Erosive esophagitis

Erosive esophagitis is a condition characterized by the inflammation, irritation, or erosion of the lining of the esophagus, which is the tube that carries food from the mouth to the stomach. This condition is a subtype of gastroesophageal reflux disease (GERD), where the primary symptom is the backward flow of stomach acid into the esophagus, leading to potential damage. Erosive esophagitis can cause significant discomfort and complications if left untreated.

Causes

The primary cause of erosive esophagitis is chronic exposure of the esophageal lining to stomach acid, a condition commonly associated with GERD. Other factors that may contribute to the development of this condition include:

• Hiatal hernia, which increases the likelihood of GERD.
• Use of certain medications that can irritate the esophagus lining or weaken the lower esophageal sphincter (LES).
• Zollinger-Ellison syndrome, a rare condition that leads to increased acid production.
• Lifestyle factors such as obesity, smoking, and alcohol use.
• Consumption of foods that can trigger reflux, such as spicy foods, caffeine, and citrus fruits.

Symptoms

Symptoms of erosive esophagitis may include:

• Heartburn, especially after eating or at night.
• Difficulty swallowing (Dysphagia).
• Painful swallowing (Odynophagia).
• Chest pain.
• Regurgitation of food or sour liquid.
• In severe cases, bleeding of the esophagus which may lead to anemia.

Diagnosis

Diagnosis of erosive esophagitis typically involves a combination of patient history, physical examination, and diagnostic tests such as:

• Endoscopy, to visually inspect the esophagus for signs of erosion and to take biopsies if necessary.
• Barium swallow X-ray, to visualize the shape and function of the esophagus.
• Esophageal manometry, to measure the pressure and muscle contractions within the esophagus.
• pH monitoring, to assess the acid levels in the esophagus over a 24-hour period.

Treatment

Treatment for erosive esophagitis aims to reduce acid reflux, heal the esophagus, and prevent complications. Treatment options include:

• Lifestyle modifications, such as weight loss, elevating the head of the bed, and avoiding reflux-triggering foods.
• Medications, including proton pump inhibitors (PPIs) and H2 receptor blockers, which reduce stomach acid production.
• In severe cases, surgical interventions such as Nissen fundoplication may be considered to strengthen the LES.

Complications

If left untreated, erosive esophagitis can lead to complications such as:

• Esophageal stricture, a narrowing of the esophagus that can cause swallowing difficulties.
• Barrett's esophagus, a condition where the esophageal lining changes, increasing the risk of esophageal cancer.
• An increased risk of esophageal ulcers and bleeding.

Prevention

Preventive measures for erosive esophagitis largely involve managing GERD symptoms through lifestyle modifications and medication. Regular follow-ups with a healthcare provider can help monitor the condition and adjust treatment as necessary.