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Esophagitis

Alternative Names: Inflammation – esophagus

Definition:
Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach.

YOU MAY CLICK TO SEE THE PICTURE.……..Eosinophilic esophagitis

Herpes esophagitis

 

Endoscopic image of peptic stricture showing n...

Endoscopic image of peptic stricture showing narrowing of the esophagus near the junction with the stomach due to chronic gastroesophageal reflux in the setting of scleroderma. (Photo credit: Wikipedia)

Esophagus is  the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers and scarring of the esophagus. In rare instances, a condition known as “Barrett’s esophagus” may develop, which is a risk factor for cancer of the esophagus.

Causes:
Esophagitis is frequently caused by the backflow of acid-containing fluid from the stomach to the esophagus (gastroesophageal reflux). You have a higher risk for esophagitis if you have had excessive vomiting, surgery or radiation to the chest (such as in lung cancer), or if you take medications such as aspirin, ibuprofen, potassium, alendronate, and doxycycline.

Persons with weakened immune systems due to HIV and certain medications (such as corticosteroids) may develop infections that lead to esophagitis. Esophageal infection may be due to viruses such as herpes or cytomegalovirus, and fungi or yeast (especially Candida infections).

The infection or irritation may cause the tissues to become inflamed and occasionally form ulcers. You may have difficulty when swallowing and a burning sensation in the esophagus.

Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi or diseases that weaken the immune system. Infections that cause esophagitis include:

*  Candida. This is a yeast infection of the esophagus caused by the same fungus that causes vaginal yeast infections. The infection develops in the esophagus when the body’s immune system is weak (such as in people with diabetes or HIV). It is usually very treatable with antifungal drugs.

* Herpes. Like Candida, this viral infection can develop in the esophagus when the body’s immune system is weak. It is treatable with antiviral drugs.

Irritation causing esophagitis may be caused by any of the following:

* GERD
* Vomiting
* Surgery
* Medications such as aspirin and anti-inflammatories
* Taking a large pill with too little water or just before bedtime
* Swallowing a toxic substance
* Hernias
* Radiation injury (after receiving radiation for cancer treatment)

You may click to see the related topics below:
Gastroesophageal reflux disease
Esophagitis Candida
Esophagitis CMV
Esophagitis herpes
Symptoms:
Symptoms of esophagitis include:

* Difficult and/or painful swallowing
* Heartburn (acid reflux)
* Mouth sores
* A feeling of something of being stuck in the throat
* Nausea
* Vomiting
*Oral lesions (herps)
If you have any of these symptoms, you should contact your health care provider as soon as possible.

Diagnosis:
Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:

* Upper endoscopy . A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus.

* Biopsy. During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope.

* Upper GI series (or barium swallow). During this procedure, x-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an x-ray. This characteristic enables doctors to view certain abnormalities of the esophagus.

Treatment:
Treatment depends on the specific cause. Reflux disease may require medications to reduce acid. Infections will require antibiotics. Possible treatments include:

* Medications that block acid production, like heartburn drugs
* Antibiotics, antifungals or antivirals to treat an infection
* Pain medications that can be gargled or swallowed
* Corticosteroid medication to reduce inflammation
* Intravenous (by vein) nutrition to allow the esophagus to heal, to reduce the likelihood of malnourishment or dehydration
* Endoscopy to remove any lodged pill fragments
* Surgery to remove the damaged part of the esophagus

While being treated for esophagitis, there are certain steps you can take to help limit discomfort.

* Avoid spicy foods such as those with pepper, chili powder, curry and nutmeg.
* Avoid hard foods such as nuts, crackers and raw vegetables.
* Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits and their juices. Instead, try imitation fruit drinks with vitamin C.
* Add more soft foods such as applesauce, cooked cereals, mashed potatoes, custards, puddings and high protein shakes to your diet.
* Take small bites and chew food thoroughly.
* If swallowing becomes increasingly difficult, try tilting your head upward so the food flows to the back of the throat before swallowing.
* Drink liquids through a straw to make swallowing easier.
* Avoid alcohol and tobacco.

