What is the treatment for esophagitis?

From the Guidelines

Esophagitis treatment should prioritize addressing the underlying cause, with fluconazole 200-400mg daily for 14-21 days being the preferred treatment for candida esophagitis, as recommended by available guidelines 1.

Key Considerations

• The treatment approach depends on the specific type of esophagitis, with different therapeutic strategies for reflux esophagitis, infectious esophagitis, and eosinophilic esophagitis.
• For infectious esophagitis, such as candida esophagitis, antimicrobial therapy is essential, with fluconazole being the preferred treatment option 1.
• Lifestyle modifications, including elevating the head of the bed, avoiding trigger foods, and maintaining a soft diet, can help alleviate symptoms and support treatment effectiveness.

Treatment Options

• For candida esophagitis, fluconazole 200-400mg daily for 14-21 days is the recommended treatment, with nystatin being considered for prophylaxis or in cases where the diagnosis is unclear 1.
• For reflux esophagitis, proton pump inhibitors (PPIs) such as omeprazole or pantoprazole, and H2 blockers like famotidine, may be used to reduce acid production and alleviate symptoms.
• Corticosteroids like fluticasone may be prescribed for eosinophilic esophagitis, often in combination with dietary elimination therapy.

Important Considerations

• Accurate diagnosis of the specific type of esophagitis is crucial to ensure effective treatment, as each type requires a different therapeutic approach.
• Treatment effectiveness depends on addressing the underlying cause, providing symptom relief, and maintaining a soft diet to minimize irritation and stay well-hydrated.
• Severe cases may require endoscopic dilation to relieve strictures, and patients should be closely monitored for treatment response and potential complications.

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 If a patient does not respond to 8 weeks of treatment, an additional 4 weeks of treatment may be given. Omeprazole delayed-release capsules are indicated for the maintenance healing of EE due to acid-mediated GERD in patients 2 years of age and older.

Esophagitis treatment: Omeprazole delayed-release capsules are used for the short-term treatment (4 to 8 weeks) of erosive esophagitis (EE) due to acid-mediated GERD. If needed, treatment may be extended for an additional 4 weeks. Omeprazole delayed-release capsules can also be used for the maintenance healing of EE due to acid-mediated GERD 2 2.

• Treatment duration: 4 to 8 weeks, with a possible extension of 4 weeks if needed.
• Maintenance healing: Omeprazole delayed-release capsules can be used for the maintenance healing of EE due to acid-mediated GERD.

From the Research

Esophagitis Treatment Options

• Esophagitis is a condition characterized by mucosal inflammation in the esophagus, often caused by acid reflux from the stomach 3.
• The treatment of esophagitis typically involves acid suppression therapies, such as proton pump inhibitors (PPIs), histamine-2 receptor antagonists, and antacids 3.

Proton Pump Inhibitors (PPIs) for Esophagitis Treatment

• PPIs are the most effective medication for controlling GERD-related symptoms, including esophagitis 3.
• Studies have shown that PPIs, such as esomeprazole, have higher healing rates than other PPIs, such as omeprazole, lansoprazole, and pantoprazole, for the treatment of reflux oesophagitis 4, 5.
• The standard dose of PPI is recommended as the initial treatment for erosive esophagitis (for 8 weeks) and non-erosive reflux disease (at least for 4 weeks) 3.

Other Treatment Options for Esophagitis

• Histamine-2 receptor antagonists (H2RAs) have been shown to be effective in healing oesophagitis, although less effective than PPIs 6.
• Prokinetic agents and mucosal protective drugs have limited roles in the treatment of esophagitis 3, 6.
• Anti-reflux surgery can be considered in well-selected patients with esophagitis 3.

Eosinophilic Esophagitis Treatment

• Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder that requires either repeated treatments or maintenance therapy 7.
• Current guidelines recommend swallowed topical corticosteroids (STCs), proton-pump inhibitors (PPIs), or dietary intervention as initial options to induce and maintain long-term disease remission in EoE patients 7.
• PPIs are the most commonly prescribed first-line therapy for EoE due to their accessibility, low cost, and safety profile, although they only induce remission in half of EoE patients 7.