Erosive oesophagitis is a condition where the lining of the oesophagus, the tube that carries food from your mouth to your stomach, becomes inflamed and develops erosions or small wounds. It is most commonly caused by stomach acid repeatedly washing back into the oesophagus, creating a burning, uncomfortable sensation that can significantly affect daily life.

Understanding How Common Erosive Oesophagitis Is

Erosive oesophagitis represents a significant health concern affecting people around the world. Professional estimates suggest that approximately 1% of the general population suffers from this condition.^[2] This type of oesophageal inflammation occurs in roughly 30% of people who have gastroesophageal reflux disease, commonly known as GERD, which is a condition where stomach contents regularly flow backward into the oesophagus.^[3]

The condition is recognized as the most common complication of GERD, and research indicates that up to 20% of patients with GERD develop serious oesophageal complications, with erosive oesophagitis being the most frequent among them.^[7] While many people experience successful treatment, studies show that approximately 10 to 15% of patients with erosive oesophagitis have what doctors call refractory disease, meaning their condition does not improve even after eight weeks of standard medical treatment.^[7]

The demographics of this condition reveal that the mean age at diagnosis for medication-induced erosive oesophagitis is around 41.5 years, though the condition can affect people across different age groups.^[3] Understanding how widespread this condition is helps healthcare professionals recognize its importance in clinical practice and emphasizes the need for proper diagnosis and management strategies.

What Causes Erosive Oesophagitis

The primary cause of erosive oesophagitis is injury to the oesophagus from gastric acid and pepsin, a digestive enzyme. When the pH level in the oesophagus drops below 4, symptoms and tissue damage begin to occur.^[7] This happens when the contents of the stomach, which are naturally acidic and designed to break down food, escape upward into the oesophagus where they do not belong. The continuous exposure to acid wears down the protective lining of the oesophagus, causing inflammation, wounds, and significant discomfort.^[5]

The most common underlying condition leading to this acid exposure is GERD. In people with GERD, the lower oesophageal sphincter, which is a muscular valve at the bottom of the oesophagus that normally prevents stomach contents from flowing backward, becomes defective or weakened.^[7] Other factors that contribute to the development of erosive oesophagitis include the presence of a hiatal hernia, which is when part of the stomach pushes up through the diaphragm, and decreased amplitude of peristaltic contractions, the wave-like movements that push food down the oesophagus.^[7]

Besides GERD, several other causes can lead to erosive oesophagitis. Certain medications taken in pill form can directly erode the mucous lining of the oesophagus. The most commonly implicated medications include oral bisphosphonates such as alendronate, which are used to treat bone conditions, and antibiotics like tetracycline, doxycycline, and clindamycin. Other medications that have been reported to cause this type of injury include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, iron supplements (ferrous sulfate), potassium chloride, and a heart medication called mexiletine.^[3]

Infections can also cause erosive oesophagitis, though this is less common. Bacterial, viral, and fungal infections, including herpes, cytomegalovirus (CMV), HIV, Helicobacter pylori, and Candida, have all been identified as potential causes.^[3] Radiation therapy, particularly for cancers in the chest area, represents another cause. For individuals undergoing radiotherapy, radiation oesophagitis is a relatively frequent complication, with acute inflammation generally occurring in all patients receiving radiation doses of 6000 cGy given in fractions of 1000 cGy per week.^[3]

In rare cases, excessive vomiting can lead to erosive oesophagitis, as can certain autoimmune diseases where the body’s immune system mistakenly attacks its own tissues.^[3] Additionally, in some cases, duodenogastric reflux of bile, a digestive fluid produced by the liver, may contribute to oesophageal injury.^[7]

Risk Factors That Increase Your Chances

Understanding what puts you at higher risk for developing erosive oesophagitis can help with prevention and early detection. The most significant risk factor is having GERD, as this condition creates the environment for repeated acid exposure that damages the oesophageal lining.^[3] If you frequently experience heartburn or acid reflux, your risk is considerably elevated.

Certain lifestyle habits and conditions also increase risk. Being overweight or obese is a major risk factor because excessive weight increases intra-abdominal pressure, which is the pressure inside your stomach cavity. This increased pressure makes it easier for stomach contents to push back up into the oesophagus.^[5] Smoking is another significant risk factor, as it weakens the lower oesophageal sphincter and increases the likelihood of acid exposure.^[5]

Dietary choices can also contribute to risk. Regular consumption of certain foods and beverages that relax the lower oesophageal sphincter or increase stomach acid production raises your chances of developing the condition. These include alcohol, caffeinated drinks like coffee and soda, carbonated beverages, spicy foods, fatty or fried foods, chocolate, peppermint, and acidic items such as citrus fruits and tomatoes.^[5] People who eat large meals or lie down soon after eating are also at higher risk because these behaviors make it easier for stomach contents to flow backward.

