Oesophagitis

What is oesophagitis?

Oesophagitis refers to inflammation of the oesophagus, the muscular tube that carries food and liquids from the mouth to the stomach. The oesophagus plays a crucial role in swallowing, using coordinated muscular contractions to move food downward while preventing stomach contents from flowing back up.

Inflammation develops when the lining of the oesophagus becomes irritated or damaged. This can occur when protective mechanisms are overwhelmed by acid exposure, infection, medication-related injury or immune-related conditions. The oesophageal lining is not designed to tolerate prolonged exposure to stomach acid, and repeated irritation can lead to redness, swelling and in more severe cases, ulceration.

The most common cause of oesophagitis is acid reflux, also known as gastro-oesophageal reflux disease (GORD). When acid repeatedly flows back into the oesophagus, it irritates the lining and may trigger inflammation. While occasional reflux may cause mild symptoms, persistent reflux can lead to clinically significant oesophagitis that requires medical treatment.

What causes oesophagitis?

Oesophagitis can develop from several different mechanisms, depending on the underlying trigger. 

• Acid reflux (GORD) — the most common cause of oesophagitis. Repeated exposure of the oesophageal lining to stomach acid leads to irritation, inflammation and, in some cases, ulceration.

• Infection — fungal infections such as Candida or viral infections may inflame the oesophagus, particularly in individuals with weakened immune systems.

• Medication-induced injury (pill oesophagitis) — certain tablets, when swallowed without sufficient water or taken while lying down, can become lodged temporarily in the oesophagus and cause local irritation and inflammation.

• Eosinophilic oesophagitis — an immune-mediated condition characterised by an increased number of eosinophils in the oesophageal lining, often associated with allergies or atopic conditions.

• Radiation or chemical injury — radiotherapy to the chest or ingestion of corrosive substances can directly damage the oesophageal lining and result in inflammation.

What are the symptoms of oesophagitis?

Symptoms of oesophagitis vary depending on severity but are typically related to irritation and inflammation of the oesophageal lining.

• Heartburn — a burning sensation behind the breastbone, commonly associated with acid exposure.

• Painful swallowing (odynophagia) — discomfort or pain when swallowing due to inflammation of the oesophageal lining.

• Difficulty swallowing (dysphagia) — a sensation of food sticking or passing slowly through the chest.

• Chest pain — central chest discomfort that may mimic cardiac pain and should be properly evaluated.

• Regurgitation — the backflow of acid or food into the throat.

• Chronic cough or throat symptoms — persistent cough, hoarseness or throat irritation due to reflux-related inflammation.

How is oesophagitis different from acid reflux?

Acid reflux refers to the backflow of stomach acid into the oesophagus, whereas oesophagitis describes the inflammation that can result from repeated or prolonged acid exposure. Not all individuals with reflux develop oesophagitis, but persistent or severe reflux can damage the oesophageal lining over time.

Who is at risk of developing oesophagitis in Singapore?

Certain individuals are more susceptible to developing oesophagitis, particularly when protective mechanisms of the oesophagus are compromised.

• Patients with chronic reflux — persistent acid exposure significantly increases the risk of inflammatory changes in the oesophagus.

• Individuals with a hiatus hernia — disruption of the lower oesophageal sphincter can worsen reflux and promote inflammation.

• Immunocompromised individuals — those undergoing chemotherapy, long-term steroid therapy or living with chronic illness are more prone to infectious oesophagitis.

• People taking certain medications — some tablets can irritate the oesophageal lining if not taken correctly.

• Individuals with allergic or atopic conditions — eosinophilic oesophagitis is more common in patients with asthma, eczema or food allergies.

Can oesophagitis lead to complications?

If left untreated, oesophagitis can result in progressive damage to the oesophageal lining.

• Oesophageal ulcers — severe inflammation may lead to open sores within the oesophagus.

• Strictures — repeated inflammation can cause scarring and narrowing, leading to difficulty swallowing.

• Barrett’s oesophagus — chronic acid exposure may cause changes in the lining of the lower oesophagus, which require monitoring.

• Bleeding — inflamed or ulcerated tissue may bleed, resulting in anaemia or more obvious signs of gastrointestinal bleeding.

Timely treatment significantly reduces these risks.

When should you seek urgent medical attention?

Immediate medical care is required if you experience:

• Persistent reflux symptoms – Frequent and regular heartburn and acid brash (sour taste in the mouth due to refluxed gastric acid) need to be assessed on an urgent basis. In severe cases, the symptoms can occur even when upright (sitting or standing) 

• Severe difficulty swallowing — inability to swallow food or liquids may indicate obstruction or significant inflammation.

• Vomiting blood — bright red blood or material resembling coffee grounds suggests bleeding.

• Black or tarry stools — dark stools may indicate digested blood from the upper digestive tract.

• Sudden severe chest pain — acute chest pain should always be evaluated urgently to exclude serious causes, including cardiac causes

Prompt assessment ensures early management of potentially serious complications.

How is oesophagitis diagnosed?

Diagnosis begins with a careful clinical assessment based on symptoms such as heartburn, painful swallowing or chest discomfort. Your doctor will review medical history, medication use and any risk factors for reflux or infection.

• Upper gastrointestinal endoscopy — endoscopy allows direct visualisation of the oesophageal lining. Inflammation, erosions, ulcers or narrowing can be identified and graded.

• Biopsy — small tissue samples may be taken during endoscopy to confirm inflammation, detect infection or diagnose intestinal metaplasia or eosinophilic oesophagitis.

• pH studies — in selected cases, ambulatory oesophageal pH monitoring may be performed to measure acid exposure and confirm reflux as the underlying cause.

Accurate diagnosis ensures that the specific cause of inflammation is identified and appropriately treated.

What are the treatment options for oesophagitis?

Treatment depends on the underlying cause and severity of inflammation. The aim is to reduce irritation, promote healing, and prevent recurrence.

• Proton pump inhibitors (PPIs) — these medications reduce acid production and are commonly prescribed for reflux-related oesophagitis.

• Lifestyle modification — weight management, avoiding late meals, reducing trigger foods and elevating the head of the bed may improve reflux control.

• Antifungal or antiviral therapy — infectious oesophagitis requires targeted medication to eliminate the causative organism.

• Steroids (for eosinophilic oesophagitis) — topical corticosteroids may be used to reduce immune-mediated inflammation.

• Medication adjustment — if tablet-induced irritation is suspected, modifying how medication is taken or changing the prescription may resolve symptoms.

Summary

Oesophagitis is inflammation of the oesophageal lining, most commonly caused by persistent acid reflux, but it may also result from infection, medication-related irritation or immune-mediated conditions such as eosinophilic oesophagitis. Symptoms can range from heartburn and chest discomfort to painful or difficult swallowing. 

While mild cases may improve with medication and lifestyle changes, untreated inflammation can lead to complications such as ulcers, strictures or Barrett’s oesophagus. Early evaluation helps identify the underlying cause and ensures appropriate, targeted treatment.

If you are experiencing persistent reflux, swallowing difficulties or unexplained chest discomfort, arrange a consultation with Dr. Aaron Poh at Alpine Surgical Practice for a comprehensive assessment and appropriate investigation to determine the underlying cause and guide effective treatment.

Frequently Asked Questions (FAQs)