We are all about the human body, how it works, and what happens if something goes wrong.

We are going to talk about an organ that is part of the digestive tract. We will first explain how this organ works and then we will explain a specific condition that happens in this part of the human body.

So, are you curious?

We are talking about an organ that we use to swallow foods and drinks, have you figured it out yet?

We are talking about the Esophagus.

The oesophagus is a long muscular tube that is approximately 25 cm long. We all know that the oesophagus is responsible for transporting food from the mouth to the pharynx to the stomach. It originates in the neck at the level of the sixth cervical vertebrae and extends to the level of the eleventh thoracic vertebrae where it is called the cardiac orifice of the stomach. In the chest, it descends down between the trachea and the vertebral bodies of the first thoracic vertebrae to the fourth thoracic vertebrae.

It enters the abdomen through an opening in the diaphragm called the oesophagal hiatus. Oesophagus has a special anatomical structure that is designed to carry out its functions. It consists of four layers:

The adventitia. It is the outer layer and is made of connective tissue. It covers the whole length of the oesophagus except for the very distal and the intraperitoneal parts, they are covered by serosa instead of adventitia.
The muscle layer. They are divided into two layers: an external longitudinal muscular layer and an internal circular muscular layer. The external layer is composed of different muscle types in each third of the oesophagus: the superior third has voluntary striated muscles, the middle third has voluntary striated and smooth muscles, and the inferior third has smooth muscles.
The submucosa.
The mucosa.

Food is transported through the oesophagus by a particular type of motion called “the peristalsis”. Peristalsis is rhythmic contractions of the muscles that propagate down the oesophagus.

Other important structures in the oesophagus include the sphincters. There are two sphincters in the oesophagus: the upper and the lower oesophagal sphincters. They are very important because they prevent the entry of air or reflux of gastric contents respectively.

The upper oesophagal sphincter is considered an anatomical structure. It lies at the junction between the pharynx and the oesophagus. It is made by the cricopharyngeal muscle. Normally, this sphincter is constricted to prevent the entry of air.

As for the lower oesophagal sphincter, it is located at the junction between the oesophagus and the stomach. This sphincter is considered a physiologic or functional sphincter because it doesn’t have any specific muscle. However, the sphincter is keeping its integrity by four factors:

The acute angle the oesophagus makes as it enters the stomach.
When there is positive intra-abdominal pressure, the walls of the intra-abdominal part of the oesophagus are compressed.
There are prominent mucosal folds at the junction between the stomach and the oesophagus that aids in the occlusion of the lumen of the oesophagus.
The muscles of the diaphragm exert some pressure as a pinch-cock mechanism.

All these structures and mechanisms are working cooperatively to deliver food from the mouth to the stomach as part of the eating and digestion mechanisms.

But what happens if something is wrong with the oesophagus?

We are going to talk about a condition that affects the oesophagus. It is esophagitis.

What is Esophagitis?

Esophagitis is inflammation of the lining of the oesophagus.

This inflammation can cause serious damage to the oesophagus and affect swallowing.

But what causes this Inflammation? What causes Esophagitis?

Esophagitis is usually categorized by causes. In some cases, more than one factor may be causing esophagitis

So, let’s have a look at the possible causes of esophagitis.

First, let’s start with reflux esophagitis. Normally, the lower oesophagal sphincter keeps the acidic contents of the stomach out of the oesophagus. If this sphincter opens when it shouldn’t or if it doesn’t close properly, the acidic gastric content will reflux back to the oesophagus. It is known as gastroesophageal reflux disease or GERD for short. It is a condition in which the backflow of acid into the oesophagus is an ongoing problem. Over time, it causes inflammation and tissue damage to the oesophagus.

