Oesophagitis

Gastroenterology (12%) Core Clinical Conditions

1A: Able to diagnose and manage

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Oesophagitis is a medical condition where there is inflammation or irritation of the oesophagus, which is the tube connecting the throat to the stomach. It is often caused by the reflux of stomach acid into the oesophagus, leading to damage and inflammation of its lining.

Oesophagitis is primarily caused by a condition called gastroesophageal reflux disease (GERD). In GERD, the muscle located at the lower end of the oesophagus, known as the lower esophageal sphincter, becomes weak or relaxes inappropriately. As a result, stomach acid is able to flow back into the oesophagus, leading to irritation and inflammation.

Other factors: Infections caused by the herpes simplex virus, candida (a type of yeast), or certain bacteria can be responsible for this condition. Additionally, the use of medications like nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, or specific antibiotics may also play a role in the development of oesophagitis.

Oesophagitis occurs when the lining of the oesophagus is exposed to acidic gastric contents, which can lead to various problems. When stomach acid comes into contact with the delicate oesophageal mucosa, it can cause damage to the tissues, resulting in inflammation and the formation of ulcers. If this happens repeatedly over time, chronic inflammation and scarring may develop in the oesophagus.

• Obesity.

• Smoking.

• Excessive alcohol consumption.

• Hiatal hernia (a condition where part of the stomach protrudes into the chest through the diaphragm).

• Heartburn (a burning sensation in the chest).

• Regurgitation of food or sour liquid.

• Difficulty swallowing (dysphagia).

• Chest pain.

• A feeling of food getting stuck in the throat.

• Endoscopy, which involves inserting a flexible tube with a camera into the oesophagus. This allows them to visualise the oesophageal lining and assess any signs of inflammation or ulceration.

• Biopsy samples may also be taken during the procedure for further examination.

• Other tests include an ECG or CXR to exclude other causes.

• Lifestyle changes may include avoiding trigger foods, losing weight if necessary, elevating the head of the bed, and quitting smoking or reducing alcohol consumption.

• Medications such as proton pump inhibitors (PPIs) e.g. omeprazole or H2 receptor antagonists e.g. ranitidine, can help reduce stomach acid production and alleviate symptoms.

• In severe cases or when complications arise, surgical procedures like fundoplication may be considered to reinforce the lower esophageal sphincter and prevent acid reflux.

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