I. Definition of Esophagitis
II. Causes of Esophagitis
This is the most frequent cause. It occurs when the Lower Esophageal Sphincter (LES)—a muscular valve between the esophagus and stomach—weakens or relaxes inappropriately. This allows stomach acid and other contents to back up (reflux) into the esophagus, irritating and inflaming its delicate lining. This condition is a hallmark of Gastroesophageal Reflux Disease (GERD).
This is an immune system-mediated condition. It is caused by a high concentration of a specific type of white blood cell, called an eosinophil, in the esophageal tissue. The body produces eosinophils in response to an allergen. This type of esophagitis is often triggered by food allergens, such as milk, soy, eggs, wheat, nuts, and seafood. Environmental allergens can also play a role.
This occurs when a pill or tablet gets lodged in the esophagus for too long before dissolving. The medication's chemical composition can directly burn or irritate the esophageal lining. Common culprits include: Pain relievers like aspirin, ibuprofen, and naproxen (NSAIDs). Antibiotics such as tetracycline and doxycycline. Potassium chloride supplements. Bisphosphonates used to treat osteoporosis (e.g., alendronate).
The risk increases if pills are taken with little or no water or while lying down.
This type is rare in healthy individuals and more common in people with weakened immune systems (e.g., those with HIV/AIDS, cancer, or on immunosuppressant drugs). It is caused by a bacterial, viral, or fungal infection in the esophagus. Common pathogens include: Fungus: Candida albicans (esophageal thrush). Virus: Herpes simplex virus (HSV) and Cytomegalovirus (CMV).
III. Signs and Symptoms
Heartburn (Pyrosis): A burning sensation in the chest, often moving up towards the throat. It is typically worse after eating, when bending over, or when lying down. Dysphagia: Difficulty swallowing. This may feel like food is "stuck" in the throat or chest. Odynophagia: Painful swallowing. A sharp or burning pain is felt with each swallow of food or liquid. Chest Pain: A non-cardiac chest pain, often located behind the breastbone. It can sometimes be mistaken for a heart attack. Acid Regurgitation: The sensation of stomach acid or food backing up into the throat or mouth, leaving a sour or bitter taste.
Nausea or vomiting. Vomiting blood (hematemesis) or material that looks like coffee grounds. Epigastric (upper abdominal) pain. Decreased appetite and unintentional weight loss. Hoarseness, chronic cough, or a sore throat (due to acid irritating the larynx).
IV. Investigation and Diagnosis
The doctor will ask detailed questions about your symptoms, eating habits, medications, and history of allergies or immune conditions.
This is the primary diagnostic tool. A thin, flexible tube with a light and camera (endoscope) is passed down the throat to directly visualize the lining of the esophagus. The doctor can look for signs of inflammation, redness, ulcers, or strictures. Biopsy: During the endoscopy, small tissue samples can be taken from the esophageal lining. These are sent to a lab to be examined under a microscope to confirm the diagnosis and identify the cause (e.g., checking for eosinophils, signs of infection, or precancerous changes).
This is an X-ray imaging test. The patient drinks a chalky liquid containing barium, which coats the lining of the esophagus. X-rays are then taken to highlight any structural abnormalities, such as narrowing (strictures), hernias, or ulcers.
If Eosinophilic Esophagitis is suspected, skin-prick tests or blood tests may be performed to identify potential food or environmental allergens. An elimination diet may also be recommended.
V. Medical Treatment
Avoid Trigger Foods: Common triggers include spicy foods, acidic foods (tomatoes, citrus), fatty or fried foods, chocolate, mint, caffeine, and alcohol. Eat Smaller, More Frequent Meals: This prevents the stomach from becoming too full, which reduces pressure on the LES. Do Not Lie Down After Eating: Remain upright for at least 2-3 hours after a meal. Elevate the Head of Your Bed: Use blocks to raise the head of the bed by 6-8 inches. Extra pillows are not as effective. Maintain a Healthy Weight: Excess weight increases abdominal pressure, promoting reflux. Stop Smoking: Nicotine weakens the LES. Avoid Tight-Fitting Clothing: Tight belts or waistbands can put pressure on the stomach.
