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Infectious lesions of the esophagus
Last reviewed: 05.07.2025
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Esophageal infections occur primarily in patients with compromised immune systems. Primary agents include Candida albicans, herpes simplex virus, and cytomegalovirus. Symptoms of esophageal infections include chest pain and sore throat when swallowing. Diagnosis is made by endoscopic imaging of the process and bacteriological examination. Treatment of esophageal infections involves the administration of antifungal or antiviral drugs.
[ What causes esophageal infections?
Esophageal infections are rare in patients with normal immune defenses. Primary esophageal defenses include saliva, esophageal motility, and cellular immunity. Thus, patients with AIDS, organ transplantation, alcoholism, diabetes, malnutrition, malignancy, and motility disorders are at risk. Candidal infection may develop in any of these patients. Herpes simplex virus (HSV) and cytomegalovirus (CMV) infections are seen mainly in AIDS and transplant patients.
Symptoms of infectious lesions of the esophagus
Patients with candidal esophagitis usually complain of pain when swallowing and, less commonly, dysphagia. About 2/3 have signs of candidal stomatitis (its absence does not exclude esophageal involvement).
HSV and CMV infections are equally likely in transplant patients, but herpes infection develops early after transplant (reactivation), and cytomegalovirus infection occurs after 2-6 months. Cytomegalovirus infection is much more common in AIDS patients than herpes infection, and viral esophagitis develops mainly if the CD4+ index is < 200/cL. Severe pain when swallowing develops with any infection.
Diagnosis of infectious lesions of the esophagus
Patients with complaints of pain when swallowing and typical signs of stomatitis in candidal esophagitis can be prescribed empirical treatment, but if significant improvement does not occur after 5-7 days, endoscopic examination is necessary. Barium swallow examination is less informative.
Endoscopy with cytology or biopsy is usually necessary to verify the diagnosis of infectious esophagitis.
Treatment of infectious lesions of the esophagus
Treatment of candidal esophagitis consists of fluconazole 200 mg orally or intravenously once, then 100 mg orally or intravenously every 24 hours for 14 to 21 days. Alternative treatments for candidal esophagitis include ketoconazole and itraconazole. There is no role for topical therapy.
For herpes infection of the esophagus, acyclovir 5 mg/kg intravenously every 8 hours for 7 days or valacyclovir 1 g orally twice daily is given. For cytomegalovirus infection of the esophagus, ganciclovir 5 mg/kg intravenously every 12 hours for 14 to 21 days is given with maintenance therapy of 5 mg/kg intravenously 5 days per week in immunocompromised patients. Alternative treatments include foscarnet and cidofovir.