Esophagitis

Question 1

DDx for esophagitis

Answer 1

1. infectious
2. inflammatory-IBD
3. eosinophilic
4. GVHD
5. Caustic ingestion
6. radiation induced

Question 2

Risk factors for infectious esophagitis?

Answer 2

1. immunocompromised host (congenital or acquired)
2. steroids
3. severe malnutrition
4. mucositis
5. broad spectrum antibiotics use
6. PPI
7. Stasis: achalasia, scleroderma
8. Eso disease: GERD, EoE

Question 3

Fungal eso infection EGD, Histo, Rx

Answer 3

EGD: adherent plaques on eso wall

Histo: hyphae and unicellular form
+ silver, PAS, GRAM stains

Rx: flucanazole

Complications: fungal ball & stricture (rare)

Question 4

HSV eso infection EGD, Histo, Dx, Rx

Answer 4

affects stratified epithelium
EGD: herpetic vesicles (1-2 days)
Volcano ulcer-round lesion with yellow border

Histo: nuclear inclusions, multinucleated giant cell, mononuclear infiltrates

Dx: viral culture, IHC stain

Rx: immunocompetent - self limited
compromised- acyclovir

Question 5

CMV eso infection EGD, Histo, Dx, Rx

Answer 5

EGD: similar to HSV but more deep and linear ulcers
mid to distal eso

Histo: basophilic inclusion bodies on biopsy from edge of ulcer

Rx: ganciclovir or foscarnet