Oesophagitis: Symptoms, Causes and Treatment


At a glance:

  • Oesophagitis is a condition in which the tube that connects the mouth and stomach (the oesophagus) becomes inflamed or irritated.
  • Typical symptoms include chest pain, acid regurgitation, heartburn, difficulty swallowing and food getting stuck in the throat.
  • If left untreated, oesophagitis may lead to a narrowing of the oesophagus, tissue damage in the throat and even an increased risk of oesophageal cancer.
  • The most common causes of oesophagitis include a reaction to medication, allergy, acid reflux and infection.
  • Depending on the cause, most oesophagitis may be managed or treated with a mixture of medication, diet and lifestyle change.

What is Oesophagitis?

Oesophagitis (Espohagitis) is a diagnosis of any condition in which the oesophagus - the muscular tube that connects the mouth and the stomach - becomes irritated or inflamed. This inflammation may be caused by a number of factors including excessive stomach acid, allergy, certain medications or infection.

Depending on the cause and severity of oesophagitis, the inflammation may cause discomfort or damage to the oesophagus. If left untreated, in some cases oesophagitis may lead to a condition known as Barrett’s Oesophagus. The normal lining of the oesophagus transforms to become more acid resistant but becomes more susceptible to the development of oesophageal cancer.

Symptoms of Oesophagitis

Although oesophagitis may have a number of different causes, the symptoms remain largely the same and typically include:

  • Acid regurgitation
  • Chest pain, typically around the solar plexus or behind the breastbone while eating
  • Difficulty or pain while swallowing
  • Food impaction - food becomes stuck in the throat while swallowing
  • Heartburn

In children, the symptoms may vary a little or present differently, such as:

  • Abdominal (gut) pains
  • Choking or gagging on food while eating
  • Food impaction
  • Regurgitating food
  • Slow eating

If left untreated, oesophagitis may lead to a number of complication, including:

  • Barett’s oesophagus - when the normal lining of the oesophagus is exposed to acid over a long period of time the colour turns from its normal whitish pink to a deep salmon pink/red. This new surface is more acid resistant, but also more prone to oesophageal cancer. Around one in 20  people diagnosed with Barrett’s oesophagus develop oesophageal cancer.
  • Narrowing of the oesophagus - also known as stricture, this narrowing is typically due to scarring. This may lead to further, permanent difficulty swallowing, potential breathing difficulties and leave the oesophagus more prone to future damage.
  • Tearing of oesophageal tissues - throat tissues in people with oesophagitis are more prone to damage through retching (when food gets stuck or is regurgitated) or when being tested, such as the insertion of an endoscope. This damage may also lead to scarring and the narrowing of the oesophagus.

Oesophagitis is typically categorised by the underlying cause of the condition. Although any condition that leads to the irritation or inflammation of the oesophagus is classified as oesophagitis, the following causes are the most common. 

Drug-induced Oesophagitis

A number of different oral medications may cause irritation or damage to the tissue of the oesophagus if they remain in contact too long. Swallowing pills with little or no water, or failing to rinse after the use of certain medications may leave the pill, or residue of the medication in the oesophagus for extended periods of time.

Other potential risk factors for drug-induced oesophagitis include taking medications while laying down, taking medications immediately prior to sleep, age, or taking large or oddly shaped pills. 

Medications that have been linked to drug-induced oesophagitis include:

  • Antibiotics -doxycycline, tetracycline and others
  • Bisphosphonates - typically used in osteoporosis treatment
  • Pain relievers - Aspirin, ibuprofen and naproxen
  • Potassium Chloride - used to treat potassium deficiency
  • Quinidine - a heart medication

Eosinophilic Oesophagitis (EoE)

Eosinophils are specialised white blood cells that play a role in allergic reactions. When a person with EoE encounters a food or other allergen, the body over responds to its presence and tries to combat it.  Eosinophils are deposited in the lining of the oesophagus as a result.

Eosinophilic oesophagitis is believed to affect around one in 1000 people, but instances appear to be on the rise, as are instances of people with allergies. The reason for the rise in allergies and EoE are unclear at this time.

Around 75% of people with EoE have other allergic conditions, such as asthma or hay fever (allergic rhinitis). Common EoE triggers include:

  • Eggs
  • Milk
  • Peanuts
  • Pollen
  • Shellfish
  • Soy
  • Tree nuts
  • Wheat

Infectious Oesophagitis

Infectious oesophagitis usually occurs in people with weakened immune systems, such as those living with HIV/AIDS  or people going through chemotherapy or radiation therapy for cancer. Any viral, bacterial or fungal infection may potentially cause infectious oesophagitis.

One of the most common causes of infectious oesophagitis is Candida albicans, a fungus that lives in the mouth. This kind of infection is most commonly associated with a low immune system, people living with diabetes, cancer, or using antibiotics or steroidal medications.

In addition to HIV/AIDS and cancer treatments, immunosuppressive medications used for transplant recipients or to help people with autoimmune diseases such as lupus may also increase the risk of infectious esophagitis.

Lymphocytic Oesophagitis

Lymphocytic oesophagitis is a newly discovered and poorly understood form of chronic oesophagitis that in many ways mimics EoE in presentation and symptoms but differs in terms of actual inflammatory process. 

