From the Guidelines
The initial treatment for esophagitis should begin with proton pump inhibitors (PPIs) such as omeprazole 20-40 mg daily or pantoprazole 40 mg daily for 4-8 weeks to reduce stomach acid production, as this approach has been strongly recommended based on good evidence that it improves important health outcomes 1.
Key Considerations
- For reflux-related esophagitis, lifestyle modifications are essential, including:
- Elevating the head of the bed 6-8 inches
- Avoiding meals within 3 hours of bedtime
- Eliminating trigger foods (spicy, fatty, acidic)
- Weight loss if overweight
- H2 blockers like famotidine 20 mg twice daily may be used as alternatives or supplements to PPIs.
- For infectious esophagitis, specific antimicrobials are needed, such as fluconazole 200-400 mg daily for 14-21 days for candida 1.
Treatment Approach
- PPIs work by blocking the enzyme system responsible for acid secretion in the stomach, allowing the esophageal tissue to heal from acid-related damage.
- Patients should avoid alcohol, tobacco, and NSAIDs during treatment as these can worsen esophageal inflammation.
- Corticosteroids such as fluticasole 440-880 mcg twice daily (swallowed, not inhaled) may be prescribed for eosinophilic esophagitis.
Evidence-Based Recommendation
- Long-term use of PPIs for the treatment of patients with esophagitis once they have proven clinically effective is strongly recommended, with the dose titrated down to the lowest effective dose based on symptom control 1.
From the FDA Drug Label
Omeprazole delayed-release capsules are indicated for the short-term treatment (4 to 8 weeks) of EE due to acid-mediated GERD that has been diagnosed by endoscopy in patients 2 years of age and older The initial treatment for esophagitis (specifically erosive esophagitis (EE) due to acid-mediated GERD) is omeprazole delayed-release capsules for 4 to 8 weeks 2 2.
- The treatment may be extended for an additional 4 weeks if the patient does not respond to the initial 8 weeks of treatment.
- If there is recurrence of EE or GERD symptoms, additional 4 to 8 week courses of omeprazole delayed-release capsules may be considered.
From the Research
Esophagitis Treatment
The initial treatment for esophagitis typically involves the use of proton pump inhibitors (PPIs) to reduce stomach acid production and allow the esophagus to heal.
- The standard dose of PPI is recommended as the initial treatment of erosive esophagitis for 8 weeks and non-erosive reflux disease for at least 4 weeks 3.
- PPIs have been shown to be highly effective in healing erosive esophagitis, with studies demonstrating that they are significantly better than H2 receptor antagonists in terms of healing rates and symptom relief 4, 5.
- The choice of PPI and dosage may vary depending on the individual patient and the severity of their esophagitis, with common options including omeprazole and lansoprazole 4, 6.
Treatment Options
In addition to PPIs, other treatment options for esophagitis may include:
- H2 receptor antagonists, which can be used as a supplementary treatment for patients with nocturnal refluxes 7.
- Anti-reflux surgery, which may be considered in well-selected patients who do not respond to medical therapy 3.
- Prokinetic agents and mucosal protective drugs, which have limited roles in the treatment of esophagitis 3, 5.
Treatment Duration and Follow-up
The duration of treatment for esophagitis will depend on the individual patient and the severity of their condition.
- For patients with severe reflux esophagitis, treatment with PPIs for 8 weeks has been shown to be effective in healing the esophagus and improving symptoms 6.
- After the initial treatment period, long-term continuous PPI or on-demand therapy may be required to prevent recurrence of esophagitis 4, 3.
- Follow-up endoscopy may be necessary to confirm healing of the esophagus and exclude complications such as Barrett's esophagus 6, 3.