Esophagitis and Gastric Reflux

Esophagitis and Gastric Reflux

While occasional heartburn is not harmful, it can become risky and severe if left untreated for a long time. This inflammation or irritation of the esophagus is called ‘Esophagitis.’ It can either be triggered due to acid reflux, as an outcome of bacterial or viral infections or sometimes as a reaction of certain medications. Reflux occurs when the stomach contents and acids back up into the esophagus.

You may want to get yourself tested for esophagitis and gastric reflux if you’re experiencing symptoms like sore throat, heartburn, and an unpleasant taste of refluxed gastric contents.

The ACG’s updated guidelines for the diagnosis and treatment of GERD in 2013 also highlights some other GERD-specific symptoms.  They include upper abdominal discomfort, constant bloating, and nausea. Apart from that, there are some less common symptoms of esophagitis as well. They include dysphagia, odynophagia, cough, hoarseness, wheezing, and hematemesis. Some people may also experience mild chest pain almost identical to coronary artery disease. The pain may also be linked with diaphoresis and shortness of breath. In the case of esophageal spasm, nitrates could act as a pain reliever.

People who have systemic diseases like diabetes, adrenal dysfunction, diabetis mellitus, alcoholism, and elderly patients could be prone to infectious esophagitis because of their altered immune function. Steroids, radiation, cytotoxic agents, and immune modulators can also add to impaired host immune function.

Types of Esophagitis

Esophagitis and Gastric Reflux

Eosinophilic esophagitis

Eosinophilic esophagitis happens due to an abundance of eosinophils in the esophagus. The latter phenomenon is triggered when your body over-respond to an allergen. This type can make eating difficult for children. The Boston Children’s Hospital states that 1 in 10,000 children has this type of esophagitis.  Some common triggers include:

  • Milk
  • Eggs
  • Wheat
  • Peanuts
  • Tree nuts
  • Soy
  • Shellfish
  • Pollen (inhaled allergens)

Reflux esophagitis

Reflux esophagitis is primarily associated with gastroesophageal reflux disease (GERD). It happens when stomach contents like acids, frequently reverse into the esophagus. Reflux causes irritation and chronic inflammation of the esophagus.

Drug-induced esophagitis

drug-induced esophagitis

This term refers to a condition that occurs when a person takes specific medications without enough water intake. This habit makes medications remain in the esophagus for too long time. Examples of drugs that can cause drug-induced esophagitis include:

  • Antibiotics
  • Pain relievers
  • Potassium chloride
  • Bisphosphonates (drugs that prevent bone loss)

Infectious esophagitis

An infectious form of esophagitis exists as well, although not very common, and it usually concerns immunocompromised individuals. It can happen due to the presence of bacteria, viruses, parasites, or fungi. However, healthy adults and even children can also become victims of it. One of the most common types of infectious esophagitis is candida. Other agents that contribute to the development of infectious esophagitis include:

  • Herpes Simplex Virus
  • Cytomegalovirus
  • Epstein-Barr virus
  • Varicella-Zoster virus
  • Human papillomavirus
  • HIV
  • Poliovirus
  • Bacterial species
  • Parasitic infections

Lymphocytic esophagitis

Lymphocytic esophagitis (LE) is a condition that is also rare. In this condition, there is an increased number of lymphocytes in the lining of the esophagus. It can also co-occur with eosinophilic esophagitis or GERD.

Behçet’s syndrome (or Behçet’s disease) 

Another rare form of esophagitis that causes ulcers in the mouth, esophagus, and other parts of the body through a form of vasculitis.

Graft-versus-host disease

This complicated form of esophagitis happens after a transplant (e.g., bone marrow transplant).  The newly transplanted cells attack the recipient’s body and, as a result, esophagitis may occur.

Cancer esophagitis

It could be a symptom of cancer of the esophagus or metastatic cancer that started in another part of the body and then spread to the esophagus.

Symptoms of Esophagitis

Common symptoms of esophagitis include:

Young-aged children may experience difficultly feeding. In that case, contact your doctor if your child experiences the following symptoms:

  • Shortness of breath or chest pain besides the eating schedule
  • Headache, muscle aches, or fever
  • Continuous symptoms for a few days
  • Severe symptoms getting in the way of your eating

What causes esophagitis? What is dysphasia?

