Erosive Esophagitis: Symptoms, Causes & Treatment

Erosive esophagitis is a condition in which chronic acid reflux damages the lining of the esophagus, causing sores known as erosions. It may cause symptoms such as pain when swallowing or eating, hoarseness, chest pain, vomiting blood, or blood in the stool.

Erosive esophagitis is most often caused by gastroesophageal reflux disease (GERD) and is usually diagnosed with an upper endoscopy. Without treatment, severe or recurrent erosive esophagitis may increase the risk of complications such as iron-deficiency anemia and Barrett's esophagus.

Treatment for erosive esophagitis may include proton pump inhibitors, H2-receptor blockers, lifestyle changes, and, in some cases, surgery. The most appropriate treatment depends on the severity of the condition, the underlying cause, and how well symptoms respond to medication.

Main symptoms

The main symptoms of erosive esophagitis include:

• Vomiting, with or without blood

• Pain when eating or drinking

• Blood in the stool

• Sore throat

• Hoarseness

• Chest pain

• Chronic cough

If erosive esophagitis is not treated, it may also lead to iron-deficiency anemia and increase the risk of developing a tumor in the esophagus.

Confirming a diagnosis

A gastroenterologist diagnoses erosive esophagitis by reviewing the person's symptoms and medical history and performing a physical exam. The doctor may also ask about factors that make the symptoms better or worse.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, an upper endoscopy may be used to examine the lining of the esophagus and identify complications of GERD. For erosive esophagitis, this procedure also allows the doctor to assess the size and extent of the erosions and classify them using the Los Angeles Classification.

Los Angeles Classification

The Los Angeles Classification groups erosive esophagitis lesions according to their severity. This classification helps the doctor determine the most appropriate treatment.

When erosive esophagitis is classified as Grade C or D and continues to recur despite treatment, additional evaluation may be needed because chronic GERD can increase the risk of Barrett's esophagus, a condition associated with a higher risk of esophageal cancer. In these cases, anti-reflux surgery may be considered if medical treatment is not effective.

Possible causes

In most cases, erosive esophagitis develops when esophagitis is not treated. This allows lesions to continue forming and can lead to the development or worsening of symptoms.

Gastroesophageal reflux disease, or GERD, can also contribute to erosive esophagitis. GERD causes acidic stomach contents to flow back into the esophagus, irritating its lining and promoting the formation of lesions.

Erosive esophagitis may also occur more often in people who smoke or regularly eat highly processed or high-fat foods.

Treatment options

Treatments that may be recommended for erosive esophagitis include:

• Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, or lansoprazole, which reduce stomach acid production and help prevent further damage to the esophagus

• Histamine H2-receptor blockers, such as famotidine or cimetidine, which reduce stomach acid production but are generally less effective than PPIs for healing erosive esophagitis

• Prokinetic medications, such as metoclopramide, which help the stomach empty more quickly

• Surgery, which may be recommended when lesions do not improve or symptoms continue despite treatment. The procedure strengthens or reconstructs the valve between the stomach and esophagus, helping prevent stomach acid from flowing back into the esophagus and causing new lesions

According to the American College of Gastroenterology, proton pump inhibitors are recommended over H2-receptor blockers for healing erosive esophagitis and maintaining healing.

People who take anticholinergic medications, such as trihexyphenidyl, or calcium channel blockers, such as amlodipine or verapamil, may receive specific instructions from their gastroenterologist about how to use these medications safely.

Treatment for erosive esophagitis may also include follow-up with a registered dietitian. The dietitian may recommend reducing highly processed and high-fat foods and losing weight when the person is overweight or has obesity.

Treatment during pregnancy

During pregnancy, treatment should include medical follow-up, nutritional guidance, and daily lifestyle measures. A doctor may recommend an H2-receptor blocker, such as famotidine or cimetidine, after evaluating the potential benefits and risks.

Care measures

Other lifestyle changes that may help relieve symptoms and improve quality of life include:

• Raising the head of the bed by approximately 6 to 12 inches (15 to 30 cm)

• Reducing the intake of citrus fruits, caffeinated drinks, alcohol, carbonated beverages, mint, peppermint, tomatoes, and chocolate

• Avoiding lying down for at least two hours after the last meal

These measures are similar to those recommended for people with GERD because they help prevent stomach acid from flowing back into the esophagus.