Oesophagitis is the inflammation of the gullet or oesophagus. This uncomfortable and sometimes painful condition can cause chest pain, difficulty swallowing food and drink, and even ulcers, scarring of the oesophagus, bloating and back pain if left untreated.
There are several different types of oesophagitis, and the causes can vary. The cause and type of oesophagitis influence treatment options, so it’s important to get a proper diagnosis for this condition. Infections, oral medicines, radiation and chemotherapy and allergies are just a few of the possible causes of this uncomfortable and sometimes painful condition.
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Symptoms of oesophagitis
Despite the different causes for this condition, symptoms are very similar. Common symptoms include:
- Dysphagia - pain when swallowing or difficulty swallowing food and drink
- Sore throat or feeling like you have something stuck in your throat
- Heartburn and acid reflux
- Nausea and vomiting
- Blood in your vomit
- Chest pain and severe chest pain
- Mouth sores and ulcers
Similar symptoms occur for other gastrointestinal complaints. Conditions such as gastroesophageal reflux, hiatus hernia (when part of the stomach moves up into the chest), and Barrett’s oesophagus can have similar symptoms to all types of oesophagitis. It is important to seek advice from your GP or other health care professional if antacids don’t relieve symptoms or if symptoms persist for more than a few days.
How is oesophagitis diagnosed?
After a physical examination, your doctor may refer you for some tests. These tests often include an endoscopy and possibly a biopsy. This will help determine the type of oesophagitis you have and the best type of treatment for it.
An endoscopy uses an endoscope, a long flexible tube with a light and camera fixed to the end. This tube goes through the mouth and into your throat and beyond. The doctor then views your mouth, oesophagus, part of the stomach and sometimes beyond through the camera. This kind of endoscopy is called a gastroscopy.
In some cases, patients are sedated before a gastroscopy. In others, a local anaesthetic spray numbs the back of your mouth and throat, but patients remain awake. The procedure takes anywhere between 15 to 45 minutes. In some cases, a small tissue sample may be taken for further testing.
The tissue is examined further to help understand the underlying causes of the inflammation and provide a diagnosis.
Other ways to test for oesophagitis
Oesophageal sponges and barium X-rays are other methods used for diagnosing oesophagitis.
Diagnosis using an oesophageal sponge can be done in your GP’s surgery. You’ll swallow a capsule on a string. The capsule dissolves in your stomach, releasing a sponge that is retrieved with the string. As the sponge is returned, it collects tissue samples for examination. This exposes the cause of the inflammation in your oesophagus without the need for an endoscopy.
For barium X-rays, you’ll swallow a pill or solution containing barium 10 - 15 minutes before the X-ray. The barium coats the lining of the throat and stomach to make them visible. This enables structural changes such as tumours, hiatus hernias, and oesophageal strictures (narrowing of the oesophagus, often caused by scarring) to be seen.
What causes oesophagitis?
There are several different types of oesophagitis, and each has different causes. Getting to the root cause of the particular kind of oesophagitis you have will help treatment to be more effective.
This is the most common form of oesophagitis, and it can often be treated with diet and lifestyle changes. It’s caused by digestive juices escaping the stomach and refluxing into the oesophagus causing painful burns and eroding the lining of the gullet. Frequent vomiting and acid reflux can cause reflux oesophagitis.
Radiation and drug-induced oesophagitis
Radiation therapy to target infections and diseases in the oesophagus, throat or chest can also cause oesophagitis. In most cases, the oesophagitis subsides once treatment is completed. However, in some cases, it can cause chronic bouts of oesophagitis.
Some medications that are taken orally can irritate the mucus lining of your oesophagus, causing discomfort, inflammation, and even eroding the mucus membranes. Chemotherapy drugs, some antibiotics, potassium chloride, quinidine and non-steroidal anti-inflammatory medications can all impact the oesophagus in this way.
Eosinophilic oesophagitis (EoE)
Eosinophilic oesophagitis (EoE) is caused by white blood cells, known as eosinophils, building up in the lining of the oesophagus. The condition is rare, and most cases are seen in people with allergies such as asthma, hay fever, eczema and food allergies. It’s also more common in white males and people that have relatives with the condition.
Most common in people with already weakened immune systems, infectious oesophagitis usually spreads from another part of the body. Fungal infections are the most common type of infectious oesophagitis. Candida albicans (a yeast infection), HSV-1 (herpes 1, which typically presents as cold sores), and HPV are the most typical fungal strains behind infectious oesophagitis.
People with HIV/AIDS, primary immunodeficiency disorders (PIDD), diabetes, some cancers, and those taking immunosuppressants are particularly vulnerable to infectious oesophagitis. Older people, long-term antibiotic use and alcohol abuse also increase the risk of contracting infectious oesophagitis.
How do you treat oesophagitis?
Treatments for oesophagitis vary depending on the type and cause of the condition.
Treating gastro-oesophageal reflux disease (GORD) and reflux oesophagitis
A weakened sphincter (the ring muscle at the bottom of the oesophagus) can allow stomach acid to leak up into the oesophagus, causing oesophagitis and other issues. Heartburn and an unpleasant taste in the mouth are some of the symptoms indicating this may be a problem.
Eating smaller yet frequent meals and avoiding spicy foods and other foods that increase acid production in the stomach can help relieve symptoms. Sugar, processed foods and grains, some dairy products and fizzy drinks should be avoided or consumed in small quantities.
Antacids and alginates that can be bought over the counter can also relieve symptoms. Prescription medicines such as proton pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs) that suppress gastric acid production may also help.
Treating drug-induced oesophagitis
Drug-induced oesophagitis and radiation oesophagitis can be cured by ceasing the course of medication that’s causing issues. In cases where painful symptoms continue, PPIs and antacids may be needed to treat this type of oesophagitis and help patients recover.
Treating eosinophilic oesophagitis
Changes to diet and PPIs can be used to treat eosinophilic oesophagitis. In some cases, switching to topical asthma corticosteroid puffers or dissolving corticosteroid tablets is recommended. In most cases of eosinophilic oesophagitis, gastroenterologists, clinical immunologists, allergy specialists, and specialist dieticians help manage a patient’s condition.
Treating infectious oesophagitis
Anti-viral medications and broad-spectrum antibiotics treat infectious oesophagitis. Acid blockers may also be used in combination with these medications. In cases where the oesophagitis has been caused by candida, antifungal medicines can kill the infection.
Living with oesophagitis
Oesophagitis is an uncomfortable and often painful condition. There is no need to put up with the symptoms, and doing so can cause further damage to your health. Our digestive system plays a key role in our physical and mental health, and that includes the oesophagus. Taking care of your entire gut, from your lips to your anus, is important for your well-being.
Noticing and acting upon symptoms indicating you may have oesophagitis is important to stop the condition from worsening. If left untreated, oesophagitis can develop into ulcers, cause strictures that restrict the passage of food from your mouth to your stomach, and even advance into a condition called Barrett's oesophagus. This condition greatly increases your risk of oesophageal cancer.