eMedicine Specialties > Emergency Medicine > Gastrointestinal

Esophagitis

Author: Chun-hing Ludwig Tsoi, MB, ChB, MPH, MRCP, FRCS(Edin), Senior Medical Officer, Accident and Emergency Department, North District Hospital, Hong Kong; Chairman, Committee on Training, Hong Kong St John Ambulance
Coauthor(s): Chin Hung Chung, MBBS, FRCS(Glasg), FHKAM(Surgery), Chief of Service, Department of Accident and Emergency, North District Hospital, Hong Kong
Contributor Information and Disclosures

Updated: Feb 2, 2009

Introduction

Background

Esophagitis is a common medical condition usually caused by gastroesophageal reflux. Less frequent causes of esophagitis include infectious esophagitis (in patients who are immunocompromised), radiation esophagitis, and esophagitis from direct erosive effects of ingested medication or corrosive agents.

Pathophysiology

Reflux esophagitis develops when gastric contents are passively regurgitated into the esophagus. Reflux happens commonly and does not cause major harm because natural peristalsis of the esophagus clears the refluxate back to the stomach. In others, where acid reflux from the stomach is persistent, the result is damage to the esophagus causing symptoms and macroscopic changes. Gastric acid, pepsin, and bile irritate the squamous epithelium, leading to inflammation, erosion, and ulceration of the esophageal mucosa.

Frequency

United States

Esophageal reflux symptoms occur monthly in 33-44% of the general population; up to 7-10% of people have daily symptoms.

International

Symptoms of reflux are up to an order of magnitude higher than the prevalence of esophagitis. In the United Kingdom, patients presenting to a general practitioner with symptoms of reflux esophagitis show rates in the 40-65% range. However, a retrospective review of the results of more than 8000 diagnostic endoscopies in Hampshire showed that gastroesophageal reflux disease (GERD) accounted for 23% of all upper gastrointestinal conditions. A review of the Swedish National Register estimated the prevalence of esophagitis (diagnosed by endoscopy) to be less than 5% in the 55-year-old group. Other reports have estimated the prevalence to be on the order of 2%. 

Mortality/Morbidity

Minimal morbidity and mortality result from mild symptoms of esophagitis. Pain from moderate-to-severe symptoms may produce anxiety and lost work and may lead to medical evaluations for more serious causes of pain. Serious GI complications of esophagitis include esophageal strictures, Barrett esophagus, and adenocarcinoma. Aspiration of gastric contents is a potentially serious respiratory complication that occurs more often in children. It may be associated with bronchospasm, pneumonitis, and apnea.

Race

No race predilection has been observed.

Clinical

History

  • The most common complaint in patients with esophagitis is heartburn (dyspepsia), a burning sensation in the mid chest caused by contact of stomach acid with inflamed esophageal mucosa. Symptoms often are maximal while the person is supine, bending over, wearing tight clothing, or has eaten a large meal.
  • Water brash is a bitter taste of refluxed gastric contents often associated with heartburn.
  • Other common symptoms of esophagitis include upper abdominal discomfort, nausea, bloating, and fullness. Less common symptoms of esophagitis include dysphagia, odynophagia, cough, hoarseness, wheezing, and hematemesis.
  • The patient may experience chest pain indistinguishable from that of coronary artery disease. Pain is often midsternal with radiation to the neck or arm and may be associated with shortness of breath and diaphoresis. Chest pain may be relieved with nitrates if esophageal spasm is involved, further confounding diagnostic evaluation.
  • Infants with gastroesophageal reflux are at greater risk of aspiration. Symptoms include weight loss, regurgitation, excessive crying, backache, respiratory distress, and apnea.

Physical

  • The physical examination usually is not helpful in confirming the diagnosis of uncomplicated esophagitis. However, the examination may reveal other potential sources of chest or abdominal pain.
  • Perform a rectal examination to identify the presence of occult bleeding.

Causes

  • Factors or conditions that may increase a person's risk of developing reflux esophagitis include the following:
    • Pregnancy
    • Obesity
    • Scleroderma
    • Smoking
    • Alcohol, coffee, chocolate, fatty or spicy foods
    • Certain medications (eg, beta-blockers, nonsteroidal anti-inflammatory drugs [NSAIDs], theophylline, nitrates, alendronate, calcium channel blockers)
    • Mental retardation requiring institutionalization
    • Spinal cord injury
    • Immunocompromise
    • Radiation therapy for chest tumors
    • Pill esophagitis, thought to be secondary to chemical irritation of esophageal mucosa from certain medications (eg, iron, potassium, quinidine, aspirin, steroids, tetracyclines, NSAIDs), especially when swallowed with too little fluid

More on Esophagitis

Overview: Esophagitis
Differential Diagnoses & Workup: Esophagitis
Treatment & Medication: Esophagitis
Follow-up: Esophagitis
Multimedia: Esophagitis
References
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References

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Further Reading

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Keywords

esophagitis, heartburn, gastroesophageal reflux, GER, gastroesophageal reflux disease, GERD, Barrett syndrome, Barrett's syndrome, Barrett's esophagus, Barrett esophagus, reflux esophagitis, pill esophagitis, medication induced esophagitis, endoscopy, gastric reflux, dyspepsia, histamine-2 receptor antagonist, H2 receptor antagonist, proton pump inhibitor, esophageal cancer, radiation esophagitis, dyspepsia, burning sensation in chest, water brash, dysphagia, odynophagia, diaphoresis, obesity, scleroderma, smoking, alcohol, coffee, fatty food, spicy food, spinal cord injury, radiation therapy, pill esophagitis

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Contributor Information and Disclosures

Author

Chun-hing Ludwig Tsoi, MB, ChB, MPH, MRCP, FRCS(Edin), Senior Medical Officer, Accident and Emergency Department, North District Hospital, Hong Kong; Chairman, Committee on Training, Hong Kong St John Ambulance
Chun-hing Ludwig Tsoi, MB, ChB, MPH, MRCP, FRCS(Edin) is a member of the following medical societies: Royal College of Physicians and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

Coauthor(s)

Chin Hung Chung, MBBS, FRCS(Glasg), FHKAM(Surgery), Chief of Service, Department of Accident and Emergency, North District Hospital, Hong Kong
Chin Hung Chung, MBBS, FRCS(Glasg), FHKAM(Surgery) is a member of the following medical societies: American College of Surgeons and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

Medical Editor

James Li, MD, Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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