Chemical and infectious oesophagitis
- Lesion
Caustic liquids, stuck tablets, radiation and germs can all inflame the oesophagus; each leaves its own pattern of injury.
What it is
The squamous lining of the oesophagus can be injured by alcohol, acids and alkalis, very hot drinks, heavy smoking, tablets that lodge and dissolve, chemotherapy, radiation and graft-versus-host disease. Infection is most often viral (herpes simplex, even in healthy people) or fungal (Candida), and is more frequent and severe in immunosuppressed patients. The pathologist tells the causes apart by the ulcer shape and the cells that carry inclusions.
Structure
- Radiation damage: intimal proliferation and narrowing of submucosal vessels, so mucosal injury is partly ischaemic.
- Graft-versus-host disease: basal-cell apoptosis, mucosal atrophy and submucosal fibrosis with little acute inflammation.
- Dense neutrophils mark most chemical and infectious injury.
Infectious oesophagitis: the three to tell apart
| Agent | Endoscopy | Where the inclusions are | Typical host |
|---|---|---|---|
| Candida | White plaques that can be scraped; pseudomembranes | No inclusions; hyphae and yeast in the pseudomembrane | Immunosuppressed, diabetes, antibiotics, inhaled steroids |
| Herpes simplex virus | Small punched-out vesicles and ulcers | Squamous cells at the ulcer edge: multinucleated, molded, ground-glass nuclei | Also healthy people |
| Cytomegalovirus | Shallow, sometimes large ulcers | Endothelial and stromal cells in the ulcer base, nuclear and cytoplasmic | Transplant, HIV, chemotherapy |
Clinical notes
- Caustic ingestion, accidental in children or deliberate in adults, can perforate and later leave long strictures with a higher cancer risk.
- Infectious oesophagitis in a person not known to be immunosuppressed should prompt an HIV test.
Test yourself
Think of the answer, then tap the question to see it.
Where do CMV inclusions appear in oesophagitis, and how does that differ from herpes?
CMV inclusions sit in endothelial and stromal cells of the ulcer base; herpes inclusions are in squamous cells at the ulcer edge.
What does Candida oesophagitis look like at endoscopy and under the microscope?
Grey-white adherent pseudomembranes made of matted fungal hyphae and inflammatory cells.
Why does pill oesophagitis favour certain sites?
Tablets lodge where the lumen is narrow, such as strictures, and dissolve against the mucosa.
Connections
Microorganisms3
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Esophagitis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.