, viral, and fungal microorganisms can cause esophagitis infection. The least common is bacterial esophagitis. The most common cause of infectious esophagitis is Candida albicans infection. The pathophysiology begins with colonization, followed by mucosal adhesion and proliferation. The second phase is to diminish the host’s defence system. C. Albicans is a natural element of oral flora; however, it may become a concern when antibiotics are used or if the patient is immunocompromised. The most frequent cause of viral esophagitis is the herpes simplex virus. It causes cysts and eventually ulcerations by infecting the squamous epithelium. Other viral causes of viral esophagitis include Epstein-Barr, cytomegalovirus, and varicella-zoster.

Reflux esophagitis

Mucosal damage results from excessive and recurrent reflux of stomach contents in the esophagus. The lower esophageal sphincter’s tone has reduced, and transient relaxations have increased. These elements help the acid to flow antegrade. Additionally, people with significant Hiatal hernias experience more reflux since they contribute to the loss of tone. Contrarily, circumstances that reduce esophageal peristalsis or impact saliva production can disrupt the defenses against esophageal injury, leading to reflux esophagitis.

Esophagitis has many etiologies, including reflux disease, medication-induced, bacterial, radiation, and eosinophilic esophagitis. The most frequent cause of esophagitis is reflux, also known as erosive esophagitis, which develops when gastric contents leak into the stomach and cause damage to the mucosa.

Bacteria, viruses, fungi, and parasitic microorganisms can all result in infection esophagitis, with fungi being the most common and bacteria being the least common. Oral bisphosphonates like alendronate and certain antibiotics, including doxycycline, tetracycline, and clindamycin, are the most frequently linked to medicine-induced esophagitis.

Ferrous sulfate, mexiletine, potassium chloride, NSAIDs, and aspirin have also been implicated in pill-induced esophagitis cases. Esophagitis is also caused by radiation therapy and can present in acute or chronic types.

sucralfate

Infants > 3 months and children <6 years:

500

mg

Orally 

4 times a day

Children > 6 years: 1000 mg/dose four times a day



https://www.ncbi.nlm.nih.gov/books/NBK442012/