Infectious lesions of the esophagus
Last reviewed: 23.04.2024
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Infectious lesions of the esophagus are observed mainly in patients with reduced immune defense. Primary agents include Candida albicans, herpes simplex virus and cytomegalovirus. Symptoms of infection of the esophagus - chest pain and sore throat when swallowing. The diagnosis is established with endoscopic visualization of the process and bacteriological examination. Treatment of infection of the esophagus consists in the appointment of antifungal or antiviral drugs.
[What causes infection of the esophagus?
Infectious lesions of the esophagus rarely occur in patients with normal immune defense. Primary protection of the esophagus includes saliva, esophageal motility and cellular immunity. Thus, the risk group includes patients with AIDS, organ transplantation, alcoholism, diabetes, malnutrition, malignancy and motor disorders. Candidiasis can develop in any of these patients. Infections of the herpes simplex virus (HSV) and cytomegalovirus (CMV) are observed mainly in AIDS and in patients after transplantation.
Symptoms of infection of the esophagus
Patients with candidal esophagitis usually complain of pain when swallowing and, more rarely, dysphagia. About 2/3 have signs of candidal stomatitis (its absence does not exclude the defeat of the esophagus).
HSV and CMV infections are equally likely in patients after transplantation, but herpetic infection develops early after transplantation (reactivation), and cytomegalovirus infection occurs after 2-6 months. For patients with AIDS, cytomegalovirus infection is much more common than a herpetic infection, and viral esophagitis develops mainly if the CD4 + index is <200 / cI. Strong pain during swallowing develops with any infection.
Diagnosis of infections of the esophagus
Patients with complaints of pain when swallowing and the typical signs of stomatitis in candidal esophagitis can be assigned empirical treatment, but if significant improvement after 5-7 days does not occur, an endoscopic examination is necessary. The study with a sip of barium is less informative.
Endoscopy with cytology or biopsy is usually necessary to verify the diagnosis of "infectious esophagitis".
Treatment of esophageal infectious lesions
Treatment of candidal esophagitis consists in the administration of fluconazole 200 mg orally or intravenously once, then 100 mg orally or intravenously every 24 hours for 14-21 days. Alternative treatment of candidal esophagitis includes ketoconazole and intraconazole. Local therapy plays no role.
When herpetic infection of the esophagus is prescribed intravenously, aciclovir 5 mg / kg every 8 hours for 7 days or valaciclovir 1 g orally 2 times a day. In cytomegalovirus infection of the esophagus, ganciclovir is given 5 mg / kg intravenously every 12 hours for 14-21 days with maintenance therapy of 5 mg / kg intravenously 5 days a week in patients with immune impairment. Alternative treatment includes foscarnet and cidofovir.