Another cause includes eosinophils, the white blood cells that play a key role in allergic reactions. It is a condition known as eosinophilic esophagitis. It occurs when there is a high concentration of these cells in the wall of the oesophagus. This usually happens as a response to an allergy-causing agent or acid reflux. In many cases, it is usually triggered by certain types of food such as milk and eggs. In other cases, people with eosinophilic esophagitis may not have a food allergy, however, they may have inhaled allergens such as pollen and it caused this allergic reaction.

Another rare cause that may be related to eosinophilic or reflux esophagitis is lymphocytic esophagitis. It happens when there is an increased number of lymphocytes in the lining of the oesophagus.

And what about drugs? Can’t drugs cause inflammation of the oesophagus? Actually, several oral medications can induce tissue damage if they remain in the oesophagus or remain in contact with the lining of the oesophagus for too long. It is called drug-induced esophagitis. For instance, if someone swallows a pill with little or no water, the pill itself or some residues will remain in the oesophagus. But what type of drugs are we talking about?

Some drugs have been linked to esophagitis such as:

Painkiller’s medications such as aspirin and ibuprofen.
Antibiotics such as tetracycline.
Potassium chloride, which is used to treat potassium deficiency.
Some heart medications, like quinidine.
Some bone medications such as bisphosphonates.

The last cause of esophagitis is infections. It is known as infectious esophagitis. Bacterial, viral or fungal infections of the oesophagus may cause damage to the tissue. It is relatively rare but we can see it in people who have a weak immune system such as people who have AIDs or cancer.

We now know all the possible causes that can induce esophagitis. But we don’t know yet what the symptoms of esophagitis are.

I mean how would someone suspect they have esophagitis.

So, let me give you an idea about the symptoms of Esophagitis.

Symptoms of esophagitis

Common signs and symptoms of esophagitis include:

Difficult swallowing.
Painful swallowing.
Chest pain that occurs with eating.
Heartburn.
Acid regurgitation.
Food impaction in the oesophagus.

In children and infants, who are too young to explain their symptoms, symptoms may include:

Feeding difficulties.
Failure to thrive.

These symptoms might seem similar to symptoms of other conditions. However, you should see a doctor if your symptoms:

Last more than a few days.
Don’t improve or go away with over-the-counter medications.
Are severe enough to make eating difficult.
Are accompanied by other signs or symptoms such as flu signs.

And some symptoms are red flags, you should get instant help if you have it, such as:

Pain in the chest that lasts more than a few minutes.
Food is impacted in the oesophagus.
Having a history of heart disease and experiencing chest pain.
Shortness of breath or chest pain that occurs shortly after eating.
Vomit large amounts of food or often have forceful vomiting.

When you experience these symptoms, call your doctor immediately. Because esophagitis, if left untreated, can lead to some severe complications.

When left untreated, esophagitis can lead to changes in the structure of the oesophagus and other complications such as:

Scarring or narrowing of the oesophagus.
Tearing the oesophagal lining tissue.
Barrett’s esophagitis. A condition that happens when there are changes in the cells lining the oesophagus. It is considered a risk factor for cancer oesophagus.

So, how can we protect ourselves from this condition? I mean there must be a way to prevent the disease at the roots.

Well, it is true. You can prevent this condition and avoid all the scary complications.

If you want to protect yourself, you have to pay attention to the risk factors.

The risk factors of esophagitis vary according to the cause of esophagitis. But let’s have a look at the most common cause, reflux esophagitis.

If you want to avoid gastroesophageal reflux, you have to avoid:

Eating immediately before going to bed.
Smoking.
Gaining extra weight including the weight women gain from pregnancy.
Excessive large fatty meals.
Excess alcohol, caffeine, and chocolate.
Weakened immune system due to HIV, AIDS, diabetes< leukemia or lymphomas.
Hiatal hernia, when the stomach pushes through the opening in the diaphragm between the oesophagus and the stomach.
Radiation therapy in the chest.
Surgery in the chest area.
Chemotherapy.
Medications that prevent organ transplantation rejections.
Immunosuppressive drugs that are used to treat autoimmune diseases.
Chronic vomiting.
Aspirin and other anti-inflammatory drugs.
A family history of allergies and esophagitis.

