Esophagitis (Pain, Symptoms, Causes, Grades, and Cure)

• Esophagitis is defined as inflammation of theesophagus, which is the tube that connects the throat to the stomach.
• Signs and symptomsof esophagitis include:
  1. Difficult and/or painful swallowing
  2. The feeling of food getting stuck while swallowing
  3. Heartburn
  4. Acid reflux
  5. Unpleasant taste in mouth
  6. Sore throat
  7. Hoarseness
  8. Cough
  9. Mouth sores
  10. Nausea
  11. Vomiting
  12. Abdominal pain
  13. Indigestion
  14. Chest pain
  15. Bad breath.
• Several grading systems are used to evaluate the severity of esophgitis. The most commonly used system is the Los Angeles Classification System, which lists four grades.
  • Grade A
  • Grade B
  • Grade C
  • Grade D
• Esophagitis can be caused by infection, irritation of the esophagus, or inflammation of the lining of the esophagus.
• There are several types of esophagitis, for example:
  • Reflux esophagitis
  • Infectious esophagitis
  • Barrett's esophagus
  • Eosinophilic esophagitis
  • Behçet's syndrome (also called Behçet's disease)
  • Graft-versus-host disease
  • Canceresophagitis
• Tests to help diagnose esophagitis includeesophagogastroduodenoscopy(EGD),esophageal manometry, and anupper GI seriesorbarium swallow.
• Treatment for esophagitis depends on its cause. It may be treated with:.
  • Dietand lifestyle changes
  • Medications
  • Endoscopy
  • Stretching (dilatation) the esophagus
  • Surgery
• Dietcan often help reduce symptoms of esophagitis. TheGERDdiet is aimed at reducing acid reflux, the main cause of esophagitis.
• Complications of esophagitis include bleeding, ulcers, chronic scarring, difficult or painful swallowing, and malnutrition. Barrett's esophagus is a complication that increases the risk ofesophageal cancer.
• A gastroenterologist, a specialist in conditions of the gastrointestinal tract, treats esophagitis.
• 食管炎的预后取决于下lying cause. Esophagitis caused by infection or inflammation is generally treatable and most people can recover fully. Esophagitis caused by reflux can recur frequently. Many people withGERDdevelop Barrett's esophagus, which increases the risk forcancer. The outlook for patients with eosinophilic esophagitis is favorable. It is a chronic, relapsing condition, but not usually life threatening.Achalasiais progressive, but treatable.

食管炎描述esophagu炎症s, which is the tube that connects the throat to the stomach. There are several types of esophagitis depending on the cause. Esophagitis can be caused by infection, irritation of the esophagus, or inflammation of the lining of the esophagus.

Symptoms of esophagitis include:

1. Bad breath (halitosis)
2. A feeling of food getting stuck while swallowing
3. Difficult and/or painful swallowing
4. Painin the middle of the chest, often radiating to the back, usually associated with swallowing or occurring soon after a meal.
5. An unpleasant taste in mouth
6. Indigestion
7. Heartburn
8. Acid reflux
9. Sore throat
10. Hoarseness
11. Cough
12. Mouth sores
13. Nausea
14. Vomiting
15. Abdominal painor indigestion

Esophagitis can be caused by infection or irritation of the esophagus.

Infections of the esophagus can be caused by bacteria,viruses, or fungi, including:

• Candida, ayeast infection. This is more commoninpatients with weakenedimmunesystems, such as those withdiabetes,HIV/AIDS, patients undergoingchemotherapy, or people who are taking antibiotics or steroids.
• Herpes, aviral infection. It may develop in the esophagus when the body'simmune systemis weak.

One of the main causes ofesophagealirritation isrefluxofstomachacid. There are several causes for reflux:

• GERD (gastroesophageal reflux disease):weakness ordysfunctionof themusclethat keeps the stomach closed (lower esophageal sphincter) can allow stomach acid to leak into the esophagus (acid reflux), causing irritation of the inner lining. Also called GERDesophagitis- in severe cases it can become erosive esophagitis (this also may be referred to as ulcerative esophagitis).
• Vomiting:when vomiting is frequent orchronicit can lead to acid damage to the esophagus. Excessive or forceful vomiting may cause small tears of the inner lining of the esophagus (a rareconditioncalled Mallory-Weisssyndrome[MWS]), leading to further damage.
• Hiatal hernia:This abnormality occurs when a part of the stomach moves above thediaphragmproducing a smallabnormalpouch, orhiatalhernia, which can lead to excess acid refluxing into the esophagus.
• Achalasia:This is a disorder where the lower end of the esophagus does not open normally, and as a result,foodcan get stuck in the esophagus or is regurgitated. People with achalasia have a higher than normal risk of esophagealcancer.

