Esophagitis

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Causes and Risk Factors

The most common cause for esophagitis is gastroesophageal reflux disease (GERD), also sometimes called acid reflux disorder or chronic heartburn. In GERD, stomach acid and bile (digestive fluid secreted by the liver) flow back up, or reflux, into the lower part of the esophagus, causing inflammation.

In a condition called Barrett's esophagus, chronic acid reflux causes abnormal changes in the cells (metaplasia) that line the esophagus, resulting in esophageal ulcers (sores or lesions). Barrett's esophagus can lead to esophagitis and can increase the risk for esophageal cancer.

Infectious esophagitis is caused by a viral, bacterial, fungal, or parasitic infection. People who have a weakened immune system (i.e., immunosuppressed patients), such as patients who have cancer (e.g., leukemia, lymphoma) or HIV/AIDS, are at increased risk for developing this condition. In patients who have a severely suppressed immune system (e.g., patients with AIDS who have CD4+ cell counts below 200), more than one microorganism (e.g., virus, bacterium) may contribute to infectious esophagitis.

The most common cause for infectious esophagitis is Candida albicans. Candida is a type of fungus that is normally present in the mouth, throat, digestive tract, vagina, and on the skin. Candida is a common cause for thrush (oral and throat infection characterized by white patches and sores) and yeast infections (e.g., vaginal yeast infection). It can cause widespread (systemic) infections and esophagitis in patients who have a compromised immune system.

Microorganisms that can cause viral esophagitis include the following:

• Cytomegalovirus (CMV; common herpesvirus that often is congenital [present at birth])
• Epstein-Barr virus (EBV; common herpesvirus that can cause mononucleosis)
• Herpes simplex virus (e.g., HSV-1, HSV-2; causes herpes infection)
• Human papillomavirus (HPV; common virus that causes warts and other lesions)
• Varicella-zoster virus (VZV; herpesvirus that causes chickenpox and shingles)

Bacterial esophagitis can result from infection with Mycobacterium tuberculosis (bacteria that causes tuberculosis [TB]) or Pneumocystitis carinii (also called Pneumocystitis jiroveci), which also causes a specific type of pneumonia (lung infection called PCP).

Patients who regularly take certain oral medications (e.g., corticosteroids, antibiotics, nonsteroidal anti-inflammatory drugs [NSAIDs], chemotherapy drugs) are at increased risk for esophagitis. Medications that are administered in pill form increase the risk in bedridden patients because they can be difficult to swallow and cause irritation and inflammation in the esophageal lining.

Systemic conditions (i.e., disorders that can affect the entire body), such as lupus (systemic lupus erythematosus), scleroderma, sarcoidosis, and inflammatory bowel disease (IBD) can increase the risk for esophagitis. Radiation therapy (using high energy x-rays to destroy cancer cells); trauma; or surgery to the head, neck, or chest area also can increase the risk.

Hiatal hernia (protrusion of the upper part of the stomach into the lower portion of the esophagus) also can contribute to esophagitis. Other risk factors include excessive vomiting and ingesting caustic substances (e.g., household or garden chemicals).

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