Causes

Esophagitis 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-o-SIN-o-fils) are white blood cells that 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) or acid reflux or both.

In many cases, this type of esophagitis may be triggered by foods such as milk, eggs, wheat, soy, peanuts, beans, rye and beef. However, conventional allergy testing does not reliably identify these culprit foods.

People with eosinophilic esophagitis may have other nonfood allergies. For example, sometimes inhaled allergens, such as pollen, may be the cause.

Lymphocytic esophagitis

Lymphocytic esophagitis (LE) is an uncommon esophageal condition in which there are an increased number of lymphocytes in the lining of the esophagus. LE may be related to eosinophilic esophagitis or to GERD.

Drug-induced esophagitis

Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for too long. For example, if you swallow a pill 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 sodium (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)
• Quinidine, which is used to treat heart problems

Infectious esophagitis

A bacterial, viral or fungal infection in tissues of the esophagus may cause esophagitis. 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, or the use of steroid or antibiotic medications.