Ulcerative Esophagitis with Competent Lower Esophageal Sphincter (LES)

Introduction to Causes

• The American Gastroenterological Association suggests that the primary causes of ulcerative esophagitis in patients with competent LES include infections, autoimmune/dermatological diseases, inflammatory bowel disease (Crohn's disease), and drug-induced injury, rather than gastroesophageal reflux disease (GERD) 1, 2, 3

Infectious Causes

• Infections are a significant cause of ulcerative esophagitis in patients with competent LES, particularly in those with compromised immune systems, with conditions such as Candida esophagitis, Herpes simplex virus (HSV), Cytomegalovirus (CMV), and HIV-associated idiopathic ulcers 1, 2, 3, 4

Dermatological Conditions with Esophageal Involvement

• Dermatological conditions like pemphigus vulgaris (PV) and esophageal lichen planus (ELP) can cause ulcerative esophagitis even without skin manifestations, according to the American Academy of Dermatology 2, 3, 5

Autoimmune and Systemic Conditions

• Autoimmune conditions such as Crohn's disease, eosinophilic esophagitis (EoE), lymphocytic esophagitis, hypereosinophilic syndromes (HES), and eosinophilic granulomatosis with polyangiitis (EGPA) can lead to esophageal ulcers in patients with competent LES, as stated by the American College of Gastroenterology 1, 2, 3, 5

Diagnostic Approach

• The American Society for Gastrointestinal Endoscopy recommends endoscopy with biopsy as the gold standard for diagnosing most infectious and inflammatory conditions, while biphasic esophagram, direct immunofluorescence (DIF), and high-resolution esophageal manometry are also important diagnostic tools 2, 3, 4