Esophagitis

Synonyms

Reflux esophagitis, infectious, mechanical, toxic (toxic), thermal (heat or cold-related), radiogenic (radiation-related), medicinal esophagitis

Medical: esophagitis

definition

Under esophagitis one understands the Inflammation of the lining of the inside of the esophagus. The esophagus connects the throat to the stomach and is about 25 cm long. It consists largely of muscle that uses wave-like motion to transport food towards the stomach. In most cases only the innermost layer, the mucous membrane, is inflamed.

The inflammation can occur in different parts of the esophagus. In consequence of heartburn it occurs mostly as Pain behind the sternum, in front of the entrance to the stomach.
As a concomitant of Laryngitis the upper esophagus, which is located in the area of ​​the throat, becomes increasingly inflamed.

Figure esophagus

1. esophagus
   (Neck section) -
   Esophagus, pars cervicalis
2. Nasal cavity - Cavitas nasi
3. Oral cavity - Cavitas oris
4. Windpipe (approx. 20 cm) - Trachea
5. esophagus
   (Chest section) -
   Esophagus, pars thoracica
6. esophagus
   (Abdominal section) -
   Esophagus, pars abdominalis
7. Stomach entrance -
   Cardia
8. Stomach body -
   Corpus gastricum
9. Throat -
   Pharynx
10. Thyroid -
    Glandula thyroidea

You can find an overview of all Dr-Gumpert images at: medical illustrations

causes

Inflammation can arise for a number of reasons. Are rare Autoimmune diseases the reason. More often can Infections cause inflammation of the esophagus with bacteria, viruses or other pathogens as an accompanying symptom.
The most common cause, however, is one irritation the esophagus. The irritation can be permanent, recurring or one-off. The triggering cause can be mechanical, thermal or chemical.

Probably the most common cause of deep esophagitis is a recurring one heartburncaused by acidic stomach contents or weakness of the upper gastric obstruction. Since the mucous membrane of the esophagus is very sensitive to the hydrochloric acid in the stomach, it can become inflamed and cause long-term irreversible changes.

Forms of esophagitis

The Esophagitis is caused by various pollutants (Noxious substances) caused. One differentiates:

Reflux esophagitis

Reflux esophagitis is the most common form of esophagitis. It is caused by the persistent chemical irritation of the esophageal mucous membrane from the acidic stomach contents / gastric juice that is pushed up. The less frequent reflux of bile or secretion from the pancreas leads to a much stronger inflammatory reaction with comparatively fewer symptoms.

Read more about this under Reflux esophagitis

Mechanical esophagitis

A mechanical irritative esophagitis arises in most cases from a long inserted Nasogastric tube. There are several situations in which a nasogastric tube is used. Long-term feeding with a nasogastric tube is mostly used to feed those patients who cannot swallow (see also: Pain when swallowing) or who are unconscious.

A nasogastric tube is a tube that is inserted through the nose into the stomach and remains there as long as tube feeding is necessary. The probe represents a foreign body in the esophagus, you irritates the mucous membrane and the resulting local inflammation can lead to ulceration.

Narrowing of the esophagus

Sometimes a scar or narrowing of the esophagus from other causes can irritate the lining, which can lead to inflammation.

Ignition by foreign bodies

Various foreign objects and hard foods can damage the surface of the esophagus. Herringbones are particularly suitable for this.

Esophageal cancer (esophageal cancer)

Also a Esophageal cancer (Esophageal carcinoma) can represent a kind of foreign body in the esophagus and thus also cause mechanical irritation.

Thermal esophagitis

As the name suggests, thermal esophagitis is one combustion the esophageal lining caused by hot food and drinks.

Burns to the esophagus

Acute burns to the esophagus are usually caused by swallowing household cleaners or other acids or alkalis. This acute emergency particularly affects children who accidentally drink these fluids or people who attempt suicide with them.

The middle section of the esophagus is usually most affected. Various complications can arise in this emergency. The larynx may swell (Glottic edema), which acutely closes the airways and thus represents a life-threatening disease. The tissue destruction can cause a tear in the esophageal wall (perforation) come and the contents in the chest cavity (Rib cage / thorax) exit. This condition, if left untreated, has inflammation of the middle skin (Mediastinitis) according to.

Infectious esophagitis

Infectious esophagitis is in most cases caused by a reduced immune system (Immunosuppression) caused. In the case of some diseases in which the immune system is directed against the body (autoimmune diseases, e.g. rheumatoid arthritis), the body's defenses must be reduced with medication. The patient is then much more susceptible to germs that are harmless to a healthy person. Immunosuppression also occurs in the following diseases:

Leukemia and other diseases affecting the blood-producing system

• More on this topic under leukemia
• Uncontrolled (i.e. poorly controlled with medication) diabetes (diabetes mellitus)
• Congenital defects in the immune system
• HIV, especially in the AIDS stage
• More on this topic under AIDS
• alcoholism
• Strong antibiotics
• Tumor disease
• rheumatic diseases under immunosuppressive therapy, such as the rheumatoid arthritis

Bacterial esophagitis

The inflammation of the esophagus occurs occasionally Scarlet fever and diphtheria on. This esophagitis runs without complications and heals without any problems when the infection is treated.

