OnlineMedEd: Gastroenterology - "Esophagitis"

Question 1

What is the mnemonic for causes of esophagitis?

Answer 1

PIECE
•Pill-induced 
•Infectious 
•Eosinophilia 
•Caustic 
•gErd

Question 2

What is the difference between dysphagia and odynophagia?

Answer 2

• Dysphagia: difficulty swallowing

* Odynophagia: painful swallowing

Question 3

Typically, ____________ is required to diagnose esophagitis.

Answer 3

endoscopy

Question 4

List the four types of medicines that are the most common causes of esophagitis.

Answer 4

• Non-enteric-coated NSAIDs
• Bisphosphonates
• HAART
• Tetracycline

Question 5

How is pill-induced esophagitis treated?

Answer 5

• Endoscopy (remove pill if still there)
• Remove offending agent or deliver another way
• PPI and time to recover

Question 6

What four infections can cause esophagitis?

Answer 6

• HSV
• Candida
• HIV opportunistic infections
• CMV

Question 7

True or false: nystatin can treat esophageal candidiasis.

Answer 7

False

Nystatin swishes are for oral candidiasis only. Oral fluconazole is needed for esophageal candidiasis.

Question 8

Oral lesions in the presence of odynophagia are suggestive of what type of esophagitis?

Answer 8

HSV esophagitis

Question 9

Go through the diagnostic/treatment paradigm for eosinophilic esophagitis.

Answer 9

• First, do a biopsy (like with all cases of odynophagia with suspected esophagitis)
• Second, for those with greater than 15 eosinophils per HPF, trial a PPI. GERD can cause eosinophilia.
• Lastly, if they fail the trial then give oral aerosolized steroids.

Question 10

What cases should make you think of caustic esophagitis?

Answer 10

• Little kids who drink drain cleaner

* Adults who ingest acid/alkaline substances in a suicide attempt

Question 11

In caustic esophagitis, you need to do an EGD to assess the severity of the injury. What should you do in mild and severe cases?

Answer 11

• Mild (evidenced by no necrotic areas or strictures): fluid diet
• Severe (evidenced by necrotic areas or strictures): NPO

Question 12

What two things should you never do in caustic esophagitis?

Answer 12

• Induce emesis –this just redamages the esophagus

* Neutralize the pH –this creates a thermal reaction that re-burns the esophagus

Question 13

Caustic esophagitis presents with what unique physical exam findings?

Answer 13

• Hoarseness
• Stridor

The caustic substance also burns the airway.