How is herpes esophagitis differentiated from Candida esophagitis?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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Occasionally, herpes esophagitis manifests as multiple plaquelike lesions in the esophagus, but this infection is more commonly associated with small superficial ulcers (see below). Superficial spreading carcinoma may also manifest as a nodular mucosa, but the nodules tend to have poorly defined borders, producing a confluent area of disease.

Undissolved effervescent particles and debris in the esophagus can be mistaken for the plaques of candidiasis. Thus, if infectious esophagitis is suggested clinically, a double-contrast study should initially be performed without the use of effervescent granules.

Diagnosis of herpes esophagitis

In the appropriate clinical setting, discrete superficial ulcers in the upper or mid esophagus without associated plaques should be highly suggestive of herpes esophagitis. In contrast, ulceration in Candida esophagitis almost invariably occurs on a background of extensive plaque formation. Candida and herpes esophagitis can often be diagnosed on double-contrast studies, obviating endoscopy. However, if radiographic findings are equivocal or if the response to treatment is inadequate, endoscopy should be performed for a more definitive diagnosis.

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