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Erosive Esophagitis

Reflux of stomach contents backwards into the esophagus is damaging to the tissue of the esophagus.  It is generally felt as heartburn or regurgitation, but it can cause dramatic changes in the tissue it comes into contact with.  Generally, damage is seen as redness and irritation if it is superficial, but deeper ulcers can also form.  This can be seen at endoscopy and biopsied to determine the extent of damage.  Esophagitis can make swallowing very painful and sometimes difficult.  Patients will almost always be put on medications to suppress stomach acid—which does not stop the reflux, but does help to heal the lining of the esophagus and helps to prevent strictures from forming.

Eosinophillic Esophagitis

Eosinophilic esophagitis is an allergic inflammatory condition of the esophagus.  Eosinophils are allergy cells that not found in normal healthy esophageal tissue.  They migrate to the esophagus when it is exposed to allergens, which in this case would be certain foods.  The inflammation caused by this allergic response can create strictures which cause difficulty swallowing. 

There is typically a very characteristic appearance of the esophagus on endoscopy, but biopsies are required to make a diagnosis.  Dysphagia is the most common symptom, but heartburn and food impactions (having bites of food get stuck) are other symptoms.  This condition occurs in both young patients and adults. 

Treatment usually involves swallowed steroids to decrease inflammation, as well as identifying and avoiding any food allergies.  Treatment of strictures is the same, and is accomplished through dilatation.