Symptoms, Diagnosis, Causes, & More

Symptoms, Diagnosis, Causes, & More


Erosive esophagitis is a condition in which inflammation damages the lining of the esophagus, the tube connecting your mouth to your stomach. Erosive esophagitis typically develops from gastroesophageal reflux (GERD), when stomach acids flow back into the esophagus. Over time, stomach acids can erode (damage) the esophageal tissues and cause ulcers (sores).

Symptoms like difficulty swallowing and chest pain are common with erosive esophagitis.

It’s estimated that about 1% of people have erosive esophagitis. Among people with GERD, approximately 30% of people have erosive esophagitis.

Treatments focus on reducing acid reflux to control inflammation, relieve symptoms, and promote healing.

Symptoms of erosive esophagitis are similar to those of GERD, including:

  • Heartburn: This type of chest pain or discomfort may feel like a burning or squeezing sensation. Heartburn commonly develops after eating. 
  • Difficulty swallowing (dysphagia): Trouble swallowing food, liquids, or saliva may lead to food getting stuck in your throat. 
  • Painful swallowing (odynophagia): You may have a painful burning sensation when swallowing.
  • Sore throatA scratchy or raw-feeling sore throat can develop when stomach acids irritate the esophagus.
  • Acid regurgitation: A burning sensation in the throat or sour taste in the mouth can occur when stomach contents flow into the esophagus. 
  • Globus sensation: This is the feeling that something is stuck in your throat. 
  • Increased salivation: Stomach acids in the esophagus can trigger increased saliva production in the mouth. 
  • Cough: Inflammation and irritation in the esophagus can lead to a chronic cough. 
  • Hoarseness: You can develop a strained or raspy voice from throat irritation. 

Erosive esophagitis develops when inflammation erodes the lining of your esophagus, causing tissue damage and, in some cases, the formation of ulcers. Most cases of erosive esophagitis occur from repeated exposure to stomach acids in people with GERD.

The lower esophageal sphincter is a muscular valve that normally prevents stomach contents from reaching the esophagus. When the lower esophageal sphincter weakens or relaxes in GERD, stomach acids can flow into the esophagus. This irritates the lining of the esophagus and leads to inflammation. Over time, inflammation damages the fragile esophageal tissues.

Other causes of erosive esophagitis include radiation therapy and medications. 

Radiation therapy is a cancer treatment that uses high doses of energy to kill cancer cells. Approximately 1% of people who receive radiotherapy in the neck or chest area develop erosive esophagitis when the radiation beams damage cells in the esophagus. 

Taking oral medications (pills) without adequate amounts of water can injure the esophageal lining, too. When the pill gets stuck and partially or wholly dissolves in the esophagus, it can damage the tissues. Taking medications when lying down can also lead to pill-induced esophagitis. Certain medications, such as antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs), are associated with higher rates of pill-induced erosive esophagitis, too.

Risk Factors

Experiencing GERD symptoms like acid reflux for five or more years is associated with an increased risk of erosive esophagitis. 

Other factors that can increase the likelihood of developing erosive esophagitis include:

  • Age: Erosive esophagitis is more common in adults aged 60 or older. 
  • Sex: People assigned male at birth are more likely to develop erosive esophagitis than people assigned female at birth. 
  • Presence of a hiatal hernia: A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm and into the chest cavity. It raises the risk of erosive esophagitis. 
  • Lifestyle: Some research suggests smoking and regular alcohol consumption may increase the risk of erosive esophagitis. 
  • Obesity: Excess body weight is associated with higher rates of erosive esophagitis. 

Your healthcare provider will likely ask about your symptoms, review your medical history, and perform a physical examination. If they suspect you have erosive esophagitis, they may order tests to confirm the diagnosis. These tests may include: 

  • Endoscopy: An endoscopy involves inserting a flexible tube (endoscope) equipped with a light and camera into your mouth and down your throat to view your esophagus and look for signs of damage, such as ulcers. An endoscopy also helps identify the severity of damage to the esophageal lining.
  • BiopsyDuring an endoscopy, your healthcare provider may remove a small sample of esophageal tissue and send it to the lab for examination under a microscope.
  • Esophageal manometry: This procedure involves inserting a thin tube through your nose and passing it through your esophagus and down into your stomach. Once the tube is in place, your provider will ask you to swallow so they can measure the strength and coordination of the muscles in your esophagus. 
  • Barium swallow: This involves taking a series of X-ray images after you drink a chalky liquid containing barium, which coats the esophagus and helps identify abnormalities in the esophagus.

