What is Esophagitis?

Esophagitis is an inflammation (swelling or irritation) of the esophagus, the swallowing tube running from the throat down to the stomach. It commonly occurs due to chronic acid reflux (GERD), but there are other causes as well. Symptoms of esophagitis include a burning chest pain and painful or difficulty swallowing due to the inflamed esophagus. Esophagitis treatment depends on the cause of the inflammation.

It's pretty common to develop esophagitis as a result of acid reflux, and the prognosis is good if diagnosed and treated early on. Getting timely esophagitis treatments can help prevent potentially serious complications.

Anatomy of the Esophagus

The esophagus, commonly called the food pipe or swallowing tube, is a hollow muscular tube, about 10-13 inches long in adults. It is located in the center of the chest, behind the trachea (windpipe), and in front of the spine. The esophagus is part of the body’s digestive system and connects the mouth and stomach. The main function of the esophagus is that it carries food and liquids from the mouth to the stomach. Some of the key structures that allow the esophagus to do its job include:

Upper esophageal sphincter: A ring-shaped muscle that stays closed but relaxes to allow food to enter the esophagus.
Esophageal muscles: Muscles in the esophageal wall contract in waves (this is called peristalsis) to move food toward the stomach.
Esophageal epithelium: The inner lining of the esophagus that can become irritated.
Lower esophageal sphincter (LES): Another ring-shaped muscle that relaxes to allow food and liquid to pass into the stomach. When you’re not eating, the LES stays closed to prevent stomach acid and digestive juices from backing up into the esophagus.

Importance of Early Detection

It’s important to recognize the symptoms of esophagitis and seek timely treatment. Undiagnosed or untreated esophagitis can lead to serious complications such as:

Esophageal stricture (the narrowing of the esophagus).
Mallory-Weiss syndrome or Mallory-Weiss tear (the tear of the lower esophagus causing bleeding
Barrett’s esophagus (damage to esophageal cells from acid reflux and chronic inflammation that causes the esophageal lining to be inflamed and thicken).
Increased risk of esophageal cancer in people with chronic esophagitis.

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Common Symptoms of Esophagitis

Trouble swallowing (dysphagia)
Painful swallowing (odynophagia)
A sensation of food stuck in your throat (food impaction)
A sharp or burning pain in the chest behind the breastbone (acid reflux and heartburn) - this pain may be constant, or it may come and go; the pain may be worse after meals and with lying down

Other potential esophagitis symptoms include:

Babies and young children with esophagitis may have the following symptoms:

Trouble feeding (easily upset while feeding, not wanting to feed, arching the back during feeds)
Failure to thrive (not gaining weight as expected)

Older children may complain of chest or belly pain.

Potential Causes and Risk Factors of Esophagitis

Reflux Esophagitis

Reflux esophagitis is a common type of esophagitis that occurs in people with acid reflux or a condition called gastroesophageal reflux disease (GERD). In people with this condition, the lower esophageal sphincter does not close properly, allowing stomach acid to backflow into the esophagus. The acid causes damage and inflammation of the esophagus (this is called erosive esophagitis).

Similarly, in people with a hiatal hernia, a part of the stomach bulges into the chest through the diaphragm. This allows stomach acid to back up into the esophagus, causing esophagitis.

Sometimes, people with eating disorders such as bulimia nervosa develop reflux esophagitis due to self-induced vomiting.

Risk factors for reflux esophagitis include:

Eating just before bedtime.
Eating large or fatty meals.
Being overweight or obese.
Smoking.
Common dietary triggers such as caffeine, alcohol, chocolate, peppermint, acidic foods, spicy foods, and greasy or fatty foods

Eosinophilic Esophagitis

Eosinophilic esophagitis, sometimes called autoimmune esophagitis, is a chronic condition causing inflammation of the esophagus; this condition occurs when large numbers of eosinophils collect in the esophagus. Eosinophils are a type of white blood cells produced during allergic reactions in the body. This usually happens due to a food allergy, acid reflux, or a combination of the two.

Foods that commonly trigger eosinophilic esophagitis include eggs, milk, wheat, seafood, peanuts, and soy. People with eosinophilic esophagitis may also have other allergies, such as seasonal allergies to pollen.

Risk factors for eosinophilic esophagitis include other allergic conditions such as allergic rhinitis, asthma, and atopic dermatitis, and a family history of the condition.

