Erosive Esophagitis and Heartburn

Male doctor examining a young woman's throat with a tongue depressor
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Esophagitis is a term used to indicate any inflammation, swelling, or irritation of the esophagus. The esophagus becomes inflamed (swollen, irritated and red).

Causes and Risk Factors

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

  • Reflux of stomach contents: Refluxed stomach contents into the esophagus is the most common cause of esophagitis. Gastroesophageal reflux disease (GERD) is the most common condition exhibiting reflux. 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 esophageal 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 esophagus doesn't contract properly, such as with a motility disorder.
  • Infections: These include infections caused by viruses (such as herpes and cytomegalovirus), fungi (such as Candida infections) and bacteria. These infections develop more often in individuals with weakened immune systems, such as caused by HIV.
  • Injury from chemicals: If strong chemicals are ingested, such as drain cleaners, injury to the esophagus can be very severe. It can also be life threatening.
  • Radiation injury: Radiation treatment in the chest of neck area as part of cancer treatment can cause esophagitis.

    Symptoms

    These are the most common symptoms seen:

    • 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, which gives the doctor a direct view of the esophagus
    • Barium X-rays, which are X-rays taken in conjunction with a special dye that is swallowed
    • Biopsy of the inflamed tissue
    • Culture of the esophagus

    Treatments

    Treatment of esophagitis depends on the cause. Treatment may include:

    • Medications to reduce acid if gastroesophageal reflux disease is the cause, such as proton pump inhibitors (PPIs) or H2 blockers
    • Antibiotics if an infection is a cause
    • Steroid medication for inflammation
    • Pain medication

    While undergoing treatment, your doctor will also talk to you about other 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:

      • If your symptoms do not go away with initial medical treatment. Scarring of the esophagus, which can lead to a stricture of the esophagus, can cause continuing swallowing difficulties, which may require additional treatment.
      • If you are not able to eat or drink due to pain. Life-threatening dehydration can occur if you cannot 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.