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Herpes simplex virus infection of the esophagus

Peter A L Bonis, MD
Dori F Zaleznik, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Esophagitis is most often caused by noninfectious conditions, such as gastroesophageal reflux disease, whereas esophageal infection occurs predominantly in hosts with impaired immunity resulting from chemotherapy, transplantation, or HIV infection. The most common causes of infectious esophagitis include candida, cytomegalovirus (CMV), and herpes simplex virus (HSV).

This topic will address the epidemiology, clinical manifestations, diagnosis, and treatment of HSV esophagitis. Topics on candidal and CMV esophagitis are found elsewhere. (See "Clinical manifestations of oropharyngeal and esophageal candidiasis" and "AIDS-related cytomegalovirus gastrointestinal disease" and "Treatment of oropharyngeal and esophageal candidiasis".)


Herpes simplex virus (HSV) infection of the esophagus is usually observed in patients who are immunocompromised, but can occasionally be seen in patients who are immunocompetent. The vast majority of infections are related to HSV type 1, although HSV-2 has occasionally been reported [1,2].

HSV esophagitis may result from reactivation of HSV with spread of virus to the esophageal mucosa by way of the vagus nerve or by direct extension of oral–pharyngeal infection into the esophagus [3].

Immunocompromised hosts — HSV esophagitis occurs most frequently in solid organ and bone marrow transplant recipients [4-8]. HSV and cytomegalovirus (CMV) were the most commonly identified pathogens (48 percent each) in a study of 21 patients with endoscopically proven esophagitis who had undergone bone marrow transplantation [9]. HSV esophagitis has also been reported in the setting of acute rejection and intensive immunosuppression [5].

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Literature review current through: Oct 2017. | This topic last updated: Jul 21, 2016.
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