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Health condition · Clinically reviewed

Oesophagitis, from reflux to eosinophilic disease - and everything in between.

Not just heartburn. Oesophagitis has many faces, from acid reflux and eosinophilic disease to infection, pill injury, caustic damage and radiation. Each has its own treatment ladder.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BSG and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on reflux, eosinophilic, infectious, pill-induced and caustic oesophagitis.

Key facts

Oesophagitis at a glance.

The essentials, in plain English. What it is, the main types, and how each is investigated and treated in the UK today.

  • What it is

    Inflammation of the oesophagus, driven by reflux, eosinophilic disease, infection, medication, radiation or systemic illness.

  • Commonest cause

    Reflux oesophagitis from GORD, graded A to D on the Los Angeles classification at endoscopy.

  • Eosinophilic form

    A Th2 immune-mediated disease, increasingly recognised and often presenting with food impaction or dysphagia.

  • Infectious causes

    Candida, CMV and HSV, seen mainly in immunocompromised patients, on chemotherapy, steroids or with HIV.

  • Pill-induced

    Bisphosphonates, doxycycline, iron and NSAIDs are classic culprits when taken lying flat or with too little water.

  • Assessment

    Gastroscopy with biopsy is the cornerstone, alongside targeted microbiology and a careful medication and immune review.

Why this guide matters

One name, many diseases.

Reflux oesophagitis is the commonest form, but it is far from the only one. Eosinophilic, infectious, pill-induced, caustic and radiation oesophagitis each demand different tests and treatments.

  • Reflux is only the start

    A large proportion of oesophagitis is driven by GORD, but persistent symptoms on PPI should trigger a rethink, not a higher dose.

  • Endoscopy and biopsy matter

    Direct visualisation and biopsies from the proximal and distal oesophagus distinguish reflux, eosinophilic, infectious and neoplastic disease.

  • Complications are preventable

    Barrett oesophagus, strictures and food impaction are avoidable with early recognition, appropriate treatment and specialist follow-up.

How the diagnosis is made

From first symptoms to a clear plan.

The steps a UK GP or gastroenterologist will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Symptom and medication history

    Heartburn, dysphagia and odynophagia are the giveaways, alongside a review of tablets, immunosuppression and radiotherapy exposure.

  2. 02

    Assessing

    Risk and immune status

    HIV testing, diabetes and steroid or chemotherapy use point towards infectious oesophagitis and change the differential.

  3. 03

    Assessing

    Empirical trial where appropriate

    For classic reflux, a short PPI trial can be diagnostic and therapeutic, before proceeding to endoscopy if symptoms persist.

  4. 04

    Confirming

    Upper GI endoscopy (OGD)

    Direct visualisation grades reflux disease and picks up rings, furrows, exudates or ulceration typical of other causes.

  5. 05

    Confirming

    Biopsy is essential

    Multiple biopsies from the proximal and distal oesophagus confirm eosinophilic oesophagitis, viral disease and Barrett dysplasia.

  6. 06

    Confirming

    Microbiology and PCR

    Fungal culture, and PCR or immunohistochemistry for HSV and CMV, when infection is suspected on endoscopic appearances.

  7. 07

    Planning

    Specialist gastroenterology plan

    A consultant-led plan for treatment, surveillance and MDT input from immunology or infectious diseases when relevant.

Typical timeline: first visit to a settled plan in weeks, not months.

Symptoms

What oesophagitis actually feels like.

A classic mix of heartburn, dysphagia and odynophagia, with warning features that mean it is time to escalate.

  • Heartburn

    Retrosternal burning, worse after meals and lying flat, is the hallmark of reflux oesophagitis.

  • Dysphagia

    Difficulty swallowing, sometimes with food sticking, points to eosinophilic disease, strictures or severe inflammation. See our dysphagia guide.

  • Odynophagia

    Painful swallowing is a classic feature of infectious, pill-induced and caustic oesophagitis.

  • Regurgitation and chest pain

    Acid regurgitation, sour taste and non-cardiac chest pain often accompany reflux disease.

  • Food impaction

    A first food bolus obstruction in a young adult should trigger a search for eosinophilic oesophagitis.

  • Haematemesis

    Vomiting blood or coffee-ground material warrants urgent assessment for ulceration or varices.

  • Weight loss and anaemia

    Unintended weight loss, iron-deficiency anaemia or persistent vomiting must never be dismissed.

  • Cough and hoarseness

    Chronic cough, sore throat and voice change can be extra-oesophageal features of reflux disease.

Treatment

How oesophagitis is treated in the UK.

Treatment always begins by identifying and addressing the underlying cause: acid suppression for reflux, PPI and topical steroids for eosinophilic disease, targeted antimicrobials for infection, and specialist care for caustic and radiation injury.

  • Proton pump inhibitor

    Omeprazole, lansoprazole, pantoprazole, esomeprazole or rabeprazole, at standard or high dose, is the mainstay for reflux oesophagitis.

  • H2 receptor antagonist

    Useful adjunct for nocturnal symptoms or step-down therapy once healing is achieved.

  • Lifestyle and posture

    Weight loss, smaller evening meals, head-of-bed elevation and avoiding tobacco and late-night alcohol all reduce reflux burden.

  • Antireflux surgery

    Laparoscopic fundoplication or LINX for selected patients with volume reflux or PPI intolerance, after specialist workup.

  • PPI and topical steroids for EoE

    High-dose PPI trial, then swallowed topical steroids such as budesonide (Jorveza) or fluticasone for eosinophilic disease.

  • Dietary elimination

    Empiric six-food or targeted elimination diets, guided by a dietitian, can induce remission in eosinophilic oesophagitis.

