Esophagitis.

Definition.—An acute inflammation of the mucous membrane of the esophagus, frequently involving the submucous tissues.

Etiology.—Inflammation of the esophagus is quite rare, and may arise from swallowing very hot drinks or hot food, or from a hard substance, as a spiculum of bone. A frequent cause is strong alkalies or acids, taken either by mistake or with suicidal intent. Carbolic acid and concentrated lye are most frequently taken. It may also be an extension of an acute pharyngitis or acute gastritis. It may be due to the infectious fevers, such as typhoid, typhus, pneumonia, or diphtheria, the latter showing its character by a membranous exudate. In confluent small-pox, ulceration of the esophagus, with its attendant inflammation, may result. Malignant growths are not uncommon.

Pathology.—The pathological changes are similar to those of inflammations of other tubes, though there may not be such a pronounced redness of the mucous membrane. The epithelium is usually thickened, and, when denuded, leaves a granular appearance. The mucous follicles become swollen, frequently followed by small follicular ulcers. In some cases there is a croupous exudate in the upper portion of the tube.

In some of the severe confluent cases of small-pox, pustules will be found in the esophagus, though this is exceedingly rare. When the submucous tissues are involved, suppuration may occur, the pus being discharged within the tissue. In the more chronic forms there is thickening of the mucous tissues in some parts, with atrophy of others, which gives a sacculated appearance to the tube. If the inflammation has been caused by a corrosive poison, stricture is very apt to follow.

Symptoms.—A dull, uneasy feeling, or sometimes a burning, smarting sensation, is experienced in the esophagus posterior to the sternum. Swallowing is difficult, and aggravates the pain. The presence of food, even though bland, often produces vomiting of blood, mucus, or pus. Where ulceration occurs, stricture is apt to take place, necessitating the use of fluid nourishment altogether. Where there is a croupous exudate, we have the history of diphtheria with its attendant symptoms. In the latter case, there is not only dysphagia, but difficult respiration as well.

Diagnosis.—The location of the pain, the difficulty of swallowing, attended by a burning sensation, are characteristic of this disease, and if an esophageal sound is used, tenderness and pain are elicited, and the sound is streaked with a bloody mucus. This latter condition is found in carcinoma, though in the latter case there would be greater systemic disturbance, and the peculiar cancerous cachexia would be noticed, also the more persistent character of the pain.

Prognosis.—The prognosis is favorable in the milder forms, but must be guarded where strong corrosives have been taken; for if life be preserved, stricture is apt to follow. Where there is the croupous exudate the amount of the systemic disturbance will have to be taken into consideration.

Treatment.—The treatment for this disease will not differ materially from that for any other part. Only the blandest form of diet should be used. Milk in some form, either as whey or malted milk, is preferable. In some cases small bits of ice are gratefully received. In the way of medication, we think of aconite, rhus tox., hamamelis, and agents of like character where there is no sepsis, but if the suppurative process has been established and there is evidence of sepsis, echinacea, baptisia, sodium sulphite, hydrochloric acid, and potassium chlorate will be the remedies indicated.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.