Erosive Esophagitis: Causes and Treatments

Male doctor examining a young woman's throat with a tongue depressor
George Doyle/Stockbyte/Getty Images

Esophagitis is the word used to describe inflammation, irritation, or swelling of the lining of the esophagus, the tube that runs from the throat to the stomach. This lining is sensitive, so it's vulnerable to irritation and swelling. 

Causes and Risk Factors

Several factors can contribute to an increased risk of developing esophagitis:

  • Refluxed stomach acid: Stomach acid that leaks back into the esophagus on a regular basis is the most common cause of esophagitis. Reflux is mainly seen with gastroesophageal reflux disease (GERD), which occurs when a muscle at the end of your esophagus doesn't close properly. Other triggers of reflux include pregnancy, obesity, smoking, alcohol, caffeinated beverages, and fatty or spicy foods.
  • Excessive vomiting: The acid contained in vomit can irritate the esophagus, and excessive vomiting can lead to inflammation.
  • Pills getting stuck: If a pill gets stuck in the esophagus, it can cause burning of the lining. This usually happens when not enough water or other fluid is used to wash down the pill. However, it may also occur when the esophagus is narrowed by scarring or strictures, or the muscles of the esophagus don't contract properly to propel contents into the gastrointestinal tract (aka a motility disorder).
  • Infections: These include infections caused by viruses (such as herpes and cytomegalovirus), fungi (such as Candida infections), and bacteria. Infections develop more often in people whose immune systems are weakened by conditions like HIV/AIDS.
  • Injury from chemicals: If strong chemicals like drain cleaners are ingested, injury to the esophagus can be very severe and even life-threatening.
  • Radiation injury: Radiation treatment in the chest or neck area as part of cancer treatment can cause esophagitis.

Symptoms

The most common symptoms of esophagitis are: 

  • Difficulty when swallowing
  • Pain when swallowing
  • Feeling like something is stuck in the throat
  • Burning sensation in the esophagus
  • Acid reflux (heartburn)
  • Bleeding, seen either as blood in vomit or in stools (turning stools black or tarry)

Diagnosis

Your doctor will perform a thorough physical exam, along with going over your medical history, before proceeding to a diagnostic test. These tests include:

  • Endoscopy: This procedure uses an endoscope, a flexible tube with a light and camera at the end, to provide a direct view of the esophagus.
  • Barium X-rays: These X-rays are taken in conjunction with a barium solution that's swallowed. This special dye coats the lining of the esophagus and shows up white on an X-ray, to help give a clear picture of the esophagus. 
  • Biopsy of the inflamed tissue
  • Culture of the esophagus

Treatments

Treatment of esophagitis depends on the cause and may include:

  • Acid-reducing medications, such as proton pump inhibitors (PPIs) or H2 blockers, if GERD is the cause 
  • Antibiotics if an infection is a cause
  • Steroid medication for inflammation
  • Pain medication

While undergoing treatment, your doctor will also talk to you about lifestyle steps you can take to ease the discomfort of esophagitis.

What you should avoid:

  • Spicy foods
  • Acidic foods and beverages, such as citrus juices and juices, and tomato-based products
  • Hard foods that can cause pain in the esophagus when swallowed, such as nuts and raw vegetables
  • Tobacco

What you can do:

  • Eat five or six smaller meals during the day instead of three larger ones.
  • Eat soft foods, such as puddings, applesauce, soups, and custards.
  • Take small bites of food and chew thoroughly before trying to swallow.
  • Drink beverages through a straw.
  • Elevate the head of the bed 8 to 10 inches or sleep on a wedge pillow to help keep stomach contents out of the esophagus during sleep.

Prognosis

Whether the esophagitis is caused by reflux disease or an infection, both usually respond well to medical treatment. However, if the cause is acid reflux, the treatment may be long-term.

Complications

You should call your doctor if any of the following occurs:

  • Your symptoms don't go away with initial medical treatment. Scarring of the esophagus can lead to a stricture (narrowing or tightening) of the esophagus. This narrowing can cause continuing swallowing difficulties that may require additional treatment.
  • You're unable to eat or drink due to pain. Life-threatening dehydration can occur if you can't drink fluids.
  • Sudden worsening chest pain, shortness of breath, or fever. This could mean a hole has developed in the esophagus, and you should call your doctor immediately. A hole can allow bacteria from your digestive tract to enter your chest cavity and cause a serious infection, which can be a life-threatening situation.
View Article Sources
  • Acid Reflux (GER and GERD) in Adults. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults.
  • Esophagitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/esophagitis/symptoms-causes/syc-20361224.