  • Antifungals and antivirals

    Fluconazole for Candida, ganciclovir or valganciclovir for CMV, and aciclovir for HSV, alongside immune review.

  • Endoscopic dilatation

    For fibrotic strictures from reflux, eosinophilic disease, caustic injury or radiation, sometimes with intralesional steroid.

Specialist and complex care

Barrett oesophagus, strictures and caustic injury are specialist-commissioned.

Barrett oesophagus is managed with surveillance and, when dysplasia is present, radiofrequency ablation, endoscopic mucosal resection or endoscopic submucosal dissection. Caustic ingestion, complex strictures and radiation injury are managed jointly by upper GI, immunology and infectious diseases teams, with an MDT approach.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gastroenterologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Gastro-oesophageal reflux disease and dyspepsia in adults (CG184).

  • British Society of Gastroenterology. Guidelines on oesophageal disease and Barrett oesophagus.

  • UEG and BSG. Eosinophilic oesophagitis guidelines.

  • MHRA and BNF. Guidance on pill-induced oesophageal injury and bisphosphonate use.

Red flags

When oesophagitis needs urgent attention.

Most reflux oesophagitis can be managed in primary care. These are the situations that cannot, and where a specialist opinion is essential.

  • Haematemesis or melaena

    Vomiting blood or passing black tarry stools needs urgent hospital assessment for bleeding oesophagitis or varices.

  • Progressive dysphagia

    Worsening difficulty swallowing solids, especially with weight loss, must be investigated urgently to exclude malignancy.

  • Food bolus obstruction

    A stuck food bolus is a medical emergency and, once resolved, an important trigger for endoscopy and biopsy.

  • Caustic ingestion

    Acid or alkali ingestion, accidental or intentional, is a specialist emergency needing early endoscopic and airway assessment.

  • Immunocompromise with odynophagia

    Painful swallowing on chemotherapy, steroids or with HIV should prompt rapid endoscopy for infectious oesophagitis.

  • Persistent symptoms on PPI

    Reflux symptoms that fail to respond to a proper PPI trial warrant specialist review and endoscopy.

  • Iron-deficiency anaemia

    New anaemia in adults with reflux symptoms is a red flag for erosive disease, ulceration or malignancy.

  • Unintentional weight loss

    Weight loss with any upper GI symptom deserves urgent gastroenterology assessment.

  • Chest pain of uncertain origin

    Chest pain should never be assumed to be reflux until cardiac causes have been excluded.

Living with it

Everyday steps that actually help.

Small changes to how tablets are taken, how meals are timed and how you sleep can make a big difference alongside medical treatment.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for months do more than a heroic week that does not last.

  1. 01 Routine

    Take tablets properly

    Bisphosphonates, doxycycline, iron and NSAIDs should be taken upright, with a full glass of water, and not just before lying down.

  2. 02 Diet

    Small evening meals

    Finishing eating three hours before bed, and going easy on alcohol, chocolate and very fatty meals, reduces overnight reflux.

  3. 03 Posture

    Elevate the head of the bed

    Raising the head of the bed by 15 to 20 cm often outperforms extra pillows for nocturnal symptoms.

  4. 04 Escalate

    Do not tolerate red flags

    Progressive dysphagia, bleeding, weight loss or food impaction always deserve an endoscopy, not another repeat prescription.

Frequently asked

Everything we get asked about oesophagitis.

Quick answers on reflux, eosinophilic disease, infections, medication injury and strictures.

  • What is oesophagitis?

    Oesophagitis is inflammation of the lining of the oesophagus. It has many causes, including acid reflux, eosinophilic disease, infections such as Candida, CMV and HSV, certain medications, caustic ingestion, radiotherapy and systemic diseases such as systemic sclerosis and Crohn disease.

  • How is oesophagitis diagnosed?

    The cornerstone is upper GI endoscopy with biopsies from the proximal and distal oesophagus. Endoscopy grades reflux disease using the Los Angeles classification and identifies features of eosinophilic, infectious, pill-induced and caustic disease. Microbiology, HIV testing and a careful medication review complete the picture.

  • What is the difference between reflux and eosinophilic oesophagitis?

    Reflux oesophagitis is caused by acid moving up from the stomach and usually presents with heartburn and regurgitation. Eosinophilic oesophagitis is a Th2 immune-mediated disease with eosinophils infiltrating the oesophageal wall and typically presents in younger adults with dysphagia and food impaction. Both need endoscopy and biopsy to distinguish reliably.

  • How is reflux oesophagitis treated?

    First-line treatment is a proton pump inhibitor, such as omeprazole, lansoprazole, pantoprazole, esomeprazole or rabeprazole, alongside lifestyle changes. Some patients benefit from an H2 antagonist for nocturnal symptoms. Selected patients with severe or PPI-intolerant disease are considered for antireflux surgery, such as laparoscopic fundoplication or LINX.

  • How is infectious oesophagitis managed?

    Candida oesophagitis is usually treated with oral fluconazole 100 to 200 mg daily for 14 to 21 days, with itraconazole as an alternative. CMV oesophagitis is treated with ganciclovir or valganciclovir, and HSV oesophagitis with aciclovir. Underlying immunocompromise, including HIV, should be identified and addressed.

  • What if oesophagitis has caused a stricture?

    Fibrotic strictures from long-standing reflux, eosinophilic disease, caustic injury or radiotherapy are treated with endoscopic dilatation, sometimes with intralesional steroid. Barrett oesophagus is managed with surveillance and, when dysplasia is present, radiofrequency ablation or endoscopic resection under specialist care.

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