Recognition
- Heartburn and dysphagia: Burning substernal discomfort and difficulty swallowing — hallmarks of reflux and structural involvement
- Odynophagia: Painful swallowing — characteristic of infectious or severely erosive esophagitis
- Chest pain: Can mimic cardiac chest pain. Worsened by lying supine or bending forward
- Regurgitation: Sour or bitter fluid returning to the throat
- Food impaction: Particularly in eosinophilic esophagitis — solid foods lodge in a narrowed esophagus
- Red flags: Progressive dysphagia, unintentional weight loss, hematemesis — suggest Barrett esophagus, stricture, or malignancy
MT Relevance
- No direct contraindication to massage — esophagitis itself does not contraindicate treatment
- Positioning is the primary modification: Avoid flat supine positioning. Semi-reclined (30-45 degrees) or side-lying reduces reflux and associated discomfort
- Post-meal timing: Ask clients not to eat heavily before the session — prone and supine positioning after large meals worsens reflux symptoms
- Infectious esophagitis: Clients with active oral or esophageal candidiasis or herpes may have concurrent immune compromise — apply immunosuppressed client precautions (strict hand hygiene, avoid treatment if therapist is ill)
- Odynophagia or hematemesis: Refer for medical assessment before proceeding with treatment
Required Actions
- Progressive dysphagia, odynophagia, or hematemesis: Refer for medical evaluation — indicates structural complications requiring endoscopic investigation
- Chest pain indistinguishable from cardiac origin: Cardiac cause must be ruled out before attributing to esophagitis
Key Takeaways
- Esophagitis is esophageal mucosal inflammation — most commonly caused by GERD-related acid exposure
- Positioning is the primary MT modification: avoid flat supine. Use semi-reclined or side-lying
- Odynophagia, progressive dysphagia, or hematemesis are red flags requiring medical referral
- Infectious esophagitis occurs in immunocompromised clients — apply appropriate immune precautions
- Esophagitis can progress to Barrett esophagus or stricture if untreated