Oesophagitis is inflammation and damage to the inner surface of the oesophagus. At endoscopy there may be redness, superficial damage or erosions.
The most common cause is gastro-oesophageal reflux — stomach contents flowing back into the oesophagus.
Oesophagitis is not cancer. But the cause and the severity of the oesophagitis matter. Severe or recurring oesophagitis in particular should be treated appropriately.
What causes oesophagitis?
The most common cause is acid reflux. Beyond that, oesophagitis can also be caused by:
- Hiatal hernia
- Some medicines becoming lodged in the oesophagus
- Eosinophilic oesophagitis
- Some infections
- Radiotherapy or chemical damage
So not every oesophagitis is due to reflux.
What symptoms can it cause?
Oesophagitis can cause heartburn, a bitter or sour taste coming into the mouth, pain or burning behind the breastbone, pain on swallowing and difficulty swallowing.
But some patients have no obvious symptoms despite oesophagitis being found at endoscopy.
What do LA Grade A, B, C and D mean?
The severity of erosive oesophagitis due to reflux is often described at endoscopy by the Los Angeles (LA) classification:
- Grade A Small, limited mucosal damage.
- Grade B Longer, but still limited mucosal damage.
- Grade C More widespread damage, involving less than 75% of the circumference of the oesophagus.
- Grade D Severe damage involving at least 75% of the circumference of the oesophagus.
From A to D the endoscopic severity of the oesophagitis increases.
These grades are not cancer stages. “LA Grade C oesophagitis”, for instance, does not mean stage three cancer; it describes the endoscopic severity of reflux oesophagitis.
Is oesophagitis cancer?
No. Oesophagitis is not cancer of the oesophagus.
Long-standing reflux can be associated with the development of Barrett’s oesophagus in some people. Barrett’s oesophagus is not cancer either; it is a different condition that may need follow-up in certain patients.
So there is no inevitable sequence of reflux → oesophagitis → certain cancer.
Is a biopsy needed?
Not every reflux oesophagitis needs a biopsy. Where the endoscopic appearance is typical, the diagnosis can usually be made from the image.
But a biopsy may be taken where Barrett’s oesophagus is suspected, where eosinophilic oesophagitis is suspected, where an infection is suspected, or where there is a suspicious or unusual lesion.
A biopsy being taken does not mean there is cancer.
How is it treated?
Treatment varies with the cause of the oesophagitis. For reflux oesophagitis it generally involves:
- Acid-suppressing treatment such as a proton pump inhibitor (PPI)
- Losing weight where there is excess weight
- Avoiding eating close to bedtime
- Adjusting the personal factors that increase reflux
In more severe oesophagitis the length and dose of treatment are planned individually.
Does oesophagitis heal?
Most reflux oesophagitis can heal with appropriate treatment. Healing rates are high in mild oesophagitis in particular.
But severe oesophagitis can come back where reflux continues or treatment is stopped.
Is a follow-up endoscopy needed?
Not in every patient with oesophagitis. In mild LA Grade A or B oesophagitis a routine follow-up endoscopy may not be needed in most patients.
By contrast, in severe oesophagitis such as LA Grade C or D, a follow-up endoscopy may be needed after treatment to assess healing and to look for Barrett’s oesophagus that may not have been visible beneath the severe inflammation at the outset.
What complications can oesophagitis lead to?
Rarely, in long-standing or severe oesophagitis:
- Narrowing of the oesophagus Can cause difficulty swallowing.
- Bleeding Can develop with severe mucosal damage.
- Recurring oesophagitis Can reappear when treatment is stopped.
- Barrett's oesophagus Can develop in some patients in association with long-standing reflux.
When should assessment not be delayed?
Assessment should not be delayed in someone with oesophagitis if there is
New or increasing difficulty swallowing · marked pain on swallowing · food sticking · vomiting blood · black, tarry stools · unexplained anaemia · unintended weight loss · persistent vomiting.
Remember
- The most common cause of oesophagitis Is gastro-oesophageal reflux.
- Oesophagitis Is not cancer.
- A–B–C–D Are not cancer stages but grades of severity of reflux oesophagitis.
- Not every oesophagitis Needs a biopsy.
- Most reflux oesophagitis Can heal with appropriate treatment.
- Grade C–D May need a follow-up endoscopy after treatment.
This is not enough to make a diagnosis
When oesophagitis is found at endoscopy, its cause and grade, the patient’s symptoms and accompanying findings such as a hiatal hernia or Barrett’s oesophagus all have to be weighed together.
Sources
- Prof. Ali Tüzün İnce, MD