Oesophagitis

Overview

Oesophagitis refers to inflammation of the oesophageal mucosa. It is commonly seen in both immunocompetent and immunocompromised patients, with multiple potential causes including infections, reflux, and allergies. Recognition is essential due to its association with dysphagia, chest pain, and complications such as strictures or bleeding. For final-year medical students, a strong grasp of the differential causes and typical endoscopic findings is crucial for both written and clinical exams.

Definition

Inflammation of the oesophageal lining, often resulting in discomfort, pain, or difficulty swallowing.

Aetiology

  • Infective Causes (more common in immunocompromised):
  • Allergic Oesophagitis:
    • Commonly Eosinophilic Oesophagitis
    • Typically food-triggered
    • Often occurs in individuals with a personal/family history of atopy
  • Gastro-Oesophageal Reflux Disease (GORD):
    • Chronic acid reflux causes mucosal injury
    • Most common cause in immunocompetent individuals

Morphology / Pathophysiology

  • Candida Oesophagitis:
    • Characteristic white plaques on endoscopy
    • Caused by fungal overgrowth in immunosuppressed hosts
Candida Oesophagitis
Creative Commons Attribution 4.0 International License: https://www.ncbi.nlm.nih.gov/books/NBK537268/figure/article-21328.image.f1/
  • Eosinophilic Oesophagitis:
    • Endoscopic findings may include:
      • Mucosal furrowing
      • Concentric rings (“feline” oesophagus)
      • Exudative plaques
      • Thickened mucosa
    • Histologically defined by eosinophil infiltration in the mucosa
Eosinophilic Oesophagitis
Samir at the English-language Wikipedia, CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons

Clinical Features

  • Dysphagia (solids ± liquids)
  • Retrosternal chest pain or oesophageal discomfort
  • Heartburn – common in reflux-related cases
  • Odynophagia (particularly in infectious causes like Candida)
  • Recurrent vomiting (in eosinophilic oesophagitis)

Investigations

  • Upper GI Endoscopy with Biopsy and MCS (Microscopy, Culture, Sensitivity)
    • Visual confirmation of morphology
    • Biopsy confirms eosinophilic infiltration or fungal/viral pathogens
  • FBC with Differential Count
    • May show eosinophilia in allergic eosophagitis
  • HIV Testing
    • Consider if infectious oesophagitis is suspected and patient has risk factors

Management

Infectious Aetiology

  • Candida: Oral Fluconazole (first-line antifungal)
  • HSV/CMV: Antiviral therapy (e.g., Acyclovir for HSV)

Eosinophilic Oesophagitis

  • Inhaled corticosteroids:
    • Fluticasone or Budesonide (swallowed rather than inhaled)
  • Dietary management:
    • Elimination diets or allergy testing in selected patients

Reflux-Associated

  • Proton Pump Inhibitors (PPIs) for acid suppression
  • Lifestyle modifications: weight loss, diet adjustment, avoiding late meals

Complications

  • Oesophageal strictures and narrowing
  • Food impaction (especially in eosinophilic variant)
  • Bleeding
  • Progression to Barrett’s oesophagus or malignancy in chronic GORD

Differential Diagnosis

  • GORD without oesophagitis
  • Oesophageal candidiasis secondary to immunosuppression
  • Achalasia (if associated with dysphagia)
  • Oesophageal carcinoma
  • Pill-induced oesophagitis

Summary

Oesophagitis is a common but multifactorial condition, with infectious, allergic, and reflux-related causes. Clinical presentation typically involves dysphagia and retrosternal discomfort. Diagnosis is confirmed by endoscopy and histopathology, while management depends on the underlying cause. Early recognition and treatment are essential to prevent complications like strictures and chronic inflammation. For a broader understanding of related conditions, visit our Gastrointestinal Overview page.

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