Endoscopy image: viral oesophagitis
In inflammation of the gullet caused by viruses, redness and sores can form on the inside lining of the gullet. This can cause pain, especially on swallowing, and difficulty in swallowing.
A biopsy is sometimes needed to confirm the diagnosis. Treatment with suitable medicines is possible, according to the cause of the disease.
What is viral oesophagitis?
Viral oesophagitis (viral inflammation of the gullet) is inflammation of the inside lining of the gullet caused by viruses.
The gullet is the organ that carries the food we eat from the mouth to the stomach. The inflammation that viruses cause here can sometimes lead to small or large sores (ulcers).
It is not cancer. Especially in people with a weakened immune system, however, it can lead to serious difficulty in swallowing and pain.
Why does it happen?
Two viruses are most often responsible:
- Herpes simplex virus (HSV): a virus that can also cause cold sores.
- Cytomegalovirus (CMV): a virus that many people may carry, but which can cause disease especially when the immune system is weakened.
Who gets it more often?
- Patients who have had an organ transplant
- People having chemotherapy or taking drugs that suppress the immune system
- People whose immune system is severely weakened
- People with certain serious illnesses
Important: viral oesophagitis can also, uncommonly, be seen in healthy people with a normal immune system.
What are the symptoms?
The commonest complaints are:
- Pain or burning on swallowing
- Difficulty in swallowing food
- Pain behind the breastbone
- A feeling of discomfort when eating
- Sometimes fever and loss of appetite
In severe cases the patient may find it hard even to drink water.
How is it diagnosed?
The most important test is gastroscopy.
During gastroscopy the inside lining of the gullet is examined with a camera. The sores caused by the viruses can be seen.
If needed, small tissue samples (biopsies) are taken from these areas. Examination of the biopsy helps to find out which virus is causing the disease.
Is there a treatment?
Yes. Viral oesophagitis can be treated.
Treatment is decided according to the virus causing the disease and the state of the patient’s immune system.
Antiviral drugs can be used, such as aciclovir for infections caused by the herpes virus and ganciclovir for CMV infections.
Some mild infections can get better on their own. In patients with a weakened immune system, however, it is important not to delay suitable treatment.
When should you see a doctor?
If you have pain on swallowing, burning in the chest or difficulty in swallowing, you are advised to see a gastroenterologist.
Being unable to drink water, being unable to swallow your saliva, or severe chest pain calls for emergency assessment.
Remember: not every pain on swallowing means a viral infection. Reflux, drugs and other diseases can also cause similar complaints. The right diagnosis is important for the right treatment.
Sources
- Prof. Ali Tüzün İnce, MD — personal endoscopy archive