Esophagitis is inflammation of the lining of the esophagus, most often from acid reflux but also from pills, infections or allergy (eosinophilic esophagitis). It makes swallowing painful and can lead to bleeding or narrowing if not treated.
Key symptoms
- Heartburn and acid taste in the mouth
- Pain when swallowing
- Trouble swallowing or food getting stuck
- Chest pain behind the breastbone
What you find on exam
- Often a normal exam
- Mouth exam for thrush in patients with weak immunity
- Weight and hydration
- Review recent pills such as doxycycline, NSAIDs or bisphosphonates
Tests
- Trial of acid suppression in typical reflux symptoms
- Upper endoscopy with biopsies for alarm signs or poor response
- Biopsies to look for eosinophils, fungi or viruses
- ECG and troponin if chest pain could be from the heart
Treatment basics
- Proton pump inhibitor such as omeprazole for reflux esophagitis
- Take pills upright with a full glass of water; stop the culprit drug
- Fluconazole for Candida; acyclovir for herpes infection
- Eosinophilic esophagitis: proton pump inhibitor, swallowed topical steroid or diet elimination
Red flags
- Unable to swallow saliva or food stuck
- Vomiting blood or black stools
- Weight loss or progressive trouble swallowing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.