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Oesophagitis – A Complete Medical Guide

Overview

Oesophagitis (also spelled esophagitis) is inflammation of the lining of the oesophagus, the muscular tube that carries food and liquids from the mouth to the stomach. The inflammation can be mild and temporary, or it can be severe and lead to ulceration, scarring, or strictures (narrowing of the oesophagus).

Although anyone can develop oesophagitis, it is most common in:

• Adults over 40 years of age
• People with gastro‑intestinal reflux disease (GERD)
• Individuals who smoke or consume alcohol heavily
• Patients with weakened immune systems (e.g., HIV/AIDS, chemotherapy recipients)

In the United States, GERD‑related oesophagitis affects roughly 10‑15 % of the adult population, while eosinophilic oesophagitis (an allergic form) has an estimated prevalence of 10–55 per 100,000 people and appears to be rising (CDC, 2022). Worldwide, the burden is similar, with higher rates reported in Western nations where diet and lifestyle promote reflux.

Symptoms

Symptoms vary with the cause, severity, and duration of the inflammation. Common manifestations include:

Typical GERD‑related oesophagitis

• Heartburn: Burning sensation behind the breastbone, often worse after meals or when lying down.
• Regurgitation: Sour or bitter fluid that rises back into the throat or mouth.
• Odynophagia: Painful swallowing.
• Dysphagia: Feeling that food sticks or is slowed down in the chest.
• Sore throat, hoarseness, or chronic cough: Result from acid irritation of the upper airway.

Eosinophilic oesophagitis (EoE)

• Difficulty swallowing solid foods (food “getting stuck”).
• Recurrent vomiting, especially in children.
• Chest or upper‑abdominal pain that mimics heartburn but does not improve with antacids.
• Food impaction requiring emergency removal.

Chemical or infectious oesophagitis

• Severe throat pain and difficulty swallowing liquids.
• Fever, chills, or general malaise (more common with infections such as Candida, herpes simplex, or cytomegalovirus).
• White or yellow plaques on the oesophageal mucosa (Candida).

Medication‑induced oesophagitis

• Sudden onset of chest pain and dysphagia after taking a pill.
• Symptoms often improve when the offending medication is stopped or taken with plenty of water.

Causes and Risk Factors

1. Gastro‑esophageal reflux disease (GERD)

Stomach acid repeatedly flows back into the oesophagus, irritating the lining. Chronic exposure leads to erosive oesophagitis.

2. Eosinophilic oesophagitis (EoE)

An allergic/immune response to food or airborne allergens causes eosinophils (a type of white blood cell) to accumulate in the oesophageal tissue.

3. Infections

• Candida albicans – common in patients with weakened immunity, diabetes, or prolonged antibiotic/ steroid use.
• Herpes simplex virus (HSV) and cytomegalovirus (CMV) – more frequent in HIV/AIDS or transplant patients.

4. Medications

Drugs that can cause direct mucosal injury when they linger in the oesophagus include:

• Non‑steroidal anti‑inflammatory drugs (NSAIDs)
• Aspirin and other salicylates
• Bisphosphonates (e.g., alendronate)
• Potassium chloride tablets
• Quinidine, doxycycline, tetracycline

5. Chemical injuries

Accidental ingestion of caustic substances (drain cleaners, bleach) can produce severe corrosive oesophagitis.

Risk Factors

• Obesity (increases intra‑abdominal pressure → reflux)
• Smoking and heavy alcohol use
• Hiatal hernia
• Pregnancy (hormonal relaxation of the lower oesophageal sphincter)
• Use of certain medications without adequate water or upright posture after swallowing
• Immunosuppression (HIV, chemotherapy, steroids)
• Allergic disorders (asthma, eczema, allergic rhinitis) – linked to EoE

Diagnosis

Accurate diagnosis combines a detailed history, physical examination, and targeted investigations.

1. Upper Endoscopy (EGD)

Considered the gold‑standard. A flexible tube with a camera visualises the oesophageal lining, detects erosions, ulcerations, strictures, or white plaques, and allows for biopsy sampling.

2. Endoscopic Findings

• GERD‑related: Erosive lesions, friable mucosa, sometimes Barrett’s oesophagus.
• Eosinophilic: Linear furrows, concentric rings (“trachealization”), white exudates.
• Infectious: Pseudomembranes (Candida), shallow ulcers (HSV), deep linear ulcers (CMV).

3. Biopsy & Histology

Required to differentiate causes:

• Eosinophil count ≥ 15 eosinophils per high‑power field supports EoE.
• Granulomatous inflammation suggests Crohn’s disease.
• Fungal hyphae, viral inclusions, or bacterial organisms identify infections.

4. Barium Swallow (Esophagram)

Useful when a stricture is suspected or when endoscopy is contraindicated. It outlines the shape of the oesophagus and can reveal narrowing or motility abnormalities.

5. pH Monitoring & Impedance Testing

Measures acid exposure over 24‑48 hours; confirms reflux as the underlying cause when endoscopic findings are subtle.

