What Is Esophagitis?
Esophagitis is an inflammation of the lining of the esophagus, the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers, and scarring of the esophagus.
Types of Esophagitis
There are several different types of esophagitis.
Erosive or reflux esophagitis
This is one of the most common types. The contents of your stomach back up into your esophagus. A valve usually keeps these backups from happening. But it doesn't always close all the way, or it might open when it shouldn't. Because the stuff in your stomach is acidic, it can damage the lining of your esophagus. This is more likely to happen if you have this kind of backflow a lot. That's called gastroesophageal reflux disease or GERD.
Eosinophilic or autoimmune esophagitis
This type is often related to having allergies, though acid backup from your stomach can also be the culprit. Eosinophils are a kind of white blood cell, and this condition happens when too many build up in the lining of your esophagus. Among the foods that might trigger it are:
- Milk
- Eggs
- Soy
- Wheat
- Peanuts
- Seafood
Lymphocytic esophagitis
When you have this condition, your esophagus has too many white blood cells called lymphocytes. It might be related to eosinophilic esophagitis or to GERD.
Drug-induced esophagitis
Medicines you take for other conditions can damage your esophagus if they stay in contact with the tissue for too long. Swallowing a pill without enough water (or none at all) can cause this. Drugs that have been linked to this condition include:
- Pain relievers such as aspirin, ibuprofen, and naproxen sodium
- Antibiotics, including tetracycline and doxycycline
- Potassium chloride
- Bisphosphonates, which are used to treat brittle bones
- Quinidine, which you might take for heart problems
Infectious esophagitis
This is caused by a virus, bacteria, or fungus. You're more likely to get it if your immune system isn't working well, perhaps because of cancer or HIV/AIDS. A common cause of infectious esophagitis is a fungus called Candida albicans, which we all have in our mouths. Aside from immune system problems, you can get an infection of this fungus if you're taking steroids or antibiotics or if you have diabetes. Herpes, a viral infection, can develop in the esophagus when your immune system is weak. It's treatable with antiviral drugs.
Radiation esophagitis
If you have radiation therapy for cancer, it can damage your esophagus.
Esophagitis Symptoms
Symptoms of esophagitis include:
- Difficult or painful swallowing
- Acid reflux
- Heartburn
- A feeling of something of being stuck in your throat
- Chest pain
- Nausea
- Vomiting
If you have any of these symptoms, contact your doctor as soon as possible.
Esophagitis in children
Symptoms of this condition in babies and children can include:
- Trouble feeding, such as not wanting to eat, being irritable, or arching their back when you try to feed them
- Not gaining weight
- In older kids, chest or belly pain
Severe esophagitis
If your condition is advanced, you might have bleeding in your esophagus.
Esophagitis Causes and Risk Factors
Causes
Esophagitis is caused by irritation in your esophagus.
This can come from any of the following:
- GERD
- Vomiting
- Surgery
- Medications
- Swallowing a toxic substance
- Hernias
- Radiation treatment for cancer
- Allergies and autoimmune conditions
- An infection caused by a bacteria, virus, or fungus
Risk factors
Some lifestyle choices can make esophagitis more likely, including:
- Eating right before you go to sleep
- Too many large meals with high-fat foods
- Smoking
- Heavy alcohol use
- Carrying extra weight, including when you're pregnant
Some foods can also give you a higher chance of esophagitis if you eat them. These include:
- Caffeine
- Citrus
- Spicy foods
- Garlic
- Onions
- Chocolate
- Mint
Other risk factors aren't related to your lifestyle. They can include:
- Being older than 60 years
- Spinal cord injury
- Family history of eosinophilic esophagitis
- Weak immune system caused by illness such as cancer or HIV/AIDS
- Taking drugs that weaken your immune system, for instance, after an organ transplant
- Surgery of your esophagus or one that uses a nasogastric tube, which goes into your nose and passes down to your stomach
Esophagitis Diagnosis
Once your doctor has done a physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:
Upper endoscopy
A test in which a long, flexible lighted tube, called an endoscope, is used to view your esophagus.
Esophageal sponge
In this test, you swallow a capsule that has a string attached. In your stomach, the capsule dissolves, releasing a sponge. Your doctor pulls the sponge up by the string, and the sponge takes samples of your tissue as it comes out. The sample then is checked by a lab. This procedure lets you skip an endoscopy.
Biopsy
During this test, a small sample of the esophageal tissue is removed and then sent to a lab to be checked under a microscope.
Upper GI series (or barium swallow)
During this procedure, X-rays are taken of the esophagus after you drink a barium solution. Barium coats the lining of your esophagus and shows up white on an X-ray. This lets doctors see problems in your esophagus.
