The 7 Main Types of Esophagitis

Esophagitis is inflammation of your esophagus, the tube from your mouth to your stomach. While a condition it its own right, diagnosis can't stop there. Esophagitis can stem from infectious or non-infectious causes, and the seven main types of esophagitis that result range in terms of treatment approaches and possible associated health consequences—some of which can be life-threatening.

The seven main types of esophagitis include:

• Acid reflux
• Infectious
• Caustic ingestion
• Medication-induced
• Eosinophilic
• Chemotherapy and radiation therapy
• Systemic illnesses

Finding out the type of esophagitis you have is the first step in getting you on the road to feeling better.

Reflux Esophagitis

Esophagitis is most commonly caused by gastroesophageal reflux disease (GERD).

Most people will experience some reflux of stomach contents. However, you will have an increased risk of developing esophagitis if you experience frequent exposure to stomach acid, pepsin (enzyme in the stomach), and bile, as they can cause inflammation and ulcerations in your esophagus.

Infectious Esophagitis

If you have a weakened immune system, you will be more susceptible to acquiring an infection that causes esophagitis. This is most often seen in people that have acquired immunodeficiency syndrome (AIDS), an organ transplant, or in people who've had chemotherapy.

While you are at an increased risk for esophagitis from infectious causes if you are immunocompromised, you can still acquire infectious esophagitis with a competent immune system.

Infections that commonly cause esophagitis include:

• Candida (yeast): most common cause
• Herpes simplex virus (HSV)
• Cytomegalovirus (CMV)
• Aphthous ulceration, a.k.a. idiopathic ulceration

Caustic Esophagitis

Caustic esophagitis occurs when you ingest a chemical that burns your esophagus. Alkaline substances—such as lye, household bleach, batteries, or detergents —are especially likely to cause irritation, ulcers, or perforation (holes or tears) of your esophagus.

Harm to your esophagus will be proportional to the amount of time your esophagus was exposed to the chemical, as well as its toxicity. If only a little contact occurred, you may only have some irritation. Further exposure increases your risk for the formation of ulcers or worse damage.

Medication-Induced Esophagitis

Esophagitis caused by medications is rare. It only occurs in about four out of every 100,000 people per year.

Medication-induced esophagitis can occur by either direct contact, similar to caustic esophagitis, or by affecting protective barriers in the stomach and esophageal lining.

Medications that have a low pH (acidic) and can cause medication-induced esophagitis include:

• Antibiotics such as tetracycline, doxycycline, and clindamycin
• Ascorbic acid (vitamin C) supplements
• Ferrous sulfate (iron) supplements

Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), like Ibuprofen, can disrupt the protective barrier of the esophagus and stomach. This can increase your risk of developing esophagitis.

Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is an allergic/immune response. Eosinophils, part of the immune system, are white blood cells that can be associated with inflammation and related to allergies. One of the main identified risk factors for the development of eosinophilic esophagitis is allergies to foods.

Environmental factors have also been identified as a possible factor in acquiring eosinophilic esophagitis. The rationale for this is similar to environmental risk factors associated with asthma and inflammatory skin disorders. It is thought that not having enough exposure to bacteria and other microbes early in life may be an underlying cause of EoE

Esophagitis Related to Chemotherapy and Radiation

Esophagitis can occur as a result of chemotherapy or radiation therapy for treating cancer, particularly of the thorax. One of the more common causes is radiation treatment for lung cancer.

The esophagus is vulnerable to radiotherapy injury due to its continuous mucosal cell turnover, with mucosal inflammation and basal epithelial thinning progressing to denudation (wearing away) and ulceration. Several months may be required for healing, if any, to occur. 

Esophagitis Related to Systemic Illness

A variety of systemic (body-wide) illnesses may make you prone to developing esophagitis.

These may include:

• Scleroderma
• Inflammatory bowel disease (IBS)
• Behçet disease
• Sjögren's syndrome

Shared Symptoms and Variations

The problem with associating symptoms with a specific type of esophagitis is that symptoms of esophagitis are often associated with other physical symptoms. Mild acid reflux, for example, would present in a much less pronounced way than esophagitis due to ingestion of a caustic substance.

Many of the symptoms related to esophagitis include:

• Heartburn (may be similar to chest pain in coronary artery disease)
• Pain with swallowing (odynophagia)
• Difficulty swallowing (dysphagia)
• Nausea and/or vomiting
• Abdominal pain
• Cough
• Hoarseness
• Anorexia and weight loss

Symptoms of esophagitis, pain in particular, are particularly severe in cases of erosive esophagitis, in which your esophagus has begun to ulcerate or erode.

Diagnosing Esophagitis Type

Your healthcare provider will assess and test for certain types of esophagitis based on your symptoms, current situation, and medical history (recent cancer treatment, for example, would be a big clue).

You will probably need at least one of the following diagnostic procedures, as blood draws will not help differentiate what is causing your symptoms. Typically, an endoscopy would be the first test, but not always.

