Erosive esophagitis is a condition where the inner lining of the esophagus, the tube connecting the throat to the stomach, becomes inflamed and damaged. This damage, characterized by visible breaks or sores, often results from exposure to stomach acid and other digestive juices. It is a more severe form of esophagitis, where the lining has been visibly eroded, ranging from small lesions to more extensive tissue loss.
Recognizing the Signs and Causes
Individuals with erosive esophagitis often experience uncomfortable symptoms. Heartburn is a common sensation, described as a burning discomfort felt behind the breastbone, frequently occurring after meals. Acid regurgitation, where stomach contents flow back into the throat, can leave a sour taste in the mouth or a burning sensation.
Difficulty swallowing, known as dysphagia, can make eating uncomfortable, sometimes feeling as if food is stuck in the throat. Painful swallowing, or odynophagia, might also occur, presenting as a burning sensation during the act of swallowing. Other symptoms can include non-cardiac chest pain, a sore throat, or increased salivation.
Gastroesophageal reflux disease (GERD) is the most frequent cause of erosive esophagitis. In GERD, the lower esophageal sphincter, a muscle at the end of the esophagus, does not close properly, allowing stomach acid to flow back into the esophagus. This chronic exposure gradually erodes the delicate esophageal lining.
Certain medications can also lead to erosive esophagitis if they become lodged in the esophagus or are not taken with enough water. These include some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates. The direct irritation from these pills can cause localized damage.
Infections can also contribute, particularly in individuals with weakened immune systems. Fungal infections, such as Candida, or viral infections like herpes simplex, can cause inflammation and erosion. Radiation therapy to the chest can also damage esophageal tissue, leading to erosions.
How Erosive Esophagitis is Diagnosed
The diagnostic process for erosive esophagitis begins with a healthcare provider evaluating a patient’s symptoms and medical history. This initial assessment helps determine the likelihood of esophageal involvement.
Esophagogastroduodenoscopy (EGD or upper endoscopy) is the primary diagnostic tool. During this procedure, a thin, flexible tube with a camera is guided down the throat into the esophagus, stomach, and the first part of the small intestine. This allows direct visualization of the esophageal lining to identify and assess inflammation, erosions, and any ulcers. The severity of erosions is often categorized using classification systems, such as the Los Angeles classification.
During an endoscopy, tissue samples, or biopsies, may be collected from the esophageal lining. These samples are then examined under a microscope to confirm the diagnosis, rule out other conditions, or identify specific causes like fungal or viral infections. Biopsies are also important for checking for pre-cancerous changes, such as those seen in Barrett’s esophagus.
A barium swallow, also called an esophagram, is an imaging test that visualizes the esophagus. The patient drinks a barium solution, which coats the esophageal lining, making it visible on X-rays. This test can reveal structural abnormalities like strictures or larger ulcers.
In some instances, pH monitoring may be used to measure acid levels in the esophagus over a period, typically 24 hours. This helps correlate symptoms with acid exposure, providing further insight into the nature of the reflux.
Treatment and Management Approaches
Treatment for erosive esophagitis primarily focuses on reducing stomach acid production to allow the esophagus to heal. Proton pump inhibitors (PPIs) are the most effective medications for this purpose. These drugs, such as omeprazole, lansoprazole, and esomeprazole, work by blocking the pumps in the stomach lining that produce acid, significantly lowering acid levels.
H2 receptor blockers represent another class of medications that reduce acid production. Antacids provide immediate, temporary relief from symptoms like heartburn by neutralizing stomach acid, but they do not promote healing of the esophageal lining.
Lifestyle modifications are a significant part of managing erosive esophagitis and preventing recurrence. Dietary changes are often recommended, including avoiding trigger foods such as spicy, acidic, or fatty foods, chocolate, caffeine, alcohol, and peppermint. Eating smaller, more frequent meals can also help reduce stomach distension and reflux.
Avoiding eating close to bedtime allows time for food to digest before lying down. Elevating the head of the bed can help gravity keep stomach acid from flowing back into the esophagus during sleep. Maintaining a healthy weight and quitting smoking are also beneficial, as both can worsen reflux symptoms.
For severe cases that do not respond to medication and lifestyle changes, surgical interventions may be considered. Fundoplication is a common surgical procedure that strengthens the lower esophageal sphincter, the muscle that prevents stomach acid from flowing back into the esophagus. This involves wrapping the upper part of the stomach around the lower esophagus, creating a tighter valve.
Understanding Potential Complications
If erosive esophagitis is left untreated, it can lead to several complications. Esophageal ulcers are deeper sores that can develop from persistent erosions in the esophageal lining. These ulcers can cause considerable pain and may lead to bleeding, which can manifest as blood in vomit or dark, tarry stools.
Chronic inflammation and scarring from ongoing acid exposure can result in esophageal strictures, which are narrowings of the esophagus. This narrowing can cause progressive difficulty swallowing, as food and liquids struggle to pass through the constricted area. Procedures to dilate, or widen, the stricture may be necessary.
Barrett’s esophagus is a complication where the normal squamous lining of the esophagus is replaced by columnar tissue, similar to the lining of the intestine. This change occurs due to prolonged exposure to stomach acid. Barrett’s esophagus is considered a pre-cancerous condition and necessitates regular endoscopic surveillance with biopsies to monitor for any further cellular changes.
There is an increased risk of developing esophageal cancer, specifically esophageal adenocarcinoma, linked to chronic untreated erosive esophagitis and the development of Barrett’s esophagus. The persistent irritation and cellular changes over time can contribute to the formation of malignant cells. Early diagnosis and consistent management are important to mitigate these long-term risks.