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Infectious Esophagitis

Esophagitis is swelling and irritation of your esophagus, the swallowing tube that connects the back of your throat to your stomach. The most common cause of this condition is stomach acid that flows back into your esophagus.

But infections can also cause this swelling and irritation. Fungi, yeast, viruses, and bacteria can all trigger the condition, called infectious esophagitis. Anyone can get it, but you are more likely to develop it if your immune system is weakened.

Symptoms

These are symptoms of infectious esophagitis:

  • Pain when swallowing

  • Difficulty swallowing

  • Mouth pain

  • Chest pain

  • Nausea or vomiting

  • Chills or fever

Who's at risk

People with a normal immune system are unlikely to get infectious esophagitis. If you have a medical condition or are undergoing treatment that weakens your immune system, you could be at risk. These conditions put you at risk:

  • HIV/AIDS

  • Cancer treatments, including chemotherapy and radiation treatments

  • Diabetes

  • Bone marrow or stem-cell transplant treatment

  • Drugs that depress the immune system, such as steroids or drugs taken after an organ transplant

  • Long-term antibiotic use

  • Drugs that limit how much stomach acid you produce

  • Alcohol abuse

Advanced age can also make you more likely to get it.

Diagnosis

Your doctor may suspect infectious esophagitis if you have symptoms of esophagitis along with a condition that weakens the immune system.

To make a diagnosis, your doctor may order certain tests:

  •  Endoscopy. During this outpatient procedure, your doctor passes a thin, flexible scope through your mouth to examine your esophagus. Your doctor might take swabs and scrapings to find the cause of an infection if he or she sees signs such as white patches, fluid filled blisters, or sore in your esophagus.

  • Blood work. Your health provider may test your blood for viruses that can cause infectious esophagitis, such as herpes simplex virus.

Treatment

If you have a healthy immune system, your infection may clear on its own without treatment. How infectious esophagitis is treated often depends on the cause:

  • Esophagitis caused by a fungus called Candida may be treated with an antifungal drug called fluconazole. If this drug doesn’t work, your doctor may try a stronger drug called amphotericin B.

  • Viral esophagitis may be treated with antiviral drugs such as acyclovir.

  • Bacterial esophagitis may be treated with broad-spectrum antibiotics. These are drugs that work against many types of bacteria.

Complications

Complications are unusual unless you have a condition or disease that weakens your immune system. Complications may include:

  • Infection that spreads to other parts of your body

  • Scar tissue that forms in the esophagus and causes a narrowing, or stricture

  • Ulcers in the esophagus that lead to bleeding

  • A hole in the esophagus called a perforation or fistula

 When to call the doctor

Call your doctor if you have any questions about your medications or any other aspect of your treatment. Let your doctor know right away if you have:

  • Increased difficulty swallowing

  • Symptoms of infection, such as chills or fever

  • Chest pain or difficulty breathing

Managing infectious esophagitis

While you are recovering from infectious esophagitis, work closely with your health provider and keep all your follow-up appointments.

If you have ongoing symptoms of painful or difficult swallowing, your doctor may suggest that you take these steps:

  • Stop smoking.

  • Avoid alcohol and caffeine.

  • Avoid over-the-counter medicines that may irritate your esophagus, such as aspirin or ibuprofen.

  • Avoid foods or beverages that give you heartburn.

  • Lose weight if you are overweight.

  • Eat more frequent, smaller meals.

  • Avoid eating for three hours before you go to bed.

  • Avoid sleeping in a flat position by elevating the head of your bed several inches.