infectious esophagitis

Etiology

• immunosuppression
• abnormal esophageal stasis
• associated disorders
  • AIDS, HIV1 infection
  • organ transplantation
  • neutropenia
  • malignancy
  • diabetes mellitus
• pathogens
  • Candida albicans (most common cause)
  • cytomegalovirus (CMV)
  • Herpes Simplex Virus (HSV)

Epidemiology

most common cause of odynophagia

Clinical manifestations

• odynophagia (most common presenting symptom)
• dysphagia
• oral lesions
  • thrush
  • herpetic vesicles
  • absence of oral lesions does not rule out infectious esophagitis
• retrosternal pain
• nausea
• fever (+/-)

Laboratory

• diagnosis is confirmed by esophageal biopsy showing pseudohyphae invading mucosal cells & a tissue culture that grows Candida

Diagnostic procedures

• esophageal endoscopy with brush biopsy & cytology
  • curdy white esophageal plaques suggests Candida albicans
  • small, raised, white mucosal plaque-like lesions suggests Candida
  • esophageal endoscopy images

Management

• general measures
  • viscous lidocaine (2%) swish & swallow 15 mL q3-4h PRN
  • sucralfate slurry 1 g PO QID
• Candida esophagitis
  • fluconazole 100 mg PO QD for 7 days
    • empiric trial is indicated prior to endoscopy
  • unresponsive disease
    • amphotericin B 0.3-0.5 mg/kg/day IV
• CMV esophagitis
  • ganciclovir (DHPG) 5 mg/kg IV evry 12 hours
  • valganciclovir is alternative
  • foscarnet
• HSV esophagitis
  • immunocompromised patients
    • acyclovir 5 mg/kg IV every 8 hours for 7 days
    • acyclovir 800 mg PO 5X/day for 14 days
    • famciclovir or valacyclovir are alternatives
  • immunocompetent patients:
    • disease is self limited, treatment is supportive

More general terms

• esophagitis
• gastrointestinal infection