Esophagitis
Also known as: Oesophagitis, Inflamed esophagus, Reflux esophagitis
Esophagitis is inflammation of the esophagus, the muscular tube that carries food and liquid from the throat to the stomach. The most common cause is acid reflux, where stomach contents repeatedly wash back up and irritate the lining, but it can also be caused by infections, allergies, certain pills that lodge in the esophagus, radiation, or swallowing harsh chemicals. Typical symptoms include heartburn, pain or difficulty swallowing, and chest discomfort. Untreated esophagitis can lead to ulcers, bleeding, narrowing (strictures), and, in the case of reflux, a precancerous condition called Barrett's esophagus. Most cases respond well once the cause is identified and treated.
At a Glance
- Common symptoms
- Heartburn, a burning feeling behind the breastbone, Painful swallowing (odynophagia), Difficulty swallowing or the sensation of food sticking
- Main treatments
- Proton pump inhibitors or H2 blockers to reduce stomach acid and allow the lining to heal, Antifungal or antiviral medication when an infection is the cause, Swallowed topical steroids or dietary elimination for eosinophilic esophagitis
- Category
- Digestive · Common; reflux-related esophagitis affects a substantial share of people with frequent heartburn
- See a doctor if
- Heartburn or swallowing discomfort that lasts more than a couple of weeks or needs daily over-the-counter medication
Symptoms
Causes
- Gastroesophageal reflux disease (reflux esophagitis), the most common cause
- Eosinophilic esophagitis, an allergy-related immune reaction in the esophageal lining
- Infections such as Candida (thrush), herpes simplex, or cytomegalovirus, mainly in people with weakened immunity
- Pill esophagitis from tablets such as doxycycline, bisphosphonates, potassium, or NSAIDs lodging in the esophagus
- Radiation therapy to the chest or neck
- Swallowing caustic substances such as strong cleaning products
Risk Factors
- Obesity, pregnancy, and hiatal hernia, which promote reflux
- Smoking and heavy alcohol use
- Taking pills with too little water or lying down right after
- Weakened immune system from HIV, chemotherapy, organ transplant, or steroid use
- Food allergies, asthma, or eczema (linked to eosinophilic esophagitis)
- Large meals late at night and frequent consumption of trigger foods such as coffee, chocolate, fatty food, and citrus
Diagnosis
- A review of symptoms, medications, allergies, and reflux history
- Upper endoscopy to directly inspect the esophageal lining
- Biopsies to identify eosinophilic, infectious, or precancerous changes
- Barium swallow X-ray to look for narrowing or structural problems
- pH monitoring or esophageal manometry in selected cases to measure acid exposure and muscle function
Treatment
- Proton pump inhibitors or H2 blockers to reduce stomach acid and allow the lining to heal
- Antifungal or antiviral medication when an infection is the cause
- Swallowed topical steroids or dietary elimination for eosinophilic esophagitis
- Changing how a culprit medication is taken, or switching to an alternative, in discussion with your prescriber
- Endoscopic dilation (stretching) if a stricture has formed
- Supportive: smaller meals, avoiding eating within three hours of bedtime, raising the head of the bed, and avoiding personal trigger foods
- Supportive: stopping smoking, limiting alcohol, and losing excess weight to reduce reflux
Prevention
- Take tablets with a full glass of water while sitting or standing, and stay upright for 30 minutes afterward
- Avoid large, fatty, or late meals and known reflux triggers
- Maintain a healthy weight and avoid tight clothing around the waist
- Do not smoke, and keep alcohol moderate
- Treat persistent heartburn rather than relying on antacids for months
- Store caustic household chemicals safely, out of reach of children
When to See a Doctor
- Heartburn or swallowing discomfort that lasts more than a couple of weeks or needs daily over-the-counter medication
- Pain or difficulty swallowing that makes it hard to eat or drink
- Chest pain, particularly if you are unsure whether it could be heart-related (seek emergency care)
- Vomiting blood, black stools, or food becoming stuck in the esophagus (emergency)
- Unintended weight loss or symptoms in someone with a weakened immune system
Frequently Asked Questions
Related Conditions
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