Medical treatments for other problems can also cause esophageal irritation.

Surgery, including certain types ofbariatric(weight loss) surgery, can lead to increased risk of esophagitis. Medications such asaspirinand otheranti-inflammatory drugs can irritate the lining of the esophagus, and cause increased acid production in the stomach that can lead to acid reflux.

Drug-induced esophagitis occurs when large pills are taken with too littlewateror just before bedtime and they dissolve get stuck in the esophagus, causing irritation.Radiationto thechest(thorax), for cancer treatment can causeburnsleading to scarring andinflammationof the esophagus.

Other causes of esophageal irritation:

• Swallowing of foreign material or toxic substances
• Diets high in acidic foods or excessivecaffeine
• Smoking

There are number of grading systems used to evaluate the severity of thedisease. The Los Angeles Classification System is most commonly used.

Los Angeles Classification System grades reflux esophagitis:

• Grade A:One (or more) mucosal break no longer than 5mmthat does not extend between the tops of two mucosal folds
• Grade B:One (or more) mucosal break more than 5 mm long that does not extend between the tops of two mucosal folds
• Grade C:One (or more) mucosal break that is continuous between the tops of two or more mucosal folds but which involve less than 75% of the circumference
• Grade D:One (or more) mucosal break which involves at least 75% of the esophageal circumference

In the past, the Savary-Miller Classification System was more widely used but the Los Angeles Classification System is considered more thorough.

There are several types of esophagitis.

• Reflux esophagitisis caused by a reflux of stomach acid into the esophagus. This can lead to erosive esophagitis.
• Infectious esophagitisis caused bybacteria, viruses, orfungus.
• Barrett's esophagusresults from untreated inflammation of the esophagus that can cause changes in the type of cells that make up the inner lining (mucosa) of the esophagus. Barrett's esophagus increases the risk for esophageal cancer.
• Eosinophilic esophagitisis inflammation of the esophagus due to an increase in the number of a type of whitebloodcells (eosinophils) in the lining of the esophageal wall. It is considered anallergic/immune condition. This leads to dysmotility of the esophagus (the muscles do not work properly to move food through) and difficulty in swallowing. Causes of eosinophilic esophagitis includefood allergies,gastroesophageal reflux disease(GERD),parasiticdiseases, orinflammatory bowel diseases.
• Behçet's syndrome (also called Behçet's disease)is a form ofvasculitisthat can cause ulcers in themouth, esophagus, and other parts of the body. This disease is rare in the U.S.
• Graft-versus-host diseaseis acomplicationthat can occur after atransplant(usuallybone marrow transplant) when the newly transplanted cells attack therecipient's body. Esophagitis may occur in this condition.
• Cancer esophagitismay be asymptomofcancer of the esophagus, or metastatic cancer (cancer that started in another part of the body and then spreads to the esophagus).

Agastroenterologist可以责令专业测试来寻找原因and extent of the esophagitis. These tests include:

• Esophagogastroduodenoscopy (EGD):Anendoscopeis used to directly examine the esophagus, stomach and first part of theintestines. In addition,tissuesamples can be obtained (biopsy) to assess the severity of the damage to the esophagus.
• Esophageal manometry: this test is used to measure the pressure inside the lower part of the esophagus. A thin, pressure-sensitivetubeis passed through the mouth ornoseand into the stomach, which is then pulled slowly back into the esophagus. Patients are asked to swallow, and the pressure of the muscle contractions is measured along several sections of the tube.
• Upper GI series or barium swallowis a test whereX-raysare taken of the esophagus after drinking abarium solution.Bariumcoats the lining of the esophagus and appears white on anX-ray, and canshowthe location and extent of damage to the esophagus.

Manyover-the-countermedications can help neutralize stomach acid and provide short-term relief for thepainof esophagitis caused by acid reflux. Do not take these medications long-term. See adoctorif symptoms persist for more than two weeks.

Pain medications and medications that decrease inflammation such as corticosteroids can be used as adjuncts in the treatment of any inflammatory cause of esophagitis.

Diet is often a key to reducing the symptoms of esophagitis. The GERD diet is aimed at reducing acid reflux, the main cause of esophagitis.

