Herpes esophagitis: Symptoms, causes, and treatments

Your digestive system, also called the gastrointestinal tract, has many organs that ensure your digestion process goes smoothly. One of the GI tract organs is the esophagus, a muscular tube running from your mouth to the stomach carrying food and liquid by contracting.

Sometimes, you can get infections from viruses, fungi, or bacteria in your esophagus, causing inflammation and irritation that can damage the tissues of the esophagus, causing esophagitis. This can lead to chest pain and swallowing difficulties due to a painful throat. Oral medications, allergies, and underlying conditions like HIV, diabetes, leukemia, etc., also cause esophagitis.

But, sometimes, the esophagus’s inflammation can be due to infection by the herpes simplex virus, though rare, leading to herpes esophagitis. This can lead to herpes in the throat. Herpes esophagitis is common in people with a compromised immune system, like those with HIV or autoimmune diseases.

In this article, we’ll look in detail at the causes, symptoms, and treatments of herpes esophagitis; stay tuned.

What is herpes esophagitis?

Herpes esophagitis is the inflammation and irritation of the esophagus due to the herpes simplex virus. It makes it difficult to swallow foods and transport them to the stomach, which is its primary function. Because it infects the esophagus, it can spread to the throat, causing herpes and leading to a severe sore throat.

Herpes esophagitis is common in people with a compromised immune system caused by conditions like HIV, cancer, autoimmune diseases, etc. Although healthy people can also get herpes esophagitis, they are less likely.

The infection of the esophagus by herpes simplex virus can lead to:

  • Swallowing difficulties
  • Inflammation of the esophagus and throat
  • Damage to the esophagus
  • Painful chest

How can I spread herpes esophagitis?

Herpes esophagitis is a herpes simplex viral infection. Generally, it passes through skin-to-skin contact like kissing or by sharing objects like straws or eating utensils, or lipsticks with someone with an active herpes outbreak.

You can also get it if you have active genital herpes, touch the sores, and then touch your mouth with your infected fingers. For this reason, it is essential to always wash your hands after touching these infected areas. You should also refrain from getting into contact with those having outbreaks of herpes esophagitis.

Is herpes esophagitis common?

Esophagitis due to infections is relatively rare; most esophagitis is due to non-infectious conditions like gastroesophageal reflux disease (GERD). Infectious esophagitis is so uncommon that even scientists don’t know its prevalence.

Scientists suggest that out of the smaller percentage of infectious esophagitis, the majority is dues to candida species like yeast, while the rest is due to cytomegalovirus and herpes infections. Infectious esophagitis can also be dues to bacteria and other viral infections besides the herpes virus.

Although herpes esophagitis can lead to herpes in the throat which is painful, other infectious and non-infectious can also cause painful sores in the throat.

Herpes esophagitis vs. cold sores

Cold sores are common infections that affect nearly half of the United States population during their lifetime. It causes round blisters filled with fluids hence the name fever blisters. The blisters are always in clusters. After the outbreak, the blisters form, rapture, and form scabs.

Cold sores are incurable, but you can treat their symptoms. You can transmit it through skin-skin contacts, like kissing or coming into contact with contaminated objects. Once infected, the virus stays in the body for the rest of your life. It can remain dormant, but you can still transmit the virus even in its dormancy state.

Most confuse herpes esophagitis with cold sores because they present similar symptoms, like round blisters. Both conditions are due to the same virus but affect different body parts. While cold sores mostly affect the lips, herpes esophagitis affects the throat, which leads to herpes in the throat.

Herpes esophagitis vs. strep throat

Both herpes esophagitis and strep throat can present symptoms resembling each other though these two conditions are entirely different. The first difference is in their causes. While strep throat is a bacterial infection; due to Streptococcus pyogenes, herpes esophagitis is a viral infection due to the herpes simplex virus.

