Most of us remain unaware of our esophagus until it's injured. However, the esophagus plays an important role in digestion. When injured, the muscular tube delivering food from the throat to the stomach causes painful and difficult swallowing. Erosive esophagitis describes a general term for inflammation, swelling, or injury to the lining of the esophagus. The multiple causes of esophagitis exist and present with similar symptoms. Each cause uniquely directs management and treatment of symptoms, with the goal of preventing complications.
Proton Pump Inhibitors
The Merck Manual recognizes acid reflux from the stomach as the most common cause of erosive esophagitis. When the muscle that protects the delicate lining of the esophagus doesn't work properly, corrosive acid from the stomach causes irritation and injury. The lining of the stomach responds to the acid in the stomach with inflammation, swelling and injury. Proton pump inhibitors reduce acid produced in the stomach and, therefore, injury to the esophageal lining. Proton pump inhibitors can be found in local pharmacies without a prescription. Examples of proton inhibitors include omeprazole (Prilosec) and pantoprazole (Protonix).
Infectious Agents
Another cause of esophagitis is infection. Bacterial, fungal or viral infections cause inflammation and injury to the esophagus. Left untreated, inflammation and the body's attempt to get rid of bacteria, can cause scarring of tissue and other complications of the esophagus. Antibiotic treatment is aimed at preventing and eradicating infection, allowing the lining to heal.
Viral infections appear most commonly in patients with poor immune systems. In one study, as reported by HIV In-Site, out of 100 patients with ulcers, 80 percent received positive results for cytomegalovirus (CMV). There are a host of other viruses that cause esophagitis including herpes simplex virus (HSV), varicella zoster virus (VZV) and human immunodeficiency virus (HIV). Antivirals help control severity of the disease and limit viral infection of other healthy cells. Some commonly used antivirals include acyclovir (Zovirax) and ganciclovir (Valcyte).
Fungal infections, also prominent in those with depressed immune systems, appear most responsive to anti-ergesterol drugs flucanozole (Diflucan) or ketocanazole (Extina), according to The Merck Manual.
Esophagoscopy
Doctors perform diagnosis and treatment of erosive esophagitis through a tube called an endoscope. A pencil-sized tube placed down the throat, allows visualization and inspection of the lining of the esophagus. Physicians locate the area of injury. In some cases, they immediately treat patients depending on the cause of erosive esophagitis. For example, in object-induced esophagitis, an esophagoscope removes pills or other objects causing irritation. Intervention with an endoscope can stop bleeding in severe cases of erosive esophagitis. Most bleeding associated with esophagitis is self-limiting. In other words, it stops on its own and is rarely severe. If narrowing is present from chronic esophagitis, special tools expand the narrowed esophagus.
Surgical Repair
When all other medical intervention fail, complications of erosive esophagitis sometimes requires surgical intervention. In the most severe cases of acid reflux, surgical intervention prevents further damage to the lining of the esophagus. The tightening of the region between the esophagus and stomach refers to a procedure called fundoplication. As detailed by the University of Maryland Medical Center, surgeons wrap the stomach around the tightening called a sphincter, creating a tighter valve.
