How Do You Get E. Coli – And How to Prevent It

Esophageal Thrush: Risks, Symptoms, And Treatment

Traces of the fungus Candida are normally present on the surface of your skin and within your body. Normally, your immune system can regulate these good and bad organisms in your body. Sometimes, though, a shift in the balance between the Candida and your healthy bacteria can cause the yeast to overgrow and develop into an infection.

If you're healthy, it's unlikely you will develop this condition. People with compromised immune systems, such as those with HIV, AIDS, or cancer, and older adults are at a higher risk. Having AIDS is the most common underlying risk factor. According to the Centers for Disease Control and Prevention (CDC), 20 percent of all people with cancer develop the condition.

People with diabetes are also at an increased risk of developing esophageal thrush, especially if their sugar levels are not well controlled. If you have diabetes, there's often too much sugar present in your saliva. The sugar allows the yeast to thrive. More importantly, uncontrolled diabetes also hurts your immune system, which allows for candida to thrive.

Babies who are born vaginally can develop oral thrush if their mothers had a yeast infection during delivery. Infants can also develop oral thrush from breastfeeding if their mother's nipples are infected. Developing esophageal thrush this way is uncommon.

There are other risk factors that make someone more likely to develop this condition. You're more at risk if you:

smoke

wear dentures or partials

take certain medications, such as antibiotics

use a steroid inhaler for conditions like asthma

have a dry mouth

eat lots of sugary foods

have a chronic disease

The symptoms of esophageal thrush include:

It's also possible for esophageal thrush to spread to the inside of your mouth and become oral thrush. The symptoms of oral thrush include:

creamy white patches on the inside of the cheeks and on surface of the tongue

white lesions on the roof of your mouth, tonsils, and gums

cracking in the corner of your mouth

Breastfeeding moms can experience Candida infection of the nipples, which they can pass on to their babies. The symptoms include:

especially red, sensitive, cracking, or itchy nipples

stabbing pains felt deep within the breast

significant pain when nursing or pain between nursing sessions

If you experience these conditions, you should watch your baby for signs of infection. While babies can't say if they're feeling bad, they may become more fussy and irritable. They can also have the distinctive white lesions associated with thrush.

If your doctor suspects you might have esophageal thrush, they will do an endoscopic exam.

Endoscopic exam

During this exam, your doctor looks down your throat using an endoscope. This is a small, flexible tube with a tiny camera and a light at the end. This tube can also be lowered into your stomach or intestines to check the extent of the infection.

The goals of treating esophageal thrush are to kill the fungus and prevent it from spreading.

Esophageal thrush warrants systemic antifungal therapy, and anantifungal medication, such as itraconazole, will likely be prescribed. This prevents the fungus from spreading and works to eliminate it from the body. The medication can come in a variety of forms, such as tablets, lozenges, or a liquid that you can swish in your mouth like mouthwash and then swallow.

If your infection is slightly more severe, you may receive an antifungal medication called fluconazole delivered intravenously in the hospital.

People with late-stage HIV might need a stronger medication, such as amphotericin B. Most importantly, treating the HIV is important for controlling the esophageal thrush.

If your esophageal thrush has compromised your ability to eat, your doctor may discuss nutritional options with you. This can include high-protein shakes if you can tolerate them or alternative feeding options, such as a gastric tube in severe situations.

The risk for complications after the development of esophageal thrush is higher in people with comprised immune systems. These complications include thrush that spreads to other areas of the body and an inability to swallow.

If you have a compromised immune system, it's very important to seek treatment for thrush as soon as you notice symptoms. Thrush can easily spread to other parts of your body, including your:

By receiving treatment as quickly as possible, you can reduce the likelihood that thrush will spread.

Esophagitis: Causes, Symptoms, & Treatments - WebMD

Esophagitis is an inflammation of the lining of the esophagus, the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers, and scarring of the esophagus.

