Summary

Acute oesophagitis is sudden inflammation of the esophagus (the tube that carries food from your mouth to your stomach), most commonly caused by stomach acid refluxing back up (gastroesophageal reflux disease, or GERD). Think of your esophagus as a pipe with a one-way valve at the bottom—when that valve doesn't work properly, stomach acid flows backward, burning and inflaming the esophagus. Other causes include infections (especially in immunocompromised patients), medications (pills getting stuck and dissolving in the esophagus), or caustic substances. This condition is very common, affecting millions of people, and is usually mild and manageable. However, severe cases can cause significant pain, difficulty swallowing, bleeding, or strictures (narrowing). The key to management is identifying the cause (reflux, infection, medications), using acid-reducing medications (PPIs) for reflux-related cases, treating infections if present, and avoiding triggers. Most cases resolve completely with treatment, but some can become chronic or cause complications.

Key Facts

• Definition: Acute inflammation of the esophageal mucosa
• Incidence: Very common (millions of cases/year), often undiagnosed
• Mortality: Very low (<0.1%) unless complications
• Peak age: All ages, but more common in adults
• Critical feature: Heartburn, difficulty/painful swallowing
• Key investigation: Clinical diagnosis (usually), endoscopy if severe or not responding
• First-line treatment: PPI (omeprazole), lifestyle modifications, treat cause

Clinical Pearls

"Reflux is the most common cause" — Gastroesophageal reflux (GERD) is the most common cause of oesophagitis. Acid from the stomach burns the esophagus, causing inflammation.

"Pills can cause oesophagitis" — Medications (especially bisphosphonates, NSAIDs, antibiotics) can get stuck in the esophagus and cause inflammation. Always take pills with plenty of water, stay upright.

"Infections are rare but important" — In immunocompromised patients (HIV, chemotherapy), infections (Candida, CMV, HSV) can cause oesophagitis. Always consider in high-risk patients.

"Most oesophagitis responds to PPI" — Proton pump inhibitors (like omeprazole) are very effective for reflux-related oesophagitis. If not responding, think of other causes.

Why This Matters Clinically

Acute oesophagitis is very common and usually mild, but can cause significant symptoms and sometimes serious complications (strictures, bleeding, Barrett's esophagus). Early recognition and treatment (PPI, lifestyle modifications) can provide rapid relief and prevent complications. Most cases resolve completely, but some can become chronic or progress to complications if not treated. This is a condition that primary care clinicians see frequently and can manage effectively.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent (unless food impaction)
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal
• Feel: Pulse (usually normal), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if severe

D - Disability

• Assessment: Usually normal
• Action: Assess if severe

E - Exposure

• Look: General examination
• Feel: Usually normal
• Action: Complete examination

Specific Examination Findings

Examination:

• Usually normal: No specific signs of oesophagitis
• May have: Signs of underlying cause

Signs of Complications (If Severe):

• Weight loss: If dysphagia severe
• Dehydration: If unable to swallow

Special Tests

Natural History (Without Treatment)

Untreated Acute Oesophagitis:

• Most cases: May resolve or become chronic
• Some cases: Progress to complications (strictures, Barrett's)

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Lifestyle modifications: Help recovery
• Cause addressed: Complete recovery
• Mild cases: Usually resolve completely

Poor Prognosis:

• Cause not addressed: May become chronic
• Severe cases: May progress to complications
• Chronic oesophagitis: Higher risk of complications

Prognostic Factors

Key Guidelines

1. NICE Guidelines (2014) — Dyspepsia and gastro-oesophageal reflux disease. National Institute for Health and Care Excellence

Key Recommendations:

• Clinical diagnosis for mild cases
• PPI for treatment
• Lifestyle modifications
• Evidence Level: 1A

2. ACG Guidelines (2013) — GERD management. American College of Gastroenterology

Key Recommendations:

• PPI first-line
• Lifestyle modifications
• Endoscopy if red flags
• Evidence Level: 1A

Landmark Trials

Multiple studies on PPI efficacy and GERD management.

Evidence Strength

What is Acute Oesophagitis?

Acute oesophagitis is sudden inflammation of your esophagus (the tube that carries food from your mouth to your stomach). The most common cause is stomach acid flowing backward (reflux), which burns and inflames your esophagus. Think of your esophagus as a pipe with a valve at the bottom—when that valve doesn't work properly, acid flows backward and irritates the pipe.

In simple terms: Your esophagus becomes inflamed, usually from stomach acid flowing backward, causing heartburn and discomfort. Most cases are mild and get better quickly with treatment.

Why does it matter?

Most cases of acute oesophagitis are mild and resolve completely with treatment. However, some can become chronic or cause complications (like narrowing of the esophagus) if not treated. The good news? With proper treatment (medicines to reduce acid and lifestyle changes), most people recover completely within weeks.

Think of it like this: It's like your esophagus getting irritated and inflamed—with the right care, it usually heals quickly.

How is it treated?

1. Lifestyle Changes (Important):

• Weight loss: If you're overweight (reduces pressure on stomach)
• Diet: Avoid foods that trigger reflux (spicy, fatty, acidic foods)
• Position: Elevate the head of your bed (gravity helps)
• Timing: Don't lie down right after eating
• Stop smoking: Smoking makes it worse
• Reduce alcohol: Alcohol can make it worse

2. Acid-Reducing Medicines:

• PPI medicines: Like omeprazole, reduce stomach acid and help your esophagus heal
• Duration: Usually 4-8 weeks
• How to take: Usually once a day, before breakfast

3. Treating the Cause:

• If it's medications: Take pills with plenty of water, stay upright after taking
• If it's infection: You'll need specific medicines (antifungals or antivirals)
• If it's other causes: Treat as appropriate

The goal: Reduce acid, help your esophagus heal, and prevent it happening again.

What to expect

Recovery:

• Most cases: Start feeling better within days
• Heartburn: Usually improves within days to weeks
• Full recovery: Most people are back to normal within 2-4 weeks

After Treatment:

• Lifestyle: Continue lifestyle changes (they help prevent recurrence)
• Medications: You may need to take acid-reducing medicines for a few weeks
• Follow-up: Usually not needed unless symptoms persist

Recovery Time:

• Mild cases: Usually recover within days to weeks
• Moderate cases: Usually recover within weeks
• Severe cases: May take longer, may need more treatment

When to seek help

See your doctor if:

• You have persistent heartburn or chest pain
• You have difficulty swallowing
• You have symptoms that concern you
• Symptoms don't improve with treatment

Call 999 (or your emergency number) immediately if:

• You can't swallow (food stuck)
• You vomit blood
• You pass black, tarry stools
• You have severe chest pain
• You feel very unwell

Remember: If you have persistent heartburn or difficulty swallowing, especially if it's not getting better with over-the-counter medicines, see your doctor. Most cases are easily treated, but some can be more serious and need prompt attention.