There is also a difference in their prevalence. Strep throat affects children aged 5-15 and is very contagious in crowded areas like classes or bus terminals. Also, strep throat is common during winter and tends to reduce during summer. Herpes esophagitis, on the other hand, mainly affects patients with a compromised immune system due to underlying conditions like HIV, autoimmune diseases, hematological malignancy, and those undertaking chemotherapy treatment.

Though both conditions affect the throat, only herpes esophagitis can cause herpes in the throat. Because it is esophagus disease, herpes esophagitis always leads to difficult and painful swallowing, vomiting of blood, and fever though not frequent.

Strep throat mainly causes inflammation and enlargement of the tonsils and fever.

Can you cure herpes esophagitis?

Herpes esophagitis is curable and should not worry you. It’s a viral infection that goes away on its own after 1-2 weeks in people with a healthy immune system. However, if you are immunocompromised, you may need antiviral medications like acyclovir, valacyclovir, or Famciclovir for faster healing which may take up to a month.

Can herpes esophagitis kill me?

You may be scared to find out that you have herpes esophagitis which you shouldn’t be because this is a common condition that can go away on its own, even without treatment. Herpes esophagitis can only cause inflammation of the esophagus and herpes in the throat and nothing serious.

It can only cause severe implications in those with a weakened immune system which can take only a month to treat using readily available prescription medications.

Symptoms of herpes esophagitis

Infection of the esophagus by the herpes virus leads to inflammation and irritation, which can have multiple effects on the esophagus and the organs surrounding it. If you experience the following, you are likely to have herpes esophagitis.

  • Pain when swallowing
  • Heartburn
  • Sores inside your mouth and around your lips
  • Blistering
  • Nausea
  • Difficulty swallowing
  • Food impactions-when food is stuck in your esophagus
  • Sores at the back of your throat
  • Fever

Causes of herpes esophagitis

There are two types of herpes simplex virus; the herpes simplex virus type 1 and type 2, and both can cause herpes esophagitis. Let’s learn how they cause this condition individually.

Herpes simplex virus type 1 (HSV-1)

HSV-1 is the virus causing most cases of herpes esophagitis, and it is the same virus that causes cold sores or fever blisters. You can transmit HSV-1 through kissing or coming into contact with the saliva of an infected person. You can develop herpes in the throat if the HSV-1 spreads to the throat after its transmission.

You should therefore ensure you regularly wash your hands if you have HSV-1 to avoid transmitting it to those close to you. And if you don’t have it, avoid close contact with those infected.

HSV-1 is incurable, but you can treat and manage its symptoms. It can lay dormant in your body, and you may not know until there is an outbreak. If you think you likely have this condition, see your doctor because you can also transmit this condition to your partner through unprotected oral sex.

Herpes simplex virus types 2

This is another type of herpes simplex virus that mainly affects the genitals; therefore, it is a sexually transmitted infection. HSV-2 is transmitted through skin-to-skin contact of the genitals and causes genital herpes.

Chances of getting herpes esophagitis through herpes simplex virus are slim because it is rare to find it in the mouth. However, if you participate in unprotected oral sex with someone having an HSV-2 outbreak, you can contract herpes esophagitis which can lead to herpes in the throat.

It is, therefore, essential to inform your partner if you have a herpes outbreak and always ensure you practice safe sex. Also, treat this infection early to prevent transmitting HSV-2, which can make your partner develop herpes esophagitis.

Other cause of esophagitis

The inflammation of the esophagus can be due to several causes hence the different names of esophagitis; for example, the inflammation due to herpes is herpes esophagitis, while the inflammation due to gastroesophageal reflux is reflux esophagitis. The other causes of esophagitis are:

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease is a condition that occurs when the acid from the stomach flows back to the mouth. Though it is a normal condition, it can be very uncomfortable. Acid reflux is due to the fault of the lower esophageal sphincter, which fails to properly close and prevent the backward movement of acid and food to the mouth.

The backward flow of the acid that causes GERD can cause severe inflammation and damage to the esophagus leading to reflux esophagitis. Though it doesn’t cause herpes in the throat, the acid passes the throat and can irritate it and cause inflammation.

