Esophagitis

Clinical Features

• Odynophagia and/or dysphagia
• 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

Diagnosis

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
• Candidal Infection: fluconazole for 14 to 21 days
• IV Fluids for dehydration

Disposition

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

See Also

• HIV - AIDS (Main)