Oesophagitis (esophagitis): symptoms, causes, treatment and diet

The NHS says the main symptoms of acid reflux are heartburn and a sour taste in the mouth, and that symptoms are often worse after eating, when lying down and when bending over. NHS inform lists oesophagitis, a sore, inflamed gullet, among the symptoms of gastro-oesophageal reflux disease (GORD).

Patient.info adds that, like heartburn, other symptoms tend to come and go and are often worse after a meal. Severe chest pain develops in some cases and may be mistaken for a heart attack.

• Heartburn, a burning feeling rising from the upper tummy or lower chest up towards the neck.

• An unpleasant sour or acid taste in the mouth.

• Pain in the upper abdomen and chest, feeling sick, bloating and belching.

• A burning pain when swallowing hot drinks or hot fatty foods.

• A cough or hiccups that keep coming back, a hoarse voice or bad breath (NHS).

• Pain or difficulty swallowing and a sore throat (NHS inform).

The NHS says to see a GP if lifestyle changes and pharmacy medicines are not helping, if you have heartburn most days, or if you also have other symptoms such as food getting stuck in your throat, frequently being sick or losing weight for no reason. NHS inform adds persistent vomiting, vomiting blood and difficulty swallowing as signs of a more serious problem.

The NHS says that for any chest pain that feels tight or like squeezing, or spreads to the arms, neck or jaw, you should call 999 and not drive yourself to A&E, because it can be a heart attack. For difficulty swallowing in general, the NHS says to ask for an urgent GP appointment or get help from NHS 111.

The NHS says simple lifestyle changes can help, and that a pharmacist can recommend antacids or alginates, which help in the short term but will not cure the problem and should not be taken regularly for long periods. If these are not enough, a GP may prescribe a PPI, which reduces how much acid your stomach makes.

Patient.info says a PPI is generally used first because it tends to work better than H2 blockers, with a full-dose course for a month or so settling symptoms and allowing the inflammation to clear. After that, it is common to step down to the lowest dose that prevents symptoms, and some people need long-term daily treatment.

The NHS says a PPI is usually needed for 4 or 8 weeks, depending on how serious the acid reflux is, and to go back to the GP if symptoms return after stopping, because you may need a long-term prescription. NHS inform says you are usually given enough medicine to last a month, and that some people need PPIs on a long-term basis.

Patient.info says that a full-dose course for a month or so often settles symptoms and allows any inflammation to clear, but that some people need long-term daily treatment because without it symptoms return quickly. Because reflux is a long-term tendency, lifestyle measures are important after the inflammation has healed.

The Northern Care Alliance leaflet says in most people oesophagitis is caused by digestive juices from the stomach repeatedly moving upwards into the lower oesophagus, producing redness and ulceration. The ring of muscle at the bottom of the oesophagus normally keeps it closed, but reflux occurs when it is weak, and it is not fully understood why it becomes weak.

NHS inform lists factors that may increase the risk of GORD. NHS inform also notes that GORD can sometimes affect several members of the same family.

• Being overweight or obese.

• Certain foods and drinks, such as coffee, alcohol, tomatoes, chocolate and fatty or spicy foods.

• Smoking and stress.

• Pregnancy.

• A hiatus hernia, where part of the stomach pushes up through the diaphragm.

• Some medicines, such as calcium-channel blockers, nitrates and non-steroidal anti-inflammatory drugs (NSAIDs).

• Gastroparesis, where the stomach is slow to empty.

The NHS says to eat smaller, more frequent meals, try to lose weight if overweight, find ways to relax, and avoid food and drink that trigger your symptoms. It says not to eat within 3 or 4 hours before bed, not to wear clothes that are tight around the waist, not to smoke and not to drink too much alcohol.

The NHS says you may find that raising the head of your bed by around 10 to 20cm, using wood, bricks or books, helps relieve symptoms, but not to use extra pillows, which can increase pressure on your belly and make symptoms worse. The Northern Care Alliance leaflet adds that avoiding stooping, for example by using long-handled tools when gardening or doing housework, is helpful, and the NHS Borders leaflet suggests avoiding fizzy drinks and chewing food well.

NHS inform says your GP will often be able to diagnose GORD from your symptoms and may prescribe treatment without tests. Patient.info says tests may be advised if symptoms are severe, do not improve with treatment or are not typical, and that gastroscopy is the common test, in which a thin flexible telescope is passed down the oesophagus into the stomach. With oesophagitis the lower oesophagus looks red and inflamed, though a normal-looking lining does not rule out reflux.

NHS inform lists other tests that may be used, including a barium swallow, manometry and 24-hour pH monitoring.

NHS inform says that if you have GORD for a long time, stomach acid can damage the oesophagus and cause further problems. The Northern Care Alliance leaflet says untreated oesophagitis can lead to narrowing (stricture) of the oesophagus, causing difficulty swallowing.

• Ulcers on the oesophagus, which may bleed and make swallowing painful.

• Scarring and narrowing of the oesophagus, which can make swallowing difficult and may need an operation.

• Changes in the cells lining the oesophagus (Barrett's oesophagus), from which oesophageal cancer can very occasionally develop, so you may need close monitoring.

On the NHS, a pharmacist or GP is the usual starting point, and a GP can start a PPI without tests. If medicines do not help or symptoms are severe or unusual, you are referred for gastroscopy and other tests at a hospital.

Some people choose to pay for a private gastroscopy to be seen sooner. The test and treatment are the same, and the results should go to your GP. Ask whether tests for Helicobacter pylori were done, because the NHS lists a stomach bacterial infection among causes of heartburn.