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Esophagitis - infectious

Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus -- the tube that leads from the back of the mouth to the stomach.

Infection in the esophagus may be due to:

  • Fungi or yeast (most often Candida)
  • Viruses, such as herpes or cytomegalovirus

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:

  • 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
  • Oral thrush (with candida)
  • Sores in the mouth or back of the throat (with herpes or cytomegalovirus)

Exams and Tests

  • Blood and urine tests for cytomegalovirus (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), caspofungin (given by injection), 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 can be 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.

Updated: 9/1/2013

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, Bethanne Black, and the A.D.A.M. Editorial team.


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