Esophageal ulcers: Symptoms, causes, and treatment
Individually, peptic ulcers are described by where they are found, the most common being gastric ulcers in the stomach and duodenal ulcers in the upper portion of the small intestine.
Peptic ulcers that occur in the esophagus are known as esophageal ulcers.
In this article, we explore the details of esophageal ulcers, including their symptoms, causes, and the available treatments.
- They are a type of peptic ulcer that develops in the lining of the esophagus, the tube that connects the throat to the stomach.
- Symptoms include pain or a burning sensation behind or below the sternum, the flat bone that runs down the center of the chest.
- Medications, infections, and exposure to stomach acid are common causes.
- Treatment involves addressing the cause of the ulcer.
What is an esophageal ulcer?
An esophageal ulcer is a type of peptic ulcer that develops in the lining of the esophagus, the tube that connects the throat to the stomach.
Esophageal ulcers occur when the layer of mucus, which lines and protects the gastrointestinal tract, wears away.
This allows stomach acid and other gastric juices to irritate the gastrointestinal wall, leading to ulceration.
Peptic ulcers commonly form in the upper digestive tract. The esophagus is part of this, between the mouth and the stomach.
Aside from a burning pain in the center of the chest, esophageal ulcers typically cause pain or a burning sensation behind or below the sternum, in the center of the chest.
Other symptoms include:
- loss of appetite
- difficulty swallowing
- shortness of breath
- sore throat
- sour taste in the mouth
- abdominal pain
- vomiting, sometimes including blood
- weight loss
How are esophageal ulcers caused?
The main causes of esophageal ulcers are:
Exposure to stomach acid: This causes chronic inflammation and irritation of the esophagus, allowing ulcers to develop. Stomach acid exposure most often occurs in people with other gastrointestinal conditions. These can include hiatal hernias and GERD, or gastrointestinal reflux disease, more commonly referred to, as severe heartburn.
Caustic injury: Esophageal ulcers may be caused by ingesting a corrosive substance. This type of injury mostly affects children, but it can also occur in adults who experience psychosis, suicidal tendencies, or who are abusing alcohol.
Certain types of gastric surgery or foreign bodies can also cause esophageal ulcers.
Spices, mint, citrus fruits, and garlic should be avoided when treating an ulcer.
Early intervention is key to preventing complications from esophageal ulcers.
In cases of acid reflux, treatment may include:
- Medication, such as antacids, H-2-receptor blockers, and proton pump inhibitors (PPIs).
- Dietary and lifestyle changes, to aid digestion.
- Surgery, for severe cases. Types of surgeries include to tighten the LES (lower esophageal sphincter) valve near the top of the stomach or to insert a magnetic device to help the LES valve function.
Esophageal ulcers that are not caused by GERD may require different interventions. For example, antibiotics or antifungals may be prescribed in cases of ulcers caused by infection.
Making changes to lifestyle and diet can be beneficial in reducing acid reflux and GERD, which are common causes of esophageal ulcer formation.
Lifestyle and dietary changes
Lifestyle changes to treat ulcers include:
- eating slowly
- never overeating
- avoiding lying down for approximately 3 hours after eating
- maintaining a healthy body weight
- wearing loose clothing to reduce pressure on the stomach
- quitting smoking, as smokers are at greater risk of GERD
- raising the head of the bed to reduce nighttime acid reflux
Dietary changes to treat ulcers include eating a balanced diet of lean protein, whole grains, nuts, seeds, fruits, and vegetables.
Certain foods and drinks trigger GERD and should be avoided. They include:
- fried foods
- high-fat foods
- spicy foods
- tomatoes and tomato-based foods
Since foods that trigger acid reflux and GERD can vary between individuals, it can be helpful to keep a diary of daily food intake and associated symptoms.
A doctor will make a diagnosis of an esophageal ulcer based upon:
- a person's medical history
- a physical examination
- an endoscopy to look inside the esophagus
- a barium X-ray
If an ulcer is detected, the doctor may take a small sample of the ulcer tissue to examine it further.
Several conditions can increase the risk of developing an esophageal ulcer. They include:
- gastric ulcers
- duodenal ulcers
- oropharyngeal candidiasis, or a yeast infection
- HIV and AIDS
- esophageal cancer
Complications that may arise from having an esophageal ulcer include:
- upper gastrointestinal bleeding, in rare cases
- recurrent peptic ulcers
- esophageal strictures that narrow the esophagus
- esophageal cancer
- excessive weight loss due to appetite loss and difficulty swallowing
- esophageal rupture
- death in the rare cases of ulcer hemorrhage or perforation