ESOPHAGITIS

Definition

Esophagitis is an inflammatory response of the esophagus to multiple causes, the most common of which is due to reflux of acidic gastric contents through an incompetent lower esophageal sphincter into the distal esophagus. It is thus considered in this instance as a chemical burn.

It is characterized by a reddened inflammed and swollen and often erosive mucosa, resulting in pain that may be epigastric or substernal. This presentation may simulate cardiac pain.

Long standing esophagitis may be complicated by a peptic stricture or Barrett’s esophagus which is a premalignant condition.

The diagnosis is suspected clinically by the classical presentation of substernal burning in the presence of symptoms of reflux, waterbrash (hypersalivation), and halitosis, with relief from antacid therapy. Documentation of the disease is best achieved by endoscopy, with double contrast barium swallow being less sensitive to the disease.

The mainstay of therapy for GERD with esophagitis remains the proton pump inhibitors (PPI) and the H2 Blockers.

The Normal (left) and Abnormal (right) Red and Swollen GE junction – Reflux Esophagitis

The GE junction is a distinct border as seen normally in the left image. The distal esophagus is normally a pearl white hue, while the gastric mucosa is a pink hue. In esophagitis the hyperemic inflammatory changes make the border less distinct (right image)01239b01.800 esophagus stomach GE junction gastroesophageaal junction inflammed inflammation GERD red swollen reflux esophagitis grosspathology Courtesy Ashley Davidoff MD

Linear Ulcer in a Hyperemic Background of Diffuse Esophagitis

On closer inspection of the GE junction, a linear ulcer is seen (overlaid in right image). It is even painful to look at.01239c esophagus stomach GE junction gastroesophageaal junction inflammed inflammation GERD red swollen reflux esophagitis linear ulcer grosspathology Courtesy Ashley Davidoff MD

Normal (a) and Reflux Esophagitis (b)

76217c esophagus normal smooth mucosa featurless heterogeneous mucosa nodular mucosa diffuse reflux esophagitis double contrast barium swallow Courtesy Ashley Davidoff MD

Reflux Esophagitis with Ulcers

70 year old male presents with burning substernal chest pain Barium swallow shows superficial ulceration at the GE junction and also small areas of ulceration along the distal esophagusesophagus GE junction ulcer esophagitis barium swallow 83326.8s Courtesy Ashley Davidoff MD copyright 2009

Mid Esophageal necrotizingh EsophagitisStricture and Ulceration

Courtesy Ashley Davidoff MD 01233 code esophagus + fx narrowing + fx ulceration + dx necrotizing esophagitis + barium swallow upper GI UGI imaging radiology contrast X-Ray

Quinidine Ulcer

Courtesy Ashley Davidoff MD 01258 01258b01 esophagus + quinidine ulcer barium swallow inflammation upper GI UGI imaging radiology contrast X-Ray

Lye Ingestion with Deep Focal Ulcers Grade 2b

Courtesy Ashley Davidoff MD 01250 code esophagus + fx irregular + fx long distal fx narrowed + fx ulceration + dx lye stricture upper GI UGI imaging radiology contrast X-Ray

Mid Esophageal Stricture from Radiation Lung Cancer

Courtesy Ashley Davidoff MD 01251 01251 b01 code esophagus + fx stricture + dx radiation stricture + barium swallow upper GI UGI imaging radiology contrast X-Ray

Linear Erosion at the GE Junction

01252c Courtesy Ashley Davidoff MD 01252 code esophagus + fx linear erosion + dx reflux esophagitis + barium swallow upper GI UGI imaging radiology contrast X-Ray

Esophagitis with Superficial Ulcerations (middle) and Stricture (right)

Courtesy Ashley Davidoff MD 01221 esophagus + reflux esophagitis stricture ulcer barium swallow upper GI UGI imaging radiology contrast X-Ray

Benign Serpigenous Obstructing Ulcer

76398c03 esophagus dysphagia odynophagia esophagus esophageal ulcer giant ulcer heaped edges 13mm barium pill stuck held up endoscopy showed a serpigenous ulcer pathology showed esophagitis interesting with the heaped edges impresio was that it was malignant barium swallow CourtesyAshley Davidoff MD 76398c01