What is Esophagitis?
Esophagitis is a condition where the lining of the esophagus becomes inflamed or damaged. There are multiple reasons why this can happen and the symptoms are usually similar regardless of the cause. These can include discomfort behind the chest bone, heartburn, or difficulty or pain while swallowing.
One of the main causes of esophagitis is gastroesophageal reflux, which can cause further damage to the esophagus. Other causes can be radiation, infections, or harm due to medications. There’s also a condition called eosinophilic esophagitis (EoE), where a type of white blood cell builds up in the lining of the esophagus. Common symptoms for patients suffering from esophagitis are chest pain, pain while swallowing, or difficulty swallowing. In EoE cases, patients might experience food getting stuck. If esophagitis becomes severe leading to complications like strictures (narrowing of the esophagus), fistulas (abnormal connections between organs), or a perforation (hole) in the esophagus, the symptoms will depend on these specific problems.
What Causes Esophagitis?
Esophagitis, or inflammation of the esophagus, can have various causes. These include acid reflux, certain medications, infections, a condition called eosinophilic esophagitis, and radiation therapy.
Acid reflux or erosive esophagitis is one of the most common causes. This happens when stomach acids flow back into the esophagus, causing damage to the lining.
Infections can also cause esophagitis. These can be from bacteria, viruses, fungi, or parasites, with fungi being the most common and bacteria being the least common.
Certain pills or medications can lead to esophagitis. This can happen with oral bisphosphonates like alendronate, some antibiotics such as tetracycline, doxycycline, and clindamycin. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, ferrous sulfate, potassium chloride, and mexiletine have also been known to cause this condition.
Eosinophilic esophagitis (EoE) is a chronic condition thought to be caused by an immune response to certain allergens. It leads to inflammation in the esophagus that’s similar to other forms of esophagitis but is characterized by an influx of a type of white blood cell called eosinophils.
Lastly, radiation-induced esophagitis is linked to radiation therapy. It can occur immediately following treatment or can develop over time.
Risk Factors and Frequency for Esophagitis
The appearance and spread of various types of esophagitis differ greatly. Here are some key facts to note about the condition:
- About 1% of people have erosive esophagitis, a type of esophagitis.
- Esophagitis caused by medication occurs in about 3.9 out of 100,000 people each year, usually diagnosed around the age of 41.5.
- Eosinophilic esophagitis, which can be related to food allergies, asthma, and eczema, is another subtype. Studies estimate that it impacts about 0.35 out of 100,000 individuals annually and is currently present in about 55 out of 100,000 people. It’s typically seen more in men, often starting in their 20s or 30s.
- Radiation esophagitis, which is esophagitis caused by radiation therapy, is quite common. It almost always develops when a specific high dose of radiation is given over a period of time. If the dose is lowered or spread out over a longer period, the risk decreases.
- Finally, esophagitis caused by infections can be tricky to track, but it’s known to be much more common in people with weakened immune systems, such as those with HIV or blood cancer.
Signs and Symptoms of Esophagitis
Eosinophilic esophagitis (EoE) is a condition that typically presents with certain symptoms. These often include chest pain located behind the breastbone, feelings of heartburn, and difficulties or discomfort when swallowing. Some people might also get food stuck in their esophagus. This is more frequently seen in young adults or children who have a history of asthma, food allergies, or atopy (a genetic tendency to develop allergic diseases). In addition, there might be symptoms of reflux esophagitis, like a sensation of a lump in the throat, regurgitation, and sometimes wheezing or a chronic cough.
It’s important to take note of a patient’s medical history, including medication use and instances of cancer treatment. Certain medications can cause pill-induced esophagitis, and a history of radiation therapy can hint at radiation esophagitis. All of this information is key to understanding the patient’s condition and potential treatment options.
- Chest pain located behind the breastbone
- Heartburn
- Difficulties or discomfort when swallowing
- Food impaction
- A sensation of a lump in the throat
- Regurgitation
- Wheezing or a chronic cough
Testing for Esophagitis
Diagnosing esophagitis, or inflammation of the esophagus, can be achieved through a medical history review and clinical examination. However, to identify different forms of esophagitis, two procedures called an endoscopy and a biopsy are necessary.
If doctors suspect that acid reflux is causing esophagitis and the symptoms are mild to moderate, an endoscopy might not be needed right away. Instead, it can be done if the initial treatment, usually with drugs called proton pump inhibitors, doesn’t work well. The same applies if a patient shows signs of having medication-induced esophagitis.
An endoscopy involves inserting a thin tube with a camera down the throat to examine the esophagus. Specific patterns of inflammation can help determine the cause of esophagitis. For instance, if eosinophilic esophagitis is suspected, the camera might reveal signs like white bumps or red furrows. However, in about 10% of cases, the esophagus may look normal even if the patient has esophagitis.
Similarly, in cases of esophagitis caused by certain infections, the endoscopy can show characteristic changes. For example, candidiasis can cause small, cheese-like, yellow-white patches in the esophagus. Certain viruses produce specific types of sores or ulcers.