On the other hand, the very rare inflammation of the esophagus by the germs of the esophagus does not run without problems tuberculosis and the syphilis (syphilis). In tuberculosis, the spread of germs can lead to the formation of nodules the size of a millet head (tubercle) throughout the body and thus also in the esophagus.
If the tuberculosis germ is swallowed, the esophagus can also be infected through direct contact.
In the syphilis can become plump and elastic under the mucous membrane of the esophagus in the course of the long-standing illness Tumors form, which are also called gums ("rubber swellings").
They usually occur in the upper part of the esophagus. Both diseases are in the stages when they can affect the esophagus, are already advanced and very difficult to treat.

Viral esophagitis

The inflammation of the esophagus through Viruses sometimes join measles, rubella and Influenza (Flu virus) and usually do not cause any problems during treatment. Other viral diseases remain in the body after the initial infection and can be reactivated if the immune system is weak, i.e. the body's defenses are no longer able to tame the virus, so that it can break out again. One of these viruses is one among others

• Herpes Simplex Virus (HPV)
• Cytomegalovirus (CMV)
• Varicella zoster virus (VZV)

Infections with the Herpes virus (HPV) can develop from the oralPharynx Spread up into the esophagus. At first, one observes small vesicles that can even spread into ulcers and are often accompanied by a fever.

The Cytomegalovirus (CMV) is particularly feared in severely immunocompromised patients; it can also cause esophagitis, among other things. The varicella zoster virus remains in the body after the first illness, chickenpox. This virus can reactivate even if the immune system is not severely weak. Then the pustule formation, which is limited to one segment, is called Shingles. Both diseases can be pronounced, and the esophagus can be affected.

Fungal infections of the esophagus

The second most common Esophagitis, just after reflux esophagitis, is candidal esophagitis or thrush esophagitis.
The causative agent is Candida albicans, a Yeast, which is a normal germ of the intestinal flora and is not a danger for an immune-healthy (body's own defense against infection).

Infants, the elderly and immunocompromised people are mostly affected, and the infection is often the first sign of AIDS.
The bacterial and fungal flora normally keep each other in balance. In some cases, strong antibiotic therapy can damage the normal bacterial flora of humans so that the Candida fungus can spread unhindered, which is a Candida infection (Thrush).

Autoimmune diseases

nRarely, various chronic diseases can lead to nodular (granulomatous) Inflammation of the esophagus. In these so-called autoimmune diseases, the immune defense is directed against structures in the own body. For example, occasionally at Crohn's disease and the Sarcoid so an esophagitis can be observed.

Radiogenic (radiation-induced) esophagitis

At the Esophageal cancer and many other cancers that are in the esophagus require radiation. It is often not possible to give the optimal radiation dose for treating cancer cells because the entire gastrointestinal tract is sensitive to radiation. Despite the strong precautions taken with radiation, the esophagus can still be affected. Radiogenic esophagitis is the result. The simultaneous administration of Chemotherapy drugs can also exacerbate the effects of radiation.

Acute radiogenic esophagitis occurs around the end of the 2nd week after the start of radio or chemoradiotherapy. The symptoms can sometimes improve during the radiotherapy, only to increase again in the 5-6 week. The symptoms can experience a significant improvement within a few days by interrupting the irradiation, but only completely disappeared after 2-10 weeks. Rarely, a complication of chronic radiogenic esophagitis caused by chronic ulcers (Ulcers), which can be very painful. The main problem with chronic radiogenic esophagitis is the difficult distinction between inflammation and recurrence of the esophageal tumor (Tumor recurrence). The mucus-forming glands can also be damaged by the radiation, so that the neutralizing function of the mucus is lost and a reflux disease is favored.

Pill ospohagitis

Another type of inflammation can be caused by medication use. If a tablet is taken with little liquid, it can stick to the mucous membrane or become stuck in the throat due to delayed swallowing or disruption. Especially if you lie down flat immediately after taking the tablet, the passage is even more delayed.

Antibiotics (tetracyclines), painkillers (e.g. NSAIDs), KCL (potassium chloride), bisphosphonates (e.g. Fosamax® against osteoporosis), Iron sulfate and many other drugs cause a local inflammatory reaction. The irritated areas are mostly circular and no larger than the tablet itself, this form is also called “pill esophagitis”.

