Esophagitis – Top USMLE Diseases

Gastritis is inflammation of the gastric mucosa and can be classified by time course (acute or chronic), histologic features, and etiology. It is usually due to an infection (usually by Helicobacter pylori) or an immune-mediated process, but it can also be caused by substances that are direct gastric irritants. Chronic, metaplastic atrophic gastritis may be due to autoimmune or environmental causes and is a risk factor for gastric cancer. Individuals with gastritis may be asymptomatic or may have abdominal pain, dyspepsia, and nausea. Treatment of acute and chronic gastritis due to H. pylori infection involves acid suppression and antibiotics. Other causes are managed by avoiding offending agents and replacing associated deficiencies.

Gastroesophageal reflux disease (GERD) is due to pathologic reflux that causes symptoms and complications, including erosive esophagitis. Common symptoms are heartburn, early satiety, bloating, and belching. Diagnosis is made clinically and requires endoscopy in adults over 55 who are unresponsive to empiric therapy with acid blockade or those with alarm symptoms. Uncomplicated GERD can be managed with lifestyle changes and over-the-counter medications. Complications include erosive esophagitis, stricture, and Barrett esophagus, which can increase the risk of esophageal cancer. Management includes lifestyle and dietary modification, acid-reducing medications, and in some cases, surgery.

Gastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn). This condition may eventually lead to inflammation (esophagitis), metaplasia (Barrett’s esophagus), and progression to esophageal cancer. Uncomplicated GERD can be managed with lifestyle changes and over-the-counter medications. Sometimes, however, stronger medications or surgery may be required to ease symptoms and prevent complications.

Esophagitis is the inflammation or irritation of the esophagus. The major types of esophagitis are medication-induced, infectious, eosinophilic, corrosive, and acid reflux. Patients typically present with odynophagia, dysphagia, and retrosternal chest pain. Diagnosis is by endoscopy and biopsy. Laboratory tests and imaging are obtained, depending on the degree of damage and involvement of other organ systems. Treatment for esophagitis depends on the underlying etiology and includes dietary changes, avoidance of offending agents, antibiotic therapy, or proton pump inhibitor use. In severe cases such as in corrosive injury, surgery may need to be performed. If left untreated, esophagitis can lead to complications such as strictures, metaplasia of the esophagus, and development of malignancy.

Gastritis refers to inflammation of the gastric mucosa. Gastritis may occur suddenly (acute gastritis) or slowly over time (chronic gastritis). Gastritis may be asymptomatic or with symptoms, including burning abdominal pain (which either worsens or improves with eating), dyspepsia, nausea, and vomiting. The most common etiologies for gastritis are Helicobacter pylori infection and autoimmune disease. Chronic gastritis is a risk factor for gastric cancer. Management involves the use of proton pump inhibitors with antibiotics (in case of H. pylori infection), avoidance of offending agents, and replacement of associated deficiencies.