Esophagitis

The esophagus is the long tube that is responsible for moving food from the throat to the stomach. Esophagitis is a type of inflammation that may damage tissues of the esophagus. If left untreated, esophagitis can interfere with the normal function of the esophagus. Treatment options depend on the underlying cause and the severity of tissue damage.

Types and Causes of Esophagitis

  • Reflux esophagitis: A valve-like structure called the lower esophageal sphincter (LES) 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). Causes of reflux esophagitis include:
    • Eating immediately before going to bed
    • Dietary factors such as excess alcohol, caffeine, chocolate and mint-flavored foods
    • Excessively large and fatty meals
    • History of cigarette smoking and/or drug abuse
    • Extra weight, including from pregnancy
  • Eosinophilic esophagitis: Eosinophils are white blood cells that play a key role in allergic reactions. Eosinophilic esophagitis occurs when there’s 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. Causes of eosinophilic esophagitis include:
    • A history of certain allergic reactions, including allergic rhinitis, asthma and atopic dermatitis
    • A family history of eosinophilic esophagitis
  • Drug-induced esophagitis: Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for too long. Drugs that have been linked to esophagitis include: pain-relieving medications, antibiotics, potassium chloride, quinidine, among others. Other causes of drug-induced esophagitis include:
  • Swallowing a pill with little or no water
  • Taking drugs while lying down
  • Taking drugs right before sleep, probably due in part to the production of 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

Symptoms of Esophagitis

Some of the most common symptoms of esophagitis include:

  • Difficult and painful swallowing
  • Chest pain, particularly behind the breastbone, that occurs with eating
  • Feeling of food becoming stuck in the esophagus
  • Heartburn
  • Acid regurgitation

Diagnosis of Esophagitis

Your doctor will most likely perform a physical exam, ask about your symptoms, and ask about your risk factors, among others items. After that, you may have:

Diagnostic tests and procedures

Treatment of Esophagitis

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. Some treatment options include:

Lifestyle changes applicable to all types of esophagitis

  • Avoid smoking
  • If you’re overweight, talk to your doctor about weight-loss options.
  • Avoid foods that may increase reflux such as alcohol, caffeine, chocolate and mint-flavored foods.
  • Avoid certain medications such as pain relievers and antibiotics
  • Avoid stooping or bending, especially soon after eating.
  • Avoid lying down after eating.
  • Make and keep appointments to see your doctor for routine check-ups and follow-up tests.

Medications for Reflux esophagitis

  • Antacids will help relieve heartburn or indigestion caused by excess stomach acid
  • H2 receptors will help reduce the amount of acid production
  • Proton pump inhibitors will help block acid production and heal the esophagus
  • Prokinetics will help your stomach empty more quickly.

Medical and surgical procedures

  • Fundoplication

Medications for Eosinophilic esophagitis

  • Proton pump inhibitors will relieve symptoms of acid reflux, or gastroesophageal reflux disease
  • Topical steroids will help reduce the inflammation within the esophagus

Medications for Drug-Induced esophagitis: 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
  • Taking a liquid version of a medication if possible
  • Drinking an entire glass of water with a pill, unless you've been told by your doctor to restrict your fluid intake
  • Sitting or standing for at least 30 minutes after taking a pill

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