Fast Five Quiz: Esophagitis

B.S. Anand, MD

Disclosures

July 14, 2020

Infectious esophagitis is most commonly observed in immunosuppressed hosts but has also been reported in healthy adults and children. Candida esophagitis is the most common type of infectious esophagitis.

Infectious agents known to cause esophagitis include the following:

  • Candida species: Candida albicans is the most common offending pathogen, but other Candida species, such as C tropicalis, C glabrata, and C parapsilosis, have also been implicated as rare causes of esophagitis.

  • Noncandidal fungi (eg, Aspergillus, Histoplasma, Cryptococcus, Blastomyces)

  • Herpes simplex virus (HSV)

  • Cytomegalovirus (CMV)

  • Varicella-zoster virus

  • Epstein-Barr virus

  • In hosts infected with HIV: CMV, HSV, Mycobacterium avium-intracellulare, idiopathic

  • Human papillomavirus

  • Poliovirus

  • Bacterial species (eg, normal flora, Mycobacterium tuberculosis, M avium-intracellulare, Staphylococcus, Streptococcus, Lactobacillus, Nocardia)

  • Parasitic infections (eg, Chagas disease [Trypanosoma cruzi], Cryptosporidium, Pneumocystis, Leishmania donovani)

A wide range of abnormalities in host defense, such as neutropenia, impaired chemotaxis and phagocytosis, alteration in humoral immunity, and impaired T-cell lymphocyte function, may predispose an individual to opportunistic infections. Patients with systemic diseases (eg, diabetes mellitus, adrenal dysfunction, alcoholism) and elderly persons can be predisposed to infectious esophagitis because of altered immune function. Steroids, cytotoxic agents, radiation, and immune modulators can also contribute to impaired host immune function.

Common types of infectious esophagitis include the following:

  • Fungal (eg, candidal) esophagitis

  • Viral (eg, herpes) esophagitis

  • Tuberculous esophagitis

Although patients may be asymptomatic, typical symptoms of infectious esophagitis include the following:

  • Onset of difficult or painful swallowing (ie, dysphagia, odynophagia)

  • Heartburn

  • Retrosternal discomfort or pain

  • Nausea, vomiting

  • Fever, sepsis

  • Abdominal pain

  • Epigastric pain

  • Hematemesis (occasionally)

  • Anorexia, weight loss (depending on chronicity and severity of underlying illness)

  • Cough

Herpes esophagitis is most commonly seen in immunocompromised patients with AIDS, an underlying cancer, or a debilitating illness or in patients who have been treated with radiation, steroids, or chemotherapy. However, it occasionally occurs as an acute self-limiting disease in otherwise healthy patients who have no underlying immunologic problems. Patients with herpes esophagitis typically present with an acute onset of severe odynophagia. Other presenting findings include dysphagia, chest pain, and upper gastrointestinal tract bleeding.

Read more about infectious esophagitis.

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