Esophagitis and Stricture
Please refer to GERD and Hiatal hernia before complete grasp of esophagitis.
When stomach acid and digestive enzymes repeatedly reflux into the esophagus, the tissues become inflamed and ulcerated. This inflammation is known as esophagitis. When the inflammation is severe, esophageal ulcers develop. Prolonged untreated reflux and esophagitis can lead to stricture or narrowing of the esophagus.
Certain infections, such as a fungus infection (monilia, candida) and viruses, can occur in the esophagus and cause inflammation. Cancer chemotherapy, radiation and caustic substances, like lye, also can cause esophagitis. Acid reflux from the stomach, however, is one of the most common esophagitis causes.
Heartburn occurs when acid refluxes into the esophagus. It is experienced as a burning sensation in the lower chest and may be felt up the esophagus. At times, bitter-tasting liquid may regurgitate up into the mouth. When esophagitis is severe and ulcers are present, swallowing may cause pain when food reaches this part of the esophagus. Furthermore, if the lower esophagus narrows due to scarring, food may stick in this area. This symptom is called dysphagia and is uncomfortable. Esophagitis also may cause bleeding. Black stools, anemia (low red-blood cell count), and vomiting of blood are signs of bleeding. Diagnosis is made by an upper endoscopy is performed during which a flexible, fiberoptic endoscope is passed into the esophagus while the patient is lightly sedated. The tissues can be visualized and biopsied during this procedure.
Esophagitis treatments include Antacids such as Rolaid, Maalox and Mylanta taken as needed usually give short lasting relief. This was the only treatment for esophagitis available before 1980 after which medications called H2 blockers and later on Proton Pump Inhibitors were invented which revolutionize the treatment of GERD as well as gastric and duodenal ulcers.
When recurrent inflammation occurs in the esophagus, scarring develops, underlying tissues become fibrous, and the opening narrows which is called stricture. In advanced cases, a stricture can be severe. Food and fluid are delayed and only move slowly across the opening into the stomach. A large piece of food, such as meat, may completely block the esophagus. As mentioned, cancer can narrow the esophagus in the same way. Therefore, it is critical that the physician rule out this diagnosis.
The physician can use a variety of methods to gently but forcefully open, or dilate, a stricture. Dilatation is often performed in conjunction with an upper endoscopy. Balloon dilatation is passage of different sizes of sausage-shaped deflated balloons passed across the stricture. The balloon is sharply inflated to open the narrowed area. The only alternative to dilatation for opening a stricture is surgery. It is recommended only in the most extreme cases and when dilatation fails. A rare, but serious, complication is a perforation, or tearing, of the esophagus. This causes increasing pain after the procedure and may require esophageal stricture surgery to correct.
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