Oesophagitis


Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.

Causes of Oesophagitis;

Causes include stomach acids backing up into the tube, infection, some medications, and allergies.


Symptoms of esophagitis include:


What are the types of esophagitis?

There are several types of esophagitis.

  • Reflux esophagitis is caused by a reflux of stomach acid into the esophagus. This can lead to erosive esophagitis.
  • Infectious esophagitis is caused by bacteria, viruses, or fungus.
  • Barrett's esophagus results from untreated inflammation of the esophagus that can cause changes in the type of cells that make up the inner lining (mucosa) of the esophagus. Barrett's esophagus increases the risk for esophageal cancer.
  • Eosinophilic esophagitis is inflammation of the esophagus due to an increase in the number of a type of white blood cells (eosinophils) in the lining of the esophageal wall. It is considered an allergic/immune condition. This leads to dysmotility of the esophagus (the muscles do not work properly to move food through) and difficulty in swallowing. Causes of eosinophilic esophagitis include food allergies, gastroesophageal reflux disease (GERD), parasitic diseases, or inflammatory bowel diseases.
  • Behçet's syndrome (also called Behçet's disease) is a form of vasculitis that can cause ulcers in the mouth, esophagus, and other parts of the body. This disease is rare in the U.S.
  • Graft-versus-host disease is a complication that can occur after a transplant (usually bone marrow transplant) when the newly transplanted cells attack the recipient's body. Esophagitis may occur in this condition.
  • Cancer esophagitis may be a symptom of cancer of the esophagus, or metastatic cancer (cancer that started in another part of the body and then spreads to the esophagus).


What procedures or tests diagnose esophagitis?

A gastroenterologist may order specialized tests to look for the cause and extent of the esophagitis. These tests include:

  • Esophagogastroduodenoscopy (EGD): An endoscope is used to directly examine the esophagus, stomach and first part of the intestines. In addition, tissue samples can be obtained (biopsy) to assess the severity of the damage to the esophagus.
  • Esophageal manometry: this test is used to measure the pressure inside the lower part of the esophagus. A thin, pressure-sensitive tube is passed through the mouth or nose and into the stomach, which is then pulled slowly back into the esophagus. Patients are asked to swallow, and the pressure of the muscle contractions is measured along several sections of the tube.
  • Upper GI series or barium swallow is a test where X-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and appears white on an X-ray, and can show the location and extent of damage to the esophagus.

Foods that soothe esophagitis symptoms

  • Eat low fat, high protein meals
  • Eat smaller meals, more frequently
  • Eat soft foods that are easily digested

Foods and drinks that aggravate esophagitis symptoms

  • Avoid fatty foods
  • Avoid spicy foods
  • Avoid acidic foods and beverages such as citrus and tomatoes
  • Avoid foods that may trigger or worsen heartburn including chocolate, mint, onions or garlic
  • Stop eating before you feel full
  • Avoid coffee or tea (even decaffeinated), alcohol, and soda

What lifestyle changes help alleviate symptoms of GERD and esophagitis?

Lifestyle changes that may alleviate symptoms of GERD and esophagitis include:

  • Stop smoking
  • Remain upright while eating and for about 2-3 hours afterwards
  • Take small bites and chew food slowly
  • Avoid eating within 3 hours of bedtime or laying down
  • Raise the head of the bed by 4 to 6 inches (put blocks or a foam wedge under the head of the bed)
  • Lose weight
  • Wear loose clothing
  • Avoid aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)

What are the medical treatments for esophagitis?

Treatment for esophagitis depends on its cause.

  • Esophagitis caused by an infection it is treated with medications to cure the infection.
  • Esophagitis caused by acid reflux or GERD, the condition is treated with medications to reduce or block acid production, for example, heartburn drugs such as H2 blockers or proton pump inhibitors (PPIs).
  • Esophagitis due to a medical procedure may need to take acid-blocking medications for a long time.
  • Esophagitis due taking medications may need changes in his/her medications. Consult your doctor before stopping or changing your medications.

If esophagitis is diagnosed early enough, medications and dietary or lifestyle changes are often enough to allow the body to heal. If the damage is severe or leads to scar tissue, which causes difficulty swallowing, more invasive treatments may be necessary.

  • Endoscopy can be used to remove any lodged pill fragments, food, or foreign bodies stuck in the esophagus. Stretching (dilatation) of the esophagus can also be done as part of the endoscopy procedure.
  • Surgery may be necessary to remove any damaged portions of the esophagus. In the case of Barrett's esophagus, where the risk of cancer is increased, surgery might be the treatment of choice.
  • Eosinophilic esophagitis is treated with gentle stretching of the esophagus (dilatation) and medications to decrease white blood cells (eosinophils) in the lining of the esophagus.
  • Achalasia may be treated with stretching of the esophagus (dilatation) when oral medications fail to improve symptoms.

Pain medications and medications that decrease inflammation such as corticosteroids can be used as adjuncts in the treatment of any inflammatory cause of esophagitis.

What are the complications of esophagitis?

If untreated, esophagitis caused by GERD can lead to bleeding, ulcers, and chronic scarring. This scarring can narrow the esophagus, eventually interfering with the ability to swallow.

A major complication that occurs in a significant portion of people with chronic or longstanding GERD, is Barrett's esophagus, which increases the risk of esophageal cancer. A very few of those who develop Barrett's esophagus will develop esophageal adenocarcinoma.

Severe esophagitis may lead to difficult or painful swallowing, and malnutrition.

How long does it take esophagitis to heal? Can it be cured?

  • The prognosis for esophagitis often depends on the underlying cause.
  • Esophagitis caused by infection or inflammation is generally treatable with medications, diet or behavioral changes and in some cases, surgery. Most people can recover fully, while some have chronic inflammation that is managed with long-term medical treatment.
  • Esophagitis caused by reflux, while often manageable, can recur frequently. Many people with reflux require medication or other treatments to prevent relapses.
  • A significant percentage of people with GERD go on to develop Barrett's esophagus. Very few of patients with Barrett's esophagus develop cancer. A gastroenterologist should monitor those who have Barrett's esophagus.
  • The outlook for people with eosinophilic esophagitis is favorable. It is a chronic, relapsing condition, but not usually one that is life threatening. Treatments are evolving using different immune modulators to decrease the allergy-like reactions.
  • Achalasia is a progressive, but treatable disorder. A gastroenterologist must monitor patients closely. A small number of individuals with achalasia may develop squamous cell cancer (carcinoma) as a result.

Which specialties of doctors treat esophagitis?

A primary care provider (PCP) such as a family medicine specialist, an internist, or a child's pediatrician, may initially diagnose esophagitis. If you need further treatment you will likely be referred to a gastroenterologist, a specialist in disorders of the digestive system.

Can esophagitis be prevented?

Some types of esophagitis can be prevented.

  • Esophagitis caused by GERD may be prevented by changes in lifestyle and diet.
  • Proper oral hygiene can aid in prevention of esophagitis caused by the Candida yeast.
  • Take all pills with plenty of water, and in an upright position.