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Cytomegalovirus Esophagitis

Last updated Jan. 11, 2019

Approved by: Maulik P. Purohit MD MPH

Cytomegalovirus Esophagitis is an inflammation of the food pipe (esophagus), caused by the cytomegalovirus (CMV).


What are the other Names for this Condition? (Also known as/Synonyms)

  • CMV Esophagitis
  • CMV Infection of Esophagus
  • Infection of Esophagus by CMV

What is Cytomegalovirus Esophagitis? (Definition/Background Information)

  • Cytomegalovirus Esophagitis is an inflammation of the food pipe (esophagus), caused by the cytomegalovirus (CMV)
  • The cytomegalovirus stays in the body for life, after an initial infection. The virus occurs latently in most of the humans, but remains inactive in a healthy host. Such individuals, who carry the infection, but do not show any signs and symptoms of the disease, are called carriers of cytomegalovirus
  • When a CMV carrier becomes immunocompromised for a variety of reasons, the virus becomes active in the body, resulting in signs and symptoms of a CMV infection. Blood vessels on the esophageal surface are infected
  • This opportunistic infection mostly affects those, in whom the immunity system is compromised; like AIDS, HIV infected individuals, or those who have undergone an organ transplantation surgery
  • Cytomegalovirus Esophagitis makes it difficult to eat and swallow food, thus imposing additional barriers to one’s recovery; worsening the already feeble physical condition
  • An early diagnosis of CMV Esophagitis and intervention with suitable treatment medication (antiviral therapy) is necessary. The occurrence of severe complications can adversely affect the prognosis

Who gets Cytomegalovirus Esophagitis? (Age and Sex Distribution)

  • Individuals, whose immune systems are weakened by immunodeficiency infections, or other debilitating conditions, or had had recent organ transplants, are easily prone to contract Cytomegalovirus Esophagitis
  • Healthy individuals are not normally affected by CMV Esophagitis. Those at an advanced age and/or with an impoverished health status are more at risk for infection

What are the Risk Factors for Cytomegalovirus Esophagitis? (Predisposing Factors)

Cytomegalovirus is an opportunistic infection. The risk factors of Cytomegalovirus Esophagitis infection include:

  • Patients, who have undergone any organ, or bone marrow transplantations (since they are on immuno-suppressant drugs)
  • Patients undergoing treatment for, or suffering from acute viral infections, such as HIV and AIDS (due to reduced blood lymphocyte count, causing decreased immunity)
  • Individuals undergoing kidney dialysis for a prolonged period
  • Those suffering from cancer, undergoing chemotherapy for cancer
  • Individuals on long-term corticosteroid therapy (either low or high dosage), for a variety of health issues

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cytomegalovirus Esophagitis? (Etiology)

  • Cytomegalovirus (CMV) Esophagitis is caused by a virus called cytomegalovirus
  • CMV Esophagitis disease is an indication of a frail immune system that is caused by other medical conditions or viral infections
  • The cytomegalovirus occurs latently in most of the humans (60-80%), but remain inactive since a healthy host immunity is strong and resilient
  • In those who have a highly susceptible or immuno-compromised system, the virus is reactivated and affects many regions, including the gastrointestinal tract. When it affects the food pipe, the condition is known as CMV Esophagitis

What are the Signs and Symptoms of Cytomegalovirus Esophagitis?

Cytomegalovirus Esophagitis infection is usually present along with many other conditions (affecting other parts of the body system). This can cause confusing signs and symptoms.

Some signs and symptoms take a long time (between 2-9 months) to present themselves and these include:

  • Ulcerous sores on the surface of the esophagus making it painful and difficult to eat, drink, or swallow
  • Nausea, vomiting, or diarrhea
  • Loss of appetite
  • Chest and abdominal pain
  • Spitting or coughing-up of blood (hemoptysis)
  • Mild fever

How is Cytomegalovirus Esophagitis Diagnosed?

Diagnostic tests that are performed for Cytomegalovirus Esophagitis include:

  • Physical examination with a detailed medical history evaluation
  • Culture of blood and urine samples
  • CMV DNA serum PCR test (a special blood test)
  • CMV antibody test, to understand how the body reacts to the CMV virus
  • Liver function tests
  • A group of chemical tests, called comprehensive metabolic panel tests
  • Culture of stools samples
  • CMV antigenemia blood test
  • Esophagogastroduodenoscopy (EGD) test - the examination of the esophageal tract by using an endoscope. A tissue biopsy of esophagus is performed during an EGD. The esophageal biopsy is sent to the laboratory for examination by a pathologist. The pathologist may perform additional special tests to confirm the diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cytomegalovirus Esophagitis?

Complications due to Cytomegalovirus Esophagitis include:

  • Narrowing of the esophagus; stricture formation
  • Bleeding from esophageal ulcers
  • CMV infection at other locations, like CMV colitis, CMV retinitis of eye, etc.
  • Perforated esophagus (occasionally)
  • Recurrence of the infection
  • Side effects from the medications used to treat CMV Esophagitis

How is Cytomegalovirus Esophagitis Treated?

Quick, early diagnosis and appropriate treatment is the key to speedy recovery from Cytomegalovirus Esophagitis. Immuno-compromised individuals may have to be closely monitored for any CMV symptoms or complications. Surgical procedures are not required to treat CMV Esophagitis. Prompt treatment with medications is adequate.

  • Intravenously or orally administered antiviral medications are effective in treating patients with weak immunity systems, caused by conditions other than HIV and AIDS
  • Those affected by immunodeficiency viruses have shown improvement with antiretroviral therapy drugs, which are normally prescribed for AIDS and HIV infections
  • Sometimes, pain-relieving medications are also used

How can Cytomegalovirus Esophagitis be Prevented?

CMV Esophagitis is an opportunistic infection. Generally, CMV infections can be prevented by averting immunodeficiency infections, providing suitable treatment and medical care after an organ transplant (especially lung or bone marrow), and prompt aggressive treatment, when a body immunity system is weakened by other illnesses.

The virus affects a large percentage of the population and this makes it acutely pathologic. However, being careful, maintaining basic hygiene, and following simple practices (like regular hand washing), reduces the risk of CMV transmission through direct contact.

Some other precautionary steps to prevent a CMV infection, such as Cytomegalovirus Esophagitis include:

  • Practicing safe sex
  • Washing hands at regular intervals, especially for individuals in the high-risk group
  • Avoiding the use of commonly shared items, such as for preparation of food and drink
  • Use of proper disposal techniques while handling tissues, diapers, other contaminated items; washing hands thoroughly, after disposing them
  • Screening organ donors for the presence of CMV
  • Educate the immunocompromised patients and create an awareness of the possible infections/conditions that may affect them, in order that they are better prepared and seek timely medical treatment

What is the Prognosis of Cytomegalovirus Esophagitis? (Outcomes/Resolutions)

  • Cytomegalovirus Esophagitis can be effectively treated, when other underlying medical conditions of the patient are favorable
  • If the immunity of the patient is severely compromised, or if there are other complications; then, the prognosis of CMV Esophagitis may be adversely effected
  • Mortality in such immunocompromised individuals is caused due to complications, resulting from a damaged immune system
  • A healthy immune system recovers faster, with little or no treatment

Additional and Relevant Useful Information for Cytomegalovirus Esophagitis:

The cytomegalovirus causes a host of other diseases in those who are rendered vulnerable, due to weak immune systems.

The following article link will help you understand acute cytomegalovirus infection:

http://www.dovemed.com/diseases-conditions/acute-cytomegalovirus-infection/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Sept. 10, 2014
Last updated: Jan. 11, 2019