Esophagitis

Background

• Almost always causes odynophagia and/or dysphagia
• Can cause prolonged periods of chest pain
• Nausea and dyspepsia

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

Diagnosis

• Clinical
• Needs further evaluation via endoscopy

Work-Up

• CBC with dif
• Chem 7
• Fluids if dehydrated
• Consider HIV workup if unknown causation, risk factors

Treatment

• PPI for GERD-induced esophagitis
• Candidal Infection: fluconazole for 14 to 21 days
  • consider IV if unable to tolerate PO
• Consider dehydration secondary to decreased PO intake

Disposition

• Low threshold to admit if not tolerating PO
• Consider additional workup depending on causation

Source

• Tintinalli
• Hess JM, Lowell MJ: Esophagus, Stomach and Duodenum, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 89: p 1170-1187.