Esophagitis: Difference between revisions

Latest revision as of 22:53, 4 January 2026

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.

Esophagus anatomy and nomenclature based on two systems.

Inflammation of the esophagus

Clinical Features

Odynophagia and/or dysphagia
- Commonly causes dehydration
Chest pain
Nausea
Dyspepsia

Differential Diagnosis

Esophagitis Types

Inflammatory
- GERD
- Allergic (eosinophilic)
Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV
- CMV esophagitis
- aphthous ulceration
Medication-induced (i.e. "pill") esophagitis, common culprits:
- Doxycycline
- Tetracycline
- Clindamycin
- NSAIDs
- ASA
- Bisphosphonates
- Ferrous sulfate
- Potassium chloride
- Ascorbic acid

Evaluation

Eophageal ulcer (the reddened area at 10 o'clock on the surface of the mucosa) and due to refulx esophatitis (GERD).

Esophageal candidiasis

Work-Up

CBC
CMP
Consider HIV workup if unknown causation, risk factors

Evaluation

Generally clinical diagnosis in ED (requires EGD for conclusive diagnosis)

Management

PPI for GERD-induced esophagitis
IV fluids for dehydration
Candida infection^[1]
- Fluconazole: 200mg PO loading dose x1 followed by 100-200 mg PO for 7-14 days

Disposition

Admit if unable to tolerate PO or if underlying immunosuppression (e.g. HIV)

References

↑ Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16.

Authors:

[1] Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16.

[1]

@@ Line 1: / Line 1: @@
+<languages/>
+<translate>
 ==Background==
-*Almost always causes odynophagia and/or dysphagia
-*Can cause prolonged periods of chest pain
-*Nausea and dyspepsia
-==Types==
+[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
-===Inflammatory Esophagitis===
+[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
-Causes
+[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]
-#GERD
+*Inflammation of the esophagus
-#Pill esophagitis (NSAIDs, antibiotics)
-===Infectious Esophagitis===
-*Mainly seen in pts w/ immunosuppression (HIV/AIDS, cancer, steroids)
+==Clinical Features==
-*Pathogens
-**Esophageal candidiasis: often an AIDS defining lesion
+*Odynophagia and/or [[Special:MyLanguage/dysphagia|dysphagia]]
-**HSV, CMV, aphthous ulceration
+**Commonly causes [[Special:MyLanguage/dehydration|dehydration]]
+*[[Special:MyLanguage/Chest pain|Chest pain]]
+*[[Special:MyLanguage/Nausea|Nausea]]
+*[[Special:MyLanguage/Dyspepsia|Dyspepsia]]
+==Differential Diagnosis==
+</translate>
+{{Esophagitis types}}
+<translate>
+==Evaluation==
+[[File:Esophageal ulcer.jpg|thumb|Eophageal ulcer (the reddened area at 10 o'clock on the surface of the mucosa) and due to refulx esophatitis (GERD).]]
+[[File:Oral Candidiasis.jpg|thumb|[[Special:MyLanguage/Esophageal candidiasis|Esophageal candidiasis]]]]
+===Work-Up===
+*CBC
+*CMP
+*Consider [[Special:MyLanguage/HIV|HIV]] workup if unknown causation, risk factors
+===Evaluation===
+*Generally clinical diagnosis in ED (requires EGD for conclusive diagnosis)
-==Diagnosis==
-*Clinical
-*Needs further evaluation via endoscopy
-==Work-Up==
+==Management==
-*CBC with dif
-*Chem 7
+*[[Special:MyLanguage/PPI|PPI]] for [[Special:MyLanguage/GERD|GERD]]-induced esophagitis
-*Fluids if dehydrated
+*[[Special:MyLanguage/IV fluids|IV fluids]] for dehydration
-*Consider HIV workup if unknown causation, risk factors
+*[[Special:MyLanguage/esophageal candidiasis|Candida infection]]<ref>Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16.</ref>
+**[[Special:MyLanguage/Fluconazole|Fluconazole]]: 200mg PO loading dose x1 followed by 100-200 mg PO for 7-14 days
-==Treatment==
-*PPI for GERD-induced esophagitis
-*Candidal Infection: fluconazole for 14 to 21 days
-**consider IV if unable to tolerate PO
-*Consider dehydration secondary to decreased PO intake
 ==Disposition==
-*Low threshold to admit if not tolerating PO
-*Consider additional workup depending on causation
-==Source==
+*Admit if unable to tolerate PO or if underlying immunosuppression (e.g. HIV)
-*Tintinalli
-*Hess JM, Lowell MJ: Esophagus, Stomach and Duodenum, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 89: p 1170-1187.
+==See Also==
+*[[Special:MyLanguage/HIV - AIDS (Main)|HIV - AIDS (Main)]]
+*[[Special:MyLanguage/Esophageal candidiasis|Esophageal candidiasis]]
+==References==
+<References/>
 [[Category:GI]]
 [[Category:ID]]
+</translate>