Esophagitis: symptoms, causes and treatment

By Cristiano Antonino On Apr 24, 2023

Esophagitis is an inflammation of the esophagus, i.e. the part of the alimentary canal that connects the pharynx to the stomach

This inflammation can be caused by the use of drugs or corrosive substances, by gastroesophageal reflux or by infectious processes and allergies, it can be acute or chronic.

Symptoms of esophagitis

The symptoms that can alert you to a possible inflammation of the esophagus are mainly sore throat, hoarseness, pain or difficulty swallowing and retrosternal pain.

In particular they can be listed as below and vary according to the type of esophagitis:

Difficulty and/or pain when swallowing
Substernal chest pain
Nausea
Vomit
Stomach pain or heartburn
Inappetence
Saliva regurgitation
Regurgitation of food or bitter or sour liquid in the mouth
Feeling of fullness and bloating
Weight loss
Cough
Bleeding
Hoarseness
Sore throat
Asthma
Sores inside the mouth
Alterations of the oral mucosa.

The types of esophagitis

Esophagitis, as mentioned above, is a condition characterized by acute or chronic inflammation of the esophagus due to the excessive rise of acidic gastric juices that come from the stomach.

Minor causes that can lead to the same disorder are infectious diseases, allergies, corrosive substances, the ingestion of drugs or tumors.

There are different types of esophagitis depending on the etiology

Reflux oesophagitis

Normally, the lower esophageal sphincter prevents gastric contents from moving up into the esophagus.

However, if this passage is not closed or opens at the wrong times, gastric juices can go back into the esophagus causing inflammation of the esophageal mucosa.

This is referred to as reflux oesophagitis.

Some of the causes related to the disorder in question can be pregnancy, obesity, always wearing very tight clothes, hiatal hernia, going to bed before two hours after the end of the meal and still the abuse of alcohol, coffee and smoking.

Eosinophilic esophagitis

We speak of eosinophilic esophagitis when chronic inflammation of the lining of the esophagus is found in the patient.

Generally this disorder affects subjects, mostly males, with autoimmune or allergic diseases.

In this case there are high concentrations of eosinophilic leukocytes in the esophageal mucosa, white blood cells responsible for controlling inflammatory and allergic reactions.

The reasons that can lead to this disorder are various, such as allergies of food origin (to soy, eggs, peanuts, milk, wheat, fish) or allergies of the respiratory tract (such as those caused by pollen or dust).

Sufferers of eosinophilic esophagitis are often affected by other allergic manifestations such as asthma, allergic rhinitis, eczema, rash, itching and food allergies.

Infectious esophagitis

This type of inflammation can be caused by viruses (herpesvirus, varicella virus and cytomegalovirus), bacteria and fungi (helicobacter pylori, candida albicans).

People with an already compromised immune system due to diabetes, HIV, cancer undergoing chemotherapy or radiation therapy, or prolonged use of antibiotics are the most exposed to this type of esophagitis.

Radiation esophagitis

It can occur as a complication of chest-focused radiotherapy used in the treatment of lung or breast cancer.

Esophagitis due to ingestion of caustic substances

Caustic esophagitis is caused by the ingestion of certain detergents.

Caustic esophagitis is caused by the ingestion of some corrosive substances such as household cleaners and batteries.

Drug-induced oesophagitis

It can be caused by taking medicines such as NSAIDs (aspirin, ibuprofen or naproxen).

It can be caused by taking drugs such as NSAIDs (aspirin, ibuprofen or naproxen), antibiotics such as clindamycin or tetracycline, biphosphates (alendronate, ibandronate or risedronate) and potassium chloride.

If drug residues remain in contact with the esophageal mucosa for a long time, this type of esophagitis can arise.

This occurs, for example, if the drug has been taken without drinking or without sufficient amounts of water, on an empty stomach, in the presence of oesophageal motility disorders or just before going to bed.

If there are residues of the drug that remain in contact with the lining of the esophagus for a long time, then this type of esophagitis can arise.

This occurs if, for example, the drug has been taken without drinking, without sufficient quantities of water, in the presence of oesophageal motility disorders or immediately before going to bed.

Esophagitis associated with other diseases

The latter type of esophagitis can be a consequence, for example, of scleroderma.

How to arrive at a diagnosis of esophagitis?

The evaluation is mainly based on the collection of the clinical history, the medical examination and through the aid of various instrumental tests such as:

barium radiography which consists in administering orally a solution containing this contrast medium which is distributed along the walls of the esophagus and thus facilitates the study of radiographic images;
esophagogastroduodenoscopy (EGDS), a procedure used to explore the state of the oesophageal lining for signs of oesophagitis. Small tissue samples (biopsy) can be taken in order to ascertain the possible presence of cancerous or precancerous lesions, or of infectious processes in progress (useful for research, for example, of helicobacter pylori);
a diet that excludes some foods that are normally eaten;
Investigations to evaluate sensitivity to certain allergens;
24-hour esophageal pH measurement and impedance measurement, which is used to evaluate the characteristics of the reflux and in particular its physical state (liquid or gaseous reflux), measure the pH of the liquid that refluxes and therefore the presence of acid and also the number of episodes of reflux that occur during the day and their relationship with physiological activities such as meals;
Finally, esophageal manometry, used to measure the tone of the lower esophageal sphincter, i.e. the pressure it is able to exert.

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Care and treatments

If neglected, the disorder of esophagitis can determine the alteration of the structure and functionality of the esophagus.

Obviously the drugs that can be prescribed for treatment vary according to the type of esophagitis and the etiology.

We list them:

proton pump inhibitors (PPI);
antacids;
antisecretory drugs;
proton pump inhibitors;
painkillers;
steroids;
antivirals;
antifungals;
antibiotics

In the treatment of esophagitis, the patient’s behavioral habits play a key role, which must go hand in hand with any drug therapy.

Here are some predisposing factors:

Smoke
Alcohol
Some irritating foods such as: citrus fruit, tomato, spices, garlic, onion, packaged nut, fried, chocolate, mint.
Intake of carbonated drinks, coffee and its derivatives
Go to bed before two hours after meals
Hearty meals

The risks of esophagitis

If the subject does not undergo adequate medical treatment, the chronicity of the inflammation can lead to structural alterations of the esophagus such as narrowing and growth of abnormal tissue rings in the internal linings.

You may experience severe difficulty swallowing and breathing problems.

Barrett’s esophagus

The most serious complication linked to neglected esophagitis is called “Barrett’s esophagus”, a condition in which the esophageal epithelium undergoes a structural modification in order to increase its resistance to acids.

The normal multilayered squamous epithelium, in this case, is replaced with a columnar glandular epithelium resembling that of the intestine.

The consequence can be the development of an esophageal adenocarcinoma, the risk of which varies from 0.5 to 10% per year per person.

Untreated reflux oesophagitis can also cause an esophageal ulcer with consequent bleeding that can lead to anemization.

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