For Reflux Esophagitis: Antacids (e.g., Tums, Rolaids): Provide rapid, short-term relief by neutralizing stomach acid. H2-Receptor Blockers (e.g., famotidine, cimetidine): Reduce acid production. Available over-the-counter and by prescription. Proton Pump Inhibitors (PPIs) (e.g., omeprazole, pantoprazole, esomeprazole): Strongly block acid production, allowing the esophageal lining time to heal. These are the most effective medications for healing erosive esophagitis.
For Eosinophilic Esophagitis: Topical Steroids: Patients swallow a steroid preparation (fluticasone or budesonide) that coats the esophagus to reduce inflammation caused by eosinophils. Elimination Diets: Systematically removing common food allergens to identify and avoid the trigger. Biologic Drugs: In some cases, drugs like dupilumab may be prescribed to target the underlying immune response.
For Infectious Esophagitis: Treatment targets the specific pathogen with antifungal, antiviral, or antibacterial medications.
For Medication-Induced Esophagitis: Discontinue the offending medication (if possible, under a doctor's guidance). Take all pills with a full glass of water and remain upright for at least 30 minutes after.
Esophageal Dilation: If esophagitis has caused a severe narrowing (stricture), an endoscope with a small balloon or dilator can be used to gently stretch the esophagus open and improve swallowing. Surgery (Fundoplication): In severe, chronic cases of GERD that do not respond to other treatments, a surgeon may perform a procedure to tighten the LES by wrapping the top part of the stomach around it.
Nursing Care Plan: Esophagitis
Patient Profile: This care plan is designed for an
adult patient diagnosed with esophagitis, most commonly due to Gastroesophageal
Reflux Disease (GERD), but it can be adapted for other causes such as
infection, medication-induced, or eosinophilic esophagitis.
Overview of Esophagitis: Esophagitis is the
inflammation, irritation, or swelling of the esophagus, the tube that leads
from the back of the mouth to the stomach. This inflammation can cause painful
swallowing, heartburn, and chest pain. If left untreated, it can lead to complications
like esophageal strictures, ulcers, and Barrett's esophagus.
I. Patient Assessment / Data Collection
This is the foundational step where the nurse gathers
information to formulate nursing diagnoses.
A. Subjective Data (What the patient reports):
- Chief
Complaint: "I have a burning pain in my chest, especially
after I eat." "It feels like food gets stuck in my throat."
- Pain:
- Onset/Duration: Reports
pain starting shortly after meals or when lying down; may be constant or
intermittent.
- Location: Substernal
(behind the breastbone), may radiate to the back, neck, or jaw.
- Characteristics: Describes
pain as "burning," "sharp," or
"pressure-like."
- Aggravating
Factors: Lying flat, bending over, eating large meals, consuming
spicy/acidic/fatty foods, alcohol, or caffeine.
- Relieving
Factors: Sitting upright, taking antacids.
- Swallowing: Reports
dysphagia (difficulty swallowing) or odynophagia (painful swallowing). May
describe a sensation of a "lump" or food impaction.
- Gastrointestinal
Symptoms: Reports regurgitation of sour or bitter fluid (acid
reflux), water brash (excessive salivation), nausea, or belching.
- Dietary
History: Describes a diet high in trigger foods; reports recent
unintentional weight loss due to fear of eating.
- Lifestyle: Reports
smoking, alcohol use, or being overweight.
B. Objective Data (What the nurse observes/measures):
- General
Appearance: May appear uncomfortable, grimacing with pain, or
guarding the chest area.
- Vital
Signs: Generally stable, but heart rate may be elevated due to
pain or anxiety.
- Oral/Pharyngeal
Exam: May show signs of acid erosion on teeth (in chronic GERD);
throat may appear erythematous (red).
- GI/Abdominal
Exam: Epigastric tenderness upon palpation may be present.
- Nutritional
Status: Current weight compared to baseline; signs of
malnutrition if chronic.
- Respiratory
Status: Assess for coughing, hoarseness, or wheezing, which could
indicate aspiration of gastric contents.
- Diagnostic
Results:
- Endoscopy
(EGD): Report may show erythema, friability (tissue that tears
easily), ulcers, or strictures in the esophagus. Biopsy results may
confirm the cause (e.g., eosinophils, infection).
- Barium
Swallow: May show motility issues, strictures, or inflammation.
II. Nursing Diagnoses and Plan of Care
Based on the assessment data, the following nursing
diagnoses are prioritized.
