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infectious esophagitis

Etiology: 1) immunosuppression 2) abnormal esophageal stasis 3) associated disorders a) AIDS, HIV1 infection b) organ transplantation c) neutropenia d) malignancy e) diabetes mellitus 4) pathogens a) Candida albicans (most common cause) b) cytomegalovirus (CMV) c) Herpes Simplex Virus (HSV) Epidemiology: most common cause of odynophagia Clinical manifestations: 1) odynophagia (most common presenting symptom) 2) dysphagia 3) oral lesions a) thrush b) herpetic vesicles c) absence of oral lesions does not rule out infectious esophagitis 4) retrosternal pain 5) nausea 6) fever (+/-) Special laboratory: - esophageal endoscopy with brush biopsy & cytology - curdy white esophageal plaques suggests Candida albicans - esophageal endoscopy images [3] Management: 1) general measures a) viscous lidocaine (2%) swish & swallow 15 mL q3-4h PRN b) sucralfate slurry 1 g PO QID 2) Candida esophagitis a) fluconazole 100 mg PO QD for 7 days - empiric trial is indicated prior to endoscopy [2] b) unresponsive disease - amphotericin B 0.3-0.5 mg/kg/day IV 3) CMV esophagitis a) ganciclovir (DHPG) 5 mg/kg IV evry 12 hours b) valganciclovir is alternative [2] c) foscarnet 4) HSV esophagitis a) immunocompromised patients - acyclovir 5 mg/kg IV every 8 hours for 7 days - acyclovir 800 mg PO 5X/day for 14 days - famciclovir or valacyclovir are alternatives [2] b) immunocompetent patients: - disease is self limited, treatment is supportive

General

esophagitis gastrointestinal infection

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 340-341
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Kondo T, Terada K. Images in Clinical Medicine: Candida Esophagitis. N Engl J Med 2017; 376:1574. April 20, 2017 PMID: 28423304 http://www.nejm.org/doi/full/10.1056/NEJMicm1614893