Treatment

Treatments for esophagitis are intended to lessen symptoms, manage complications and treat underlying causes of the disorder. Treatment strategies vary primarily based on the cause of the disorder.

Reflux esophagitis

Treatment for reflux esophagitis may include:

• Over-the-counter treatments. These include antacids (Maalox, Mylanta, others); medications that reduce acid production, called H-2-receptor blockers, such as cimetidine (Tagamet HB); and medications that block acid production and heal the esophagus, called proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec).
• Prescription-strength medications. These include H-2-receptor blockers as well as proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and pantoprazole (Protonix). You also may be prescribed prokinetics such as bethanechol and metoclopramide (Reglan), which help your stomach empty more quickly.

• Surgery. Fundoplication may be used to improve the condition of the esophagus if other interventions don't work. A portion of the stomach is wrapped around the valve separating the esophagus and stomach (lower esophageal sphincter). This strengthens the sphincter and prevents acid from backing up into the esophagus.

  A newer treatment involves minimally invasive surgery to place a ring of tiny magnetic titanium beads around the junction of the stomach and esophagus. In that position, the ring of beads strengthens the lower esophageal sphincter, preventing acid reflux.

Eosinophilic esophagitis

Treatment for eosinophilic esophagitis is primarily avoiding the allergen and reducing the allergic reaction with medications. Medications may include:

• Proton pump inhibitors. Your doctor will likely first prescribe a proton pump inhibitor, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) or pantoprazole (Protonix).

• Steroids. Some studies have shown that swallowed steroids such as fluticasone (Flovent) and budesonide (Pulmicort) may act topically in the esophagus and help treat eosinophilic esophagitis. The same steroid medications that are inhaled to manage asthma are swallowed to treat eosinophilic esophagitis.

  Your doctor will instruct you on how to swallow the steroid preparation so that it coats your esophagus. This delivery system of steroids is much less likely to cause serious side effects than taking oral steroid pills.

• Elimination and elemental diets. A response to a food allergen is likely the cause of eosinophilic esophagitis. Therefore, elimination of the culprit food may be an effective treatment strategy.

  However, as no tests are currently available to identify the culprit food, your doctor may recommend that you remove common food allergens from your diet. Under your doctor's direction, you'll gradually add foods back into your diet and note when symptoms return.

  Another, more restrictive, approach is to remove all food from your diet and replace it with an amino acid-based formula.

New biologic therapies are being developed to treat eosinophilic esophagitis and will likely be available within a few years. These medications stimulate your body's immune response to fight infection, inflammation or disease.

Drug-induced esophagitis

Treatment for drug-induced esophagitis is primarily avoiding the problem drug when possible and reducing the risk with better pill-taking habits. Your doctor may recommend:

• Taking an alternative drug that is less likely to cause drug-induced esophagitis
• Taking a liquid version of a medication if possible
• Drinking an entire glass of water with a pill, unless you've been told by your doctor to restrict your fluid intake because of another condition, such as kidney disease
• Sitting or standing for at least 30 minutes after taking a pill

Infectious esophagitis

Your doctor may prescribe a medication to treat a bacterial, viral, fungal or parasitic infection causing infectious esophagitis.

Treating common complications

A gastroenterologist may perform a procedure to expand (dilate) the esophagus. This treatment is generally used only when the narrowing is very severe or food has become lodged in the esophagus.

In esophageal dilation, your doctor uses one or more endoscopic devices — small narrow tubes inserted through the esophagus. Versions of these devices may be equipped with:

• A tapered tip that starts with a rounded point that gradually widens
• A balloon that can be expanded after it's inserted in the esophagus