Esophagitis

Written by Ann Pietrangelo | Published on September 10, 2012
Medically Reviewed by George Krucik, MD

What Is Esophagitis?

Esophagitis is any inflammation or irritation of the esophagus (the tube that sends food from your throat down to your stomach). Common causes include reflux (stomach contents backing up into the esophagus), certain oral medications, and bacterial or viral infections.

This disorder can cause a wide variety of symptoms, including trouble swallowing, sore throat, and heartburn. Left untreated, esophagitis can lead to the development of ulcers or even to a severe narrowing of the esophagus.

Your treatment options and outlook depend on the exact cause of your condition. Most healthy people improve within a few days. In people with a weakened immune system or infection, recovery may take longer.

Types of Esophagitis

Eosinophilic Esophagitis

Eosinophilic esophagitis is caused by too many white blood cells in the esophagus. This is the result of your body over-responding to an allergen. In children, this allergic reaction can make it difficult to eat. According to the Boston Children’s Hospital, one in every 10,000 children has this form of esophagitis (BCH, 2011). Common triggers include milk, soy, eggs, rye, wheat, peanuts, beans, and beef. Inhaled allergens, such as pollen, can also cause this form of esophagitis.

Reflux Esophagitis

Reflux esophagitis is usually caused by gastro-esophageal reflux disease (GERD). In people with GERD, the stomach contents, including acids, frequently back up into the esophagus. Over time, this causes chronic inflammation and irritation of the esophagus.

Drug-Induced Esophagitis

Drug-induced esophagitis is caused when certain medications are taken with too little water. This causes them to linger in the esophagus too long. These may include pain relievers, antibiotics, potassium chloride, and bisphosphonates (drugs that prevent bone loss).

Infectious Esophagitis

Infectious esophagitis is rare and can be caused by bacteria, viruses, fungi, or parasites. You are at increased risk for this type of esophagitis if you have a weakened immune system due to disease and medication. This type of inflammation is common in people with HIV/AIDS, cancer, and diabetes.

Symptoms of Esophagitis

Symptoms of esophagitis include:

  • difficulty swallowing (dysphagia)
  • pain when you swallow (odynophagia)
  • sore throat
  • hoarse voice
  • heartburn
  • acid reflux
  • chest pain when eating
  • nausea, vomiting
  • abdominal pain
  • decrease in appetite
  • cough

Very young children may have difficulty feeding.

If you or your child is experiencing these symptoms, contact your doctor if:

  • you also have shortness of breath or chest pain, especially if it does not occur while eating
  • symptoms continue for more than a few days
  • symptoms are severe enough to interfere with your ability to eat properly
  • you also have headache, muscle aches, or fever

Seek immediate medical attention if:

  • you have chest pain lasting more than a few minutes, especially if you have a history of heart problems
  • you think you may have food stuck in your esophagus

Risk Factors for Esophagitis

Risk factors for developing esophagitis include:

  • weakened immune system due to HIV/AIDS, diabetes, leukemia, lymphoma, or other autoimmune diseases
  • hiatal hernia, where the stomach pushes through the opening in the diaphragm where the esophagus and stomach meet
  • chemotherapy
  • radiation therapy of the chest
  • surgery in the chest area
  • medications to prevent organ transplant rejection
  • aspirin and anti-inflammatory medications
  • chronic vomiting
  • obesity
  • alcohol and cigarette use
  • a family history of allergies or esophagitis

If your immune system is healthy, your chance of developing an infection of the esophagus (infectious esophagitis) is low.

Potential Long-Term Health Complications

Left untreated, esophagitis can lead to other, more serious health complications related to the function and structure of the esophagus. Complications include:

  • Barrett’s esophagus, a condition in which the cells in the lining of your esophagus undergo abnormal changes due to long-term irritation from stomach acid. These cell changes increase your risk for developing esophageal cancer.
  • stricture, or narrowing of the esophagus that can lead to problems swallowing
  • holes or ulcers in the esophagus

How Esophagitis Is Diagnosed

If you have signs of esophagitis, make an appointment to see your doctor. Be prepared to provide a full medical history, including any previously diagnosed conditions. List all the prescription and over-the-counter medications you take.

In addition to a physical examination, your doctor will likely order diagnostic tests, which may include:

  • endoscopy (a tube with a camera is inserted down the throat to allow the doctor to see the esophagus)
  • barium X-ray, also called an upper GI series (your doctor will have you drink a barium solution, which helps abnormalities to show up on an X-ray image)
  • biopsy (a piece of tissue from your esophagus is removed and examined under a microscope)
  • allergy tests, which may include skin tests and eliminating certain foods from your diet

Treatment for Esophagitis

Treatment depends on the specific cause of your symptoms. Medications may include:

  • antiviral medications
  • antifungal medications
  • pain relievers
  • oral steroids
  • proton pump inhibitors to block stomach acid production

If your condition is caused by food allergies, trigger foods must be identified and eliminated from your diet. Common food triggers include tomatoes, citrus fruits, spicy food, alcohol, caffeine, onions, garlic, mint, and chocolate.

Even if your condition is not caused by food allergies, you can ease your symptoms by avoiding spicy foods, acidic foods and drinks, and raw or hard foods. Take smaller bites and chew your food well. You should also avoid tobacco and alcohol, which increase inflammation and suppress the immune system. Ask your doctor for dietary guidelines.

Surgery to dilate the esophagus may be recommended if the esophagus has become too narrow and causes food to become lodged.

If your symptoms are caused by medication, you may be advised to drink more water, take a liquid version of the medication, or to try a different medication. You may also be advised not to lie down for 30 minutes after taking medication in pill form.

Long-Term Outlook

If chronic esophagitis is not treated, it can cause narrowing of the esophagus or tissue damage. Your chances of developing esophageal cancer are higher if the cells lining your esophagus have changed.

You can lower your risk of future bouts of esophagitis by avoiding identified triggers.

Your individual outlook depends on the cause and on your overall health. Most people improve with treatment. Healthy people often recover within three to five days, even without treatment. If you have a weakened immune system, recovery may take longer.

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