Esophagitis is the inflammation of the esophagus lining, the muscular tube extending from the mouth to the stomach that allows the passage of food and drinks. Heartburn is one of the more common symptoms of esophagitis. Although heartburn could generally be a benign and transient symptom that results from acid reflux, other symptoms like persistent trouble swallowing, pain when swallowing or the feeling that food is getting stuck can point to something more serious and concerning.
Kim Kardashian recently revealed that she was diagnosed with esophagitis, bringing attention to a digestive issue that can have several causes and may affect swallowing and eating.
This article explains in more detail the symptoms and causes of esophagitis, including when trouble swallowing should be evaluated, as well as how it is diagnosed and treated.
What Are the Symptoms of Esophagitis?
Common symptoms of esophagitis include:
- Difficulty swallowing (dysphagia)
- Pain when swallowing (odynophagia)
- Feeling like food is stuck in the throat or chest
- Heartburn or acid coming back up into the throat
- Chest discomfort
- Sore throat
- Hoarseness
- Unintended weight loss in some cases
- Nausea with or without vomiting
- Constant pooling of saliva in the throat or constant throat clearing
- Respiratory complaints
- Early satiety
- Failure to thrive in children
Some people may eat less because swallowing is uncomfortable. Others may notice that certain foods, particularly solid foods, seem to move slowly or become stuck. And some people may even have “silent reflux.”
When To See a Doctor
See your healthcare provider if you have:
- Persistent acid reflux that lasts more than several days
- Acid reflux that is not relieved with over-the-counter acid blockers
- Unintentional weight loss
- Difficulty swallowing
- Painful swallowing
- Blood loss and anemia
- Chest pain that lasts more than a few minutes
- Food impaction
- Shortness of breath with or without chest pain
- Vomiting with or without blood
What Causes Esophagitis?
Common causes of esophagitis include:
- Acid reflux or gastroesophageal reflux disease (GERD): When stomach contents repeatedly flow back into the esophagus, acid can irritate its lining and cause inflammation. This is called reflux esophagitis or GERD.
- Eosinophilic esophagitis (EoE): EoE is a chronic inflammatory condition in which eosinophils, a type of white blood cell, build up in the esophagus and cause inflammation. It can occur in children and adults and is often associated with allergic conditions such as asthma, eczema or food allergies. Common food allergens include milk, eggs, wheat, soy, peanuts and seafood. Typical allergy testing could be performed but may not be able to identify the triggers.
- Lymphocytic esophagitis: A less common form of esophagitis that may be related to EoEs or GERD.
- Medications: Some pills can irritate the esophagus if they become lodged there or remain in contact with the esophageal lining. Taking medications with too little water or lying down soon afterward can increase the risk. Medications that have been linked to pill-induced esophagitis include anti-inflammatory drugs (NSAID’s) such as ibuprofen (Advil, Motrin), naproxen sodium (Aleve), antibiotics such as doxycycline and tetracycline, potassium supplements, oral medications used to treat osteoporosis (Binosto, Fosamax) and some heart medications like Quinidine.
- Infections: Infectious esophagitis is uncommon in otherwise healthy people and is more likely in people whose immune systems are weakened, diabetic patients and those exposed to steroids and antibiotics. The infection could be due to bacteria, viruses or fungi. Candida esophagitis, caused by the fungus Candida albicans is one of the more common causes of infectious esophagitis.
A less common cause of esophagitis is acute radiation induced esophagitis.
Is Esophagitis the Same as GERD?
No. GERD can cause esophagitis, but the conditions are not the same. Esophagitis is a broader term used to describe inflammation of esophagus. GERD is a more specific form of esophagitis secondary to acid reflux.
GERD occurs when stomach contents repeatedly flow back into the esophagus. The degree of inflammation because of acid reflux, however, can vary. While some patients experience severe inflammation with visible ulceration others may experience minimal or no tissue damage.
How Is Esophagitis Diagnosed?
A gastroenterologist will consider symptoms, medical history and medications when evaluating possible esophagitis.
