Could You Be at Risk for Esophagitis?

Heartburn, gastroesophageal reflux disease (GERD), and esophagitis can have a complicated, intertwined relationship.

"Esophagitis simply means inflammation of the esophagus," says Stella Y. Chow, MD, the director of gastroenterology at the Lahey Clinic North Shore in Burlington, Massachusetts.

Your esophagus is the tube that connects your throat to your stomach. When your esophagus becomes irritated or swollen, it causes esophagitis symptoms. Heartburn, a common symptom of esophagitis, affects almost 40 percent of Americans at least twice a month, but having occasional heartburn does not necessarily mean you have esophagitis.

GERD, which affects approximately 20 percent of people in the United States, is a more serious form of regular and frequent heartburn that is more likely to lead to esophagitis. GERD occurs when stomach acid spills out of your stomach and moves upward into your esophagus, a condition called reflux. Since the lining of your esophagus is not designed to tolerate stomach acid, the acid causes irritation and swelling inside your esophagus.

Common Causes of Esophagitis

It’s not always clear why some people have a lot of acid reflux, but it may be due to a weakness of the muscles that keep acid inside the stomach, called a hiatal hernia.

"Esophagitis from acid reflux may be mild or it may be quite serious. Over time, acid reflux may cause swelling or scarring of the esophagus that interferes with swallowing," says Dr. Chow.

"GERD is the most common cause of esophagitis, but other conditions can also cause esophagitis," Chow explains. These include:

• Pill esophagitis "This condition may occur from swallowing pills that irritate your esophagus. Common examples include the antibiotic doxycycline and potassium pills," says Chow. Pill esophagitis may also occur when you swallow pills without drinking enough water.
• Esophageal infection Yeast infections, fungal infections, bacterial infections, and some viral infections can all cause esophagitis.
• Eosinophilic esophagitis. An estimated 56.7 out of 100,000 people are diagnosed with eosinophilic esophagitis in the United States, according to a study published in April 2014 in Clinical Gastroenterology and Hepatology. "This is a rare type of allergic reaction that causes inflammation of the esophagus," says Chow. Foods such as milk, eggs, wheat, soy, peanuts, beans, rye, and beef may trigger this form of esophagitis, according to the Mayo Clinic.
• Other causes These include irritation from excessive vomiting due to illness or bulimia, alcohol, caffeine, cigarette smoking, or heartburn-causing medications like aspirin or anti-inflammatories.

Heartburn and Other Esophagitis Symptoms

Heartburn or acid indigestion may be the most common symptom of esophagitis. Heartburn may occur after meals, especially when when you're lying down, and may cause burning in your chest or throat and a bitter taste in your mouth.

Other esophagitis symptoms may include:

• Difficult or painful swallowing
• Chest pain
• Cough
• Food impaction
• Acid regurgitation
• Chronic hoarseness
• Sore throat

All these symptoms can also be caused by other conditions, so you should see your doctor to determine their cause. Do not assume they are all due to esophagitis. In children and infants, feeding difficulties and failure to thrive may be signs of esophagitis, according to the Mayo Clinic.

How Esophagitis Is Diagnosed

Diagnosis of esophagitis starts with a history and physical exam, Chow explains. “If your doctor thinks you might have esophagitis, you will probably need a special type of imaging study. You may also need a special examination to look inside your esophagus, called an endoscopy.”

Diagnostic tests include:

• Esophageal manometry A thin, pressure-sensitive tube is passed through your nose, into the esophagus to measure the pressures and the pattern of muscle contractions in your esophagus.
• Barium swallow This imaging study takes an X-ray picture of your esophagus after you drink a barium solution. Barium coats the inside of the esophagus to reveal any narrowing from esophagitis.
• Endoscopy During this procedure, a doctor investigates your esophagus through a flexible lighted tube. The tube is inserted through your mouth and requires light anesthesia.
• Biopsy During an endoscopic procedure, doctors frequently remove a piece of esophageal tissue to be looked at under a microscope for signs of inflammation.

Tips to Avoid Esophagitis

"Some things you can do to prevent esophagitis symptoms caused by GERD include taking over-the-counter antacids, avoiding meals close to bedtime, losing weight, not wearing tight-fitting clothing, not smoking, and cutting back on alcohol, spicy foods, and caffeine," suggests Chow.

Untreated esophagitis can lead to serious complications, including changes to the structure of the esophagus and tearing of the esophagus lining tissue, and can even increase your risk of developing esophageal cancer, according to the Mayo Clinic. You can lower your risks of these complications by staying away from identified triggers. Healthy people usually recover within three to five days, but those with a weakened immune system may take longer to heal from an episode of GERD with esophagitis.

If you have esophagitis symptoms that occur more than twice a week, they don't seem to be responding to over-the-counter antacid medications, the symptoms are so severe that it is difficult to eat, or if the symptoms are accompanied by headache, fever, and muscle aches, you should visit your doctor. Esophagitis symptoms such as food getting stuck in your throat, pain when swallowing, and weight loss should be further investigated.

Additional reporting by Erica Tricarico.