Esophageal Inflammation – Causes, Symptoms & Treatment
Esophageal inflammation, known as esophagitis, is an irritation or swelling of the esophageal lining. It causes swallowing difficulties and heartburn and requires medical evaluation.
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Esophageal inflammation, known as esophagitis, is an irritation or swelling of the esophageal lining. It causes swallowing difficulties and heartburn and requires medical evaluation.
What Is Esophageal Inflammation?
Esophageal inflammation, medically referred to as esophagitis, is an inflammation of the mucous membrane lining the esophagus -- the muscular tube that carries food and liquids from the mouth to the stomach. When the lining becomes irritated or damaged, an inflammatory response occurs that can cause a range of uncomfortable and potentially serious symptoms. If left untreated, esophagitis can lead to complications such as scarring, narrowing of the esophagus, or precancerous cell changes.
Causes
Esophageal inflammation can result from several different causes:
- Gastroesophageal reflux disease (GERD): The most common cause. Stomach acid flows back into the esophagus and damages the lining, causing reflux esophagitis.
- Infections: Fungi (e.g., Candida albicans), viruses (e.g., herpes simplex virus, cytomegalovirus), or bacteria can cause esophagitis, particularly in individuals with weakened immune systems.
- Medications: Certain pills such as bisphosphonates, antibiotics like doxycycline, and nonsteroidal anti-inflammatory drugs (NSAIDs) can damage the esophageal lining if not taken with sufficient water.
- Eosinophilic esophagitis: An allergic and immune-mediated condition in which a type of white blood cell (eosinophils) accumulates in the esophageal lining, causing chronic inflammation.
- Radiation therapy: Radiation treatment to the chest or neck area can cause esophageal inflammation as a side effect.
- Chemical injury: Swallowing corrosive substances such as strong acids or alkalis can cause severe damage to the esophageal mucosa.
Symptoms
The symptoms of esophageal inflammation can vary depending on the cause and severity. Common signs include:
- Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
- Heartburn and acid regurgitation
- Chest pain or a feeling of pressure behind the breastbone
- Nausea and vomiting
- Hoarseness or a chronic cough (especially with reflux-related esophagitis)
- Loss of appetite and unintentional weight loss
Diagnosis
Several diagnostic procedures are available to confirm esophageal inflammation:
- Upper endoscopy (esophagogastroduodenoscopy, EGD): A camera is used to directly examine the esophageal lining. Tissue samples (biopsies) can also be taken during this procedure.
- 24-hour pH monitoring and impedance testing: Measures the level of acid exposure in the esophagus over a 24-hour period to confirm GERD.
- Barium swallow X-ray: A contrast X-ray study that may be used to detect narrowing or swallowing abnormalities.
- Laboratory tests: Blood tests or swab cultures can help identify infectious causes.
Treatment
Treatment depends on the underlying cause of the esophageal inflammation:
Reflux Esophagitis
Proton pump inhibitors (PPIs) such as omeprazole or pantoprazole are the first-line treatment, reducing stomach acid production. Lifestyle changes are also recommended, including avoiding fatty foods, alcohol, and tobacco, and sleeping with the head of the bed elevated.
Infectious Esophagitis
Fungal infections are treated with antifungal medications (e.g., fluconazole). Viral esophagitis is managed with antiviral drugs (e.g., acyclovir).
Eosinophilic Esophagitis
Treatment includes topical or systemic corticosteroids, elimination of food allergens from the diet, and in some cases, dilation (stretching) of narrowed esophageal segments performed by a specialist.
Medication-Induced Esophagitis
The causative medication should be discontinued or substituted after consulting a physician. Taking pills with a full glass of water while sitting upright can help prevent this condition.
References
- Katzka D.A., Kahrilas P.J. - Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ. 2020;371:m3786. PubMed PMID: 33168568.
- Dellon E.S., Hirano I. - Epidemiology and Natural History of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):319-332. PubMed PMID: 28774845.
- World Gastroenterology Organisation (WGO) - Global Guidelines: Esophageal Diseases, 2014. Available at: www.worldgastroenterology.org.
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