Herpes esophagitis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's weight loss doctor NYC
Philadelphia GLP-1 weight loss and GLP-1 clinic NYC

Herpes esophagitis
File:Herpes esophagitis.JPG Herpes esophagitis
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Odynophagia, dysphagia, fever, chest pain
Complications	Esophageal perforation, stricture
Onset	Sudden
Duration	Variable
Types	N/A
Causes	Herpes simplex virus infection
Risks	Immunocompromised state, HIV/AIDS, chemotherapy, organ transplantation
Diagnosis	Endoscopy, biopsy, PCR
Differential diagnosis	Cytomegalovirus esophagitis, Candida esophagitis, gastroesophageal reflux disease
Prevention	N/A
Treatment	Antiviral drugs such as acyclovir, valacyclovir
Medication	Acyclovir, valacyclovir, famciclovir
Prognosis	N/A
Frequency	Rare in immunocompetent individuals
Deaths	N/A

Herpes esophagitis is an acute viral infection of the esophagus caused by the herpes simplex virus (HSV), most commonly HSV-1. It is characterized by painful swallowing and inflammation of the esophageal mucosa. The condition is most frequently seen in immunocompromised individuals, but it can also occur in otherwise healthy persons.

Overview

Herpes esophagitis results from infection of the esophageal mucosa by HSV, leading to the formation of ulcers and inflammation. The infection may arise from:

• Reactivation of latent HSV infection
• Primary HSV infection involving the esophagus
• Direct spread from the oropharynx

Epidemiology

• More common in patients with weakened immune systems
• Seen in individuals with:
• HIV/AIDS
• Cancer receiving chemotherapy
• Organ transplantation
• Immunosuppressive therapy
• Can occur in healthy individuals, particularly young adults

Etiology

The primary cause is infection with:

• Herpes simplex virus type 1 (HSV-1)
• Less commonly Herpes simplex virus type 2 (HSV-2)

Transmission may occur through:

• Reactivation of latent infection
• Direct contact with infected secretions

Pathophysiology

After infection, HSV replicates within epithelial cells, leading to:

• Cell destruction
• Formation of vesicles
• Ulceration of the esophageal lining

The virus may remain dormant in nerve ganglia and reactivate under conditions of stress or immunosuppression.

Signs and symptoms

Common symptoms include:

• Odynophagia (painful swallowing)
• Dysphagia (difficulty swallowing)
• Retrosternal chest pain
• Fever
• Nausea and vomiting
• Loss of appetite

Some patients may also have:

• Oral herpes simplex lesions (cold sores)
• Sore throat

Diagnosis

Diagnosis is based on clinical suspicion and confirmatory testing.

Endoscopy

Endoscopy typically shows:

• Multiple small, shallow ulcers
• "Volcano-like" lesions with raised edges
• Lesions most commonly in the distal esophagus

Biopsy

Histological examination may reveal:

• Multinucleated giant cells
• Intranuclear inclusion bodies
• Viral cytopathic effects

Laboratory tests

• Polymerase chain reaction (PCR) for HSV DNA
• Viral culture (less commonly used)

Differential diagnosis

Conditions to consider include:

• Candida esophagitis
• Cytomegalovirus esophagitis
• Reflux esophagitis
• Pill esophagitis
• Eosinophilic esophagitis

Treatment

Treatment depends on the immune status of the patient.

Antiviral therapy

First-line medications include:

• Acyclovir
• Valacyclovir
• Famciclovir

These drugs inhibit viral replication and shorten the course of illness.

Supportive care

• Adequate hydration
• Pain control
• Nutritional support

Severe cases

Hospitalization may be required for:

• Severe pain
• Inability to swallow
• Complications

Prognosis

• Generally favorable in immunocompetent individuals
• Symptoms usually resolve within 1–2 weeks
• Immunocompromised patients may have prolonged or recurrent disease

Complications

Although uncommon, complications may include:

• Esophageal ulceration
• Bleeding
• Perforation (rare)
• Secondary infections

Prevention

Preventive strategies include:

• Managing underlying immunosuppression
• Antiviral prophylaxis in high-risk patients
• Avoiding exposure to active HSV infections

See also

• Herpes simplex virus
• Esophagitis
• Candida esophagitis
• Cytomegalovirus infection
• Gastroenterology
• Infectious disease

External links

• Centers for Disease Control and Prevention – Herpes
• National Institute of Diabetes and Digestive and Kidney Diseases