ESOPHAGITIS

Question 1

Pertinent Anatomy of a patient with Esophagitis.

Answer 1

Esophagus

Question 2

Pertinent Physiology

Answer 2

The esophagus functions to promote motility, via peristalsis, to introduce ingested food to the stomach

Question 3

Esophagitis could range from

Answer 3

pill-induced, reflux, Eosinophilic to infectious

Question 4

Medications that cause direct esophageal mucosal injury include

Answer 4

(a) Antibiotics Tetracycline, Doxycycline, Clindamycin have been associated with
esophagitis due to their direct irritant effect.
(b) Anti-inflammatory medications — Aspirin and anti-inflammatory agents can cause severe esophagitis, esophageal strictures, and bleeding.
(c) Bisphosphonates — Although the incidence of side effects with bisphosphonates is low if proper administration instructions are followed, esophagitis, esophageal ulcers, and strictures can still occur.

Question 5

a subset of patients with GERD who have endoscopic evidence of esophageal inflammation

Answer 5

Reflux esophagitis

Question 6

Esophagitis and thrush often occur together in immunosuppressed patients
and the presence of thrush may help determine the cause of esophageal symptoms.
However, the absence of thrush does not preclude the diagnosis of candida esophagitis.

Answer 6

Infectious

Question 7

If the underlying cause remains, the tissue of the esophagus will

Answer 7

remain impacted and

symptoms will persist.

Question 8

Causative agent attacks tissue of the esophagus and breaks down the integrity of the tissue which cause

Answer 8

esophageal inflammation. .

will remain impacted and symptoms will persist

Question 9

Patients with medication-induced esophagitis usually present with

Answer 9

retrosternal pain or

heartburn (60 percent), odynophagia (50 percent), and dysphagia (40 percent).

Question 10

Patients often have a

history of swallowing a pill without water, commonly at what time of the day

Answer 10

bedtime

Question 11

(a) Rarely, patients may have hematemesis, abdominal pain, and weight loss. The onset of the symptoms can occur within a few hours to one month after ingestion of the culprit medication. Patients often have a history of swallowing a pill without water,
commonly at bedtime

Answer 11

Pill Induced

Question 12

The hallmark of Candida esophagitis is odynophagia, or pain on swallowing. Patients usually localize their pain to a discrete retrosternal area. The diagnosis of Candida esophagitis is usually made when white mucosal plaque-like lesions are noted on endoscopy. Esophageal candidiasis is most common in HIV-infected patients, in which it is an AIDS-defining illness, and in patients with hematologic malignancies.

Answer 12

Candida Esophagitis-Symptoms

Question 13

Differential Diagnosis

Answer 13

(1) GRED
(2) Peptic Stricture
(3) Mallory-Weiss Tear

Question 14

Lab

If infection is considered:

Answer 14

(a) CBC
(b) Specimen culture
(c) Swab for candida

Question 15

RAD

Answer 15

Consider Endoscopy

Question 16

Treatment

(1) Treat the underlying cause
(a) Pill induced

Answer 16

1) Stop taking offensive medication

2) Take with water

Question 17

Treatment

(2) Candida Esophagitis

Answer 17

Evaluate for immunocompromised conditions: HIV, Cancer, Diabetes

Question 18

Initial Care

Answer 18

(1) Determine the underlying cause and treat.
(2) Most infectious manifestations require endoscopy with biopsy to confirm diagnosis.
(3) Broad spectrum antibiotic should be considered in those who present with fever and
elevated WBC.
(4) Pill induced patients should d/c oral medications unless absolutely necessary, then
reduced dose should be considered

Question 19

Complications

Answer 19

(1) Peptic Stricture
(2) Esophageal Spams
(3) Mallory-Weiss Tear
(4) Boerhaave