Doctors also have identified some foods that worsen the symptoms of GERD and thus worsen reflux esophagitis, including:

Tomato-based food.
Spicy food.
Garlic and onions.
Mint-flavored food.
Citrus fruits.

What happens if Esophagitis is left without treatment?

Untreated esophagitis can lead to serious health problems related to the function and structure of the oesophagus, including:

Barrett’s oesophagus. It damages the lining of the oesophagus which can lead to precancerous changes in the tissue of the oesophagus.
Stricture or narrowing of the oesophagus, which can lead to obstruction and swallowing problems.
Holes or ulcers in the oesophagus, or worse, it can lead to perforation.
Tearing the oesophagus lining tissue from retching because food gets stuck or during endoscopy due to inflammation.
Increase in the risk of oesophagal cancer.

So, how is Esophagitis diagnosed?

Esophagitis diagnosed

First of all, your physician will need to ask you some questions and take good history before making a confirmed diagnosis.

Your doctor or specialist will likely make a diagnosis based on your answers to these questions., physical examinations and one or more tests.

Tests that diagnose esophagitis include:

Barium X-ray. For this test, you might need to drink a solution that contains a compound called barium or take a pill that is coated with barium. This compound, the barium, coats the oesophagus and the stomach and makes them visible. it makes organs visible. Then, X-ray images are taken. These images can help the physician identify any narrowing, ulcers, strictures, hiatal hernia, tumors of the gastrointestinal tract or any abnormality that could be causing symptoms.
Endoscopy. Doctors usually use a long flexible thin tube guided by a tiny camera at the end of the tube to view inside the gastrointestinal tract. Using this instrument, your doctor can view any abnormality in the oesophagus or remove a tissue sample for testing. The oesophagus might look different according to the cause of inflammation either it is drug-induced or reflux esophagitis. Patients usually get slightly sedated during this test.
Laboratory tests. When a small tissue sample is removed during endoscopy, it is sent to the laboratory to be tested. According to the suspected cause of the disease, tests are used to diagnose bacterial/ fungal/ viral infections, determine the concentrations of allergy-related eosinophils ( white blood cells) or identify any abnormality in the structure of the cell that would indicate oesophagal cancer or indicate precancerous changes.

After confirming the diagnosis of esophagitis, the treatment phase comes. Because as we mentioned, this condition must be treated properly or else it will cause some serious complications.

Before we start talking about the treatment you must know that treatment of esophagitis is intended to reduce symptoms, manage complications and treat the direct underlying causes of the condition.

So, what is the treatment of Esophagitis?

Treatment strategies, naturally, vary according to the cause of the condition.

So, let's start with reflux esophagitis. Treatment of reflux esophagitis includes:

Over the counter treatments. Those are very popular antacids people usually use when they have heartburn. Antacid medications such as Maalox reduce acid production. Sometimes H-2 receptor blockers such as cimetidine are used. They also block acid production and give the oesophagus a chance to heal. Other over the counter medications are the proton pump inhibitor such as omeprazole.
Prescription-strength medications. These include H-2 receptor blockers as well as proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole and pantoprazole. In this option, patients might also be prescribed prokinetics such as metoclopramide, which helps your stomach empty its contents quickly.
Surgery. If other interventions didn’t work, doctors usually go for surgery. Fundoplication is a surgery that may be used to improve the condition of the oesophagus. A portion of the stomach is wrapped around the valve separating the oesophagus and the stomach. This surgery strengthens the sphincter and prevents the gastric acid from backing up to the oesophagus.
Other new techniques of treatment include minimally invasive surgeries to put a ring of tiny magnetic titanium beads around the junction between the oesophagus and the stomach. This ring of beads strengthens the lower oesophagal sphincter and prevents acid reflux.

