Gastroenterology · USMLE Step 1 and Step 2

Esophagitis song

Esophagitis - Reflux, Pill & Eosinophilic, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Esophagitis

Full song on YouTube ↗Spotify ↗

Key points in this song10

GERD is caused by transient lower esophageal sphincter (LES) relaxation, leading to acid exposure that causes heartburn and regurgitation, classically worsened by lying down, fatty foods, alcohol, and caffeine.
Barrett's esophagus is a complication of chronic GERD in which normal squamous epithelium is replaced by intestinal metaplasia (columnar epithelium with goblet cells), a precancerous condition that increases risk of esophageal adenocarcinoma.
First-line treatment for GERD is proton pump inhibitors (PPIs); H2 blockers (e.g., ranitidine, famotidine) are second-line; antacids provide only symptomatic relief without healing esophagitis.
PPI side effects include increased risk of C. difficile infection, hypomagnesemia, osteoporosis/hip fractures, vitamin B12 deficiency, and community-acquired pneumonia with long-term use.
Pill esophagitis presents as sudden-onset odynophagia and chest pain in patients who take medications (especially doxycycline, bisphosphonates, NSAIDs, potassium chloride, or iron) without sufficient water or while lying down.
Bisphosphonate-induced esophagitis is prevented by instructing patients to take the pill with a full glass of water and remain upright for at least 30 minutes after ingestion.
Eosinophilic esophagitis (EoE) is an immune/antigen-mediated condition defined histologically by ≥15 eosinophils per high-power field on esophageal biopsy, not responsive to PPI therapy (used to distinguish from GERD-related eosinophilia).
EoE classically presents in young atopic males with dysphagia to solids and food impaction; it is strongly associated with other atopic conditions such as asthma, eczema, and allergic rhinitis.
Endoscopic findings in EoE include esophageal rings (trachealization), linear furrows, white exudates, and a narrow-caliber esophagus; esophageal dilation is used therapeutically for strictures.
First-line treatment for EoE includes swallowed (not inhaled) topical corticosteroids (fluticasone or budesonide) and dietary elimination therapy (six-food elimination diet removing milk, wheat, egg, soy, nuts, and seafood).