Nursing Diagnosis 1: Acute Pain
Related to: Inflammation and irritation of the
esophageal mucosa from exposure to gastric acid or other irritants.
As Evidenced By: Patient's verbal report of heartburn and chest pain
(rated 7/10), facial grimacing, and guarding behavior.
Patient Goal (Outcome):
- The
patient will report a significant reduction in pain (e.g., to a level of ≤
3/10 on a 0-10 scale) within 1-2 hours of interventions.
- The
patient will identify and avoid factors that precipitate pain by
discharge.
|
Nursing Interventions |
Rationale |
|
1. Assess and Document Pain: Use a standardized pain
scale (e.g., 0-10) to assess pain characteristics (PQRST: Provokes, Quality,
Radiates, Severity, Time). |
A systematic assessment provides a baseline to evaluate
the effectiveness of interventions and guides treatment choices. |
|
2. Administer Medications as Prescribed:<br>- Proton
Pump Inhibitors (PPIs): e.g., omeprazole, pantoprazole.<br>- H2-Receptor
Blockers: e.g., famotidine.<br>- Antacids: e.g., calcium
carbonate. |
PPIs and H2 blockers suppress gastric acid production,
which is the primary irritant. Antacids provide rapid, temporary relief by
neutralizing existing stomach acid. |
|
3. Provide Non-Pharmacological Comfort Measures:<br>-
Instruct the patient to maintain an upright position (sitting or standing)
for at least 30 minutes after meals.<br>- Offer cool liquids or milk
(if tolerated) to sip. |
Gravity helps prevent the reflux of stomach contents into
the esophagus. Cool liquids can provide a soothing effect on inflamed tissue. |
|
4. Educate on Dietary Modifications for Pain Relief:<br>-
Advise avoiding trigger foods: spicy, acidic (citrus, tomatoes), fatty/fried
foods, caffeine, chocolate, and peppermint. |
These foods can either increase acid production, are
direct irritants to the esophageal mucosa, or relax the lower esophageal
sphincter (LES), promoting reflux. |
|
5. Differentiate Chest Pain: Carefully assess if
chest pain is esophageal or cardiac in nature. Note relationship to food,
position, and exertion. Obtain an EKG if there is any suspicion of a cardiac
origin. |
Esophageal spasm and GERD can mimic angina. It is critical
to rule out a life-threatening cardiac event. |
Evaluation:
- Patient
reports pain level is 2/10 one hour after receiving medication and sitting
upright.
- Patient
correctly lists three personal trigger foods to avoid. Goal met.
Nursing Diagnosis 2: Imbalanced Nutrition: Less Than Body
Requirements
Related to: Dysphagia, odynophagia (painful
swallowing), and fear of eating due to pain.
As Evidenced By: Patient report of "food getting stuck,"
eating only small amounts, and a documented 5 lb weight loss in the past month.
Patient Goal (Outcome):
- The
patient will consume 75% of all meals without reporting significant pain
by the end of the hospital stay.
- The
patient will maintain their current weight or demonstrate weight gain by
the follow-up appointment.
|
Nursing Interventions |
Rationale |
|
1. Assess Nutritional Status: Monitor daily weights,
calorie counts, and review lab values such as albumin and pre-albumin. |
Provides objective data to track nutritional status and
the effectiveness of interventions. Low albumin can indicate chronic
malnutrition. |
|
2. Collaborate with a Dietitian: Request a
consultation for a personalized meal plan. |
A dietitian is an expert in creating nutritionally dense
meal plans that accommodate the patient's dietary restrictions and
preferences. |
|
3. Provide a Modified Diet: Offer small, frequent
meals (5-6 per day) with a soft, bland, non-acidic consistency. |
Smaller meals prevent stomach distention and reduce
pressure on the LES. A soft, bland diet is less irritating to the inflamed
esophageal mucosa. |
|
4. Instruct on Proper Eating Habits:<br>- Encourage
the patient to eat slowly and chew food thoroughly.<br>- Ensure the
patient is sitting upright during and for at least 30-60 minutes after meals. |
Thorough chewing aids digestion and reduces the risk of
food impaction. An upright position uses gravity to aid in esophageal
clearance and prevent reflux. |
|
5. Monitor for Signs of Dysphagia: Observe the
patient during meals for coughing, choking, or pocketing of food. If severe,
recommend a swallow evaluation by a speech-language pathologist (SLP). |
Identifies a risk for aspiration and the need for further
intervention, such as a texture-modified diet (e.g., pureed, mechanical soft)
or swallowing therapy. See More: |
Evaluation:
- Patient
is observed eating 80% of their soft diet lunch without grimacing.
