Esophagitis is inflammation of the esophagus, the muscular tube that passes food and drink from the mouth to the stomach.

This inflammation can cause damage, and in some severe cases, it can cause bleeding, aspiration pneumonia, or stricture or tearing of the esophagus.

Treating esophagitis involves eliminating the cause of the inflammation and avoiding any triggers, such as certain foods or allergens.

For some people, medication can also help. If a doctor diagnoses and treats esophagitis swiftly, the outlook is good.

A person with esophagitisShare on Pinterest
Sergey Filimonov/Stocksy

Several conditions can cause esophagitis. Sometimes, the condition may be caused by more than one factor.

These include:

GERD

This is the most common cause – known as reflux esophagitis. At the lower end of the esophagus, there is a ring of muscle that stops acids in the stomach from going back up into the esophagus. This is called the lower esophageal sphincter.

If the esophageal sphincter is faulty – it does not close and open properly – stomach contents can make their way back up into the esophagus (reflux). GERD can irritate the esophagus, leading to esophagitis.

Everyone experiences a certain amount of normal, or physiologic, reflux. Excess reflux can be problematic. An issue with lower esophageal sphincter function is only one part of the story for GERD.

Other factors may include the presence of a hiatal hernia (when part of the stomach slides up into the chest). Some of the more common factors tend to be foods that may have a high acidic content, such as red salsa, onions, alcohol, citrus fruits or juices, and so on.

Allergies

Certain allergies can cause eosinophilic esophagitis, triggered by an allergic reaction. Eosinophils are a type of white blood cell. When there is an allergic reaction or an infection, the numbers of eosinophils in the esophagus rise and cause inflammation.

Medications

Some medications can cause esophagitis, this is known as drug-induced esophagitis. If drugs are in contact with the esophagus lining for too long, or if a large pill causes irritation as it is swallowed, it can produce inflammation.

This can happen if tablets are swallowed without washing them down with enough water. Residue from the tablet, pill, or capsule may stay in the esophagus. Most commonly, it occurs with some painkillers, antibiotics, drugs to treat potassium deficiency, and certain drugs for the treatment for osteoporosis.

This issue can be aggravated by decreased mobility. For instance, people who are bedridden, or just not moving enough, may be more subject to drug-induced esophagitis.

Infections

Infectious esophagitis can occur in people who have weakened immune systems. It can be caused by fungal infections like candida, or viral infections like herpes simplex orcytomegalovirus. With the help of endoscopy, a trained doctor can identify the source of the infection.

Other causes

Other causes of esophagitis include alcohol abuse, radiation therapy, nasogastric tubes, and chemical injury from ingested alkaline or acid solutions. Chemical injury can occur if a child drinks cleaning solutions, or if an adult swallows caustic substances during a suicide attempt.

These are the signs and symptoms most commonly linked to esophagitis:

  • abdominal pain
  • pain and difficulty when swallowing
  • food becoming stuck in the esophagus
  • lack of appetite
  • nausea and possibly vomiting
  • cough
  • pain in the chest when eating, heartburn
  • mouth sores

In children and infants, symptoms include feeding difficulties, and possible failure to thrive, or difficulty gaining adequate weight. At this age, most patients are too young to describe their symptoms.

Treatment will depend almost entirely on what caused the inflammation:

Gastroesophagal reflux disease (GERD)

  • Acid blockers, including H2-blockers and proton pump inhibitors: These are drugs that have a long-lasting effect on reducing gastric acid production.
  • Fundoplication: This is surgery to treat GERD. Part of the stomach is wrapped around the lower esophageal sphincter, which strengthens it and prevents stomach acid from making its way back to the esophagus.

Surgeries or endoscopic procedures such as Transoral Incisionless Fundoplication are typically reserved for cases who are not responsive to maximal medical therapy.

Allergies

  • Corticosteroids: These oral medications can reduce allergy-related inflammation, resulting in less inflammation in the esophagus, allowing it to heal.
  • Proton pump inhibitors: Patients with esophagitis caused by allergies may have good results when prescribed proton pump inhibitors if there is a certain amount of reflux as well.
  • Food allergy: The treatment here is simply to eliminate foods that cause allergies. A doctor will usually refer the patient to a qualified dietician, or in some cases to an allergist for testing if it is unclear which foods are related.
  • Esophagitis caused by certain medications: The doctor may prescribe an alternative medication, or change how it is given – from solid to liquid form, for example.
  • Esophagitis caused by infections: The doctor will probably prescribe a specific medication to fight the infection, depending on whether the pathogen is a virus, fungus, parasite, or bacterium.
  • Severe narrowing of the esophagus: The doctor will typically try medication first to try an alleviate any component of inflammation. A procedure may be performed to dilate the esophagus if there is persistent narrowing and medication is not successful.

The following are risk factors for GERD, which also raise the chances of developing reflux esophagitis:

  • being overweight or obese
  • hiatal hernia
  • pregnancy
  • smoking
  • consuming certain foods and drinks in large quantities regularly, such as tomato-based foods, citrus fruits, chocolate, garlic, onions, spicy foods, alcohol, and caffeine
  • allergies
  • medications, especially having to swallow large pills
  • lying down immediately after a meal
  • taking medications when lying down, or taking medications before going to bed
  • infections, as having a weakened immune system may raise the risk of developing infectious esophagitis

After asking the patient about their symptoms, their medical history, and carrying out a physical examination, the doctor may order some further diagnostic tests:

Barium X-ray: This provides a well-defined X-rays of the esophagus, which helps the doctor determine whether there is any narrowing or structural alteration in the esophagus.

Endoscopy: A long, thin tube with a small camera at the end is threaded down the patient’s throat. By looking at the esophagus and possibly taking a small sample, the physician can determine what caused the inflammation.

Tissue samples: A small amount of tissue may be removed to determine whether the inflammation is caused by an organism, allergy, cancer, or a precancerous change.

Allergy: Some tests may be performed to find out whether the patient is sensitive to one or more allergens. This may involve a skin-prick test, blood test, or elimination diet.

Article resources