Esophagitis
Background
- 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
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
- Candidal Infection[1]
- 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
References
- ↑ Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16.