What is the treatment for esophagitis?

From the Guidelines

Esophagitis treatment should be guided by the underlying cause, with a focus on managing symptoms and preventing complications, as recommended by the most recent guidelines 1. The treatment approach varies depending on the type of esophagitis. For infectious esophagitis, such as candida esophagitis, fluconazole 200-400mg daily for 14-21 days is the preferred treatment 1. In contrast, reflux esophagitis may require lifestyle modifications, including weight loss, avoiding trigger foods, and elevating the head of the bed, as well as medication therapy with proton pump inhibitors (PPIs) like omeprazole 20-40mg daily or pantoprazole 40mg daily for 4-8 weeks 1. Some key points to consider in esophagitis treatment include:

• Accurate diagnosis of the specific type of esophagitis is crucial for effective treatment
• Treatment of infectious esophagitis requires specific antimicrobials, such as fluconazole for candida esophagitis
• Reflux esophagitis may require long-term therapy with PPIs to prevent recurrence of erosive disease 1
• Eosinophilic esophagitis may respond to swallowed topical steroids or elimination diets, with proton pump inhibitor therapy also being effective in inducing histological and clinical remission 1 It is essential to note that the treatment approach may vary depending on the individual patient's needs and the severity of the disease. A comprehensive treatment plan should prioritize the patient's quality of life, morbidity, and mortality, and be guided by the most recent and highest-quality evidence 1.

From the FDA Drug Label

1.1 Short-Term Treatment of Erosive Esophagitis Associated With Gastroesophageal Reflux Disease (GERD) Pantoprazole sodium delayed-release tablets are indicated in adults and pediatric patients five years of age and older for the short-term treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis (EE) For those adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of pantoprazole sodium delayed-release tablets may be considered.

Treatment Options for Esophagitis:

• Pantoprazole: indicated for short-term treatment (up to 8 weeks) of erosive esophagitis in adults and pediatric patients five years of age and older.
• Lansoprazole: indicated for short-term treatment (up to 8 weeks) of erosive esophagitis in adults and pediatric patients 12 to 17 years of age (up to 8 weeks) and pediatric patients one to 11 years of age (up to 12 weeks).
• Omeprazole: indicated for short-term treatment (4 to 8 weeks) of erosive esophagitis due to acid-mediated GERD in patients 2 years of age and older.

Key Considerations:

• The treatment duration may vary depending on the patient's response to therapy.
• For patients who do not heal after the initial treatment period, an additional course of treatment may be considered. 2, 3, 4

From the Research

Esophagitis Treatment Options

• Proton pump inhibitors (PPIs) are a common treatment for esophagitis, with studies showing their effectiveness in healing and symptom relief 5, 6, 7, 8.
• Different PPIs have been compared in terms of their healing rates and symptom relief, with esomeprazole showing higher healing rates than omeprazole at 4 and 8 weeks 6.
• A comparative study of omeprazole, lansoprazole, pantoprazole, and esomeprazole found that esomeprazole may be more effective for rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis 7.
• Another study found that esomeprazole was more effective than lansoprazole or pantoprazole for maintaining remission after sequential healing and 6 months' maintenance therapy for reflux esophagitis 8.

Comparison of PPIs and Other Treatments

• A systematic review compared the efficacy of vonoprazan, a new potassium-competitive acid blocker, with PPIs in healing gastroesophageal reflux disease (GERD) 9.
• The review found that vonoprazan had a higher healing effect than rabeprazole, but not higher than other PPIs, and was more effective than most PPIs for patients with severe erosive esophagitis 9.
• The choice of PPI may matter in the management of reflux esophagitis, with some PPIs showing higher healing rates and symptom relief than others 5, 6, 7, 8.

Treatment Outcomes

• Studies have shown that PPIs can effectively heal esophagitis and improve symptoms, with healing rates ranging from 77.5% to 95.5% 5, 6, 7, 8.
• The treatment outcome may depend on the severity of the esophagitis, with vonoprazan showing higher efficacy in patients with severe erosive esophagitis 9.
• Repeat endoscopy after 8 weeks of PPI therapy is recommended to assure healing and exclude Barrett's esophagus 5.