ESOPHAGITIS

PREFERRED BY:
DARYL S . ABRAHAM
OVERVIEW
• Esophagitis (uh-sof-uh-JIE-tis) is inflammation that may damage tissues
of the esophagus, the muscular tube that delivers food from your mouth to
your stomach.
• Esophagitis can cause painful, difficult swallowing and chest pain. Causes
of esophagitis include stomach acids backing up into the esophagus,
infection, oral medications and allergies
OVERVIEW
• Treatment for esophagitis depends on the underlying cause and the
severity of tissue damage. If left untreated, esophagitis can damage the
lining of the esophagus and interfere with its normal function, which is to
move food and liquid from your mouth to your stomach. Esophagitis can
also lead to complications such as scarring or narrowing of the esophagus,
and difficulty swallowing.
SYMPTOMS
Common signs and symptoms of esophagitis include:
• Difficult swallowing
• Painful swallowing
• Chest pain, particularly behind the breastbone, that occurs with eating
• Swallowed food becoming stuck in the esophagus (food impaction)
• Heartburn
• Acid regurgitation
SYMPTOMS
In infants and young children, particularly those too young to explain their
discomfort or pain, signs of esophagitis may include:
• Feeding difficulties
• Failure to thrive
WHEN TO SEE DOCTOR?
Most signs and symptoms of esophagitis can be caused by a number of different
conditions affecting the digestive system. See your doctor if signs or symptoms:
• Last more than a few days
• Don't improve or go away with over-the-counter antacids
• Are severe enough to make eating difficult
• Are accompanied by flu signs and symptoms, such as headache, fever and
muscle aches
WHEN TO SEE DOCTOR?
Get emergency care if you:
• Experience pain in your chest that lasts more than a few minutes
• Suspect you have food lodged in your esophagus
• Have a history of heart disease and experience chest pain
• Experience pain in your mouth or throat when you eat
• Have shortness of breath or chest pain that occurs shortly after eating
• Vomit large amounts, often have forceful vomiting, have trouble breathing after vomiting
or have vomit that is yellow or green, looks like coffee grounds, or contains blood
CAUSES

Esophagitis is generally categorized by the conditions

that cause it. In some cases, more than one factor may be
causing esophagitis.
CAUSES
Reflux esophagitis
• A valve-like structure called the lower esophageal
sphincter usually keeps the acidic contents of the stomach
out of the esophagus. If this valve opens when it shouldn't
or doesn't close properly, the contents of the stomach may
back up into the esophagus (gastroesophageal reflux).
Gastroesophageal reflux disease (GERD) is a condition in
which this backflow of acid is a frequent or ongoing
problem. A complication of GERD is chronic
inflammation and tissue damage in the esophagus.
CAUSES
Eosinophilic esophagitis
• Eosinophils (e-o-SIN-o-fils) are white
blood cells that play a key role in allergic
reactions. Eosinophilic esophagitis occurs
with a high concentration of these white
blood cells in the esophagus, most likely in
response to an allergy-causing agent
(allergen) or acid reflux or both.
CAUSES
Lymphocytic esophagitis
• Lymphocytic esophagitis (LE) is an
uncommon esophageal condition in
which there are an increased number of
lymphocytes in the lining of the
esophagus. LE may be related to
eosinophilic esophagitis or to GERD.
CAUSES
Drug-induced esophagitis
Several oral medications may cause tissue damage if they remain in contact
with the lining of the esophagus for too long. For example, if you swallow a
pill with little or no water, the pill itself or residue from the pill may remain
in the esophagus. Drugs that have been linked to esophagitis include:
• Pain-relieving medications, such as aspirin, ibuprofen (Advil, Motrin,
others) and naproxen sodium (Aleve, others)
• Antibiotics, such as tetracycline and doxycycline
• Potassium chloride, which is used to treat potassium deficiency
• Bisphosphonates, including alendronate (Fosamax), a treatment for weak
and brittle bones (osteoporosis)
• Quinidine, which is used to treat heart problems
CAUSES
Infectious esophagitis
• A bacterial, viral or fungal infection
in tissues of the esophagus may
cause esophagitis. Infectious
esophagitis is relatively rare and
occurs most often in people with
poor immune system function, such
as people with HIV/AIDS or cancer.
RISK FACTORS
Risk factors for esophagitis vary depending on the different
causes of the disorder.
RISK FACTORS
Reflux esophagitis
Factors that increase the risk of gastroesophageal reflux disease (GERD) — and therefore are factors in
reflux esophagitis — include the following:

• Eating immediately before going to bed

• Dietary factors such as excess alcohol, caffeine, chocolate and mint-flavored foods
• Excessively large and fatty meals
• Smoking
• Extra weight, including from pregnancy
A number of foods may worsen symptoms
of GERD or reflux esophagitis:

• Spicy foods
• Tomato-based foods
• Garlic and onions
• Citrus fruits
• Chocolate
• Caffeine
• Mint-flavored foods
• Alcohol
RISK FACTORS
Eosinophilic esophagitis
Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may
include:

• A history of certain allergic reactions, including allergic rhinitis, asthma

and atopic dermatitis
• A family history of eosinophilic esophagitis
RISK FACTORS
Drug-induced esophagitis
Factors that may increase the risk of drug-induced esophagitis are generally
related to issues that prevent quick and complete passage of a pill into the
stomach. These factors include:

• Swallowing a pill with little or no water

• Taking drugs while lying down
• Taking drugs right before sleep, probably due in part to the production of
less saliva and swallowing less during sleep
• Older age, possibly because of age-related changes to the muscles of the
esophagus or a decreased production of saliva
• Large or oddly shaped pills
RISK FACTORS
Infectious esophagitis
• Risk factors for infectious esophagitis often relate to medications, such as
steroids and antibiotics. People with diabetes also are at increased risk of
candida esophagitis in particular.
COMPLICATIONS
Left untreated, esophagitis can lead to changes in the structure of the esophagus.
Possible complications include:

• Scarring or narrowing (stricture) of the esophagus

• Tearing of the esophagus lining tissue from retching (if food gets stuck) or during
endoscopy (due to inflammation)
• Barrett's esophagus, characterized by changes to the cells lining the esophagus,
increasing your risk of esophageal cancer
Laboratory and diagnostic study findings:
• Esophagogastroduodenoscopy may reveal irritated, inflamed areas with
possible eroded areas. Brushing and biopsy results can exclude cancer of
the esophagus.
• Twenty-four-hour pH monitoring detects decreased pH of gastric contents.
• Esophagoscopy and barium swallow detect anatomic or functional
derangements of esophagus secondary to acid erosion.
NURSING MANAGEMENT
• Promote adequate nutritional intake. Instruct the client to:
• Eat small, frequent meals of mostly bland foods
• Chew food thoroughly before swallowing
• Drink fluids to aid swallowing and food passage down the esophagus.
• Refrain from laying down after eating
• Avoid eating within 3 hours of bedtime
CONTD…
• Assess all vomitus for content, note undigested food and blood (i.e.
coffee-ground or bright red appearance)
• Maintain integrity of the oral mucosa.
• Minimize pain.
• Instruct the client to avoid irritants. Advise the client to elevate head of his
bed with blocks to help minimize reflux.
THANK YOU