Esophagitis - Eosinophilic, Infectious, Medication-Induced Esophagitis
When I mention the word esophagitis, you would say it is the inflammation of the esophagus, and yes, you are correct. So since you know what esophagitis is, let's continue with this topic.
It is not enough to know that it is an inflammation of the esophagus, patients with esophagitis present with certain clinical manifestations such as Dysphagia which is difficulty in swallowing, Odinophagia (painful swallowing), and burning of the chest such as heartburn or dyspepsia. Patients with esophagitis can possess certain complications such as strictures, which happen as a result of the tissues of the esophagus healing up undergoing fibrosis, and narrowing the esophageal lumen. Patients with esophagitis can also experience esophageal perforation where there is a ripping off of the esophageal causing air and other materials to enter into the mediastinum, causing the patient to become septic as the patient will have an increased white blood cell count, fever, and hypotension. The ripping of the esophageal muscles can also cause blood to leak into the lumen of the esophagus leading to Gastrointestinal bleeding.
Looking at the causes of esophagitis can be pill/drug-induced esophagitis, reflux esophagitis, Infectious esophagitis, Caustic esophagitis, and Eosinophilic esophagitis. Pill-induced esophagitis can be drugs such as NSAIDs, doxycycline, Potassium chloride, and bisphosphate which will cause an injury to the mucosa of the esophagus. Reflux esophagitis has to do with reflux in the case of refractory gerd where the hydrochloric acid starts to destroy the esophagus. Infectious esophagitis has to do with patients who are immunocompromised making them susceptible to infections that normal people wouldn't get easily. These esophagitis are HSV esophagitis, CMV esophagitis, and candida esophagitis, or esophageal candidiasis. Caustic Esophagitis is usually caused by taking in corrosive substances that would corrode the esophagus. Substances such as strong acid or base burns the mouth cavity, causing drooling, and the tearing up of the airway. Eosinophilic esophagitis will usually occur in patients with Atopic Triad (Asthma, Allergies, and atopic dermatitis) where a trigger of the eosinophils can lead to the infiltration of the esophagus.
Diagnosis of esophagitis includes a contrast esophagram where gastrographen is given to find a leak or perforation in the esophagus. A CT chest scan can be done, as well as an Esophagogastroduodenoscopy (EGD) can be done. If the patient presents with ulcers in the esophagus, then it would probably be pill/drug-induced esophagitis, if the patient has a history of GERD or Erosion, then it can be Reflux Esophagitis. In immunocompromised patients, they can suffer from infectious esophagitis. If the ulcer is large with cytomegaly, then this is possibly CMV esophagitis. If the biopsy shows white plaques, then this is probably candida esophagitis. In the case of a giant cell in the rounded hepatic vesicle with cowdry A, then this is HSV esophagitis. If the patient has Escars, Fistula in the esophagus, then this is Caustic Esophagitis.
Treatment of esophagitis starts with preventing the further progression of the esophagitis by putting the patient on Proton Pump Inhibitor (PPI). If there is a perforation of the esophagus, then intubation putting an NG tube, using antibiotics, and possibly surgery. If the esophagitis is pill/drug-induced, then discontinuing the medication is a great first step, then treat. In reflux esophagitis, it is important to treat the GERD, decrease hydrochloric production, and treat. In the case of infectious esophagitis, treat CMV esophagitis with Ganciclovir, with HSV esophagitis with Acyclovir, and if it is it candida esophagitis treating with Fluconazole and amphotericin B is required. In Caustic esophagitis, supportive care is important. It is important not to induce emesis as well as not to neutralize the acid or base. With eosinophilic esophagitis, taking care of allergies is very important. Also, using Fluticasone proportionate from the mouth will reduce allergies.
Reference
https://www.ncbi.nlm.nih.gov/books/NBK537268/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948703/
https://www.ncbi.nlm.nih.gov/books/NBK442012/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423037/
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Even with the name Esophagitis, one will have known it is associated with esophagus. This is really an interesting article which I was able to learn a lot I must confess