Esophagitis (Inflamed Esophagus)

Definition

Esophagitis is inflammation or swelling of the esophagus (generally known as the food pipe), which is a tube through which food travels from the mouth to the stomach. It is usually a consequence of another underlying medical condition or infection.

Untreated esophagitis may lead to severe scarring and damage of the esophagus. This in turn can lead to a condition known as Barrett’s esophagus, problems with swallowing (dysphagia), ulcers and esophageal cancer.

Symptoms

The following are the common symptoms of esophagitis:

  • Difficulty or pain during swallowing is the most common symptom.
  • Pain in the chest region (heartburn) might occur due to reflux of stomach acid into the esophagus.
  • Sore throat and hoarse voice.
  • Nausea and vomiting

Diagnosis of esophagitis requires close examination of the lining of the esophagus by X-ray, endoscopy and tissue biopsy.

Causes

The following are some of the causes of esophagitis.

  • The most common cause of esophagitis is reflux of stomach acid in gastroesophageal reflux disease and recurrent vomiting. Persistent contact with stomach acid and enzymes causes irritation and ulceration of the inner lining of the esophagus. Conditions that increase the risk of reflux esophagitis include pregnancy, obesity, smoking, alcohol, coffee, chocolate, fatty or spicy foods, and certain drugs (likee.g., beta-blockers, theophylline, calcium channel blockers, and NSAIDs)
  • Ingestion of certain toxins and drugs (like aspirin) could irritate the lining of the esophagus and cause esophagitis.
  • Trauma to the esophagus due to surgery or radiation could also lead to esophagitis.
  • In people whose immune system is weak (with HIV infection, diabetes mellitus, adrenal dysfunction, corticosteroid medications), the esophageal surface could become infected by bacteria (like Mycobacterium tuberculosis, Streptococcus, Staphylococcus), fungi (like Candida, Aspergillus) or viruses (like herpes simplex virus, cytomegalovirus), leading to esophagitis. In people with a healthy immune system, these pathogens are kept in check by the mucosal immunity of the esophageal lining.
  • Certain food allergies could also cause esophagitis – eosinophilic esophagitis.
  • Not drinking enough water with certain medications (tetracycline, doxycycline, and Vitamin C) could also lead to esophagitis as these substances directly irritate the lining of the esophagus.

Treatment

Esophagitis can usually be treated with medication. The exact line of treatment for esophagitis depends on the cause of the condition. The following are some of the treatment options :

  • If acid reflux from the stomach is causing esophagitis, medications that block acid production (like proton pump inhibitors) in the stomach are given.
  • Antibiotics, anti-fungal and anti-viral drugs can successfully treat esophagitis caused by infections. Gargling with an oral antiseptic solution could also help.
  • Corticosteroids could be given to reduce inflammation of the esophagus.
  • If intake of certain medicines or foods is causing esophagitis, then the offending substances are avoided.
  • Surgical removal of the inflamed or damaged part of the esophagus is the last line of treatment. It is done only when the pain is very severe and all other treatment approaches fail.

For long term management, certain precautionary measures like drinking plenty of water, avoiding alcohol, tobacco, and spicy or acidic foods should be instituted along with the necessary medication.

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