Endoscopy

Also known as an esophagogastroduodenoscopy (EGD), this is performed as an outpatient procedure. A gastroenterologist will look at your esophagus, stomach, and upper intestine with a scope. They will check for signs of inflammation or ulceration and attempt to identify any causes of your symptoms.

Biopsies are usually taken to look for any infectious causes.

You will be given conscious sedation, so you will need to have someone drive you home after the procedure.

Barium Swallow Study

A barium swallow study is also known as an esophagography. A clinician will take X-rays of your esophagus while you ingest barium with some food.

The barium coats your esophagus, which then shows up white on imaging. This will allow your healthcare provider to see if you have any obstructions or narrowing in your esophagus.

Esophageal Manometry

A third possibility is the esophageal manometry exam, which measures how well your esophagus is working. Your healthcare provider will insert a pressure-sensitive tube through your nose, down your esophagus, and into your stomach.

As your healthcare provider pulls the tube back out, you will be asked to swallow. The tube measures the pressure of the esophageal contractions.

Other Tests

It is possible that further type-specific testing may be necessary to confirm the diagnosis.

For example, if infectious esophagitis is suspected, your healthcare provider will take "brushings" or biopsies of your esophagus. This is necessary because this type of esophagitis is generally not able to be distinguished by symptoms or by visualization of the ulcers during an endoscopy.

The lesions found during an endoscopy are generally white to yellow in coloration. Candida is often found to be plaque-like, while HSV or CMV is more likely to have ulcers.

With cases of EoE, a biopsy sample collected during endoscopy will reveal the presence of eosinophils—white blood cells that are part of your immune system and that are not normally present in the esophagus. That would prompt a gastroenterologist to refer you to an allergist for allergy testing, which can include:

• Skin prick test, a common method to test different allergens
• Blood tests
• Food patch test, where food is placed in a small, flat aluminum container (called a Finn chamber) that adheres to your skin and is left in contact with your skin for 48 hours

Identifying the exposure(s) causing an allergic response in your esophagus is necessary to determine an avoidance plan that can reduce your symptoms.

In some cases, you may be able to identify the instigating foods to avoid as a result of the above tests. However, this may not always identify all the foods you should avoid. In this case, your healthcare provider may recommend a food elimination diet, which removes common foods from your diet.

Treatment Approaches

Given the range of possible causes behind the types of esophagitis, it's easy to see why there is no one-size-fits-all approach to treatment.

The possibilities range from dietary changes to avoidance strategies, medications to surgery depending on the type of esophagitis.

Watch and Wait

If you do not have any adverse symptoms after ingesting a caustic substance, you may only be watched for a few hours. However, if you have symptoms of esophageal damage, you will need to be admitted to the hospital for medical management.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) like Prilosec (omeprazole) or Dexilant (dexlansoprazole) are indicated for reflux esophagitis.

You should be treated with a PPI for four to eight weeks. After at least four weeks, your healthcare provider should reevaluate your symptoms.

If after you have recurrent issues with esophagitis related to GERD or have Barrett's esophagus, you will likely need ongoing PPI therapy.

Oral Solutions

Treatment of esophagitis related to chemo and radiation will involve viscous lidocaine to numb your esophagus.

As sucralfate, an antacid, can help treat any ulcers, many patients are prescribed "magic mouthwash"—a gargle that contains these two ingredients.

Corticosteroids

While corticosteroids like prednisone are commonly used for treatment of esophagitis related to systemic illness, you should always discuss the best treatment method with your healthcare provider.

Prednisone is, however, the treatment of choice if you are diagnosed with aphthous esophagitis.

Treatment with oral medications will usually last between 14 and 21 days.

Monoclonal Antibodies

Dupixent (dupilumab) is the first and only treatment approved by The Food and Drug Administration (FDA) to treat eosinophilic esophagitis. Dupixent is a monoclonal antibody that is injected once weekly.  

Other Medications

If you are diagnosed with a Candida infection, you'll most likely be prescribed an anti-fungal medication. If you are diagnosed with a viral infection, like HSV or CMV, then your healthcare provider will prescribe an antiviral.

Medication Cessation

Treatment for any type of medication-induced esophagitis consists of stopping the medication. If you are unable to stop the medication, your healthcare provider may order a liquid version.

In general, medication-induced esophagitis will resolve quickly without any long-term effects if the damage is stopped early. Typically you will see improvements in as soon as a few days.

Never stop taking a medication without your prescribing healthcare provider's approval.

Dietary Changes

Cases of EoE can be addressed with changes to your diet so that what causes the allergic reaction is eliminated. Testing can help you identify what foods are at the heart of your esophagitis.

A Word From Verywell

While these seven types of esophagitis comprise the main causes of esophagitis, there are many other less common causes. Esophagitis can be very serious, and it's important to understand what type you have so you can work with your healthcare provider to treat it correctly.

Chronic esophagitis can destroy the tissue of the esophagus. Given the organ's role in the most basic bodily function—digesting food—it's vital to monitor its health, particularly if you have other conditions that can contribute to esophagitis.