In the Name of God, the Compassionate, the Merciful

INFECTIOUS ESOPHAGEAL DISORDERS

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Presenting by:Dr. Aiydarus Ali Ahmed

MBBS, MDMogadishu-Somalia

INFECTIOUS ESOPHAGEAL DISORDERS

• Esophageal infection occurs mainly in patients with impaired host defenses.

• Primary agents include Candida albicans, herpes simplex virus, and cytomegalovirus.

• Symptoms are odynophagia and chest pain.

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• Diagnosis is by endoscopic visualization and culture.

• Treatment is with antifungal or antiviral drugs.

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• Esophageal infection is rare in patients with normal host defenses.

• Primary esophageal defenses include saliva, esophageal motility, and cellular immunity.

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• Thus, at risk patients include those with AIDS, organ transplants, alcoholism, diabetes, malnutrition, malignancy, and motility disorders.

• Candida infection may occur in any of these patients.

• Herpes simplex virus (HSV) and cytomegalovirus (CMV) infections occur mainly in AIDS and transplant patients.

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• Patients with Candida esophagitisusually complain of odynophagia and, less commonly, dysphagia.

• About ⅔ have signs of oral thrush (thus its absence does not exclude esophageal involvement).

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• Patients with odynophagia and typical thrush may be given empiric treatment, but if significant improvement does not occur in 5 to 7 days, endoscopic evaluation is required.

• Barium swallow is less accurate.

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• Treatment is with fluconazole 200 mg po or IV for one dose, then 100 mg poor IV q 24 h for 14 to 21 days.

• Alternatives include ketoconazole and itraconazole.

• Topical therapy has no role.

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• Endoscopy, with cytology or biopsy, is usually necessary for diagnosis.

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MALLORY-WEISS SYNDROME

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MALLORY-WEISS SYNDROME

• Mallory-Weiss syndrome is a nonpenetrating mucosal laceration of the distal esophagus and proximal stomach caused by vomiting, retching, or hiccuping.

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• Initially described in alcoholics.

• Mallory-Weiss syndrome can occur in any patient who vomits forcefully.

• It is the cause of about 5% of episodes of upper GI hemorrhage.

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• Most episodes of bleeding stop spontaneously; severe bleeding occurs in about 10% of patients who require significant intervention, such as transfusion or endoscopic hemostasis(by injection of ethanol, polidocanol, or epinephrine or by electrocautery).

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• Intra-arterial infusion of pitressin or therapeutic embolization into the left gastric artery during angiography may also be used to control bleeding.

• Surgery is rarely required.

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THE END

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