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 of infection include those who have AIDS, an organ transplant, alcohol use disorder, diabetes, a weakened or impaired immune system, undernutrition, cancer, or movement (motility) disorders of the esophagus. Additionally, swallowed or inhaled corticosteroids may put people at increased risk of infection 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.
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).
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). During endoscopy, doctors usually remove tissue for examination under a microscope (biopsy).
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 can be given by injection into a vein.
People with herpes simplex virus infections are given antiviral drugs such as acyclovir given by mouth or by injection into a vein. People with cytomegalovirus infection are given antiviral drugs such as ganciclovir given by injection into a vein.