HomeHealth articlesviral esophagitisWhat Is Meant by Viral Esophagitis?

Viral esophagitis refers to any inflammation, irritation, or swelling of the esophagus caused by viruses. Read further.

Medically reviewed by

Dr. Ghulam Fareed

Published At February 15, 2023
Reviewed AtFebruary 15, 2023


Any inflammation, irritation, or swelling of the esophagus caused by viruses is termed viral esophagitis. This usually occurs in immunocompromised patients. Infectious esophagitis is rare in a healthy individual, as the immune system immediately destroys any foreign body detected.

What Is Esophagitis?

Esophagitis is the inflammation of the tissues lining the esophagus. If left untreated, they can be uncomfortable and cause problems in swallowing, ulcers, and scars in the esophagus. There can be many causes for esophagitis, and when the cause is a virus, it is called viral esophagitis.

What Is Viral Esophagitis?

Viral esophagitis is any inflammation, irritation, or swelling of the esophagus caused by viruses. This usually occurs in immunocompromised patients (people whose immunity is weak). The herpes simplex virus and the cytomegalovirus usually cause it. The human papillomavirus also causes esophagitis at times. It might take one to three weeks to recover.

What Causes Viral Esophagitis?

Viral esophagitis is usually found in patients with weak immunity. The reasons behind weak immunity can be:


  • Chemotherapy.

  • Diabetes.

  • Leukemia.

  • Medicines that suppress the immune system, like those given after an organ transplant.

  • Long-term use of antibiotics.

  • Alcohol abuse.

  • Age- As people get older, their immune system becomes weaker.

  • Other conditions can weaken the immune system.

How Is Viral Esophagitis Different From Reflux Esophagitis?

Both viral and reflux esophagitis have the same clinical presentations. However, the diagnosis can be confirmed by the patient’s history. For example, if the patient has a history of an organ transplant or gives any clue that they are HIV positive, are undergoing chemotherapy, are on steroids for some reason, etc., they can be classified as having viral esophagitis since they are immunocompromised.

What Are the Symptoms of Viral Esophagitis?

  • Dysphagia (difficulty in swallowing).

  • Odynophagia (pain while swallowing).

  • Throat issues.

  • Retrosternal chest pain (pain inside the chest, particularly behind the breast bone).

  • Inflammation.

  • Fever.

  • Ulcers around the mouth and oropharynx.

  • Joint-pain.

  • Malaise(general feeling of being unwell).

  • Fatigue.

  • Heartburn.

  • Substernal burning pain(a burning sensation that spreads from the tip of the breast bone)

How Is Viral Esophagitis Transmitted?

Viral esophagitis is usually transmitted through direct contact with the contaminated substance. Direct contact can be mouth-to-mouth through contact with the infected person’s saliva. It can also be transmitted through unprotected sex, though this is rare. Herpes simplex virus type 2 can be transmitted through oral sex.

How Can Viral Esophagitis Be Prevented?

  • Thorough and frequent washing of hands with soap and warm water, avoiding or limiting direct contact with an infected person, engaging in safe sexual activity, etc., are some ways to prevent the transmission of the virus.

  • The initial symptoms of a viral infection include throat irritation and fever. It is always better to prevent the infection from spreading. The key to preventing the infection from spreading is detecting the symptoms in the initial stage and preventing it.

How Is Viral Esophagitis Diagnosed?

  1. A thorough case history is taken to understand the source of infection, symptoms presented, duration of the presenting symptoms, etc.

  2. Physical examination includes checking mouth and throat for ulcers and other symptoms.

  3. Blood tests can be advised to determine the causative pathogen and rule out other conditions.

  4. An endoscopy can be done to check the esophagus for signs of inflammation and ulcers. Ulcers less than 2cm can be observed in the distal esophagus. In herpes-simplex esophagitis, the ulcers will be well-circumscribed and have a volcano-like appearance. Diffuse erosive esophagitis(a type of esophagitis where the lining of the esophagus is destroyed) can be observed in herpes-simplex esophagitis. In cytomegalovirus esophagitis, the ulcers will be linear and deep.

