OVERVIEW
病毒侵犯食管壁引起食管黏膜糜烂、溃疡的食管炎性疾病
主要表现为吞咽痛和/或吞咽困难，也可有胸骨后疼痛、发热等
主要为单纯疱疹病毒和巨细胞病毒感染所致
主要为抗病毒治疗
Definition of viral esophagitis
Viral esophagitis is an inflammatory disease of the esophagus in which the virus invades the esophageal wall causing erosion and ulceration of the esophageal mucosa.
It is most common in immunocompromised individuals, such as those with malignant tumors, AIDS, organ transplantation, and long-term use of glucocorticoids and immunosuppressants.
The most common are herpes esophagitis and cytomegalovirus esophagitis.
疱疹性食管炎偶见于免疫功能正常者，此时本病可有自限性。
巨细胞病毒性食管炎多在人类免疫缺陷病毒（HIV）感染基础上发生，多见于艾滋病患者。
Epidemiology
The disease is rare and no clear epidemiologic information is available.
About 40% of AIDS patients with esophageal ulcers have comorbid viral esophagitis.
Viral esophagitis occurs in about 10% of patients after liver and kidney transplantation.
Etiology
Causes
The most common pathogens are herpes simplex virus (HSV) and cytomegalovirus (CMV). Infections with varicella-zoster virus (HZV), human papillomavirus (HPV), and Epstein-Barr virus are also seen.
Risk factors
Organ transplantation.
Suffering from malignant tumors, AIDS and certain chronic diseases such as diabetes.
Long-term use of glucocorticoids, immunosuppressants.
Mechanism of occurrence
Damage to the esophageal mucosa after continuous irritation, which in turn induces an inflammatory response with congestion, edema and erosion, or even ulceration.
Symptoms
Main Symptoms
Patients usually present with dysphagia (which often worsens after swallowing food or comes on suddenly) and/or dysphagia, but may also have retrosternal foreign body sensation or retrosternal pain, fever, and occasionally esophageal bleeding.
Minor infections are mostly asymptomatic.
In herpes esophagitis, herpes may be present on both the nose and lips.
Complications
Bleeding from the upper gastrointestinal tract
Breaks in the mucosa can lead to bleeding in the esophagus with black stool or vomiting of blood.
Esophageal stricture
Repeated episodes of esophagitis cause fibrous tissue proliferation, leading to scarring and narrowing.
Seek medical attention
Conditions requiring medical attention
Patients need to seek medical attention when they experience painful swallowing, dysphagia, or retrosternal pain.
Suggested departments
Gastroenterology is recommended for patients who present with painful swallowing and dysphagia.
Cardiology or Emergency Medicine is recommended for patients with retrosternal pain.
Preparation
If there are no special circumstances, you need to register through the hospital’s official website, official app, 114 and other regular channels, prepare the social security card (medical insurance card) and other medical information, bring the previous medical information, and apply for a record for patients who have traveled to a different place for medical treatment.
Emergency department visits can be registered directly. The social security card and previous medical documents can be replenished at any time during the visit. There is no need to file a medical record for off-site visits.
What questions the doctor may ask
How long has the swallowing pain been present? Does it worsen or come on suddenly after swallowing food?
Is there dysphagia?
Do you have difficulty swallowing solid food alone, or do you have difficulty swallowing both solids and liquids?
Is there a burning sensation in the chest (heartburn)?
Is there a sensation of food or liquid reflux?
Is there chest pain?
Is there a history of coronary heart disease or angina?
Are there any chronic medical conditions such as diabetes?
What medications are currently being taken?
Questions you can ask your doctor
What disease is currently being considered for diagnosis?
What tests are required?
What causes painful swallowing?
What can be done on a daily basis to strengthen the immune system?
Is it curable?
Diagnosis
Disease Diagnosis
Medical History
Mostly seen in immunocompromised people, such as those suffering from malignant tumors, AIDS, diabetes mellitus, after organ transplantation and long-term use of glucocorticoids or immunosuppressants.
Clinical manifestations
The main manifestations are painful swallowing and/or dysphagia, but there may also be retrosternal pain and fever.
