Esophagitis

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Background

  • Inflammation of the esophagus

Clinical Features

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

Differential Diagnosis

Esophagitis Types

  • Inflammatory
    • GERD
    • Pill esophagitis (NSAIDs, antibiotics)
    • Allergy (esoninophillic)
  • Infectious Mainly seen in pts w/ immunosuppression (HIV/AIDS, cancer, steroids)
    • Esophageal candidiasis: often an AIDS defining lesion
    • HSV, CMV esophagitis, aphthous ulceration
  • 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

  1. 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.