Esophagitis can lead to painful swallowing, acid reflux, chest pain, a feeling that something is stuck in your throat, and more. The side effects happen due to inflammation in your esophagus. (Photo Credit: Science Photo Library/Getty Images)

There are several different types of esophagitis.

Erosive or reflux esophagitis

This is one of the most common types. The contents of your stomach back up into your esophagus. A valve usually keeps these backups from happening. But it doesn't always close all the way, or it might open when it shouldn't. Because the stuff in your stomach is acidic, it can damage the lining of your esophagus. This is more likely to happen if you have this kind of backflow a lot. That's called gastroesophageal reflux disease or GERD.

Eosinophilic or autoimmune esophagitis

This type is often related to having allergies, though acid backup from your stomach can also be the culprit. Eosinophils are a kind of white blood cell, and this condition happens when too many build up in the lining of your esophagus. Among the foods that might trigger it are:

Milk

Eggs

Soy

Wheat

Peanuts

Seafood

Lymphocytic esophagitis

When you have this condition, your esophagus has too many white blood cells called lymphocytes. It might be related to eosinophilic esophagitis or to GERD.

Drug-induced esophagitis

Medicines you take for other conditions can damage your esophagus if they stay in contact with the tissue for too long. Swallowing a pill without enough water (or none at all) can cause this. Drugs that have been linked to this condition include:

Pain relievers such as aspirin, ibuprofen, and naproxen sodium

Antibiotics, including tetracycline and doxycycline

Potassium chloride

Bisphosphonates, which are used to treat brittle bones

Quinidine, which you might take for heart problems

Infectious esophagitis

This is caused by a virus, bacteria, or fungus. You're more likely to get it if your immune system isn't working well, perhaps because of cancer or HIV/AIDS. A common cause of infectious esophagitis is a fungus called Candida albicans, which we all have in our mouths. Aside from immune system problems, you can get an infection of this fungus if you're taking steroids or antibiotics or if you have diabetes. Herpes, a viral infection, can develop in the esophagus when your immune system is weak. It's treatable with antiviral drugs.

Radiation esophagitis

If you have radiation therapy for cancer, it can damage your esophagus.

Symptoms of esophagitis include:

Difficult or painful swallowing

Acid reflux

Heartburn

A feeling of something of being stuck in your throat

Chest pain

Nausea

Vomiting

If you have any of these symptoms, contact your doctor as soon as possible.

Esophagitis in children

Symptoms of this condition in babies and children can include:

Trouble feeding, such as not wanting to eat, being irritable, or arching their back when you try to feed them

Not gaining weight

In older kids, chest or belly pain

Severe esophagitis

If your condition is advanced, you might have bleeding in your esophagus.

One of the most common types of esophagitis is called erosive, or reflux, esophagitis. It happens when the contents of your stomach back up into your esophagus, irritating it.

Causes

Esophagitis is caused by irritation in your esophagus.

This can come from any of the following:

GERD

Vomiting

Surgery

Medications

Swallowing a toxic substance

Hernias

Radiation treatment for cancer

Allergies and autoimmune conditions

An infection caused by a bacteria, virus, or fungus

Risk factors

Some lifestyle choices can make esophagitis more likely, including:

Eating right before you go to sleep

Too many large meals with high-fat foods

Smoking

Heavy alcohol use

Carrying extra weight, including when you're pregnant

Some foods can also give you a higher chance of esophagitis if you eat them. These include:

Caffeine

Citrus

Spicy foods

Garlic

Onions

Chocolate

Mint

Other risk factors aren't related to your lifestyle. They can include:

Being older than 60 years

Spinal cord injury

Family history of eosinophilic esophagitis

Weak immune system caused by illness such as cancer or HIV/AIDS

Taking drugs that weaken your immune system, for instance, after an organ transplant

Surgery of your esophagus or one that uses a nasogastric tube, which goes into your nose and passes down to your stomach

Once your doctor has done a physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:

Upper endoscopy

A test in which a long, flexible lighted tube, called an endoscope, is used to view your esophagus.

