Esophagus: Esophagitis

Esophagitis

Erosive Esophagitis (Reflux Esophagitis)

  • Mucosal Damage & Erosion From: Gastric Acid & Pepsin
  • Los Angeles Classification:
    • The Most Thoroughly Evaluated & Widely Used
    • Grade A: One or More Mucosal Break Each ≤ 5 mm in Length
    • Grade B: At Least One Mucosal Break > 5 mm in Length, Not Continuous Between the Tops of Adjacent Mucosal Folds
    • Grade C: At Least One Mucosal Break Continuous Between the Tops of Adjacent Mucosal Folds, Not Circumferential Mn
    • Grade D: Mucosal Break Involves ≥ 75% of the Luminal Circumference
  • Savary-Millar Classification:
    • More Historical & Now Less Often Used
    • Grade I: Erythema, With or Without Exudate
    • Grade II: Linear Erosions, Not Circumferential
    • Grade III: Circumferential Erosions
    • Grade IV: Chronic Complications (Deep Ulcers, Stenosis, Scarring or Barrett’s)
    • *Often Subdivisions of Grade IV or Added Grade V Although There is No Consistent Meaning

Erosive Esophagitis 1

Eosinophilic Esophagitis (EoE)

  • Chronic Immune/Antigen-Mediated Reaction with Eosinophilic Inflammation of the Esophagus
  • Most Common in Men Aged 20-30’s
  • Primarily Associated with Allergies, Asthma & Atopic Dermatitis
    • Associations Also Seen in Celiac Disease & IBD
  • Sx: Dysphagia (Most Common), Food Impaction & Pain
  • Endoscopic Findings:
    • Linear Furrows – Most Common
    • Stacked Rings (“Feline” Esophagus)
    • White Papules (Eosinophilic Micro-Abscesses)
    • Strictures
    • Edema
  • Dx: Bx (Eosinophil-Predominant Inflammation)
  • Tx:
    • Allergist Evaluation & Allergy Avoidance
    • Dietary Modifications (Avoiding Dairy, Egg, Wheat & Soy)
    • Medication Options:
      • PPI
      • Swallowed Steroid (Fluticasone or Budesonide)

EoE with Linear Furrows 2

EoE Papules 3

Esophageal Candidiasis

  • Most Common in HIV (AIDS-Defining Illness) & Hematologic Malignancy
  • May See Concomitant Thrush
  • Dx: White Mucosal Plaque or Bx on Esophagoscopy
  • Tx: Fluconazole

Esophageal Candidiasis 4

Mnemonics

Los Angeles Classification

  • Grade “C” – “Connects” Two Folds

References

  1. Naoe H, Iwasaki H, Kawasaki T, Ozaki T, Tsutsumi H, Okuda A, Konoe T, Nonaka K, Kaku E, Shono T, Yokomine K, Sakurai K, Iyama K, Hirota M, Sasaki Y. Primary hepatic gastrinoma as an unusual manifestation of zollinger-ellison syndrome. Case Rep Gastroenterol. 2012 Sep;6(3):590-5. (License: CC BY-NC-ND-3.0)
  2. Singla MB, Moawad FJ. An Overview of the Diagnosis and Management of Eosinophilic Esophagitis. Clin Transl Gastroenterol. 2016 Mar 17;7(3):e155. (License: CC BY-NC-ND-4.0)
  3. Jideh B, Keegan A, Weltman M. Lymphocytic esophagitis: Report of three cases and review of the literature. World J Clin Cases. 2016 Dec 16;4(12):413-418. (License: CC BY-NC-4.0)
  4. Choi JH, Lee CG, Lim YJ, Kang HW, Lim CY, Choi JS. Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Med J. 2013 Jan 1;54(1):160-5. (License: CC BY-NC-3.0)