OESOPHAGEAL ULCERATION INFECTIONS

OESOPHAGEAL ULCERATION/ INFECTIONS

GORD is the most common cause of oesophageal ulceration but there are a variety of other reasons, including iatrogenic related to endoscopic procedures, the presence of a naso - gastric tube and medications such as tetracyclines, potassium chloride tablets, non-steroidal anti-inflammatory drugs and bisphosphonates. Typically , when a medication is lodged in the oesophagus there may be ‘kissing’ ulcers with ulcera tion on opposite sides of the oesophagus. Patients may present with odynophagia ( Figure 66.38 ). Infection of the oesophagus typically occurs in immuno - compromised, elderly , debilitated or steroid-dependent patients. Candidiasis is the most common fungal infection, characteristically seen as adherent white pseudo-membranes ( Figure 66.39 ). Viral infections include herpes simplex virus (HSV) or cytomegalovirus (CMV). HSV gives rise to punched- out ulcers with edges that appear vesicular, while CMV ulcers are more shallow . CMV inclusions can be found histologically . Special immunohistochemical stains are required to make the diagnosis. Tuberculous infection can also occur, such as bovine tuberculosis when infected unpasteurised milk is consumed. Treatment would depend on individual aetiology and under lying predisposing conditions.

Figure 66.39 Oesophageal candidiasis.