The oesophagus, called in medicine from the Latin esophagus, is the part of the digestive tract that connects the mouth and throat area with the stomach. It is a kind of tube consisting of an outer layer of muscles and an inner mucosa that connects to the cavity of the tube. Through precisely coordinated contraction of the muscles, the food pulp is pushed along the mucous membrane towards the stomach.
At the transition to the stomach, as at the upper end, there is a ring-shaped sphincter muscle which ensures that stomach contents cannot return to the oesophagus. Inflammation of the oesophagus, or esophagitis as it is known, is not a rare disease in Germany. Over 1% of the population suffers from this clinical picture.
Inflammation of the oesophagus can have various causes and is usually caused by weakness of the lower sphincter muscle of the oesophagus (lower oesophageal sphincter) at the base of the reflux disease, where stomach contents are returned to the oesophagus. This is then called reflux esophagitis. An inflammation of the esophagus can also be caused by viruses or fungi.
In most cases, inflammation of the oesophagus causes a number of classic complaints which, taken as a whole, lead relatively quickly to the correct diagnostic path. Particularly in the case of reflux-induced inflammation of the esophagus, patients initially notice an unpleasant heartburn that lasts for a long time and occurs mainly after eating or lying down. In this case, heartburn is not a symptom of the inflammation itself, but an expression of the causal problem, namely a weakness of the lower sphincter muscle.
It should be noted that mild heartburn is quite normal after fatty and very voluminous meals, but it becomes a symptom when it also occurs after light meals or when it becomes permanent. A symptom that also leads to all types of inflammation of the oesophagus is pain, which is particularly indicated behind the breastbone and is of a stabbing or burning character. The pain can also be felt a little deeper in the area of the upper abdomen.
This pain can become worse in the event of inflammation of the oesophagus, especially when swallowing. In addition, swallowing difficulties with swallowing and the feeling of “getting stuck” in the throat can occur during the course of the disease. In addition to this, an increased burping or belching is observed, which can be the first signs of an inflammation of the oesophagus besides heartburn. In rare cases, patients complain of difficulty breathing. In addition, the inflammation of the esophagus causes in most cases a clearly perceptible bad breath.
An inflammation of the esophagus means nothing more than that the mucous membrane lining the esophagus is attacked and damaged by a disturbing factor. In addition to the direct damage, this causes inflammatory reactions and causes the complaints mentioned above. By far the main cause of an inflamed esophagus is reflux-induced damage to the mucous membrane.
This causes gastric acid to flow from the stomach back into the oesophagus, where it causes irritation because the mucous membrane of the oesophagus is not designed for this acidic environment. Hydrochloric acid is mainly responsible for this, which makes up a large part of the stomach secretion and directly attacks the mucous membrane. In addition, protein-splitting enzymes attack the tissue of the oesophagus.
In response, the body’s own defence cells migrate into the affected area and try to repair the damage. This, together with the destruction of cells, triggers an inflammation of the oesophagus. Normally, the lower sphincter of the oesophagus prevents a reflux of gastric juice, but there are a number of reasons why it can no longer fulfil its task, resulting in insufficiency.
A distinction is made between primary and secondary causes of a defective lower sphincter. Primary direct causes are mainly congenital or acquired malformations or malpositions of the stomach and oesophagus, whereby the stomach, and thus the lower part of the oesophagus, slides out of the abdomen a little or completely into the thorax. This disrupts the nervous supply to the sphincter.
More common are secondary causes, which lead to inflammation of the oesophagus due to sphincter insufficiency. Typically, obesity or pregnancy lead to increased pressure in the abdominal cavity, which exceeds the normal closing pressure of the sphincter and thus presses stomach acid into the oesophagus. However, systemic diseases such as diabetes mellitus, neurological diseases or previously performed operations on the affected area also potentially cause sphincter insufficiency.
In addition, it is also possible that too much gastric acid is produced as a result of a permanently incorrect diet and lifestyle, which can lead to reflux and inflammation of the oesophagus if the sphincter muscle is intact. Especially fatty foods, caffeine, alcohol and cigarette smoke promote the production of gastric juice. In contrast to reflux esophagitis, where the reflux of gastric acid is the cause, an inflammation of the esophagus can also be triggered directly by pathogens and substances acting locally.
However, these causes are much rarer. Almost exclusively in patients who have a weakened immune system, inflammation of the esophagus can be caused by fungi such as Candida albicans, which results in so-called thrush esophagitis. The oesophagus is colonized by this pathogen, which triggers the inflammation.
Well-known viruses such as the herpes virus or the rarer cytomegalovirus are also known to cause inflammation of the oesophagus. However, these pathogen-caused diseases are very rare and practically never affect healthy people. In contrast, they play a role in patients who are immunocompromised, for example because of an HIV infection or leukaemia. Finally, chemical or physical damage such as burns or burns should be mentioned as rare causes of oesophagitis.