Oesophagitis

Description

The oesophagus is a muscular tube that carries food from the mouth to the stomach. Oesophagitis is inflammation of the lining of the oesophagus which may be caused by an infection or irritation. It can be painful and make swallowing difficult.

Causes

Oesophagitis may be caused by different conditions and sometimes more than one factor may play a role. Reflux oesophagitis occurs when acidic contents of the stomach enter the oesophagus causing irritation. A sphincter muscle at the junction of the oesophagus and stomach usually prevents this from happening, but it may occur with gastroesophageal reflux disease, vomiting, hiatal hernia, achalasia or following bariatric surgery. An allergic reaction can cause eosinophilic oesophagitis which is associated with an increase in the number of eosinophils, a type of white blood cell in the lining of the oesophagus. People with weakened immune systems may develop oesophagitis from fungal infections such as candida or viral infections such as herpes. Oesophagitis can also develop because of an immune disorder or due to immunosuppressant medication. Certain medications can irritate the oesophageal lining or increase the production of acid. If pills are not swallowed with an adequate amount of water they may dissolve or get stuck in the oesophagus causing irritation. Other causes include radiation treatment, swallowing a toxic or foreign substance, smoking and drinking. Oesophagitis is more common in those who are overweight.

Impact

Oesophagitis can be irritating and make swallowing difficult. This can affect your eating habits and daily routine. Children may not put on adequate weight or may lose weight.

Anatomy

The oesophagus is a narrow tube that passes food from the mouth to the stomach. At the junction of the stomach, the oesophagus is surrounded by ring shaped muscles called the lower oesophageal sphincter (LES), which acts as a valve, ensuring the one-way movement of food.

Symptoms

Oesophagitis is commonly associated with pain or difficulty with swallowing, chest or abdominal pain, heartburn, mouth sores, sore throat, nausea, vomiting, indigestion, excessive belching, bad breath and food or pills getting impacted within the oesophagus. If symptoms are severe or persistent you should see a doctor.

Diagnosis

Your doctor will review your symptoms and medical history and perform a physical examination. Certain specialized tests may be ordered if the diagnosis is unclear. These include an upper endoscopy, where a narrow lighted tube with a camera is inserted through the mouth to inspect the oesophagus and possibly to obtain a sample of tissue for examination. Laboratory tests can identify infection, allergy, and other abnormal cells that indicate diseases such as cancer. A barium swallow may be recommended. This is an X-ray examination of the oesophagus which is performed after drinking a solution of barium to improve the visibility of the oesophagus.

Untreated

Oesophagitis may improve on its own or may lead to complications where the structure of the oesophagus undergoes changes. Untreated oesophagitis can lead to scarring, stricture or narrowing of the oesophagus, ulcer formation, tearing or a change in structure of the lining cells, referred to as Barrett’s oesophagus, which can sometimes precede a cancerous change. Symptoms can worsen your ability to eat or drink. An underlying condition may need treatment to avoid complications.

Treatment

Your doctor will decide on treatment based on the cause of the condition. Anti-reflux medications may be prescribed to control acid production. In some cases, long-term usage is necessary. Severe cases of reflux may require surgery. Fundoplication is a common surgical procedure to treat the reflux. It involves wrapping a portion of the stomach around the junction between the oesophagus and stomach to strengthen the sphincter in between. A newer minimally invasive procedure is also available where a ring of magnetic titanium beads is placed around the sphincter to strengthen it. Treatment for eosinophilic esophagitis involves reducing exposure to the allergen or administration of steroids to reduce inflammation. Antibiotics are administered in cases of infection. Medications causing oesophagitis may be stopped or changed by your doctor. A special diet may be recommended to control your symptoms. While eating, you are advised to remain upright, take small bites and chew your food carefully. Avoid eating at least 3 hours before bed time. Smoking should be avoided. Weight loss is recommended for some. If diagnosed early, oesophagitis can be managed by medications and lifestyle changes alone. Invasive treatment may be needed to repair changes to the structure of the oesophagus. An endoscopic procedure can be used to stretch or dilate the oesophagus and remove any food or pills stuck within the passage.

Prognosis

Oesophagitis caused by inflammation or infection usually responds well to treatment with medication, diet and lifestyle changes. Some individuals may need long-term treatment with medications. Eosinophilic oesophagitis may be chronic and recurrent but can be managed well. A very small percentage of GERD patients or those with achalasia may develop cancer.