[Inflammatory esophageal diseases caused by herpes simplex virus infections--overview and report of 15 personal cases].

Abstract

Frequency of herpes simplex virus(HSV)-induced esophagitis was reported to range from 0.5% to 6% in non-selected patients according to autopsy and clinical studies. In case of gastrointestinal involvement, affinity of herpes simplex virus to squamous epithelia predisposes the esophagus to be affected. Typically, patients complain about acute onset of odynophagia, retrosternal pain, or symptoms of gastrointestinal blood loss, while systemic signs of inflammation are often absent. Endoscopic examination usually reveals disseminated, roundish mucosal defects with distinct borders preferably in the distal part of the esophagus. If suspected clinically and by endoscopy, a histological and/or cytological diagnosis should be achieved by carefully taking multiple biopsies from the edge of the suspicious lesions. Antiviral therapy is not obligatory, since HSV esophagitis often resolves spontaneously. In the presence of preexisting immunodeficiency, marked clinical symptoms, or complicated course, however, the guanosine analogue aciclovir is the treatment of choice. In view of a comparably low sensitivity of macroscopic assessment and an expected increase in incidence of this viral infection, a high index of suspicion for this disorder appears to be necessary for all clinicians working in the field of endoscopy. Based on 15 personal observations recorded from 1983 to 1995, epidemiological, pathogenetic, morphological, and clinical features of HSV esophagitis will be summarized and discussed in the light of the pending literature on this subject.