Esophagitis - Inflammation of the Oesophagus

Inflammation of the esophagus, also called esophagitis, is an inflammatory disease of the lining of the esophagus. In the International Classification of Diseases ICD 10, it is listed as K20 - oesophagitis - oesophagitis, which does not include reflux oesophagitis (K21.0) and oesophageal erosion (K22.1).

It is most commonly associated with GERD, which is gastroesophageal reflux disease.

But many other factors may be behind its emergence. The manifestation is the typical pain behind the sternum, also known as heartburn, but also problematic or painful swallowing.

FAQs: 

Why does the disease arise and how does it manifest? 

How is it treated? Will herbs or teas help to relieve the discomfort? 

Esophagitis can be acute, i.e. occurring suddenly, or chronic, i.e. persisting or recurring for a longer period of time. It can be categorised into reflux esophagitis, catarrhal, erosive esophagitis, and eosinophilic esophagitis. Diagnosis is determined on the basis of the severity, laboratory tests, however, the main method is an endoscopy.

Proper treatment depends on diagnosis and determination of the type and provoking cause. Diet and overall lifestyle modification is necessary. Of course, prevention against the onset or re-emergence of the disease also plays an important role.

The esophagus is part of the digestive system. It is a hollow organ, a tube that connects the pharynx to the stomach. It is approximately 30 cm long and 1.5 cm in diameter. The oesophagus is a muscular organ. Its muscles provide for the movement of food, or bites, processed in the mouth to the stomach.

The oesophagus is an important part of the digestive system and is adjacent to other structures and parts of the organ systems. Such as the respiratory system and the cardiovascular system. This is also why differential diagnosis has an important role.

Esophageal reflux disease causes esophagitis, however, it can also be the cause of airway inflammation. An invasive tumor, or cancer, grows into the surrounding area, also causing other complications. And pain behind the sternum for esophagitis can be mistaken for cardiovascular disease.

Learn more: Read the articles on esophageal cancer or heart attack.

The cause of inflammation of the esophagus is not the only one. Behind it there are various provoking factors. It is most commonly caused by gastroesophageal reflux disease, or GERD for short.

The mechanism is prolonged irritation of the esophageal mucosa by acidic contents from the stomach. The problem occurs on the basis of the non-functioning or insufficient ability of the sphincter, the sphincter, to prevent the back-penetration of acid from the stomach into the esophagus.

TIP: Read more in the article on reflux disease.

However, this cause is just one example of many. Another form is inflammation of the mucous membranes due to infection with viruses, bacteria or fungi. Examples are Candida, Herpes simplex or Cytomegalovirus. Food intake is difficult, especially if a person consumes too spicy, hot or cold food and beverages for a long time.

Erosive esophagitis is characterized by erosion, that is, deep damage to the lining of the esophagus. It is a consequence mainly of long-term exposure to negative factors. Acutely, it can be triggered by burning of the esophagus with chemicals, acid or high temperature of food and liquid.

The immune-mediated form is referred to as eosinophilic esophagitis (EoE). This form is predominantly benign and persists long term. The disease occurs at any age, however, mostly in the young and children, especially in boys.

Its cause is not yet clarified. Behind its occurrence is the interplay of several risk factors, along with an immune component. The influence of food allergy and genetic disposition is assumed. But also the action of negative factors in the early age of a person. 

The esophageal mucosa in this type of inflammation typically contains an increased amount of eosinophils. Eosinophils are white blood cells, or leukocytes, and their main role is the body's immune defence. Another form is drug-induced oesophagitis.

Table: risk factors and causes of esophagitis

Symptoms of oesophagitis can be typical, however, sometimes the disease can take its course asymptomatically, i.e. witout any symptoms.

They can be acute, i.e. short-term, or long-lasting and recurrent, i.e. chronic. Chronicity contributes to complications. The esophagus is located predominantly in the thoracic cavity. Symptoms from this area can be confused with difficulties with the respiratory or cardiovascular system.

