Esophagitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Assistant Editor-in-Chief: Soumya Sachdeva

Synonyms and keywords: Oesophagitis

Overview

Esophagitis is defined as inflammation of the esophagus. The inflammation can be due to a variety of causes such as gastroesophageal reflux disease, viruses, or chemical injuries.

Pathophysiology

• The most common cause is gastroesophageal reflux disease (GERD). If caused by GERD, the diseases is also called reflux esophagitis.
• Other causes of esophagitis include infections (most commonly candida, herpes simplex and cytomegalovirus). These infections are typically seen in immunocompromised people, such as those with HIV.
• Food allergies have also been known to cause esophagitis
• Chemical injury by alkaline or acid solutions may also cause esophagitis, and is usually seen in children or in adults who attempt suicide.
• Physical injury resulting from radiation therapy or by nasogastric tubes may also be responsible.

Pathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Gross Images

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  Esophagus: Candida: Gross natural color close up of distal esophagus mucosa, an excellent example of candida esophagitis
• 
  Esophagitis Candida: Gross natural color close-up, an excellent example

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  Esophagitis Candida: Gross natural color excellent close-up photo case of acute myelomonocytic leukemia
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  Necrotizing esophagitis and gastritis, sulfuric acid ingested as suicide attempt

Microscopic Images

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  Herpes esophagitis 100 x
• 
  Herpes esophagitis 400 x
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  Herpes esophagitis 600 x

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  Reflux esophagitis 100 x
• 
  Reflux esophagitis 400 x
• 
  Necrotizing esophagitis and gastritis, sulfuric acid ingested as suicide attempt

Histopathological Findings: Herpes esophagitis

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Causes

Common Causes

• Gastroesophageal reflux disease

Casues in Alphabetical Order

• Gastroesophageal reflux disease
• GERD)
• Reflux esophagitis

• Other causes of esophagitis include infections (most commonly candida, herpes simplex and cytomegalovirus). These infections are typically seen in immunocompromised people, such as those with HIV.
• Food allergies have also been known to cause esophagitis
• Chemical injury by alkaline or acid solutions may also cause esophagitis, and is usually seen in children or in adults who attempt suicide.
• Physical injury resulting from radiation therapy or by nasogastric tubes may also be responsible.

Diagnosis

Symptoms

The symptoms of esophagitis include:

• Bad breath (halitosis)
• Chest pain, in the middle of the chest, often radiating to the back, usually associated with swallowing or soon after a meal
• Difficulty swallowing and/or painful swallowing, especially if there is a feeling of food getting stuck on the way down
• Hoarseness
• Mouth sores
• Nausea
• Sore throat
• Vomiting

Symptoms of underlying diseases that cause esophagitis include:

• Indigestion
• Heartburn, acid reflux, or unpleasant taste in the mouth
• Excessive belching

Complete Differential Diagnosis

In alphabetical order.

• Bacterial infection
• Candida
• Caustic burn
• Crohn's Disease
• Cytomegalovirus (CMV)
• Drugs, toxins
• Fungal infection
• Gastric tube
• Gastroesophageal reflux
• Gastroscopy
• Hernias
• Herpes
• Metastasis
• Radiation
• Surgery
• Tumor
• Vomiting

Diagnostic Findings

X-ray Findings

(Images shown below are courtesy of RadsWiki)

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Endoscopic Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  Candida esophagitis
• 
  NSAID esophagitis
• 
  Peptic esophagitis

• 
  Herpetic esophagitis
• 
  Caustic lye esophagitis

References

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