++
Esophagitis is defined as inflammation of the esophagus. The most common cause is gastroesophageal reflux disease (GERD). Other causes include infection, retained pill, caustic ingestion, radiation, autoimmune, and eosinophilic esophagitis.
++
Infectious esophagitis is usually seen in immunosuppressed patients. It is primarily caused by Candida albicans, though viral (primarily cytomegalovirus [CMV], herpes simplex virus [HSV]) and fungal infections are also seen.
++
Pill esophagitis occurs when a pill fails to pass through the esophagus causing focal esophageal inflammation. Structural or functional disorders of the esophagus make this more likely. Common offending pills include potassium chloride, ferrous sulfate, bisphosphonates, nonsteroidal anti-inflammatory drugs (NSAIDs), and tetracycline antibiotics.
++
Substernal chest pain, odynophagia, dysphagia, and drooling are common symptoms. Oral lesions are not reliable diagnostic indicators. Some patients may be severely dehydrated from poor oral intake.
++
KEY FACT
Advanced acquired immune deficiency syndrome (AIDS) (CD4 count < 200) should make you more aware of the potential for esophageal candidiasis. However, 25% of patients with esophageal candidiasis will not have evidence of thrush on oral examination.
++
Includes functional dyspepsia, esophageal stricture, mass lesion, motility disorders, esophageal spasm, and cardiac disease.
++
++
Pill esophagitis: Instruct patients to drink 8 oz of water with each pill and then remain upright for at least 30 minutes. Full symptom relief may take up to 6 weeks.
C albicans: Clotrimazole troches or nystatin swish and swallow for 1-2 weeks in patients with mild disease limited to the oropharynx and a normal immune state. Advanced cases and immunocompromised patients should be treated with an oral antifungal agent such as fluconazole or itraconazole for 3-4 weeks.
CMV: Intravenous (IV) ganciclovir or foscarnet.
HSV: Oral antiviral, such as acyclovir or valacyclovir.
++
Include dehydration requiring IV resuscitation, stricture, perforation/mediastinitis, malnutrition, and hemorrhage. Viral or fungal cases may lead to disseminated infection.
+++
Gastroesophageal Reflux Disease
++
Affects approximately 10% of adults daily; often related to incompetence of the lower esophageal sphincter, hiatal hernia, increased intragastric pressure (pregnancy, obesity), or incomplete emptying of the stomach. Medications that relax smooth muscle (eg, nitrates, calcium channel blockers [CCBs], anticholinergics, or albuterol) can contribute.
++
Q
A father brings his 6-year-old child to the emergency department (ED) for evaluation of drooling after “getting into something” under the sink. Examination reveals mild drooling and stridor, but no evidence of perioral or oropharyngeal burns or injury. What is the likely diagnosis?
++