Esophagitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

If left untreated, 20% of patients with esophagitis may progress to develop esophageal stricture due to excessive acid in the lower esophagus. Common complications of esophagitis include esophageal ulcer, and esophageal adenocarcinoma. Prognosis of esophagitis is generally good with appropriate treatment.

Natural History

• If left untreated, 20% of patients with esophagitis may progress to develop esophageal stricture due to excessive acid in the lower esophagus..
• Symptoms often persist for years in eosinophilic esophagitis raising suspicion of a underlying chronic inflammatory disease process.
• The inflammatory activity is proportional to the density of the eosinophilic infiltration in the esophageal tissue.
• Similar to asthma, EoE has chronic persistent eosinophilic inflammation and can eventually lead to irreversible structural changes of the esophagus which is called re-modeling of the esophagus.
• The esophageal mucosa in patients with a longstanding EoE is characterized by a loss of elasticity.

Complications

Common complications of esophagitis include:

• Esophageal ulcer
• Esophageal adenocarcinoma
• Esophageal scarring / stenois resulting in progressive dysphagia
• Tears of perforation during endoscopy or retching leading to boerhaave syndrome

Prognosis

• Prognosis of esophagitis is generally excellent with appropriate treatment.
• The majority of people respond to non-surgical measures, with lifestyle changes and medications. However, many patients need to take medications to control their symptoms.