Taking certain medications regularly, particularly the ones mentioned earlier like oral bisphosphonates and specific antibiotics, puts you at risk for medication-induced erosive oesophagitis.^[3] People undergoing radiation therapy for cancers in the chest area face increased risk of radiation-induced inflammation.^[3]

Those with weakened immune systems, such as people with HIV/AIDS, organ transplant recipients taking immunosuppressant medications, people with diabetes, or those undergoing chemotherapy for cancer, are at higher risk for infectious erosive oesophagitis.^[1] Additionally, individuals with food allergies, asthma, or eczema have an association with eosinophilic oesophagitis, a specific type of inflammation where certain white blood cells accumulate in the oesophagus.^[3]

Recognizing the Symptoms

The symptoms of erosive oesophagitis can range from mild discomfort to severe pain that significantly affects your quality of life. The most common symptoms are heartburn and regurgitation, with many people also experiencing chest pain behind the breastbone.^[3] This burning sensation in the chest, known as heartburn, is particularly common and usually becomes worse after eating.^[5]

Many people with erosive oesophagitis experience difficulty swallowing, medically termed dysphagia. This occurs because inflammation or narrowing of the oesophagus makes it harder for food to pass through smoothly. The condition can also cause odynophagia, which is sharp pain when eating or drinking, making mealtimes uncomfortable and sometimes leading people to avoid eating altogether.^[5]

Another troubling symptom is the sensation of food getting stuck in the throat or chest. This feeling, sometimes called globus sensation, can be frightening and may lead to food impaction, where food actually becomes lodged in the narrowed oesophagus.^[6] Acid reflux, where acidic food or liquid returns to the throat or mouth, is also frequently reported.^[5]

Additional symptoms include nausea, a feeling of fullness in the abdomen, indigestion, wheezing, and a persistent cough that doesn’t seem to be related to a respiratory infection.^[6] Some people experience dental erosion over time as stomach acid reaches the mouth. Others develop laryngitis, which is inflammation of the voice box, leading to hoarseness.^[3]

The pain associated with erosive oesophagitis may be mild to severe and can be constant or come and go throughout the day.^[1] It’s important to note that chest pain from oesophageal causes can sometimes be difficult to distinguish from chest pain related to heart problems, so any new or severe chest pain should be evaluated by a healthcare professional promptly.

In babies and young children who are too young to describe their discomfort, symptoms may present differently. Parents might notice feeding troubles, such as the child becoming easily upset during meals, arching of the back, refusing to eat, or failure to gain weight appropriately, which doctors call failure to thrive.^[4]

Preventing Erosive Oesophagitis

Prevention of erosive oesophagitis focuses largely on reducing acid reflux and avoiding substances that can damage the oesophageal lining. Making thoughtful dietary modifications represents one of the most effective preventive strategies. Avoiding foods that trigger acid reflux is crucial. This means limiting or eliminating acidic items like tomatoes, citrus fruits, and vinegar-based products; spicy foods containing chili peppers or hot sauces; high-fat foods such as fried items, fatty meats, and full-fat dairy products; caffeinated and carbonated drinks including coffee, soda, and energy drinks; and treats like chocolate and peppermint that relax the lower oesophageal sphincter.^[5]

Instead, your diet should emphasize foods that are less likely to cause problems. These include low-acidity fruits like bananas, melons, and apples; vegetables such as leafy greens, carrots, and broccoli; whole grains like oats, brown rice, and whole-grain bread; lean proteins including skinless chicken, fish, tofu, and egg whites; and low-fat milk substitutes such as almond milk, soy milk, and low-fat yogurt.^[5]

How and when you eat matters just as much as what you eat. Eating small, frequent meals rather than large ones helps reduce pressure on your stomach. Chewing food slowly and thoroughly aids in proper digestion. Perhaps most importantly, you should avoid lying down for at least 2 to 3 hours after eating, as gravity helps keep stomach contents where they belong when you’re upright.^[5]

Lifestyle modifications beyond diet also play a crucial protective role. Maintaining a healthy weight through a balanced diet combined with low-impact exercise such as walking or swimming helps reduce intra-abdominal pressure that can force stomach contents upward.^[5] If you smoke, quitting is one of the most important steps you can take, as smoking weakens the lower oesophageal sphincter. Similarly, limiting or avoiding alcohol consumption helps because alcohol stimulates the oesophagus and increases acid production.^[5]

Stress management techniques such as mindfulness, meditation, or yoga can help reduce reflux symptoms, as stress can worsen GERD.^[5] Wearing loose-fitting clothing, especially around the abdomen, prevents increased pressure that can worsen acid reflux. Belts and tight clothing should be avoided.^[5]

For nighttime protection, keeping your head elevated while sleeping makes a significant difference. Using a wedge pillow or raising the head of your bed by 6 to 8 inches helps reduce acid reflux at night when you’re lying flat for extended periods.^[5]

If you regularly take medications that can cause erosive oesophagitis, such as bisphosphonates or certain antibiotics, taking them with plenty of water and remaining upright for at least 30 minutes afterward can help prevent pill-induced damage to the oesophageal lining. Discuss with your healthcare provider whether alternative medications or formulations might be appropriate for you.

