Esophagitis & Stricture Specialist

Leo Treyzon, MD -  - Gastroenterologist

Leo Treyzon, MD

Gastroenterologist & Clinical Nutrition Specialist located in Cedars-Sinai Medical Towers & West Los Angeles, Los Angeles, CA

Esophagitis usually can be treated easily with a conservative program of medical care. When scarring becomes severe, a stricture can occur. This condition can be treated by simple dilatation. While complications can occur, they are uncommon. Most patients obtain complete relief of their swallowing problems. By working with an experienced physician like Dr. Treyzon, who treats patients in and around the Cedars Sinai Medical Towers, Los Angeles, CA area, the correct program can be developed for each patient.

Esophagitis & Stricture Q&A

What is the Esophagus?

The esophagus is the food tube that carries food and liquid from the mouth to the stomach. The stomach churns the food and secretes a strong acid that aids in digestion. A specialized muscle, known as the lower esophageal sphincter (LES), is located at the end of the esophagus. This muscle normally contracts firmly, relaxing only to allow food and liquid to pass from the esophagus into the stomach. This muscle maintains a certain pressure to keep the end of the esophagus closed, preventing stomach acid and digested food from moving back into the esophagus.

However, the LES muscle does not always work perfectly. It can easily be overcome by a number of factors, the most common being eating a large meal. Other agents that weaken the LES muscle and allow reflux of stomach juices are:

  • Nicotine (cigarettes)
  • Fried or fatty foods
  • Chocolate
  • Coffee
  • Citrus fruits and juices
  • Peppermints
  • Pregnancy

What Is Esophagitis?

When stomach acid and digestive enzymes repeatedly reflux into the esophagus, the tissues become inflamed and ulcerated. This inflammation is known as esophagitis. When the inflammation is severe, esophageal ulcers develop.

Does a Hiatus Hernia cause Esophagitis?

A hiatus hernia exists when part of the stomach protrudes through the diaphragm muscle into the chest. When the hernia is fixed in this position, stomach acid and food do not drain out of it quickly and the LES pressure is overcome. This results in tissue damage to the esophagus. A fixed hiatus hernia, therefore, is an important factor in causing esophagitis.

Are there Other Causes of Esophagitis?

Certain infections, such as a fungus infection (Candida) and viruses, can occur in the esophagus and cause inflammation. Irradiation and caustic substances, like lye, also can cause esophagitis. Acid reflux from the stomach, however, is by far the most common cause of the condition.

What Are the Signs and Symptoms?

Heartburn occurs when acid refluxes into the esophagus. It is experienced as a burning sensation in the lower chest and may be felt up the esophagus. At times, bitter-tasting liquid may regurgitate up into the mouth. When esophagitis is severe and ulcers are present, swallowing may cause pain when food reaches this part of the esophagus. Furthermore, if the lower esophagus narrows due to scarring, food may stick in this area. This symptom is called dysphagia and is uncomfortable. Esophagitis also may cause bleeding. Black stools, anemia (low red-blood cell count), and vomiting of blood are signs of bleeding.

Diagnosis

An endoscopy is often performed during which a flexible, fiberoptic endoscope is passed into the esophagus while the patient is lightly sedated. The tissues can be visualized and biopsied during this procedure. This examination is important since cancer of the esophagus can mimic esophagitis.

What is the Treatment for Esophagitis?

General measures the patient can take to treat esophagitis are:

  • Eat smaller and more frequent meals.
  • Avoid eating for 2 hours before going to bed.
  • Eliminate excessive bending, lifting, abdominal exercises, girdles, and tight belts, all of which increase abdominal pressure and provoke reflux.
  • If overweight, lose weight. Being overweight causes reflux.
  • Eliminate or significantly reduce consumption of nicotine (cigarettes), fatty foods, alcohol, coffee, chocolate, and peppermint.
  • Elevate the head of the bed 8” to 10” by placing pillows or a wedge under the upper part of the mattress. In this way, gravity helps keep stomach juices out of the esophagus during sleep.

Other Treatments Include:

Antacids — These can and should be used often. Generally, antacids should be taken 30 to 60 minutes after eating and at bedtime. Liquids are preferred to tablets.
Drugs — Medicines are now available that effectively reduce or stop the secretion of stomach acid. These medicines are usually the most important part of treating esophagitis.
Surgery — Surgery is occasionally required to treat esophagitis, especially if a hiatal hernia is present and when the above steps have been ineffective. Newer laparoscopic surgery has simplified this procedure.

What Is a Stricture?

The lower esophagus can open to the size of a quarter or wider. When recurrent inflammation occurs in the esophagus, scarring develops, underlying tissues become fibrous, and the opening narrows. In advanced cases, this narrowing, or stricture, can be severe. The opening may be reduced to the size of a pencil or even smaller. Food and fluid are delayed and only move slowly across the opening into the stomach. A large piece of food, such as meat, may completely block the esophagus. As mentioned, cancer can narrow the esophagus in the same way. Therefore, it is critical that the physician rule out this diagnosis.

What is the Treatment for a Stricture?

The physician can use a variety of methods to gently but forcefully open, or dilate, a stricture. Dilatation is often performed in conjunction with an upper endoscopy exam. One of the following dilatation methods may be used. See the section on Esophageal dilation.

Summary

Esophagitis usually can be treated easily with a conservative program of medical care. When scarring becomes severe, a stricture can occur. This condition can be treated by simple dilatation. While complications can occur, they are uncommon. Most patients obtain complete relief of their swallowing problems. By working with the physician, the correct program can be developed for each patient.

Insurances We Work With

Here is a list of just some of the plans we work with -- depending on your insurance plan, your co-pay due upon the visit is variable. You might be responsible for a small co-pay like $10, or you might be responsible for the full amount. It is dependent on your insurance unmet deductible, which insurance network you are in, and other insurance factors. Please contact our office if you have any questions. We can verify on the phone what your co-pay would be. Please note that we are not contracted with Medicare. If a claim is submitted to your insurance, we submit the necessary billing forms ourselves.

Aetna
AFTRA
Anthem Blue Cross of California
Cigna
Director's Guild (DGA)
Motion Picture Industry Health Plan
United Healthcare
Writers Guild