Esophagitis (erosive, eosinophilic, reflux): what is it?

What is esophagitis?

Esophagitis is an inflammation of the esophagus (the conduit that leads food to the stomach). When not diagnosed and treated early, it causes changes in its structure, as well as in its function.

Among the symptoms that can characterize the condition is chest pain related to heartburn generated by the swallowing problems that are caused. It affects, in most cases, people aged 55 and over.

Causes and types of esophagitis

A case of esophagitis can be caused by two factors: an infection or an irritation in the muscle region of the site. These causing irritations can be of different natures, from allergies to some types of food to the presence of Gastroesophageal Reflux Disease. Infections can be developed by pathogens, such as Candida or Herpes .

Esophagitis by infection

The mere presence of a bacterium, a virus or a fungus can cause esophagitis. Cases of esophagitis due to infection are extremely rare and usually occur in people who have a weakened immune system due to some other disease, such as AIDS ( HIV ) or some type of cancer .

Usually, an infection in the esophagus occurs due to a fungus already present in the mouth, Candida albicans , however it can be developed by several other types of infectious agents.

Esophagitis due to irritation

More than one factor can develop esophagitis, as a small irritation is enough for the inflammation to appear in the region of the esophagus. Irritations that usually lead to esophagitis may be due to:

  • Gastroesophageal Reflux Disease (GERD);
  • Vomiting;
  • Surgery;
  • Allergy to certain foods;
  • Use of anti-inflammatory drugs;
  • Take a relatively large tablet with little or no water;
  • Hernias, mainly hiatus;
  • Swallowing a toxic substance;
  • Radiation injury that can occur due to cancer treatments.

Check below the classifications that esophagitis can have due to these irritating agents.

Reflux esophagitis

At the end of the esophagus, a valve-like structure, called a sphincter, is present. The sphincter has the function of keeping the acidic content of the stomach inside it, however, when it cannot remain closed, the content returns to the esophagus (gastroesophageal reflux).

When this situation occurs on a recurring basis, the condition is called Gastroesophageal Reflux Disease, which in turn has a chronic inflammation in the esophageal tissue as a complication.

Eosinophilic esophagitis

Eosinophilic esophagitis occurs due to the large amount of white blood cells present in the region, probably in response to any allergen or acid reflux that has happened.

The main cause of most cases of this type of esophagitis is some allergy to certain foods, such as milk, wheat or peanuts. However, these allergies can be caused by items other than food, such as pollen or some toxic substance.

Drug-induced esophagitis

There are several medications that can trigger esophagitis. This is due to the fact that the product remains in contact with the lining of the esophagus for a long time.

A clear example of this is the ingestion of a pill with little or no water, which can cause it to become entrapped in the esophagus, thus generating the characteristic inflammation of the disease.

Degrees of esophagitis

Esophagitis can be classified into different degrees, which will depend on the severity of each case. Currently, there are two types of systems that can make this assessment: Savary-Miller and the Los Angeles Classification System.

Savary-Miller

The Savary-Miller system classifies esophagitis into four distinct degrees (from I to IV):

  • Grade I: one or more non-confluent red spots, with or without exudate (liquid produced in reaction to damage to tissues and blood vessels).
  • Grade II: erosive and exudative lesions that can be confluent, but not circumferential.
  • Grade III: circumferential erosions covered by hemorrhagic and pseudomembranous exudates.
  • Grade IV: presence of chronic complications, such as deep ulcers.

Los Angeles Classification System

This system also classifies esophagitis into four different degrees (from A to D):

  • Grade A: one (or more) rupture not exceeding 5mm that does not extend between the upper parts of two folds of the mucosa.
  • Grade B: one (or more) rupture of more than 5mm that does not extend between the upper parts of two folds of the mucosa.
  • Grade C: one (or more) continuous rupture between the tops of two or more folds of the mucosa. They involve less than 75% of the circumference.
  • Grade D: a (or more) rupture that involves at least 75% of the circumference of the esophagus.

