Reflux esophagitis or eosinophilic esophagitis

Esophagitis is a general term for inflammation of the esophagus (esophagus), which can be acute or chronic.
The esophagus is a muscular tube that starts in the throat and ends at the stomach and through which food and drinks pass.


Classification of esophagitis

  • Reflux esophagitis (or peptic esophagitis) – caused by the reflux of stomach acid into the esophagus.
  • Infectious esophagitis – caused by bacteria, viruses or fungi, for example, esophagitis herpetica is caused by the virus herpes simplex.
  • Erosive esophagitis – caused by ulcers and bleeding of the mucosa.
  • Stenosing esophagitis – causes a decrease in the inner esophageal diameter (lumen) due to fibrosis.
  • Barrett’s esophagus – arises as a result of untreated inflammation of the esophagus and can lead to changes in the cells that form the inner wall (mucosa) of the esophagus.
    Barrett’s esophagus increases the risk of esophageal cancer.
  • Eosinophilic esophagitis – an inflammation of the esophagus caused by the increased number of a type of white blood cell (eosinophilia) in the esophageal wall.
    This leads to changes in esophageal motility, that is, the muscles in the esophagus do not work correctly.
    The result is difficulty in moving the food into the stomach and swallowing.
    Causes of eosinophilic esophagitis are allergies to food, gastroesophageal reflux, parasites or inflammatory bowel diseases.
  • Behçet’s syndrome – a form of vasculitis that can lead to ulcers in the mouth, esophagus and other parts of the body. It is a rare disease.
  • Transplant rejection – a complication that can occur as a result of a transplant (usually bone marrow) when the transplanted cells attack the recipient’s body. In this situation, esophagitis may occur.
  • Cancerous esophagitis – possible symptom of esophageal cancer or metastases (tumor that originates in another part of the body and then spreads to the esophagus).

Severity of esophagitis

  1. Esophagitis I degree (mild): with lesions of the mucosa less than 5 mm.
  2. Esophagitis II degree: with lesions above 5 mm, which occur in non-adjacent folds of the esophagus (mucosal folds).
  3. Esophagitis III degree: with lesions in at least two consecutive folds, but occupying less than 75% of the circumference of the esophagus.
  4. Esophagitis II degree (severe): with extensive loss of mucosa over more than 75% of the circumference.

Causes of esophagitis

Esophagitis is often caused by stomach acid flowing back into the esophagus. This condition is called reflux esophagitis.
It can also be caused by an autoimmune disease called eosinophilic esophagitis.

Risk factors for esophagitis

  • Alcohol.
  • Cigarette.
  • Surgery or radiation of the chest (for example, in the treatment of lung cancer).
  • Taking some medications with too little water, especially antibiotics, nonsteroidal anti-inflammatories, alendronate, doxycycline, risedronate, tetracycline and vitamin C.
  • Vomit.
  • Pregnancy.
  • People with weakened immune systems due to HIV or taking some medications (for example, corticosteroids can cause infections that lead to esophagitis).
  • An infection of the esophagus can be caused by fungi, yeasts (especially Candida) or viruses such as herpes or cytomegalovirus.

What are the signs and symptoms of esophagitis?

What is the difference between a sign and a symptom?
A sign is something that other people may also notice, such as a rash, abdominal swelling, or weight loss.
A symptom is that only the patient feels and can describe, such as dizziness, pain or fear.

Signs and symptoms of esophagitis include:

  • Hoarseness
  • Odynophagia – pain when swallowing
  • Dysphagia – difficulty swallowing
  • Food that gets stuck in the esophagus
  • Lack of appetite
  • Nausea and vomiting
  • Cough
  • Pain when eating, heartburn
  • pain behind the sternum and Sore throat. In addition, esophagitis can cause chest pain, so it is sometimes associated with angina pectoris or a heart attack.
  • Sores in the oral cavity
  • Difficulties in food intake in infants and children and consequent possible growth problems.
    At this age, most patients are too small to describe their symptoms.

