In which systemic disorders is esophagitis prevalent?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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The prevalence of symptomatic infectious esophagitis is high in individuals with acquired immunodeficiency syndrome (AIDS), leukemia, and lymphoma and is low (< 5%) in the general medical population.

Candida esophagitis is the most common type of infectious esophagitis. Herpes simplex virus (HSV) type I is the second most common cause of infectious esophagitis. Although obtaining accurate figures regarding the prevalence of herpes esophagitis is difficult, this infection has been reported in approximately 1% of patients who are immunocompromised and in as many as 43% of patients at autopsy. [29, 30, 31, 32, 33, 34]

Cytomegalovirus (CMV) is a recognized cause of esophagitis. Asymptomatic CMV infection is common worldwide, and a large percentage of the world’s population has been exposed to CMV. Before the AIDS epidemic, CMV infections of the esophagus were primarily found on postmortem examinations. The first clinical case of CMV esophagitis was not reported until 1985.

Unlike herpes esophagitis, CMV esophagitis almost never occurs in immunocompetent patients, and the vast majority of affected individuals are found to have AIDS. The incidence of CMV esophagitis—like that of other forms of infectious esophagitis—has declined among AIDS patients since the widespread use of highly active antiretroviral therapy. [35] However, CMV esophagitis has increased among patients with solid organ transplants, [36] in whom delayed-onset disease is typical because of increasing routine use of early CMV prophylaxis. [37]

Giant esophageal ulcers have been described in patients with AIDS in whom no other infectious etiology for the ulcers can be found. These ulcers have been termed idiopathic or HIV (human immunodeficiency virus) ulcers because they are believed to be caused by HIV. In fact, results of electron microscopy confirm the presence of HIV-like viral particles in these lesions.

Although some patients with HIV ulcers may have undergone recent seroconversion, most are found to have chronic AIDS with CD4 counts lower than 100 cells/μL. HIV ulcers are more common than is generally recognized, accounting for as many as 40% of all esophageal ulcers in patients with AIDS. [23, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47]

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