Esophagitis is inflammation and irritation of the esophagus. The cause of esophagitis is usually acid reflux. But, rarely, it results from a herpes infection.
The esophagus, or food pipe, is part of the digestive system. It is a tube that begins at the back of the throat and carries foods and liquids from the mouth to the stomach.
When esophagitis results from an infection with the herpes simplex virus (HSV) the medical name for it is “herpes esophagitis.” This type usually only occurs in people with weakened immune systems.
In this article, we look at the symptoms and causes of herpes esophagitis. We also describe its diagnosis and treatment, as well as who is at risk and how to prevent it.
Herpes esophagitis causes inflammation and irritation in the esophagus. As a result, a person might experience:
- pain or difficulty when swallowing
- heartburn or chest pain
- symptoms that typically accompany a fever
- sores in the back of the throat
- sores on or around the mouth
The sores on or near the mouth are called herpes labialis, or cold sores.
Cold sores result from an oral herpes infection — they do not accompany other types of esophagitis. People with oral herpes tend to experience outbreaks of these sores that come and go.
HSV causes herpes esophagitis. There are two main strains of this virus:
- HSV-1 is the primary cause of oral herpes, but it can cause genital herpes. This virus typically transmits through mouth-to-mouth contact, though it can happen through oral sex.
- HSV-2 is the primary cause of genital herpes, but it can cause oral herpes. This virus typically transmits through vaginal, anal, or oral sex.
Both of these types of HSV are highly contagious, and the infections that they cause are very common.
According to the Centers for Disease Control and Prevention (CDC), in the United States in 2015–2016:
- 47.8% of people aged 14–49 years had HSV-1
- 11.9% of people aged 14–49 years had HSV-2
Both types of HSV can cause herpes esophagitis, but HSV-1 is the most common cause of the condition. Still, herpes esophagitis is rare and usually develops in people with weakened immune systems.
This form of esophagitis typically occurs when HSV is active in the body and spreads from other areas to the esophagus, via the vagus nerve or mouth.
A person can contract HSV through direct contact with sores, affected skin, or bodily fluids of someone with the virus. The infection is most contagious during or just before an outbreak of symptoms.
Contracting an HSV infection does not usually lead to herpes esophagitis, however. The main risk factor is having a weakened immune system, which may result from:
Before diagnosing herpes esophagitis, a doctor takes the person’s medical history and evaluates their symptoms. They may also examine the person’s mouth and throat.
Although the condition is rare, herpes esophagitis is usually identifiable when the symptoms occur in a person with a weakened immune system.
Further tests can confirm the doctor’s diagnosis and help distinguish the type of esophagitis. These tests may include:
- blood tests to check for the virus and rule out other conditions
- an endoscopy, which involves inserting a thin tube containing a light and camera down the throat to inspect the esophagus for inflammation and ulcers
- a biopsy, which involves taking a tissue sample from the esophagus and analyzing it under a microscope
A doctor can take the biopsy sample during an endoscopy.
In people with healthy immune systems, herpes esophagitis usually clears up on its own within 1–2 weeks. In people with weakened immune systems, a doctor may prescribe an oral antiviral medication, such as:
- acyclovir (Zovirax)
- famciclovir (Famvir)
- valacyclovir (Valtrex)
These treatments may be unsuccessful if a person has a drug resistant strain of HSV.
In this case, the doctor may prescribe an intravenous antiviral drug called foscarnet (Foscavir). They may also recommend pain-relief medications.
Strategies that can help ease the pain and make swallowing easier include:
- stopping smoking
- avoiding foods, drinks, and medications that make the symptoms worse
- avoiding alcohol and caffeine
- eating smaller meals
- keeping the head elevated during sleep, by using more pillows, for example
HSV infections are highly contagious and common. A person can reduce the chances of the virus passing on by:
- using barrier methods of protection, such as condoms and dental dams, during sexual activity
- avoiding mouth-to-mouth contact and oral sex during an oral herpes outbreak
- not sharing objects that the mouth has touched during an oral herpes outbreak
- avoiding sexual contact during a genital herpes outbreak
- not touching any sores during an outbreak
Esophagitis is inflammation and irritation of the esophagus, and herpes esophagitis is a rare type that results from an HSV infection.
The condition usually develops in people with weakened immune systems. Treatment involves antiviral medications and avoiding foods and other substances that trigger symptoms.