Viral Esophagitis

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Herpes Esophagitis (HSV-1)

Herpes esophagitis is a viral infection of the esophagus, the tube that carries food and liquids from the mouth to the stomach. The herpes simplex virus type 1 (HSV-1) causes herpes esophagitis.  This is the same virus that causes cold sores and eye infections such as conjunctivitis.  The inflammation and open sores of herpes esophagitis can cause pain and damage the throat tissues.

Herpes esophagitis is not very common in healthy people. Antibodies help the body fight off viruses and other invaders so a person doesn’t get sick.  This herpes simplex type 1 virus is spread through infected saliva.  It can develop into a throat infection through close contact with someone who has mouth ulcers, cold sores, or eye infections.  Avoiding contact with those who have an active infection, and washing hands with warm water and soap, can avoid spreading the virus.


The primary symptoms include:

  • Difficulty or pain in swallowing
  • Open sores in the mouth
  • Joint pain
  • Chills
  • Fever
  • Generally not feeling well (malaise).


The gastroenterologist will take a medical history and look into the esophagus using an upper GI endoscopy call an esophagogastroduodenoscopy to determine the cause of the symptoms. Throat cultures, mouth swabs, blood tests, and urine tests can also be done to confirm herpes esophagitis.


Medication can be used to treat esophagitis caused by the herpes virus. One of three anti-viral drugs can be prescribed:

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

Over-the-counter (OTC) or prescription-strength pain relievers may also be used to ease the pain of herpes esophagitis. The doctor may prescribe medication on a long-term basis to prevent the infection from recurring.

Cytomegalovirus Esophagitis (CMV)

Cytomegalovirus (CMV) is a common virus in the same family as the herpes simplex virus (HSV 1 and 2), and Epstein-Barr virus. If CMV infects the esophagus, the long tub that extends from your throat to your stomach, it becomes CMV esophagitis.  Cytomegalovirus esophagitis is really two conditions, the CMV virus itself and esophagitis that results from the CMV.

Cytomegalovirus can infect almost anyone. Most people don’t know they have CMV because it rarely causes symptoms.  Healthy children and adults who contract the infection usually have few if any symptoms, so CMV goes undiagnosed. Once a person is infected, however, the virus remains in the body for life but can remain asleep or inactive (dormant).

CMV spreads from person to person through body fluids, such as blood saliva, urine, semen and breast milk. CMV that spreads through breast milk usually doesn’t make the baby sick.  The virus is commonly spread in childcare centers or preschool settings, where it passes thru close contact with infected children not washing their hands correctly.  It can also be passed from things like toys that are not cleaned properly.


CMV can show up in symptoms that include:

  • Difficult or painful swallowing
  • Stomach pain and heartburn
  • Nausea and vomiting
  • Fever
  • Diarrhea
  • Coughing up blood

Symptoms can become so severe that a person looses their appetite, looses weight, and become undernourished. Poor nutrition can further weaken the immune system.


The primary diagnostic test for CMV esophagitis is by an upper GI endoscopy called an esophagogastroduodenoscopy. The test allows the gastroenterologist to visually inspect the entire intestinal tract and take biopsies of damaged tissue.

The doctor will first look for signs of CMV such as shallow ulcers on the walls of the esophagus. Samples of diseased tissue (biopsies) may be taken through the endoscope.  The tissue samples will be examined in a lab for abnormal cells, and tested for different types of antigens and viruses.  The results will help determine whether this condition is from CMV or a different condition.


The doctor may prescribe ganciclovir, and antiviral drug used for CMV. If for any reason this drug cannot be used, foscarnet can be prescribed.  In some cases, both drugs are used but may cause serious side effects so only one may be used at a time.