From the Guidelines
Esophagitis typically does not require antibiotics as treatment. The appropriate therapy depends on the underlying cause, with most cases being treated with acid-suppressing medications like proton pump inhibitors (PPIs) for 4-8 weeks if caused by acid reflux 1. For instance, omeprazole 20-40mg daily or lansoprazole 30mg daily can be used. In cases of fungal esophagitis, antifungal medications such as fluconazole may be necessary, while viral esophagitis might require antiviral medications.
Key Considerations
- Antibiotics are only necessary if the esophagitis is caused by a bacterial infection, which is rare.
- Lifestyle modifications are also important, including elevating the head of the bed, avoiding eating within 3 hours of bedtime, and eliminating trigger foods like spicy foods, caffeine, and alcohol.
- The treatment approach targets the inflammation and its cause rather than using antibiotics, as most cases stem from acid reflux, allergic reactions, or certain medications rather than bacterial infections.
Treatment Approach
- For eosinophilic esophagitis, offering PPI to reduce the risk of recurrence, considering additional treatments like steroids or elimination diet, and aiming for histological remission are recommended 1.
- In cases of narrow calibre oesophagus or failure of medical treatment in the absence of a visible stricture, dilatation may be considered.
- Informing patients that chest pain is common and managing it appropriately is also crucial.
Underlying Cause
- The underlying cause of esophagitis determines the treatment approach, with acid reflux being the most common cause.
- Other causes like fungal or viral infections require specific treatments.
- Bacterial infections are rare but may require antibiotic treatment.
From the Research
Esophagitis Treatment
The treatment of esophagitis depends on the underlying cause of the condition.
- For infectious esophagitis, treatment is based on the host immune status, the severity of infection, and the risk of complications 2.
- The most common cause of infectious esophagitis is Candida albicans, and treatment typically involves antifungal medications 2, 3.
- Bacterial esophagitis may require antibiotics, but this is not always the case 3.
- Viral esophagitis, such as that caused by Herpes simplex virus, may require antiviral medications 4, 3.
Non-Infectious Esophagitis
For non-infectious forms of esophagitis, such as eosinophilic esophagitis or reflux esophagitis, treatment typically involves medications to reduce inflammation and alleviate symptoms.
- Proton pump inhibitors, such as omeprazole and lansoprazole, can provide rapid symptom relief and esophageal healing in patients with mild to severe esophagitis 5.
- Lifestyle modifications, such as dietary changes and avoidance of trigger foods, can also help manage symptoms 5.
Diagnostic Considerations
Diagnosing esophagitis requires a combination of clinical evaluation, endoscopy, and biopsy.