Endoscopy
疱疹性食管炎
In the early stage, the lesions appear as vesicles, and in the later stage, the lesions merge into shallow “crater-like” ulcers, which have clear borders and are usually less than 2 centimeters in size.
The lesion mainly involves the lower part of the esophagus, but may also involve the whole esophagus or even the stomach.
巨细胞病毒性食管炎
The ulcers are linear or longitudinal (usually greater than 2 centimeters) and deeper, with well-defined borders, and may be single or multiple.
The lesions are mainly located in the lower and middle esophagus.
Barium esophagogram
Multiple small volcano-shaped ulcers may suggest herpes virus infection.
Deep linear ulcers are suggestive of cytomegalovirus or human immunodeficiency virus infection.
Pathologic examination
疱疹性食管炎
Biopsies obtained from the margins of the ulcers are most likely to show characteristic features such as hairy glass nuclei, eosinophilic Cowdry type A inclusion bodies, and giant cells.
Early antigens of herpes simplex virus can be detected by immunohistochemistry.
巨细胞病毒性食管炎
Biopsy specimens obtained from the base of the ulcer are most likely to reveal enlarged endothelial cells and fibroblasts with large, dense intranuclear inclusion bodies.
Early antigens of cytomegalovirus can be detected by immunohistochemistry.
Nucleic acid testing
DNA and mRNA of herpes simplex virus and cytomegalovirus can be detected by polymerase chain reaction (PCR), which is simple, fast, sensitive, specific and quantifiable.
Virus isolation culture
Virus isolation culture is the gold standard for the diagnosis of viral infection, but it has the disadvantages of high technical requirements, easy contamination and time-consuming, so it is less used in clinical application and mainly used in scientific research.
Differential Diagnosis
Gastroesophageal reflux disease
Similarity: both of them can have pain in swallowing, dysphagia and other manifestations.
Differences: typical symptoms, prevalent population are different, and pathologic examination is helpful for differentiation.
胃食管反流病：最典型的症状为反酸和烧心，吞咽痛与吞咽困难相对少见；年龄＞40岁、肥胖、吸烟、饮酒、有食管裂孔疝者好发。
病毒性食管炎：一般不会有反酸；免疫功能低下者好发。
Fungal esophagitis
Similarity: both of them may have pain in swallowing, dysphagia and other manifestations.
Difference: The most common fungal esophagitis is Candida albicans infection, which is characterized by loose white spots covering the esophageal wall, and can be distinguished by endoscopy and pathological examination.
Treatment
The main treatment is antiviral therapy. Commonly used antiviral drugs include acyclovir and ganciclovir.
Herpes esophagitis
Normal immune function: at this time, the disease may be self-limiting and may resolve by itself in 1~2 weeks.
Immunocompromised: Acyclovir can be taken orally, which mostly takes effect within 1 week; in the presence of severe dysphagia, Acyclovir can be injected intravenously.
Cytomegalovirus esophagitis
Preferred regimen is ganciclovir IV; alternatives are phosphonate IV or valganciclovir orally.
Treatment should be continued until the lesion resolves, which takes 3 to 6 weeks.
Long-term maintenance therapy is not recommended, but one should be alert to the possibility of relapse.
Prognosis
Cure
The prognosis is generally good.
Herpes esophagitis in immunocompetent individuals is self-limiting and may not require treatment.
Cytomegalovirus esophagitis may recur in patients with AIDS.
Hazards
Complications such as upper gastrointestinal bleeding and esophageal stricture are possible if not treated promptly and effectively.
Daily
Daily life
Diet
Supplement more high-quality protein, such as eggs, lean meat, milk, soymilk, tofu, to improve the body’s immunity.
Choose a light, easy-to-digest diet with low salt and low oil.
Lifestyle Habits
Quit smoking and drinking.
Take appropriate physical exercise to improve immunity and avoid excessive exercise.
Regular work and rest, avoid staying up late, and ensure sufficient sleep time.
Prevention
HIV-infected patients should receive antiretroviral therapy (ART) as early as possible to rebuild immune function.
Avoid prolonged, high-dose use of immunosuppressants and glucocorticoids.
For diabetic patients, blood glucose should be actively controlled.
Adjust the dietary structure, balanced dietary nutrition, correct poor work and rest, and enhance the body’s immunity.
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