Esophagitis Treatments
Treatment of esophagitis depends on the type you have.
Reflux esophagitis
To treat this, you might use:
- Over-the-counter drugs like antacids or medications that block acid production like lansoprazole (Prevacid) and omeprazole (Prilosec)
- Prescription drugs that can block acid production or help clear your stomach
- Surgery to strengthen the valve that separates your stomach and esophagus
- Surgery to put a ring of metal beads around the lower part of your esophagus. This fairly new process is called a LINX procedure. The beads make your esophagus stronger, so acid can't back up
Eosinophilic esophagitis
To treat this, you might take:
- Prescription medicines to block acid production
- Steroids like budesonide (Pulmicort) and fluticasone (Flovent) that you swallow in liquid form; you may have fewer side effects than if you take steroids as a pill
- Monoclonal antibodies like dupilumab (Dupixent) work by stopping the action of inflammation-causing proteins; you get it in a weekly injection
Your doctor may also suggest an elimination diet. This is where you stop eating certain foods that tend to cause allergic reactions for a while, and then slowly add them back in. This can help you and your doctor figure out whether foods might be triggering your esophagitis.
Drug-induced esophagitis
If medicines are touching the lining of your esophagus for too long, your doctor might:
- Change your medication
- Give it to you in liquid form, if possible
They might also advise you to take your medicine with a full glass of water or ask that you stand or sit for at least 30 minutes after you take it.
Infectious esophagitis
You can get an infection in your esophagus when your immune system is weak. This can happen if you have cancer or HIV. To treat it, you'll take a medication to clear up your infection.
If your esophagus is very narrow or food is stuck in it, your doctor may do a procedure called esophageal dilation, which will expand your esophagus.
Some people turn to alternative treatments to ease symptoms. These aren't used in place of medical treatments but in addition to them.
They can include:
- Herbal remedies like licorice, chamomile, and marshmallow
- Relaxation practices like progressive muscle relaxation or guided imagery
- Acupuncture
Make sure you talk with your doctor before you start any alternative treatments.
During recovery care
Once your doctor has figured out what's causing the esophagitis, you'll probably start to feel better within a few days of starting treatment. It may be weeks before your esophagus heals completely. Your doctor can prescribe pain medication if you need it.
While you're healing, you can help yourself feel better by avoiding spicy or acidic foods, drinking plenty or water, and chewing your food very well or trying a soft diet.
Esophagitis Prevention
To avoid getting esophagitis, or to keep it from coming back, try these tips:
- Avoid foods that are spicy, fatty, hard, or acidic, and keep caffeine, chocolate, and mint-flavored foods to a minimum.
- Try not to eat right before bedtime.
- Take small bites and chew food thoroughly.
- Avoid alcohol and tobacco.
- When you take medication, take it with plenty of water.
- Don't take medicine lying down or right before you go to sleep.
- Ask your doctor if losing weight would help your symptoms.
- Avoid bending or stooping down right after you eat.
- Raise one end of your bed by 6-8 inches to elevate your head. You can put blocks under your bed or put a wedge between your box springs and mattress. Simply using more pillows won't work.
Esophagitis Complications
It's very important that you follow your doctor's treatment plan for your esophagitis. If you do, you should get relief.
If esophagitis goes untreated, it can lead to:
- An ulcer, or break, in the tissue that lines your esophagus.
- Scarring of your esophagus. Your doctor might call this "stricture." It can make swallowing very difficult.
- Something doctors call "esophageal perforation." That's a tear of the tissue that lines your esophagus, creating a hole. It can come from gagging when food gets stuck there or when you have an upper endoscopy. This can also make swallowing difficult and make it hard to breathe.
You may get a condition known as Barrett's esophagus. This is also called "intestinal metaplasia." When it happens, the lining of your esophagus changes to be more like the lining of your intestines. Barrett's esophagus can lead to esophageal cancer.
When Should I Consult a Doctor?
The signs of esophagitis are similar to those of a lot of other conditions. See your doctor if:
- Your symptoms last more than a few days.
- Over-the-counter antacids don't help.
- It's hard for you to eat or you're losing weight.
- You also have a headache, fever, or muscle aches.
Get help right away if:
- Pain in your chest lasts more than a few minutes.
- You have a history of heart disease and your chest hurts.
- You think you have food stuck in your esophagus.
- Your mouth or throat hurts when you eat.
- Your chest hurts and you're short of breath right after you eat.
- You throw up large amounts of food or you have trouble breathing after you throw up.
- Your vomit is yellow or green, contains blood, or looks like coffee grounds.
