Bacterial infections

The greatest risk factors for occurrence of bacterial infections of the esophagus are granulocytopenia (as seen in patients undergoing chemotherapy) and hypochlorhydria or acid suppression.42 Despite often being unrecognized, bacterial esophagitis may have significant clinical relevance. Infection is usually polymicrobial and consists mainly of oral and upper respiratory flora (e.g. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus viridans). It is possible that these organisms invade and colonize esophageal mucosa damaged by gastroesophageal reflux. Clinical presentation includes classical symptoms such as dysphagia, odynophagia and chest pain. Endoscopic pictures are non-specific and consist of ulcerations, discrete plaques, pseudomembranes and mucosal friability. Histology shows bacteria on Gram stain, but culture is not useful, since non-pathological bacteria can grow as well. The clinical course is usually mild and asymptomatic. At histology, features of bacterial invasion (either superficial or transmural) can be evident. Treatment consists of broad-spectrum antibiotics such as ampicillin-sulbactam or ticarcillin-clavulanic acid, which effectively treat both Gram-positive and -negative oropharyngeal flora. In patients systemically ill, combined therapy with a ß-lactam/aminoglycoside or monotherapy with a carbapenem should be considered.

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