Some factors increase the chances of developing gastroesophageal reflux disease, and they include:

  • Smoking
  • Weight gain that can be due to various factors like pregnancy
  • Eating excessive large and fatty meals
  • Eating late at night and going to bed immediately
  • Excess drinking of caffeine, chocolate, and alcohol

Some foods can also worsen the symptoms of GERD, and they include:

  • Chocolate
  • Mint-flavored foods
  • Citrus fruits
  • Caffeine
  • Alcohol
  • Garlic and onions
  • Tomato
  • Spicy foods

Allergies

When your body detects an allergen, it reacts by producing eosinophils- the type of white blood cells playing a crucial role in allergic reactions. An allergy-causing agent or acid reflux can trigger eosinophils’ production, leading to their high concentration in the esophagus, thus causing eosinophilic esophagitis.

Eosinophilic esophagitis is primarily due to food allergies like soy, peanuts, wheat, milk, beans, beef, eggs, and rye. You can also develop eosinophilic esophagitis through nonfood allergies by inhaling allergens like pollen.

Some things can increase your chances of developing allergy-related esophagitis like:

  • Having a family history of eosinophilic esophagitis
  • Having a history of allergic conditions like atopic dermatitis and allergic asthma

High concentration of lymphocytes in the esophagus

A high number of lymphocytes in the lining of your esophagus can cause lymphocytic esophagitis, which is a rare condition.

The cause of lymphocytic esophagitis is unclear as there is little research done on this disorder. However, researchers connect it to eosinophilic esophagitis and GERD.

Medications

Certain medications can cause esophagitis leading to drug-induced esophagitis, which occurs when drugs, especially oral medications, come in contact with the lining of the esophagus for too long. This can also happen when one swallows a large pill irritating the esophagus lining as it passes to the stomach, which sometimes leads to inflammation of the esophagus.

Some factors may hinder the quick passage of pills or tablets to your stomach, making them contact the esophagus lining, thus causing drug-induced esophagitis. These factors include:

  • Taking larger pills
  • Using inadequate or no water when taking your pills or tablets
  • Sleeping immediately after taking drugs
  • Old age, which can cause reduced saliva production or changes in esophagus muscles

To avoid drug-induced esophagitis, wash down drugs after swallowing with enough water to prevent the tablet or capsule residue from staying in the esophagus. This condition is common with drugs like:

  • Painkillers like naproxen sodium, ibuprofen, aspirin, etc.
  • Potassium chloride for treating potassium deficiency
  • Antibiotics like doxycycline and tetracycline
  • Quinidine for treating heart problems
  • Bisphosphonates like alendronate for treating osteoporosis- a condition associated with weak bones.

Drug-induced esophagitis is high in bedridden people or those not moving enough.

Risk factors

You can get herpes simplex virus by being in contact with sores, body fluids, or infected skin of someone with HSV because the virus is most contagious during symptom outbreaks. Herpes is a common condition, but it doesn’t mean you must develop herpes esophagitis if you have it.

Having a weak immune system can make you susceptible to herpes esophagitis which can, in turn, lead to herpes in the throat. Some of the causes of a compromised immune system are:

  • Having conditions like leukemia, lymphoma, or HIV
  • Undergoing chemotherapy due to cancer
  • Taking immunosuppressant drugs after undergoing an organ transplant
  • Obesity
  • Pushing of the diaphragm’s opening between the stomach and esophagus
  • Chronic vomiting
  • Drinking alcohol and smoking cigarette
  • Allergic or esophagitis history from the family
  • Anti-inflammatory medications
  • Aspirin
  • Chest surgery
  • Chest radiation therapy

Diagnosis

Either a doctor or a dentist can perform a herpes esophagitis diagnosis. Your doctor will look into your medical history and evaluate your symptoms. They will examine your mouth, throat, and esophagus using an endoscope- a small lightning camera.

There are many causes of infectious esophagitis, and it can be due to bacteria, fungi, or viruses—conditions like strep throat may not cause herpes in the throat. Still, they may manifest symptoms resembling herpes esophagitis, so your doctor may perform several tests.

