Esophagitis

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Treatment

Esophagitis treatment depends on the underlying cause. Treatment often involves lifestyle modifications and medications. In severe cases, surgery may be required.

Dietary changes, such as avoiding foods that cause esophageal irritation and eating smaller meals, can be helpful in treating esophagitis caused by chronic acid reflux. Foods and beverages that trigger heartburn and irritation vary from person to person.

Common acid reflux triggers include the following:

• Alcohol
• Carbonated drinks
• Chocolate
• Coffee and tea
• Fried foods
• Garlic
• Onions

Acidic foods (e.g., tomatoes, citrus fruits), hard foods (e.g., nuts, seeds, raw vegetables), and spicy foods (e.g., peppers, foods flavored with curry or chili powder) can worsen esophageal irritation.

Other lifestyle changes that may be helpful include maintaining a healthy weight, exercising regularly, and avoiding smoking. If possible, patients who develop chemical (pill-induced) esophagitis should take medications with plenty of water and only while upright.

Medications
Depending on the cause, a number of different medications can be used to treat esophagitis.

Types of medicines include the following:

• Antibiotics (used to treat bacterial esophagitis; broad-spectrum antibiotics often are prescribed)
• Antifungals (used to treat fungal esophagitis; e.g., nystatin [Mycostatin®], fluconazole [Diflucan®], clotrimazole [Mycelex®])
• Antivirals (used to treat viral esophagitis; e.g., acyclovir [Zovirax®], foscarnet [Foscavir®])
• Corticosteroids (used to reduce inflammation; e.g., prednisone)
• H-2 receptor blockers (used to reduce acid reflux; e.g., Pepsid® AC, Tagamet®)
• Pain relievers (may be taken orally, applied topically, or gargled; e.g., lidocaine)
• Proton pump inhibitors (used to reduce acid reflux; e.g., Prilosec®, Nexium®, Prevacid®)

To allow the esophagus to heal during treatment and to ensure proper nutrition and reduce the risk for malnutrition and dehydration, some patients require parenteral feeding (e.g., nutrition administered through a vein [IV]).

Surgery
Esophagitis usually responds to lifestyle changes and medical treatment. However, in severe cases, surgery to remove all or part of the esophagus may be necessary (called esophagectomy).

There are two types of esophagectomy: standard transthoracic esophagectomy is performed through an incision between the ribs that opens one side of the chest and transhiatal esophagectomy is performed through incisions in the upper abdomen and lower neck.

Following esophagectomy, the remaining healthy portion of the esophagus is attached to the stomach (called anastomosis) or a section of the intestine is used to replace the removed portion of the esophagus.

Esophagectomy can cause serious complications, including the following:

• Anastomotic leakage (leakage of stomach contents into the abdomen caused by a breakdown in the anastomosis)
• Heart and lung complications (e.g., arrhythmias [may cause heart attack in severe cases], pneumonia, pleural infusion)
• Infection at the incision site or throughout the body (sepsis)
• Nerve injury
• Severe bleeding

After the procedure, pain usually can be controlled using prescription pain medications. Most patients remain in the hospital for about 2 weeks and can return to normal activity in about 2 months.

Other types of surgery may be performed to treat severe complications of esophagitis. These procedures include surgery to repair a perforation (hole) in the esophagus and dilation, or dilatation, to reduce stricture (narrowing). Dilation involves inserting a guidewire into the constricted area of the esophagus and passing a device called a dilator over the wire to widen the esophageal opening.

Esophagitis usually is treated by a physician who specializes in diseases of the gastrointestinal (GI) tract or digestive system (called a gastroenterologist).

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