Esophageal sponge

In this test, you swallow a capsule that has a string attached. In your stomach, the capsule dissolves, releasing a sponge. Your doctor pulls the sponge up by the string, and the sponge takes samples of your tissue as it comes out. The sample then is checked by a lab. This procedure lets you skip an endoscopy.

Biopsy

During this test, a small sample of the esophageal tissue is removed and then sent to a lab to be checked under a microscope.

Upper GI series (or barium swallow)

During this procedure, X-rays are taken of the esophagus after you drink a barium solution. Barium coats the lining of your esophagus and shows up white on an X-ray. This lets doctors see problems in your esophagus.

Treatment of esophagitis depends on the type you have.

Reflux esophagitis

To treat this, you might use:

Over-the-counter drugs like antacids or medications that block acid production like lansoprazole (Prevacid) and omeprazole (Prilosec)

Prescription drugs that can block acid production or help clear your stomach

Surgery to strengthen the valve that separates your stomach and esophagus

Surgery to put a ring of metal beads around the lower part of your esophagus. This fairly new process is called a LINX procedure. The beads make your esophagus stronger, so acid can't back up

Eosinophilic esophagitis

To treat this, you might take:

Prescription medicines to block acid production

Steroids like budesonide (Pulmicort) and fluticasone (Flovent) that you swallow in liquid form; you may have fewer side effects than if you take steroids as a pill

Monoclonal antibodies like dupilumab (Dupixent) work by stopping the action of inflammation-causing proteins; you get it in a weekly injection

Your doctor may also suggest an elimination diet. This is where you stop eating certain foods that tend to cause allergic reactions for a while, and then slowly add them back in. This can help you and your doctor figure out whether foods might be triggering your esophagitis.

Drug-induced esophagitis

If medicines are touching the lining of your esophagus for too long, your doctor might:

Change your medication

Give it to you in liquid form, if possible

They might also advise you to take your medicine with a full glass of water or ask that you stand or sit for at least 30 minutes after you take it.

Infectious esophagitis

You can get an infection in your esophagus when your immune system is weak. This can happen if you have cancer or HIV. To treat it, you'll take a medication to clear up your infection.

If your esophagus is very narrow or food is stuck in it, your doctor may do a procedure called esophageal dilation, which will expand your esophagus.

Some people turn to alternative treatments to ease symptoms. These aren't used in place of medical treatments but in addition to them.

They can include:

Herbal remedies like licorice, chamomile, and marshmallow

Relaxation practices like progressive muscle relaxation or guided imagery

Acupuncture

Make sure you talk with your doctor before you start any alternative treatments.

During recovery care

Once your doctor has figured out what's causing the esophagitis, you'll probably start to feel better within a few days of starting treatment. It may be weeks before your esophagus heals completely. Your doctor can prescribe pain medication if you need it.

While you're healing, you can help yourself feel better by avoiding spicy or acidic foods, drinking plenty or water, and chewing your food very well or trying a soft diet.

To avoid getting esophagitis, or to keep it from coming back, try these tips:

Avoid foods that are spicy, fatty, hard, or acidic, and keep caffeine, chocolate, and mint-flavored foods to a minimum.

Try not to eat right before bedtime.

Take small bites and chew food thoroughly.

Avoid alcohol and tobacco.

When you take medication, take it with plenty of water.

Don't take medicine lying down or right before you go to sleep.

Ask your doctor if losing weight would help your symptoms.

Avoid bending or stooping down right after you eat.

Raise one end of your bed by 6-8 inches to elevate your head. You can put blocks under your bed or put a wedge between your box springs and mattress. Simply using more pillows won't work.

It's very important that you follow your doctor's treatment plan for your esophagitis. If you do, you should get relief.

If esophagitis goes untreated, it can lead to:

An ulcer, or break, in the tissue that lines your esophagus.

Scarring of your esophagus. Your doctor might call this "stricture." It can make swallowing very difficult.

Something doctors call "esophageal perforation." That's a tear of the tissue that lines your esophagus, creating a hole. It can come from gagging when food gets stuck there or when you have an upper endoscopy. This can also make swallowing difficult and make it hard to breathe.

