Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Esophagitis


Related Terms

  • Corrosive Esophagitis
  • Esophageal Inflammation
  • Gastroesophageal Reflux Disease (GERD)
  • Infectious Esophagitis
  • Reflux Esophagitis

Differential Diagnosis

Specialists

  • Gastroenterologist
  • General Surgeon
  • Otolaryngologist

Comorbid Conditions

Factors Influencing Duration

Factors that might influence the length of an individual's disability include the cause of the esophageal inflammation, the extent of tissue damage, and the treatment used to alleviate the condition. Generally, the length of disability from esophagitis should be minimal except in extreme cases. Severe cases of corrosive esophagitis may require recovery time lasting days to weeks.

Medical Codes

ICD-9-CM:
530.10 - Esophagitis, Unspecified; Esophagitis NOS
530.11 - Esophagitis, Reflux
530.19 - Esophagitis, Other; Abscess of esophagus

Overview

Esophagitis refers to inflammation of the tube (esophagus) that leads from the back of the mouth or throat to the stomach.

There are three main types of esophagitis: reflux, infectious, and corrosive. Reflux esophagitis is a complication of backflow of stomach contents into the esophagus (gastroesophageal reflux). The stomach contents contain hydrochloric acid and a protein-digesting enzyme (pepsin). These can irritate and cause inflammation of the mucus membrane (mucosa) that lines the esophagus when it is exposed to these substances on a long-term basis. Risk factors for developing reflux esophagitis include gastroesophageal reflux disease (GERD), hiatal hernia, or chronic ingestion of highly-seasoned foods or drugs that increase stomach acidity. It can also develop because of vomiting, surgery, or swallowing a sharp object.

Infectious esophagitis develops when fungus, yeasts (especially Candida), viruses (such as herpes or cytomegalovirus), or bacteria invade the esophagus, causing it to become irritated and inflamed. Taking antibiotics is a risk factor for developing infectious esophagitis because antibiotics decrease the number of normal mouth and throat bacteria, while allowing yeast organisms to grow unchecked. Other risk factors for infectious esophagitis include diabetes mellitus, any condition that decreases the movement (motility) capacity of the esophagus, and the decreased responsiveness of the immune system.

Corrosive esophagitis will develop when the esophagus becomes burned, irritated, and inflamed in response to the accidental or deliberate ingestion of corrosive chemicals. The severity of the burn depends upon the type and concentration of the chemical, and the length of time the esophagus has been exposed to the chemical. As with other kinds of burns, esophageal burns are classified as first-, second-, or third-degree. First-degree burns of the esophagus involve only the outer (superficial) mucosa, while second-degree burns involve the entire thickness of the mucosa, and may extend into the muscular layer of the esophageal wall. Notably, ingestion of strong acids usually produces minor esophageal injury with severe stomach (gastric) burns. Risk factors for corrosive esophagitis include ingestion of strong acids (such as drain cleaners, vinegar, or aspirin) or bases (such as lye, oven cleaner, or ammonia). Third-degree burns affect all layers of the esophagus.

Recently there is increased awareness of eosinophilic esophagitis (EE), which may be related to a food allergy or autoimmune disorder. Like other types of esophagitis, symptoms in adults are heartburn, reflux, and dysphagia. A common complaint with EE is food impaction. There is a presence of vast numbers of intra-epithelial eosinophils in the esophagus as diagnosed by endoscopic esophageal biopsy. A high index of suspicion is required to make this diagnosis.

Incidence and Prevalence: The incidence of reflux esophagitis is estimated to be relatively low in the general population. In one study of 470,000 people living in Denmark, the estimated rate of esophageal lesions was 2.4 per 1,000 population (Lassen). However, this figure increases substantially among the obese and in individuals who have been treated for other gastrointestinal maladies such as hiatal hernia and gastritis (Dutta; Yamamoto). Incidence rates at a clinic in Baltimore of 12% and 24% were reported among non-obese and obese patients, respectively (Dutta). A systematic review of the literature resulted in estimating 10% to 20% of the population suffers from reflux or heartburn regularly (Dent). Prevalence of esophagitis in individuals with GERD has been reported between 10% and 70% depending on the patient population (Faybush).

