The esophagus, or food pipe, is the tube that begins at the back of the throat and is part of the digestive system. It carries food and liquids from the mouth to the stomach.
When this condition results from infection with the herpes simplex virus, or HSV, it is known as herpes esophagitis. This type of esophagitis normally only occurs in people with weakened immune systems.
In this article, we look at the symptoms, causes, and risk factors for herpes esophagitis. We also cover diagnosis, treatment, and prevention of the condition.
Herpes esophagitis can cause pain when swallowing and sores at the back of the throat.
Herpes esophagitis causes inflammation and irritation in the food pipe, which can lead to symptoms such as:
- pain or difficulty when swallowing
- heartburn or chest pain
- fever-like symptoms
- sores in the back of the throat or in or around the mouth
The sores in the mouth are called herpes labialis or cold sores.
Cold sores only occur with herpes esophagitis and not in other types of infectious esophagitis. People with oral herpes tend to experience outbreaks of cold sores that come and go throughout their lifetime.
HSV causes herpes esophagitis. There are two main strains of HSV:
- HSV-1 is the primary cause of oral herpes but can also lead to genital herpes. People typically pass on HSV-1 through mouth-to-mouth contact, but a person can also pass it on through oral sex.
- HSV-2 is the primary cause of genital herpes but can also cause oral herpes. People typically pass on HSV-2 through vaginal, anal, and oral sex.
Both types of HSV are highly contagious, and infection with this virus is very common.
According to the Centers for Disease Control and Prevention (CDC), in the United States in 2015–2016:
- 47.8 percent of people aged 14 to 49 years had HSV-1
- 11.9 percent of people aged 14 to 49 years had HSV-2
Both types of HSV can cause herpes esophagitis, but HSV-1 is the most common cause of the condition. However, herpes esophagitis is rare and usually only develops in people with weakened immune systems.
The condition usually occurs when HSV reactivates and spreads from other areas of the body, such as via the vagus nerve or mouth to the esophagus.
A person undergoing chemotherapy may have an increased risk of developing herpes esophagitis.
A person can contract HSV through direct contact with the sores, affected skin, or bodily fluids of someone who has the virus. The infection is most contagious during or just before an outbreak of symptoms.
Becoming infected with HSV does not usually lead to herpes esophagitis, however. The main risk factor for this condition is having a weakened immune system, such as from:
- living with HIV, leukemia, or lymphoma
- receiving chemotherapy for cancer
- taking immunosuppressant drugs, such as for organ or bone marrow transplant
To diagnose herpes esophagitis, a doctor will start by taking the person's medical history and evaluating their symptoms. They may also examine the 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 are useful for confirming a doctor's diagnosis and can help to distinguish between the different types of esophagitis. These tests may include:
- Blood tests to check for the presence of viruses and to rule out other conditions.
- Endoscopy, which involves inserting a thin tube with a light and camera down the throat to inspect the esophagus for inflammation and ulcers.
- Biopsy which involves taking a tissue sample from the esophagus and analyzing it under a microscope. Doctors can take a sample during an endoscopy.
In people with healthy immune systems, herpes esophagitis usually clears up on its own within 1 to 2 weeks. For people with weakened immune systems, a doctor may prescribe an oral antiviral medication, such as:
If these treatments are unsuccessful, an individual may have contracted a drug-resistant strain of HSV. In this case, doctors may prescribe an intravenous antiviral drug called foscarnet.
A doctor may also recommend pain medications for anyone experiencing significant discomfort.
Lifestyle changes may be necessary if swallowing becomes too painful or difficult. These may include:
- stopping smoking
- avoiding foods, drinks, or medications that trigger symptoms
- avoiding alcohol and caffeine
- eating smaller meals
- keeping the head elevated during sleep, such as by raising the head of the bed
Using a condom during sexual activity can help prevent the spread of HSV.
HSV is a highly contagious and common infection. A person can reduce the risk of contracting or transmitting the virus by:
- using a condom or dental dam during sex
- avoiding mouth-to-mouth contact or 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 sores during an outbreak
Herpes esophagitis is a rare type of esophagitis that results from an HSV infection. This condition usually only develops in people with a weakened immune system. Treatment of herpes esophagitis involves antiviral medications and avoiding foods and substances that trigger symptoms.