You may get a condition known as Barrett's esophagus. This is also called "intestinal metaplasia." When it happens, the lining of your esophagus changes to be more like the lining of your intestines. Barrett's esophagus can lead to esophageal cancer.

The signs of esophagitis are similar to those of a lot of other conditions. See your doctor if:

Your symptoms last more than a few days.

Over-the-counter antacids don't help.

It's hard for you to eat or you're losing weight.

You also have a headache, fever, or muscle aches.

Get help right away if:

Pain in your chest lasts more than a few minutes.

You have a history of heart disease and your chest hurts.

You think you have food stuck in your esophagus.

Your mouth or throat hurts when you eat.

Your chest hurts and you're short of breath right after you eat.

You throw up large amounts of food or you have trouble breathing after you throw up.

Your vomit is yellow or green, contains blood, or looks like coffee grounds.

Esophagitis: Causes, Symptoms, Treatments, And More - Los Angeles Times

Imagine swallowing food and feeling pain, like something is scraping your throat. That's what people with esophagitis experience. Esophagitis is the medical term for inflammation of the esophagus—the tube that moves food from your mouth to your stomach. This can be short-term or chronic, mild or severe and can be caused by acid reflux, infections, immune reactions, and even certain medications or chemicals [1].

Table of ContentsWhat is Esophagitis?

At its core esophagitis is inflammation—meaning the esophageal lining is irritated or damaged. Infections that weaken the immune system and allergies, especially food allergies can cause esophagitis. This can make swallowing painful, uncomfortable or difficult. Various risk factors, lifestyle choices and health conditions can contribute to esophagitis.

In some cases the inflammation can lead to ulcers, scarring or narrowing of the esophagus which can complicate eating and digestion. Symptoms of esophagitis can vary in severity from mild discomfort to severe pain. Different from something like Gastroparesis, The cause determines the type of esophagitis and getting the diagnosis right is key to choosing the right treatment [1].

Types of Esophagitis

Esophagitis isn't a one size fits all condition. There are several types, each with its own causes and characteristics. Each type has its own risk factors so certain groups are more prone to developing the condition.

For example some types of esophagitis are linked to certain medications such as NSAID pain relievers, nitrates and beta blockers which can increase the risk of developing this condition.

Also chronic vomiting medicines can cause esophagitis through irritation and inflammation of the esophagus potentially leading to serious health implications if left untreated.

1. Reflux Esophagitis

This is the most common type and is directly linked to a condition called gastroesophageal reflux disease (GERD)—a condition where stomach acid flows back into the esophagus regularly. That acid meant to break down food in the stomach can wreak havoc on the esophageal lining. The lower esophageal sphincter acts as a valve to prevent this acid reflux and its dysfunction is a common cause of GERD and reflux esophagitis.

Over time this acid exposure can cause erosions, ulcers and even strictures (narrowing due to scar tissue). Doctors use the Los Angeles (LA) classification system to grade the severity based on what they see during an upper endoscopy [5], [10].

2. Eosinophilic Esophagitis (EoE)

This is not acid related. EoE is driven by the immune system. EoE occurs when eosinophils—a type of white blood cell involved in allergic responses—build up in the esophagus often in response to allergens or food triggers [3]. Allergic reactions can cause this accumulation leading to inflammation.

It's on the rise now affecting around 1 in 700 Americans [13]. People with EoE often have trouble swallowing and food getting stuck. Trouble swallowing also known as dysphagia is a common symptom of eosinophilic esophagitis. Long term inflammation can lead to strictures and about 28% of patients develop them mostly in the distal esophagus, or the lower third near the stomach [14].

3. Lymphocytic Esophagitis

Still a bit of a mystery lymphocytic esophagitis features an excess of lymphocytes, a type of white blood cell, in the esophageal tissue without signs of acid damage or typical allergic inflammation [2].

