Esophagitis

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Introduction

What is esophagitis?

Esophagitis is inflammation of the esophagus, which can result in symptoms such as hoarseness, difficulty swallowing, and heartburn. Esophagitis is most commonly caused by acid reflux, which is the upward movement of gastric fluids from the stomach to the esophagus. Your risk of developing acid reflux is increased by obesity, alcohol or tobacco use, a hiatal hernia (protrusion of the stomach into the chest), or frequent vomiting. Different types of infections, including herpes virus and Candida infections, may also lead to esophagitis.

If you have a weakened immune system, for example as the result of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), leukemia, or chemotherapy, your risk of esophagitis is also increased. Taking certain types of pills, such as vitamin C, doxycycline, tetracycline, or alendronate (Fosamax), without drinking enough water may also increase your risk of esophagitis.

The signs and symptoms of esophagitis can occur every day or only after eating certain foods. Some people with esophagitis have mild symptoms such as hoarseness, while others may have severe burning and difficulty swallowing. Esophagitis can be treated with antacids and, in cases in which the esophagitis is due to a viral or Candida infection, antiviral or antifungal medications. Healthy lifestyle changes, such as maintaining a healthy weight, limiting alcohol intake, not smoking, and always taking medications with enough water, can help reduce your risk of esophagitis.

Esophagitis alone is rarely a serious condition; however, some of the symptoms of esophagitis may be a sign of a more life-threatening condition such as a heart attack. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms such as severe breathing problems, bluish coloration of the lips or fingernails, and chest pain, chest tightness, chest pressure, or palpitations. Also seek immediate medical care (call 911) if you, or someone you are with, are vomiting blood or black material.

Seek prompt medical care if you are being treated for esophagitis but mild symptoms recur or are persistent.

Symptoms

What are the symptoms of esophagitis?

The symptoms of esophagitis result from irritation or infection of the esophagus and can vary in intensity among individuals.

Esophageal symptoms of esophagitis

You may experience esophagitis symptoms daily or just once in a while. At times any of these symptoms can be severe:

Other symptoms of esophagitis

You may experience other symptoms with esophagitis. Examples include:

In some cases, symptoms that occur with esophagitis can be a sign of a heart attack or other serious condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Chest pain, chest tightness, chest pressure, palpitations

  • Radiating pain down your shoulder and arm

  • Respiratory or breathing problems such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

  • Vomiting blood or black material (resembling coffee grounds)

Causes

What causes esophagitis?

Esophagitis is most commonly caused by acid reflux, which is the upward movement of gastric fluids from the stomach to the esophagus. Your risk of acid reflux is increased by obesity, alcohol or tobacco use, hiatal hernia (protrusion of the stomach into the chest), or frequent vomiting. Different types of infections, including herpes virus and Candida infections, may also lead to esophagitis.

What are the risk factors for esophagitis?

A number of factors increase the risk of developing esophagitis. Not all people with risk factors will get esophagitis. Risk factors for esophagitis include:

  • Alcohol abuse

  • Diabetes (a chronic disease that affects your body’s ability to use sugar for energy)

  • Hiatal hernia (protrusion of the stomach into the chest through an opening in the diaphragm)

  • Obesity

  • Repeated vomiting

  • Sleep posture (head elevation reduces risk)

  • Smoking

  • Swallowing pills such as vitamin C, doxycycline, tetracycline, or alendronate without drinking enough water

  • Weakened immune system, which could be a result of chemotherapy, HIV/AIDS, lymphoma (cancer of the immune cells), or leukemia (cancer of the blood or bone marrow)

Treatments

How is esophagitis treated?

Treatment for esophagitis will depend on the underlying cause of the disease, but medications such as proton pump inhibitors and histamine H2-receptor antagonists, which reduce stomach acids, are the mainstay of treatment. If your esophagitis is caused by a viral or fungal infection, you will likely benefit from treatment with an antiviral or antifungal medication. Lifestyle modifications include: avoidance of spicy foods, elevated head position while sleeping, smoking cessation, and wearing loose fitting garments. Reductions in consumption of alcohol, caffeine, chocolate, fatty foods, and peppermint can also significantly improve symptoms.

Treatments for esophagitis that reduce stomach acid

Proton pump inhibitors that may be effective in the treatment of esophagitis include:

  • Esomeprazole (Nexium)

  • Lansoprazole (Prevacid)

  • Omeprazole (Prilosec)

  • Pantoprazole (Protonix)

  • Rabeprazole (Aciphex)

Histamine H2-receptor antagonists that may be effective in the treatment of gastritis include:

  • Cimetidine (Tagamet)

  • Famotidine (Pepcid)

  • Nizatidine (Axid)

  • Ranitidine (Zantac)

Treatments that target an infection

If your esophagitis is caused by infection, treatment will include medications designed to target the specific pathogen. If Candida is responsible for your esophagitis, an antifungal medication, such as amphotericin B (for example, Fungilin, Fungizone, and Abelcet) or fluconazole (Diflucan), will be an effective treatment. Herpes-related esophagitis requires treatment with antiviral medications such as valacyclovir (Valtrex), famciclovir (Famvir), or acyclovir (Zovirax).

What are the potential complications of esophagitis?

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of esophagitis include:

  • Barrett’s esophagus (cellular changes in the esophageal lining that are a precursor to esophageal cancer)

  • Esophageal cancer

  • Esophageal scarring and narrowing

  • Perforated esophagus

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Esophagitis. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/001153.htm
  2. Candidiasis. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.intelihealth.com/print-article/candidiasis
  3. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108:308.
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