Esophagitis

Esophagitis

Updated: 02/12/2021

General features

Reflux: Most common

Chemical: Alcohol, corrosive acid or alkalis, medical pills

Iotrogenic: Chemotherapy, radiation, graft vs host disease

Infectious: Virus, bacteria, fungi

Part of systemic disease: Bullous pemphigoid, epidermolysis bullosa, Crohn’s, etc

Infiltrating inflammatory cells: Eosinophilic, lymphocytic, neutrophilic

Inflammatory pattern: Granulomatous, erosive, necrotic, etc

Etiology

Most common cause: Gastroesophageal reflux; less commonly infectious
Other causes: Alcohol, corrosive acids or alkalis, excessively hot fluids, and heavy smoking, pills

Clinical presentations

Heartburn (the most common symptom)
Regurgitation, upper abdominal discomfort, nausea, bloating, fullness, dysphagia, odynophagia, cough, hoarseness, wheezing, and hematemesis

Reflux esophagitis

Most common cause of esophagitis
Due to reflux of gastric or duodenal contents into lower esophagus
Erosive or non-erosive
Higher risk for stricture and Barrett's esophagus
Severity of symptoms may not correlate with biopsy findings
Diagnosis: Usually clinical presentation, intra-esophageal pH monitoring etc
Treatment: Motility promoting drugs, H2 receptor antagonists, proton-pump inhibitors, surgery to reduce hiatal hernia

Eosinophilic esophagitis

Isolated or part of eosinophilic gastroenteritis, peripheral eosinophilia or reflux esophagitis
More common in younger population
Associated with allergy, bacterial infection, reflux, proton pump inhibitor
Diagnosis based on clinical, endoscopic and pathological findings
Endoscopy: White flecks or plaques, stipple-like exudates, linear fissures or furrows, trachealization (ringed esophagus), strictures
Pathological features: Markedly increased eosinophils in squamous epithelium

Infectious esophagitis

Pathology Notes