Esophageal Ulcers: Causes, Symptoms, and Treatment
Key takeaways:
The cause of most esophageal ulcers is stomach acid in the esophagus, which can damage the lining of the esophagus. Other causes include certain infections and large pills that get caught in the esophagus.
Common symptoms of esophageal ulcers include burning or pain in the chest, trouble swallowing, or signs of bleeding (bloody vomit or dark and sticky stool).
Treatment usually involves acid-blocking medications and time for the ulcers to heal. But depending on the cause, other types of medications can also help.
An esophageal ulcer is an erosion that forms in the lining of your esophagus — the long tube that connects the throat to the stomach. Esophageal ulcers are much less common than other types of ulcers that affect the GI tract. In one study of people who had an endoscopy procedure, under 2% had an esophageal ulcer. But when they do occur, they can be particularly uncomfortable. We’ll discuss causes, treatment, and ways to recognize if you may have an esophageal ulcer.
What can cause an esophageal ulcer?
The most common cause of an esophageal ulcer is stomach acid going up into the esophagus. This is known as “gastroesophageal reflux disease” (GERD). The esophagus serves as a path for food to travel to the stomach after you swallow it. While the path usually goes one way, sometimes acid from the stomach can rise up into the esophagus and injure its protective lining.
Other causes of esophageal ulcers include:
NSAID use can irritate the lining of the esophagus, leading to acid injury. Long-term NSAID use leads to a higher risk of ulcers.
Pill esophagitis is when a pill gets stuck in the esophagus and breaks down the lining. This can occur if someone doesn’t drink enough liquid while taking a pill or lies down immediately after taking their medication.
Infection with certain yeast or viruses, like HIV and herpes simplex virus, can cause ulcers. The fungus Candida is usually the culprit of yeast ulcers. These types of ulcers are more common in people who have conditions that weaken their immune system.
Ingestion of strongly acidic or alkaline (caustic) substances may be accidental or intentional. These include substances like bleach, strong chemical cleaning agents, battery fluid, and others.
Esophageal cancer can cause ulcers, though this is less common.
Symptoms of an esophageal ulcer
In a study of 100 people with esophageal ulcers, some of the most common symptoms were:
Trouble swallowing or painful swallowing
Heartburn
A feeling of food stuck in the throat
Blood in the vomit or black and tarry stools (which is how blood looks in the stool after it travels through the digestive system)
Abdominal or chest pain
Esophageal ulcers can also cause bleeding over time, which can lead to low blood counts. The bleeding itself may not be very noticeable. But you might instead have symptoms of a low blood count (anemia), including:
Dizziness
Shortness of breath with activity, or at rest if the blood count is low enough
Tiredness or fatigue
Pale skin
Weakness
Diagnosis of esophageal ulcers
Healthcare providers use an endoscopy to diagnose esophageal ulcers. But not everyone with an esophageal ulcer will necessarily have an upper endoscopy. Typically providers only perform these when someone with ulcers has more serious or unexplained symptoms, like bleeding or difficulty swallowing.
But if your only symptoms are heartburn or GERD, your provider may recommend that you first try medications to treat your symptoms. Having GERD symptoms doesn’t necessarily mean that you have an esophageal ulcer. And if the symptoms aren’t serious enough to require an endoscopy, medications may be enough to take care of them and heal the underlying problem.
Treatment of esophageal ulcers
The treatment of esophageal ulcers depends on the cause. Treatment for most ulcers uses proton pump inhibitors (PPIs), an acid-blocking medication. If you are diagnosed with an esophageal ulcer on endoscopy, you may need long-term treatment with PPI medication.
If the ulcer is bleeding, a provider can treat the bleeding during an endoscopy. They can do this by injecting the area with medication or applying heat to the area to stop the bleeding. They may also recommend that you avoid taking NSAIDs, especially if those medications caused the ulcer. If the ulcer is linked to an infection, your provider can recommend medications to treat that, too.
If you have had the typical symptoms of pill esophagitis after taking a pill, the treatment usually doesn’t require an endoscopy. In such cases, where there’s a clear link, the injury usually just needs time to heal.
The bottom line
Esophageal ulcers aren’t common, but they can cause significant discomfort. Typical symptoms include trouble swallowing, heartburn, or an uncomfortable feeling that food is stuck in the throat. Your provider may recommend an endoscopy if you have bleeding or severe symptoms. Luckily, most esophageal ulcers will heal over time with the help of acid-blocking medications
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References
American Gastroenterological Association. (n.d.). Peptic ulcer disease.
Cohen, D. L., et al. (2021). Real world management of esophageal ulcers: Analysis of their presentation, etiology, and outcomes. Acta Gastro-Enterologica Belgica.
Higuchi, D., et al. (2003). Etiology, treatment, and outcome of esophageal ulcers: A 10-year experience in an urban emergency hospital. Journal of Gastrointestinal Surgery.
Kikendall, J. W., et al. (2007). Pill-induced esophagitis. Gastroenterology & Hepatology.
Society of American Gastrointestinal and Endoscopic Surgeons. (2009). Esophageal ulcers at a large urban emergency hospital: A seventeen year experience.
Tang, S. J. (2013). Endoscopic treatment of upper gastrointestinal ulcer bleeding. Video Journal and Encyclopedia of GI Endoscopy.
University of Michigan Health. (2020). GERD: Esophageal erosion and ulcers.