Lymphocytic Esophagitis

Lymphocytic esophagitis is a rare type of esophagitis that occurs due to increased lymphocytes in the esophageal lining. Lymphocytes are white blood cells that protect the body from infections. Lymphocytic esophagitis sometimes co-occurs with eosinophilic esophagitis or gastroesophageal reflux disease (GERD).

Drug-Induced Esophagitis

Certain medications taken by mouth can damage the lining of the esophagus and cause inflammation. Sometimes, the damage can occur because of how you take the medicine. For example, if you swallow a pill with no water or too little water, it may stick to the esophageal lining, cause damage, and result in an inflamed esophagus (this is sometimes called pill esophagitis).

Some of the medications that can cause medicine-induced esophagitis include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) (over-the-counter pain relievers) such as aspirin, ibuprofen (Motrin, Advil), and naproxen sodium (Naprosyn, Aleve).
Bisphosphonates (prescribed for osteoporosis), for example, alendronate (Fosamax, Binosto) and risedronate (Actonel).
Certain antibiotics, such as doxycycline and tetracycline.
Quinidine (prescribed for heart problems).
Potassium chloride (used to treat low potassium).
Iron supplements.
Chemotherapy and radiation treatment for cancer (radiation esophagitis).

Risk factors for drug-induced esophagitis include:

Swallowing pills without water or with very little water.
Taking large or oddly shaped pills.
Taking medicines while lying down or right before bedtime.
Older age.

Infectious Esophagitis

Bacterial, fungal, or viral infections of the esophagus can cause an inflamed esophagus. A common cause of infectious esophagitis is a fungus called Candida albicans which causes oral candidiasis or thrush. This fungal infection often occurs in people with a weakened immune system, such as those with cancer or HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), people with diabetes, and those taking certain antibiotics or steroid medicines. Other possible causes include viral infections caused by the herpes simplex virus (HSV) or cytomegalovirus (CMV).

Impact on Daily Life

The symptoms of esophagitis, such as chest pain and difficulty swallowing, can impact daily life, including decreased work productivity, sleep disturbances, and impact on social life by limiting the ability to eat.

Medical History and Physical Examination

Your healthcare provider can make a diagnosis of esophagitis based on your symptoms, medical history, and physical exam. You may need one or more tests to confirm the diagnosis.

Diagnostic Tests and Procedures

Upper Endoscopy

Upper endoscopy, also called esophagogastroduodenoscopy or EGD, is a minimally invasive diagnostic test that allows your healthcare provider to directly visualize the inside of your esophagus. It is done using an instrument called an endoscope, which is a long, flexible tube with a tiny video camera at its tip. A biopsy (a small sample of esophageal tissue) can be taken during an upper endoscopy for examination in the laboratory.

Esophageal Capsule

Esophageal capsule is a test in which you swallow a capsule attached to a string. It dissolves in your stomach and releases a sponge, which your healthcare provider pulls out with the help of the string. The sponge brings with it a sample of your esophageal tissue. This tissue is then examined in the laboratory to look for signs of an inflamed esophagus.

Barium X-Ray

A barium X-ray is an X-ray that is done after you swallow a substance called barium. The barium coats the inside of your esophagus and stomach and allows your doctor to see if there is any change in the structure, such as a narrowing, hiatal hernia, or tumor.

Biopsy

A biopsy consists of small tissue samples obtained during an endoscopy. This tissue sample is examined in the laboratory to look for signs of infection, allergic reaction, or cancer cells.

Differential Diagnosis

Some of the conditions that can cause similar symptoms as esophagitis include:

When to Seek Emergency Care for Esophagitis Symptoms

Seek emergency medical care if you have the following symptoms:

Chest pain that does not go away within a few minutes or keeps coming back.
Any chest pain if you have a history of heart disease.
A sensation of food stuck in your chest.
Pain in the mouth and throat with swallowing.
Shortness of breath.
Large amounts of vomit.
Blood in vomit, green or yellow vomit, or vomit that looks like coffee grounds.

Management and Treatment of Esophagitis

How Do Doctors Treat Reflux Esophagitis?

Treatment for esophagitis depends on the underlying cause. Esophagitis treatments can help to treat or cure the underlying condition, manage symptoms, and lower the risk of esophagitis complications.

Treatment options for reflux esophagitis may include:

Avoid foods that trigger acid reflux, such as high-fat foods.
Over-the-counter acid-blocking medication:
- Antacids (Tums, Rolaids, Alka-Seltzer, Mylanta, Maalox, others).
- H-2 blockers to reduce acid production in the stomach, such as cimetidine (Tagamet HB).
- Proton pump inhibitors to block stomach acid formation and allow the esophagus to heal, such as lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC).
Prescription acid-blocking medications:
- Prescription-strength H-2-receptor blockers.
- Prescription-strength proton pump inhibitors.

