What is it?
- Esophagitis is inflammation that damages tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach.
- Esophagitis often causes painful, difficult swallowing and chest pain. Causes of esophagitis include stomach acids backing up into the esophagus, infection, oral medications and allergies.
- Treatments for esophagitis depend on the underlying cause and the severity of tissue damage. If left untreated, esophagitis may change the structure and function of the esophagus.
Common signs and symptoms of esophagitis include:
- Difficult swallowing (dysphagia)
- Painful swallowing (odynophagia)
- Chest pain, particularly behind the breastbone, that occurs with eating
- Swallowed food becoming stuck in the esophagus (food impaction)
- Stomach pain
- Regurgitation of saliva (water brash)
- Decreased appetite
In young children, particularly those too young to explain their discomfort or pain, signs of esophagitis may include:
- Feeding difficulties
- Failure to thrive
Esophagitis is generally categorized by the conditions that cause it. In some cases, more than one factor may be causing esophagitis.
A valve-like structure called the lower esophageal sphincter usually keeps the acidic contents of the stomach out of the esophagus. If this valve opens when it shouldn't or doesn't close properly, the contents of the stomach may back up into the esophagus (gastroesophageal reflux). Gastroesophageal reflux disease is a condition in which this backflow of acid is a frequent or ongoing problem. A subsequent complication of GERD is chronic inflammation and tissue damage in the esophagus.
Eosinophils are white blood cells that regulate inflammation and play a key role in allergic reactions. Eosinophilic esophagitis occurs with a high concentration of these white blood cells in the esophagus, most likely in response to an allergy-causing agent (allergen).
In many cases, people who have this kind of esophagitis are allergic to one or more foods. Possible food allergens that may cause eosinophilic esophagitis include milk, egg, wheat, soy, peanuts, beans, rye and beef. People with eosinophilic esophagitis may have other nonfood allergies. For example, inhaled allergens, such as pollen, may be the cause in some cases.
Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for a prolonged period. For example, if a pill is swallowed with little or no water, the pill itself or residue from the pill may remain in the esophagus. Drugs that have been linked to esophagitis include:
- Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Antibiotics, such as tetracycline and doxycycline
- Potassium chloride, which is used to treat potassium deficiency
- Bisphosphonates, including alendronate (Fosamax), a treatment for weak and brittle bones (osteoporosis)
Esophagitis may also be caused by a bacterial, viral, fungal or parasitic infection in tissues of the esophagus. Infectious esophagitis is relatively rare and occurs most often in people with poor immune system function, such as people with HIV/AIDS or cancer.
A fungus normally present in the mouth called Candida albicans is a common cause of infectious esophagitis. Such infections are often associated with poor immune system function, diabetes and antibiotic use.
Risk factors for esophagitis vary depending on the different causes of the disorder.
Factors that increase the risk of gastroesophageal reflux disease (GERD) — and therefore are factors in reflux esophagitis — include the following:
- Hiatal hernia, a condition in which the stomach pushes through the opening in the diaphragm where the esophagus joins the stomach
A number of foods may worsen symptoms of GERD or reflux esophagitis:
- Tomato-based foods
- Citrus fruits
- Spicy foods
- Garlic and onions
Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include:
- A family history of the disorder, suggesting that a gene or genes may increase the risk of eosinophilic esophagitis
- A family history of allergies
Factors that may increase the risk of drug-induced esophagitis are generally related to issues that prevent quick and complete passage of a pill into the stomach. These factors include:
- Swallowing a pill with little or no water
- Taking drugs while lying down
- Taking drugs right before sleep, probably due in part to producing less saliva and swallowing less during sleep
- Older age, possibly because of age-related changes to the muscles of the esophagus or a decreased production of saliva
- Large or oddly shaped pills
- Sustained-release pills
The primary risk factor for infectious esophagitis is poor immune system function due to such conditions as HIV/AIDS, certain cancers, certain cancer treatments, drugs that block immune system reactions to transplanted organs (immunosuppressants) and various immune system disorders.
Left untreated, esophagitis can lead to changes in the structure and function of the esophagus. Possible complications include:
- Narrowing of the esophagus (esophageal stricture)
- Rings of abnormal tissue in the lining of the esophagus (esophageal rings)
- Barrett's esophagus, a condition in which the cells lining the esophagus are changed — a condition that's a risk factor for esophageal cancer
Your doctor or specialist will likely make a diagnosis based on your answer to questions, a physical exam, and one or more tests. These tests may include:
For this test, you drink a solution containing a compound called barium or take a pill coated with barium. Barium coats the lining of the esophagus and stomach, and it enables the organs to be well outlined in a series of X-ray images. These images can help identify narrowing of the esophagus, other structural changes, a hiatal hernia, tumors or other abnormalities that could be causing symptoms.
