Esophagitis

Esophagitis is inflammation of the esophagus, the muscular tube that carries food from the mouth to the stomach. It has multiple causes and can present with chest pain, trouble swallowing, or pain on swallowing. The most common form is reflux-related esophagitis associated with gastroesophageal reflux disease (GERD), but infection, medications, eosinophilic inflammation, radiation, and chemical injury can also cause it.

Clinically, patients may experience odynophagia (painful swallowing), dysphagia (difficulty swallowing), retrosternal chest pain, heartburn, regurgitation, or minimal symptoms in milder cases. In immunocompromised individuals, infections such as Candida, herpes simplex virus, or cytomegalovirus are more likely. Eosinophilic esophagitis is a distinct form linked to allergic disease and often presents with dysphagia to solids.

Causes are categorized as reflux-related, infectious, medication-induced, eosinophilic, radiation-related, or chemical/caustic injury. Pill esophagitis can result from certain medications (eg, bisphosphonates, NSAIDs, potassium chloride) when taken without enough water or while lying down.

Diagnosis typically relies on upper endoscopy with biopsy to identify erosions, plaques, strictures, or eosinophilic infiltration. Additional testing (pH monitoring, impedance, or infection-specific cultures/PCR) may be used to establish GERD or infectious etiology.

Treatment is cause-specific. GERD-related symptoms are managed with acid suppression (often proton pump inhibitors) and lifestyle modifications. Infections are treated with appropriate antimicrobials (eg, fluconazole for Candida; antivirals for HSV/CMV). Pill esophagitis requires cessation or modification of the offending medication. Eosinophilic esophagitis is treated with dietary elimination and topical swallowed steroids. Complications can include strictures or perforation; most patients respond to targeted therapy.