Esophagitis is an inflammation of the esophagus generally caused by an infection or irritation of the esophagus.

Esophagus infections can be due to bacteria, viruses, or fungi, such as the following:

  • Candida, a yeast infection. It is very common in patients with weakened immune systems, especially those with HIV/AIDS, diabetes, patients undergoing chemotherapy, or those who take antibiotics or steroids.
  • Herpes, a well-known viral infection. It also develops in the esophagus when a person has a weak immune system.

One of the causes of esophageal irritation is the reflux of stomach acid. The several causes for reflux include:

  • Gastroesophageal reflux disease (GERD):  Dysfunction/weakness of the muscle that keeps the stomach closed, also known as lower esophageal sphincter can allow stomach acid to leak into the esophagus. It is called acid reflux or GERD, and it irritates the inner lining. In severe cases, it can evolve into erosive esophagitis, a form of ulcerative esophagitis.
  • Vomiting: When an individual is experiencing vomiting frequently or chronically, it indicates acid damage to the esophagus. In case of excessive or forceful vomiting, small tears of the inner lining of the esophagus (a rare condition known as Mallory-Weiss syndromes) can lead to further damage.
  • Hiatal hernia: This is a kind of abnormality that occurs when a part of the stomach moves above the diaphragm, where it produces a small abnormal pouch. This abnormal pouch is a hiatal hernia which leads to excess acid refluxing into the esophagus.
  • Achalasia: When the lower end of the esophagus does not open normally, food can get stuck in the esophagus. This condition is known as achalasia. People with achalasia have a higher risk of esophageal cancer than healthy people.

Medical treatments of any kind for any condition can also cause esophageal irritation.

Any surgery, including bariatric (weight loss) surgery, can increase the risk of esophagitis. Aspirin and other anti-inflammatory drugs can irritate the lining of the esophagus that increases acid production in the stomach that eventually leads to acid reflux.

Drug-induced esophagitis happens when high potency pills are consumed with less amount of water, swallowing pills before bedtime, so the extracts get trapped in the esophagus, causing irritation. Radiation for cancer treatment at the chest can also cause burns and inflammation to the esophagus.

Other causes of esophageal irritation include:

  • Accidental swallowing of a foreign substance or expired food
  • Diet with high acidic foods, spices, or excessive caffeine
  • Smoking

What are the grades of esophagitis?

Esophagitis and Gastric Reflux

There are a lot of grading systems that can help evaluate the severity of esophagitis. The Los Angeles Classification System is the most commonly used method.

This method grades esophagitis in the following way:

  • Grade A: One (or more) mucosal break no longer than 5 mm that does not extend between the tops of two mucosal folds
  • Grade B: One (or more) mucosal break more than 5 mm long that does not extend between the tops of two mucosal folds
  • Grade C: One (or more) mucosal break that is continuous between the tops of two or more mucosal folds but which involve less than 75% of the circumference
  • Grade D: One (or more) mucosal break which involves at least 75% of the esophageal circumference

The Savary-Miller Classification System was in use in the past, but since Los Angeles Classification System’s introduction, it is considered more valid and thorough.

Diagnosis

Esophagitis and Gastric Reflux

To diagnose the extent of esophagitis, a gastroenterologist can order specialized tests. These tests include:

  • Esophagogastroduodenoscopy: A prevalent method of using an endoscope to examine the esophagus directly, stomach, as well as the first part of the intestines.  During this procedure, tissue samples are usually obtained through a biopsy to determine the damage to the esophagus.
  • Esophageal manometry: a thin, pressure-sensitive tube is passed through the mouth or nose and into the stomach to measure the pressure inside the lower part of the esophagus. Then, it is pulled slowly back into the esophagus. When the patient swallows, the tube measures the force of muscle contraction.
  • Upper GI series or barium swallow: In this test, X-rays  of the esophagus are taken after drinking a barium solution. Barium solution appears white on an X-ray, whereas this highlights the extent of damage to the esophagus and location.

Available Treatments

treatments for esophagitis

Several medical treatments are available that help neutralizes stomach acids and provide short-term relief for esophagitis. But these over the counter medications are not for long-term, and I recommend to see a doctor if symptoms last for more than two weeks.

Pain medications such as corticosteroids are among the available medicines for the treatment of any inflammatory cause of esophagitis.