- Patient's
weight has stabilized. Goal in progress; continue plan of care.
Nursing Diagnosis 3: Deficient Knowledge
Related to: New diagnosis and lack of
familiarity with disease management strategies (medications, diet, lifestyle
changes).
As Evidenced By: Patient asking, "What can I do to stop this from
happening again?" and "How am I supposed to take these pills?"
Patient Goal (Outcome):
- The
patient will verbalize a comprehensive understanding of their prescribed
medication regimen, dietary restrictions, and necessary lifestyle
modifications before discharge.
- The
patient will demonstrate the ability to plan a one-day menu that adheres
to dietary guidelines.
|
Nursing Interventions |
Rationale |
|
1. Assess Current Knowledge and Readiness to Learn: Determine
what the patient already knows and identify any misconceptions. |
Education must be tailored to the individual's starting
point and learning style to be effective. |
|
2. Educate on Medication Regimen: Explain the
purpose, dose, schedule, and potential side effects of each medication.
Emphasize taking PPIs 30-60 minutes before the first meal of
the day. |
Understanding the "why" behind the medication
schedule improves adherence. PPIs work best when taken before meals to
inhibit the active proton pumps stimulated by food. |
|
3. Teach Lifestyle Modifications:<br>- Diet: Provide
a written list of foods to eat and avoid.<br>- Positioning: Advise
elevating the head of the bed 6-8 inches with blocks.<br>- Habits: Discuss
smoking cessation, weight management, and avoiding tight-fitting clothing. |
Elevating the head of the bed prevents nocturnal reflux.
Smoking, excess weight, and tight clothing all increase intra-abdominal
pressure, which worsens reflux and esophagitis. |
|
4. Explain "Red Flag" Symptoms: Instruct
the patient on when to seek medical attention (e.g., worsening or persistent
dysphagia, vomiting blood, black/tarry stools, unintentional weight loss). |
Empowers the patient to recognize signs of serious
complications (e.g., bleeding, stricture, or malignancy) and seek timely
care. |
|
5. Use the "Teach-Back" Method: Ask the
patient to explain the management plan in their own words. For example,
"Can you tell me which foods you are going to avoid?" |
This is a proven method to confirm comprehension and
retention of information, moving beyond a simple "yes" or
"no" answer. |
Evaluation:
- Patient
correctly states that their omeprazole should be taken 30 minutes before
breakfast.
- Patient
successfully creates a sample menu including baked chicken, mashed
potatoes, and green beans. Goal met.
Nursing Care Plan: Esophagitis (Inflammation of the
Esophagus)
|
Nursing Diagnosis |
Goals/Expected Outcomes |
Nursing Interventions |
Rationale |
Evaluation |
|
Acute Pain related to inflammation of the esophageal
mucosa as evidenced by complaints of burning chest pain and painful
swallowing. |
Short-term: Patient will report decreased pain
within 48 hours. |
- Assess pain intensity, duration, and triggers. |
- Pain assessment ensures proper treatment. |
Patient reports decreased chest pain and improved comfort
with eating. |
|
Imbalanced Nutrition: Less Than Body Requirements
related to painful swallowing and reduced intake |
Short-term: Patient will consume ≥50% of meals. |
- Monitor daily weight, intake, and output. |
- Weight monitoring identifies nutritional deficits. |
Patient maintains stable weight and consumes meals with
minimal discomfort. |
|
Risk for Aspiration related to impaired swallowing and
regurgitation |
Patient will remain free from signs of aspiration
(coughing, choking, abnormal lung sounds). |
- Position patient in semi-Fowler’s or Fowler’s during and
after meals. |
- Upright position reduces aspiration risk. |
Patient eats without signs of aspiration; lung sounds
remain clear. |
|
Deficient Knowledge related to disease process, diet,
and lifestyle modifications |
Patient will verbalize understanding of condition, diet,
and treatment before discharge. |
- Educate patient on causes of esophagitis (GERD,
irritants, infections, medications). |
- Knowledge empowers patient in self-care. |
Patient verbalizes understanding and demonstrates correct
self-care strategies. |
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