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Prognosis:-
The disorders that cause esophagitis usually respond to treatment.

Possible Complications :-
If untreated, esophagitis may cause severe discomfort, swallowing difficulty to the extent of causing malnutrition or dehydration, and eventual scarring of the esophagus. This scarring may lead to a stricture of the esophagus, and food or medications may not be able to pass through to the stomach.

A condition called Barrett’s esophagus can develop after years of gastroesophageal reflux. Rarely, Barrett’s esophagus may lead to cancer of the esophagus.

When to Contact a Medical Professional
Call your health care provider if you have symptoms that suggest esophagitis.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.medicinenet.com/esophagitis/article.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001153.htm

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Fruit And Veg May Slash Gullet Cancer Risk

An increased intake of fruit and vegetables may cut the risk of Barrett’s oesophagus, a precursor to oesophageal cancer, suggests a new study form California.
click & see

Healthy dietary habits, rich in fruit and vegetables, was associated with a 65 per cent reduction in the occurrence of Barrett’s oesophagus, according to the new study involving 913 people and published in the American Journal of Epidemiology.

The study, by researchers from Kaiser Permanente Northern California and the University of California, also heaps more pressure on the Western diet pattern, high in fast food and meat, with the data indicating an adverse effect on the risk of Barrett’s oesophagus

Barrett’s oesophagus is cause by acid reflux, and although it can occur early in life, most sufferers are in their 40s and 50s. Although it has been reported to be a precursor to oesophageal cancer, 90 per cent of patients are said to never develop into cancer, and although some speculation as to dietary and drug history, the reason why this is so is not really known.

The new study, which recruited 296 people with Barrett’s oesophagus, 308 people with gastroesophageal reflux disease but no Barrett’s oesophagus, and 309 healthy controls, used a 110-item food frequency questionnaire to evaluate dietary patterns.

Lead author Ai Kubo and co-workers report that two major dietary patterns were observed amongst the participants, with subjects classified as eating either the Western or “health-conscious” diet. The latter was characterised by being high in fruits, vegetables, and non-fried fish.

The researchers report that strong adherence to the health-conscious diet was associated with a 65 per cent reduction in the risk of developing Barrett’s oesophagus.

Moreover, while an increased risk was suggested by stronger adherence to the Western diet pattern, no dose-effect relation was reported by Kubo and co-workers.

“Results suggest strong associations between a diet rich in fruits and vegetables and the risk of Barrett’s oesophagus,” concluded Kubo.

The study does have limitations, most notable is the use of the FFQ to establish dietary patterns. Such questionnaires are susceptible to recall errors by the participants, and may no reflect dietary changes. Significant further research is needed. A mechanistic study to elucidate the bioactive constituents of the fruit and vegetables which may be responsible for the benefits is also necessary.

The “five-a-day” message is well known, but applying this does not seem to be filtering down into everyday life. Recent studies have shown that consumers in both Europe and the US are failing to meet recommendations from the WHO to eat 400 grams of fruit and vegetables a day.

A report from the European Union showed that global fruit and vegetable production was over 1,230 million tonnes in 2001-2002, worth over $50 bn (€41 bn). Asia produced 61 per cent, while Europe and North/Central America both producing nine per cent.

Source: American Journal of Epidemiology
Published online ahead of print, doi:10.1093/aje/kwm381
“Dietary Patterns and the Risk of Barrett’s Esophagus”
Authors: A. Kubo, T. R. Levin, G. Block, G.J. Rumore, C.P. Quesenberry Jr, P. Buffler, D.A. Corley

Barrett’s Esophagus

Barrett’s esophagus is a condition in which the esophagus, the muscular tube that carries food and saliva from the mouth to the stomach, changes so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine. This process is called intestinal metaplasia.

While Barrett’s esophagus may cause no symptoms itself, a small number of people with this condition develop a relatively rare but often deadly type of cancer of the esophagus called esophageal adenocarcinoma. Barrett’s esophagus is estimated to affect about 700,000 adults in the United States. It is associated with the very common condition gastroesophageal reflux disease or GERD.

