What Are the Symptoms of Herpes Esophagitis?

The pathogenic microorganism of viral esophagitis is herpes virus, so it is also called herpes esophagitis. The main symptoms are foreign body sensation or pain behind the sternum, pain and difficulty swallowing, and occasionally esophageal bleeding. Minor infections are mostly asymptomatic.

Basic Information

nickname

Herpes esophagitis

English name

viral esophagitis

Visiting department

Internal medicine

Common locations

esophagus

Common causes

Infected by herpes simplex virus or by cytomegalovirus infection

Common symptoms

Foreign body sensation or sternum pain, swallowing pain and difficulty swallowing, occasionally esophageal bleeding, and minor infections are mostly asymptomatic.

Causes of viral esophagitis

Viral esophagitis is mainly a herpes simplex virus infection and can also be caused by a cytomegalovirus infection, but it is rare. The disease is more common in patients with malignant tumors, immune disorders and chronic wasting diseases. Chemotherapy, radiotherapy, hormone therapy, AIDS and local trauma can increase the body's sensitivity to herpes virus infection. Many patients have a history of recent viral infections. With the increase of kidney transplantation and application of immune drugs in recent years, the incidence of the disease has increased.

Clinical manifestations of viral esophagitis

The main symptoms are foreign body sensation or pain behind the sternum, pain and difficulty swallowing, and occasionally esophageal bleeding. Minor infections are mostly asymptomatic. Endoscopic examination showed vesicles in the distal end of the esophagus, drilling ulcers of various sizes, marked congestion and edema in the base, mucous membranes became brittle, and bleeding was easy to touch. Biopsy of the ulcer showed acute or chronic inflammation, and the inclusion bodies in the giant cell nucleus and early biopsy tissues were positive for virus culture. Three to four weeks later, herpes virus complement binding test was positive at 1:64. Double contrast esophagus revealed scattered, multiple superficial ulcers.

Viral esophagitis examination

Laboratory inspection

(1) The diagnosis of this disease requires cytology, pathology, and virus culture examination. Use brush cytology to collect specimens, find inclusions in squamous epithelial cells, and obtain results within 24 hours. The positive rate of biopsy was taken by fiber gastroscope at the edge of ulcer. It is difficult to obtain materials at the later stage of the disease, and the results can be obtained within 24 to 72 hours by using virus culture.

(2) Immunohistochemistry and in situ hybridization methods can make a diagnosis. Immunohistochemical staining was performed with formalin, and paraffin-embedded serial sections were performed with anti-herpes simplex virus type I polyclonal antibodies and polyclonal ABC methods; in situ hybridization was performed with herpes simplex virus DNA probes. Immunohistochemical staining of epithelial cells showed strong cytoplasm, nucleus, giant cell inclusions, etc., and in situ hybridization showed positive nucleus.

2. Other auxiliary inspections

(1) Examination of barium swallowing in the esophagus is characterized by isolated ulcers found on normal mucosa. The lesions are shallow or oval in the early stage, and the ulcers fuse to form plaques in the later stage. However, this test is usually not abnormal in most patients.

(2) In the early stage of gastroscopy, it is found that there are superficial isolated small ulcers on the completely normal mucosa, several millimeters to tens of millimeters, and the mucosa between the ulcers is intact; in the later period, the ulcers are fused, the mucosa becomes brittle, and the diffuse ulceration and bleeding appear And may have white plaque-like changes.

Diagnosis of viral esophagitis

During the virus epidemic, patients with systemic soreness, sore throat, upper respiratory tract infection, or immunocompromised persons with esophageal symptoms should be suspected of having viral esophagitis. Endoscopy revealed a typical drilling-like ulcer. Superficial ulcers in the barium of the esophagus can support herpes virus infection, and further biopsy or culture can be used to confirm the diagnosis.

Differential diagnosis of viral esophagitis

1. Esophageal cytomegalovirus infection (CMV)

Esophageal CMV infection can often be accompanied by other visceral infections, so CMV can often be found in the stomach, intestinal mucosa, and submucosa. In patients with severe immune suppression and long-term survival, CMV can often cause esophageal ulcers, and it is easy to be combined with HSV, fungal and bacterial infections. If candida infections or acid reflux occur, patients often have persistent retrosternal pain.

2. Varicella-zoster virus infection

Varicella-zoster virus (VZV) can occasionally cause shingles in the esophagus in adults and chickenpox in the esophagus in children, and usually heal itself. However, in patients with severe immunosuppression and immune dysfunction, VZV can cause necrotizing esophagitis. Both herpes and fused necrosis were seen in the esophagus. Similar findings in HSV infection can be seen in esophageal brushes and biopsy specimens, but immunohistology can distinguish the two types of infections.

3. Human immunodeficiency virus infection

The esophagus can become the primary site of human immunodeficiency virus (HIV) infection, and multiple small ulcers can appear. Clinical manifestations include fever, diarrhea, swallowing pain, and transient rash.

4. Papillomavirus infection

Papillomavirus can cause warts and condyloma acuminata in normal human squamous epithelium. Papillomavirus infection is less common in the esophagus than in the anus and perineum, and the lesions are a version of skin warts and genital warts. Diagnosis is mainly based on histopathology and immunohistochemistry. Esophageal papillomavirus infection generally does not require treatment. If it is treated, the use of interferon is mostly effective. Large lesions need to be removed endoscopically.

Viral esophagitis complications

Complications include esophageal mucosal hemorrhage, esophageal fistula, and infection caused by viral spread. Late comorbidities are esophageal strictures.

Viral esophagitis treatment

Acyclovir (acyclovir) and ganciclovir (propoxyguanosine) are highly active broad-spectrum antiviral drugs that can inhibit herpes virus polymerase and have significant effects on HSV esophagitis. Most can be effective within 1 week, but the healing of large ulcers and the repair of covered epithelium take longer. The course of treatment is usually 2 to 3 weeks. In recent years, due to mutations in the virus, anti-ACV virus strains have appeared. Sodium phosphonate can be replaced, but it can cause renal insufficiency and decrease in serum Ca ²⁺ concentration, and then cause adverse reactions in the heart and nerves. Ara-A also has a broad-spectrum anti-DNA virus effect, and it has an inhibitory effect on human herpes virus. Pay attention to its adverse effects such as neurotoxicity and bone marrow suppression during medication. It has been reported that the combination of antiviral drugs with higher titers of antiviral human blood gamma globulin (human immunoglobulin) in patients with immunocompromised patients can achieve better efficacy. If the patient is accompanied by Candida infection, fluconazole or itraconazole can be taken at the same time for 10 days, and the effect is significant.

Prognosis of viral esophagitis

The disease is mainly a self-limiting disease, and the above symptoms can disappear within a few days.

Prevention of viral esophagitis

For patients with frequent recurrent herpes, try to remove or avoid predisposing factors. The above measures are helpful to prevent the occurrence of herpes simplex infection or the outbreak of the original hidden infection. Currently, vaccines to prevent herpes simplex have entered the clinical trial stage.