Esophagitis

What is esophagitis?

Esophagitis is inflammation in your esophagus, the swallowing tube that runs from your throat down to your stomach. It may feel sore, swollen, raw or burning. Inflammation in your tissues occurs when your immune system has been activated to destroy an infection or allergen or to repair tissue damage. Erosive substances, such as stomach acid and certain medications, can injure your esophagus tissues.

How common is esophagitis?

Chronic acid reflux (GERD) is a common cause of esophagitis. Other types of esophagitis are relatively rare. Esophageal infections are uncommon, except in people who have compromised immune systems.

What are the symptoms of esophagitis?

Esophagitis may feel like:

• A sore throat.
• Heartburn.
• Difficulty swallowing.
• Chest pain.

The pain may be mild to severe and may be constant or come and go.

Depending on the cause and the severity, you might also notice:

• Acid reflux.
• Regurgitations.
• Food getting stuck in your throat.
• Indigestion.
• Feeding difficulties in children.
• Nausea and vomiting.
• Blood in your vomit.
• Mouth sores.

What causes esophagitis?

Your esophagus tissues might become inflamed if your immune system has been activated to fight an infection, if you’re having an allergic reaction or if something corrosive has injured the tissues.

Causes include:

• Acid reflux.
• Medications.
• Infections.
• Allergies.
• Radiation.
• Autoimmune disease.

Different causes make up different subtypes of esophagitis.

What are the different types of esophagitis?

Reflux esophagitis

The most common type of esophagitis occurs when acids and digestive agents escape your stomach and reflux into your esophagus, irritating and eroding the mucous lining (mucosa). This may happen if you have frequent acid reflux or if you vomit frequently. Causes include:

• GERD (gastroesophageal reflux disease).
• Bile reflux.
• Bulimia nervosa.

Drug-induced esophagitis

Also called pill esophagitis, this type occurs when frequently used medications erode the mucous lining of your esophagus. Medicines that may have this effect include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Acetaminophen.
• Antibiotics.
• Potassium chloride.
• Bisphosphonates.
• Chemotherapy drugs.

Infectious esophagitis

Infections in your esophagus are uncommon unless you have a weaker immune system and are prone to more frequent and more severe infections in general. When they do occur, infections usually spread to your esophagus from somewhere else. Fungal infections are the most common type, followed by viral infections. Infections that may cause esophagitis include:

• Candida albicans (yeast infection).
• Cytomegalovirus (CMV).
• Oral herpes simplex virus 1 (HSV-1).
• Oral human papillomavirus (HPV).

Factors that may weaken your immune system, making you susceptible to esophageal infections, include:

• HIV/AIDS.
• Primary immunodeficiency disorders (PIDD).
• Immunosuppressants.
• Diabetes.
• Systemic cancers, such as leukemia and lymphoma.
• Chemotherapy.

Eosinophilic esophagitis

Eosinophilic esophagitis is a type of immune hypersensitivity reaction (an overreaction of your immune system). It happens when your immune system sends too many white blood cells (eosinophils) to attack a perceived threat, such as an infection or allergy. The white blood cells accumulate in your esophagus and cause chronic inflammation, even after the perceived threat has passed. This is a rare condition that’s more likely to affect people with multiple allergies.

Autoimmune esophagitis

Besides eosinophilic esophagitis, certain other autoimmune diseases can cause esophagitis as a side effect. These include:

• Graft vs host disease.
• Inflammatory bowel disease (IBD).
• Behçet’s disease.

Radiation esophagitis

Radiation therapy targeting your esophagus, chest or throat may cause radiation mucositis, inflammation of the mucosa in your esophagus. This is usually a temporary reaction, but rarely, some people develop chronic esophagitis from radiation.

How serious is esophagitis?