Symptoms of eosinophilic esophagitis
The most common symptoms of eosinophilic esophagitis in adults are difficulty and pain when swallowing solid food. The cause of this is inflammation of the esophagus.

Other symptoms include:

  • Heartburn
  • Vomiting (often while eating)
  • Stomach ache
  • Chest pain

In children, symptoms of eosinophilic esophagitis may include reduced growth, weight loss, lack of appetite or refusal to eat.

How is esophagitis diagnosed?

The doctor asks about the patient’s symptoms and medical history. The doctor can carry out some examinations:

Gastroscopy. In this examination, the doctor inserts a thin, flexible tube through the throat into the esophagus. This examination allows the doctor to take cell samples to look for infection.

Sometimes a small amount of tissue is taken for a biopsy. A biopsy is an examination to determine:

  • Cancer cells
  • Inflammation
  • allergy (eosinophil levels),
  • Organisms (bacteria, fungi, parasites or viruses).

X-ray examination of the esophagus with barium. It is an X-ray of the throat and esophagus.
Before the X-ray examination, it is necessary to drink a liquid containing barium. The barium lines the inside of the esophagus and you can see it on an X-ray.

Allergy – some tests can be done to see if the patient is sensitive to one or more allergens.
For example, the skin prick test is an examination in which one sees the reaction to the contact of the allergen with the skin.

Treatment of esophagitis

Therapeutic measures for inflammation of the esophagus are aimed at alleviating the symptoms, avoiding complications and treating the causes of the disorder.
Treatment strategies vary depending on the underlying cause of the complaints.

Reflux oesophagitis

Therapy of reflux esophagitis includes proton pump inhibitors, which block acid production in the stomach and allow the gradual healing of the damaged esophageal tissue.
Available prescription medications include: omeprazole (Antra), esomeprazole (Nexium), and lansoprazole (Agopton). You can also get over-the-counter proton pump inhibitors.
Other treatments for reflux oesophagitis can temporarily relieve the symptoms of this disorder, but they usually have little effect on esophagitis.

Fundoplication according to Nissen-Rossetti is a surgical procedure for the treatment of reflux oesophagitis and improves the health of the esophagus when other therapies have not worked. In this operation, part of the stomach is placed around the lower esophageal sphincter (lower esophageal sphincter), which separates the esophagus and stomach. This strengthens the sphincter and prevents acid from rising into the esophagus. Fundoplication can also eliminate symptoms caused by a diaphragmatic hernia (hiatal hernia).

Eosinophilic esophagitis

Treatment of eosinophilic esophagitis consists in avoiding the allergens and relieving the allergic reaction by means of pharmaceuticals.

Oral corticosteroids
Corticosteroids can reduce inflammation caused by allergic reactions and help heal the esophagus. The side effects associated with long-term oral cortisone intake can be serious.
These side effects include: bone density loss, growth slowdown in children, diabetes, mood swings and acne.
The doctor may prescribe inhaled corticosteroids to minimize side effects.

Inhaled corticosteroids
Inhaled corticosteroids are used to treat asthma. Some studies have shown that these drugs are helpful for treating eosinophilic esophagitis.
The doctor shows how to swallow this medicine more than inhale it so that it can act on the inner esophageal walls. This method of corticosteroid intake has a much lower chance of developing severe side effects.

Proton pump inhibitors
If the doctor thinks that there is also acid reflux and heartburn, he may prescribe a proton pump inhibitor or a drug such as Gaviscon, which contains sodium alginate.

If the tests indicate a food allergy, the doctor may recommend avoiding foods that cause problems in the diet. The doctor may refer the patient to a nutritionist to choose the right foods and put together healthy meals. The doctor may also recommend vitamins, certain supplements, or special nutritional drinks if the allergy severely limits food choices.