Risk factors

The risk factors that can facilitate the development of esophagitis will depend a lot on the type of disease that you have developed. Check out the main ones below:

Reflux esophagitis

Gastroesophageal reflux can be triggered by the following practices:

  • Lie down immediately after eating;
  • Eat meals with a high fat rate and in large quantities;
  • Consume some dietary factors, such as excess alcohol, caffeine and chocolate.

Eosinophilic esophagitis

Risk factors for this type of esophagitis can be:

  • History of allergic reactions, including rhinitis, asthma and atopic dermatitis;
  • Family history of eosinophilic esophagitis.

Drug-induced esophagitis

Most of the risk factors for drug-induced esophagitis are due to problems that prevent a pill from passing quickly and completely through the esophagus. These factors can be:

  • Swallow a pill with little or no water;
  • Take medication while lying down;
  • Take medication right before bed, as the production of saliva is less, which prevents the complete swallowing of the drug;
  • Large pills or exotic shapes;
  • Older age, possibly due to age-related changes in the esophageal muscle or lower saliva production.

Infectious esophagitis

This type of esophagitis is usually associated with medications or certain diseases, such as diabetes . Other causes, however, may be related to the individual’s low immunity, often caused by the HIV virus or certain cancers. Cancer treatment is also a high risk factor for weakening the immune system.

Symptoms of esophagitis

The symptoms of esophagitis are often similar to those of gastroesophageal reflux, but a little more intense. In addition to these, it may be that other symptoms will appear, such as difficulty in swallowing and bad breath .

Symptoms similar to gastroesophageal reflux

These symptoms include:

  • Heartburn, which starts at the level of the stomach and can reach the throat;
  • Pain in the chest, sometimes so intense that it gets to be confused with the pain of angina or infarction;
  • Back pain (back pain), radiated from chest pain.

Other symptoms

In addition to the symptoms already mentioned, there may be the presence of others, such as:

  • Dysphagia (difficulty swallowing);
  • Blood in the vomit and feces, when the inflammation is more pronounced;
  • Bitter taste in the mouth;
  • Bad breath;
  • Hoarseness;
  • Sore throat;
  • Cough.

Symptoms in children

Young children are often unable to explain exactly what they feel when they are in pain. Therefore, be aware of two signs that they may show in case of esophagitis:

  • Difficulty in feeding;
  • Growth problems due to difficulty in feeding.

How is esophagitis diagnosed?

The specialist doctor who takes care of the digestive part of our body is called a gastroenterologist . Therefore, it will be with him that the diagnosis and treatment for esophagitis will be carried out.

There are two types of tests that can be performed to detect changes in the esophagus and thus accurately diagnose inflammation in the esophagus. Look:

Barium X-ray

For this examination, the patient ingests a solution that contains barium compound or takes a pill that is coated with the element, which will make the lining of the esophagus and stomach visible. With that done, the images that will appear can help identify any changes in structure, from narrowing to tumors or other abnormalities.

Endoscopy

During an endoscopy, the doctor inserts a long, thin tube, equipped with a very small camera, into your throat. With this instrument, the specialist will be able to see some type of change in the esophageal muscle, as well as collect some samples for analysis (biopsy) of the injured tissue.

Biopsy is usually performed to:

  • Diagnose a bacterial, viral or fungal infection;
  • Determine the amount of white blood cells related to the allergy possibly caused;
  • Identify abnormal cells that indicate esophageal cancer or precancerous changes.

Is esophagitis curable? What is the treatment?

For a cure for esophagitis to be achieved, it must be diagnosed and treated correctly as soon as possible. In the case of treatment, you must first find out what caused the disease. That done, the step by step to treat the inflammation becomes simpler and more direct.

Reflux esophagitis

For this type of esophagitis, the following treatments can be indicated:

Drugs that control acidity

Among these medications, you can make use of the following:

  • Antacids , such as Mylanta Plus and Maalox ;
  • Reducers of acid production , such as cimetidine and ranitidine;
  • Blockers of acid production , such as lansoprazole and omeprazole .

Prescription Drugs

Depending on your case of esophagitis, your doctor may prescribe other types of medication for your treatment:

  • Reducers of acid production , such as famotidine , nizatidine and ranitidine ;
  • Proton pump inhibitors , such as esomeprazole, lansoprazole , omeprazole, pantoprazole, rabeprazole and dexlansoprazole.

