Many Americans - in fact, over 60 million - report experiencing heartburn once a month. Of those reported cases, roughly 15 million experience frequent heartburn. Sometimes it can simply be the cause of eating too much spicy food or lying down too quickly after eating. However, sometimes there are other causes, such as gastroesophageal reflux disease (GERD), or esophagitis, which is an inflammation of the esophageal tract. Read on to learn more about esophagitis, its causes, when you should see a healthcare provider, and what treatments are available.
What Is Esophagitis?
The esophagus is the tube that connects the pharynx (throat) to the stomach. If it becomes inflamed for any reason, patients can experience moderate-to-severe pain, especially when they are eating or swallowing. Esophagitis is the medical term for inflammation of the esophagus. Esophagitis may initially feel like heartburn or acid reflux, and these may indeed be the root causes of the condition, but it is more dangerous than uncomplicated acid reflux or heartburn. If the condition is left untreated, the tissues that coat the lining of the esophagus may be permanently damaged. This can lead to irreversible conditions such as scarring of the esophagus, difficulty swallowing, and narrowing of the esophagus. If diagnosed, esophagitis can be successfully treated, and the treatment path depends on the root cause of the issue, as there can be several.
Types of Esophagitis
There are several different types of esophagitis, and each type is directly related to the root condition that is causing the issue. For example, esophagitis can be caused by acid reflux or GERD, by taking certain medications, white blood cell (WBC) disturbances, and viral or bacterial infections. There are five distinct and diagnosable types of esophagitis:
- Reflux esophagitis. The lower esophageal sphincter is a muscle that, when working correctly, keeps food and bile from escaping the stomach and returning to the esophagus. When the sphincter is working, the valve closes. This backflow can cause issues like acid reflux and GERD. Because of the constant irritation of the esophagus from stomach contents, esophagitis can occur.
- Lymphocytic esophagitis. This type occurs when there are too many lymphocytes located in the esophagus. This may be caused by GERD or by another type of esophagitis known as eosinophilic esophagitis.
- Eosinophilic esophagitis. Eosinophils are a type of white blood cell. When there are too many congregating in the esophagus, it can cause irritation. WBCs in the esophagus may be due to an allergic reaction or acid reflux. If it is an allergic reaction, it is often due to food. Common culprits include eggs, milk, peanuts, wheat, and soy.
- Infections esophagitis. Those who are immunocompromised (weakened immune system) have a much higher risk of contracting bacterial infections. This includes patients with HIV/AIDS, cancer, and diabetes. A fungus known as Candida albicans is quite often the cause of this type of condition.
- Drug-induced esophagitis. This type occurs in patients who may be taking certain medications. If a patient does not drink enough water when swallowing a pill, particles of it can remain in the esophagus. Certain drugs are irritants, and over time this can cause esophagitis. These include ibuprofen, naproxen, tetracycline, doxycycline, bisphosphonates, and quinidine.
Risk Factors for Esophagitis
Risk factors for esophagitis are dependent upon the type of esophagitis it is. For reflux esophagitis, risk factors can include obesity, extra weight due to pregnancy, spicy foods, alcohol, caffeine, smoking, fatty meals, and eating directly before going to bed. Some certain foods and beverages can be irritants, and patients should avoid them if possible. These include:
- Citrus fruits
- Tomato-based foods
Risk factors for eosinophilic esophagitis include a family history of allergies, a history of allergic reactions, and anemia. To avoid this type of esophagitis, it’s ideal to know your family history. Risk factors for infections esophagitis include a compromised immune system. Certain cancer treatments and medications such as steroids can cause Candida infection as well.
Drug-induced esophagitis has several risk factors, including taking medications immediately before sleep, taking drugs with no or very little water, older age, and large-shaped pills.
Symptoms of Esophagitis
Esophagitis can affect anyone of any age. In adults, the most common symptoms of esophagitis include trouble swallowing (dysphagia), sore throat, pain when swallowing (odynophagia), heartburn, chest pain that worsens when you eat, nausea and vomiting, cough, abdominal pain, loss of appetite, and hoarseness.
Infants and young children may have a noticeable symptom of trouble feeding or trouble eating.
It’s important to see a doctor if symptoms worsen or persist for more than a few days. If you have shortness of breath or chest pain, it’s also essential to see your healthcare provider. If this is accompanied by muscle aches, fever, or elevated blood pressure, you should be seen right away. Also, if you have trouble swallowing and believe there may be food lodged in the esophagus, you should proceed to an urgent care facility or emergency room immediately.
Treatment of esophagitis also depends on its root cause. Your doctor will likely diagnose your condition by using a barium X-ray or endoscopy. Allergy testing may be needed if allergens are thought to be the root cause. If acid reflux or GERD is the cause of the problem, antacids and proton pump inhibitors (PPIs) are first-line treatments to help keep acid reflux at bay. Anti-fungal or antiviral medications are used for infectious esophagitis. Your healthcare provider may also prescribe pain relief medications to help with associated pain.
In addition to medication, your physician will likely advise some lifestyle changes, such as cutting back on alcohol and caffeine, quitting smoking if you are a smoker, and avoiding spicy foods.
If allergens are thought to be the root cause, you will need to pinpoint which food is causing the problem by practicing elimination. The most common foods that cause eosinophilic esophagitis include shellfish, eggs, wheat, soy, legumes, tree nuts, peanuts, and milk.
Potential Long-Term Health Complications
The long-term outlook for esophagitis is good as long as patients adhere to treatment courses and don’t have other underlying problems (such as a weakened immune system). Some milder cases of esophagitis even go away on their own, without treatment. It’s essential to remember to visit your healthcare provider if you have esophageal or heartburn symptoms that persist for more than a few days.
If you have chronic esophagitis and it is left untreated, the risk of developing Barrett’s esophagus is much higher. This is a fairly rare but dangerous condition in which the cells that line the esophagus change over time. This significantly increases the chance of contracting esophageal cancer.
Other long-term health complications that can arise from untreated esophagitis include scarring of the esophagus, narrowing of the esophageal pathway, and tearing of the esophagus. These can all be painful and irreversible conditions. If you need more information on esophagitis or would like to be seen by a physician, request an appointment with Dr. Sameer Islam, MD today. Dr. Islam has been practicing as a gastroenterologist for many years and provides each patient with individualized, supportive care.