What Is Esophagitis?

Medically reviewed by Jay N. Yepuri, MD

Esophagitis is when the esophagus—the hollow muscular tube that carries food from your throat to your stomach—is irritated or inflamed. Several factors can contribute to the development of esophagitis. The most common cause is gastroesophageal reflux disease (GERD), where stomach acid flows into the esophagus. Other causes include infections, certain medications, and overactive immune responses. Symptoms of esophagitis can include heartburn, difficulty swallowing, cough, and sore throat.

Esophagitis treatment involves addressing the underlying cause to reduce inflammation and relieve symptoms and may include medication and lifestyle changes. Severe cases may require esophageal dilation or surgery.

Types

There are several types of esophagitis, which are classified based on their underlying causes.

Reflux Esophagitis

The most common type of esophagitis, reflux esophagitis occurs when the lower esophageal sphincter (LES), a muscular ring that normally prevents stomach acid from flowing back into the esophagus, becomes weakened or relaxed, allowing stomach contents to flow back up into the esophagus. Repeated exposure to stomach acid leads to inflammation and irritation of the esophagus.

Infectious Esophagitis

Caused by bacterial, fungal, or viral infections that irritate the esophagus. People with weakened immune systems have an increased risk of developing infectious esophagitis.

Related:What Is the Difference Between Viral and Bacterial Infection?

Eosinophilic Esophagitis (EoE)

An allergic condition characterized by elevated levels of eosinophils, a type of white blood cell, in the esophagus. EoE occurs in response to exposure to food or environmental allergens.

Drug-Induced Esophagitis

This occurs when certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics, are not taken with enough water and stay in the esophagus too long, leading to irritation and inflammation.

Radiation Esophagitis

Radiation therapy to the chest or neck area, which is often used to treat cancer, can damage the cells lining the esophagus, resulting in inflammation and discomfort.

Esophagitis Symptoms

Symptoms of esophagitis can vary from person to person, depending on the underlying cause. Common esophagitis symptoms include:

• Heartburn (acid reflux)

• Difficulty swallowing

• Pain when swallowing

• Nausea or vomiting

• Cough

• Hoarseness

• Sore throat

What Causes Esophagitis?

Esophagitis occurs when the lining of the esophagus becomes irritated, inflamed, or swollen. Several factors can lead to the development of esophagitis, including:

• Reflux: Stomach acid flowing up and into the esophagus occurs in people with gastroesophageal reflux disease (GERD). This happens when a ring of muscle called the lower esophageal sphincter (LES) does not close properly, and stomach contents leak into the esophagus, leading to irritation and inflammation.

• Infections: Fungal, bacterial, and viral infections can sometimes irritate the esophagus. The herpes simplex virus, Candida yeast (fungal) infection, and bacterial infections that lead to esophagitis are most common in people with weakened immune systems, such as those with HIV/AIDS and recent organ transplant recipients.

• Frequent vomiting: Repeated exposure to stomach acids from excessive vomiting can irritate and damage the esophageal lining.

• Allergic response: Certain trigger foods or allergens can trigger an allergic/overactive immune response and lead to eosinophilic esophagitis, which is a chronic autoimmune disease.

• Certain medications: Taking certain medications (e.g., antibiotics, vitamin C supplements) without plenty of water or lying down before the medicine has time to pass through the esophagus can cause esophagitis.

Other factors that can cause esophagitis include:

• Ingestion of harmful chemicals, such as bleach

• Radiation injury

Risk Factors

Several risk factors can increase the likelihood of developing esophagitis, including:

• Smoking

• Excess alcohol or coffee consumption

• Having a weakened immune system

• Having obesity

• Hiatal hernia (a condition in which part of the stomach pushes upward into the chest)

• Pregnancy

• Lying down after eating

Diagnosis

To diagnose esophagitis, your healthcare provider will review your medical history, ask about your symptoms, and perform a physical exam. They may order diagnostic tests to confirm the diagnosis, determine its cause, and guide appropriate treatment decisions.

• Upper endoscopy: A flexible tube with a camera (endoscope) is inserted through the mouth to examine the esophagus, stomach, and upper part of the small intestine. This procedure lets your healthcare provider (usually a gastroenterologist) visualize your esophagus and look for signs of inflammation and swelling.

• Biopsy: During the endoscopy, your healthcare provider may remove a small tissue sample from the esophagus and send it to the lab for further analysis.

• Barium swallow: For this procedure, you will drink a chalky liquid containing barium, which coats the esophagus and makes it easier to view on X-ray images.

• Esophageal manometry: A thin tube is inserted through the nose and passed through the esophagus to measure how well your esophagus functions while you swallow.

Treatments for Esophagitis

Esophagitis treatments reduce inflammation and relieve symptoms to help your esophagus heal. Treatment options for esophagitis vary, depending on the cause. Common esophagitis treatment approaches include making lifestyle changes, taking medications, and, in some cases, surgery.

