Viral esophagitis in non-human immunodeficiency virus patients: a case-control study

Area of Science:

• Gastroenterology
• Infectious Diseases
• Virology

Background:

• Esophagitis is esophageal inflammation with diverse causes, including reflux, infections, and allergies.
• Infectious esophagitis, particularly viral esophagitis (VE) from herpes simplex virus (HSV) or cytomegalovirus (CMV), is a significant concern.
• While typically linked to immunosuppression, VE is increasingly reported in immunocompetent individuals.

Purpose of the Study:

• To investigate the risk factors and patient demographics of viral esophagitis (VE) in non-HIV individuals.
• To understand the clinical presentation and endoscopic findings associated with HSV and CMV esophagitis.
• To identify potential risk factors for VE in a non-HIV patient cohort.

Main Methods:

• A case-control study identified 50 VE cases (HSV, CMV) via histopathology and immunohistochemistry from 2009-2022.
• Controls were selected based on esophagogastroduodenoscopy (EGD) with negative VE results.
• Data on demographics, comorbidities, lab parameters, endoscopic findings, and risk factors were collected via chart review.

Main Results:

• Hematemesis was more common in HSV esophagitis, while dysphagia predominated in CMV esophagitis.
• Ulceration was the main EGD finding in HSV cases (67%), whereas esophagitis was noted in CMV cases (37%).
• Immunosuppressive therapy, organ transplant, malignancy, and steroid use were associated with VE, yet 34% had no clear risk factors.

Conclusions:

• Findings enhance understanding of VE in non-HIV patients, aiding early detection and management.
• Identifying specific risk factors like immunosuppression is crucial for targeted VE interventions.
• Further research is needed on the rising VE incidence in immunocompetent individuals and optimizing treatment.