Quick answer: The most common cause of oesophagitis is acid reflux, which irritates the surface of the mucous membrane as stomach contents flow back up. With medication (proton pump inhibitors), lifestyle changes and targeted diagnostic tests – primarily gastroscopy – it can usually be managed effectively, and complications can be prevented.
A burning sensation in the chest after eating? Painful or difficult swallowing? In many cases, these symptoms are signs of oesophageal erosion. Oesophagitis is one of the most common digestive problems, yet many people put up with the symptoms for years without knowing exactly what is causing them.
This article summarises the key points to bear in mind when treating oesophageal erosion: what causes it, when and why you should see a doctor, what tests and treatments are available, and what you can do yourself to aid recovery.
What causes erosion of the oesophagus?
The mucous membrane of the oesophagus is a sensitive tissue. If it comes into regular contact with acid, irritants or infectious agents, inflammation and subsequently erosion may develop.
The most common causes are:
- Acid reflux (GERD): The reflux of stomach contents is the main cause. In such cases, stomach acid, pepsin and even bile acids irritate the lining of the oesophagus. This is most commonly caused by a temporary relaxation of the lower oesophageal sphincter.
- Medicines: Certain medicines – such as non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates and potassium supplements – can directly irritate the mucous membrane if they come into contact with it for a prolonged period.
- Infections: In cases of a weakened immune system, fungal (Candida) or viral (herpes, CMV) infections can also cause severe ulcers.
- Lifestyle factors: Smoking, alcohol consumption, obesity, stress and fatty foods all increase the risk of reflux.
- Mechanical causes: A hiatal hernia may also contribute to the reflux of stomach contents.
Who is most affected?
Reflux and oesophageal erosion can occur at any age, but are particularly common in people over the age of 50, those who are overweight, smokers, and those who regularly take painkillers or other medicines that irritate the mucous membranes.
What symptoms should you look out for?
Symptoms can vary. Some people experience clearly recognisable symptoms, whilst others experience atypical signs.
Characteristic (typical) symptoms
- Heartburn: A burning, stabbing pain in the area behind the breastbone, which may worsen after eating, when lying down, or during physical exertion.
- Acid reflux (regurgitation): A sour or bitter taste rising into the mouth.
- Increased salivation (known as ‘water brash’): A sudden, profuse flow of saliva.
Less well-known (atypical) symptoms
- Difficulty swallowing (dysphagia) – when food seems to „get stuck”
- Painful swallowing (odynophagia)
- Non-cardiac chest pain, which may also radiate to the neck or arms
- Persistent cough, hoarseness, sore throat
- Asthma symptoms
When should you seek urgent medical attention?
If you experience any of the following symptoms, consult a specialist immediately, as they may indicate a more serious condition:
- Unexplained weight loss
- Blood in the vomit or black, tarry stools
- Worsening difficulty in swallowing
- New-onset, persistent symptoms in people over 50
How is oesophageal erosion diagnosed?
Without an accurate diagnosis, treatment cannot be targeted. The doctor may recommend various tests based on the patient’s symptoms.
The role of gastroscopy in diagnosis
An oesophagoscopy is the most important diagnostic tool for treating oesophageal erosion. During the examination, the doctor can directly observe the condition of the mucous membrane: the extent of the erosions, the severity of the inflammation, and the presence of strictures. If necessary, a tissue sample (biopsy) can also be taken to rule out more serious conditions, such as Barrett’s oesophagus or a malignant process.
The severity of the erosions is determined according to the Los Angeles classification (stages A–D), where A is the mildest and D is the most severe stage.
At Endomedix Gastroenterology, the GASTROSCOPY UNDER ANAESTHESIA We use only deep anaesthesia during the procedure – to ensure the patient’s maximum comfort and safety. This means that you will be completely asleep during the examination and will not feel anything at all.
