A Look at Esophagitis

Woman suffering from abdominal pain.
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Medical Specialties:

Allergy/immunology, Family practice, Gastroenterology

Clinical Definition:

Esophagitis is a swelling and irritation of the esophagus. As a result, swallowing can be painful or difficult. Causes can include acid reflux, vomiting, medications, infections and an allergy-associated condition known as eosinophilic esophagitis.

In Our Own Words:

Esophagitis is inflammation and irritation of the esophagus (i.e., the tube that transports liquids and food from the mouth to the stomach), which can make swallowing difficult or painful.

It can affect those with gastroesophageal reflux disease, in which the stomach acid flows back into and irritates the esophagus. Esophagitis also may occur after vomiting or with use of certain medicines, including aspirin and anti-inflammatories. The latter is sometimes referred to as “pill esophagitis.”

Another type, eosinophilic esophagitis, is named after eosinophils, white blood cells that move in to the esophagus and trigger the inflammation. This form is associated with allergies and asthma, and its incidence appears to be on the rise. Esophagitis from infectious causes is usually due to impaired immunity.

The Relationship Between GERD and Esophagitis

In the United States, the incidence of esophagitis attributable to gastroesophageal reflux disease (GERD) is increasing. In fact, GERD is the most common cause of esophagitis closely followed by medications and infections.

GERD results from the reverse flow of gastric contents into the esophagus, which causes inflammation of the mucosa, or lining, of the esophagus.

Specifically, the introduction of hydrogen ions (acid) into the esophagus liquefies and kills cells in the esophagus. This cellular destruction is followed by inflammation. Symptoms of GERD include chest discomfort, "heartburn," regurgitation and trouble swallowing.

About 25 percent of people living in Western countries have symptoms of GERD on a monthly basis, with 5 percent of all Westerners experiencing symptoms everyday.

Obesity is a leading risk factor in the development of GERD. Obesity not only causes GERD but also exacerbates symptoms, too.

Most of the time, people who present to a primary care physician with symptoms of GERD are given a trial of proton-pump inhibitors (PPIs), such as omeprazole (Prilosec) or lansoprazole (Prevacid). If this trial works, then a physician assumes that you have GERD and no further tests are needed. However, sometimes these PPIs don't work and further testing is needed, such as upper endoscopy, esophageal gastroduodenoscopy (EGD), radiographic studies (barium swallow or upper GI series), motility studies and so forth.

The treatment of GERD-induced esophagitis focuses on reducing symptoms as well as healing inflammation. Typical treatment of GERD involves use of antacids and antisecretory agents like histamine-2 (H2) receptor antagonists (think ranitidine or Zantac) and PPIs. Of note, PPIs are best taken on an empty stomach about 30 minutes before a meal.

If treatment with medications fails, surgery is sometimes performed to treat GERD and associated esophagitis.

For instance, Nissan fundoplication is a procedure that involves increasing the pressure between the outlet of the esophagus and the entry of the stomach (lower esophageal sphincter or LES) so as to decrease the flow of stomach contents into the esophagus.


Harvard Medical School. "Medical Dictionary of Health Terms." Accessed August 2013.

Cleveland Clinic. "Esophagitis." Accessed August 2013.

American Academy of Allergy Asthma & Immunology. "Eosiniphilic Esophagitis (EoE)." Accessed August 2013.

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