  5. A biopsy can be done, if necessary, to confirm the diagnosis. It can be done along with the endoscopy as well. Multinucleated giant cells with ground glass nuclei and eosinophilic inclusions (a characteristic feature of viral infections) are found on histologic evaluation in Herpes-simplex esophagitis. In a cytomegalovirus infection, tissue destruction and intranuclear inclusion bodies (seen in viral infections) can be seen histologically.

How Is Viral Esophagitis Treated?

  • The treatment for viral esophagitis depends on the patient’s immune system.

  • Viral esophagitis usually gets resolved in people with a normal immune system (though the chance of people with a normal immune system getting viral esophagitis is meager).

  • A short course of oral acyclovir 400 mg, three times daily for one to two weeks, can be given for faster recovery if required.

  • Patients with a weakened immune system need to be treated longer. Oral acyclovir 400mg can be given five times daily for two to three weeks.

  • Alternatively, valacyclovir 1gm thrice a day for two to three days can be given.

  • Patients with severe difficulty swallowing the oral medication might require hospitalization for parenteral delivery of the drug. They can be switched to the oral drug as they get better at swallowing the oral form of the drug.

What Is Cytomegalovirus-Induced Esophagitis?

  • Cytomegalovirus (CMV)-induced esophagitis is seen in those who have had an organ transplant, those who undergo long-term dialysis, those who are HIV-infected, or those on long-term steroid therapy.

  • No literature has come across CMV-induced esophagitis in a healthy individual.

  • The average time for a patient undergoing an organ transplant to develop CMV esophagitis is about six months.

  • Induction therapy using ganciclovir 5 mg/kg for three to six weeks is given in CMV esophagitis.

  • A maintenance therapy using oral valganciclovir 900 mg twice daily is done in patients who have relapsed.

What Are the Complications of Viral Esophagitis?

Complications are very rare, though they can be seen in severe immunodeficiency. They may include:

  • Spread of the infection to other parts of the body.

  • Scar formation in the esophagus causes esophageal stricture(narrowing the esophagus).

  • Bleeding from the ulcers in the esophagus.

  • Esophageal fistula or perforation(a hole in the esophagus).


Esophagitis is the inflammation of the tissues of the esophagus, and when a virus causes it, it is called viral esophagitis. The condition is commonly seen in immunocompromised patients. Treatment includes taking antiviral drugs and avoiding anything that might trigger the condition. Recovery depends on the patient’s immune system and the response to the medications used.

Frequently Asked Questions


Can Esophagitis Be Caused By Viruses?

Inflammation of esophageal lining tissue caused by viruses is called viral esophagitis. Viral esophagitis is mostly caused by cytomegalovirus or herpes simplex virus. It usually occurs in immunocompromised subjects. At times it can also be caused due to human papillomavirus infection.


Is Viral Esophagitis A Painful Condition?

Viral esophagitis results in pain during swallowing (odynophagia), pain inside the chest (retrosternal chest pain), joint pain, and substernal burning pain (pain spreads from the tip of the breast bone). Other symptoms include fever, fatigue, ulcers around the oropharynx and mouth, and malaise.


How Long Will It Take for Viral Esophagitis to Go Away?

Herpes simplex virus (HSV) esophagitis generally resolves in one to two weeks if affected without impaired immunity. In patients whose immunity is compromised, a longer treatment course with an antiviral drug is required, and recovery usually takes place in two to three weeks.


Will a Person Recover From Viral Esophagitis?

The recovery from viral esophagitis largely depends on the person’s immune response. In those without impaired immunity, antiviral therapy can provide recovery in one to two weeks. On the other hand, in those with impaired immunity, a longer treatment course may be needed.


Is Esophagitis A Lifelong Condition?

