Learn more about the causes and treatment of inflammation of the esophagus.
Esophagitis (uh-sof-uh-JIE-tis) is inflammation that may damage tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach.
Esophagitis can cause painful, difficult swallowing and chest pain. Causes of esophagitis include stomach acids backing up into the esophagus, infection, oral medications and allergies.
Treatment for esophagitis depends on the underlying cause and the severity of tissue damage. If left untreated, esophagitis can damage the lining of the esophagus and interfere with its normal function, which is to move food and liquid from your mouth to your stomach. Esophagitis can also lead to complications such as scarring or narrowing of the esophagus, and difficulty swallowing.
Common signs and symptoms of esophagitis include:
In infants and young children, particularly those too young to explain their discomfort or pain, signs of esophagitis may include:
Most signs and symptoms of esophagitis can be caused by a number of different conditions affecting the digestive system. See your doctor if signs or symptoms:
Get emergency care if you:
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 (GERD) is a condition in which this backflow of acid is a frequent or ongoing problem. A complication of GERD is chronic inflammation and tissue damage in the esophagus.
Eosinophils (e-o-SIN-o-fils) are white blood cells that 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) or acid reflux or both.
In many cases, this type of esophagitis may be triggered by foods such as milk, eggs, wheat, soy, peanuts, beans, rye and beef. However, conventional allergy testing does not reliably identify these culprit foods.
People with eosinophilic esophagitis may have other nonfood allergies. For example, sometimes inhaled allergens, such as pollen, may be the cause.
Lymphocytic esophagitis (LE) is an uncommon esophageal condition in which there are an increased number of lymphocytes in the lining of the esophagus. LE may be related to eosinophilic esophagitis or to GERD.
Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for too long. For example, if you swallow a pill 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:
A bacterial, viral or fungal infection in tissues of the esophagus may cause esophagitis. 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, cancer, or the use of steroid or antibiotic medications.
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:
A number of foods may worsen symptoms of GERD or reflux esophagitis:
Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include:
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:
Risk factors for infectious esophagitis often relate to medications, such as steroids and antibiotics. People with diabetes also are at increased risk of candida esophagitis in particular.
Other causes of infectious esophagitis may relate to poor immune system function. This may be due to an immune disorder, HIV/AIDS or certain cancers. Also, certain cancer treatments and drugs that block immune system reactions to transplanted organs (immunosuppressants) may increase the risk of infectious esophagitis.
Left untreated, esophagitis can lead to changes in the structure of the esophagus. Possible complications include:
Your doctor or specialist will likely make a diagnosis based on your answers 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 makes the organs visible. These images can help identify narrowing of the esophagus, other structural changes, a hiatal hernia, tumors or other abnormalities that could be causing symptoms.
Doctors guide a long, thin tube equipped with a tiny camera (endoscope) down your throat and into the esophagus. Using this instrument, your doctor can look for any unusual appearance of the esophagus and remove small tissue samples for testing. The esophagus may look different depending on the cause of the inflammation, such as drug-induced or reflux esophagitis. You'll be lightly sedated during this test.
Small tissue samples removed (biopsy) during an endoscopic exam are sent to the lab for testing. Depending on the suspected cause of the disorder, tests may be used to:
Treatments 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:
Surgery. Fundoplication may be used to improve the condition of the esophagus if other interventions don't work. 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.
A newer treatment involves minimally invasive surgery to place a ring of tiny magnetic titanium beads around the junction of the stomach and esophagus. In that position, the ring of beads strengthens the lower esophageal sphincter, preventing acid reflux.
Treatment for eosinophilic esophagitis is primarily avoiding the allergen and reducing the allergic reaction with medications. Medications may include:
Steroids. Some studies have shown that swallowed steroids such as fluticasone (Flovent) and budesonide (Pulmicort) may act topically in the esophagus and help treat eosinophilic esophagitis. The same steroid medications that are inhaled to manage asthma are swallowed to treat eosinophilic esophagitis.
Your doctor will instruct you on how to swallow the steroid preparation so that it coats your esophagus. This delivery system of steroids is much less likely to cause serious side effects than taking oral steroid pills.
Elimination and elemental diets. A response to a food allergen is likely the cause of eosinophilic esophagitis. Therefore, elimination of the culprit food may be an effective treatment strategy.
However, as no tests are currently available to identify the culprit food, your doctor may recommend that you remove common food allergens from your diet. Under your doctor's direction, you'll gradually add foods back into your diet and note when symptoms return.
Another, more restrictive, approach is to remove all food from your diet and replace it with an amino acid-based formula.
New biologic therapies are being developed to treat eosinophilic esophagitis and will likely be available within a few years. These medications stimulate your body's immune response to fight infection, inflammation or disease.
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:
Your doctor may prescribe a medication to treat a bacterial, viral, fungal or parasitic infection causing infectious esophagitis.
A gastroenterologist may perform a procedure to expand (dilate) the esophagus. This treatment is generally used only when the narrowing is very severe or food has become lodged in the esophagus.
In esophageal dilation, your doctor uses one or more endoscopic devices — small narrow tubes inserted through the esophagus. Versions of these devices may be equipped with:
Depending on the type of esophagitis you have, you may lessen symptoms or avoid recurring problems by following these steps:
No alternative medicine therapies have been proved to treat esophagitis. Still, some complementary and alternative therapies may provide some relief from heartburn or reflux symptoms when combined with your doctor's care. Talk to your doctor about what alternative treatments may be safe for you. Options may include:
If you're experiencing severe chest pain that lasts more than a few minutes or if you suspect you have food lodged in your esophagus or are unable to swallow, get emergency medical care.
If you have other signs or symptoms of esophagitis, you'll likely start by seeing your primary care doctor. For some diagnostic tests, your doctor may refer you to a specialist in digestive system disorders (gastroenterologist) or an allergy specialist (allergist). Preparing for your appointment with your doctor or a specialist will help you make the best use of your time.
Make a list ahead of time that you can share with your doctor. Your list should include:
List questions for your doctor from most important to least important in case time runs out. If you think you have signs or symptoms of esophagitis, you may ask some of the following questions.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
If you know that certain foods trigger or worsen symptoms, avoid them. Common culprits include caffeine-containing drinks, alcohol or spicy foods. Taking over-the-counter antacids may provide short-term relief of symptoms.
If you suspect that your symptoms are related to a prescription medication, don't stop taking the drug without first talking to your doctor. If possible, limit the use of over-the-counter medications that could be causing problems. When you take pills, drink a glass of water and avoid lying down immediately afterward.
February 23rd, 2021
