Oesophagitis

Oesophagitis is an inflammation of the lining of the oesophagus (gullet). In most people this is caused by the digestive juices in the stomach, repeatedly moving upwards into the lower oesophagus (reflux). Muscle contraction normally keeps the lower end of the oesophagus closed, but reflux occurs when this muscle is weak. The reason why the muscle becomes weak is not fully understood.

Types
The two principal types of esophagitis are corrosive esophagitis and reflux esophagitis.
Corrosive esophagitis is caused by swallowing of caustic chemicals (acid or lye) accidentally or in a suicide attempt. The severity of the inflammation depends on the type, amount, and concentration of caustic chemical swallowed.

Immediately after swallowing such a chemical, there is severe pain and edema in the throat and mouth. Antidotes are of limited value and gastric lavage must be avoided as this may only increase the damage. Treatment consists mainly of reducing pain and providing nursing care until the esophagus heals.
Reflux esophagitis or gastroesophageal reflux disorder (GERD) is a very common condition. The cause is poor functioning of the musculature of the lower esophageal segment, which permits reflux of the stomach's contents.

 

Causes
Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include:
    * Candida. This is a yeast infection of the esophagus caused by the same fungus that causes vaginal yeast infections. The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetes or HIV). It is usually very treatable with antifungal drugs.
    * Herpes. Like Candida, this viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.
Irritation causing esophagitis may be caused by any of the following:
    * GERD, or gastro esophageal reflux disease
    * Vomiting
    * Surgery
    * Medications such as aspirin and other anti-inflammatory drugs
    * Taking a large pill with too little water or just before bedtime
    * Swallowing a toxic substance
    * Hernias
    * Radiation injury (after receiving radiation for cancer treatment)

Symptoms
Symptoms of esophagitis include:
    * Difficult and/or painful swallowing
    * Heartburn
    * Mouth sores
    * A feeling of something of being stuck in the throat
    * Nausea
    * Vomiting

Diagnosis

Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:
    * Upper endoscopy. A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus.
    * Biopsy. During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope.
    * Upper GI series (or barium swallow). During this procedure, x-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an x-ray. This characteristic enables doctors to view certain abnormalities of the esophagus.

Treatment

Treatment for esophagitis depends on its cause. Possible treatments include:

• Medications that block acid production, like heartburn drugs.
• Antibiotics, antifungals, or antivirals to treat an infection.
• Pain medications that can be gargled or swallowed.
• Corticosteroid medication to reduce inflammation.
• Intravenous (by vein) nutrition to allow the esophagus to heal and to reduce the likelihood of malnourishment or dehydration.
• Endoscopy to remove any lodged pill fragments.
• Surgery to remove the damaged part of the esophagus.

While being treated for esophagitis, there are certain steps you can take to help limit discomfort.

• Avoid spicy foods such as those with pepper, chili powder, curry, and nutmeg.
• Avoid hard foods such as nuts, crackers, and raw vegetables.
• Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits, and their juices. Instead, try imitation fruit drinks with vitamin C.
• Add more soft foods such as applesauce, cooked cereals, mashed potatoes, custards, puddings, and high protein shakes to your diet.
• Take small bites and chew food thoroughly.
• If swallowing becomes increasingly difficult, try tilting your head upward so the food flows to the back of the throat before swallowing.
• Drink liquids through a straw to make swallowing easier.
• Avoid alcohol and tobacco.

Nursing considerations

Elevating the head of the bed

Avoiding strong stimulants of acid secretions (e.g., coffee, alcohol)

Avoiding certain drugs (e.g., anticholinergics), specific foods (fats, chocolate), and smoking, all of which lower esophageal sphincter competence

Giving an antacid to neutralize gastric acidity and possibly increase lower esophageal sphincter competence

Use of cholinergic agonists to increase sphincter pressure

Use of H2 agonists to reduce stomach acidity