Now let’s move to eosinophilic esophagitis. Treatment for eosinophilic esophagitis includes mainly avoiding allergens and reducing allergic reactions with medications.

Medications that are used to treat eosinophilic esophagitis include:

Proton pump inhibitors. Doctors usually start with proton pump inhibitors and see the results.
Steroids. Studies show that some types of swallowed steroids such as fluticasone or budesonide may work topically on the oesophagus and treat eosinophilic esophagitis. The same idea of treating asthma by inhaling steroids. Doctors use the same medications that are used to treat asthma but orally. Doctors usually give their patients some instruction on how to swallow the steroids so that they coat the oesophagus. This way, by swallowing the steroids, it is much less likely to cause steroids side effects than taking steroids pills.
Elimination and elemental diet. Eosinophilic esophagitis usually occurs due to a response to a food allergen. Therefore, elimination of this food allergen might be an effective treatment. Under the doctor’s instruction, patients will gradually add these foods back into their diets and note when symptoms return. Currently, there are no tests available to identify the culprit food, that’s why doctors usually suggest common food allergens. Another more restrictive approach is to remove all food from your diet and stick to an amino acid-based formula.
New biologic treatments are being developed currently to treat eosinophilic esophagitis. These new biologic medications stimulate the body’s immune response to fight infection, inflammation or diseases.

What about drug-induced Esophagitis? How is it treated?

Treatment of drug-induced esophagitis is mainly avoiding the irritable drugs that cause damage to the lining of the oesophagus and following better pill-taking habits.

Doctors usually recommend:

Taking an alternative drug that is less likely to cause drug-induced esophagitis.
Taking the liquid version of the medication if possible.
Drinking a whole glass of water with a pill unless your doctor told you to restrict water intake with certain medications due to other conditions such as kidney diseases.
Sitting or standing for at least 30 minutes after taking your medications.

As for infectious esophagitis, doctors usually prescribe medications to treat the bacterial, viral, or fungal infection that is causing this inflammation and damage in the oesophagal lining.

But what if some complications happened?

Gastroenterologists might need to dilate the oesophagus when there is a severe narrowing in the esophagus or food has become lodged in the oesophagus.

In this oesophagal dilatation, doctors usually use one or more endoscopic devices. These devices might be equipped with

A tapered tip with a rounded end that widens the oesophagus gradually.
A balloon that can expand after its insertion in the oesophagus.

Some people might prefer homemade remedies and lifestyle modifications to treat esophagitis. However, it depends on the type of esophagitis you have.

But here are some tips that can lessen the symptoms of esophagitis:

Avoid foods that might increase reflux. Eating an excessive amount of food always worsens the symptoms, so avoiding that bad habit will save your stomach from these consequences. Some types of food are known to increase reflux such as alcohol, caffeine, chocolate and mint-flavored food.
Follow good pill-taking habits. Always take your pills with plenty of water and don’t lie down for at least 30 minutes after taking the pill.
Lose weight. Discuss with your doctor a diet and exercise plan that can reduce your weight. This can help you lose and maintain a healthy weight.
If you smoke, quit this bad habit. Talk to your doctor if you find it hard to quit.
Avoid certain medications, especially those that are known to induce esophagitis. Avoid some painkillers as well as some antibiotics.
Avoid stooping or bending, especially after eating.
Avoid lying down directly after eating. Wait at least three hours to lie down or go to bed after eating. And never eat large quantities before going to bed.
Raise the head of the bed. Raise the pillow under your head. Aim for an elevation of 6 to 8 inches. Usually raising your head by using one pillow isn’t effective.

Some people also prefer alternative medicine; however, no alternative medicine therapies have been proved to treat esophagitis. Complementary and alternative therapies might provide some relief from heartburn and other symptoms.

And at the end, whenever you feel any heartburn or discomfort in your stomach or chest, always visit your doctor.

An early visit to the doctor, early diagnosis, and early management or treatment could save you from suffering from serious complications of esophagitis.