Natural remedies
Aloe vera and ginger are natural anti-inflammatories that promote the healing of lesions in the gastric mucosa.
One can take a teaspoon of sodium bicarbonate dissolved in a glass of water to temporarily relieve the symptoms of esophagitis.

Drug-induced esophagitis
Treatment for esophagitis caused by medication consists of avoiding the medications that are causing the problem, if possible.

The doctor may recommend:

  • taking an alternative medication that is less likely to cause esophagitis,
  • take the medicine, if possible, in liquid form,
  • drink a full glass of water with the tablets (unless there is a fluid limitation due to another condition, especially of the kidneys),
  • Sit or stand for at least 30 minutes after taking the tablet.

Infectious esophagitis
The doctor may prescribe a medication to treat a bacterial, viral, mycotic or parasitic infection that causes infectious esophagitis.

Treatment of the most common complications

A gastroenterologist may use a procedure to expand (dilate) the esophagus. This treatment is usually used only if the narrowing is severe or the food gets stuck in the esophagus.

This procedure is performed with one or more endoscopic devices. These are small narrow tubes that are inserted through the esophagus. These devices can be equipped with:

  1. conical tip, which has a rounded end and gradually expands,
  2. small balloon, which can be inflated after entering the esophagus.

What is the prognosis for esophagitis?

The causes of esophagitis can usually be treated well. Nevertheless, some causes, such as acid reflux, may require lengthy treatment.

Possible complications

If left untreated, esophagitis can cause serious discomfort and possibly scarring (stenosis) on the esophagus. This can lead to discomfort when swallowing food or medication.
A so-called beret esophagitis can develop years after the onset of reflux esophagitis. In rare cases, Barrett’s esophagus can lead to esophageal cancer.

What should you eat? Diet and nutrition for the prevention of esophagitis

One should avoid foods that promote esophagitis.
Although the condition can be treated with medication, the healing process can be accelerated by following an appropriate diet.
If esophagitis has been diagnosed, spicy foods such as pepper, chili (red and green) and curry should be removed from the diet plan.
Even if raw vegetables are healthy, it is better to avoid them until the esophagus has healed.
In addition, you should refrain from hard foods such as nuts and crackers.
This precaution is necessary because these foods can cause difficulty swallowing.
You can eat low-acid fruit, such as apples, bananas, pears, watermelon and honeydew melon.

If the mucous membrane of the esophagus is inflamed, citric acid and acidic foods such as oranges, tomatoes and grapes should be avoided. One should not drink too much juice of these fruits, because this can worsen the inflammation.

It is important to stay strong. Therefore, a diet with cereal products (cooked), pudding, protein shakes and mashed potatoes is recommended.
Cooked foods and/or puree can be eaten as they are easy to swallow.

Fatty foods should be avoided, especially fried foods or those cooked in too much oil, as this can aggravate the disease.
Fried foods are also harder to chew and swallow.

If possible, caffeine should be avoided. If you can not do without coffee, you should drink only a small amount per day, ideal would be only one cup.

As long as the healing process is not completed, you should also refrain from chocolate.

Even if this does not directly affect the diet, it is better to avoid alcohol and smoking, as they can cause further damage.

The inflammation of the esophagus can cause discomfort when eating and swallowing. It is therefore better to divide the three big meals of the day into different small meals throughout the day. It is especially important to eat slowly and chew well before swallowing the food to minimize irritation of the esophagus.

Drink plenty of water. This disease can also cause discomfort when swallowing too much water. In such a case, using a straw may be less painful.

As soon as you are full, you should stop eating.

One should choose decaffeinated coffee, tea or alcoholic beverages without caffeine and avoid milk.

Alcohol and caffeine act as diuretics. Thus, more water is excreted in the urine and you have to drink more.

When eating, you should sit as straight as possible. After eating, you should stay in a sitting position for at least 45-60 minutes. One should avoid eating in the last three hours before bedtime.

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