What You Need to Know About Esophagitis
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Key Facts
- Esophagitis is inflammation of the esophagus, the tube that carries food from your mouth to your stomach, and can be caused by various factors including acid reflux, infections, and immune reactions.
- There are several types of esophagitis, such as reflux, eosinophilic (EoE), and infectious, each with different causes and characteristics.
- Common symptoms of esophagitis include difficulty swallowing, pain with swallowing, chest pain, and in severe cases, bleeding.
- Diagnosis of esophagitis often involves an upper endoscopy and possibly biopsies to examine the esophagus and identify the cause.
- Treatment for esophagitis varies depending on the type, ranging from medications to lifestyle changes and dietary adjustments.
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].
Table of Contents
- What is Esophagitis?
- Types of Esophagitis
- Common Symptoms to Watch For
- Treatment
- Closing Thoughts
- References
What is Esophagitis?
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].
Types of Esophagitis
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.
1. Reflux Esophagitis
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].
2. Eosinophilic Esophagitis (EoE)
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].
3. Lymphocytic Esophagitis
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.
4. Infectious 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.
5. Other Notable Types
- Crohn’s Disease-Related Esophagitis: When the chronic inflammation from Crohn’s disease spreads to the esophagus.
- Drug-Induced Esophagitis: Certain pills can cause localized damage especially if taken without water or while lying down. Additionally, spinal cord injury is a risk factor for developing esophagitis unrelated to an infection.
- Caustic Esophagitis: Results from ingesting harmful chemicals like household cleaners.
- IgG4-Related Esophagitis: A rare autoimmune version that’s part of a broader condition called IgG4-related disease [1], [4]. Autoimmune esophagitis, often associated with allergies and acid reflux, is another related condition that involves the role of eosinophils.
Common Symptoms to Watch For
No matter the type esophagitis tends to show up with some common symptoms. The most common are:
- Difficulty swallowing (dysphagia) or the sensation of something stuck in your throat
- Pain with swallowing (odynophagia) and a sore throat feeling
- Chest pain that might mimic heartburn
- In more severe cases bleeding in the upper gastrointestinal tract can occur [11]
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.
How Esophagitis is Diagnosed
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].
Treatment
Fortunately esophagitis is treatable—especially when the cause is identified. Treatment depends on the type:
- Reflux Esophagitis: Treated with PPIs to reduce stomach acid, along with lifestyle changes like avoiding trigger foods and elevating the head during sleep. A bland diet can help manage symptoms by reducing irritation. Maintaining a healthy weight is also important to minimize esophageal irritation. Avoid spicy foods to limit acid exposure and discomfort.
- Eosinophilic Esophagitis: Managed through elimination diets, topical corticosteroids (swallowed not inhaled) and allergen testing.
- Infectious Esophagitis: Requires antifungal, antiviral or antibiotic medication depending on the underlying pathogen.
- Drug-Induced Esophagitis: Adjusting how medications are taken (e.g. sitting upright, drinking more water) or switching to a different drug often helps.
- Caustic and IgG4-Related Esophagitis: These usually require more complex care, immunosuppressive therapy and ongoing monitoring.
Closing Thoughts
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.
References
[1] Grossi, L., Ciccaglione, A. F., & Marzio, L. (2017). Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”?. World journal of gastroenterology, 23(17), 3011–3016. https://doi.org/10.3748/wjg.v23.i17.3011
[2] Pittman M. E. (2022). Lymphocytic Esophagitis: Current Understanding and Controversy. The American journal of surgical pathology, 46(1), e55–e63. https://doi.org/10.1097/PAS.0000000000001667
[3] Dellon, E. S., Muir, A. B., Katzka, D. A., Shah, S. C., Sauer, B. G., Aceves, S. S., Furuta, G. T., Gonsalves, N., & Hirano, I. (2025). ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. The American journal of gastroenterology, 120(1), 31–59. https://doi.org/10.14309/ajg.0000000000003194
[4] Lisovsky M. (2020). Inflammatory conditions of the esophagus: an update. Annals of the New York Academy of Sciences, 1481(1), 5–10. https://doi.org/10.1111/nyas.14450
[5] Nguyen, A. D., Spechler, S. J., Shuler, M. N., Souza, R. F., & Dunbar, K. B. (2019). Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis. Journal of clinical gastroenterology, 53(1), 9–14. https://doi.org/10.1097/MCG.0000000000000870
[6] Patel, N. C., & Caicedo, R. A. (2015). Esophageal infections: an update. Current opinion in pediatrics, 27(5), 642–648. https://doi.org/10.1097/MOP.0000000000000266
[7] Hoversten, P., Kamboj, A. K., & Katzka, D. A. (2018). Infections of the esophagus: an update on risk factors, diagnosis, and management. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 31(12), 10.1093/dote/doy094. https://doi.org/10.1093/dote/doy094
[8] Goff J. S. (1988). Infectious causes of esophagitis. Annual review of medicine, 39, 163–169. https://doi.org/10.1146/annurev.me.39.020188.001115
[9] Reddy, C. A., McGowan, E., Yadlapati, R., & Peterson, K. (2024). AGA Clinical Practice Update on Esophageal Dysfunction Due to Disordered Immunity and Infection: Expert Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 22(12), 2378–2387. https://doi.org/10.1016/j.cgh.2024.08.027
[10] Lottrup, C., Khan, A., Rangan, V., & Clarke, J. O. (2020). Esophageal physiology-an overview of esophageal disorders from a pathophysiological point of view. Annals of the New York Academy of Sciences, 1481(1), 182–197. https://doi.org/10.1111/nyas.14417
[11] Guntipalli, P., Chason, R., Elliott, A., & Rockey, D. C. (2014). Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome. Digestive diseases and sciences, 59(12), 2997–3003. https://doi.org/10.1007/s10620-014-3258-4
[12] Carmack, S. W., Vemulapalli, R., Spechler, S. J., & Genta, R. M. (2009). Esophagitis dissecans superficialis (“sloughing esophagitis”): a clinicopathologic study of 12 cases. The American journal of surgical pathology, 33(12), 1789–1794. https://doi.org/10.1097/PAS.0b013e3181b7ce21
[13] Thel, H. L., Anderson, C., Xue, A. Z., Jensen, E. T., & Dellon, E. S. (2025). Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 23(2), 272–280.e8. https://doi.org/10.1016/j.cgh.2024.09.031
[14] Eluri, S., Tappata, M., Huang, K. Z., Koutlas, N. T., Robey, B. S., Fan, C., Reed, C. C., Shaheen, N. J., & Dellon, E. S. (2020). Distal esophagus is the most commonly involved site for strictures in patients with eosinophilic esophagitis. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 33(2), doz088. https://doi.org/10.1093/dote/doz088
[15] Mohamed, A. A., Lu, X. L., & Mounmin, F. A. (2019). Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Canadian journal of gastroenterology & hepatology, 2019, 3585136. https://doi.org/10.1155/2019/3585136
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