Infectious esophagitis occurs infrequently in the general population; however, it develops in significantly higher rates in individuals who have compromised immune systems (Kaplan).

Incidence of eosinophilic esophagitis (EE) is unknown but suspected to be as high as 2 in 10,000 among children (Rothenberg).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Infectious esophagitis from Candida infection is common in individuals with AIDS (Kaplan 2000).

Ingestion of irritating materials that result in corrosive esophagitis usually happens among children but is also seen among adults both in accidental and intentional ingestion. The amount of damage caused by the ingestion of corrosive material depends on the amount of material ingested and the time it takes to reach appropriate medical care. However, a basic guide to potential damage is that intake of 5 to 10 ml can cause mild damage of the upper intestinal tract, 10 to 20 ml can cause serious post corrosive injuries and intake of 30 ml or more may be lethal during the acute phase, but if not it will cause serious post corrosive complications and long term disability (Chibishev).

Seventy-five percent of individuals reported with eosinophilic esophagitis were male, with the diagnosis usually occurring between 30 and 40 years of age but older patients have also been reported (Fox).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of pain underneath the breastbone (substernal), which is often described as burning. Reflux esophagitis (heartburn) may produce this pain 30 to 60 minutes after eating; it may be aggravated by lying down. The individual with infectious esophagitis may experience painful swallowing (odynophagia) or difficult swallowing (dysphagia). Symptoms of corrosive esophagitis include severe burning pain in the mouth and throat immediately after ingestion of the corrosive material, which increases with swallowing, followed by substernal chest pain. Food impaction and dysphagia are common signs of eosinophilic esophagitis.

Physical exam: The physical exam of an individual with reflux esophagitis may reveal abdominal distention and increased bowel sounds due to excessive gas in the stomach or intestines. Mouth sores (oral lesions) may be apparent with infectious esophagitis. A low-grade fever and enlarged lymph nodes may also be evident. Burns of the lining (mucosa) of the mouth and throat are usually seen with corrosive esophagitis. In some cases, the causative chemical may be identified by odor, and the individual may drool or gag.

Tests: The esophagus and stomach may be visualized by x-ray after swallowing a radiopaque contrast medium (upper GI series). A flexible fiber-optic tube (endoscope) may be inserted into the esophagus to examine the inner (mucosal) lining and to obtain a tissue sample (biopsy) for microscopic analysis. Biopsy specimens may be cultured to identify bacteria, fungus, yeasts or viruses. For corrosive esophagitis, endoscopy is done primarily to determine the extent and depth of esophageal burns. Capsule endoscopy is a less invasive method to evaluate the esophagus.

Source: Medical Disability Advisor



Treatment

Left untreated, esophagitis can cause severe discomfort, swallowing difficulty severe enough to cause malnutrition or dehydration, and eventual esophageal scarring. Treatment for reflux esophagitis may be divided into three phases. Phase I involves general self-care measures that may decrease production of stomach acid. This includes taking over-the-counter antacids and reducing the intake of irritating and acid-producing foods. Phase II involves taking prescription drugs that prevent stomach acid secretion such as histamine receptor antagonists or proton pump inhibitors, as well as taking drugs that stimulate stomach emptying and decrease acid reflux into the esophagus (prokinetic agents). Phase III includes surgical intervention, which includes wrapping (plicating) of the upper part of the stomach (gastric fundus) around the lower end of the esophagus (fundoplication). Gastric acid reflux that causes esophagitis usually requires phase II or III treatment.

Infectious esophagitis that is caused by a fungus usually requires oral antifungal medication. If this is ineffective, antifungal agents may be administered directly into a vein (intravenously). For viral esophagitis, antiviral agents may be given either orally or intravenously. Antibiotics are the best therapeutic option for bacterial esophagitis. Standard antituberculosis medication is recommended if microorganisms that cause tuberculosis (mycobacteria) are present.

