Symptoms of Esophagitis
The typical symptoms of esophagitis are dysphagia (difficulty swallowing), odynophagia (painful swallowing), chest pain, and heartburn, with the specific symptom pattern varying by the underlying etiology and patient age 1.
Core Symptom Patterns by Etiology
Infectious Esophagitis
The most common infectious causes—Candida, HSV, and CMV—typically present with:
- Dysphagia and odynophagia as the predominant complaints 1
- These symptoms occur in both immunosuppressed and immunocompetent patients, though more frequently in the former
Candida esophagitis specifically manifests with dysphagia or odynophagia and is the most commonly encountered infectious esophagitis 1.
Eosinophilic Esophagitis (EoE)
The symptom presentation is strongly age-dependent 2:
In adults and adolescents:
- Dysphagia (most common)
- Food impaction (often requiring urgent endoscopic intervention) 3, 4
- Chest pain
- Heartburn (can mimic GERD) 5
In infants and young children:
Reflux Esophagitis (GERD)
- Heartburn (primary symptom)
- Acid regurgitation 7
- Non-cardiac chest pain
- Extra-esophageal symptoms: chronic cough, dysphonia, sore throat, globus sensation 8
Important Clinical Pitfalls
Do not dismiss atypical presentations: Throat clearing, choking, gagging, and hoarseness can be presenting symptoms of EoE, often leading patients to seek otolaryngology or pulmonary evaluation first 6. Maintain a low threshold for considering esophagitis even without frank gastrointestinal symptoms.
Heartburn is not specific to GERD: EoE patients may experience heartburn, so always consider EoE in cases of heartburn refractory to PPI therapy 2. Up to 50% of patients with presumed GERD do not respond adequately to empirical PPI therapy, suggesting alternative diagnoses 8.
Recognize the progressive nature: In EoE, the prevalence of strictures significantly increases with disease duration, emphasizing the importance of early symptom recognition 2. Untreated transmural inflammation leads to esophageal wall remodeling and reduced compliance 1.
Associated Features to Query
When evaluating for esophagitis, specifically ask about:
- Atopic history: Asthma, allergic rhinitis, eczema are prevalent in EoE patients 2, 3
- Risk factors for infectious causes: Recent antibiotics, steroid use, immunosuppression, malignancy, PPI use, diabetes, chronic kidney disease, alcohol use 1
- Systemic disease: Systemic sclerosis, mixed connective tissue disease, SLE, Sjögren's disease, Crohn's disease, lichen planus can all cause esophageal symptoms 1
The key to accurate diagnosis is recognizing that esophageal dysfunction symptoms—particularly dysphagia, odynophagia, chest pain, and heartburn—require a high index of suspicion for varied etiologies, as these symptoms are not pathognomonic for any single cause 1.