Other diagnostic tests
If an upper gastrointestinal endoscopy alone is not sufficient to make an accurate diagnosis, the following additional tests may also be considered:
- 24-hour pH monitoring: A test that measures the volume and duration of acid reflux, which confirms whether the symptoms are indeed acid-related.
- Impedance measurement: It detects not only acidic but also non-acidic reflux episodes.
- Oesophageal manometry (pressure measurement): A method suitable for examining the sphincter and motor functions of the oesophagus.
If you would like to find out the exact reasons behind your complaints, please ask for a specialist gastroenterology consultation, where our specialists draw up a personalised examination plan.
Treating oesophageal erosion: medicines and treatment options
The aim of treatment is twofold: to relieve symptoms and to promote healing of the mucous membrane. The treatment consists of medication and lifestyle changes.
Proton pump inhibitors (PPIs): first-line treatment
Proton pump inhibitors (PPIs) are the most effective medicines for treating oesophageal erosion. These drugs irreversibly inhibit the H⁺-K⁺-ATPase pump in the gastric mucosa, which is responsible for gastric acid production, thereby permanently reducing acid production.
The most commonly used PPIs and their usual daily doses:
| Active ingredient | Daily dose |
|---|---|
| Omeprazole | 20–40 mg |
| Pantoprazole | 40 mg |
| Esomeprazole | 20–40 mg |
| Lansoprazole | 30 mg |
| Rabeprazole | 20 mg |
Important: PPIs should always be taken 30–60 minutes before a meal to ensure maximum effectiveness. The duration of treatment is determined by the doctor – in typical cases of GERD, it usually lasts for 8 weeks, whilst in cases involving extra-oesophageal symptoms (e.g. cough, hoarseness), it may take up to 12 weeks for the symptoms to subside.
H2 receptor antagonists
For milder reflux symptoms, H₂ receptor blockers (e.g. famotidine) may also be used; these reduce acid production by blocking the histamine receptors on parietal cells. They are particularly effective at reducing night-time acid secretion.
Antacids and mucosal protectants
Antacids (e.g. calcium carbonate, magnesium-based preparations) provide rapid, temporary relief by neutralising stomach acid through chemical neutralisation. However, they are not recommended in cases of peptic ulcers. Sucralfate forms a physical protective barrier over the damaged mucous membrane.
Lifestyle and dietary advice to aid recovery
Medication alone is not enough. Lifestyle changes are essential for a lasting recovery and to prevent a relapse.
Things to avoid:
- Fatty, spicy and acidic foods (tomatoes, citrus fruits, chocolate)
- Fizzy drinks, coffee, alcohol
- Eating within 2–3 hours of going to bed
- Smoking – increases acid secretion and damages the mucous membrane
Things worth introducing:
- Smaller but more frequent meals to prevent the stomach from becoming distended
- Raising the head of the bed by approx. 15 cm to reduce night-time reflux
- Weight loss, if necessary – reflux can be alleviated by reducing intra-abdominal pressure
- Regular, moderate intensity exercise
What complications might arise if the erosion is left untreated?
An untreated or neglected oesophageal ulcer can lead to serious complications over time. It is important to be aware of these, as early diagnosis and treatment can prevent more serious conditions from developing.
Oesophageal stricture
Chronic inflammation leads to scarring and narrowing of the oesophagus. This causes increasing difficulty in swallowing, regurgitation and chest pain. Treatment can be carried out endoscopically: the doctor dilates the narrowed area using a balloon or a dilator (bougie). In more severe cases, it may be necessary to insert a self-expanding metal stent (SEMS).
Barrett's downpipe
This complication arises when, as a result of chronic acid exposure, the normal squamous epithelium of the oesophagus transforms into columnar epithelium (metaplasia). Barrett’s oesophagus is a precancerous condition: it increases the risk of developing oesophageal adenocarcinoma. It requires regular endoscopic monitoring and biopsy. In the event of dysplasia, endoscopic ablation (e.g. radiofrequency ablation – RFA) or endoscopic resection (EMR, ESD) is required.