Immediate supportive hospital treatment is required for corrosive esophagitis. A small amount of fluid (water or milk) may be taken immediately after ingestion of the corrosive agent to help minimize exposure to chemical. Vomiting should not be induced because this may result in further corrosive exposure and additional damage to the mucosa of the esophagus. Tubes inserted into the nose and down through the esophagus into the stomach (nasogastric, or NG tubes) should be avoided because they may perforate the damaged esophagus. Medications can be given for pain, and intravenous fluids may be administered to avoid the shut-down of vital organ systems (shock). Corticosteroids may be given to decrease inflammation, and antibiotics can be administered to prevent infection (prophylactically).

Further treatment of corrosive esophagitis depends upon the extent and depth of the burn. First-degree burns usually heal without complications and do not require further treatment; the individual can be released from medical care after a period of observation. Second- or third-degree burns may be an indication that a surgical incision into the abdomen (laparotomy) for visualization of the external surface of the stomach and esophagus is necessary. A tissue sample (biopsy) may be taken to define the extent and depth of the burn. Second-degree and small third-degree burns may be treated by placing a slender rod-like supportive device (stent) in the esophagus. While the esophagus heals, the individual is fed through a surgical opening (jejunostomy) in the second portion of the small intestine (jejunum). Extensive third-degree burns may be treated by removing (excising) part of the esophagus (esophagectomy); the esophagus can then be reconstructed 6 to 8 weeks later.

Eosinophilic esophagitis is most effectively treated by systemic use of corticosteroids to reduce the inflammatory response, or by an elimination diet to identify causative food allergies.

Source: Medical Disability Advisor



Prognosis

In most cases, reflux esophagitis is treated effectively using antacids to reduce stomach acidity. Histamine receptor antagonists or proton pump inhibitors lead to a marked reduction in stomach acid output; this has produced significant relief of pain due to acid reflux (gastroesophageal reflux). Fundoplication is generally safe and effective in hands of an experienced surgeon, with a less than 1% mortality rate. . Infectious esophagitis treated effectively with appropriate medications yields positive results in a high percentage of cases. Ongoing treatment of infectious esophagitis is necessary to prevent recurrence among those whose immune system is compromised. The outcome for corrosive esophagitis depends upon the type and amount of irritating agent that was consumed, and the effectiveness of treatment. Generally, esophageal burns from corrosive agents heal in a matter of days to weeks following appropriate treatment. If treatment included abdominal surgery (laparotomy) or esophageal reconstructive surgery, recovery may take weeks to months. However, most individuals may be expected to fully recover after these procedures.

Source: Medical Disability Advisor



Rehabilitation

Regular physical activity on a daily basis is recommended to relieve stress that may exacerbate gastric acid reflux and esophageal irritation. Aerobic exercise such as walking, jogging, or swimming is usually beneficial.

If a fundoplication or a laparotomy has been performed, pulmonary techniques may be necessary to prevent pulmonary complications. Also, exercises may be done to reduce postoperative pain and speed recovery, such as progressive relaxation and deep breathing techniques until pain from inhalation/exhalation is less noticeable. Range of motion and isometric exercises of the lower extremities will help to increase circulation and make walking easier, especially when performed during the first 48 hours after surgery. Individuals may continue with these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.

Source: Medical Disability Advisor



Complications

Complications of esophagitis may include narrowing of the esophagus (esophageal stricture) and the new growth of abnormal tissue (neoplasm) within the esophagus. Individuals with deep esophageal burns may occasionally develop an abnormal passageway (fistula) between the esophagus and an adjacent organ (trachea or aorta).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not usually associated with esophagitis. However, each case must be evaluated on an individual basis taking into consideration the underlying cause for the condition. If stress is aggravating the esophagitis by increasing stomach acid reflux, transfer to a less stressful position may be necessary. Individuals with infectious esophagitis do not usually require work restrictions, although, if they have esophagitis because their immune system is compromised, they may require a less demanding work environment. Following initial treatment for corrosive esophagitis, most individuals may return to a full work load. If treatment included surgery, the individual may require a job with less demanding physical requirements until recovery is complete.

For more information risk, capacity, and tolerance, refer to "Work Ability and Return to Work," pages 354-355.

Risk: No job meeting OSHA standards would contribute to caustic esophageal changes, progressive cancer or impact webs. GERD can be brought out by large late night meals, obesity, alcohol, caffeine, cigarettes, anti-inflammatories, pain, stress and at times chocolate, peppermint, and spearmint. Scleroderma has been associated with exposure to silica dust, vinyl chloride and polyvinyl chloride.

