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Infectious Esophagitis Symptoms and Treatment Guidelines

What triggers esophagitis? How long do esophagitis symptoms last? Can esophagitis cause flu-like symptoms? Let’s find out about infectious esophagitis symptoms and treatment!

Infectious Esophagitis Definition

Infectious esophagitis meaning – What is infectious esophagitis? Infectious esophagitis is when a virus, bacteria, fungus, or yeast gets into the esophagus and causes an infection.

infectious esophagitis symptoms and treatment guidelines - symptoms of bacterial infection in esophagus

Infectious Esophagitis Causes

What causes infectious esophagitis? What is the most common cause of infectious esophagitis?

Most people with weakened immune systems get infectious esophagitis. Opportunistic infections are more likely to happen in people with AIDS, solid organ transplants, leukemia, lymphoma, or who are taking drugs that weaken the immune system.

People often get sick from Candida albicans, herpes simplex, and CMV. Candida infections can also happen in people with diabetes that isn’t under control or who are getting systemic corticosteroids, radiation therapy, or systemic antibiotic therapy. Herpes simplex can affect healthy people, but the infection usually goes away.

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Infectious Esophagitis Diagnosis

  • Immunosuppressed patient.
  • Odynophagia, dysphagia, and chest pain.
  • A diagnosis is made with endoscopy and a biopsy.

Infectious Esophagitis Symptoms

Signs and symptoms of infectious esophagitis: What are some symptoms of infectious esophagitis?

Most people have odynophagia and trouble swallowing. Some people have pain under the sternum. People with candidal esophagitis don’t always have any symptoms. Oral thrush is only present in 75% of people with candidal esophagitis and between 25% and 50% of people with viral esophagitis. Because of this, it is not a good way to figure out what is causing an esophageal infection.

Patients with a CMV infection in the esophagus may also have infections in other places, like the colon and retina. Herpes simplex esophagitis is often linked to oral ulcers called herpes labialis.

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Special Examinations

Treatment may be based on experience. Endoscopy with a biopsy and brushings (for microbiologic and histopathologic analysis) is the best way to ensure a diagnosis because it is so accurate. Endoscopically, candidal esophagitis shows up as yellow-white, linear plaques stuck to the mucosa.

You might have one or more large, shallow, superficial ulcers when you have CMV esophagitis. Herpes esophagitis results in multiple small, deep ulcerations.

Infectious Esophagitis Treatment and Management Guidelines

Treatment of infectious esophagitis – What is the best treatment for infectious esophagitis?

Candida Esophagitis Treatment

Esophageal candidiasis needs treatment that affects the whole body. Most of the time, an antifungal therapy trial is given without a diagnostic endoscopy.

Most people start treatment with 400 mg of fluconazole on the first day, followed by 2000 mg orally every day for 14 to 21 days. Patients who don’t respond to initial treatment within 3 to 5 days should have an endoscopy with brushings, a biopsy, and a culture to tell the difference between a resistant fungal infection and another kind of infection (e.g., CMV, herpes).

Esophageal candidiasis that doesn’t get better with fluconazole can be treated with 200 mg/day of itraconazole suspension (not capsules) or 200 mg twice daily voriconazole. In addition, caspofungin, 50 mg daily, can be given through an IV to treat infections that don’t go away.

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Cytomegalovirus Esophagitis Treatment

The best way to stop CMV disease in people with HIV is to restore their immune systems with antiretroviral therapy. The first treatment is to give 5 mg/kg of ganciclovir through an IV every 12 hours for 3–6 weeks.

Neutropenia is a frequent dose-limiting side effect. However, once the symptoms go away, it may be possible to finish the treatment with 900 mg of oral valganciclovir once a day.

Patients who don’t respond to ganciclovir or can’t handle it are given foscarnet 90 mg/kg intravenously every 12 hours for 3 to 6 weeks. The main side effects are sudden kidney damage, low calcium, and low magnesium levels.

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Herpetic Esophagitis Treatment

Immunocompetent people can be treated based on their symptoms and usually don’t need special antiviral therapy.

Patients with low immunity can be given acyclovir orally, 400 mg five times a day, or intravenously, 250 mg/m every 8 to 12 hours, usually for 14 to 21 days. Oral famciclovir, taken three times a day at a dose of 500 mg, or valacyclovir, taken twice a day at a dose of 1 g, are also effective, but they cost more than generic acyclovir. Nonresponders need to take foscarnet by IV every 8 hours for 21 days at a 40 mg/kg dose.


Most people with infectious esophagitis can be treated so that all of their symptoms go away. However, depending on the patient’s immunodeficiency, a return of symptoms after stopping treatment can cause problems. Therefore, there are times when long-term suppressive therapy is needed.

I hope you understand infectious esophagitis symptoms and treatment guidelines.

About Micel Ortega

Dr. Micel Ortega, MD, PhD, is a highly respected medical practitioner with over 15 years of experience in the field of internal medicine. As a practicing physician, Dr. Micel has built a reputation for providing compassionate and evidence-based care to his patients. He specializes in the diagnosis and management of chronic conditions, including diabetes, hypertension, and heart disease. In addition to his clinical work, Dr. Micel has published extensively in top-tier medical journals on the latest advancements in internal medicine and has played an instrumental role in the development of innovative treatment options.

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