Esophagitis can cause prolonged periods of chest pain and almost always causes odynophagia as well. Diagnosis of advanced esophagitis is by endoscopy. Low-grade disease can be seen by histopathologic examination.

INFLAMMATORY ESOPHAGITIS GERD may induce an inflammatory response in the lower esophageal mucosa. Over time, this can progress to esophageal ulcerations, scarring, and stricture formation. The presence of esophagitis due to reflux warrants aggressive pharmacologic therapy with acid-suppressive medications. If this treatment regimen is not sufficient, surgical options are considered.17 Barrett's esophagus, mentioned above, can develop as well.

Ingested medications can also be a source for inflammatory esophagitis, usually from prolonged contact of the medication with the esophageal mucosa. Ulceration can be associated with this process. Multiple medications have been implicated: nonsteroidal anti-inflammatory drugs (NSAIDs), potassium chloride, and antibiotics, especially doxycycline, cause a large proportion of medication-related esophageal inflammation. 21 Risk factors for pill-induced esophageal injury include swallowing position, fluid intake, capsule size, and age, with swallowing position being the most important. Withdrawal of the offending agent is generally curative.

INFECTIOUS Patients with immunosuppression [acquired immunodeficiency syndrome (AIDS), iatrogenic causes, cancer] may develop an infectious esophagitis. AIDS especially has made esophageal infection more routine in the ED. The diagnosis of esophageal infection in an otherwise seemingly healthy host should prompt a search for underlying immunocompromise. Candidal species are the most common pathogens, often associated with dysphagia as a primary symptom. Herpes simplex, cytomegalovirus, and aphthous ulceration are also seen and may be more frequently associated with odynophagia. Other agents are rare and include other fungal infections, mycobacteria, and other viral pathogens such as varicella zoster and Epstein-Barr virus. Endoscopy with biopsy and cultures is used to establish this diagnosis.22

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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