Is There a Diet that Soothes Esophageal Pain?

Diet plays a crucial role in reducing the symptoms of esophagitis. A GERD diet can minimize acid reflux, which is the leading cause of esophagitis.

Foods that can soothe esophagitis symptoms include:

  • High protein meals with low fats
  • Small meals, more frequently throughout the day
  • Soft foods for easy digestion

Associated Risk Factors

If esophagitis remains untreated, it can lead to ulcers, bleeding, and chronic scarring. The scarring can narrow the esophagus, which interferes with the ability to swallow.

People who have esophagitis are at a greater risk of Barrett’s esophagus. This one increases the risk of esophageal cancer. A few individuals who develop Barrett’s esophagus will also develop esophageal adenocarcinoma.

Severe esophagitis can lead to painful swallowing and severe malnutrition.

Is Esophagitis Curable?

The prognosis for esophagitis depends upon finding the root cause. When an infection causes esophagitis, the latter is treatable with medications, as well as with dietary and behavioral changes. Sometimes through surgery as well. Most people can recover fully through medicines, while some will take long-term medical treatment to maintain health.

Esophagitis caused by acid reflux is quite manageable but can frequently occur in most people, so they use medication to prevent any severe condition.

Some people with GERD can develop Barrett’s esophagus, and a few patients with Barrett’s esophagus can develop cancer. Therefore, a gastroenterologist should always monitor patients with Barrett’s esophagus

The prognosis of people with eosinophilic esophagitis tends to be favorable. It is a chronic and relapsing condition, but not life-threatening. Treatments for it, are advancing through different immune modulators to reduce the allergy-like reactions

Achalasia, on the other hand, is a progressive, yet treatable disease, although some individuals with achalasia may develop squamous cell cancer (a carcinoma).

When do you need to see a doctor?

medical treatment for esophagitis

Most of the time, esophagitis can happen due to underlying conditions affecting the digestive system. If you suffer from symptoms of esophagitis lasting more than a few days and you don’t feel any improvement after taking the antacids, consult with a doctor. Do this especially if your symptoms include flu signs including headache, fever, and muscle aches

Moreover, you should get emergency aid if you:

  • experience pain in the chest that lasts more than a few minutes
  • feel like you have food stuck in the esophagus
  • have a cardiac history
  • experience pain in the mouth or throat when you eat
  • experience shortness of breath or chest pain shortly after eating meals
  • experience forceful vomiting, nausea, and trouble breathing in that stage
  • vomit green or yellow material, or if the latter contains blood and looks like ground coffee


Medical Treatments for Esophagitis

Medical treatment for esophagitis largely depends on its fundamental causes. In particular, when an infection causes esophagitis, it can be treated with antibiotics. When acid reflux or GERD caused esophagitis, the latter can also be treated with specific medications. Using proton pump inhibitors (PPIs) will reduce or block the acid reflex while giving it full relief. When esophagitis arises after a surgical treatment may require a medical procedure to permanently make the acid-blocking or a medication course for a long time. If esophagitis is happening due to taking certain medications as a reaction, the doctor must change the medication

If esophagitis is diagnosed timely in the early stages, there is a high chance that the right medications, diet, and lifestyle changes can help the body to heal itself. When diagnosed later, the condition becomes more severe, and more invasive treatments are needed to encounter difficulty swallowing and scar tissue problems. Endoscopy is commonly used to eliminate any residuals of medications, food, or foreign substance that are stuck in the esophagus. Dilatation of the esophagus can also be applied during the endoscopic procedure. In particular, eosinophilic esophagitis is treated with gentle stretching of the esophagus (dilatation) together with specific medications. When oral medication doesn’t work, achalasia can also be treated with an extension of the esophagus (dilatation). Surgery can be the best solution to remove damaged portions of the esophagus and eliminate the risk of cancer, especially in the case of Barrett’s esophagus.