It's more common in older women and individuals with other immune related issues. While rare this condition may overlap with disorders like celiac disease or autoimmune conditions. An autoimmune disease such as scleroderma can increase the risk of esophagitis.

4. Infectious Esophagitis

When infection is the cause Candida albicans, herpes simplex virus, and cytomegalovirus are the usual culprits [6], [7]. These are more common in immunocompromised individuals such as those undergoing chemotherapy or living with HIV but are also being seen more frequently in healthy people with a weakened immune system.

One subtype esophageal candidiasis occurs when Candida, a fungal organism that normally lives in the body, overgrows in the esophagus [15]. This often appears as white patches visible during an endoscopy. Radiation therapy infections can also cause esophagitis by causing irritation and inflammation in the esophagus.

5. Other Notable Types

Crohn's Disease-Related Esophagitis: When the chronic inflammation from Crohn's disease spreads to the esophagus.

Drug-Induced Esophagitis: Certain pills can cause localized damage especially if taken without water or while lying down. Additionally, spinal cord injury is a risk factor for developing esophagitis unrelated to an infection.

Caustic Esophagitis: Results from ingesting harmful chemicals like household cleaners.

IgG4-Related Esophagitis: A rare autoimmune version that's part of a broader condition called IgG4-related disease [1], [4]. Autoimmune esophagitis, often associated with allergies and acid reflux, is another related condition that involves the role of eosinophils.

Common Symptoms to Watch For

No matter the type esophagitis tends to show up with some common symptoms. The most common are:

Difficulty swallowing (dysphagia) or the sensation of something stuck in your throat

Pain with swallowing (odynophagia) and a sore throat feeling

Chest pain that might mimic heartburn

In more severe cases bleeding in the upper gastrointestinal tract can occur [11]

Severe esophagitis can lead to complications such as difficulty eating, risk of bleeding and narrowing of the esophagus.

Symptoms may vary depending on the cause and some people especially with infectious or drug induced esophagitis may only notice symptoms when things become severe.

How Esophagitis is Diagnosed

Diagnosing esophagitis starts with a thorough review of symptoms and medical history. A physical exam by a healthcare provider, especially a gastroenterologist, is also necessary. To confirm the diagnosis esophagitis is diagnosed through various tests and procedures including an upper endoscopy where a flexible tube with a camera is passed down the throat to examine the esophagus directly.

They may also take biopsies (small tissue samples) during the procedure especially if they suspect EoE or want to rule out infection or other immune related issues [3].

Treatment

Fortunately esophagitis is treatable—especially when the cause is identified. Treatment depends on the type:

Reflux Esophagitis: Treated with PPIs to reduce stomach acid, along with lifestyle changes like avoiding trigger foods and elevating the head during sleep. A bland diet can help manage symptoms by reducing irritation. Maintaining a healthy weight is also important to minimize esophageal irritation. Avoid spicy foods to limit acid exposure and discomfort.

Eosinophilic Esophagitis: Managed through elimination diets, topical corticosteroids (swallowed not inhaled) and allergen testing.

Infectious Esophagitis: Requires antifungal, antiviral or antibiotic medication depending on the underlying pathogen.

Drug-Induced Esophagitis: Adjusting how medications are taken (e.G. Sitting upright, drinking more water) or switching to a different drug often helps.

Caustic and IgG4-Related Esophagitis: These usually require more complex care, immunosuppressive therapy and ongoing monitoring.

Closing Thoughts

Severe esophagitis is more than just a sore throat or heartburn—it's a condition that reflects the complexity of how our body's systems interact and can result in serious complications like bleeding. From acid reflux to immune responses and infections multiple pathways can lead to the same inflamed result. Untreated esophagitis can lead to Barrett's esophagus a condition that increases the risk of esophageal cancer.

Though GERD is the most common type, the increasing awareness of EoE and other immune related types emphasizes the need for early diagnosis and accurate diagnosis. As research evolves new treatments and diagnostic tools will help patients with this uncomfortable condition.

