Infection of the esophagus occurs mainly in people who have impaired host defenses. The main causes are Candida albicans, herpes simplex virus infections, and cytomegalovirus infection.
There are several defense mechanisms that protect the esophagus against infection. These defenses include saliva, the normal movement (motility) of the esophagus, and the cells of the immune system. Thus, people at risk include those who have AIDS, an organ transplant, alcoholism, diabetes, malnutrition, cancer, or motility disorders. Candida infection may occur in any of these people. Herpes simplex virus infections (see Viral Infections: Herpes Simplex Virus Infections) and cytomegalovirus infection (see Viral Infections: Cytomegalovirus (CMV) Infection) occur mainly in people who have AIDS or who have had an organ transplant and are on immunosuppressant medications.
Pain with swallowing (odynophagia) is the typical symptom. Some people also notice difficulty swallowing (dysphagia).
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 mouths 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 with a camera on the end (esophagoscopy—see Diagnosis of Digestive Disorders: Endoscopy).
People with Candida are given an antifungal drug such as fluconazole. The drug is given by mouth or, if people are having trouble swallowing, 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.
Last full review/revision October 2007 by Michael C. DiMarino, MD