The most common cause of esophagitis is gastroesophageal reflux disease (GERD). (See Epidemiology) Other important, but less common, types of esophagitis include infectious esophagitis (in patients who are immunocompromised), radiation esophagitis, and esophagitis from direct erosive effects of ingested medication or corrosive agents. Eosinophilic esophagitis has also emerged as an important cause of esophagitis in both children and adults. Other causes of esophagitis include systemic disease and trauma. The prognosis is good with rapid diagnosis and proper treatment. Ultimately, prognosis depends on the underlying disease process. The history findings vary based on the type of esophagitis (eg, reflux or infectious). The physical examination usually is not helpful in confirming the diagnosis of uncomplicated esophagitis. However, the examination may reveal other potential sources of chest or abdominal pain.
The pathophysiology of esophagitis depends on its etiology. Common forms of esophagitis include reflux esophagitis, infectious esophagitis, pill esophagitis, eosinophilic esophagitis, and radiation and chemoradiation esophagitis. Esophagitis is commonly seen in adults and is uncommon in childhood. The most common type of esophagitis is that associated with GERD (ie, reflux esophagitis). Candida esophagitis is the most common type of infectious esophagitis. Esophageal reflux symptoms occur monthly in 33-44% of the general population; up to 7-10% of people have daily symptoms. The incidence of symptoms of reflux is up to an order of magnitude higher than the prevalence of esophagitis. In the United Kingdom, patients presenting to a general practitioner with symptoms of reflux esophagitis show rates in the 40-65% range.
However, a retrospective review of the results of more than 8000 diagnostic endoscopies in Hampshire showed that GERD accounted for 23% of all upper GI conditions. Candida esophagitis is the most common type of infectious esophagitis. Herpes simplex virus type I is the second most common cause of infectious esophagitis . Although obtaining accurate figures regarding the prevalence of herpes esophagitis is difficult, this infection has been reported in approximately 1% of patients who are immunocompromised and in as many as 43% of patients at autopsy. Treatment begins with hemodynamic stabilization and pain management. Subsequent therapy depends on the cause of the esophagitis and on any complications present. Surgery (fundoplication) is sometimes indicated in patients with severe pain who fail to respond to medical management.