Bleeding
Deeper erosions and ulcers can lead to active bleeding. This may be slow, hidden (occult) bleeding, which causes iron-deficiency anaemia, or acute bleeding, which manifests as vomiting or black, tarry stools (melaena). In the latter case, immediate medical attention is required.
Endomedix Gastroenterology: expert diagnosis and treatment
Treating oesophageal erosion is not just about medication. An accurate diagnosis, regular check-ups and a personalised treatment plan are essential – particularly if the symptoms have persisted for a long time, or if medication has not brought about sufficient improvement.
The gastroenterologists at Endomedix always carry out examinations using the most up-to-date methods and with the utmost care. For professional reasons, endoscopic examinations – whether gastroscopy or colonoscopy – are carried out exclusively under general anaesthesia, as this ensures the safest and most comfortable conditions for patients.
Select the appropriate test:
- If you have symptoms affecting the upper digestive tract (heartburn, difficulty swallowing, acid reflux): GASTROSCOPY UNDER ANAESTHESIA
- If you also have symptoms affecting the lower gastrointestinal tract, or if your bowel habits have changed: COLONOSCOPY UNDER ANAESTHESIA
- If you require an examination covering both areas: GASTRIC AND COLONOSCOPY UNDER ANAESTHESIA
- If you would like to consult a specialist for the first time: Gastroenterology consultation
Don’t wait until your symptoms get worse. Book an appointment at the Endomedix Gastroenterology Clinic and take the first step towards recovery.
Do not leave the symptoms untreated
Oesophageal erosion is a treatable condition – but only if treatment is started in good time. Persistent heartburn, recurrent acid reflux or painful swallowing should not be regarded as „normal” symptoms. These are signs worth paying attention to, as they may indicate an underlying condition that is treatable but can lead to complications.
The good news is that, with the right medication, lifestyle changes and regular check-ups with a specialist, the symptoms experienced by most patients can be permanently alleviated and complications prevented.
Frequently asked questions about oesophageal erosion
How can you tell that it’s not heartburn, but actual erosion?
Heartburn itself can be a symptom of erosion. An endoscopic examination (gastroscopy) is the only method that allows the actual condition of the mucous membrane to be seen directly and the severity of the erosions to be determined. If symptoms occur several times a week or do not subside without medication, it is advisable to consult a specialist.
How long should proton pump inhibitors be taken for?
The duration of PPI treatment depends on the severity of the symptoms, the extent of the erosion and any complications. In mild to moderate cases, 8 weeks is usually required; in more severe or recurrent cases, a longer course of treatment, or even maintenance therapy, may be warranted. The exact duration and dosage of treatment are always determined by the doctor.
Will an erosion of the oesophagus heal on its own?
In mild cases, lifestyle changes may alleviate the symptoms, but spontaneous healing of the mucosal lesions is not guaranteed. Without treatment, recurrent irritation can lead to complications – such as stricture or Barrett’s metaplasia – so medical care is essential.
Is Barrett’s oesophagus dangerous?
Barrett’s oesophagus is not a cancerous condition in itself, but is considered a precancerous condition. Through regular endoscopic monitoring and biopsy, any malignant transformation can be detected and treated at an early stage. Long-term PPI treatment reduces the risk of malignant transformation.
Do all patients with reflux need a gastroscopy?
Not necessarily. In younger patients who show no warning symptoms, the doctor may start with empirical PPI treatment. A gastroscopy is mandatory if the patient is over 50 years of age, if alarm symptoms (e.g. weight loss, blood in the stools) are present, if medication fails to bring about improvement, or if Barrett’s oesophagus is suspected.
How can I book an appointment at the Endomedix Gastroenterology Clinic?
At Endomedix Gastroenterology, you can book an appointment either online or by telephone. As a first step, it is worth a specialist gastroenterology consultation to make an appointment, where the doctor will assess your symptoms and determine which tests are required.
