Synopsis
Differentiate major causes of oesophagitis from history, endoscopy and tissue, and act urgently on caustic injury, perforation, bleeding and severe infection.
- Oesophagitis is a mucosal injury pattern; reflux, tablets, infection, caustic exposure, radiation and immune disease require different treatments.
- Heartburn and regurgitation favour reflux, while odynophagia is a stronger clue to ulceration, infection, pill injury or severe erosive inflammation.
- Pill oesophagitis follows prolonged mucosal contact, commonly after a tablet is swallowed with little water or immediately before lying down.
Key red flags
Severe odynophagia, chest pain and discrete or linear ulcers occur in profound cellular immunosuppression; HSV and CMV require correctly targeted biopsy and distinct antivirals.
Investigation priorities
Identify a plausible tablet cause and prevent recurrence.
Management branches
Pain on swallowing or acute retrosternal pain suggests mucosal ulceration.
- Assess fluid intake, bleeding, sepsis and airway or perforation signs, admitting patients who cannot maintain hydration or are systemically unwell.
- Build medicine, immune, infection, reflux and radiation timelines; stop a likely injurious tablet when safe and contact its prescriber for an alternative.
Key medicines
Omeprazole for acid-mediated injuryA common licensed adult regimen for reflux oesophagitis is 20 mg orally once daily for four weeks, extending to eight weeks or using 40 mg daily for severe disease under product guidance.
Fluconazole for oesophageal candidiasisBNF adult treatment is 200–400 mg orally or intravenously on day one, then 100–200 mg once daily for 7–21 days, with longer treatment in selected severely immunocompromised patients.