Esophagitis – Diagnosis and Treatment
Diagnosis
Viewing the Esophagus With a Camera
Doctors often use a thin tube with a camera called an endoscope to look inside the esophagus. This tool helps them see if the lining is red, swollen, or irregular, which can mean esophagitis.
Sometimes, doctors take a small sample of tissue from the esophagus during the procedure. This process is called a biopsy. The sample helps doctors find out if swelling comes from infection, acid reflux, or medicine damage.
Table: Endoscopy Features
| Step | Purpose |
|---|---|
| Insert camera | Inspect esophageal lining |
| Collect tissue | Analyze under a microscope (biopsy) |
| Use anesthesia | Provide comfort during the procedure |
Swallowable Esophageal Sponge Test
Doctors also use a less invasive test with a small capsule tied to a string. The capsule holds a sponge. After the capsule reaches the stomach and dissolves, the sponge is released.
Doctors pull the sponge back up by the string. As it moves through the esophagus, the sponge collects tissue samples. These samples show signs of inflammation or cell buildup, such as eosinophils, which are linked to allergies.
Barium-Based Imaging
Doctors may ask patients to drink a barium solution or swallow a barium pill. The barium coats the esophagus lining, making it easier to see on X-rays.
These images help doctors spot narrow areas, odd shapes, or other signs of damage. Doctors can also find tumors or hernias that may cause swallowing problems.
Laboratory Analysis of Tissue
Lab experts study tissue samples taken during camera exams or sponge tests. They check for bacteria, viruses, or fungi that could cause infection.
They also look for more white blood cells called eosinophils, which can mean allergies are causing inflammation. If they find abnormal cells, doctors can spot cancer early or watch for risky changes.
Summary Table
| Method | What It Checks For |
|---|---|
| Endoscopy | Structural changes, inflammation, obtain biopsies |
| Sponge Test | Inflammation, eosinophil buildup |
| Barium Imaging | Narrowing, tumors, hernias, anatomical changes |
| Lab Tests | Infections, eosinophilic esophagitis, cancer risk |
Treatment
Managing Esophagitis Caused by Acid Reflux
Proton pump inhibitors (PPIs) give stronger acid suppression and help heal the esophagus. If these medicines do not work, doctors may prescribe higher doses or stronger PPIs.
For ongoing problems, surgeons may perform a fundoplication. In this surgery, the lower esophageal sphincter is tightened using part of the stomach to stop acid from coming back up.
Summary Table: Treatment Options for Acid Reflux Esophagitis
| Treatment | Details |
|---|---|
| Antacids | Neutralize stomach acid, relieve symptoms |
| H-2 Blockers | Lower acid, available OTC or by prescription |
| PPIs | Stronger acid reduction, healing effects |
| Surgery (Fundoplication) | For severe cases, reinforces sphincter |
Therapy for Allergic Esophagitis (Eosinophilic Esophagitis)
The main approach for eosinophilic esophagitis is to avoid triggers, especially certain foods. Elimination diets help identify which foods cause symptoms.
Sometimes, an elemental diet based on amino acid formulas is used. These diets need guidance from a healthcare provider.
Doctors often start with PPIs to reduce inflammation. If this does not help, they use topical steroids that are swallowed to coat the esophagus.
If other treatments do not work, doctors may suggest biologic medicines. These medicines block proteins that cause allergic inflammation. They are usually injected weekly or every other week for patients age 12 and older.
Key Points:
- Elimination diets can be simple (one food at a time) or elemental (all food replaced by formula).
- Topical steroids usually have fewer side effects because they are not absorbed by the whole body.
- Monoclonal antibodies are used for ongoing symptoms when other treatments fail.
Symptoms That May Improve with Treatment:
- Less trouble swallowing
- Fewer times food gets stuck
- Fewer esophageal strictures
Handling Esophagitis from Medications
If medicine causes esophagitis, stopping the problem drug is the first step. Doctors may switch to a different medicine or recommend a liquid form.
Good pill-taking habits help prevent symptoms. Sitting or standing upright for at least 30 minutes after taking pills and drinking a full glass of water helps the tablet move quickly through the esophagus.
Some people may need to limit fluids, so advice should fit their health needs.
Helpful Habits:
- Use pill alternatives (liquids or different drugs).
- Stay upright after taking medication.
- Take pills with enough water (unless fluid is restricted).
Approaches for Esophagitis Caused by Infection
Doctors treat infectious esophagitis based on the microbe causing it. Antiviral drugs treat viruses, antifungal medicine treats fungi, and antibiotics treat bacteria.