Esophagitis is treatable, but severe esophagitis that goes untreated can lead to serious complications, such as:

• Ulcers. Ulcers are open sores that may occur in your esophagus lining. They can cause pain and bleeding. In rare cases, an ulcer that doesn’t heal may continue to wear all the way through your esophagus, making a hole (gastrointestinal perforation). This raises the risk of infections spreading from your esophagus to your chest cavity or to your bloodstream (septicemia).
• Esophageal stricture. Long-term inflammation of your esophageal tissues can cause scarring. Scar tissue can cause your esophagus to narrow (stricture), leading to swallowing difficulties. Severe swallowing difficulties may lead to dehydration, weight loss and malnutrition.
• Intestinal metaplasia. Intestinal metaplasia is a cellular change that can occur in your esophageal tissues. When it happens in your esophagus, it’s sometimes called Barrett’s esophagus. The tissues lining your esophagus adapt to constant inflammation by changing to resemble the lining of your intestines. This change can be a precursor to esophageal cancer.

How is esophagitis diagnosed?

A healthcare provider can often diagnose esophagitis based on your symptoms. They might give you a prescription for acid-blocking medications to see if it helps. If it does, they can assume reflux esophagitis. If it doesn’t, they might need to investigate further. They might look inside your esophagus with an upper endoscopy or measure the acid content in your esophagus with an esophageal pH test.

How do you cure esophagitis?

Esophagitis will heal if you can stop what’s irritating your esophagus long enough to let the natural healing process continue. This may require various lifestyle changes or medications, depending on the cause. Medications can also help to protect and promote healing in your esophagus.

What is the treatment for esophagitis?

Treatment typically includes medication and lifestyle changes.

Medications may include:

• Acid-blocking medication. Antacids, H2 blockers and proton-pump inhibitors (PPIs) can help treat acid reflux. There are over-the-counter (OTC) and prescription-strength options.
• Anti-inflammatory drugs. For eosinophilic esophagitis, healthcare providers sometimes recommend swallowing a liquid steroid formula. The formula coats your esophagus and relieves inflammation without causing the same side effects that you may get from the pill form.
• Antifungal medication for fungal infections, such as candida.
• Antiviral medication for viral infections, such as herpes.
• Monoclonal antibodies. These are synthetic versions of proteins that communicate with your immune system to stop inflammation. Dupilumab is a monoclonal antibody medication that’s been recently approved by the U.S. Food and Drug Administration to treat eosinophilic esophagitis.

Lifestyle recommendations may include:

• Dietary changes. Identify the foods and drinks that trigger acid indigestion and reflux or that trigger an allergic reaction.
• Medication changes. Ask your provider about switching medications that cause esophagitis, or consider switching to a liquid form. If you have to take a pill, take it with a full glass of water.
• Evening routine. To reduce acid reflux, eat smaller meals, especially at dinner time. Make sure dinner is at least three hours before bedtime to give it a chance to digest before you lie down.
• Commonsense self-care. Quit smoking and avoid alcohol to protect your esophagus.

Can esophagitis go away by itself?

If you’re confident that the injury that caused it has stopped, your esophagitis may be able to heal on its own after several weeks. But it’s a good idea to get a medical evaluation and opinion. A healthcare provider can confirm the cause of your esophagitis and advise you on treating that particular cause.

How long does esophagitis last?

It depends on how easily the cause can be addressed. Some persistent cases may take some trial and error with different medications before landing on the right treatment. Once the right treatment begins, healing usually begins immediately. But it may take three to six weeks for esophagitis to heal completely. If the cause is a chronic condition, you may need long-term therapy to manage it.

How do I take care of myself while healing from esophagitis?

During recovery, take care to:

• Avoid irritants in your esophagus, such as spicy and acidic foods, alcohol and smoking.
• Consider a soft diet to reduce friction in your esophagus while it’s healing.
• Take small bites of food and chew well before swallowing.
• Stay hydrated with water or soothing teas, such as marshmallow and slippery elm.

When should I see a healthcare provider about my esophagitis?

Seek healthcare if you have undiagnosed symptoms of esophagitis or if your treatment isn’t working. Sometimes esophagitis has more than one contributing cause that needs to be addressed.

Is esophagitis the same as GERD?

GERD is the most common cause of esophagitis, but not the only cause. And GERD doesn’t always cause esophagitis in everyone. It takes persistent reflux over time to cause an inflammatory response.