Gastro - Online MedEd - esophagitis Flashcards
Esophagitis - what is it?
Inflammation of the esophagus
One must often do a biopsy to determine the cause/endoscopy: mnemonic to remember the causes: PIECE
Causes - esophagitis
P - pill-induced I - infections E - eosinophilic C - caustic E - GERD (common)
Presentation - esophagitis
Odynophagia
Dysphagia - difficulty swallowing
Dx - esophagitis
Endoscopy with biopsy
Treatment - esophagitis
Disease specific
Use some sort of antacid (PPI, H2 blocker)
PPI is more often correct
Pill-induced esophagitis - cause
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
Dx of pill-induced esophagitis
Endoscopy and biopsy
Treatment of pill-induced esophagitis
Often won’t see pill, if can see, then remove it
Remove offending agent
Give time to heal
Give PPI
Follow-up of pill-induced esophagitis - how to avoid this in the future?
Avoid recumbency
Drink a glass of water with each pill
Infectious esophagitis - cause (types of organisms)
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
Presentation of infectious esophagitis
Esophagitis
Dx of infectious esophagitis
Endoscopy
Biopsy - will tell you what type of infection it is
Treatment of infectious esophagitis
Antibiotics - correspond to the organism
Oral thrush can be treated with
Nystatin swish and spit
-If patient has oral thrush and candida esophagitis, do not just use nystatin swish and swallow –> use systemic treatment, fluconazole
HSV treat with
Valcyclovir/acyclovir
CMV treat with
Valgancyclovir/agancyclovir
HIV treat with
HAART
Eosinophilic esophagitis* what is it
Allergic reaction to food that causes eosinophilia in the esophagus
Type of people who get eosinophilic esophagitis
Asthma
Allergies
Atopy
Dx of eosinophilic esophagitis
EGD and biopsy
>15 eos/high power field
*If not previously on PPI, now give PPI
Treatment of eosinophilic esophagitis
Once diagnosis made –> 1) place on 6 weeks PPI (treat the GERD)
2) If trial fails or previously on PPI –> use oral aerosolized steroids
Caustic ingestion - causes?
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
Dx of caustic esophagitis
Endoscopy
Often not a mystery
EGD is done to determine severity
Treatment of caustic esophagitis
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)