Symptoms

The typical symptom of esophagitis is pain in swallowing (odynophagia). This is particularly pronounced in the mechanical-irritative form.
Non-specific swallowing difficulties (dysphagia) also occur. Often the pain behind the sternum (retrosternal pain) that occurs is misinterpreted with pathological processes in the area of ​​the heart and bronchi. Particularly in the case of pronounced infectious esophagitis, bleeding, edematous swellings or even scarring and, as a result, narrowing (so-called stenoses) can occur and thus complicate the clinical picture.
If, in addition to the mucous membrane, other wall layers (especially the muscle layer) are also affected, this can lead to disorders of the muscle function (peristalsis), which can lead to swallowing difficulties and reflux disease.

Pain associated with esophagitis

One of the main signs of inflammation is pain. It goes hand in hand with a functional restriction. In addition, a Swelling, redness, and overheating which cannot be found externally in the esophagus.

Of the pain becomes particular when touched and moved triggered. It can range from feeling uncomfortable when eating to burning pain when breathing. Depending on the location of the inflammation, the pain is felt in the neck area or behind the breastbone up to the level of the stomach.
With severe inflammation, deep breathing is enough to trigger the pain. The breathing movement shifts the chest and thus onto the esophagus. The slight movement already causes a sharp pain.

The severe pain associated with a pronounced esophagitis can radiate into the back. The pain pulls around the body to the back, parallel to the ribs. The pain can be sharp with any food intake, with deep breathing and with slight movement and can be felt in the back. Often the back pain is misdiagnosed as a nerve entrapment, pancreatic disease, or generally as an orthopedic problem.

However, if there is severe pain when swallowing, an esophagitis is likely. If the suspicion is confirmed, the doctor may have to perform a gastroscopy.

First signs

Typical signs of an inflammation of the esophagus are an unpleasant burning sensation in the chest, more precisely behind the breastbone, also known as a "retrosternal" burning sensation. This is the case with many types of esophagitis coupled with difficulty swallowing.

Since the entire esophagus is around 25 cm long and is rarely completely infected by inflammation, the symptoms occur at different levels. Swallowing difficulties also vary. With high esophagitis, the pain is noticeable the second you swallow. In the case of deep inflammation just before the stomach, the uncomfortable feeling arrives with a time delay. It can take up to 8-9 seconds for food to travel through the esophagus.

Is there a pathogen-related inflammation before, typical infection symptoms can occur in addition to the difficulty swallowing. These include weakness, fever, or aching limbs.

If the burning sensation begins behind the breastbone a few minutes after consuming certain foods, this is also a sign of a acid-related inflammation.

Other typical signs can only be identified in the gastroscopy. One look at the inner mucous membrane is enough for the doctor to recognize an inflamed mucous membrane.

Diagnosis

Typical symptoms of esophagitis are an indefinable, burning sensation pain at the level of the breastbone.Also difficulties swallowing occur that feel differently depending on the location of the inflammation. In addition, you stumble across the stomach more often and when you swallow you get a kind of foreign body sensation.
Already exist Pre-existing illness, is an acute one Infectious disease before or is a common heartburn known, the suspicion of an esophagitis hardens.

To diagnose them for sure is one Gastroscopy necessary. A tube is passed through the mouth and into the stomach. The hose contains a light and a camera. The esophagus can then be viewed from the inside on a high-resolution screen. The doctor can tell by the appearance of the mucous membrane that there is inflammation. By means of a Tissue sample the inflammation can be proven and using an additional probe of the Acidity measured in the stomach.

Read more on this topic under: Esophagitis Diagnostics

treatment

Treatment of inflammation of the esophagus must be depending on the cause of inflammation should be planned. In the most common form of esophagitis caused by heartburn already help in the early stages Changes in eating habits. Acidic foods in particular need to be reduced. Typical triggers are sour drinks. This applies to coffee, carbonated drinks and often alcohol, especially wine. Drinks that are pleasant for the esophagus are still water and tea instead of coffee.

It may also help not to eat or drink just before bed and sleep with your head slightly elevated in bed. In addition to habits you can too medicinal and in severe cases too operational Treatments may be necessary. Many medications can reduce the acidity of the stomach to help protect the esophagus.

Various surgical techniques are used to treat advanced esophageal diseases. Almost all of them aim to constrict the sphincter muscle between the esophagus and stomach and to protect the esophagus from stomach acid in the long term.

Esophagitis that is not caused by heartburn also needs to be treated entirely differently. Is the inflammation by one bacterial pathogen triggered, this must be done by Antibiotics causally be treated.

Read more on this topic at: Esophagitis Treatment

Medication

Medicines of first choice for treating esophagitis are Antacids. They are used for initial inflammation and minor discomfort. With a simple chemical neutralization reaction, they bind stomach acid and counteract inflammation caused by heartburn.

