Reflux esophagitis, infectious, mechanical, toxic (toxic), thermal (heat or cold), radiogenic (radiation), drug-induced esophagitis Medical: esophagitis
Definition
Inflammation of the oesophagus is the inflammation of the mucous membrane of the inner side of the oesophagus. The esophagus connects the throat with the stomach and is about 25 cm long. It consists mainly of muscle, which transports food in the direction of the stomach by undulating movement.
In most cases, only the innermost layer, the mucous membrane, is inflamed. The inflammation can occur at various points of the esophagus. As a consequence of heartburn, it usually occurs as a pain behind the breastbone, in front of the entrance to the stomach. As a side effect of laryngitis, the upper esophagus, which is located in the area of the throat, becomes increasingly inflamed.
Causes
Inflammation can occur for various reasons. Autoimmune diseases are rarely the cause. More often, infections with bacteria, viruses or other pathogens can cause oesophagitis as a concomitant symptom.
The most common cause, however, is irritation of the oesophagus. The irritation can be permanent, recurrent or one-off. The triggering cause can be mechanical, thermal or chemical. Probably the most common cause of deep esophagitis is recurrent heartburn caused by stomach contents that are too acidic or weakness of the upper gastric outlet. Since the mucous membrane of the esophagus is very sensitive to the hydrochloric acid of the stomach, it can become inflamed and cause long-term irreversible changes.
Forms of esophagitis
Inflammation of the oesophagus is caused by various pollutants (noxae). One distinguishes:The reflux esophagitis is the most common form of esophagitis. It is caused by the persistent chemical irritation of the esophageal mucosa by the acidic gastric juices that have been pushed up into the stomach.
The less frequent reflux of bile or pancreatic secretion leads to a much stronger inflammatory reaction with comparatively less discomfort. A mechanical-irritative esophagitis is usually caused by a long inserted gastric tube. There are several situations where a gastric tube is used.
Long-term care with a gastric tube is mostly used to feed those patients who cannot swallow or who are not conscious. A gastric tube is a tube that is inserted through the nose and into the stomach, where it remains for as long as the tube feeding is necessary. The probe represents a foreign body in the esophagus, it irritates the mucous membrane and the resulting local inflammation can lead to ulceration.
Sometimes a scar or a narrowing of the esophagus of other cause can cause irritation of the mucous membrane, so that an inflammation can develop. Various foreign bodies and hard food can cause surface damage to the oesophagus. Fishbones are particularly predestined for this.
Cancer of the esophagus (esophageal carcinoma) can also be a type of foreign body in the esophagus, and thus also cause mechanical irritation. As the name suggests, thermal esophagitis is a burn of the esophageal mucosa caused by hot food and drinks. The acute burn of the esophagus is usually caused by swallowing household cleaners or other acids or alkalis.
This acute emergency mainly affects children who accidentally drink these liquids or people who try to commit suicide with them. The middle section of the esophagus is usually the most severely affected. Various complications can arise in this emergency.
There may be swelling of the larynx (glottis oedema), which acutely closes the airways and is therefore a life-threatening condition. The destruction of the tissue can lead to a tear in the wall of the oesophagus (perforation) and the contents can leak into the chest (thorax). If left untreated, this condition results in inflammation of the mediastinum (mediastinitis).
Infectious esophagitis is usually caused by a reduction in the immune system (immunosuppression). In some diseases where the immune system is directed against the body (autoimmune diseases, e.g.B. the rheumatoide arthritis), one must reduce the body-own defense by medicines.
The patient is then much more susceptible to germs, which are harmless for a healthy person. The following illnesses also involve immunosuppression: Leukemia and other diseases affecting the blood-forming system
Inflammation of the esophagus is occasionally accompanied by scarlet fever and diphtheria. This inflammation of the oesophagus is free of complications and heals without problems when the infection is treated.
Not quite without problems, however, are the quite rare inflammations of the esophagus caused by the germs of tuberculosis and syphilis (syphilis). With tuberculosis, the scattering of the germs can lead to the formation of millet head-sized nodules (tubercle) in the whole body and thus also in the esophagus. By swallowing the tuberculosis germs, the oesophagus can also be infected by direct contact.
