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Esophagitis

 Synonyms : 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  

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.

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Revised: 06/07/07.  Copyright © 2006 Clinical Research Associates of Tidewater.  All rights reserved.