What You Need to Know About Esophagitis

Los Angeles Times

02-05-2025

Imagine swallowing food and feeling pain, like something is scraping your throat. That's what people with esophagitis experience. Esophagitis is the medical term for inflammation of the esophagus—the tube that moves food from your mouth to your stomach. This can be short-term or chronic, mild or severe and can be caused by acid reflux, infections, immune reactions, and even certain medications or chemicals [1].
At its core esophagitis is inflammation—meaning the esophageal lining is irritated or damaged. Infections that weaken the immune system and allergies, especially food allergies can cause esophagitis. This can make swallowing painful, uncomfortable or difficult. Various risk factors, lifestyle choices and health conditions can contribute to esophagitis.
In some cases the inflammation can lead to ulcers, scarring or narrowing of the esophagus which can complicate eating and digestion. Symptoms of esophagitis can vary in severity from mild discomfort to severe pain. Different from something like Gastroparesis, The cause determines the type of esophagitis and getting the diagnosis right is key to choosing the right treatment [1].
Esophagitis isn't a one size fits all condition. There are several types, each with its own causes and characteristics. Each type has its own risk factors so certain groups are more prone to developing the condition.
For example some types of esophagitis are linked to certain medications such as NSAID pain relievers, nitrates and beta blockers which can increase the risk of developing this condition.
Also chronic vomiting medicines can cause esophagitis through irritation and inflammation of the esophagus potentially leading to serious health implications if left untreated.
This is the most common type and is directly linked to a condition called gastroesophageal reflux disease (GERD)—a condition where stomach acid flows back into the esophagus regularly. That acid meant to break down food in the stomach can wreak havoc on the esophageal lining. The lower esophageal sphincter acts as a valve to prevent this acid reflux and its dysfunction is a common cause of GERD and reflux esophagitis.
Over time this acid exposure can cause erosions, ulcers and even strictures (narrowing due to scar tissue). Doctors use the Los Angeles (LA) classification system to grade the severity based on what they see during an upper endoscopy [5], [10].
This is not acid related. EoE is driven by the immune system. EoE occurs when eosinophils—a type of white blood cell involved in allergic responses—build up in the esophagus often in response to allergens or food triggers [3]. Allergic reactions can cause this accumulation leading to inflammation.
It's on the rise now affecting around 1 in 700 Americans [13]. People with EoE often have trouble swallowing and food getting stuck. Trouble swallowing also known as dysphagia is a common symptom of eosinophilic esophagitis. Long term inflammation can lead to strictures and about 28% of patients develop them mostly in the distal esophagus, or the lower third near the stomach [14].
Still a bit of a mystery lymphocytic esophagitis features an excess of lymphocytes, a type of white blood cell, in the esophageal tissue without signs of acid damage or typical allergic inflammation [2].
It's more common in older women and individuals with other immune related issues. While rare this condition may overlap with disorders like celiac disease or autoimmune conditions. An autoimmune disease such as scleroderma can increase the risk of esophagitis.
When infection is the cause Candida albicans, herpes simplex virus, and cytomegalovirus are the usual culprits [6], [7]. These are more common in immunocompromised individuals such as those undergoing chemotherapy or living with HIV but are also being seen more frequently in healthy people with a weakened immune system.
One subtype esophageal candidiasis occurs when Candida, a fungal organism that normally lives in the body, overgrows in the esophagus [15]. This often appears as white patches visible during an endoscopy. Radiation therapy infections can also cause esophagitis by causing irritation and inflammation in the esophagus.
No matter the type esophagitis tends to show up with some common symptoms. The most common are:
Severe esophagitis can lead to complications such as difficulty eating, risk of bleeding and narrowing of the esophagus.
Symptoms may vary depending on the cause and some people especially with infectious or drug induced esophagitis may only notice symptoms when things become severe.
Diagnosing esophagitis starts with a thorough review of symptoms and medical history. A physical exam by a healthcare provider, especially a gastroenterologist, is also necessary. To confirm the diagnosis esophagitis is diagnosed through various tests and procedures including an upper endoscopy where a flexible tube with a camera is passed down the throat to examine the esophagus directly.
They may also take biopsies (small tissue samples) during the procedure especially if they suspect EoE or want to rule out infection or other immune related issues [3].
Fortunately esophagitis is treatable—especially when the cause is identified. Treatment depends on the type:
Severe esophagitis is more than just a sore throat or heartburn—it's a condition that reflects the complexity of how our body's systems interact and can result in serious complications like bleeding. From acid reflux to immune responses and infections multiple pathways can lead to the same inflamed result. Untreated esophagitis can lead to Barrett's esophagus a condition that increases the risk of esophageal cancer.
Though GERD is the most common type, the increasing awareness of EoE and other immune related types emphasizes the need for early diagnosis and accurate diagnosis. As research evolves new treatments and diagnostic tools will help patients with this uncomfortable condition.
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