Esophagitis (uh-sof-uh-JIE-tis) is inflammation of the esophagus. The esophagus is the muscular tube that delivers food from your mouth to your stomach.
Esophagitis can cause painful, difficult swallowing and chest pain. Many different things can cause esophagitis. Some common causes include stomach acids backing up into the esophagus, infection, oral medicines and allergies.
Treatment for esophagitis depends on the underlying cause and how badly the tissue lining the esophagus is damaged. If left untreated, esophagitis can damage this lining and interfere with its function, which is to move food and liquid from your mouth to your stomach. Esophagitis also can lead to complications such as scarring or narrowing of the esophagus, unintended weight loss and dehydration.
Common symptoms of esophagitis include:
- Difficulty swallowing.
- Painful swallowing.
- Swallowed food becoming stuck in the esophagus, also known as food impaction.
- Chest pain, particularly behind the breastbone, that occurs with eating.
- Acid regurgitation.
In infants and young children, particularly those too young to explain their discomfort or pain, symptoms of esophagitis may include:
- Feeding difficulties, such as irritability, arching of the back and not wanting to eat.
- Failure to thrive.
- Chest or belly pain in older children.
When to see a doctor
Most symptoms of esophagitis can be caused by a few different conditions affecting the digestive system. See your health care provider if symptoms:
- Last more than a few days.
- Aren't relieved by nonprescription antacids.
- Are bad enough to make eating difficult or if you are losing weight.
- Are accompanied by flu symptoms, such as headache, fever and muscle aches.
Get emergency care if you:
- Have pain in your chest that lasts more than a few minutes.
- Suspect you have food stuck in your esophagus.
- Have a history of heart disease and experience chest pain.
- Have pain in your mouth or throat when you eat.
- Have shortness of breath or chest pain that happens shortly after eating.
- Vomit large amounts, often have forceful vomiting, have trouble breathing after vomiting or have vomit that is yellow or green, looks like coffee grounds, or contains blood.
Esophagitis is generally labeled by the condition that causes it. In some cases, it may have more than one cause. Some of the most common types include:
A valve called the lower esophageal sphincter usually keeps the acidic contents of the stomach out of the esophagus. But sometimes this valve doesn't close properly or opens when it shouldn't. The upper part of the stomach can sometimes slide into the chest above the diaphragm, known as a hiatal hernia. If this happens, 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 ongoing inflammation and tissue damage in the esophagus.
Eosinophils (e-o-SIN-o-fils) are white blood cells that play a key role in allergic reactions. Eosinophilic esophagitis can occur if there is a high concentration of these white blood cells in the esophagus. This is most likely in response to an allergy-causing agent (allergen), acid reflux or both.
In many cases, this type of esophagitis may be triggered by foods such as milk, eggs, wheat, soy, peanuts and seafood. However, typical allergy testing does not reliably identify these culprit foods.
People with eosinophilic esophagitis may have other nonfood allergies. For example, sometimes allergens in the air, such as pollen, may be the cause. The most common symptom of eosinophilic esophagitis is food impaction or trouble swallowing, also called dysphagia.
Lymphocytic esophagitis (LE) is an uncommon esophageal condition in which there are an increased number of white blood cells known as lymphocytes in the lining of the esophagus. LE may be related to eosinophilic esophagitis or to GERD.
Several oral medicines 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. Medicines that have been linked to esophagitis include:
- Pain-relieving medications, such as aspirin, ibuprofen (Advil, Motrin IB, 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, called osteoporosis.
- Quinidine, which is used to treat heart problems.
A bacterial, viral or fungal infection in tissues of the esophagus may cause esophagitis. Infectious esophagitis is fairly rare and occurs most often in people with poor immune system function, such as people with HIV/AIDS or cancer.
A fungus usually 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, or the use of steroid or antibiotic medications.
Risk factors for esophagitis vary depending on the different causes of the disorder.
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.
- Excessively large and fatty meals.
- Extra weight, including from pregnancy.
Several foods may worsen symptoms of GERD or reflux esophagitis:
- Fatty foods.
Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include:
- A history of certain allergic reactions, including asthma, atopic dermatitis and allergic rhinitis, also known as hay fever.
- A family history of eosinophilic 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.
Risk factors for infectious esophagitis often relate to medications, such as steroids or 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:
- Scarring or narrowing of the esophagus, known as a stricture.
- Tearing of the esophageal lining due to retching or passing instruments through an inflamed esophagus during endoscopy.
- Barrett's esophagus, a condition in which the cells lining the esophagus are damaged from acid reflux, increasing your risk of esophageal cancer.