Treatment for Esophagitis

Ruth Collins, MSN, CRNP, OCN
Last Modified: September 29, 2002

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Question

Dear OncoLink "Ask The Experts,"

My brother in law's last radiation treatment was 2 weeks ago. He still has pain and trouble swallowing. I believe the term is acute esophagitis. Can you tell me how long this lasts after radiation treatment is stopped?

 

Answer

Ruth Collins, MSN, CRNP, OCN, Advanced Practice Nurse in the Research Division of the Department of Radiation Oncology, responds:

When radiation therapy is the only treatment being used, esophagitis, usually has its onset at about 20-30 Gy, or two to three weeks into treatment. The condition usually begins to subside 10 days to 2 weeks post radiation. This is best accomplished if the person's nutritional status is maintained at an optimal level. If chemotherapy is being administered at the same time as the radiation, the esophagitis can take longer to subside. Immunocompromised patients with persistent symptoms should be should be assessed for potential infections such as esophageal candida.

Symptom regression can further be delayed by: acid reflux; poor nutritional status, foods strongly spiced or seasoned, dry coarse foods, hot foods and fluids, citrus or acidic or citrus food or juices; alcohol; smoking; medications such as aspirin or nonsteroidal anti-inflammatory medications or steroids.

Treatment for esopagitis consists of:

  1. Bland, soft diet
  2. Topical anesthetics, such as 2% viscous xylocaine
  3. Systemic pain medications (analgesics either narcotic or non narcotic)
  4. Mixture of equal parts of:
    • Topical anesthetic (2% viscous xylocaine)
    • Antacid (Maalox, Mylanta)
    • Antihistamine (Benadryl)
    Take 5-15 minutes prior to meals or as ordered by your physician. This mixture can suppress a persons gag reflex; therefore patients should eat slowly and sit upright for at least 30 minutes after eating to prevent aspiration.
  5. Appropriate antibiotic or anti- fungal for infection.
  6. Sucralfate suspension to coat esophagus between meals
  7. Treat acid reflux with medication and elevation of head of bed.

References

A clinical guide to cancer nursing: A companion to cancer nursing, 3rd. ed. Groenwald, S.L., Frogge, M.H., Goodman, M. & Yarboro, C.H. (Eds). Boston:Jones and Bartlett Publishers; 1995; pp.75, 246-47.

Kelvin, J.F. Gastrointestinal cancers In: Nursing care in radiation oncology, 2nd ed. Dow, K.H., Bucholtz, J.D., Iwamoto, R., Fieler, V. & Hilderley, L. (Eds). Philadelphia:W.B. Saunders Co.; 1997; p174.

Peacock, J L., Keller, J. W. & Asbury, R.F. Alimentary cancer In: Clinical oncology, 7th ed. Rubin, P. (Ed). Philadelphia:W.B. Saunders Co. 1993. p562-63.

Shank, B. Radiotherapy: Implications for general patient care In: Manual of oncologic therapeutics, 3rd ed. Macdonald. J. S., Haller, D. G. & Mayer, R. J.(Eds) Philadelphia:J.B. Lippincott; 1995; p.74.