Definition

Esophagitis is the inflammation of the mucous layer of the esophagus, which is the channel connecting the mouth to the stomach. Esophagitis can cause pain, difficulty swallowing, and chest pain. The causes of esophagitis include the reflux of stomach acid into the esophagus, infections, certain drugs, and allergies. The treatment for esophagitis depends on the underlying cause and the severity of the damaged tissue. If left untreated, esophagitis can lead to more severe damage and disrupt the function of the esophagus, affecting the flow of food and fluids from the mouth to the stomach. The complications of untreated esophagitis may include scar tissue, esophageal narrowing, and difficulty swallowing.

Causes

Esophagitis is classified depending on the cause. There are times when more than one factor can cause esophagitis. There are several classifications of esophagitis:

• Reflux esophagitis: This type of esophagitis results from stomach acid refluxing into the esophagus, irritating its layers. Usually, a valve at one end of the esophagus, connected to the stomach, protects against such reflux. If this valve is damaged, stomach acid can enter and irritate the esophagus. Gastroesophageal reflux disease (GERD) is when stomach acid continuously irritates the esophagus. Complications of GERD include chronic inflammation and damage to esophageal tissue.
• Eosinophilic Esophagitis: Eosinophils are white blood cells involved in allergic processes. There are more eosinophil cells in the esophagus in people allergic to milk, eggs, nuts, and other foods. This is called eosinophilic esophagitis.
• Drug-Induced Esophagitis: Some oral medications can cause damage to the esophageal tissue with prolonged contact. For instance, swallowing a pill or capsule without drinking water can cause the medicine to become stuck in the esophagus, leading to inflammation. Medications associated with drug-induced esophagitis include ibuprofen, aspirin, antibiotics (tetracycline, doxycycline), and quinidine.
• Infection: Bacterial, viral, or fungal infections can cause esophagitis. Esophagitis caused by infection is rare and typically occurs in individuals with compromised immune systems, such as those with HIV/AIDS or cancer. The fungus Candida albicans can also grow in the mouth and cause esophagitis.

Risk Factor

The risk factors for esophagitis include:

• Lying or sleeping directly after eating
• Consumption of excessive alcohol, caffeine, chocolate, or mint-flavored foods
• Eating lage quantities of food or food containing high-fat
• Smoking
• Being overweight
• Pregnancy
• A history of allergies or a family history of allergy
• Consuming medication (pill or capsule) without drinking water
• Consuming medication while lying down
• Taking medication that reduces the immune system, such as steroids

Symptoms

The symptoms of esophagitis include:

• Swallowing difficulty
• Pain while swallowing
• Chest pain, located behind the ribs, often occurs while eating
• Residual food in the esophagus after swallowing (food impaction)
• Sensation of stomach acid reflux causing heartburn
• Mouth feeling acidic

In children and babies, esophagitis can exhibit symptoms such as:

• Refusal to eat or difficulty eating
• Growth problems

Diagnosis

Diagnosing esophagitis involves a thorough examination by a doctor, considering primary symptoms, a physical examination, and additional tests as needed. The following examinations may be conducted:

• Barium X-ray: In this procedure, the patient consumes a barium substance or a pill coated with barium. Barium enhances the clarity of the esophageal layers in X-ray images. This examination helps identify esophageal narrowing, structural changes, tumors, or other factors causing symptoms.
• Endoscopy: A doctor inserts a camera into the esophagus to observe its condition. This procedure allows real-time visualization of changes in the esophageal surface due to reflux or esophagitis. If necessary, the doctor may also take tissue samples (biopsy) during endoscopy. Patients are usually sedated before this examination.
• Laboratory Tests: Tissue samples obtained from esophageal biopsies can be examined in the laboratory. This analysis helps detect infections or abnormal cells that may indicate cancer.

Management

The management of esophagitis is tailored to its specific cause. The drug choices include:

• Over-the-counter drugs: Medications such as antacids, available without a prescription, can neutralize stomach acid, preventing it from irritating the esophagus.
• Prescription Drugs: Medications prescribed by a healthcare professional may include proton pump inhibitors (PPIs) and H2 receptor antagonists, which can reduce the production of stomach acid.
• Avoiding allergens: In cases of eosinophilic esophagitis, primary management involves avoiding exposure to allergens and discontinuing the consumption of foods that can trigger allergies. Doctors may also prescribe corticosteroids to reduce the immune system's response to the esophagus.
• Surgery: If drug therapy is ineffective in repairing esophagitis, a fundoplication procedure may be considered. This surgical intervention involves strengthening the valve at one end of the esophagus to prevent stomach acid reflux that could irritate the esophagus.

It is crucial to consult with a healthcare professional to determine the most appropriate management strategy based on esophagitis's specific circumstances and causes.

Complications

If left untreated, esophagitis can lead to structural changes in the esophagus, resulting in complications such as:

• Narrowing or Stricture of the Esophagus
• Esophagus Tearing
• Barrett’s Esophagus: Changes in the cells that make up the surface of the esophagus can occur, leading to Barrett’s esophagus. This condition increases the risk of esophageal cancer.
• Aspiration and Pneumonia
• Laryngitis

If complications arise, doctors may perform esophageal dilation or widening through endoscopy.

Prevention

There are several ways to prevent esophagitis or reduce its severity:

• Dietary Changes: Reduce the consumption of foods that can worsen reflux, such as tomato-based foods, oranges, caffeine, alcohol, spicy foods, garlic, and chocolate
• Hydration with Medication: Always consume water while taking pills or capsules, and avoid lying down immediately afterward
• Weight Management: Consult a doctor to achieve and maintain a healthy weight
• Smoking Cessation: Quit smoking to reduce the risk of esophagitis
• Avoidance of Esophagitis-Inducing Drugs: Refrain from taking medications that can induce esophagitis
• Posture after Eating: Avoid lying down immediately after eating
• Elevate Head while Sleeping: Position the head higher to prevent stomach acid from flowing into the esophagus
• Relaxation Therapy: Consider relaxation therapy to reduce anxiety and promote calmness, potentially alleviating reflux symptoms. Consult with a doctor to discuss relaxation methods.

When to see a doctor?

Other conditions in the gastrointestinal tract can cause some signs and symptoms of esophagitis. Consult a doctor if you experience symptoms or signs such as:

• Symptoms last for a few days
• Lack of improvement after eating over-the-counter antacids
• Worsening symptoms that disrupt eating
• Symptoms accompanied by other issues such as headache, fever, and muscle pain

Seek emergency medical attention if you experience:

• Chest pain lasted for a few minutes
• Suspected food impaction in the esophagus
• A history of chest pain and heart disease
• Stomach or esophageal pain while eating
• Breathing difficulty or chest pain after eating
• Vomiting with a large quantity, projectile vomiting, difficulty breathing after vomiting, or vomit that is yellowish, greenish, brownish like coffee, or includes blood

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