Normal Function of the Esophagus

The esophagus seems to have only one important function in the body—to carry food, liquids, and saliva from the mouth to the stomach. The stomach then acts as a container to start digestion and pump food and liquids into the intestines in a controlled process. Food can then be properly digested over time, and nutrients can be absorbed by the intestines.

The esophagus transports food to the stomach by coordinated contractions of its muscular lining. This process is automatic and people are usually not aware of it. Many people have felt their esophagus when they swallow something too large, try to eat too quickly, or drink very hot or very cold liquids. They then feel the movement of the food or drink down the esophagus into the stomach, which may be an uncomfortable sensat

 

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.Digestive trac

The muscular layers of the esophagus are normally pinched together at both the upper and lower ends by muscles called sphincters. When a person swallows, the sphincters relax automatically to allow food or drink to pass from the mouth into the stomach. The muscles then close rapidly to prevent the swallowed food or drink from leaking out of the stomach back into the esophagus or into the mouth. These sphincters make it possible to swallow while lying down or even upside-down. When people belch to release swallowed air or gas from carbonated beverages, the sphincters relax and small amounts of food or drink may come back up briefly; this condition is called reflux. The esophagus quickly squeezes the material back into the stomach. This amount of reflux and the reaction to it by the esophagus are considered normal.

While these functions of the esophagus are obviously an important part of everyday life, people who must have their esophagus removed, for example because of cancer, can live a relatively healthy life without it.

GERD

Having occasional liquid or gas reflux is considered normal. When it happens frequently, particularly when not trying to belch, and causes other symptoms, it is considered a medical problem or disease. However, it is not necessarily a serious one that requires seeing a physician.

The stomach produces acid and enzymes to digest food. When this mixture refluxes into the esophagus more frequently than normal, or for a longer period of time than normal, it may produce symptoms. These symptoms, often called acid reflux, are usually described by people as heartburn, indigestion, or “gas.” The symptoms typically consist of a burning sensation below and behind the lower part of the breastbone or sternum.

Almost everyone has experienced these symptoms at least once, typically after overeating. GERD symptoms can also result from being overweight, eating certain types of foods, or being pregnant. In most people, GERD symptoms last only a short time and require no treatment at all. More persistent symptoms are often quickly relieved by over-the-counter acid-reducing agents such as antacids. Common antacids are

  • Alka-Seltzer
  • Maalox
  • Mylanta
  • Pepto-Bismol
  • Riopan
  • Rolaids

Other drugs used to relieve GERD symptoms are antisecretory drugs such as histamine2 (H2) blockers or proton pump inhibitors. Common H2 blockers are

Common proton pump inhibitors are

  • esomeprazole (Nexium)
  • lansoprazole (Prevacid)
  • omeprazole (Prilosec)
  • pantoprazole (Protonix)
  • rabeprazole (Aciphex)

People who have GERD symptoms frequently should consult a physician. Other diseases can have similar symptoms, and prescription medications in combination with other measures might be needed to reduce reflux. GERD that is untreated over a long period of time can lead to complications, such as an ulcer in the esophagus that could cause bleeding. Another common complication is scar tissue that blocks the movement of swallowed food and drink through the esophagus; this condition is called stricture.

Esophageal reflux may also cause certain less common symptoms, such as hoarseness or chronic cough, and sometimes provokes conditions such as asthma. While most patients find that lifestyle modifications and acid-blocking drugs relieve their symptoms, doctors occasionally recommend surgery. Overall, more than 60 million American adults experience GERD, making it one of the most common medical conditions.

GERD and Barrett’s Esophagus

The exact causes of Barrett’s esophagus are not known, but it is thought to be caused in part by the same factors that cause GERD. Although people who do not have heartburn can have Barrett’s esophagus, it is found about three to five times more often in people with this condition.

Barrett’s esophagus is uncommon in children. The average age at diagnosis is 60, but it is usually difficult to determine when the problem started. It is about twice as common in men as in women and much more common in white men than in men of other races.

