5 Causes of Esophagitis

Many common medications taken by mouth have been linked to esophagitis. Aspirin, for example, can cause inflammation of the esophagus if you take it too often or not with plenty of water. Other oral medicines that can cause drug-induced esophagitis include antibiotics, medicines to treat osteoporosis (bisphosphonates), nonsteroidal anti-inflammatory medications (such as ibuprofen and COX-2 inhibitors), potassium chloride pills, and the heart medication quinidine. To avoid developing drug-induced esophagitis, wash pills down with plenty of water so they do not remain in contact with esophageal tissue, and don’t take medications while lying down.

Although researchers are not yet certain what causes eosinophilic esophagitis (EoE), an overactive immune system likely plays a role. In EoE, esophageal tissue becomes overpopulated with white blood cells called eosinophils. These cells cause chronic inflammation of the esophagus that may lead to difficulty swallowing and esophageal narrowing. Symptoms of EoE in infants include poor feeding, vomiting, and failure to gain weight. Older children, adolescents, and adults might report difficulty swallowing food completely or abdominal pain. Doctors treat EoE with medications to reduce inflammation and sometimes acid reflux.

Occasionally, infectious organisms can attack esophageal tissue and lead to a case of infectious esophagitis. This more commonly occurs in people with a weakened immune system, such as those with HIV/AIDS or diabetes, those who take medications to suppress the immune system, or those who are undergoing chemotherapy. The most common causes of infectious esophagitis include human papillomavirus (HPV), Candida (yeast infection) and the bacterium that causes tuberculosis. If your immune system is compromised and you develop difficulty swallowing, you should see a doctor to find out if you might have infectious esophagitis.

Acid reflux represents one of the more common causes of esophagitis. When stomach contents regurgitate upwards into the esophagus, the acid component can irritate esophageal tissues. Left untreated, stomach acid can cause serious esophageal damage. To treat reflux esophagitis, doctors usually recommend lifestyle changes that include losing weight, elevating the head of your bed, and avoiding foods and beverages that can trigger episodes of heartburn. You also may receive medication for esophagitis healing, such as antacids. In severe cases, surgery may be required to prevent stomach acid from reaching the esophagus.

A newly recognized type of chronic esophagitis occurs when the lower portion of the esophagus becomes infiltrated with too many white blood cells called lymphocytes. Doctors don’t yet know why this happens, though the condition may be related to eosinophilic or reflux esophagitis. Lymphocytic esophagitis produces the same symptoms (swallowing problems in older children or adults, poor feeding in infants and young children) as other types of esophagitis, so doctors will confirm a diagnosis based on tissue biopsy. Treatment options for lymphocytic esophagitis include antacids and anti-inflammatory medications like steroids.