A biopsy involves taking a small tissue sample from the esophagus during the endoscopy. Looking at the tissue under a microscope can help reveal the cause of esophagitis. For example, seeing an influx of a certain type of white blood cell, called eosinophils, is indicative of eosinophilic esophagitis. The detected features in tissue samples also help to diagnose infectious esophagitis types, such as those caused by a herpes virus or a virus called cytomegalovirus.
Treatment Options for Esophagitis
Treatment for esophagitis, or inflammation of the esophagus, depends on what has caused it. But there are a few common tactics that can be used in most cases. These include the use of medicines like proton-pump inhibitors (PPIs) or acid-blocking medicines (H2 blockers) to reduce stomach acid; changes in diet and lifestyle; and sticking to soft or liquid foods to give the esophagus time to heal.
If it seems like acid reflux might be the cause based on the patient’s symptoms, doctors will often recommend taking an H2 blocker twice a day or a proton pump inhibitor once a day. It’s also advised to make lifestyle and dietary changes. This might include losing weight, raising the head end of the bed (especially if symptoms like cough, hoarseness or sore throat occur at night), and eliminating certain foods and drinks such as fatty food, chocolate, fizzy drinks, spicy food, smoking, and alcohol.
If it seems like certain medications might be the cause of esophagitis, the medicines should be stopped if they can be, or changed to something else if they can’t be stopped. It’s important to take pills with a good amount of water (about 4 oz), and to stay upright for 30 minutes after taking them.
If esophagitis is caused by an abundance of white blood cells called eosinophils, the treatment can include acid reduction, systemic or topical steroids like budesonide or fluticasone, and dietary changes if it seems like a food allergy might be the cause.
If esophagitis is caused by an infection, the treatment will focus on that specific infection. For instance, for a Candida Albicans infection, oral fluconazole is usually used. For a herpes simplex virus (HSV) infection, treatment will be oral or intravenous acyclovir. Non-responders can be given Foscarnet. A cytomegalovirus (CMV) infection of the esophagus is usually treated with Ganciclovir or Valganciclovir.
Some complications of esophagitis, like narrowing or tightening (stenosis) of the esophagus or scars that form narrowed areas (strictures) might need to be treated with a procedure called endoscopic dilation.
Pain from ulcers can be eased by using topical local anesthetic agents like lidocaine in a mixture commonly known as a GI cocktail and opioids. However, nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they may make symptoms worse.
What else can Esophagitis be?
Esophagitis is a condition that inflames the esophagus, and it can mimic other diseases because it usually presents with similar initial symptoms. To correctly diagnose esophagitis, doctors often need to gather a detailed medical history from the patient and conduct additional diagnostic tests. These tests might include an endoscopy (a procedure to examine the digestive tract) and a histopathology examination (study of diseased tissue).
For example, Reflux esophagitis, which occurs when stomach acid flows back into the esophagus, can look a lot like another type of esophagitis called eosinophilic esophagitis. When these two conditions appear similar, doctors often prescribe a type of medicine called Proton pump inhibitors (PPI) for about 8 weeks. If it’s acid reflux esophagitis, this treatment usually works well and gets rid of the inflammation caused by eosinophils (a type of white blood cell that fights disease). But if the symptoms persist or eosinophilic infiltration is seen on a repeat endoscopy, it could confirm that it’s actually eosinophilic esophagitis. The presence of certain esophageal lesions revealed by an endoscopy, along with histology, also help to confirm other types of infectious esophagitis.
Other diseases often share common symptoms with esophagitis, such as chest pain behind the breastbone and difficulty or pain while swallowing, which makes the diagnosis challenging. Doctors must consider a range of possible conditions in their diagnosis, including heart disease presenting with atypical chest pain, cancer, peptic ulcer disease (ulcers in the stomach or upper part of the intestine), abnormal rings and webs in the esophagus, pneumonia, lung blood clots, achalasia (a digestive disorder affecting the esophagus), and other esophageal motility disorders.
Possible Complications When Diagnosed with Esophagitis
If you have esophagitis that is chronic or untreated, you may end up with these complications:
- Bleeding
- Stricture
- Barrett esophagus
- Perforation
- Laryngitis
- Aspiration pneumonitis
Preventing Esophagitis
Changing your lifestyle and diet are crucial steps in treating and preventing further issues from esophagitis. If you have esophagitis because of acid reflux and you’re overweight, it’s recommended to try losing some weight. Certain foods and habits can worsen your condition and should be avoided – things like high-fat or spicy foods, coffee, fizzy drinks, spicy food, chocolate, alcohol, smoking, or not waiting enough time between your last meal and bedtime.
Helpful tips can include raising the head of your bed between 30-45 degrees. This can ease symptoms during the night, like a cough, sore throat, and hoarseness. If you’ve been diagnosed with EoE (Eosinophilic Esophagitis), you should avoid any foods that you’re allergic to.
Sticking to a diet of small, frequent meals, and choosing clear liquids or soft pureed foods while in treatment can alleviate symptoms and speed up your healing process.