Lifestyle Changes

Certain lifestyle and dietary modifications may help manage and reduce esophagitis symptoms, especially for GERD- or allergy-related esophagitis. This may include:

• Avoiding trigger foods and beverages (e.g., spicy or acidic foods, caffeine, alcohol)

• Eating smaller, more frequent meals

• Maintaining a healthy weight

• Avoiding lying down after meals

• Not smoking

Medications

Depending on the cause of esophagitis, medications may be prescribed. These may include:

• Proton pump inhibitors (PPIs): These reduce the production of stomach acid and can effectively treat esophagitis caused by GERD.

• H2 blockers: These reduce stomach acid production and may be used as an alternative or combined with PPIs.

• Antacids: Over-the-counter medications like Tums can help neutralize stomach acid and temporarily relieve symptoms.

Antifungal, antiviral, or antibiotic medications may be prescribed to help eliminate the infection associated with infectious esophagitis.

If a specific medication is causing drug-induced esophagitis, your healthcare provider may switch you to an alternative drug, if possible, or look for the liquid version.

Surgery

Surgery may be recommended if you have GERD-related esophagitis that does not respond to other treatments. Surgical treatments for esophagitis include:

• Fundoplication: In this procedure, a surgeon will wrap the upper portion of your stomach to the end of your esophagus, creating pressure that helps strengthen the lower esophageal sphincter (LES) to reduce acid reflux.

• Esophageal dilation: Chronic acid reflux can sometimes lead to scarring of the esophagus, causing it to become narrowed. In this procedure, a surgeon will stretch and widen the narrowed areas to make it easier to swallow food and liquid.

Prevention

It is not always possible to prevent esophagitis, but certain preventive measures may lower your risk of developing the condition or prevent recurrences:

• Maintain a healthy weight

• Avoid eating large meals and opt for smaller, more frequent meals

• Avoid lying down immediately after meals

• Identify and avoid trigger foods that worsen acid reflux symptoms (e.g., spicy, acidic, or fried foods, alcohol, caffeine, carbonated beverages)

• Quit smoking

• Take all medications while you are sitting or standing upright, and swallow with plenty of water

• Seek treatment for ongoing episodes of acid reflux (heartburn)

Related:7 Daily Habits That Can Halt Heartburn

Complications

Untreated esophagitis can sometimes lead to serious health complications, such as:

• Esophageal stricture: Chronic inflammation and scarring of the esophagus can result in the narrowing of the esophagus, leading to difficulty swallowing (dysphagia).

• Barrett's esophagus: Chronic GERD or esophagitis can sometimes cause normal esophageal tissue to be replaced with tissue that resembles the lining of the intestines. Barrett's esophagus increases the risk of developing esophageal adenocarcinoma, a type of esophageal cancer.

• Esophageal ulcers: Open sores on the esophagus lining can develop due to prolonged inflammation of the esophagus or chronic acid reflux. These ulcers can cause chest pain and trouble swallowing.

Living With Esophagitis

Most people with esophagitis can expect to recover fully with appropriate treatment and lifestyle modifications. The healing time for esophagitis varies, depending on the severity of inflammation and the effectiveness of treatment. Mild cases of esophagitis caused by temporary factors (e.g., medication use or infections) can often heal within a few days to weeks. Severe or recurrent cases of esophagitis usually require long-term management and may take several weeks to heal.

It is important to remember that esophagitis can come back again and again. Lifestyle modifications—avoiding trigger foods and medicines and eating smaller, more frequent meals—and following your treatment plan is the best way to help your esophagus heal and prevent esophagitis from returning.

Frequently Asked Questions

What does esophagitis pain feel like?

Esophagitis pain can manifest as a burning sensation or discomfort in the chest area, commonly known as heartburn. It may also cause pain or difficulty swallowing (dysphagia), a feeling of food getting stuck in the throat, or sharp, stabbing pains in the chest or upper abdomen. 

Does esophagitis ever go away?

Esophagitis can go away, especially if caused by temporary factors such as medication use or infections. With proper treatment and lifestyle modifications, the inflammation can be resolved, allowing the esophagus to heal. Chronic or recurrent cases of esophagitis associated with conditions like GERD ongoing management can help control symptoms and prevent flare-ups.

What happens if esophagitis is left untreated?

Untreated esophagitis can lead to more severe symptoms and potential health complications. Chronic inflammation can result in the formation of strictures, narrowing the esophagus and causing difficulty swallowing. In some cases, untreated esophagitis may also increase the risk of developing Barrett's esophagus, which can progress to esophageal cancer.

What drink is good for esophagitis?

A soothing drink for esophagitis can be plain, cool water, as it helps to hydrate the throat and esophagus. When lukewarm or at room temperature, herbal teas (e.g., chamomile, ginger) may soothe an irritated esophageal lining and help prevent acid reflux.

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