What Is It?

The esophagus is the muscular tube that carries food through the chest, from the mouth to the stomach. Normally you don’t feel it except when you are swallowing. Sometimes, though, symptoms in the chest can signify problems with the esophagus. If the inside lining of your esophagus becomes inflamed, causing pain and problems with swallowing, you have esophagitis.

Esophagitis has several common causes:

• Acid reflux — By far the most common cause of esophagitis, acid reflux (also called gastroesophageal reflux disease or GERD) is a backflow of digestive acid from the stomach, resulting in a chemical burn of the esophagus.
• Eating disorders — Like acid reflux, frequent vomiting can cause acid burn in the esophagus. Esophagitis sometimes is seen in people with eating disorders who make themselves vomit.
• Medications — Some common medications also can cause a chemical burn in the esophagus. Pills that are most likely to cause esophagitis include potassium, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or aspirin, osteoporosis medications such as alendronate (Fosamax or Actonel), iron supplements and quinidine (sold under several brand names).
• chemotherapy and radiation therapy for cancer — Some of these treatments can have a side effect of injuring the esophagus lining, resulting in esophagitis.
• Infections — Infections in the esophagus can also result in esophagitis. Only a few types of infection are common in the esophagus, and they usually do not occur if your immune system is normal. If your immune system is weakened, you may develop esophagitis from yeast (candidal esophagitis) or from viruses such as cytomegalovirus (CMV) or herpes. Even in someone who already has a herpes infection, herpes very rarely causes esophagitis if the immune system is normal. Esophagitis from infections is common in people who have HIV infection, use long-term steroid medicines, have had organ transplants, and have been treated with chemotherapy for cancer.

The main symptoms of esophagitis are:

• Pain in the chest (behind the breastbone) or throat that can be burning, heavy or sharp — If acid reflux is the cause of esophagitis, the pain may be worse after meals or when you lie flat. Pain from esophagitis may be constant or may come and go.
• Swallowing problems including worsening of the chest pain when you swallow or a feeling of food sticking in your chest after you swallow
• Bleeding, seen as blood in vomit or as darkening of the stools

The diagnosis often is made based on your symptoms. The most accurate way to check for esophagitis is for a gastroenterologist to look directly at the inside of the esophagus with a video camera called an endoscope. The endoscope has a camera at the end of a flexible, plastic-coated tube. This tube is long enough to reach through the stomach to the first portion of the intestine (duodenum), so the procedure is sometimes called esophagogastroduodenoscopy or EGD. Using the endoscope, the gastroenterologist can see evidence of injury from esophagitis, such as areas where the lining of the esophagus has worn away (called erosions or ulcers), blisters or scarred areas. Some infections leave a deposit on the esophagus walls that can be sampled through the endoscope by using a remote-controlled brush. In some cases the doctor will biopsy the esophagus by snipping a small sample of the inside lining through the end of the endoscope. This tissue is examined under a microscope.

Since esophagitis is only one of the things that can cause symptoms of chest pain or swallowing problems, your doctor may order other tests to evaluate your heart, lungs or digestive tract.

How long symptoms last depends on how easily their cause can be eliminated. Bad cases of reflux or resistant viruses, for example, might require several tries before the right medicine or treatment is found. In most cases, symptoms begin to improve within a few days of starting the right treatment, but it can take weeks for symptoms to go away completely. Esophagitis from infections is harder to cure if the immune system is severely weakened.

The most common cause of esophagitis, acid reflux, sometimes can be prevented by some very simple measures:

• Avoid heavy meals, especially within several hours of bedtime
• Cut out cigarettes and alcohol
• Avoid large amounts of caffeine, chocolate, peppermint and high-fat foods.
• Control your weight.

If you have heartburn despite these measures, your doctor may suggest you take a preventative acid-blocking medicine.

All prescription and nonprescription pills should be taken while you are upright and should be swallowed with water. This is especially important for the medicines that frequently cause esophagitis.

If you are at risk of developing infections in the esophagus because you have a weakened immune system, or if you are about to undergo treatment with chemotherapy, be sure to tell your doctor about past herpes infections. In some cases it is important to use the antibiotic acyclovir (Zovirax) to prevent herpes virus from causing a deep infection.

Treatment depends on the cause of esophagitis.

• Acid reflux — Anti-acid medications, including H2-blockers and proton-pump inhibitors, may be used. For a few difficult cases, a type of stomach surgery can also help prevent reflux.
• Medications — Drinking a full glass of water after taking a pill can be helpful. For severe esophagitis, it is sometimes preferable to stop the medicine and find alternative treatment.
• Infections — These are treated with specific antibiotics. Some esophagus infections are difficult to treat with swallowed pills or liquids, so intravenous medicines may be used.

While your esophagus is recovering, your doctor can ease your pain symptoms by prescribing pain relievers or a local anesthetic that can be swallowed in a thick liquid form to coat the esophagus lining.

If you are unable to eat or drink due to pain during swallowing, you should contact your doctor. Life-threatening dehydration can develop quickly if you cannot drink liquids.

Occasionally an injured esophagus can develop a hole, causing sudden worsening of chest pain, shortness of breath or fever. Report these symptoms to your doctor immediately, because bacteria from your digestive tract can contaminate your chest cavity and cause a serious infection.

If your symptoms do not clear up with initial treatment, consult your doctor. Occasionally, scarring in the esophagus will cause persistent swallowing difficulty that might require treatment by a gastroenterologist.

Almost all cases of esophagitis can be cured. Some causes, such as acid reflux, may require long-term treatment.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.