Erosive Esophagitis (inflammation of the esophagus)

Erosive esophagitis is inflammation of the esophagus, the tube that carries food from your mouth to your stomach, with visible breaks or small ulcers in its lining. It is usually the result of acid and other stomach contents flowing back up. Day to day it can mean burning behind the breastbone, a sour taste at the back of the throat, and pain or a sticking feeling when you swallow, often worse after a meal or when you lie down.

What erosive esophagitis is, and what it is not

Reflux that turns up now and then, after a large meal or a late night, is not the same thing. Gastroesophageal reflux disease, or GERD, is the ongoing version: reflux frequent enough to cause symptoms or damage and to affect daily life. Erosive esophagitis is a more specific finding within that. It is what a doctor sees during an endoscopy when reflux has worn breaks into the lining of the esophagus.

Symptoms and damage do not always line up. Some people have difficult reflux symptoms and an esophagus that looks normal. Others have visible erosions and notice very little. This is why the diagnosis rests on what is seen inside the esophagus rather than on how severe the heartburn feels, and why two people describing much the same symptoms can need different care.

Signs and symptoms

• Burning in the chest, often after meals or when lying down
• Sour or bitter fluid coming back up into the throat or mouth
• Chest discomfort that can be mistaken for heart pain
• A cough, hoarse voice or sore throat that keeps coming back
• A feeling that food is sticking, or pain when swallowing
• Nausea, burping, or a bloated feeling after eating
• Sleep broken because symptoms are worse lying flat

The pattern differs from person to person, and it can change over months and years. Some people notice symptoms only after particular meals, while others have them most days.

What raises the risk

Some risk factors cannot be changed:

• A hiatus hernia, where part of the stomach sits above the diaphragm
• A family history of reflux or other digestive symptoms
• Being male, which the Canadian Digestive Health Foundation lists as a risk factor for GERD
• Some connective tissue conditions, such as scleroderma

Others can often be worked on, usually with support from a health care team:

• Carrying extra weight, particularly around the abdomen
• Smoking
• Alcohol intake, large or late evening meals, and personal trigger foods

How erosive esophagitis is diagnosed in Canada

A family doctor usually starts with the pattern of your symptoms and a review of the medicines you take. Upper endoscopy, also called gastroscopy, is the test that shows whether the lining of the esophagus is eroded. It also allows biopsies, and it lets a specialist grade erosive esophagitis and look for Barrett’s esophagus, a change in the lining that can follow long standing reflux. Where the picture is unclear, a gastroenterologist may add pH monitoring, either worn for a day or swallowed as a capsule, esophageal manometry to measure how the muscle of the esophagus works, or a barium swallow.

Treatment and day-to-day management

Clinical research for Erosive Esophagitis (inflammation of the esophagus) is enrolling. See the current studies ↓

Care in Canada aims to reduce how much acid reaches the esophagus, give the lining a chance to heal, and keep symptoms manageable. Depending on your situation, what an endoscopy showed, and what matters to you, a health care team may discuss:

• Meal timing and meal size, weight management, reducing smoking, and raising the head of the bed
• Antacids and alginate products available without a prescription at Canadian pharmacies
• Acid suppressing prescription medicines, including proton pump inhibitors and H2 receptor antagonists
• Endoscopic follow up and surveillance for people found to have Barrett’s esophagus
• Anti reflux surgery, or an endoscopic anti reflux procedure, for selected people after assessment by a surgeon or gastroenterologist

Which of these fits depends on your own history, what the endoscopy showed and the other medicines you take. These are decisions for you and your own clinician, and nothing on this page is a recommendation about any of them.

When to talk to a doctor

• Difficulty swallowing, food sticking, or pain on swallowing that is new or getting worse
• Vomiting blood, or bowel movements that are black and tarry, which can signal bleeding
• Unintended weight loss, ongoing vomiting, or new symptoms starting after age 50, all of which warrant prompt assessment and usually an endoscopy

Why clinical research matters for erosive esophagitis

A sizeable group of people keep having symptoms, or keep having erosions at endoscopy, while already taking standard acid suppressing medicine, and there is no agreement on how that group should be managed. Studies in Canada and elsewhere are testing potassium competitive acid blockers, longer acting acid suppression, endoscopic and surgical anti reflux techniques, and better ways to work out who benefits from Barrett’s esophagus surveillance. Researchers are also studying non acid reflux and esophageal hypersensitivity, which may help explain why symptoms and visible damage so often fail to match.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up the care you have now, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Digestive Health Foundation: GERD
• Gastrointestinal Society (Canadian Society of Intestinal Research)
• Canadian Cancer Society: esophageal cancer
• HealthLink BC