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Esophageal Ulcer

The esophagus is the tube that carries food, liquid, and saliva from your mouth to the stomach. An esophageal ulcer is an open sore in the lining of the esophagus. This sheet tells you more about esophageal ulcers and how they are treated.

Outline of human head and chest with head turned to side. Cross section of esophagus leading from mouth to stomach is shown.

Causes of an esophageal ulcer

Esophageal ulcers can be caused by:

  • GERD (gastroesophageal reflux disease). This is a condition that occurs when acid from the stomach flows back into the esophagus. It is the most common cause of esophageal ulcerations.

  • Infection of the esophagus. This is caused by certain types of fungus, bacteria, or viruses such as herpes simplex virus 1 (HSV-1) or cytomegalovirus (CMV).

  • Irritants that damage the esophagus. These include cigarette smoke, alcohol, and certain medications.

  • Excessive vomiting.

  • Certain types of treatments done on the esophagus. These include chemotherapy and radiation.

Symptoms of an esophageal ulcer

Esophageal ulcer symptoms can include:

  • Pain when swallowing or trouble swallowing

  • Heartburn (pain behind the breastbone)

  • Nausea and vomiting  

  • Chest pain

Diagnosing an esophageal ulcer

Your doctor will ask about your symptoms and health history. You will also be examined. Tests will be done to confirm the problem as well. These can include:

  • Upper endoscopy. This is done to see inside the esophagus. This allows the doctor to check for ulcers. During the test, an endoscope (“scope”) is used. This is a thin, flexible tube with a tiny camera and light on the end. The scope is placed through the mouth. It is then guided down the esophagus. Small brushes may be passed through the scope to loosen cells from the lining of the esophagus (brushing). Other tools may also be passed through the scope to remove tiny tissue samples (biopsy). These samples are then sent to a lab for study.

  • Barium swallow. This is done to take X-rays of your esophagus. This helps the doctor check for ulcers. For this test, you’ll drink a chalky liquid that contains a substance called barium. The barium coats your esophagus so that it will show up clearly on X-rays.

  • Blood tests. These check for infection, such as HSV-1 and CMV in the esophagus. For a blood test, a small sample of your blood is taken and sent to a lab.

Treating an esophageal ulcer

Treatment focuses on giving the ulcer time to heal, relieving symptoms, and preventing further damage. Treatment may include:

  • Medications to reduce the amount of acid your stomach makes.

  • Medications to treat infection.

  • Quitting smoking and not drinking alcohol.

  • Avoiding irritating medications, such as aspirin, ibuprofen, potassium, tetracyclines, quinidine, iron, and alendronate.

Recovery and follow-up

With treatment, an esophageal ulcer takes several weeks or longer to heal. A follow-up endoscopy may be done to check the ulcer’s healing. Let your doctor know if your symptoms do not improve or if they come back again. If you have GERD, work with your doctor to manage it. You can take steps to help keep your esophagus healthy and prevent future problems.

When to call the doctor

Call your doctor right away if you have any of the following:

  • Fever of 100.4°F (38.0°C) or higher

  • Continued pain or trouble swallowing

  • Coughing up of blood

  • Frequent nausea or vomiting that looks like bloody coffee grounds

  • Dark, tarry, or bloody stools



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