Reflux esophagitis

by Jason Wasserman MD PhD FRCPC
July 26, 2025

Reflux esophagitis, also known as gastroesophageal reflux disease (GERD), is a common condition that occurs when acid from the stomach flows backward (refluxes) into the esophagus. This acid irritates the inner lining of the esophagus, causing inflammation and tissue damage. Over time, this can lead to symptoms that affect eating, swallowing, and overall comfort.

What are the symptoms of reflux esophagitis?

Many people with reflux esophagitis experience symptoms that can range from mild to severe. Common symptoms include:

  • A burning sensation in the chest or throat (heartburn).

  • Chest pain.

  • Difficulty swallowing, especially solid foods.

  • A sensation of food getting stuck in the throat or chest.

  • Sore throat or hoarseness.

  • Symptoms may be worse after eating, especially large meals, or when lying down or bending over.

Some people may not experience noticeable symptoms, especially in the early stages.

What causes reflux esophagitis?

Reflux esophagitis is caused by the backflow of stomach acid into the esophagus. The esophagus is not designed to handle this acid, so repeated exposure leads to irritation and inflammation. This backward flow is often related to problems with the lower esophageal sphincter (LES), a muscle that normally keeps stomach contents from entering the esophagus.

Several factors increase the risk of reflux esophagitis:

  • Certain foods and drinks, including spicy or fatty foods, chocolate, coffee, and alcohol.

  • Smoking.

  • Obesity, especially abdominal obesity.

  • Pregnancy, due to pressure on the stomach from the growing uterus.

  • Medical conditions, such as diabetes, hypothyroidism, or autoimmune diseases.

  • Medications, including some used for blood pressure, asthma, and anxiety.

Making lifestyle changes, such as avoiding trigger foods, losing weight, or elevating the head of the bed, can often help reduce symptoms.

How is reflux esophagitis diagnosed?

Reflux esophagitis is often suspected based on symptoms, but a definitive diagnosis is usually made by examining the inside of the esophagus using a test called an upper endoscopy. During this procedure, a thin, flexible tube with a camera is passed through the mouth into the esophagus. If abnormal areas are seen, small samples of tissue called biopsies may be taken and sent to a pathologist for examination under a microscope.

What does reflux esophagitis look like under the microscope?

The inner lining of the esophagus is normally covered by squamous cells, which form a protective layer called the epithelium. In reflux esophagitis, this layer becomes inflamed and damaged.

When viewed under a microscope, a tissue sample from someone with reflux esophagitis may show:

  • Increased numbers of immune cells, such as neutrophils, eosinophils, and plasma cells, in the epithelium.

  • Basal cell hyperplasia, which means more basal cells are seen at the bottom of the epithelium than usual.

  • Dilated blood vessels in the connective tissue beneath the epithelium.

  • In more severe cases, the squamous epithelium may be eroded or completely lost. This is called an erosion, and when this change is seen, some pathology reports use the term erosive esophagitis.

What can happen if reflux esophagitis is not treated?

If left untreated, ongoing acid reflux can cause chronic injury to the esophagus. Over time, the repeated damage may cause the squamous cells that normally line the esophagus to be replaced by intestinal-type glandular cells that are more resistant to acid. This process is called intestinal metaplasia.

When intestinal metaplasia occurs in the esophagus, the condition is called Barrett esophagus. Although Barrett esophagus is not cancer, it is considered a precancerous condition because it increases the risk of developing esophageal adenocarcinoma, a type of esophageal cancer.

Regular monitoring with endoscopy and biopsies is important for people with Barrett esophagus to detect any further changes early, especially dysplasia, which is a more advanced precancerous change.

Questions to ask your doctor

  • What lifestyle changes or treatments can help reduce my symptoms?

  • Do I need an endoscopy or biopsy to check for complications like Barrett esophagus?

  • Are there signs of inflammation or erosion in my biopsy report?

  • How often should I follow up for monitoring?

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