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:
- Diagnose a bacterial, viral or fungal infection
- Determine the concentration of allergy-related white blood cells (eosinophils)
- Identify abnormal cells that would indicate esophageal cancer or precancerous changes
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:
- Over-the-counter treatments. These include antacids (Maalox, Mylanta, others); medications that reduce acid production, called H-2-receptor blockers, such as cimetidine (Tagamet HB); and medications that block acid production and heal the esophagus, called proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec).
- Prescription-strength medications. These include H-2-receptor blockers, such as famotidine (Pepcid). They also include proton pump inhibitors, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and pantoprazole (Protonix). You also may be prescribed prokinetics such as bethanechol and metoclopramide (Reglan), which help your stomach empty more quickly.
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:
- Proton pump inhibitors. Your doctor will likely first prescribe a proton pump inhibitor, such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) or pantoprazole (Protonix).
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:
- Taking an alternative drug that is less likely to cause drug-induced esophagitis
- 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 because of another condition, such as kidney disease
- Sitting or standing for at least 30 minutes after taking a pill
Your doctor may prescribe a medication to treat a bacterial, viral, fungal or parasitic infection causing infectious esophagitis.
Treating common complications
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:
- A tapered tip that starts with a rounded point that gradually widens
- A balloon that can be expanded after it's inserted in the esophagus
Lifestyle and home remedies
Depending on the type of esophagitis you have, you may lessen symptoms or avoid recurring problems by following these steps:
- Avoid foods that may increase reflux. Avoid eating excessive amounts of foods that you know worsen your symptoms of gastroesophageal reflux. These may include alcohol, caffeine, chocolate and mint-flavored foods.
- Use good pill-taking habits. Always take a pill with plenty of water. Don't lie down for at least 30 minutes after taking a pill.
- Lose weight. Talk to your doctor about an appropriate diet and exercise routine to help you lose weight and maintain a healthy weight.
- If you smoke, quit. Talk to your doctor if you need help ending a smoking habit.
- Avoid certain medications. Avoid some pain relievers and antibiotics, as well as some other medications, if you have an enlarged left upper heart chamber (atrium) or after heart surgery.
- Avoid stooping or bending, especially soon after eating.
- Avoid lying down after eating. Wait at least three hours after eating to lie down or go to bed.
- Raise the head of your bed. Place wooden blocks under your bed to elevate your head. Aim for an elevation of 6 to 8 inches (15 to 20 centimeters). Raising your head by using only pillows isn't effective.
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:
- Herbal remedies. Herbal remedies sometimes used for heartburn or reflux symptoms include licorice, slippery elm, chamomile, marshmallow and others. Herbal remedies can have serious side effects, and they may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.
- Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of heartburn or reflux. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.
- Acupuncture. Acupuncture involves inserting thin needles into specific points on your body. Limited evidence suggests it may help people with regurgitation and heartburn, but major studies have not proved a benefit. Ask your doctor whether acupuncture is safe for you.
Preparing for your appointment
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.
What you can do
Make a list ahead of time that you can share with your doctor. Your list should include:
- Symptoms you're experiencing, including any that may seem unrelated to pain, difficulty swallowing or reflux
- Key personal information, including any major stresses or recent life changes
- Medications that you're taking, including vitamins and other supplements
- Family history of allergies and disorders of the esophagus or stomach
- Questions to ask your doctor
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.
- What tests will I need to diagnose the condition?
- Do these tests require any special preparation?
- How long will it take to find out the results of tests?
- What treatments are available, and which do you recommend?
- How will we know if the treatment is working?
- Will I need follow-up tests?
- What steps can I take on my own to prevent a recurrence of the symptoms?
- I have other medical conditions. How can I best manage these conditions together?
What to expect from your doctor
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:
- How severe is your pain or discomfort?
- Do you have difficulty swallowing?
- How often do you experience symptoms?
- Does anything seem to prompt or worsen symptoms, such as certain foods?
- Does anything lessen symptoms, such as taking over-the-counter antacids or avoiding certain foods?
- Are symptoms worse at certain times of the day?
- Do your symptoms begin shortly after taking any medications? If so, which medications?
- Do you have any allergies, and do you take any allergy medication?
- Have you ever had food get stuck in your throat after swallowing?
- Do you ever have food come back up after swallowing?
- Do you have a family history of gastrointestinal problems?
What you can do in the meantime
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.