What is the clinical presentation of esophagitis?

From the Guidelines

Esophagitis typically presents with symptoms of dysphagia or odynophagia, and the clinical presentation varies based on the underlying cause, with infectious etiologies such as candida esophagitis presenting with white nummular lesions and symptoms of dysphagia or odynophagia 1. The clinical presentation of esophagitis can be categorized based on the underlying cause, with different etiologies presenting with distinct symptoms.

• Infectious esophagitis, such as candida esophagitis, is the most commonly encountered infectious esophagitis, presenting endoscopically with white nummular lesions, which in severe cases, may carpet the entire esophagus, and patients commonly complain of dysphagia or odynophagia 1.
• The suggested risk factors for candida esophagitis include recent antibiotics, local or systemic steroids or immunosuppression, malignancy, proton pump inhibitor use, older age, chronic alcohol use, chronic kidney disease, diabetes, and motility disorders that lead to esophageal stasis 1.
• Diagnosis can be made with cytobrush or esophageal biopsies where fungal forms are identified, and available guidelines recommend fluconazole as the preferred treatment, dosed at 200 to 400 mg per day for 14 to 21 days 1.
• It is essential to identify and address the specific cause of esophagitis while providing symptomatic relief, and treatment depends on the underlying etiology, with fluconazole being the preferred treatment for candida esophagitis 1.

From the Research

Clinical Presentation of Esophagitis

• The clinical presentation of esophagitis can vary, but common symptoms include:
  • Odynophagia (painful swallowing) 2
  • Dysphagia (difficulty swallowing) 2, 3, 4
• These symptoms can be difficult to distinguish from other causes of esophagitis based on patient symptoms alone 2
• Other symptoms that may be associated with esophagitis include:
  • Acute chest pain 4
  • Food bolus impaction 4
• The clinical presentation can also vary depending on the underlying cause of esophagitis, such as:
  • Infectious esophagitis (e.g. Candida albicans) 2
  • Eosinophilic esophagitis (EoE) 3
  • Gastroesophageal reflux disease (GERD) 3

Diagnostic Challenges

• Definitive diagnosis of esophagitis requires esophagoscopy with biopsy for histologic and microbiologic evaluation 2
• Endoscopic findings can differ based on the cause of esophagitis 2
• The diagnosis of esophagitis can be challenging, and alternative diagnoses should be considered when treatment is unsuccessful 2