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Esophagitis

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.

Treatments for esophagitis depend on the underlying cause and the severity of tissue damage. If left untreated, esophagitis can damage the lining, interfere with normal function and lead to complications such as scarring, stricture and difficulty swallowing.

Symptoms Causes Risk factors Complications

Common signs and symptoms of esophagitis include:

  • Difficult swallowing
  • Painful swallowing
  • Chest pain, particularly behind the breastbone, that occurs with eating
  • Swallowed food becoming stuck in the esophagus (food impaction)
  • Heartburn
  • Acid regurgitation

In young children, particularly those too young to explain their discomfort or pain, signs of esophagitis may include:

  • Feeding difficulties
  • Failure to thrive

When to see a doctor

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:

  • Last more than a few days
  • Don't improve or go away with over-the-counter antacids
  • Are severe enough to make eating difficult
  • Are accompanied by flu signs and symptoms, such as headache, fever and muscle aches
  • Are accompanied by shortness of breath or chest pain that occurs shortly after eating

Get emergency care if you:

  • Experience pain in your chest that lasts more than a few minutes
  • Suspect you have food lodged in your esophagus
  • Have a history of heart disease and experience chest pain

Esophagitis is generally categorized by the conditions that cause it. In some cases, more than one factor may be causing esophagitis.

Reflux 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.

Eosinophilic esophagitis

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, people who have this kind of esophagitis are allergic to one or more foods. Some foods that may cause eosinophilic esophagitis include 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, inhaled allergens, such as pollen, may be the cause in some cases.

Drug-induced esophagitis

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:

  • Pain-relieving medications, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others)
  • 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)
  • Quinidine, which is used to treat heart problems

Infectious esophagitis

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 and antibiotic use.

Risk factors for esophagitis vary depending on the different causes of the disorder.

Reflux esophagitis

Factors that increase the risk of gastroesophageal reflux disease (GERD) — and therefore are factors in reflux esophagitis — include the following:

  • Eating immediately before going to bed
  • Dietary factors such as excess alcohol, caffeine, chocolate and mint-flavored foods
  • Excessively large and fatty meals

A number of foods may worsen symptoms of GERD or reflux esophagitis:

  • Tomato-based foods
  • Citrus fruits
  • Caffeine
  • Alcohol
  • Spicy foods
  • Garlic and onions
  • Chocolate
  • Mint-flavored foods

Eosinophilic esophagitis

Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include:

  • A history of certain allergic reactions, including allergic rhinitis, asthma and atopic dermatitis
  • A family history of eosinophilic esophagitis

Drug-induced esophagitis

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 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

Infectious esophagitis

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:

  • Narrowing of the esophagus (esophageal stricture)
  • Barrett's esophagus, characterized by changes to the cells lining the esophagus, increasing your risk of esophageal cancer
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