Esophagitis in the Immunocompromised Host

This chapter focuses on esophagitis in the immunocompromised host and reviews the epidemiology, pathology, presentation, diagnosis, and therapy for specific infections. It also reviews selected esophageal disorders associated with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). A high HIV viral load is a predisposing factor for opportunistic diseases. Bacterial and fungal infections are most common during the initial months after transplantation, because it is during this period that granulocyte number and/or function are most compromised. A number of factors guide the approach to the immunosuppressed patient with suspected esophageal infection. Herpes simplex virus esophageal infection commonly presents with the sudden onset of severe odynophagia, heartburn, or chest pain. Mycobacterial involvement of the esophagus is rare in both immunocompromised and immunocompetent patients with advanced pulmonary tuberculosis, even in countries with high prevalence rates. In developed countries, protozoal infections of the esophagus are very rare, having been reported almost exclusively in AIDS patients.