Barrett’s Esophagus and Cancer of the Esophagus

Barrett’s esophagus does not cause symptoms itself and is important only because it seems to precede the development of a particular kind of cancer—esophageal adenocarcinoma. The risk of developing adenocarcinoma is 30 to 125 times higher in people who have Barrett’s esophagus than in people who do not. This type of cancer is increasing rapidly in white men. This increase may be related to the rise in obesity and GERD.

For people who have Barrett’s esophagus, the risk of getting cancer of the esophagus is small: less than 1 percent (0.4 percent to 0.5 percent) per year. Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective.

Diagnosis and ScreeningBarrett’s esophagus can only be diagnosed by an upper GI endoscopy to obtain biopsies of the esophagus. At present, it cannot be diagnosed on the basis of symptoms, physical exam, or blood tests. In an upper GI endoscopy, a flexible tube called an endoscope, which has a light and miniature camera, is passed into the esophagus. If the tissue appears suspicious, then biopsies must be done. A biopsy is the removal of a small piece of tissue using a pincher-like device passed through the endoscope. A pathologist examines the tissue under a microscope to confirm the diagnosis.
Click & see >..Normal esophagus.Metaplasia

Looking for a medical problem in people who do not know whether they have one is called screening. Currently, there are no commonly accepted guidelines on who should have endoscopy to check for Barrett’s esophagus. Among the many reasons for the lack of firm recommendations about screening are the great expense and occasional risk of side effects of the test. Also, the rate of finding Barrett’s esophagus is low, and finding the problem early has not been proven to prevent deaths from cancer.

Many physicians recommend that adult patients who are over the age of 40 and have had GERD symptoms for a number of years have endoscopy to see whether they have Barrett’s esophagus. Screening for this condition in people who have no symptoms is not recommended.

Cause and Symptoms
For unknown reasons, Barrett’s esophagus is found three times more often in males than in females. In some instances, Barrett’s esophagus appears to be congenital (present at birth). However, current evidence is strong that in most instances, it develops as a result of longstanding GERD.

Patients with Barrett’s usually have symptoms similar to those produced by chronic GERD, such as heartburn and reflux of stomach acid into the mouth. Some Barrett’s patients may also suffer from other complications of GERD, such as esophageal peptic ulcers and stricture — narrowing of the esophagus that comes from scarring. These facts are why it is important for patients with these symptoms to see their physicians regularly.

Diagnosis
Diagnosis of Barrett’s esophagus requires an examination called upper endoscopy or EGD (esophagogastroduodenoscopy). A barium x-ray is not accurate for detecting Barrett’s esophagus. An EGD is done with the patient under sedation. The physician examines the lining of the esophagus and stomach with a thin, lighted, flexible endoscope. Biopsies are performed, taking pieces of tissue to be examined under a microscope for abnormal cells which have the potential of becoming malignant. The changes may be indefinite dysplasia where the pathologist may be uncertain of the changes. In this circumstance, medical treatment is intensified and repeat biopsies are performed in 6-12 months. When dysplasia is definite, some type of definite correction is necessary.

Treatment

Barrett’s esophagus has no cure, short of surgical removal of the esophagus, which is a serious operation. Surgery is recommended only for people who have a high risk of developing cancer or who already have it. Most physicians recommend treating GERD with acid-blocking drugs, since this is sometimes associated with improvement in the extent of the Barrett’s tissue. However, this approach has not been proven to reduce the risk of cancer. Treating reflux with a surgical procedure for GERD also does not seem to cure Barrett’s esophagus.

Several different experimental approaches are under study. One attempts to see whether destroying the Barrett’s tissue by heat or other means through an endoscope can eliminate the condition. This approach, however, has potential risks and unknown effectiveness.

Surveillance for Dysplasia and Cancer

Periodic endoscopic examinations to look for early warning signs of cancer are generally recommended for people who have Barrett’s esophagus. This approach is called surveillance. When people who have Barrett’s esophagus develop cancer, the process seems to go through an intermediate stage in which cancer cells appear in the Barrett’s tissue. This condition is called dysplasia and can be seen only in biopsies with a microscope. The process is patchy and cannot be seen directly through the endoscope, so multiple biopsies must be taken. Even then, the cancer cells can be missed.

