Esophagitis: Etiologies & Distinctions
Esophagitis is inflammation of the esophagus, often presenting with odynophagia (painful swallowing), dysphagia (difficulty swallowing), and retrosternal chest pain.
1. Infectious & Non-Infectious Patterns
| Etiology | Key Features/Pathology |
|---|---|
| Candida | White pseudomembranes on endoscopy. Biopsy: Pseudohyphae/yeast. |
| HSV-1 | “Punched-out” ulcers. Biopsy: Cowdry type A inclusions (ground-glass nuclei). |
| CMV | Linear, shallow ulcers. Biopsy: Large cells with intranuclear and cytoplasmic inclusions (“owl’s eye”). |
| Eosinophilic | Associated with atopy/allergies. Biopsy: Dense eosinophilic infiltration. |
2. Exam Must-Knows
- GERD: The most common cause of non-infectious esophagitis. Biopsy shows basal cell hyperplasia and eosinophils (but less than Eosinophilic Esophagitis).
- Pill-induced: Common culprit drugs include tetracyclines, NSAIDs, bisphosphonates, and potassium chloride.
- Eosinophilic Esophagitis: Often shows “ringed esophagus” or “trachealization” on endoscopy. Does not respond to PPIs.
Pathology Board Hint: For board questions in an immunocompromised patient (e.g., HIV), always differentiate: Candida (white plaques), HSV (punched-out, ground-glass), and CMV (linear ulcers, owl’s eye inclusions).