Surgery

If none of the previous treatments has an effect on the patient, surgery may be indicated. In it, a part of the esophagus is wrapped around the sphincter, strengthening it and ensuring its resumed function.

Eosinophilic esophagitis

As this type of esophagitis is caused by allergic reactions, the best means of treatment are:

Proton pump inhibitors

Some medications may be indicated by the doctor, such as:

  • Esomeprazole ;
  • Lansoprazole;
  • Omeprazole;
  • Pantoprazole ;
  • Rabeprazole;
  • Dexlansoprazole .

Topical steroids ingested

Usually used to control asthma , these steroids are inhaled and act directly on the airways. This type of administration (inhalation) is less likely to trigger serious side effects compared to taking oral steroid pills.

Food elimination diet

If the cause of the allergic reaction is a food, its elimination from the diet is essential. However, if there is no knowledge of which food specifically causes esophagitis, a test should be performed.

This test consists of removing allergenic foods from your diet at once. Then, little by little, these foods are being added to the diet. When any sign of allergy appears, the food is removed again.

Drug-induced esophagitis

To prevent the development of a major problem related to medication intake, the doctor may recommend the following items:

  • Make use of a medication that is less likely to cause esophagitis;
  • Take the medication in a liquid version, when possible;
  • Drink a full glass of water when taking the medicine;
  • Sit or stand for at least 30 minutes after taking the medicine.

Infectious esophagitis

The doctor will prescribe the appropriate medication to treat the infection that causes esophagitis. Among the options, this medication can be an antibiotic, antiviral or antifungal.

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Alternative treatment

There is no evidence that these alternative treatments have any efficacy in relation to the treatment. However, when used in conjunction with medical treatments, they can relieve some of the symptoms of the disease.

Herbal remedies

Usually used to relieve symptoms of gastroesophageal reflux, herbal remedies include licorice, chamomile and slippery elm. Some of these remedies can cause relevant side effects and also interact with some type of medication. Therefore, always consult your doctor before using any type of medicine.

Relaxing therapies

Some techniques are super efficient for relieving stress and anxiety , which, in turn, can reduce the symptoms of heartburn and reflux.

Acupuncture

Some patients who have had esophagitis say that doing acupuncture can help with regurgitation and heartburn, but there is no study that actually proves this.

Teas and juices

Some liquids, due to the nature of their ingredients, serve as natural antacids. Are they:

  • Lettuce tea;
  • Potato tea;
  • Melon juice.

Complications and Prognosis

The prognosis of the disease depends a lot on how it was treated and on how much the patient collaborated so that the administration was the best possible. However, most patients improve with the treatment imposed by the doctor and recover in about three to five days.

When not treated properly, esophagitis can cause some serious complications, such as those described below.

Barrett’s esophagus

This complication is due to chronic Gastroesophageal Reflux Disease and is characterized by changes in the cells that line the bottom of the esophagus. Due to reflux, these cells become irritated and can even cause esophageal cancer.

Esophageal stricture

Stenosis is the narrowing of the esophagus, making the passage of food and drinks much more difficult. In that case, the food may get stuck in the region.

Oesophageal rings

A ring of tissue inside the esophagus (lower part) develops, narrowing the passage and partially blocking the region.

How to prevent esophagitis?

To prevent the development of esophagitis, some tips are valid to follow during your day to day:

  • Avoid foods that can cause reflux;
  • Have good habits regarding medication intake;
  • Lose weight;
  • Stop smoking if you do;
  • Avoid certain types of medication, such as painkillers and antibiotics, if you have an enlarged atrium (upper left heart) or after heart surgery;
  • Avoid leaning or bending, especially after eating;
  • Avoid lying down right after eating;
  • Lift the head of your bed 15 to 20 cm to prevent reflux while sleeping.

Esophagitis, as much as it happens more frequently in people aged 55 or over, is a disease that causes any age and has several causes. Share this text with your family and friends so that more people have access to the information!

Loading...