6. Lab Tests

• Complete blood count (CBC) – may show eosinophilia in EoE.
• Serology for HIV, CMV, or HSV in immunocompromised patients.
• Allergy panels (skin prick or serum IgE) to identify food triggers for EoE.

Treatment Options

1. Pharmacologic Therapy

• Proton Pump Inhibitors (PPIs) – omeprazole, esomeprazole, pantoprazole. First‑line for GERD‑related oesophagitis; heal rates 70‑90 % after 8 weeks.<sup>Mayo Clinic</sup>
• H2‑Receptor Antagonists – ranitidine, famotidine. Useful as adjuncts or in patients intolerant to PPIs.
• Topical Corticosteroids for EoE – fluticasone propionate (inhaler puffed into the mouth) or budesonide viscous slurry; induce remission in ~80 % of adults.<sup>Cleveland Clinic</sup>
• Systemic Corticosteroids – short course for severe eosinophilic or infectious cases.
• Antifungals – fluconazole or itraconazole for Candida oesophagitis.
• Antivirals – acyclovir (HSV) or ganciclovir (CMV) in immunocompromised hosts.
• Sucralfate – a mucosal protectant that adheres to ulcerated areas, aiding healing.

2. Endoscopic and Surgical Procedures

• Dilation – balloon or bougienage dilation for strictures; usually performed in an outpatient setting.
• Endoscopic mucosal resection (EMR) – for isolated ulcerative lesions suspicious for neoplasia.
• Fundoplication – laparoscopic anti‑reflux surgery considered when medical therapy fails.
• Removal of impacted food – urgent endoscopy in cases of food bolus obstruction.
• Management of caustic injury – early endoscopic assessment, followed by possible stenting or reconstructive surgery if severe.

3. Lifestyle & Dietary Modifications

• Elevate head of the bed 6‑12 inches.
• Avoid meals within 3 hours of bedtime.
• Limit trigger foods: citrus, tomato‑based products, chocolate, peppermint, fatty/fried foods, caffeine, alcohol.
• Weight loss for BMI > 30 kg/m².
• Quit smoking; limit alcohol to ≤ 1 drink/day for women, ≤ 2 for men.
• For EoE, an elimination diet (e.g., six‑food elimination) guided by an allergist.

Living with Oesophagitis

Long‑term management focuses on symptom control, preventing recurrence, and protecting the oesophageal lining.

Daily Management Tips

• Take medications exactly as prescribed – PPIs are usually taken 30 minutes before breakfast.
• Swallow pills with a full glass of water (8‑10 oz) and stay upright for at least 30 minutes.
• Keep a food diary to pinpoint personal triggers.
• Eat small, frequent meals rather than large meals.
• Chew food thoroughly; soft or pureed diets may be needed during acute flares.
• Stay hydrated – dry throat worsens discomfort.
• Regular follow‑up endoscopy is recommended for Barrett’s or persistent erosive disease (usually every 2‑3 years).

Psychosocial Support

Chronic oesophageal symptoms can affect quality of life and cause anxiety about eating. Referral to a dietitian, support group, or mental‑health professional can be beneficial.

Prevention

Most cases are preventable with lifestyle and medication strategies.

• Maintain a healthy weight and exercise moderately (150 min/week).
• Adopt a low‑acid, low‑fat diet and limit known reflux triggers.
• Never lie down immediately after eating; walk for 10–15 minutes.
• Use the right pill technique – plenty of water, upright posture.
• For patients on chronic NSAIDs or bisphosphonates, consider gastro‑protective agents (PPIs or misoprostol).
• Manage allergies promptly; in EoE, early dietary elimination can halt disease progression.
• Screen and treat Helicobacter pylori infection, as it can coexist with reflux and increase symptoms.
• Vaccinate immunocompromised individuals against influenza and pneumococcus to reduce secondary infection risk.

Complications

If untreated or poorly controlled, oesophagitis can lead to serious sequelae:

• Strictures: Fibrotic narrowing causing dysphagia; may require repeated dilations.
• Barrett’s Oesophagus: Metaplastic change of the distal oesophageal epithelium; known precursor to adenocarcinoma (≈ 0.5‑1 % annual progression risk).
• Oesophageal Ulcers & Bleeding: Can present as hematemesis or melena.
• Perforation: Rare but life‑threatening; most often from caustic injury or severe ulceration.
• Esophageal Cancer: Long‑standing chronic reflux is associated with an increased risk of adenocarcinoma, especially in males over 50.
• Nutritional Deficiencies: Chronic dysphagia may lead to weight loss, iron‑deficiency anemia, or vitamin B12 deficiency.

When to Seek Emergency Care

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Sources: Mayo Clinic, CDC, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), World Health Organization, Cleveland Clinic, peer‑reviewed gastroenterology journals (American Journal of Gastroenterology, Gut, Gastroenterology). All information reflects current knowledge as of 2026 and is for educational purposes only; it does not replace personalized medical advice.

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