Foods and Drinks that Aggravate Esophagitis Symptoms

Esophagitis and Gastric Reflux
  • Avoid foods with fats
  • Avoid spicy foods to reduce inflammation
  • Avoid acidic foods and beverages that are high with citrus and tomatoes
  • Avoid foods that cause heartburn like chocolate, onions,  garlic, or mint
  • Finish eating before you feel full
  • Avoid soda, coffee or tea, and alcohol

Lifestyle changes that can reduce esophagitis symptoms include:

  • Quit smoking
  • Try to lose weight
  • Wear comfortable clothing
  • Avoid painkillers and anti-inflammatory drugs (NSAIDs) such as ibuprofen (AdvilMotrin) or naproxen (Aleve)
  • Don’t eat right after a big meal for about 2-3 hours
  • Take small bites and chew food properly
  • Avoid eating before at least 3 hours of bedtime
  • Raise the area of your bed by 4 to 6 inches where you put the head

Esophagitis Dietary Guidelines

Esophagitis dietary guidelines

When you feel irritation happening in your throat or lower chest while eating certain foods or following a medical procedure, taking a digestible esophageal soft food diet can help.

The food passes from the mouth to the stomach through the esophagus. When feeling a burning inflammation in the lower chest, usually it is because some food is stuck there as a consequence of esophagitis. The subject experiences irritation or inflammation of the esophagus. 

The esophagus can develop inflamed tissues due to the complications from radiation therapy, acid refluxhiatal hernias, vomiting, and by using oral medications. Esophagitis can heal on its own without intervention, but for a quick recovery, individuals must eat a soft diet.

The aim of eating a soft and fiber-rich diet is to make the digestion process smooth within the esophagus by avoiding any irritation.

Diet Plan to Consider

If you suffer from esophagitis, you should eat easily digestible foods. It helps to avoid carbonated drinks and beverages that are either too hot or too cold. Your doctor can also list some of the food items that suit your body in the healing process as well.

Dairy

If you have esophagitis, you are allowed to drink milk and other dairy products, but in case of cheese, choose the soft type of cheese such as cream cheese, ricotta, brie, and Neufchâtel. Yogurt is like a superfood for people with esophagitis, but don’t add cereal, granola, or other citrus foods in it. You can eat ice cream if it is low fat. 

Fiber

For soft food options, you can replace the raw food and vegetables with canned or frozen fruits available in the market. Add banana, avocados in your diet. Broths and soups are very healthy meal option. Add potatoes, carrots, and peas in the broth.

Bread and Grains

Bread and grain could become problematic for the stomach to digest. A solution to this problem can be to dip them in soups or broths. Extra cook them to make them soft. Avoid donuts, fruit cakes, roll, rice, and any other things that can cause irritation or pain in your esophagus. 

Proteins

Most foods contain proteins, particularly eggs, meat, fish, legumes, dairy, and grains. You must avoid dry roast beef, fried bacon, patty sausage, and cured meat. Boneless white fish and soft scrambled eggs will be good options for swallowing too.

Can Esophagitis be Prevented?

Although it just happens in most people, there are ways to prevent it. Esophagitis that is caused by GERD can be prevented by following a healthy lifestyle, by maintaining a healthy weight, and by following dietary recommendations. Proper oral hygiene is a crucial aid to prevent esophagitis caused by the Candida yeast. Medications should be taken with water and while standing.

Take-Home Messages

If esophagitis remains untreated, it could become chronic and leads to narrowing of the esophagus and tissue damage. One can also develop cancer due to too tissue damage consequent to acid exposure.

Esophagitis is painful and discomforting. But just like most of the other diseases, you can manage that well with lifestyle modifications and dietary changes.

For further queries, I am always there for you. Feel free to ask questions, share experiences, and write feedback in the comment box below. I’d love to connect with you all.

Picture of Gianluca Tognon

Gianluca Tognon

Gianluca Tognon is an Italian nutrition coach, speaker, entrepreneur and associate professor at the University of Gothenburg. He started his career as a biologist and spent 15 years working both in Italy and then in Sweden. He has been involved in several EU research projects and has extensively worked and published on the association between diet, longevity and cardiovascular risk across the lifespan, also studying potential interactions between diet and genes. His work about the Mediterranean diet in Sweden has been cited by many newspapers worldwide including the Washington Post and The Telegraph among others. As a speaker, he has been invited by Harvard University and the Italian multi-national food company Barilla.

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About Me

I’m an Italian nutrition coach, speaker, entrepreneur and associate professor at the University of Gothenburg. I started MY career as a biologist and spent 15 years working both in Italy and then in Sweden.

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