Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Esophagus is the food tube. It conveys food from our mouth to our stomach.
Esophagitis is a condition wherein there is inflammation of esophagus. This inflammation could damage the tissues of your food tube.
This condition is marked with difficulty in swallowing. There will also be pain while swallowing the food. There are many causes for esophagitis. The main causes include the acids moving upwards into the food pipe from the stomach, infection, some oral medicines and allergies.
Treatment depends on the underlying cause. It also depends on the extent and severity of tissue damage occurring in the esophagus. If it is not treated properly esophagitis would damage the esophagus lining and would meddle with its normal functioning. This would cause difficulty in the foods and liquids to move down from the mouth to the stomach. Complications like scarring and esophagus narrowing and difficulty in swallowing can occur as complications of esophagitis on the long run, especially when it is not treated promptly.
Causes of Esophagitis
There are many conditions that cause esophagitis. Esophagitis may be caused by more than one factor in some of the cases. They include –
Reflux esophagitis – Due to dysfunction of lower esophageal sphincter, the stomach contents may be pushed back into the esophagus (gastro-esophageal reflux). When this acid backflow is ongoing and frequently occurs it is called Gastro-esophageal reflux disease (GERD). Chronic inflammation and tissue damage in the esophagus (esophagitis) is a complication of GERD.
Eosinophilic Esophagitis – This condition occurs when there is high concentration of white blood cells called eosinophils in the esophagus. This mostly happens in response to an allergen or acid reflux or both. This leads to esophagitis which might be triggered by foods including eggs, peanuts, beef, milk, wheat, soy, beans etc. This may also be caused by non-food allergies like inhaled allergens (pollen etc).
Lymphocytic Esophagitis – In this there is an increased number of lymphocytes in the esophageal lining. This is an uncommon condition and may be related to eosinophilic esophagitis or GERD.
Drug induced Esophagitis – Some medications might cause tissue damage provided they stay in contact with esophageal lining for long duration. Example – swallowing a pill with little or no water. Drugs which have been linked to esophagitis include pain relieving medications (aspirin, ibuprofen etc), antibiotics (tetracycline, doxycycline etc), potassium chloride, bisphosphonates and quinidine.
Infectious Esophagitis – Esophagitis may be caused by a bacterial, viral or fungal infection in esophageal tissues. This is a rare condition. It usually occurs in people with poor immunity as in those suffering from cancer or HIV / AIDS. Candida albicans (a fungus) is also a common cause of infectious esophagitis. Such infections are often associated with poor immunity, diabetes, cancer or use of steroids / antibiotics.
Symptoms of esophagitis
Below mentioned are the most common symptoms of esophagitis –
– Difficulty in swallowing
– Pain while swallowing
– Pain in the chest (behind the sternum – breastbone) that occurs while eating food
– Impaction of food – food gets stuck in the food pipe
– Heartburn
– Regurgitation of acid from stomach to the food pipe
Esophagitis in infants and young children can be identified by feeding difficulties and failure to thrive.
Risk Factors of Esophagitis
The risk factors of this condition vary depending on different causes causing this disorder.
| Sl No | Cause (condition causing) of Esophagitis | Risk Factors |
| 1 | Reflux esophagitis | Taking food immediately before going to bedExcessive consumption of alcohol, caffeine, chocolate,Excessively large mealsExcessive fatty mealsSmokingExtra weight of the body (including pregnancy)Tomato, Citrus fruits, spicy foods, garlic, onions, mint flavors in foods |
| 2 | Eosinophilic esophagitis | History of allergic reactions (asthma, atopic dermatitis, allergic rhinitis)Family history of eosinophilic esophagitis |
| 3 | Drug induced esophagitis | Taking pills with less or no waterTaking drugs while lying downTaking drugs just before sleepingLarge / odd shaped pillsOld age (age related changes in esophageal muscles / decreased saliva production) |
| 4 | Infections esophagitis | Steroids and antibioticsCandida esophagitis (in diabetic subjects)Poor immune system function – due to cancers, HIV / AIDS etcCertain cancer treatments and drugs that block immune system reactions to transplanted organs |
Complications of Esophagitis
If it is not treated properly esophagitis leads to changes in structure of esophagus.
The common complications of esophagitis are –
– Esophageal stricture (narrowing) or scarring
– Tearing of esophageal lining tissue
– Barrett’s esophagus
What is the right time to consult the doctor?
Many conditions affecting the digestive system might cause the signs and symptoms of esophagitis. One should see the doctor immediately if the signs and symptoms of esophagitis –
– persist for more than few days
– neither improve nor go away in spite of using the antacids available over the counter
– are severe and make eating food difficult
– are associated with signs and symptoms of flu (headache, fever, muscle aches etc)
Emergency care shall be sought for if one –
– experiences severe chest pain which lasts for more than few minutes (sign of medical emergency and need for immediate intervention)
– suspects that the food has been trapped in the food pipe (esophagus) or if there is inability to swallow food
– has history of heart disease and experiences chest pain
– experiences pain in the mouth and throat while / after eating food
– has shortness of breath / chest pain that manifests immediately or within short duration of eating food
– vomits in large amounts (forceful vomiting, suffers from breathing trouble following vomiting, has vomitus which looks green or yellow, appears like coffee grounds or has blood in it)
Also see your doctor for an opinion if you have signs and symptoms of esophagitis or if they are not getting reduced with medicines and lifestyle changes.
Diagnosis of Esophagitis
Your doctor might diagnose esophagitis on the basis of interrogation, physical examination and a few relevant tests.
