viral esophagitis
Introduction
Introduction to viral esophagitis The pathogenic microorganism of viral esophagitis (viralesophagitis) is herpesvirus, which is also known as herpesicesophagitis. It is currently believed to be mainly herpessimplex (HSV) I and II (HSV-I, HSV-II). Five kinds of varicella-zoster virus (HZV), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) can cause human herpes esophagitis, of which HSV is more common. basic knowledge The proportion of illness: 0.004%-0.007% Susceptible people: no specific population Mode of infection: non-infectious Complications: tracheoesophageal fistula esophageal stricture
Cause
Cause of viral esophagitis
(1) Causes of the disease
Viral esophagitis is mainly herpes simplex virus infection, but also caused by cytomegalovirus infection, but it is rare. This disease is more common in malignant tumors, immune dysfunction and chronic wasting diseases, chemotherapy, radiotherapy, hormone therapy, AIDS and local Trauma can increase the body's sensitivity to herpes virus infection. Many patients have a history of recent viral infections. In recent years, with the increase of kidney transplantation and the application of immune drugs, the incidence of this disease has increased.
(two) pathogenesis
The pathogenesis of esophagitis caused by herpes virus is still controversial. Some scholars believe that the virus causes inflammation of capillaries, arterioles and venules in the intima, and can cause thrombosis, causing local necrosis leading to mucosal ulcers. HSV can cause vagus nerve to reach the esophagus. Mucosal herpes lesions, the earliest esophageal pathological damage is the formation of a vesicle, and then the central part of the detachment, forming a sparse localized ulcer of the edge of the ridge, in general, the disease has three stages: the first stage is the esophagus The end of the discontinuous vesicles, the second stage is the mucosal damage fused into the edge of 0.5 ~ 2cm edge, the third stage is diffuse mucosal necrosis and ulcer.
Prevention
Viral esophagitis prevention
Prevention: In patients with frequent recurrence of herpes, predisposing factors should be removed or avoided as much as possible. All of the above measures can help prevent the occurrence of herpes simplex infection or the onset of the original concealed infection. At present, the vaccine against herpes simplex has entered the stage of clinical trials.
Complication
Viral esophagitis complications Complications, esophageal esophageal fistula
Complications include esophageal mucosal hemorrhage, infection of esophageal fistula and virus, and late complication of esophageal stricture.
Symptom
Viral esophageal symptoms Common symptoms Edema Esophageal bleeding Dysphagia Congestion
The main symptoms are post-sternal foreign body sensation or sternal pain, swallowing pain and difficulty in swallowing, occasional esophageal hemorrhage, mild infection and asymptomatic, endoscopic examination showed small vesicles at the distal end of the esophagus, borehole-like ulcers of different sizes, base There is obvious congestion, edema, mucous membrane becomes brittle, and it is easy to hemorrhage. The ulcer biopsy shows acute or chronic inflammation. It can be seen that the inclusion of giant cell nuclear inclusion body and early biopsy tissue is positive for virus culture, and the herpesvirus complement binding test after 3 to 4 weeks. 1:64 was positive, and the double contrast of the esophagus was scattered and multiple superficial ulcers.
Examine
Examination of viral esophagitis
1. The diagnosis of this disease requires cytology, pathology and virus culture examination. The specimens are collected by brush cytology, and the inclusion bodies are found in the squamous epithelial cells. The results can be obtained in 24 hours. The positive rate of biopsy at the edge of the ulcer is obtained by fiber endoscopy. High, the disease is difficult to obtain in the late stage of the disease, and the results can be obtained in 24-72 hours using virus culture.
2. Immunohistochemistry and in situ hybridization can be used for diagnosis. Immunohistochemical staining is performed with formalin, paraffin-embedded serial sections, anti-herpes simplex virus type I polyclonal antibody, multi-antibody ABC method; Hybridization was carried out with herpes simplex virus DNA probe. The cytoplasm, nucleus and giant cell inclusion bodies of the epithelial cells were strongly positive by immunohistochemical staining.
3. Esophageal swallowing examination is characterized by the discovery of solitary ulcer on the normal mucosa. The early stage of the lesion is shallow or oval, and the later ulcers fuse to form plaque, but most of the patients often have no abnormalities.
4. Early gastroscopy can be found on the completely normal mucosa with superficial isolated small ulcers, several millimeters to tens of millimeters, the mucosa between the ulcers is intact; the ulcer fusion occurs in the later stage, the mucous membrane becomes brittle, and there is diffuse ulceration and bleeding. There may be white plaque-like changes.
Diagnosis
Diagnosis and diagnosis of viral esophagitis
During the epidemic, patients with systemic aches, sore throat, upper respiratory tract infections, or immunocompromised persons with esophageal symptoms should be suspected of viral esophagitis, endoscopic findings of typical drilling-like ulcers, esophageal sputum Scattered superficial ulcers support herpes virus infection, and further confirmed by biopsy or culture.
1. Esophageal cytomegalovirus (CMV) esophageal CMV infection can often be accompanied by other visceral infections, so CMV can be found in the stomach, intestinal mucosa and mucosa. Patients with severely suppressed immunity and long-term survival, CMV can often cause esophagus. Ulcers, and easy to combine with HSV, fungal and bacterial infections, if concomitant Candida infection or acid reflux, patients often with persistent esophageal pain.
2. Varicella-Zoster virus infection of varicella-zostervirus (VZV) can occasionally cause herpes zoster in the esophagus in adults and chickenpox in the esophagus in children, generally self-healing, however, in severe In patients with immunosuppression and immune dysfunction, VZV can cause necrotic esophagitis, both herpes and necrotic foci can be seen in the esophagus, and similar manifestations of HSV infection can be seen in esophageal brush and biopsy specimens. However, immunohistochemical examination can distinguish between the two types of infection. In the case of no herpes zoster in the skin, VZV infection can further cause disseminated infection of the viscera, and ACV can be effectively prevented in patients with previous VZV infection.
3. Human immunodeficiency virus infection esophagus can become the primary site of human immunodeficiency virus (HIV) infection, which can cause multiple small ulcers, clinical manifestations of fever, diarrhea, swallowing pain and transient rash .
4. Papillomavirus infection of papillomavirus can cause normal human squamous epithelium to grow sputum and flattened genital warts. Papillomavirus infection of the esophagus is more common than the anus, the perineum is rare, and the lesion is a replica of the skin and flat warts.
Diagnosis mainly relies on histopathology and immunohistochemical examination. Esophageal papillomavirus infection generally does not require treatment. If the treatment is applied, interferon is mostly effective, and large lesions need to be removed under endoscopy.