Source: Medical Disability Advisor



Maximum Medical Improvement

2 weeks

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have reflux, infectious, or corrosive esophagitis?
  • Does individual have gastroesophageal reflux disease (GERD), dyspepsia, or chronic ingestion of highly seasoned foods or drugs that increase stomach acidity?
  • Has individual vomited, had surgery, or swallowed a sharp object?
  • Were antibiotics recently taken?
  • Does individual have diabetes or an immunocompromised condition?
  • Were corrosive chemicals accidentally or intentionally ingested?
  • Does individual complain of substernal pain or burning? Is it aggravated when lying down?
  • Does individual complain of painful or difficult swallowing? Did severe burning pain occur in the mouth and throat immediately after ingestion of the corrosive material?
  • On exam, does individual have abdominal distension? Increased bowel sounds? Are oral lesions present? Does individual have a fever? Enlarged lymph nodes? Is individual drooling or gagging?
  • Has individual had an upper GI series? Endoscopy? Biopsy?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • What is the underlying cause of the esophagitis? Is it being treated?
  • Is individual on the appropriate medications? Was a fundoplication considered?
  • Was a small amount of fluid (water or milk) used to reduce exposure to the corrosive material? Did vomiting occur?
  • Was a laparotomy necessary? Was a biopsy done?
  • Was it necessary to place a stent in the esophagus? Was a jejunostomy done?
  • Was an esophagectomy necessary? Has it been reconstructed?

Regarding prognosis:

  • Does individual exercise regularly?
  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications occurred such as esophageal stricture, neoplasm, or a fistula between the esophagus and the trachea or aorta?

Source: Medical Disability Advisor



References

Cited

Chibishev, A. , et al. "Clinical and Epidemiological Features of Acute Corrosive Poisonings." Medicinski arhiv 66 (2012): 11-15.

Dent, J. , et al. "Epidemiology of Gastro-Oesophageal Reflux Disease: A Systematic Review." Gut 54 (2005): 710-717.

Dutta, S. k. , et al. "Upper Gastrointestinal Symptoms and Associated Disorders in Morbidly Obese Patients: A Prospective Study." Digestive Diseases and Sciences 54 (2009): 1243-1246.

Faybush, Elisa M., and Ronnie Fass. "Gastroesophageal Reflux Disease in Noncardiac Chest Pain." Gastroenterology Clinics of North America 33 1 (2004): 41-41. MD Consult. Elsevier, Inc. 4 Jun. 2013 <http://home.mdconsult.com/das/journal/view/43283956-2/N/14572404?ja=408919&PAGE=1.html&sid=288416452&source=>.

Fox, V. L., S. Nurko, and G. T. Furuta. "Eosinophilic Esophagitis: It's Not Just Kid's Stuff." Gastrointestinal Endoscopy 56 2 (2002): 260-270. MD Consult. Elsevier, Inc. 4 Jun. 2013 <http://home.mdconsult.com/das/journal/view/43283956-2/N/12497803?sid=288416452&source=MI>.

Kaplan, J. E. , et al. "Epidemiology of Human Immunodeficiency Virus-Associated Opportunistic Infections in the United States in the Era of Highly Active Antiretroviral Therapy." Clinical Infectious Diseases 30 Suppl 1 (2000): s5-s14.

Lassen, A. , J. Hallas, and O. B. de Muckadell. "Esophagitis: Incidence and Risk of Esophageal Adenocarcinoma--a Population-Based Cohort Study." The American journal of gastroenterology 101 (2006): 1193-1199.

Rothenberg, M. E. "Eosinophilic Gastrointestinal Disorders." Journal of Allergy and Clinical Immunology 113 1 (2004): 11-28. MD Consult. Elsevier, Inc. 4 Jun. 2013 <http://home.mdconsult.com/das/journal/view/43283956-2/N/14299843?sid=288433304&source=MI>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Yamamoto, S. , K. Watabe, and T. Takehara. "Is Obesity a New Risk Factor for Gastritis?" Digestion 85 (2012): 108-110.

Source: Medical Disability Advisor






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