With this procedure a specialist inserts a long tube equipped with a tiny camera (endoscope) down your throat and into the esophagus. Using this instrument, your doctor can view irregularities in the tissues of the esophagus and remove small tissue samples for testing. The appearance of the esophagus may also provide clues to the cause of inflammation. For example, the condition of the esophagus may look different depending on whether you have drug-induced or reflux esophagitis.
Small tissue samples removed during an endoscopic exam are sent to the lab for testing. Depending on the suspected cause of the disorder, tests may be used to:
- Diagnose a bacterial, viral, fungal or parasitic infection
- Determine the concentration of eosinophils, allergy-related white blood cells
- Identify abnormal cells that would indicate esophageal cancer or precancerous changes
You may undergo tests to determine if you're allergic to a food or another allergy-causing agent (allergen) that may be causing eosinophilic esophagitis. These tests may include one of the following:
- Elimination diet. Your doctor may recommend a diet with certain foods removed, particularly those foods that are common allergens. Under your doctor's direction, you'll gradually add foods back into your diet and note when symptoms return.
- Skin test. In this test, tiny drops of allergen extracts are pricked onto your skin's surface. This is usually carried out on the forearm, but it may be done on the upper back. The drops are left on your skin for 15 minutes before your skin is observed for signs of allergic reactions. If you're allergic to wheat, for example, you'll develop a red, itchy bump where the wheat protein extract was pricked onto your skin. The most common side effect of these skin tests is itching and redness. This usually subsides within 30 minutes.
Treatments and drugs
Interventions for esophagitis are intended to lessen symptoms, manage complications and treat underlying causes of the disorder. Treatment strategies vary primarily based on the cause of the disorder.
Treatment for reflux esophagitis may include the following:
- Proton pump inhibitors block acid production in the stomach and allow time for damaged esophageal tissue to heal. Drugs available by prescription include omeprazole, esomeprazole (Nexium) and lansoprazole. Over-the-counter proton pump inhibitors also are available. Other treatments for gastrointestinal reflux disease (GORD) may alleviate GORD symptoms but generally have little effect on esophagitis.
- Fundoplication, a surgical procedure, may be used to treat GORD and improve the condition of the esophagus if other interventions don't work. During this procedure, a portion of the stomach is wrapped around the valve separating the esophagus and stomach (lower esophageal sphincter). This strengthens the sphincter and prevents acid from backing up into the esophagus. Fundoplication may also correct problems related to a hiatal hernia.
Treatment for eosinophilic esophagitis is primarily avoiding the allergen and reducing the allergic reaction with medications.
- Oral steroids. Corticosteroids may lessen the inflammation associated with allergic reactions and allow for the esophagus to heal. Side effects associated with long-term use of oral steroids, however, can be severe. These effects include loss of bone density, slowed growth in children, diabetes, acne and mood disorders.
- Inhaled steroids. Inhaled steroids are used to manage asthma. Some studies have shown that the use of these medications may help treat eosinophilic esophagitis. Your doctor will instruct you on how to swallow the steroid preparation, rather than inhaling it, so that it coats your esophagus. This delivery system for steroids rarely results in serious side effects.
- Restricted diet. If tests show that you have food allergies, your doctor may ask you to eliminate the problem foods from your diet completely. Your doctor may refer you to a dietitian, who can help you manage your diet and plan healthy meals. Your doctor may also recommend vitamins or supplements or special nutritional drinks if your allergies significantly limit your food choices.
Treatment for drug-induced esophagitis is primarily avoiding the problem drug when possible and reducing the risk with better pill-taking habits. Your doctor may recommend:
- Taking an alternative drug that is less likely to cause drug-induced esophagitis
- Taking a liquid version of a medication if possible
- Drinking an entire glass of water with a pill
- Sitting or standing for at least 30 minutes after taking a pill
Your doctor may prescribe a medication to treat a bacterial, viral, fungal or parasitic infection causing infectious esophagitis.
Treating common complications
A gastroenterologist may perform a procedure to expand, or dilate, the esophagus. This treatment is generally used only when the narrowing is very severe or food has become lodged in the esophagus.
This procedure is performed with one or more endoscopic devices, small narrow tubes inserted through the esophagus. Versions of these devices may be equipped with a:
- Tapered tip that starts with a rounded point that gradually widens
- Balloon that can be expanded after it's inserted in the esophagus
Depending on the type of esophagitis you have, you may lessen symptoms or avoid recurring problems by following these steps:
- Avoid food allergens. Read food labels carefully to avoid food to which you have an allergy. Be careful when eating out. Ask about what ingredients are in a dish and how they're prepared.
- Avoid foods that may increase reflux. Avoid foods that you know worsen your symptoms of gastroesophageal reflux. These may include alcohol, caffeine, citrus fruits, tomatoes and spicy foods.
- Use good pill-taking habits. Always take a pill with plenty of water. Don't lie down for at least 30 minutes after taking a pill.
- Lose weight. Talk to your doctor about an appropriate diet and exercise routine to help you lose weight and maintain a healthy weight.
- If you smoke, quit. Talk to your doctor if you need help ending a smoking habit.