- An upper endoscopy (EGD) is commonly used to examine the esophagus and look for inflammation, narrowing, bleeding and other changes. During the procedure, a thin, flexible tube with a camera is guided through the mouth into the esophagus and stomach under sedation. Upper endoscopy can also help evaluate unexplained swallowing problems.
- Small tissue samples, called biopsies, may be taken during the procedure. Biopsies are particularly important when EoE is suspected because inflammation may not always be visible during the visual examination.
- A noninvasive alternative to establish whether gastroesophageal reflux is present is to perform an X-ray (upper GI series). By swallowing contrast material and obtaining pictures by radiology one can diagnose GERD. The drawback, however, is the lack of sensitivity and specificity to distinguish different causes of esophagitis and the inability to obtain tissue samples.
Depending on the symptoms and suspected cause, additional testing may be recommended. This can include testing for acid reflux or tests that evaluate how well the esophagus moves food toward the stomach.
How Is Esophagitis Treated?
Treatment depends on the underlying cause.
Reflux-related esophagitis
Reflux-related esophagitis may be treated with medications that reduce stomach acid and lifestyle changes that help manage reflux. Proton pump inhibitors (PPI’s) are commonly used to treat GERD and can help heal damage to the esophageal lining. Usually, a two-month course is adequate, but some patients may require prolonged maintenance therapy.
For milder acid reflux a class of medications called H2-blockers are also used. These drugs generally have safer long-term side effect profile without causing osteoporosis or malabsorption problems.
Lifestyle changes to manage acid reflux include eating smaller meals, maintaining ideal body weight, avoiding spicy or acidic foods, avoiding chocolate and caffeine, avoiding alcohol and smoking, raising the head of bed at night and avoiding eating or snacking within three to four hours before going to bed.
Eosinophilic esophagitis
Eosinophilic esophagitis may be treated with medication (including acid blockers and steroids or immune modulating drugs), dietary approaches or a combination of treatments. The goal is to control inflammation and prevent complications such as narrowing of the esophagus.
Medication-related esophagitis
Medication-related esophagitis may require changing the medication when appropriate and reviewing how it should be taken. Medications in general are best taken in an upright position and with a glass of water. Walking around for about 30 minutes after a pill is taken may further help the transit into the stomach.
Infectious esophagitis
Infectious esophagitis requires treatment directed at the underlying infectious cause.
When esophagitis or another condition has caused the esophagus to become narrowed, esophageal dilation may be performed during an endoscopic procedure under sedation to widen the narrowed area and improve swallowing.
Frequently Asked Questions About Esophagitis
What does esophagitis feel like?
Esophagitis can feel like heartburn, burning or discomfort in the chest, pain when swallowing or a sensation that food is stuck in the throat or chest. Symptoms vary depending on the cause.
Can esophagitis cause esophageal cancer?
Esophagitis itself does not mean that a person has or will develop esophageal cancer. However, long-term GERD can sometimes lead to Barrett’s esophagus, a change in the lining of the esophagus that is associated with an increased risk of esophageal cancer. Most people with Barrett’s esophagus do not develop cancer however will require long-term ongoing monitoring and surveillance by upper endoscopy (EGD).
Can esophagitis heal on its own?
Some mild cases may improve when the underlying cause is addressed and with lifestyle changes. However, persistent symptoms should not be ignored. Treating the cause can reduce inflammation and help prevent complications.
Can esophagitis cause food to get stuck?
Yes. Inflammation and narrowing of the esophagus can make it difficult for food to pass normally. EoE is one condition that can cause recurrent food impaction, particularly with solid foods. Repeated episodes of food becoming stuck should be evaluated by a gastroenterologist promptly.
Is trouble swallowing always caused by esophagitis?
No. Trouble swallowing can have many causes, including strictures and tumors, problems with the muscle contraction or movement of the esophagus, acid reflux and other conditions. Persistent difficulty swallowing should always be promptly evaluated to determine the underlying cause.
If swallowing problems, chest discomfort or other symptoms persist, an evaluation can help identify the cause and guide appropriate treatment. Making the right diagnosis is an important step toward protecting the esophagus and preventing symptoms from interfering with eating and daily life.
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