The primary goal of treatment for erosive esophagitis is to reduce inflammation in the esophagus, relieve symptoms, and promote healing. Treatment options vary depending on the underlying cause. 

Lifestyle Changes

Adopting certain lifestyle habits and dietary modifications may help prevent or relieve some symptoms of erosive esophagitis. These changes can include the following:

  • Avoid or limit your intake of foods and beverages that can trigger heartburn, such as fatty foods, chocolate, tomato-based foods, citrus fruits, caffeine, and alcohol. 
  • Eat smaller, more frequent meals throughout the day rather than three larger meals.
  • Cut solid foods into smaller pieces if you have difficulty or painful swallowing.
  • Avoid eating close to bedtime to reduce the likelihood of stomach acid backing up into the esophagus.
  • Quit smoking
  • Maintain a body weight that you and your healthcare provider decide is ideal for you.

Medications

Proton pump inhibitors (PPIs) are the mainstay treatment for erosive esophagitis. These medicines reduce stomach acid production to relieve symptoms and promote healing. Up to 80% of people with erosive esophagitis show signs of healing within eight weeks of PPI treatment. Examples of PPIs include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole).

Your healthcare provider may also prescribe H2 blockers, such as Pepcid AC (famotidine), Tagamet (cimetidine), and Axid AR (nizatidine), to reduce stomach acid production.

Antacids such as Tums or Calid (calcium carbonate) are available over-the-counter and may provide short-term relief for acid reflux symptoms. However, they do not promote healing and are unsuitable for long-term use. 

Surgery 

When lifestyle modifications and medications are ineffective, surgery may be necessary for GERD-related erosive esophagitis. Fundoplication is a surgical procedure that strengthens the lower esophageal sphincter to prevent acid reflux. 

The most common method surgeons use for performing fundoplication is laparoscopic surgery. This involves making three to five small incisions in your belly and inserting a surgical tool and a camera into the incisions.

During the procedure, the surgeon wraps the upper part of your stomach around the end of your esophagus and stitches them together. This surgery creates pressure at the end of your esophagus and prevents stomach contents from flowing into the esophagus.

You can lower your risk of developing erosive esophagitis by taking certain preventative measures, including:

  • Sit or stand upright when taking medications, and swallow with plenty of water. 
  • See a healthcare provider if you have symptoms of acid reflux, like heartburn or chest pain.
  • Follow your treatment plan and take medications as prescribed if you have GERD.  
  • Eat smaller, more frequent meals.
  • Avoid lying down after eating. 
  • Avoid or limit your intake of foods that trigger acid reflux symptoms, such as spicy, acidic, fried, and fatty foods; alcohol; and caffeinated beverages.
  • Quit smoking. 
  • Manage your weight. 

Left untreated, erosive esophagitis can lead to serious complications, including:

  • Ulcers: Open sores or lesions in the esophageal lining can cause bleeding or lead to a hole in your esophagus, increasing the risk of a potentially life-threatening infection when stomach fluids enter the esophagus. 
  • Esophageal stricture: Chronic inflammation and tissue damage cause scarring and narrowing of the esophagus, leading to difficulty swallowing, food regurgitation, or malnutrition.
  • Barrett’s esophagus: Chronic inflammation of the esophagus can lead to changes in the cells of the esophageal lining, causing them to resemble tissues that line the intestines. Barrett’s esophagus increases the risk of esophageal adenocarcinoma, a type of cancer.

Erosive esophagitis develops when inflammation damages the lining of the esophagus. GERD, when stomach acids regularly backflow into the esophagus, is the most common cause, but radiation therapy and certain medications can also injure the esophageal tissues. Difficulty swallowing, chest pain, and cough are common symptoms of erosive esophagitis.

See a healthcare provider if you have symptoms of GERD or erosive esophagitis. Early diagnosis and treatment can help prevent complications and promote healing.

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