Key takeaways
- Esophageal ulcers are sores in the esophagus that can result from GERD, certain medications, or other conditions.
- Symptoms of esophageal ulcers may include chest pain, heartburn, acid reflux, and difficulty swallowing.
- Treatment options range from medications and lifestyle changes to surgery in severe cases, with early intervention being important to prevent complications.
Ulcers are sores or lesions that can occur along the upper digestive tract. Esophageal ulcers form in the esophagus, which is the pipe that connects the throat to the stomach.
In this article, we explore the details of esophageal ulcers, including their symptoms, causes, and the available treatments.
An esophageal ulcer is a type of peptic ulcer that develops in the lining of the esophagus, also known as the “food pipe”.
Esophageal ulcers occur when the layer of mucus that lines and protects the gastrointestinal tract wears away.
Esophageal ulcers can cause pain or a burning sensation behind or below the sternum, which is the bone in the center of the chest.
Depending on the cause, the other symptoms may include:
The potential causes of esophageal ulcers are:
- Exposure to stomach acid: Acid exposure causes chronic inflammation and irritation of the esophagus, which can lead to the development of ulcers. The
most common reason for this is gastrointestinal reflux disease (GERD), a condition that causes chronic acid reflux. - Medications: Certain drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, and some antibiotics, can cause inflammation of the esophagus. Some dietary supplements, such as iron or potassium supplements, may also have this effect.
- Infections: The fungal infection known as candida, the herpes simplex virus (HSV), and HIV can all cause esophageal ulcers. Rarely, there have been reports of esophageal ulcers in people with COVID-19, tuberculosis, and mpox.
- Injury: Esophageal ulcers may be caused by ingesting an irritating substance, such as foods that are too hot. Sometimes, people may get esophageal ulcers from injuring themselves by drinking corrosive substances.
- Surgery or radiotherapy: Esophageal ulcers may develop after surgery in the area, or from procedures such as endoscopy or the placement of a nasogastric tube. Radiation around the chest can also inflame the area and may lead to ulcers in severe cases.
- Autoimmune or inflammatory conditions: Rarely, inflammatory bowel disease (IBD) can affect the esophagus, resulting in ulcers. Autoimmune or inflammatory skin conditions, such as lichen planus and systemic sclerosis, can also affect the esophagus.
- Cancer: Some types of cancer can form in the esophagus, such as squamous cell cancer (SCC) or adenocarcinoma.
A doctor may 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 there is an ulcer, the doctor may take a small sample of the ulcer tissue to examine it further.
Early intervention is key to preventing complications from esophageal ulcers. Treatment will vary depending on the cause.
Treatment for GERD
If acid reflux caused the ulcer, treatment may include:
- medication to reduce stomach acid, such as antacids, H2 receptor blockers, and proton pump inhibitors (PPIs)
- dietary and lifestyle changes reduce triggers
- surgery, for severe cases
Dietary and lifestyle changes that a doctor
- avoiding lying down after eating
- maintaining a healthy body weight
- raising the head of the bed to reduce nighttime acid reflux
- quitting smoking
People may also find it helpful to keep a symptom diary to determine if any specific foods or drinks exacerbate their GERD,
- alcohol
- caffeine
- citrus
- garlic
- high-fat foods
- mint
- onions
- spicy foods
- tomatoes and tomato-based foods
People do not necessarily need to avoid all these foods. People with GERD can have different triggers. It may be helpful to remove them from the diet and then test each one individually with the assistance of a dietitian.
Treatment for other causes
Treatment for other causes of esophageal ulcers
- stopping or altering the medications a person takes
- taking antibiotics or antifungal drugs for inections
- taking medications that reduce inflammation or manage autoimmune conditions
- temporarily taking PPIs to allow an injury to heal after surgery, radiotherapy, or other procedure
- cancer treatment
- emergency treatment in a hospital if the cause is drinking a corrosive substance
Do not stop or change a medication without consulting a doctor first.
Complications that may arise from having an esophageal ulcer include:
- bleeding
- recurrent ulcers
- strictures that narrow the esophagus
- excessive weight loss due to appetite loss and difficulty swallowing
- esophageal cancer, if the cause is GERD or chronic irritation
- perforation of the ulcer, which
can be fatal
Dial 911 or the number of the nearest emergency department if a person:
- has consumed a toxic or corrosive substance, such as an acid or bleach
- vomits blood, which may look bright red or like coffee grounds
- has blood in their stool, or it is black and tarry
- has chest pain
- has severe abdominal pain
- the abdomen feels swollen or tender to touch
Ask for an ambulance and do not attempt to drive. Bring any medications the person takes with them to the hospital.
Contact with a toxic substance: What to do
If someone has come into contact with a toxic substance, take action immediately. First, reduce harm in one of the following ways:
- For swallowed poison: If a person is experiencing burning or irritation and they are conscious, not having convulsions, and able to swallow, help them drink a small amount of water or milk.
- For poison in the eye: Remove contact lenses and rinse the eye immediately under a running faucet for at least 15 to 20 minutes. Adults or older children may find it easier to rinse eyes in the shower.
- For poison on clothing: Remove the contaminated clothing immediately and rinse the skin under running water.
- For inhaled poison: Get to fresh air and stay away from the toxic fumes or gases.
Next, contact Poison Control, or ask someone else to do this. There are two methods: - call Poison Control at 800-222-1222
- use the POISONCONTROL tool
Both options provide free, expert advice on what to do in a given situation and are available 24–7.
Do not try to treat poisoning at home with ipecac syrup, charcoal, or other home remedies. These substances can be ineffective or even harmful.
Esophageal ulcers are sores that develop in the esophagus, also known as the food pipe. The most common cause of these ulcers is GERD, but they can also occur due to medications, inflammatory and autoimmune conditions, injuries, and cancer.
Esophageal ulcers often cause pain behind the sternum or breastbone. A person may also have heartburn, acid reflux, or pain when swallowing.
It is essential to consult a doctor for a diagnosis if a person suspects they have an ulcer. Depending on the cause, a range of medications, dietary changes, or procedures may help alleviate the condition.