If the symptoms persist for about two weeks despite the antacids, come back Proton pump inhibitors for use. The most prominent representatives of this group are Pantozol®, Omeprazole or Esomeprazole. They block an enzyme that plays a key role in the production of hydrochloric acid in the stomach. The funds must therefore taken before a meal so they can block the enzyme before the acid is created.
Proton pump inhibitors vary in their effective doses depending on the severity of the esophagitis. For stubborn inflammation, they can be used for 6 months.

"Histamine receptor blockers"Or so-called"Prokinetics“Used. They also reduce the contact between the esophagus and the harmful acid, but have larger ones Side effects. The Side effects of proton pump inhibitors however, are extremely low, which is why they are widely used in everyday clinical practice. Since some of the prominent pain medication can trigger heartburn, the proton pump inhibitors are also prescribed to protect the stomach.

If the inflammation of the esophagus progresses over the months and years despite drug treatment, surgical methods can be used.

Read more about this topic under: Proton pump inhibitor comparison and proton pump inhibitor effect

Duration of treatment

The duration of treatment for inflammation of the esophagus depends on the severity of the inflammation and its treatment. Slight complaints can be avoided by changing eating and drinking habits and within less hours to days alleviate. These changes can initially have the effect that an incipient inflammation can subside. If the habits are resumed afterwards, the symptoms may stop or start again. Long-term symptoms should be considered Adjust lifestylebefore consequential damage can occur.

If there is an actual inflammation, gastric acid-binding drugs are usually used. Antacids are agents that can bind and neutralize gastric acid through simple chemical reactions. If the symptoms do not subside after about 2 weeks despite taking it, other medications must be prescribed. Come often Proton pump inhibitors used for about one to two weeks daily be taken. They inhibit the production of stomach acid and give the inflammation time to slowly subside.

If the esophagus is inflamed for years due to stomach acid, long-term damage to the esophageal mucous membrane can occur. Before irreversible damage occurs, a surgery which strengthen the lower esophageal sphincter and reduce acidity.

The total time of discomfort can vary. Frequent heartburn and initial difficulty swallowing are too often ignored until a solid esophagitis has developed. This can cause irreversible long-term damage over the years. The symptoms must be recognized in good time. Even mild heartburn several times a week for years can have serious consequences.

Symptoms after eating

Food plays a role in the esophagitis caused by stomach acid, in particular. The body registers an intake of food and the stomach begins to produce acid to chemically break down the food. Lots of people are prone to one excessive acid production when consuming acidic foods. The excess stomach acid can rise and come into contact with the lower esophagus. This creates a heartburn. If this happens repeatedly, manifest esophagitis can develop.

One thing is important Change in eating habits. Foods that often cause problems are coffee and alcoholic beverages. In particular Wine can lead to a sour belching. Frequent vomiting can also affect the entire esophagus.

If the morning coffee is drunk in addition to breakfast, the food can bind the acid and the symptoms stay away. If possible, the carbonated water should also be replaced with still water. For the mucous membrane soothing drinks are mainly still water and teas, for example Camomile tea.

In addition to acidic drinks, fatty foods in particular can cause acidification. Since fat has the highest chemical calorific value of all food, it causes an enormous amount of hydrochloric acid to be released through the stomach. Symptoms can appear within a few minutes after eating fatty foods.

Esophagitis without heartburn

An esophagitis without previous and accompanying heartburn suggests one of the rarer causes down. In addition to bacterial, viral and parasitic causes with infestation of the esophagus also occur thermal or mechanical irritation in question.

The esophagus can become inflamed in severe burns. In particular, subsequent contact with liquid or food leads to severe pain in the inflamed esophagus. A burn in the esophagus is almost always accompanied by burns in the upper throat and oral cavity.

Mechanical causes of esophagitis are also conceivable. Swallowing sharp, hard or large objects can irritate or injure the lining of the esophagus. Small injuries to the mucous membrane also allow pathogens to enter, which in turn can cause inflammation.

Esophagitis in pregnancy

An esophagitis in pregnancy is not a rare problem. They arise favored by pregnancy. Changing hormone levels and increased pressure in the abdomen relax the lower esophageal sphincter and acid reflux can occur, which can cause inflammation.

An inflammation of the esophagus during pregnancy brings with it the problem that the pain and difficulty swallowing can lead to a lack of food. At the same time, drug therapies should be used with caution during pregnancy.

Especially with pregnant women, certain To change habits. This includes at night to sleep with your head high or switch from sparkling to still water. High-fat and voluminous meals should also be avoided, as well as coffee and alcoholic beverages. If the symptoms persist, drug therapy can be started with careful consideration and caution.

Read more on this topic at: Heartburn During Pregnancy