In the case of syphilis, bulging elastic tumors can form under the mucous membrane of the esophagus over the course of many years of illness, which are also called gums (“rubber tumors”). They usually occur in the upper section of the esophagus. Both diseases are already well advanced and very difficult to treat in the stages when they can affect the esophagus.
Inflammation of the oesophagus by viruses sometimes accompanies measles, rubella and influenza (flu virus) and usually does not cause any problems during treatment. Other viral diseases remain in the body after the initial infection and can be reactivated if the immune system is weakened, i.e. the body’s own defence is no longer able to control the virus, so that it can then break out again. These viruses include herpes virus (HPV) infections, which can spread from the mouth and throat to the esophagus.
At first, small blisters are observed, which can even spread to ulcers and are often accompanied by fever. The cytomegalovirus (CMV) is particularly feared in severely immunocompromised patients and can cause esophagitis, among other things. The varicella zoster virus remains in the body after the initial illness, chickenpox.
This virus can undergo reactivation even in patients with non-serious immune deficiencies. In this case, the pustular formation limited to one segment is called shingles. Both diseases can have a pronounced course, in which the oesophagus can be affected.
- Herpes Simplex Virus (HPV)
- Cytomegalovirus (CMV)
- Varicella zoster virus (VZV)
The second most common esophagitis, right after reflux esophagitis, is candidal esophagitis or thrush esophagitis. The pathogen is Candida albicans, a yeast fungus, which represents a normal germ of the intestinal flora and is no danger for an immune-healthy (body’s own infection defence) person. Mostly infants, elderly and immunocompromised people are affected, and the infection is often the first sign of AIDS.
The bacterial and fungal flora normally keep each other in balance. Thus, in some cases, a strong antibiotic therapy can damage the normal bacterial flora of humans, so that the candida fungus can spread unhindered, which results in a candida infection (thrush). nSeltener, various chronic diseases can lead to a nodular (granulomatous) inflammation of the esophagus.
With these so-called autoimmune diseases, the immune defense is directed against structures of the own body. For example, in isolated cases of Crohn’s disease and sarcoidosis, such an inflammation of the esophagus can be observed. In esophageal cancer and many other types of cancer that are located in the area of the esophagus, irradiation is necessary.
Often, it is not possible to give the optimal radiation dose to treat the cancer cells because the entire gastrointestinal tract is sensitive to radiation. Despite the strong precautions taken during radiation therapy, the esophagus can still be affected. Radiogenic esophagitis is the consequence.
The simultaneous administration of chemotherapeutic drugs can also intensify the consequences of the radiation. Acute radiogenic esophagitis occurs approximately at the end of the 2nd week after the start of radio- or radiochemotherapy. The symptoms can sometimes improve during radiotherapy, only to increase again in the 5-6 week after the start of radiotherapy.
The symptoms can be significantly improved within a few days by stopping the radiation, but they will not disappear completely until 2-10 weeks.Rarely, chronic radiogenic esophagitis can develop as a complication, which is characterized by chronic ulcers that can be very painful. The biggest problem with chronic radiogenic esophagitis is the difficulty in differentiating between inflammation and a recurrence of the esophageal tumor (tumor recurrence). The mucus-forming glands can be damaged by radiation, so that the neutralizing function of the mucus is lost and reflux disease is promoted.
Another type of inflammation can be caused by taking medication. If a tablet is taken with little liquid, it can stick to the mucous membrane or become stuck in the throat due to a delay in swallowing or disorder. Especially if you lie down flat immediately after taking the tablet, the passage is even more delayed.
In particular, antibiotics (tetracyclines), painkillers (e.g. NSAIDs), KCL (potassium chloride), bisphosphonates (e.g. Fosamax® for osteoporosis), ferrous sulfate and many other drugs can cause a local inflammatory reaction. The irritated areas are usually circular and no larger than the tablet itself, this form is also called “pill esophagitis”.