How Erosive Oesophagitis Changes Normal Body Functions

Understanding the pathophysiology of erosive oesophagitis means understanding how the condition disrupts the normal functioning of the oesophagus and digestive system. In a healthy person, food and liquid travel from the mouth to the stomach through wave-like muscular contractions of the oesophageal wall called peristalsis. At the junction where the oesophagus meets the stomach sits the lower oesophageal sphincter, a circular band of muscle that acts as a one-way valve. This valve opens to allow food to enter the stomach and then closes to prevent stomach contents from flowing backward.^[6]

In erosive oesophagitis, this system breaks down. The most frequent pathophysiological mechanism involves a defective lower oesophageal sphincter that fails to maintain adequate pressure. When this valve weakens or relaxes inappropriately, stomach acid and pepsin can escape upward into the oesophagus.^[7] The oesophageal lining, unlike the stomach lining, is not designed to withstand such acidic exposure. The stomach has specialized cells that produce protective mucus and bicarbonate to neutralize acid, but the oesophagus lacks these defenses.

When gastric acid with a pH less than 4 comes into contact with the oesophageal mucosa, the protective lining begins to break down. This leads to inflammation as the body’s immune system responds to the tissue injury. White blood cells rush to the area, releasing chemicals that cause swelling, redness, and pain. Over time, if the acid exposure continues, the inflammation progresses to actual erosions, which are areas where the surface layer of tissue has worn away.^[7]

The process of erosion represents necrosis, or death, of the oesophageal mucosa. In more advanced cases, deeper ulcerations can form, and in severe situations, hemorrhage or bleeding may occur.^[7] The damaged, inflamed tissue becomes sensitive and painful, explaining why swallowing hurts and why the burning sensation of heartburn occurs.

Several factors beyond a weak sphincter contribute to this pathological process. The presence of a hiatal hernia, where part of the stomach protrudes through the diaphragm into the chest cavity, disrupts the normal anatomical barriers that prevent reflux. Abnormal oesophageal clearance, meaning the oesophagus cannot efficiently push refluxed material back down into the stomach, allows acid to remain in contact with the oesophageal lining for longer periods. Decreased amplitude of peristaltic contractions makes this clearing mechanism even less effective.^[7]

In cases of medication-induced erosive oesophagitis, the mechanism is slightly different. Pills that dissolve in the oesophagus before reaching the stomach can directly damage the mucous lining through chemical injury. This is why taking medications with adequate water and remaining upright afterward is so important—it helps ensure pills reach the stomach rather than getting stuck partway down.

When erosive oesophagitis is caused by infections, the pathophysiology involves direct invasion and damage of the oesophageal tissue by bacteria, viruses, or fungi. In radiation-induced cases, the high-energy rays damage the cells of the oesophageal lining, leading to inflammation and tissue breakdown.

If left untreated, erosive oesophagitis can lead to serious complications that further alter normal body function. Chronic inflammation can cause scarring, where healthy tissue is replaced by fibrous scar tissue. This scarring can stiffen and narrow the oesophagus, a condition called stricture formation, which impairs the passage of food from the mouth to the stomach.^[6] Severe narrowing may lead to repeated episodes of food getting stuck, requiring emergency intervention.

The chronic acid exposure can also cause changes in the cellular structure of the oesophageal lining, potentially leading to a condition called Barrett’s oesophagus, where the normal squamous cells of the oesophagus are replaced by intestinal-type cells. Research indicates that erosive oesophagitis may evolve to Barrett’s oesophagus in 1% to 13% of cases.^[3] This condition is significant because it increases the risk of developing oesophageal cancer.

Inflamed and eroded areas are also at risk for perforation, where holes or tears develop in the oesophageal wall. Additionally, when refluxed material reaches the throat, it can cause laryngitis, inflammation of the voice box. If material is accidentally inhaled into the lungs, it can cause aspiration pneumonitis, inflammation of lung tissue.^[6] All of these pathophysiological changes underscore the importance of early diagnosis and proper management of erosive oesophagitis to prevent progression to more serious conditions.