The process of change from Barrett’s to cancer seems to happen in only a few patients, less than 1 percent per year, and over a relatively long period of time. Most physicians recommend that patients with Barrett’s esophagus undergo periodic surveillance endoscopy to have biopsies. The recommended interval between endoscopies varies depending on specific circumstances, and the ideal interval has not been determined.

Treatment for Dysplasia or Esophageal Adenocarcinoma

If a person with Barrett’s esophagus is found to have dysplasia or cancer, the doctor will usually recommend surgery if the person is strong enough and has a good chance of being cured. The type of surgery may vary, but it usually involves removing most of the esophagus and pulling the stomach up into the chest to attach it to what remains of the esophagus. Many patients with Barrett’s esophagus are elderly and have many other medical problems that make surgery unwise; in these patients, other approaches to treating dysplasia are being investigated.

Things Patients Can Do
Currently, there are no medications to reverse Barrett’s esophagus. However, it appears that treating the underlying GERD may slow the progress of the disease and prevent complications. Following are some things the patient can do to help reduce acid reflux and strengthen the LES.

  • Avoid eating anything within three hours before bedtime.
  • Avoid smoking and tobacco products. Nicotine in the blood weakens the LES.
  • Reduce consumption of fatty foods, milk, chocolate, mints, caffeine, carbonated drinks, citrus fruits and juices, tomato products, pepper seasoning, and alcohol (especially red wine).
  • Eat smaller meals. Avoid tight clothing or bending over after eating.
  • Review all medications with the physician. Certain drugs can actually weaken the LES.
  • Elevate the head of the bed or mattress 6 to 8 inches. This helps to keep acid in the stomach. Pillows by themselves are not very helpful. Wedging pillows under the head tends to bend the body at the waist which can push more fluid back up into the esophagus.
  • Lose weight if overweight. This may relieve upward pressure on the stomach and LES.

Ayurvedic Treatment

There are alternative homeopathic remedies for easing heartburn.

Alternative Treatment Of Barrett’s Esophagus , Homeopathic Treatment

Hope Through Research

Many important questions about Barrett’s esophagus need further research to

  • find better ways to identify people who have the problem
  • find out what causes it
  • test treatments that may prevent or eliminate it
  • find better treatments for people who have Barrett’s esophagus with cancer

The National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute sponsor research programs to investigate Barrett’s esophagus.

Summary
Barrett’s esophagus is a condition that may develop as a result of chronic GERD. Barrett’s tissue growing in the esophagus appears to be the body’s defense against continued stomach acid irritation. Yet, this tissue does not belong in the esophagus, and for some patients, it increases the risk of developing cancer. While treatment does not reverse Barrett’s, the likelihood of developing cancer and complications can probably be reduced with a combination of diet, lifestyle changes, medication, and/or surgery. A regular program of endoscopic examination and biopsy is essential to monitor the Barrett’s tissue. By working closely with a physician, patients can expect good control of both GERD and Barrett’s, and an excellent long-term outcome.

Points to Remember

  • In Barrett’s esophagus, the cells lining the esophagus change and become similar to the cells lining the intestine.
  • Barrett’s esophagus is associated with gastroesophageal reflux disease or GERD.
  • A small number of people with Barrett’s esophagus may develop esophageal cancer.
  • Barrett’s esophagus is diagnosed by upper gastrointestinal endoscopy and biopsy.
  • People who have Barrett’s esophagus should have periodic esophageal examinations.
  • Taking acid-blocking drugs for GERD may result in improvements in Barrett’s esophagus.
  • Removal of the esophagus is recommended only for people who have a high risk of developing cancer or who already have it.

For More Information

International Foundation for Functional Gastrointestinal Disorders (IFFGD) Inc.
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet:www.iffgd.org

National Cancer Institute (NCI)
National Institutes of Health
31 Center Drive
Building 31, Room 10A-19
Bethesda, MD 20892
Phone: 301–496–6641
Fax: 301–496–0846
Internet: www.nci.nih.gov

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm
http://www.gicare.com/pated/ecdgs40.htm

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