Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

552 Esophageal Infections and Inflammation

esophageal motility such as achalasia, presence of malignancy such

as leukemia or lymphoma, current radiation therapy

■use of immunosuppressive medications including corticosteroids,

azathioprine, methotrexate, or medications administered after solid

organ transplantation

■medications associated with pill-induced esophagitis: antibiotics

including doxycycline, tetracycline, clindamycin, trimethoprim-

sulfamethoxazole, quinidine, potassium chloride pills, zalcitabine,

zidovudine, alendronate and risedronate, iron, vitamin C

■Hospitalized or bed-bound patients are at greatest risk of pill-

induced esophagitis since injury is more likely if pills are swallowed

when supine or without water.

■History of accidental (usually in children) or deliberate (suicidal)

ingestion of liquid or crystalline alkali (drain cleaners, etc.) or acid

causing caustic injury to the esophagus

■History of radiation for lung or thyroid cancer; odynophagia usually

occurs after 25–30 Gy and lasts until completion of radiation therapy

Signs & Symptoms

■sudden onset of retrosternal pain, exacerbated by swallowing, can

occur hours after pill ingestion. Elderly patients may report less pain.

■odynophagia

■dysphagia

■oral thrush may be a sign of underlying esophageal candidiasis; pres-

ence of herpetic vesicles might suggest HSV esophagitis

■rare signs include upper GI hemorrhage, tracheoesophageal fistula

or food impaction, unexplained nausea

■Post-radiation patients complain of both odynophagia and dys-

phagia to solids; pain is constant and exacerbated by swallowing

attempts

tests

Laboratory

Basic Studies: Blood

■check blood cultures

■WBC and positive blood cultures

■CMV PCR if CMV suspected

Upper Endoscopy

■if no response to empiric antifungal therapy after 3 days

■obtain brushings for candidiasis if suspected