References

[1] Grossi, L., Ciccaglione, A. F., & Marzio, L. (2017). Esophagitis and its causes: Who is "guilty" when acid is found "not guilty"?. World journal of gastroenterology, 23(17), 3011–3016. Https://doi.Org/10.3748/wjg.V23.I17.3011

[2] Pittman M. E. (2022). Lymphocytic Esophagitis: Current Understanding and Controversy. The American journal of surgical pathology, 46(1), e55–e63. Https://doi.Org/10.1097/PAS.0000000000001667

[3] Dellon, E. S., Muir, A. B., Katzka, D. A., Shah, S. C., Sauer, B. G., Aceves, S. S., Furuta, G. T., Gonsalves, N., & Hirano, I. (2025). ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. The American journal of gastroenterology, 120(1), 31–59. Https://doi.Org/10.14309/ajg.0000000000003194

[4] Lisovsky M. (2020). Inflammatory conditions of the esophagus: an update. Annals of the New York Academy of Sciences, 1481(1), 5–10. Https://doi.Org/10.1111/nyas.14450

[5] Nguyen, A. D., Spechler, S. J., Shuler, M. N., Souza, R. F., & Dunbar, K. B. (2019). Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis. Journal of clinical gastroenterology, 53(1), 9–14. Https://doi.Org/10.1097/MCG.0000000000000870

[6] Patel, N. C., & Caicedo, R. A. (2015). Esophageal infections: an update. Current opinion in pediatrics, 27(5), 642–648. Https://doi.Org/10.1097/MOP.0000000000000266

[7] Hoversten, P., Kamboj, A. K., & Katzka, D. A. (2018). Infections of the esophagus: an update on risk factors, diagnosis, and management. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 31(12), 10.1093/dote/doy094. Https://doi.Org/10.1093/dote/doy094

[8] Goff J. S. (1988). Infectious causes of esophagitis. Annual review of medicine, 39, 163–169. Https://doi.Org/10.1146/annurev.Me.39.020188.001115

[9] Reddy, C. A., McGowan, E., Yadlapati, R., & Peterson, K. (2024). AGA Clinical Practice Update on Esophageal Dysfunction Due to Disordered Immunity and Infection: Expert Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 22(12), 2378–2387. Https://doi.Org/10.1016/j.Cgh.2024.08.027

[10] Lottrup, C., Khan, A., Rangan, V., & Clarke, J. O. (2020). Esophageal physiology-an overview of esophageal disorders from a pathophysiological point of view. Annals of the New York Academy of Sciences, 1481(1), 182–197. Https://doi.Org/10.1111/nyas.14417

[11] Guntipalli, P., Chason, R., Elliott, A., & Rockey, D. C. (2014). Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome. Digestive diseases and sciences, 59(12), 2997–3003. Https://doi.Org/10.1007/s10620-014-3258-4

[12] Carmack, S. W., Vemulapalli, R., Spechler, S. J., & Genta, R. M. (2009). Esophagitis dissecans superficialis ("sloughing esophagitis"): a clinicopathologic study of 12 cases. The American journal of surgical pathology, 33(12), 1789–1794. Https://doi.Org/10.1097/PAS.0b013e3181b7ce21

[13] Thel, H. L., Anderson, C., Xue, A. Z., Jensen, E. T., & Dellon, E. S. (2025). Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 23(2), 272–280.E8. Https://doi.Org/10.1016/j.Cgh.2024.09.031

[14] Eluri, S., Tappata, M., Huang, K. Z., Koutlas, N. T., Robey, B. S., Fan, C., Reed, C. C., Shaheen, N. J., & Dellon, E. S. (2020). Distal esophagus is the most commonly involved site for strictures in patients with eosinophilic esophagitis. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 33(2), doz088. Https://doi.Org/10.1093/dote/doz088

[15] Mohamed, A. A., Lu, X. L., & Mounmin, F. A. (2019). Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Canadian journal of gastroenterology & hepatology, 2019, 3585136. Https://doi.Org/10.1155/2019/3585136

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