Gastro - Online MedEd - esophagitis

Question 1

Esophagitis - what is it?

Answer 1

Inflammation of the esophagus

One must often do a biopsy to determine the cause/endoscopy: mnemonic to remember the causes: PIECE

Question 2

Causes - esophagitis

Answer 2

P - pill-induced
I - infections
E - eosinophilic
C - caustic
E - GERD (common)

Question 3

Presentation - esophagitis

Answer 3

Odynophagia

Dysphagia - difficulty swallowing

Question 4

Dx - esophagitis

Answer 4

Endoscopy with biopsy

Question 5

Treatment - esophagitis

Answer 5

Disease specific
Use some sort of antacid (PPI, H2 blocker)
PPI is more often correct

Question 6

Pill-induced esophagitis - cause

Answer 6

Pill gets stuck
In contact with esophageal mucosa –> cause irritation and burns esophagus
-Patient feel the caustic/chemical reaction, not the pill because it has usually passed
-What type of pills: non-enteric coated NSAIDs, tetracyclines, bisphosphonates, HIV meds (ARTs) - large pills

Question 7

Dx of pill-induced esophagitis

Answer 7

Endoscopy and biopsy

Question 8

Treatment of pill-induced esophagitis

Answer 8

Often won’t see pill, if can see, then remove it
Remove offending agent
Give time to heal
Give PPI

Question 9

Follow-up of pill-induced esophagitis - how to avoid this in the future?

Answer 9

Avoid recumbency

Drink a glass of water with each pill

Question 10

Infectious esophagitis - cause (types of organisms)

Answer 10

Candida (cottage cheese stuff in mouth - clinical dx, oral candidiasis)
HSV (oral lesions, herpes crusty etc.)
CMV
HIV (opportunistic infections)
*Many of these infections are in the immunocompromised state, so check HIV status

Question 11

Presentation of infectious esophagitis

Answer 11

Esophagitis

Question 12

Dx of infectious esophagitis

Answer 12

Endoscopy

Biopsy - will tell you what type of infection it is

Question 13

Treatment of infectious esophagitis

Answer 13

Antibiotics - correspond to the organism

Question 14

Oral thrush can be treated with

Answer 14

Nystatin swish and spit
-If patient has oral thrush and candida esophagitis, do not just use nystatin swish and swallow –> use systemic treatment, fluconazole

Question 15

HSV treat with

Answer 15

Valcyclovir/acyclovir

Question 16

CMV treat with

Answer 16

Valgancyclovir/agancyclovir

Question 17

HIV treat with

Answer 17

HAART

Question 18

Eosinophilic esophagitis* what is it

Answer 18

Allergic reaction to food that causes eosinophilia in the esophagus

Question 19

Type of people who get eosinophilic esophagitis

Answer 19

Asthma
Allergies
Atopy

Question 20

Dx of eosinophilic esophagitis

Answer 20

EGD and biopsy
>15 eos/high power field
*If not previously on PPI, now give PPI

Question 21

Treatment of eosinophilic esophagitis

Answer 21

Once diagnosis made –> 1) place on 6 weeks PPI (treat the GERD)
2) If trial fails or previously on PPI –> use oral aerosolized steroids

Question 22

Caustic ingestion - causes?

Answer 22

1) Kid with accident - drinking bad stuff
2) Adult - suicide
Very strong acid/base
Because ingested –> substance burns everything, including larynx - hoarse voice and stridor
If hear stridor –> intubate patient and make sure can breathe, handle burn later
Damage esophagus –> drooling

Question 23

Dx of caustic esophagitis

Answer 23

Endoscopy
Often not a mystery
EGD is done to determine severity

Question 24

Treatment of caustic esophagitis

Answer 24

Low severity --> liquid diet and observe
High severity (strictures) --> NPO, then repeat EGD to see when have food
-If early on, can do NGD tube with lavage (i.e. flush with water and suck it out)
*Do not neutralize the base! Can cause thermophilic reaction from the neutralization (never do this, not even on skin), NEVER induce emesis (but then it passes again over esophagus/larynx)