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Infection of the Esophagus

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

Infection of the esophagus occurs mainly in people who have impaired defense mechanisms that protect the esophagus from infection. The main causes of infection are Candida albicans, herpes simplex virus, and cytomegalovirus.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.

There are several defense mechanisms that protect the esophagus against infection. These defenses include saliva, the normal movement (contractions) of the esophagus, and the cells of the immune system. Thus, people at risk for infection include those who have AIDS, an organ transplant, alcoholism, diabetes, a weakened or impaired immune system, undernutrition, cancer, or movement (motility) disorders of the esophagus. Candida infection may occur in any of these people. Herpes simplex virus infections and cytomegalovirus infection occur mainly in people who have AIDS or who have had an organ transplant and are taking drugs that suppress the immune system.

Did You Know...

  • Saliva helps protect the esophagus from infection.

Pain with swallowing (odynophagia) is the typical symptom. Some people also notice difficulty swallowing (dysphagia). These infections also cause ulcers (sores) and irritation and swelling of the esophagus (esophagitis).

Diagnosis

  • Endoscopy

Sometimes, the doctor can see signs of Candida infection in the mouth (thrush) in people who have Candida infection of the esophagus. Usually there are no abnormalities in the mouth of people with herpes simplex virus infections or cytomegalovirus infection.

To diagnose an infection of the esophagus, usually the doctor looks down the esophagus using a flexible viewing tube (endoscopy).

Treatment

  • For Candida infection, antifungal drugs

  • For herpes simplex virus infections or cytomegalovirus, antiviral drugs

People with Candida are given an antifungal drug such as fluconazole. The drug is given as a pill or, if people are having trouble swallowing, it is given as a liquid. Rarely, it can be given by injection into a vein.

People with herpes simplex virus infections or cytomegalovirus infection are given antiviral drugs such as acyclovir or ganciclovir by injection into a vein.

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