Esophagitis, which means inflammation of the esophagus, is a disease of the inner lining of the esophagus. Generally, inflammation is a defensive reaction of the body to harmful processes affecting our body. This reaction is mediated mostly by immune system, either by its cells or chemical substances. In many cases, however, the process is greatly exaggerated and rather damages the tissue instead of protecting it. In esophagitis, mostly the mucosa of the esophagus is harmed. In most cases, esophagitis is caused by gastroesophageal reflux disease, less often by infection, chemical substances, radiation or drugs.
Causes of Esophagitis
Esophagitis is a very unpleasant disease that affects mostly adults. The most common causes for esophagitis are gastroesophageal reflux disease and infections.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease develops when the function of lower esophageal sphincter and protective mechanisms of the esophageal lining are impaired. The gastric juices leak into the esophagus and its lining suffers. Patients experience unpleasant burning or pyrosis. In longer lasting gastroesophageal reflux disease, swallow problems or heartburn, belching, coughing and increased cariosity of the teeth may arise. On the esophageal inner surface chaps and ulcers may develop, leading to formation of inelastic scars and narrowing of the esophagus.
Esophagitis Caused by Infection
Infectious esophagitis is caused by microbes in the esophageal wall. The main symptoms in this type of esophagitis are also swallowing problems, especially painful swallowing. Unlike esophagitis in reflux disease, which is typically located in the lower part of the esophagus, infectious esophagitis can affect esophagus along its entire length. Infectious esophagitis is not often seen in healthy individuals, it affects mostly weakened people (patients with immune disorders, in poor general condition, with diabetes or after chemotherapy). Esophageal infection is caused mostly by fungi and viruses.
Chemical inflammation of the esophagus occurs after ingestion of chemicals, acids or lye. It is not quite common; and when it does occur, it is a very serious condition. The ingestion may be either accidental, or less often in suicide attempt. By far, the most common reason for ingestion of chemicals is confusing them with drinks, for example when the chemical is poured into a bottle normally used to store beverages and the bottle is not properly labelled. In case ingestion of chemicals appears, it is not recommended to induce vomiting. This will only cause second passage of the aggressive chemical through the esophagus and further damage of the organ. Moreover, there is also risk of aspiration of the chemical into the respiratory tract and consequent suffocation. In such cases, the mucosa of the esophagus is chemically burnt. Degree of infliction depends on concentration of the aggressive substance in the ingested fluid – it might be only superficial inflammation for diluted solutions, whereas in more concentrated solutions the damage penetrates to a considerable depth of the mucosa. The impaired cells are replaced by inelastic scar, causing narrowing of the tube.
Drug-induced esophagitis is caused by medicines and is similar to chemical esophagitis; just the extent is much lesser. It is typically caused by medication applied just before bedtime, or by medication difficult to swallow that has not been properly washed down. The most problematic drugs in this disease are medicines containing acetylsalicylic acid (aspirin), other non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and some antibiotics. If drug-induced esophagitis is diagnosed, it is beneficial to temporarily discontinue the treatment.
Symptoms of Esophagitis
Esophagitis is a disease that may, as stated above, arise from various reasons. According to the underlying cause, there may or may not be clear symptoms of the inflammation of the esophagus. Main symptom usually is heartburn, especially after meals. In the early stages of gastroesophageal reflux disease, only specific meals cause heartburn; when the disease has advanced, heartburn comes up after every meal. Other symptoms include difficult and sometimes painful swallowing, loss of appetite, belching, chest pain, and increased cariosity. Also hoarseness or chronic cough may appear.
Complications of Esophagitis
Esophagitis is a disease that must be treated; otherwise complications might develop. A typical complication of long lasting esophagitis is narrowing of the esophagus in the area of former inflammation, this is called esophageal stenosis. The narrowing is an obstacle in food passage to the stomach, leading to vomiting, loss of appetite and weight. Furthermore, the inflammation may cause esophageal ulcer, a deep esophageal wall erosion that can lead to bleeding or rupture of the organ. The most serious complication of esophagitis is so-called Barrett's esophagus – on the base of esophagitis, mucosal cells irreversibly change and this can lead even to development of malignant tumour.
Diagnosis of Esophagitis
Diagnostics of esophagitis must be opened by a careful analysis of the patient's history and symptoms. Attention should be paid also to used medication. Afterwards, the diagnosis must be verified by endoscopic examination – gastroesophagoscopy. It is an endoscopic method, in which a flexible tube with light source and camera is inserted through the mouth to the esophagus and stomach. During the examination, the state of gastric and esophageal inner wall is assessed. If necessary, small tissue samples are collected.
Treatment of Esophagitis
Treatment for esophagitis must be chosen according to the underlying cause of esophagitis. In reflux esophagitis, medicaments lowering gastric acid production are used (proton pump inhibitors) or drugs supporting natural movements of stomach and the esophagus (prokinetics). Sometimes, it is necessary to adopt also preventive measures, i.e. diet – esophagitis is supported by consuming certain food (chocolate, sourdough bread, spicy food), by smoking, obesity, and other factors. For infectious esophagitis, the treatment with antifungal or antiviral medicaments is essential. Chemical esophagitis is the most tough to treat. Usually, immediate medical assistance is needed and hospitalization of the patient is necessary.