Esophagitis

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: This is a condition in which inflammation develops in the esophageal mucosa, causing damage such as erosions, ulcers, and blisters. The main mechanisms include chemical damage from gastric acid, direct chemical damage from corrosive substances, local irritation caused by medications, or infectious inflammation caused by pathogens such as fungi, viruses, and bacteria. Repeated or chronic reflux of gastric acid can progress from superficial mucosal damage to intestinal metaplasia (Barrett’s esophagus).
• Main causes:
  • Gastroesophageal reflux disease (GERD) — most common
  • Infectious esophagitis: Candida, HSV (herpes simplex virus), CMV, etc. — occurs mainly in people with weakened immune systems
  • Medication-induced (chemical irritation when pills remain in the esophagus for a prolonged period) — antacids, antibiotics, iron supplements, NSAIDs, etc.
  • Corrosive (acid/alkali) injury, radiation therapy, and chemotherapy
• Main symptoms:
  • Dysphagia (difficulty swallowing), odynophagia (pain when swallowing), heartburn (burning sensation), chest pain
  • Nausea and vomiting, hematemesis, melena (in cases of bleeding)
  • Fever and chills (infectious esophagitis), sensation of food getting stuck

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Treatment Methods

• General principles: Identify the cause (reflux, infection, medication, etc.) → cause-specific targeted treatment + symptom relief · prevention of complications
• Medication treatment
  • Related to gastroesophageal reflux: Proton pump inhibitors (PPIs) are used first (follow the doctor’s prescription and instructions). If necessary, an H2 blocker may be added or the PPI dosage may be adjusted.
  • Infectious esophagitis:
    • Candida: Oral fluconazole (follow the doctor’s prescription and dosage instructions)
    • HSV: Antiviral agents (such as acyclovir)
    • CMV: Gentamicin-class agents (e.g., ganciclovir, etc.) — IV treatment is required in severe cases and in people with weakened immune systems
  • Medication-induced: Discontinue or switch the suspected medication, take it with water after meals as recommended, and use a mucosal protectant (e.g., sucralfate) or a PPI if necessary
• Procedures and surgery
  • Endoscopic hemostasis (in cases of bleeding); surgical treatment may be considered in cases of perforation, severe ulcers, strictures, persistent bleeding, or failure of medication or medical treatment
  • Chronic strictures: Endoscopic dilation; stent placement or surgical correction in severe cases
  • Corrosive injury: Early endoscopy (usually within 24 hours) to determine the stage and establish a treatment plan
• Lifestyle management (self-care)
  • Weight control, no eating within 2–3 hours before bedtime, sleep with the upper body elevated (head and upper body at 15–20 degrees)
  • Avoid foods that stimulate gastric acid, such as overeating, fatty foods, chocolate, alcohol, caffeine, carbonated beverages, and orange juice
  • Quit smoking (to improve lower esophageal sphincter function), and do not lie down immediately after meals
  • Take medications with plenty of water (especially iron tablets, bisphosphonates, antibiotics, etc.)
• Precautions and complication management
  • Visit the emergency room immediately if acute perforation, massive bleeding, or difficulty breathing (airway involvement) occurs
  • If left untreated chronically, esophageal stricture, bleeding, perforation, and Barrett’s esophagus (intestinal metaplasia) may occur → potentially increased risk of esophageal cancer
  • If infectious esophagitis is found in a patient with weakened immunity, evaluation of immune status (such as HIV) is necessary

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Checklist Before an Outpatient Visit (Including Preparation and Example Questions)

• Items to prepare before the visit
  • List of currently taken medications (including prescription drugs, OTC medications, and supplements)
  • Bring copies of recent test results if available (upper endoscopy, blood tests, imaging tests, etc.)
  • Notes recording when symptoms began, their course, factors that worsen or improve symptoms (meals, posture, medication use, etc.)
  • Record whether fever, weight changes, melena, or hematemesis have occurred
• Materials useful to present to the doctor during the outpatient visit
  • Symptom diary (when symptoms occur, which foods they are associated with, degree of pain when swallowing)
  • Whether risk factors for weakened immunity are present (chemotherapy, immunosuppressants, diabetes, organ transplantation, etc.)
• Emergency warning signs to know before the outpatient visit (seek immediate care)
  • Severe chest pain or difficulty breathing, persistent high fever, heavy bleeding (hematemesis or melena), sudden severe abdominal pain, or symptoms of shock

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Examples of General Questions to Ask the Doctor

• "What is the most likely cause of my esophagitis?"
• "What tests are recommended, and is an endoscopy necessary?"
• "What are the expected effects and possible side effects of the medication you plan to prescribe?"
• "If my symptoms do not improve or recur, what is the next step in treatment?"
• "Which lifestyle habits must I change, and for approximately how long?"

Examples of Disease-Specific Questions

• "If the endoscopy shows ulcers, a coating, or a white membrane (suggestive of Candida), what antifungal or antiviral treatment would you recommend?"
• "I have recurrent reflux esophagitis. Do I need to take a PPI long term? If so, how should monitoring (e.g., bone density and the risk of gastrointestinal infection) be carried out?"