oesophagitis

Oesophagitis is inflammation of the oesophagus, the muscular tube that transports food from the mouth to the stomach. It has several causes, with reflux esophagitis from gastroesophageal reflux disease (GERD) being the most common. Other forms include eosinophilic oesophagitis, infectious oesophagitis (notably in immunocompromised people, caused by Candida species, cytomegalovirus, or herpes simplex virus), pill-induced oesophagitis, chemical or caustic injury, and radiation- or therapy-related oesophagitis.

Symptoms typically include odynophagia (painful swallowing), dysphagia (difficulty swallowing), chest pain, heartburn, and regurgitation. Fever may occur with infectious oesophagitis. Eosinophilic oesophagitis often presents in younger individuals with dysphagia to solids and food impaction.

Diagnosis relies on clinical history and endoscopic evaluation, with biopsy providing definitive information. Endoscopic findings vary by type: GERD-associated oesophagitis may show erosions; candidal infection often causes white plaques; eosinophilic oesophagitis may show rings and linear furrows, with histology showing eosinophilic infiltration (typically >15 eosinophils per high-power field). Additional testing such as pH monitoring or impedance studies can help in gastro-oesophageal reflux assessment. In suspected infectious cases, appropriate microbiological testing supports targeted therapy.

Treatment depends on the underlying cause. GERD is managed with proton pump inhibitors and lifestyle measures; eosinophilic oesophagitis with swallowed topical steroids or elimination diets; infectious oesophagitis with antifungals (and antivirals for viral causes); pill-induced oesophagitis by stopping the offending medication and taking pills with water while remaining upright; severe cases may require hospitalization or endoscopic dilation for strictures.

Prognosis is generally favorable with treatment, though recurrences are common, particularly in chronic conditions. Complications can include oesophageal ulcers, strictures, perforation, and, with long-standing GERD, Barrett’s oesophagus.