Introduction
The therapy can vary greatly depending on the form and origin of the esophagitis.
General information
General therapeutic measures for esophagitis/esophagitis must primarily ensure food intake. It may be necessary to insert a stomach tube temporarily to ensure food intake and also to prevent complete closure of the esophagus in the case of advanced scarring. In the case of pain on swallowing, the administration of an analgesic (analgesic), either in the form of a local anesthetic that temporarily numbs the mucous membrane or a systemic anesthetic, i.e. an anesthetic that is effective throughout the body, helps.
If the oesophagus is infected with tuberculosis, special antibiotics (so-called tuberculostatics) are given, which kill the tuberculosis bacteria. The therapy with tuberculostatics must be continued for at least 6 months and these drugs must always be administered in multiple combinations, i.e. several antibiotics must be given at the same time. In the case of syphilis, high and repeated doses of antibiotics (penicillin, tetracycline) are given at this late stage of the disease, when the esophagus is affected.
Thrush esophagitis is treated with drugs that combat the fungi (antimycotics). If the reduction of the immune system is relatively easy, it can be treated with antifungal drugs in tablet form (orally), e.g. with nyastine. However, if the immune defence is severely reduced, the antimycotics must be administered via the vein (intravenously), like the strongly effective Amphotericin B.
In the case of viral esophagitis, drugs that inhibit the virus must be given (antiviral). Herpes esophagitis and varicella zoster esophagitis can be treated effectively with Aciclovir. In cytomegalovirus esophagitis, the antiviral Ganciclovir is more effective.
Here too, the principle applies that, depending on the degree of immunosuppression, the antiviral is administered either orally or intravenously. If the esophagus is involved in Crohn’s disease or sarcoidosis, an immunosuppressive therapy (which suppresses the body’s own defenses) must be initiated, for example with cortisone. Of course, in the case of a thermal esophagitis, the affected person must be advised to avoid excessively hot food and drinks in the future.
Special diagnostics and therapy for acute esophagitis: A special case is the treatment of acute esophagitis. As a first measure, the injured person should be allowed to drink plenty of water or milk quickly on site. Under no circumstances should the injured person be allowed to vomit, as the swallowed acid (or lye) can cause further damage by passing through the esophagus again.
Next, a laryngoscopy of the larynx should be performed to detect swelling of the larynx and, if necessary, to quickly secure the patient’s airways. This is done by means of intubation, i.e. a tube is inserted into the windpipe under anesthesia and connected to a ventilator. Next, the chest (thorax) must be x-rayed in order to diagnose a tear in the esophagus (perforation) at an early stage.
If there is a tear in the oesophagus, immediate surgery is required. In the case of a perforation, the X-ray image shows free air in the middle of the chest (mediastinum). Since air appears black in the x-ray, black inclusions can be seen in areas where they do not belong. If no rupture of the esophagus is diagnosed, the patient must still be monitored for 72 hours, as there is a risk of late perforation. In the case of a proven perforation, the administration of an antibiotic is planned in addition to the emergency operation, because bacteria of the esophagus always enter the chest through the tear.
