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Esophagitis: Causes, Symptoms and Treatment
Esophagitis is an inflammation of the lining of the esophagus, the tube connecting the mouth to the stomach. It causes heartburn, painful swallowing, and chest pain, and requires medical evaluation.
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Esophagitis is an inflammation of the lining of the esophagus, the tube connecting the mouth to the stomach. It causes heartburn, painful swallowing, and chest pain, and requires medical evaluation.
What is Esophagitis?
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. It is one of the most common disorders of the upper digestive tract and can occur in both acute and chronic forms. Left untreated, esophagitis can lead to serious complications.
Causes
There are several possible causes of esophagitis:
- Reflux esophagitis (GERD-related): The most common type. Stomach acid flows back into the esophagus, irritating and damaging the lining. This is typically caused by a weakened lower esophageal sphincter.
- Infectious esophagitis: Caused by fungi (e.g., Candida albicans), viruses (e.g., herpes simplex virus, cytomegalovirus), or bacteria -- most often in immunocompromised individuals.
- Drug-induced esophagitis: Certain medications such as aspirin, bisphosphonates, or some antibiotics can injure the esophageal lining, especially when swallowed without enough water.
- Eosinophilic esophagitis: A chronic, immune-mediated condition in which large numbers of eosinophils (a type of white blood cell) accumulate in the esophageal lining, often triggered by food allergens.
- Radiation esophagitis: A side effect of radiation therapy to the chest or neck area.
- Chemical injury: Caused by swallowing corrosive or caustic substances.
Symptoms
Common signs and symptoms of esophagitis include:
- Heartburn and acid regurgitation
- Painful swallowing (odynophagia) or difficulty swallowing (dysphagia)
- Chest pain, which may mimic cardiac symptoms
- Hoarseness and chronic cough (especially with reflux)
- Nausea and occasional vomiting
- In severe cases: bleeding in the esophagus, indicated by blood in vomit or black, tarry stools
Diagnosis
The following diagnostic procedures are used to identify esophagitis:
- Upper endoscopy (esophago-gastroscopy): A flexible camera is used to directly visualize the esophageal lining. Tissue samples (biopsies) can be taken during this procedure.
- 24-hour pH monitoring: Measures the acid levels in the esophagus over 24 hours to confirm acid reflux.
- Barium swallow X-ray: Imaging study that outlines the structure of the esophagus using a contrast agent.
- Laboratory tests: Used to identify infections or allergic causes.
Treatment
Treatment depends on the underlying cause of the esophagitis:
Reflux Esophagitis
- Acid-suppressing medications: Proton pump inhibitors (e.g., omeprazole, pantoprazole) or H2-receptor antagonists
- Lifestyle modifications: weight loss, avoiding fatty foods, alcohol, and nicotine, not eating late at night, elevating the head of the bed
- In severe cases: surgical intervention (fundoplication)
Infectious Esophagitis
- Antifungal agents (e.g., fluconazole for Candida infections)
- Antiviral medications (e.g., acyclovir for herpes esophagitis)
- Antibiotics (for bacterial infections)
Eosinophilic Esophagitis
- Dietary management (elimination of trigger food allergens)
- Topical corticosteroids (e.g., swallowed budesonide) to reduce inflammation
- Proton pump inhibitors as adjunct therapy
General Recommendations
- Soft, easily digestible diet during the acute phase
- Avoiding acidic foods and beverages (e.g., coffee, citrus fruits, carbonated drinks)
- Regular follow-up examinations with a gastroenterologist
Complications
If left untreated, esophagitis can lead to serious complications, including:
- Barrett esophagus: Abnormal changes in the esophageal lining caused by chronic acid exposure, associated with an increased risk of esophageal cancer
- Esophageal stricture: Narrowing of the esophagus due to scarring
- Ulcers: Open sores in the esophageal lining
- Bleeding: From damaged blood vessels in the esophagus
References
- Katzka, D.A. & Kahrilas, P.J. - Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ, 354, i2393 (2016). PubMed PMID: 27411037.
- Dellon, E.S. & Hirano, I. - Epidemiology and Natural History of Eosinophilic Esophagitis. Gastroenterology, 154(2), 319-332 (2018). PubMed PMID: 28774845.
- World Gastroenterology Organisation (WGO) - Global Guidelines: Gastroesophageal Reflux Disease (GERD). WGO Practice Guidelines (2022).
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