Esophagitis is an inflammation of the esophagus – the muscular tube that passes food and drink from the mouth to the stomach. It can result in damage of the esophagus.
In some severe cases, untreated esophagitis can lead to alterations in the structure and function of the esophagus.
Treatment focuses on eliminating the cause of the inflammation and making sure to avoid triggers, such as certain foods or allergens. In some cases, using medication to treat the inflammation can also help. If diagnosed rapidly and treated properly, the outlook for esophagitis is good.
Several conditions can cause esophagitis. Sometimes, the condition may be caused by more than one factor.
This is the most common cause – known as reflux esophagitis. At the lower end of the esophagus, there is a valve that stops acids in the stomach from going back up into the esophagus. This is called the 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.
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 blood rise and cause inflammation.
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.
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 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
- 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.
- Corticosteroids: These oral medications can reduce allergy-related inflammation, resulting in less inflammation in the esophagus, allowing it to heal.
- Inhaled steroids: Primarily used for the treatment of asthma, inhaled steroids can help reduce the symptoms of eosinophilic esophagitis.
- 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: A procedure may be performed to dilate the esophagus.
The following are risk factors for GERD, which also raise the chances of developing reflux esophagitis:
- being overweight or obese
- hiatal hernia
- consuming certain foods and drinks in large quantities regularly, such as tomato-based foods, citrus fruits, chocolate, garlic, onions, spicy foods, alcohol, and caffeine
- 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.