How Do Doctors Treat Eosinophilic Esophagitis?

Treatment for eosinophilic esophagitis involves:

Avoiding the allergens that trigger symptoms.
Elimination diet to identify and avoid common food allergens (substances that cause food allergies and eosinophilic esophagitis).
Elemental diet which involves stopping all oral intake of food and taking an amino acid formula instead. You then slowly add back foods under the careful supervision of a healthcare provider.
Proton pump inhibitors such as omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), or lansoprazole (Prevacid).
Corticosteroids such as liquid budesonide (Eohilia) or fluticasone spray.
Monoclonal antibodies such as dupilumab (Dupixent) for eosinophilic esophagitis. This drug works by blocking certain proinflammatory proteins. It is given by injection every 1-2 weeks.

How Do Doctors Treat Drug-Induced Esophagitis?

Treatment options for medication-induced esophagitis include:

Stopping treatment with the culprit drug, if possible, and switching to a different medicine that is less likely to cause esophagitis.
Taking a liquid form of the medicine, if available.
Taking the medicine with a full glass of water.
Remaining upright for 30-60 minutes after taking the pill.

How Do Doctors Treat Infectious Esophagitis?

Treatment options for infectious diseases (infectious esophagitis) may include prescription medicines such as antibiotics, antifungal drugs (for example, fluconazole), and antiviral medicines (for example, foscarnet) to treat the infection.

Surgical Interventions

Fundoplication Surgery: A procedure such as a transoral incisionless fundoplication (TIF) can be done to treat GERD and hiatal hernia. During this procedure, the surgeon wraps a part of the stomach around the lower part of the esophagus to strengthen the sphincter and prevent gastric acid from backing up into the esophagus. It is done for severe esophagitis that has not responded to conservative treatments.
Esophageal Dilation: This procedure is done to treat an esophageal stricture (narrowing), which is a complication of esophagitis and can cause food to become stuck in the esophagus.

Lifestyle Changes

Experts in digestive and kidney diseases recommend the following lifestyle modifications to manage esophagitis symptoms:

Avoid foods that trigger acid reflux or make it worse.
Avoid eating large meals.
Avoid bending, stooping, or lying down soon after meals.
Take pills with a full glass of water.
Remain upright during and immediately after taking medicines.
Lose weight if you are overweight or obese.
Quit smoking, if you smoke.
Raise the head of your bed.

Can Esophagitis Be Cured?

Is Esophagitis Curable?

Yes, esophagitis is curable if you remove or treat whatever is causing the irritation and inflammation.

What Is The Fastest Way To Cure Esophagitis?

The fastest way to cure esophagitis is to treat the underlying cause of the inflammation (for example, acid reflux) with lifestyle changes and/or medications that heal and protect the esophagus lining.

Does Drinking Water Help Esophagitis?

Frequent sips of water can soothe an inflamed esophagus. Staying well-hydrated is also important for overall good health.

In terms of nutrition, if you have a food allergy, avoid common food allergens. Also avoid certain foods that are common dietary triggers for acid reflux, such as alcohol, caffeine, and spicy, acidic, or fatty foods.

While you are healing from esophagitis, consider eating a soft, bland diet. Take small bites of food and chew thoroughly.

Can An Inflamed Esophagus Heal On Its Own?

An inflamed esophagus may heal on its own if it is caused by temporary factors such as short-term use of a medicine or an infection. For example, symptoms of radiation esophagitis typically resolve within 2-3 weeks of completing radiation therapy. In addition, removing whatever is irritating your esophagus for long enough can allow the esophagus to heal naturally on its own. However, people with severe esophagitis may need to be treated with medications and lifestyle modifications.

Preventive Measures and Living with Esophagitis

Managing Recurrence

Follow the treatment plan developed by your healthcare professional to prevent the recurrence of esophagitis. You may need long-term treatment with acid-blocking medications to prevent further damage and allow your esophagus to heal. If you experience a recurrence of esophagitis symptoms after being symptom-free for some time, seek prompt medical care.

Diet and Lifestyle Adjustments

See the lifestyle changes listed above for the treatment of esophagitis. These same measures can help to prevent esophagitis.

Resources and Support Systems

Resources for people living with eosinophilic esophagitis
Information and tips on living with GERD

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