Symptoms occurring in esophagitis include:

• difficulty swallowing (dysphagia)
• pain when swallowing (odynophagia), the pain is aggravated by swallowing
• sensation of a foreign body in the throat (globus sensation, lump in the throat)
• sensation of a piece of food stuck in the throat
• pyrosis, i.e. heartburn
• pain behind the sternum
  • burning sensation in the chest
  • mainly behind the sternum, retrosternal pain
  • pain after meals
• bad breath
• taste of bitterness in the mouth
• increased saliva production, paroxysmal drooling
• dry throat
• return of stomach contents to the oral cavity, i.e. regurgitation
• burping
• increased body temperature, in infectious origin
• feeling like vomiting, nausea
• vomiting
• lack of appetite
• blood in the vomit, vomiting of blood, i.e. haematemesis
• melena, i.e. black, tarry stool, from blood that has been broken down
• anemia
• loss of weight
• increased tooth decay
• coughing and hoarseness with irritation of the airways and vocal cords
  • repeated respiratory infections, laryngitis, pneumonia
• in irritation of the vagus nerve, nervus vagus (X. cranial nerve) also bradycardia

If esophagitis recurs or persists for a long time, it can lead to complications. These are, for example, scarring of the lining of the oesophagus. And this in turn leads to a narrowing of the diameter of the oesophagus. Reflux disease influences the development of inflammation, but also Barrett's oesophagus. A serious complication is cancer.

Table: symptoms according to a person's age

Diagnosis of oesophagitis is based both on history taking (anamnesis) and on the clinical picture. The history also includes family history and genetic or hereditary predispositions. The clinical picture takes into account the difficulties encountered. 

Laboratory tests are performed. The search for infection with helicobacter pylori is carried out. And for the exclusion of other diseases, other examination methods are also used. Such as X-ray, ultrasound, CT or ECG. An example is also the X-ray passage through the esophagus. A pH test or esophageal manometry, which evaluates the function of the sphincter between the esophagus and the stomach.

The main diagnostic method is endoscopy. That is, the introduction of a probe with optics into the esophagus and evaluation of the appearance of the mucosa. Esophagogastroscopy also includes tissue biopsy, which is the collection of a small sample and its subsequent histological analysis.

The doctor assesses possible risk factors, such as medication use, diet and lifestyle, or whether he or she has had other esophageal diseases in the past. Ingestion of a chemical or a burn to the esophagus is also detected. Differential diagnosis and differentiation from angina pectoris, peptic ulcer or oesophageal cancer is important.

The course of the disease depends on the provoking factor. It can be acute, especially in the case of intoxication, but also after ingestion of concentrated alcohol in higher volumes or as a consequence of poor diet. The chronic form develops as a result of negative and prolonged exposure.

The disease can also be asymptomatic for some time. However, typically the first symptoms are difficulty swallowing or pain, which is exacerbated by swallowing a bite. Similarly, the feeling of a bite being stuck in the throat is also a common symptom. And what is popularly known as heartburn, or pyrosis.

Especially pain behind the sternum is feared, in the form of burning. It can be mistaken for angina pectoris, which is the pain that occurs when the heart muscle does not clot, or a heart attack. It is important to investigate quickly to find out the cause and then treat it.

At first, these symptoms appear only after a certain meal, however, later on, as the inflammation progresses, they appear at every meal. In advanced stages, even fasting, during the night. The pain worsens in the supine position. Many times there is also scratching and pain in the throat.

The person becomes nauseous and may vomit. If the mucous membrane is disturbed and bleeds, blood may be present in the vomit. But also in the form of melena, which is black stool. Its coloration is caused by the presence of digested blood. In addition, symptoms from irritation of the respiratory tract may also be associated. In particular, coughing, later hoarseness, thickened voice and frequent respiratory tract infections.

Read the articles Stool - what you should know

and Black stool - when it is safe and when to see a doctor