Esophagitis

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.

Esophagus anatomy and nomenclature based on two systems.

• Inflammation of the esophagus

Clinical Features

• Odynophagia and/or dysphagia
  • Commonly causes dehydration
• Chest pain
• Nausea
• Dyspepsia

Differential Diagnosis

Esophagitis Types

• Inflammatory
  • GERD
  • Allergic (eosinophilic)
• Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
  • Esophageal candidiasis: often an AIDS defining lesion
  • HSV
  • CMV esophagitis
  • aphthous ulceration
• Medication-induced (i.e. "pill") esophagitis, common culprits:
  • Doxycycline
  • Tetracycline
  • Clindamycin
  • NSAIDs
  • ASA
  • Bisphosphonates
  • Ferrous sulfate
  • Potassium chloride
  • Ascorbic acid

Evaluation

Eophageal ulcer (the reddened area at 10 o'clock on the surface of the mucosa) and due to refulx esophatitis (GERD).

Esophageal candidiasis

Work-Up

• CBC
• CMP
• Consider HIV workup if unknown causation, risk factors

Evaluation

• Generally clinical diagnosis in ED (requires EGD for conclusive diagnosis)

Management

• PPI for GERD-induced esophagitis
• IV fluids for dehydration
• Candida infection
  • Fluconazole: 200mg PO loading dose x1 followed by 100-200 mg PO for 7-14 days

Disposition

• Admit if unable to tolerate PO or if underlying immunosuppression (e.g. HIV)

See Also

• HIV - AIDS (Main)
• Esophageal candidiasis