Esophagitis and its causes: Who is “guilty” when acid is found “not guilty”?

Core Tip

Core tip: This manuscript analyzes the esophageal diseases whose etiology is not directly related to abnormal gastro-esophageal reflux episodes. These conditions occur less frequently than gastroesophageal reflux disease, but their diagnosis should always be considered when managing patients with unexplained upper gastrointestinal symptoms. Some of these diseases are immune-mediated inflammatory processes, either limited to the esophageal wall such as eosinophilic esophagitis or part of systemic diseases such as Crohn’s disease. Other possible etiologies include viral or fungal infections in immunocompromised patients, and corrosive agents causing direct damage to the esophageal mucosa as well as therapeutic regimen used for neoplasms. All these possibilities should be taken into consideration when Reflux esophagitis cannot be diagnosed.