The tests may include –
– Barium X-ray – helps in diagnosing narrowing of esophagus, hiatus hernia, structural changes in esophagus, tumors and other abnormalities.
– Endoscopy – shows unusual appearance of the esophagus. It is used to remove small tissue samples of esophagus for testing.
– Laboratory tests – The small samples of tissue removed during endoscopic exam are further tested in the laboratory to diagnose infection (bacterial, viral or fungal), to determine allergy related with eosinophils or to identify cells which would indicate precancerous changes in the esophagus or esophageal cancer
Caution and prevention
– Avoid known foods which would trigger or worsen your symptoms
– Keep away from drinks containing caffeine, alcohol or spicy foods
– Keep over-the-counter antacids at hand
– Limit over-the-counter medications that could cause problems
– While taking pills, take sufficient quantities of water and avoid lying down immediately after taking medicines / pills
– If a prescription medicine is causing or worsening your symptoms, talk to your doctor
Lifestyle changes and home remedies
The below mentioned steps shall be adopted / followed so as to avoid recurring problems or lessen the symptoms of the disease, depending on the type of esophagitis –
– Avoid ‘reflux causing or increasing’ foods – One should avoid eating excessive quantities of foods that are known to worsen the gastroesophageal reflux symptoms. They include caffeine, alcohol, chocolate, mint flavored foods etc.
– Quit smoking habits – with the help of doctor
– Don’t sleep or lie down immediately after eating food. Wait for at least three hours after taking food to go to bed.
– One should avoid stooping or bending, especially after eating food.
– Sleep by raising the head end of your bed. The head end shall be elevated for at least 6-8 inches and shall be done by putting wooden blocks under the bed.
– One should lose weight and maintain healthy weight. This can be achieved by following an appropriate diet and exercise plan with the help of your healthcare provider.
– One should take pills with plenty of water and should not sleep or lie down for at least half an hour after popping the pill.
– Some pain relievers and antibiotics may worsen the symptoms of esophagitis. Such medicines shall be identified and brought to the notice of your doctor.
Treatment of Esophagitis
The treatment of esophagitis varies depending on the cause and is focused to reduce symptoms of the disease, manage complications and also treat its underlying causes.
Treatment of Reflux esophagitis – Reflux esophagitis is one of the chief causes of esophagitis. Treatment of this condition includes use of antacids, H-2 receptor blockers like cimetidine (which reduce acid production) and proton pump inhibitors (which block acid production and also heal the esophagus), Ex – lansoprazole and omeprazole. Prokinetics which help in emptying the stomach more quickly may also be prescribed, Ex – Metoclopramide. Surgery may be advised if other interventions do not work in treating esophagitis, mainly fundoplication. Other minimally invasive surgeries may also be done.
Treatment of Eosinophilic esophagitis – It involves avoiding the allergen and reducing the allergic reactions by using medications which include proton pump inhibitors and steroids. Elimination of food allergen is very essential. Identifying such foods which have caused allergy is the key. New biologic therapies which may consist of medications which would stimulate the body’s immune response to fight against inflammation, infection or disease are under development.
Treatment of Drug induced esophagitis – It is important to avoid using the drug which has caused the problem. You may be recommended to take an alternative drug or take the liquid form of the same medicine, drinking more water with the pill or sitting or standing for at least half an hour after taking the pill.
Treatment of Infectious esophagitis – In presence of this condition, you may be prescribed medicines for treating bacterial, viral, fungal or parasitic infection.
Treatment of common complications –
When there is severe narrowing of the esophagus or when the food is lodged in the esophagus, a procedure to dilate the esophagus may be performed by a gastroenterologist. This is called esophageal dilation which is done by using one or more endoscopic devices.
Alternative medicine
There are no proofs and studies which suggest alternative medicinal therapies working in the perspective of treating esophagitis. In spite of that, these therapies provide some relief from heartburn and reflux symptoms for sure. One may also work with their doctor in this direction. Some options to consider are as below mentioned –
Some herbal remedies like licorice, chamomile etc work in a good way to reduce heartburn and reflux symptoms.
Any measures and techniques adopted to calm stress and anxiety levels might reduce the signs and symptoms of heartburn or reflux. Yoga and meditation are the most important ones. Progressive muscle relaxation or guided imagery are also included.
Acupuncture is said to be a useful remedy for those having regurgitation and heartburn but is supported by less evidence.
Ayurveda perspective of Esophagitis
Esophagitis is inflammation of the esophagus. Inflammation is caused by abnormally increased vata in the stomach trying to move upwards into the food pipe. Vata too is involved in pathogenesis.
It is also caused due to sama pitta – pitta associated with ama and amlapitta – a pathological condition caused due to pitta getting transformed into vidagdha avastha i.e. acquiring sourness against its natural bitterness. In amlapitta, there is a transformation of the nature and taste of pitta. It has two courses i.e. urdhwaga – moving upwards – compared to gastritis and GERD and adhoga – moving downwards. Urdhwaga Amlapitta causes symptoms similar to esophagitis.
Treatment of Esophagitis should be done on the lines of treating –
– Increased pitta
– Amlapitta
– Samapitta
– Udavartha
– Shotha / pittaja shotha
All pitta (and vata) aggravating foods and activities should be avoided. Seasonal regimen of pitta accumulating and aggravating seasons shall be followed with discipline i.e. varsha rtucharya – monsoon seasonal regimen and sharad rtucharya – autumn seasonal regimen.
Related Reading – ‘Esophagitis – Ayurveda Perspective’
