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Causes
By Mayo Clinic staffEsophagitis is generally categorized by the conditions that cause it. In some cases, more than one factor may be causing esophagitis.
Reflux esophagitis
A valve-like structure called the lower esophageal sphincter usually keeps the acidic contents of the stomach out of the esophagus. If this valve opens when it shouldn't or doesn't close properly, the contents of the stomach may back up into the esophagus (gastroesophageal reflux). Gastroesophageal reflux disease (GERD) is a condition in which this backflow of acid is a frequent or ongoing problem. A complication of GERD is chronic inflammation and tissue damage in the esophagus.
Eosinophilic esophagitis
Eosinophils (e-oh-SIN-oh-phils) are white blood cells that regulate inflammation and play a key role in allergic reactions. Eosinophilic esophagitis occurs with a high concentration of these white blood cells in the esophagus, most likely in response to an allergy-causing agent (allergen).
In many cases, people who have this kind of esophagitis are allergic to one or more foods. Some foods that may cause eosinophilic esophagitis include milk, eggs, wheat, soy, peanuts, beans, rye and beef. People with eosinophilic esophagitis may have other nonfood allergies. For example, inhaled allergens, such as pollen, may be the cause in some cases.
Drug-induced esophagitis
Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for a prolonged period. For example, if a pill is swallowed with little or no water, the pill itself or residue from the pill may remain in the esophagus. Drugs that have been linked to esophagitis include:
- Pain-relieving medications, such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others)
- Antibiotics, such as tetracycline and doxycycline
- Potassium chloride, which is used to treat potassium deficiency
- Bisphosphonates, including alendronate (Fosamax), a treatment for weak and brittle bones (osteoporosis)
Infectious esophagitis
Esophagitis may also be caused by a bacterial, viral, fungal or parasitic infection in tissues of the esophagus. Infectious esophagitis is relatively rare and occurs most often in people with poor immune system function, such as people with HIV/AIDS or cancer.
A fungus normally present in the mouth called Candida albicans is a common cause of infectious esophagitis. Such infections are often associated with poor immune system function, diabetes, cancer and antibiotic use.
- Franciosi JP. Eosinophilic esophagitis. Immunology and Allergy Clinics of North America. 2009;29:19.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm. Accessed Aug. 1, 2011.
- Castell DO. Medication-induced esophagitis. http://www.uptodate.com/home/index.html. Accessed Aug. 1, 2011.
- Graman PS. Esophagitis. In: Mandell GL, et al. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2010. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-443-06839-3..00094-1&isbn=978-0-443-06839-3&uniqId=270386537-4#4-u1.0-B978-0-443-06839-3..00094-1. Accessed Aug. 1, 2011.
- Patti MG. Gastroesophageal reflux disease: From pathophysiology to treatment. World Journal of Gastroenterology. 2010;16:3745.
- Geagea A, et al. Scope of drug-induced, infectious and allergic esophageal injury. Current Opinion in Gastroenterology. 2008;24:496.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 11, 2011.
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