What causes oesophagitis

Overview

Oesophagitis is a condition characterized by inflammation or irritation of the oesophagus, the muscular tube connecting the throat to the stomach. This inflammation can cause pain, difficulty swallowing, and other uncomfortable symptoms. Understanding the various causes of oesophagitis is crucial for effective diagnosis and treatment, allowing individuals to manage their condition and prevent potential complications.

Common Causes of Oesophagitis

Gastroesophageal Reflux Disease (GERD)

The most prevalent cause of oesophagitis is gastroesophageal reflux disease (GERD). In GERD, the lower oesophageal sphincter (LOS), a muscular ring at the bottom of the oesophagus, relaxes inappropriately or becomes weak, allowing stomach acid and contents to flow back (reflux) into the oesophagus. The oesophageal lining is not equipped to handle the acidity of stomach contents, leading to irritation and inflammation. Chronic acid exposure can damage the oesophageal lining over time, potentially causing erosions, ulcers, and even precancerous changes (Barrett's oesophagus).

Factors that can worsen GERD and contribute to oesophagitis include:

• Obesity
• Pregnancy
• Certain foods and beverages (e.g., fatty foods, chocolate, caffeine, alcohol, spicy foods)
• Smoking
• Hiatal hernia
• Delayed stomach emptying
• Certain medications (e.g., calcium channel blockers, sedatives)

Eosinophilic Oesophagitis (EoE)

Eosinophilic oesophagitis (EoE) is an immune-mediated condition where a type of white blood cell called an eosinophil builds up in the oesophagus. This buildup is typically triggered by food allergens or, less commonly, environmental allergens. EoE is considered an allergic inflammatory disease. Symptoms often include difficulty swallowing, food impaction (food getting stuck in the oesophagus), chest pain, and vomiting. It is particularly common in children and young adults and is often associated with other allergic conditions like asthma, eczema, and food allergies.

Infections

Infections can also lead to oesophagitis, especially in individuals with weakened immune systems. Common infectious agents include:

• Fungal infections: Candida albicans is the most common fungal cause, often seen in people with diabetes, HIV, or those taking long-term antibiotics or corticosteroid medications.
• Viral infections: Herpes simplex virus (HSV) and cytomegalovirus (CMV) can infect the oesophagus, particularly in immunocompromised patients.
• Bacterial infections: While less common, certain bacteria can also cause oesophagitis.

Medications

Many medications can irritate or damage the oesophageal lining, leading to pill-induced oesophagitis. This occurs when a pill gets stuck in the oesophagus or dissolves too slowly, exposing the lining to irritants. Common culprits include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen
• Bisphosphonates (used to treat osteoporosis, e.g., alendronate)
• Potassium chloride supplements
• Certain antibiotics (e.g., tetracyclines, doxycycline)
• Antiviral medications (e.g., zidovudine)
• Chemotherapy drugs

Taking these medications with plenty of water and avoiding lying down immediately after taking them can help reduce the risk.

Other Causes

Less common causes of oesophagitis include:

• Radiation therapy: Radiation treatment to the chest area can damage the oesophageal lining, causing inflammation.
• Corrosive ingestion: Swallowing caustic substances like strong cleaning agents can cause severe oesophageal burns and inflammation.
• Crohn's disease: This inflammatory bowel disease can sometimes affect the oesophagus.
• Chemotherapy: Certain chemotherapy drugs can cause oesophagitis as a side effect.
• Allergic reactions: Besides EoE, severe systemic allergic reactions can sometimes involve the oesophagus.

Symptoms and Diagnosis

Symptoms of oesophagitis vary depending on the cause but commonly include heartburn, chest pain, difficulty swallowing (dysphagia), pain when swallowing (odynophagia), a feeling of food getting stuck in the throat or chest, and regurgitation. Diagnosis typically involves a medical history, physical examination, and often an endoscopy. An endoscopy allows a doctor to visualize the oesophagus directly and take biopsies to identify the cause of inflammation, such as infection, eosinophils, or damage from acid reflux.

Treatment and Management

Treatment for oesophagitis depends on the underlying cause. For GERD-related oesophagitis, treatments focus on reducing stomach acid with proton pump inhibitors (PPIs) or H2 blockers, lifestyle modifications (dietary changes, weight loss, smoking cessation), and sometimes surgery. For EoE, treatments may include dietary changes (elimination diets), medication (corticosteroids), and dilation of oesophageal strictures. Infectious oesophagitis is treated with specific antifungal, antiviral, or antibiotic medications. Pill-induced oesophagitis usually resolves by stopping the offending medication and ensuring proper intake with water. Prompt diagnosis and appropriate management are key to relieving symptoms and preventing long-term complications of oesophagitis.