Foods that soothe esophagitis symptoms

• Eat lowfat, highproteinmeals
• Eat smaller meals, more frequently
• Eat soft foods that are easily digested

Foods and drinks that aggravate esophagitis symptoms

• Avoid fatty foods
• Avoid spicy foods
• Avoid acidic foods andbeveragessuch as citrus and tomatoes
• Avoid foods that maytriggeror worsen heartburn includingchocolate, mint, onions orgarlic
• Stop eating before you feel full
• Avoid coffee or tea (even decaffeinated),alcohol, and soda

Lifestyle changes that may alleviate symptoms of GERD and esophagitis include:

• Stopsmoking
• Remain upright while eating and for about 2-3 hours afterwards
• Take small bites and chew food slowly
• Avoid eating within 3 hours of bedtime or laying down
• Raise the head of the bed by 4 to 6 inches (put blocks or a foam wedge under the head of the bed)
• Lose weight
• Wear loose clothing
• Avoid aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such asibuprofen(Advil,Motrin) ornaproxen(Aleve)

Treatment for esophagitis depends on its cause.

• Esophagitis caused by aninfectionit is treated with medications tocurethe infection.
• Esophagitis caused by acid reflux or GERD, the condition is treated with medications to reduce or block acid production, for example, heartburn drugs such as H2 blockers or proton pump inhibitors (PPIs).
• Esophagitis due to a medical procedure may need to take acid-blocking medications for a long time.
• Esophagitis due taking medications may need changes inhis/her medications. Consult your doctor before stopping or changing your medications.

如果及早诊断食管炎,medications and dietary or lifestyle changes are often enough to allow the body to heal. If the damage is severe or leads toscar tissue, which causesdifficulty swallowing, more invasive treatments may be necessary.

• Endoscopycan be used to remove any lodgedpillfragments, food, or foreign bodies stuck in the esophagus. Stretching (dilatation) of the esophagus can also be done as part of the endoscopy procedure.
• Surgery may be necessary to remove any damaged portions of the esophagus. In the case of Barrett's esophagus, where the risk of cancer is increased, surgery might be the treatment of choice.
• Eosinophilic esophagitis is treated with gentle stretching of the esophagus (dilatation) and medications to decrease white blood cells (eosinophils) in the lining of the esophagus.
• Achalasia may be treated with stretching of the esophagus (dilatation) whenoralmedications fail to improve symptoms.

If untreated, esophagitis caused by GERD can lead to bleeding, ulcers, and chronic scarring. This scarring can narrow the esophagus, eventually interfering with the ability to swallow.

Amajorcomplication that occurs in a significant portion of people with chronic or longstanding GERD, is Barrett's esophagus, which increases the risk of esophageal cancer. A very few of those who develop Barrett's esophagus will develop esophagealadenocarcinoma.

Severe esophagitis may lead to difficult or painful swallowing, andmalnutrition.

• Theprognosisfor esophagitis often depends on the underlying cause.
• Esophagitis caused by infection or inflammation is generally treatable with medications, diet or behavioral changes and in some cases, surgery. Most people can recover fully, while some have chronic inflammation that is managed with long-term medical treatment.
• Esophagitis caused by reflux, while often manageable, canrecurfrequently. Many people with reflux requiremedicationor other treatments to prevent relapses.
• A significant percentage of people with GERD go on to develop Barrett's esophagus. Very few of patients with Barrett's esophagus develop cancer. A gastroenterologist should monitor those who have Barrett's esophagus.
• The outlook for people with eosinophilic esophagitis is favorable. It is a chronic, relapsing condition, but not usually one that is life threatening. Treatments are evolving using different immune modulators to decrease theallergy-like reactions.
• Achalasia is aprogressive, but treatable disorder. A gastroenterologist must monitor patients closely. A small number of individuals with achalasia may develop squamouscellcancer (carcinoma) as a result.

Aprimary care provider(PCP) such as afamily medicinespecialist, aninternist, or a child's pediatrician, may initially diagnose esophagitis. If you need further treatment you will likely be referred to a gastroenterologist, a specialist in disorders of thedigestive system.

Some types of esophagitis can be prevented.

• Esophagitis caused by GERD may be prevented by changes in lifestyle and diet.
• Proper oralhygienecan aid inpreventionof esophagitis caused by theCandidayeast.
• Take all pills with plenty of water, and in an upright position.