Esophagitis

Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.

Esophagitis can be asymptomatic; or can cause epigastric and/or substernal burning pain, especially when lying down or straining; and can make swallowing difficult (dysphagia). The most common cause of esophagitis is the reverse flow of acid from the stomach into the lower esophagus: gastroesophageal reflux disease (GERD).

Signs and symptoms[edit]

The symptoms of esophagitis include:

• Heartburn – a burning sensation in the lower mid-chest
• Nausea
• Dysphagia – swallowing is painful, with difficulty passing or inability to pass food through the esophagus
• Vomiting (emesis)
• Abdominal pain
• Cough

Complications[edit]

If the disease remains untreated, it can cause scarring and discomfort in the esophagus. If the irritation is not allowed to heal, esophagitis can result in esophageal ulcers. Esophagitis can develop into Barrett's esophagus and can increase the risk of esophageal cancer.

Causes[edit]

Infectious esophagitis cannot be spread. However, infections can be spread by those who have infectious esophagitis. Esophagitis can develop due to many causes. GERD is the most common cause of esophagitis because of the backflow of acid from the stomach, which can irritate the lining of the esophagus.

Other causes include:

• Medicines – Can cause esophageal damage that can lead to esophageal ulcers
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) – aspirin, naproxen sodium, and ibuprofen. Known to irritate the GI tract.
  • Antibiotics – doxycycline and tetracycline
  • Quinidine
  • Bisphosphonates – used to treat osteoporosis
  • Steroids
  • Potassium chloride
• Chemical injury by alkaline or acid solutions
• Physical injury resulting from nasogastric tubes.
• Alcohol use disorder – Can wear down the lining of the esophagus.
• Crohn's disease – a type of IBD and an autoimmune disease that can cause esophagitis if it attacks the esophagus.
• Stress – Can cause higher levels of acid reflux
• Radiation therapy - Can affect the immune system.
• Allergies (food, inhalants) – Allergies can stimulate eosinophilic esophagitis.
• Infection - People with an immunodeficiencies have a higher chance of developing esophagitis.
• Vitamins and supplements (iron, vitamin C, and potassium) – Supplements and minerals can be hard on the GI tract.
• Vomiting – Acid can irritate esophagus.
• Hernias – A hernia can poke through the diaphragm muscle and can inhibit the stomach acid and food from draining quickly.
• Surgery
• Eosinophilic esophagitis, a more chronic condition with a theorized autoimmune component

Mechanism[edit]

The esophagus is a muscular tube made of both voluntary and involuntary muscles. It is responsible for peristalsis of food. It is about 8 inches long and passes through the diaphragm before entering the stomach. The esophagus is made up of three layers: from the inside out, they are the mucosa, submucosa, muscularis externa. The mucosa, the inner most layer and lining of the esophagus, is composed of stratified squamous epithelium, lamina propria, and muscularis mucosae. At the end of the esophagus is the lower esophageal sphincter, which normally prevents stomach acid from entering the esophagus.

If the sphincter is not sufficiently tight, it may allow acid to enter the esophagus, causing inflammation of one or more layers. Esophagitis may also occur if an infection is present, which may be due to bacteria, viruses, or fungi; or by diseases that affect the immune system.

Irritation can be caused by GERD, vomiting, surgery, medications, hernias, and radiation injury. Inflammation can cause the esophagus to narrow, which makes swallowing food difficult and may result in food bolus impaction.