Doctors choose the treatment after checking symptoms or test results.
Addressing Usual Complications of Esophagitis
Esophagitis can cause narrowing (stricture) of the esophagus, making swallowing hard. Food can also get stuck.
Gastroenterologists use special procedures to stretch (dilate) the esophagus and ease blockages or narrowing. They may use slender tubes that widen slowly or a balloon that inflates inside the esophagus.
Common Methods for Dilation:
| Tool Type | Method of Action |
|---|---|
| Tapered Tube | Starts small and widens slowly |
| Inflatable Balloon | Inserted collapsed, then expanded |
This procedure is generally safe and brings fast relief. Sometimes, it needs to be repeated if narrowing comes back.
Lifestyle and Home Tips
People with esophagitis can take steps at home to ease discomfort and help prevent symptoms from returning. Simple changes in eating and daily habits are often helpful.
Food and Drink Choices
- Avoid foods and drinks that make symptoms worse, such as alcohol, caffeine, chocolate, and mint.
- Eating smaller meals can help lower pressure on the esophagus.
- Consider a food elimination plan or an elemental diet if certain foods cause allergic reactions. A doctor or dietitian can help identify problem foods.
- For those with an overactive immune system, the six-food elimination diet (removing dairy, wheat, eggs, soy, nuts, and seafood) may be suggested. Track symptoms to see if removing certain foods helps.
Daily Habits and Environment
- Take pills with plenty of water and avoid lying down for at least 30 minutes afterward.
- Stay upright for at least three hours after eating.
- Avoid bending or stooping after meals to reduce reflux.
- Raise the head of your bed by 6โ8 inches (15โ20 cm) using blocks or a wedge under the mattress. This helps keep stomach acid down while you sleep.
Other Helpful Practices
- Keep a healthy weight, as extra weight puts pressure on the stomach.
- Stop smoking to lower the risk of symptoms returning.
- Talk to your healthcare professional before making major changes to your diet or habits.
| Helpful Actions | Description |
|---|---|
| Avoid trigger foods | Stay away from foods/drinks that cause issues. |
| Modify mealtimes | Eat smaller portions, avoid late-night eating. |
| Sleep adjustments | Elevate bed head, no lying down after meals. |
| Healthy lifestyle | Lose weight, quit smoking. |
Alternative Therapies
Some people use remedies like ginger, chamomile, and slippery elm to help with heartburn or reflux symptoms. These may offer comfort, but they are not proven treatments for esophagitis.
Always talk to a healthcare provider before trying supplements or herbal remedies. Do not replace standard medical treatments with alternative therapies.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Being prepared before seeing a healthcare professional or gastroenterologist helps your visit go smoothly.
- List all symptoms. Write down what you notice, even if it seems unrelated to the esophagus or stomach.
- Collect your health details. Note recent major life events, stresses, or health changes.
- Gather information about your medicines. Include prescription drugs, over-the-counter medicine, vitamins, and supplements.
- Write down your family’s medical history. Note any allergies or digestive issues like esophageal or stomach problems.
- Prepare your questions. List what you want to know, starting with the most important. Here are some examples:
| Question Example |
|---|
| What tests will I need to confirm my diagnosis? |
| How should I get ready for these tests? |
| When will the test results be available? |
| Which treatment options are best for my situation? |
| How do we track if my treatment is working? |
| Will I need future tests or check-ups? |
| How do I prevent problems from happening again? |
| How can I manage this diagnosis with other health problems? |
These steps help make the visit more effective and ensure you get the answers you need.
Questions Your Healthcare Professional Might Ask
During your appointment, your healthcare professional or gastroenterologist will ask questions to better understand your condition. Being ready to answer helps save time and lets you discuss your main concerns.
Common questions include:
- How strong is your pain or discomfort?
- Are you having trouble swallowing?
- How often do your symptoms happen?
- Is there anything that triggers your symptoms, like a specific food?
- Does anything help relieve the symptoms, such as antacids or avoiding certain foods?
- Are symptoms worse at certain times of day?
- Did you notice symptoms after starting any medication, and which one?
- Do you have a history of allergies or take allergy medicine?
- Have you ever had food get stuck in your throat?
- Does food ever come back up after you swallow?
- Does anyone in your family have digestive or stomach issues?
Having details and examples ready helps your healthcare professional give you better care.
If you have severe chest pain that does not go away, cannot swallow, or think food is stuck in your esophagus, get emergency care right away. These can be signs of a serious problem that needs urgent attention.
