Pain or difficulty while swallowing? Blood in cough? (CMV Esophagitis): Cause, Symptoms, Diagnosis, Treatment, Prevention, Outlook

CMV esophagitis is a serious infection caused by a pathogen called Cytomegalovirus. CMV esophagitis is really two linked conditions. It’s an infection from this virus and the esophagitis that often occurs as a result of that infection.

Cytomegalovirus is a common virus in the same family as the herpes, shingles, and Epstein-Barr viruses. The virus can live in your body in a dormant state for many years. Later in life, it can become activated, and may pose a significant health risk if your body’s immune system becomes weakened, or if you are re-exposed to the virus.

When this virus becomes activated, it can invade various body parts and organs, causing serious infections. CMV esophagitis is one example of what can happen when the active form of this virus infects a specific body part.

What Are the Symptoms of CMV Esophagitis?

CMV esophagitis involves a wide range of symptoms, including:

Difficulty swallowing

Pain while swallowing

Stomach pain

Heartburn

Nausea

Vomiting

Loss of appetite

A fever

Diarrhoea

Spitting or coughing up blood

The symptoms can become so severe that you can lose your appetite, lose weight, and become undernourished. Poor nutrition can further weaken your immune system.

How Do You Get CMV Esophagitis?

CMV is transmitted in three ways:

From mothers to infants

Through normal child-to-child contact

Through adult contact with bodily fluids

Each type of contact has different degrees of risk.

Mother-to-Infant Transmission

CMV that’s transmitted from mothers to infants is one of the most serious forms of the virus, causing life-threatening infections in babies. If you’re pregnant and have CMV, your doctor will want to take special precautions to try to prevent your baby from getting the virus.

Childhood Transmission

Childhood transmission is usually not serious. School-aged children pass CMV to each other via contact with other children’s saliva, urine, or nasal secretions. Childhood CMV usually remains dormant for many years, with no symptoms or illness.

Adult Transmission

Adult transmission or reinfection is serious. You can acquire or re-acquire CMV as an adult through blood transfusions, sexual contact, or other exchanges of body fluids. If you had latent CMV exposure as a child, re-exposure as an adult can trigger serious illness. Activated CMV can cause many illnesses, such as:

CMV retinitis

CMV colitis

CMV adrenalitis

CMV pneumonia

CMV esophagitis

How Does CMV Become CMV Esophagitis?

Your oesophagus is the long tube that extends from your throat to your stomach. If CMV infects your oesophagus, you can develop CMV esophagitis, which is a very painful infection.

Prevalence and Risk Factors

Between 50 and 80 per cent of people in the United States are infected by CMV by age 40, according to the Centers for Disease Control and Prevention (CDC). In most cases, CMV remains inactive and causes no symptoms.

The people at greatest risk of serious CMV infections are those whose immune systems are weakened, such as:

People who have HIV or AIDS

People who’ve received a transplant and are using immunosuppressive drugs

People who have cancer

People who take long-term corticosteroids, such as prednisone

People who are very sick

Older adults

How Is CMV Esophagitis Diagnosed?

The primary and most accurate diagnostic test for CMV esophagitis is the esophagogastroduodenoscopy (EGD), which is also known as an upper GI endoscopy. The test allows your doctor to visually look at your entire intestinal tract and take biopsies of damaged tissue.

This EGD is performed as an office procedure, usually under local anaesthetic. While lying on your side, you’ll be fitted with a mouthpiece. Your doctor will insert a long, flexible tube through the mouthpiece, down your throat, and into your stomach so they can inspect your intestinal tract.

Your doctor will first look for signs of CMV, such as shallow ulcers on the walls of your oesophagus. Samples of diseased tissue may be taken through the endoscope. The tissue samples will be examined in a lab for abnormal cells and tested for different types of antigens and viruses. This is known as a biopsy. The results will help your doctor determine whether your condition is from CMV or another cause.

How Is CMV Esophagitis Treated?

Your doctor may prescribe intravenous (IV) ganciclovir, which is an antiviral drug used for both HIV and CMV infections. If for any reason ganciclovir can’t be used, other effective treatments include valganciclovir, cidofovir, or foscarnet. In some cases, combination therapy of two or more drugs may be recommended.

However, serious side effects have been reported when people take multiple drugs, so your doctor will probably try treating your condition with one at a time initially.

What Is the Outlook for People with CMV Esophagitis?

Your outlook is fairly good if you’re relatively healthy, contract CMV esophagitis, and get treated early. If you have damaged immunity, your outlook for CMV-related diseases depends on many factors. Speak with your doctor to learn more.

Can CMV Esophagitis Be Prevented?

You probably won’t be able to prevent the childhood form of CMV. The virus is common and mostly harmless. Preventing adult transmission or retransmission is far more important. The best way to avoid CMV as an adult is to practice safe sex and avoid sharing needles and exchanging bodily fluids with others.

Preventing transmission from mothers to infants is an important focus of research. Scientists are working on CMV vaccines for young women in the hopes of one day preventing transmission from mothers to babies.