ABSTRACT
The majority of esophageal infections are predominantly fungal or viral. Infectious esophagitis is caused by fungi or yeast, most commonly Candida albicans, viruses such as herpes simplex virus (HSV) or cytomegalovirus (CMV), and less commonly bacteria. Oral lesions suggest infection with Candida species, HSV, or human immunodeficiency virus (HIV), and less commonly with CMV infection and tuberculosis. Complications from viral esophagitis include hemorrhage, fistula formation, dissemination, and superinfection. CMV esophagitis may reveal multiple shallow or large elongated ulcers in the distal esophagus. Late complications include esophageal narrowing with stricture formation and necrosis. Fungal esophagitis in the presence of acquired human immunodeficiency syndrome generally carries a survival rate of approximately 1 year in untreated HIV patients. Intravenous acyclovir is used to treat HSV esophagitis. Alternatives include valacyclovir and famciclovir because of their bioavailability and clinical efficacy. Discrete stellate ulcers in the mid esophagus are typical of HSV, whereas elongated or oval large ulcers are characteristic of CMV.
