How Serious Is Erosive Esophagitis?

Erosive esophagitis is the inflammation of the esophagus along with areas of erosion (wearing away) of its lining.

• The passage of food and fluids you eat and drink to the stomach is achieved by wave-like motion (peristalsis) of the esophageal wall.
• The backflow of the contents in the stomach is prevented by the lower esophageal sphincter (a muscular valve) at the lower end of the esophagus where it meets the stomach.

Symptoms of erosive esophagitis include:

• Retrosternal chest pain (pain felt behind the breastbone)
• Dysphagia (difficulty swallowing)
• Odynophagia (pain while swallowing)
• Heartburn
• Globus sensation (feeling as if a lump is stuck in the throat)
• Acid reflux or regurgitation
• Food getting stuck in the esophagus (food impaction)
• Wheezing
• Persistent cough

Difficulty swallowing may impair sufficient nutrient intake, leading to nutritional deficiencies. This may present as feeding difficulties and failure to gain weight (failure to thrive) in infants and young children.

Depending on its cause, esophagitis can be of five main types:

1. Reflux esophagitis
   • Caused by the reflux of stomach contents into the esophagus. This leads to injury to the lining of the esophagus, resulting in erosions and inflammation. It occurs due to the failure of the lower esophageal sphincter that prevents the backflow of stomach contents into the esophagus (gastroesophageal reflux).
2. Infectious esophagitis
   • Occurs due to an infection of the esophagus, leading to its inflammation. A yeast infection mainly causes infectious esophagitis in people with poor immunity, such as people with HIV or organ transplant recipients. It could be caused by other disease-causing organisms, such as bacteria, parasites, and viruses.
3. Eosinophilic esophagitis (EoE)
   • This may occur due to a chronic accumulation of immune cells called eosinophils in the esophagus. This happens in response to an allergen (allergy-causing agent) or acid reflux. At times both acid reflux and allergens could be involved.
4. Pill-induced or drug-induced esophagitis
   • Caused in response to certain medications, such as oral bisphosphonates (such as alendronate that is used to treat and prevent osteoporosis in postmenopausal women), aspirin, nonsteroidal anti-inflammatory drugs, iron supplements (ferrous sulfate), and certain antibiotics (such as tetracycline, doxycycline, and clindamycin).
5. Radiation-induced esophagitis
   • Affects people who undergo radiotherapy. The radiation can cause esophagitis by damaging the esophageal lining, leading to inflammation.

The diagnosis of erosive esophagitis could be done by the doctor based on your detailed medical history, physical examination, and certain investigations.

Your doctor may ask about the symptoms you experience, their onset and duration, and whether you have any underlying health conditions or take any supplements or medications. They may ask for other relevant information, such as dietary habits or smoking or alcohol consumption.

They will then perform a detailed physical examination including an abdominal examination (for bowel sounds, any lump, or distension), nutrition status, and oral examination to look for any damage to the teeth or mouth caused by acid reflux.

They may suggest investigations to reach a definitive diagnosis, such as:

• Blood counts
• Barium X-ray (involves drinking a chalky fluid containing a barium salt or swallowing a barium-coated pill and then taking X-rays)
• Prolonged (24 to 96 hours) esophageal pH study (measures the frequency of acid reflux)
• Upper gastrointestinal endoscopy (allows the doctor to directly examine the esophagus, stomach, and small bowel)
• Esophageal manometry (measures the pressure from the muscle contractions in the esophagus by inserting a tube that helps determine the functioning of the lower esophageal sphincter)

Esophagitis can be cured especially when detected and treated early. Once the wall of the esophagus is eroded, it may take several months to achieve complete healing.

Treatment mainly depends on the type of esophagitis.

• Reflux esophagitis
  • Dietary and lifestyle modifications, such as avoiding spicy, fatty foods, not lying down right after a meal, and maintaining a healthy weight
  • Medications, such as antacids, H2-blockers, prokinetics, and proton pump inhibitors
  • Surgery could be needed in some cases that may not improve with conservative management
• Pill-induced esophagitis
  • Prescribing an alternative treatment or alternative form of the drug, such as a liquid or injectable form
  • Taking the medication with enough water
  • Staying upright for at least half an hour after taking the drug
• Eosinophilic esophagitis
  • Avoiding the culprit foods or food allergens
  • Treatment of acid reflux when present
  • Medications called biologics that alter the immune response
• Infections esophagitis is mainly treated by appropriate medications to treat the infection (such as antifungals, antibiotics, or antiviral medications). Appropriate measures are taken to improve the person’s immunity.
• Radiation-induced esophagitis could be treated with proton pump inhibitors, prokinetic drugs, and viscous lidocaine. Dietary modifications could be advised.