While EoE is caused by the deposit of eosinophils, lymphocytic oesophagitis is caused by the swelling and presence of an increased number of lymphocytes (specialised white blood cells related to the lymphatic system) in the lining of the oesophagus. 

The exact cause of lymphocytic oesophagitis is unknown, but some studies have shown some association with other inflammatory or oesophageal conditions, including,Gastro-oesophageal Reflux Disease (GORD) and Crohn’s disease .

Reflux Oesophagitis

The bottom of the oesophagus contains a valve-like structure known as the oesophageal sphincter, designed to close off the stomach, preventing the acids it contains from entering the throat. When this sphincter either opens when it shouldn’t or doesn’t properly close, stomach contents, including partially digested food and stomach acid may wash into the oesophagus. The is known as gastro-oesophageal reflux.

Gastro-oesophageal reflux disease (GORD) is a condition in which the gastro-oesophageal reflux is frequent and ongoing. Prolonged periods of reflux may lead to inflammation of the tissue of the oesophagus, and may result in permanent damage and scarring.

Risk factors that may increase the risk of GORD or gastro-oesophageal reflux include:

  • Being overweight or obese. The extra weight from pregnancy may also increase the risk of GORD/reflux oesophagitis
  • Eating immediately before sleeping or laying down
  • Excess consumption of alcohol, caffeine, chocolate and mint-flavored foods
  • Gorging on large or fatty meals
  • Smoking

A number of foods may exacerbate the symptoms of GORD or reflux oesophagitis, including:

  • Alcohol
  • Caffeine
  • Chocolate
  • Citrus fruits or juices
  • Garlic and onions 
  • Mint-flavored foods. Mint herb is typically fine.
  • Spicy foods 
  • Tomato-based foods

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Treatment for Oesophagitis

Before treatment may begin, the underlying cause of the oesophagitis must be identified. Proper diagnosis may require the patient to undergo a number of tests, including:

  • Barium X-Ray - this test requires the patient to drink a barium solution. The barium coats the lining of the oesophagus and stomach allowing it to be properly x-rayed. This allows the doctor to identify any narrowing of the oesophagus, tumours, hernias or other structural changes that may be responsible for the oesophagitis. 
  • Endoscopy - a long thin tube with a camera on the end (an endoscope) is passed down the patient’s throat into their oesophagus and stomach allowing a gastroenterologist to visually inspect the oesophagus, looking for changes in appearance or damage. Small tissue samples may also be taken during an endoscopy, allowing the doctor to test for cancerous or precancerous cells, as well as the presence or reaction to allergens or medications to better inform diagnosis and treatment. This is the preferred initial investigation in all patients with oesophagitis, to make a diagnosis & specifically to exclude Helicobacter infection & Barrett’s.  

Once the cause of the oesophagitis is determined, treatment varies.

Drug-induced Oesophagitis Treatment

The primary treatment for drug-induced oesophagitis is avoiding the medications causing the problem or switching to an alternate medication. If this is not possible, changing pill taking habits is recommended. Such habits may include: 

  • Drinking a full glass of water when taking a pill
  • Remaining sitting or standing for at least 30 minutes after taking medication
  • Taking a liquid version of the medication rather than a pill (and drinking water afterwards to flush the oesophagus)

Eosinophilic Oesophagitis (EoE) Treatment

EoE treatment revolves around identifying and avoiding the allergens that cause the eosinophilic reaction as well as the use of medications that reduce the severity of allergic reactions. 

If the reaction is due to a food allergy, it may require a structured elimination approach to diet. As there is no way to easily identify which food or additive someone is allergic to, a doctor will typically remove all common allergens from your diet and then slowly reintroduce them one by one to find the culprit.

In severe cases of EoE, all food may be removed from the patients diet, being replaced instead with a hypoallergenic amino acid based nutritional formula.

Infectious Oesophagitis Treatment

Medication to treat the infection is the prescribed treatment of infectious oesophagitis. Depending on the cause of the infection (bacterial, fungal or viral), the medication will vary.

Lymphocytic Oesophagitis Treatment

There is currently no defined treatment for lymphocytic oesophagitis. Treatment instead focuses on limiting or managing symptoms, such as using proton pump inhibitor medications to reduce the intensity to ease heartburn, one of the most common symptoms. 

Reflux Oesophagitis Treatment

Medications that control stomach acid, empty the stomach faster or reduce acid production may be prescribed or available over the counter. Antacids and over the counter medications are suitable for short term use, but long term treatment and management may require stronger or more specifically targeted medications as they may help reduce symptoms and allow the oesophagus to heal.

Lifestyle changes, such as losing weight, quitting smoking, eating a healthy diet, not laying down soon after eating, not eating before bed and raising the head of your bed may also help alleviate symptoms

If medication doesn’t work, surgical treatment may be required to strengthen the lower oesophageal sphincter. This may be achieved by wrapping a small portion of the stomach around the lower sphincter strengthening it and stopping the flow of acid into the oesophagus. A less invasive surgical treatment utilises a ring of small titanium magnets to reinforce and strengthen the sphincter.

If you have difficulty or pain while swallowing, experience heartburn or acid reflux, don’t ignore the symptoms. The easiest and most convenient way to schedule a medical appointment is to do it online with MyHealth1st.

 

 

  

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