Cytomegalovirus esophagitis, or CMV esophagitis, is a serious infection of the esophagus triggered by the cytomegalovirus (CMV). Cytomegalovirus esophagitis is really two conditions; the cytomegalovirus itself, and the esophagitis that occurs as a result of CMV.
The cytomegalovirus (CMV) is a common virus in the same family as the herpes, shingles, and Epstein-Barr viruses. CMV can live in the body in a dormant state for many years. Later in life, it can become activated and dangerous if the body’s immune system becomes weakened, or if you are re-exposed to the virus.
When CMV becomes activated, it can invade various body parts and organs, causing serious infections. CMV esophagitis is one example of what happens when active CMV infects a specific body part.
Between 50 percent and 80 percent of adults in the United States are positive for CMV antibodies but display no symptoms. This means they have been infected with the virus but show no signs that they have been infected. For persons over the age of 80, the infection rate is closer to 90 percent. In most cases, CMV remains inactive, with no symptoms.
Persons at greatest risk for serious CMV infections are those whose immune systems are weakened, such as:
- HIV and AIDS patients
- transplant recipients using immunosuppressive drugs
- persons using prednisone
- elderly or very sick persons
The cytomegalovirus is transmitted 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 is one of the most serious forms of CMV, causing life-threatening infections in babies. If you are pregnant and have CMV, your doctor will want to take special precautions to try to prevent transmission to your baby.
Childhood transmission is usually not serious. School-age children pass CMV to each other via contact with other children’s respiratory sprays, saliva, or bodily fluids. Childhood CMV usually remains dormant for many years, with no symptoms or illness.
Adult transmission or reinfection is also serious. CMV can be acquired, or re-acquired 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, including, among others:
- CMV retinitis
- CMV colitis
- CMV adrenalitis
- CMV pneumonia
- CMV esophagitis
How Does CMV Become CMV Esophagitis?
Your esophagus is the long tube that extends from your throat to your stomach. If CMV infects the esophagus, it becomes CMV-esophagitis, a very painful infection.
CMV esophagitis exhibits a wide range of symptoms, including:
- difficult or painful swallowing
- stomach pain and heartburn
- nausea and vomiting
- coughing up blood
Symptoms can become so severe that you lose your appetite, lose weight, and become undernourished. Poor nutrition can further weaken your immune system.
The primary diagnostic test for CMV esophagitis is the esophagogastroduodenoscopy (EGD), also known as an upper GI, or an endoscopy. The test allows your doctor to visually inspect your entire intestinal tract and take biopsies of damaged tissue.
This EGD is performed as an office procedure under local anesthetic. While lying on your side, you will be fitted with a mouthpiece. A long, flexible tube will be inserted through the mouthpiece, down your throat, and into your stomach so the doctor can inspect your intestinal tract.
The doctor will first look for signs of CMV such as shallow ulcers on the walls of the esophagus. Samples of diseased tissue (biopsies) 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. The results will help determine whether your condition is from CMV or a different condition.
Your doctor may prescribe ganciclovir, an antiviral drug used for both HIV and CMV infections. If for any reason ganciclovir cannot be used, foscarnet may be prescribed. In some cases, the two drugs may be used together. However, serious side effects have been reported when the drugs are combined, so it is likely that your doctor will try treating you with only one at a time before going to a combination.
Prevention of the childhood form of CMV is probably not realistic. It’s everywhere, and is 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.
If you are a relatively healthy individual who contracts CMV esophagitis, your prognosis is fairly good if you get treated early. However, in persons with damaged immunity, the prognosis for CMV-related diseases depends on many factors.