Overview
Esophagitis involves inflammation of the esophageal mucosa, often due to acid reflux, but can also result from other causes such as medication side effects, infections, and mechanical factors. 147Diagnosis
Clinical Presentation: Dysphagia, odynophagia, retrosternal pain.
Endoscopy: Gold standard for diagnosis, visualizes mucosal changes. 247
Imaging: Useful in specific cases, e.g., cholescintigraphy for duodenogastroesophageal reflux. 5
Grading: Typically assessed based on endoscopic findings (e.g., Los Angeles Classification for reflux esophagitis).Management
First-Line Treatment: Standard-dose proton pump inhibitors (PPIs) 1.
- Dose: Adjust to double-dose PPI if standard dose is ineffective 1.
- Alternative PPIs: Switching to another PPI may help 1.
- Administration: Consider pre-meal dosing 1.
Adjunctive Treatments:
- Vonoprazan: Potent acid suppression for PPI-resistant cases 1.
- Symptomatic Relief: Proton pump inhibitors for drug-induced esophagitis 2.
- Antifungal Therapy: Intravenous amphotericin for severe Candida esophagitis 4.Special Populations
Pediatrics: Not specifically addressed in provided abstracts.
Elderly: Increased risk of complications; careful monitoring and management of comorbidities recommended 6.
Comorbidities: Patients with renal failure may require tailored antifungal therapy for Candida esophagitis 4.
Pregnancy: Not directly addressed in abstracts; management typically involves safer PPI alternatives if necessary [Expert opinion].Key Recommendations
Initiate treatment with standard-dose proton pump inhibitors for reflux esophagitis (Evidence: Strong 1).
For PPI-resistant cases, consider dose escalation, switching PPIs, or using vonoprazan (Evidence: Moderate 1).
In cases of drug-induced esophagitis, discontinue the offending agent and manage symptoms with PPIs (Evidence: Weak 2).
Aggressive medical management is crucial in preventing esophagitis complications in patients with mechanical interventions like orthotic devices (Evidence: Expert opinion 6).
Intravenous antifungal therapy may be necessary for severe Candida esophagitis, especially in immunocompromised states (Evidence: Weak 4).References
1 Iwakiri K. Treatment Strategy for Standard-Dose Proton Pump Inhibitor-Resistant Reflux Esophagitis. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi 2017. link
2 Shelat VG, Seah M, Lim KH. Doxycycline induced acute erosive oesophagitis and presenting as acute dysphagia. The Journal of the Association of Physicians of India 2011. link
3 Amin MR, Postma GN, Setzen M, Koufman JA. Transnasal esophagoscopy: a position statement from the American Bronchoesophagological Association (ABEA). Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2008. link
4 Kumar A. Massive upper gastrointestinal bleeding due to Candida esophagitis. Southern medical journal 1994. link
5 Blue PW, Jackson JH, Ghaed N. Duodenogastroesophageal reflux. Demonstration with Tc-99m DISIDA imaging. Clinical nuclear medicine 1984. link
6 Kling TF, Drennan JC, Gryboski JD. Esophagitis complicating scoliosis management with the Boston thoracolumbosacral orthosis. Clinical orthopaedics and related research 1981. link
7 Meyers C, Durkin MG, Love L. Radiographic findings in herpetic esophagitis. Radiology 1976. link
8 Stanciu C. Gastric secretion, gastroesophageal reflux and esophagitis. The American journal of gastroenterology 1975. link
9 Safie-Shirazi S. Competency test after fundoplication for treatment of reflux esophagitis. Archives of surgery (Chicago, Ill. : 1960) 1975. link
10 Franklin RH. Oesophageal surgery. Annals of the Royal College of Surgeons of England 1975. link