P1: OXT/OZN/JDO P2: PSB
0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10
Esophageal Infections and Inflammation 555➣famciclovir 250 mg three times daily, and valacyclovir, 1 g twice
daily
➣For nonresponders: foscarnet 40 mg/kg IV q8h for 21 days
■varicella zoster: same treatment as HSV
■esophageal tuberculosis
➣9-month course of multidrug therapy
➣therapy guided by drug sensitivities to anti-TB therapy
■idiopathic ulcer or ulceration due to HIV infection
➣prednisone 40 mg daily for 2 weeks
➣thalidomide
■pill-induced esophagitis
➣withdrawal of offending pill if pill-induced esophagitis suspected
➣drink at least 4 oz of fluid with pills and stay upright for at least
30 minutes after ingestion
➣proton-pump inhibitor therapy for 4–6 weeks to heal inflamma-
tion
■caustic-induced injury
➣patients with mild esophageal injury on endoscopy (edema, ery-
thema, or exudative esophagitis) may be advanced from liquids
to a regular diet over 24–48 hours
➣if signs of severe esophageal injury are present, such as deep or
circumferential ulcers or necrosis (black discoloration), patients
should be kept fasting with placement of a nasoenteric feeding
tube after 24 h. Oral feedings of liquids may be initiated after 2–3
days if the patient is able to tolerate secretions. Neither steroids
nor antibiotics are recommended.follow-up
■repeat endoscopy not indicated unless lack of symptomatic improve-
ment after specific treatment
■After caustic ingestion, esophageal strictures develop in approxi-
mately 70% of patients weeks to months after initial injury, requiring
recurrent esophageal dilations. Caustic strictures are usually long
and rigid. Endoscopic injection of intralesional corticosteroids (tri-
amcinolone 40 mg) increases the interval between dilations.complications and prognosis
Complications
■rare occurrence
■can include hemorrhage presenting as hematemesis or melena, fis-
tula, fevers, dissemination