Esophagitis - infectious

Causes

Infection of the esophagus is rare in people whose immune system works well.

A weakened immune system raises your risk for this type of infection, and makes it harder to treat.

Common causes include:

• HIV /AIDS
• Chemotherapy
• Diabetes
• Leukemia or lymphoma
• Organ transplants (due to drugs that suppress the immune system)
• Other conditions that suppress or weaken your immune system

Symptoms

Symptoms include:

• Difficulty swallowing and painful swallowing
• Fever and chills
• Joint pain or other general symptoms (with herpes)
• Oral thrush (with candida)
• Sores in the mouth (with herpes or cytomegalovirus)

Exams and Tests

• Blood and urine tests for cytomegalovirus (CMV)
• Cold agglutinins for CMV
• Culture of cells from the esophagus for herpes or CMV
• Mouth or throat swab culture for candida

Treatment

In most people with esophagitis, medicines can control the infection:

• Antiviral medication such as acyclovir, famciclovir, or valacyclovir can treat a herpes infection.
• Antifungal medicines such as fluconazole (taken by mouth) or amphotericin (given by injection) can treat candida infection.
• Antiviral medicines that are given through a vein (intravenously), such as ganciclovir or foscarnet can treat CMV infection. In some cases, a medicine called valganciclovir, which is taken by mouth, can be used for CMV infection.

Some people may also need pain medicine.

Many people who are treated for an episode of infectious esophagitis need other, long-term medicines to suppress the virus or fungus, and to prevent the infection from coming back.

Outlook (Prognosis)

Esophagitis can usually be treated effectively. Healthy people recover on their own in 3 - 5 days, but those with a weakened immune system take longer to get better.

The outcome depends upon the immune system problem that makes the person more likely to develop the infection.

Possible Complications

• Holes in your esophagus (perforations)
• Infection at other sites
• Recurrent infection

When to Contact a Medical Professional

Call your health care provider if you have any condition that can cause reduced immune response and you develop symptoms of infectious esophagitis.

Prevention

The herpes simplex virus is contagious by direct contact, so avoid contact with known herpes sores (lesions).

References

Graman PS. Esophagitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 94.

Update Date: 8/24/2011

Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.