What are esophagitis?
Esophagitis is classified by cause and depth of damage. The doctor indicates in the gastroscopy conclusion the form of inflammation and the degree (for example, according to the Los Angeles classification for reflux esophagitis - from A to D). The choice of drugs and duration of treatment depend on this.
- Reflux esophagitis is the most common and is associated with reflux of gastric contents
- Candidiasis (fungal) - in people with reduced immunity, after antibiotics and hormones
- Medicinal (“tablet”) - for tablets stuck in the esophagus
- Eosinophilic - allergic in nature, often in young men
- Chemical burn - after ingesting aggressive liquids
Causes and risk factors
The esophageal mucosa is protected by the lower esophageal sphincter and the ability of the esophagus to quickly “cleanse” itself of contents. If the sphincter is weakened, pressure in the abdomen is increased, or the esophagus is in contact with an irritant for a long time, inflammation develops. Separately, there are tablets that especially often damage the mucous membrane when taken without water and before bed: some antibiotics, potassium and iron preparations, NSAIDs.
- Gastroesophageal reflux disease and hiatal hernia
- Excess weight and pregnancy
- Smoking, alcohol, overeating, eating before bed
- Diabetes mellitus, HIV infection, glucocorticoid use
- Taking pills lying down and without enough water
Symptoms
The severity of complaints does not always correspond to the severity of the lesion: sometimes with erosions a person feels almost nothing, and with mild inflammation he suffers from heartburn. In children and the elderly, esophagitis can manifest itself unusually - refusal to eat, cough, hoarseness.
- Heartburn and burning sensation in the chest, worse after eating and when lying down
- Pain when swallowing (odynophagia) and sensation of food being stuck
- Sour belching, bitterness in the mouth
- Night cough, hoarseness of voice
- White plaque in the mouth with fungal esophagitis
Diagnostics
The main method is gastroscopy. The doctor evaluates the color of the mucosa, the presence of erosions, ulcers, plaque and narrowings, and, if necessary, takes a biopsy: it is needed to confirm fungal and eosinophilic esophagitis and exclude Barrett’s esophagus. With a typical picture of reflux and no changes on gastroscopy, 24-hour pH monitoring may be required. Chest pain in older people always requires excluding a cardiac cause - an ECG is performed first.
- Esophagogastroduodenoscopy with biopsy
- Daily pH impedance measurements
- X-ray of the esophagus with contrast if narrowing is suspected
- ECG for chest pain
- Blood tests, if necessary - for HIV and glucose
Treatment and prevention
For reflux esophagitis, the mainstay of treatment is proton pump inhibitors: they reduce acidity and allow the mucous membrane to heal. The course usually lasts several weeks, with severe degrees - longer, with control gastroscopy. Fungal esophagitis is treated with antifungal drugs, medicinal esophagitis is treated with drug withdrawal or replacement, eosinophilic esophagitis is treated with diet and special forms of hormones. In case of cicatricial narrowing, the esophagus is expanded endoscopically. The doctor selects the regimen and dose: uncontrolled use of antacids relieves heartburn, but does not heal erosions.
- Raise the head of the bed 15–20 cm
- Stay up 2-3 hours after eating, have dinner beforehand
- Lose weight if you are overweight
- Stop smoking, limit alcohol, coffee, chocolate and fatty foods
- Take the tablets while standing and drink a full glass of water