Because infectious esophagitis can be due to several pathogens, your doctor may perform tests like:

  • Throat and mouth swabs. Your doctor may take a fluid sample from your mouth or throat and add it to a specific cell to grow the virus. If it doesn’t infect the cell, then your condition is not due to herpes.

They can also perform a throat swab culture by taking the sample to determine if your infection is due to bacteria or fungi.

  • Urine molecular test. Your doctor may take a sample of your urine and test for herpes virus if he thinks your condition might be due to herpes simplex virus type 2.
  • Blood tests. Your doctor may also use blood tests to check for antibodies though this is only effective for a previous infection.

These tests will aid in knowing the source of your condition for appropriate medications. If there is a presence of herpes, then your doctor will know that you have herpes esophagitis.

Though it doesn’t cause herpes in the throat, candidiasis is the leading cause of infectious esophagitis.

Treatment

Herpes esophagitis is a viral disease, and like most of them, it goes away on its own after a few days, but in those with a healthy immune system. Those with a compromised immune system may need to take antiviral medications to ease and treat the symptoms of this condition, like herpes in the throat, which can cause painful sore throats. These antiviral medications are:

  • Acyclovir
  • Famciclovir
  • Valacyclovir

If you have used these drugs and developed resistance, your doctor may recommend foscavir- an intravenous antiviral drug or pain reliever to ease your symptoms.

Other treatments of herpes esophagitis include:

  • Oral steroids
  • Antifungal medications
  • Antacids
  • Proton pump inhibitors

Because this condition can affect both esophagus and throat, it may make swallowing drugs difficult; make them easier, do the following:

  • Avoid alcohol and caffeine
  • Eat small-particle meals
  • Stop smoking
  • Avoid foods and drinks that may worsen the symptoms.

Can herpes esophagitis affect children?

It is rare but possible for herpes esophagitis to occur in children. Because the conditions are common in immunocompromised individuals, it doesn’t mean that if your child has herpes esophagitis, there is a problem with their immune system. Even healthy children can develop herpes esophagitis.

Most cases of esophagitis in children are not due to herpes, but you can also treat herpes esophagitis in your child with acyclovir, just like in adults. Because herpes esophagitis leads to herpes in the throat, making it difficult to swallow, you should take this seriously with your child and see your doctor when your child starts having difficulties taking food.

Women who get herpes infection during pregnancy have a high chance of transmitting it to their unborn infants during delivery- this is why herpes infections are serious in newborns. If you are experiencing herpes symptoms, you should see your doctor and discuss safe delivery plans to ensure you don’t infect your child.

If you don’t, you may infect your child with the herpes simplex virus, which can spread to the esophagus and cause inflammation and irritation. This can also lead to herpes in the throat of your child, which may make it difficult even to swallow saliva.

Prevention

Herpes simplex virus infection is widespread, but not all herpes virus infections lead o herpes esophagitis. However, you can reduce the risk of developing herpes esophagitis or spreading it to other people by preventing contracting the herpes virus. Below are ways of reducing your chances of developing or reducing it.

  • Consistent and effectively use of protection while having oral sex
  • Avoid sharing objects that touch the mouth, like straws or utensils, during cold sore outbreaks
  • Don’t touch herpes sores and blisters; if you do, wash your hands thoroughly because you might spread the infection to your mouth, which could lead to herpes esophagitis.
  • Avoid sexual contact when having an active herpes outbreak
  • Having kissing when you or your partner has an active oral herpes
  • Regularly wash your hands if you have a herpes esophagitis outbreak to avoid spreading it to your loved ones through contact.

Conclusion

Herpes esophagitis may be uncommon, but it can cause severe pain due to inflammation of the esophagus and throat. This can also make it difficult to swallow and can worsen in children.

However, herpes esophagitis is not a severe condition and should heal on its own after about two without treatment for those with a healthy immune system. But, if your immune system is compromised, you may need medications to speed up the healing process, which takes about a month.

Contributor: admin