Introduction

Endoscopists will be well acquainted with gastro-oesophageal reflux disease (GORD) and eosinophilic oesophagitis (EoE) as the most common causes of oesophageal inflammation, each with distinctive endoscopic features and well established management strategies outlined in clinical guidelines ^1–3. Whilst this forms the majority of presentations, it is important to be mindful of other rarer causes of oesophagitis, particularly in atypical presentations, to ensure correct management.

Drawing on current literature, this article will provide an overview of rare causes of oesophagitis, outlining their clinical presentations, endoscopic and histological findings, and management approaches. Systemic inflammatory and neuromuscular conditions, such as systemic sclerosis, SLE, Sjogren’s syndrome, mixed connective tissue disease, and dermatomyositis, may predispose to secondary GORD, by degrading oesophageal smooth muscle and causing oesophageal dysmotility, but whilst they justify awareness these conditions are not within the scope of this article ^4,5.

Appreciation of rarer causes of oesophagitis will aid clinicians make timely diagnoses and implement appropriate interventions, ultimately improving patient outcomes.

With thanks to the Gastroenterology and Endoscopy department at Guys C St Thomas’ NHS Foundation Trust for use of these images.

Conclusion

Gastroenterologists must remain vigilant for rarer causes of oesophagitis that can present with similar symptoms and endoscopic appearances to GORD and EoE. These include autoimmune disorders, infections, and direct injury from ingested substances or medications. A thorough clinical history is often key to diagnosing these rare causes, providing essential clues that guide further testing and treatment. Whilst endoscopic appearances are non-specific for these conditions, any inflammation in the upper and mid oesophagus should warrant suspicion and appropriate further investigation. Prompt and accurate identification of these conditions is crucial for ensuring appropriate management.

Please see the author’s References list for this article after the below CME information.

Author Biography

Dr Joseph Cooney

Dr Cooney is a Locum Consultant Gastroenterologist at Guy’s and St Thomas’ NHS Foundation Trust. He graduated from St George’s Medical School in 2013 and completed his specialist training across several hospitals in London. He has a particular interest in therapeutic endoscopy, physiology, and oesophageal diseases, including eosinophilic oesophagitis, Barretts and motility disorders. He is completing a PhD at St George’s, University of London, on Novel Diagnostics and Therapeutics in Oesophageal Diseases. Dr Cooney serves as the trainee representative on the BSG Oesophageal Committee and is committed to both research and medical education.