Most of the cases of esophagitis can be cured permanently. However, some, like reflux esophagitis due to acid reflux, require long-term treatment. 


How Fast Can Esophagitis be Cured?

The treatment of esophagitis depends on the type of esophagitis (that is, depends on the cause):
- For infectious esophagitis, antimicrobial medication is given.
- For reflux esophagitis, over-the-counter drugs like antacids, prescription drugs like proton pump inhibitors, or severe surgical intervention are needed.
- For drug-induced esophagitis, alternative medication is given.
- For eosinophilic esophagitis, proton pump inhibitors, steroids, and monoclonal antibodies are given.


Can Esophagitis Be Cancerous?

For those patients who have not taken adequate treatment or if the diagnosis is delayed, reflux esophagitis will progress to stage 4(reflux-induced precancerous lesion or cancer). This increases the risk of developing Barrett’s esophagus and esophageal cancer. Barrett’s esophagus is a precancerous condition characterized by changes in esophageal lining cells, which increases the risk of esophageal cancer.


What Are the Different Stages of Esophagitis?

Reflux esophagitis occurs due to GERD (gastroesophageal reflux disease), a condition in which stomach contents flow backward into the esophagus. GERD consists of the following stages:
- Stage 1 (Mild GERD)- In this stage, acid reflux is minimal and occurs once or twice a month. Over-the-counter medications and lifestyle modifications are the treatment options.
- Stage 2 (Moderate GERD)- In this stage, symptoms are more frequent, and the patient requires acid reflux medications.
- Stage 3 (Severe GERD)- In this stage, the patient experiences painful symptoms and requires treatment by a GERD specialist.
- Stage 4 (Reflux-induced precancerous lesion or cancer)- This stage is the most severe after-effect of long-term reflux and may lead to esophageal cancer.


Can Esophagitis Be a Risk for COVID?

Some studies have shown that individuals with Barrett’s esophagus and GERD are at increased risk of mortality following COVID-19 (coronavirus disease 2019) infections. Studies suggest that pH changes in tissues of the esophagus due to esophagitis favors an increase in the viral load. Some studies also suggest that individuals with eosinophilic esophagitis do not seem to have an increased risk for COVID.


What to Eat if a Person Has Esophagitis?

An esophageal or soft food diet is recommended for those with esophagitis. Hot and cold beverages, carbonated drinks, fibrous or seed-filled food, bread crusts, hard grains, etc., should be avoided. An easily digestible soft food, eaten in small amounts at frequent intervals after proper chewing, is recommended.


Can Esophagitis Be Detected In Blood Tests?

A blood test is used for diagnosing eosinophilic esophagitis (a chronic allergic condition of the esophagus). A blood test in such cases is used for detecting the level of circulating Immunoglobulin E and high eosinophil count.


Can Esophagitis Be Cured Permanently?

Most of the cases of esophagitis can be cured permanently. However, some, like reflux esophagitis due to acid reflux, require long-term treatment.


What Natural Remedies Can Heal Esophagitis?

Natural remedies for healing esophagitis include the following:
- Acupuncture- Acupuncture, when used alone or along with other remedies, is effective for treating heartburn.
- Diaphragmatic Breathing - Diaphragmatic breathing, also called belly breathing, helps in reducing acid reflux.
- Licorice- Licorice increases mucus production and protects the esophageal lining from digestive acid.
- Turmeric- Curcumin in turmeric has anti-inflammatory properties that protect the esophageal lining.


At What Age Is Esophagitis Common?

Esophagitis is more common in middle-aged men between the age of thirty to fifty years. It is more common in males than females, with male to female risk ratio being 3:1.


How To Know if the Esophagus Is Damaged?

A person with esophagitis shows one or more of the following symptoms:
- Difficulty and pain while swallowing.
- Heartburn.
- Acid regurgitation.
- Chest pain (beneath the breastbone).
- A feeling of food stuck in the chest after swallowing.
- Bleeding may lead to the darkening of stool.
Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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