Original article The clinical characteristics and manifestations of cytomegalovirus esophagitis H.-W. Wang, 1, * C.-J. Kuo, 1,2, * W.-R. Lin, 1,2 C.-M. Hsu, 1 Y.-P. Ho, 1 C.-J. Lin, 1 M.-Y. Su, 1,2 C.-T. Chiu, 1,2 C.-L. Wang, 3 K.-H. Chen 4 1 Department of Gastroenterology and Hepatology, 3 Department of Thoracic Medicine, 4 Department of Pathology, Chang Gung Memorial Hospital, and 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan SUMMARY. Esophagitis is the second most common gastrointestinal manifestation of cytomegalovirus (CMV) infection after colitis. CMV esophagitis has been reported in patients who have undergone transplantation, are on long-term renal dialysis, or who have the human immunodeficiency virus infection. This study aimed to investigate the clinical characteristics and manifestations of CMV esophagitis in patients who underwent diagnostic endos- copy. A total of 16 patients with histologically proven CMV infection were identified from 1539 patients with esophageal ulcers and analyzed retrospectively (January 2006 to December 2013). Patients’ personal data (age, smoking, and alcohol consumption), underlying systemic diseases (diabetes mellitus, end-stage renal disease, and chronic obstructive pulmonary disease), malignancy, indication for esophagogastroduodenoscopy, endoscopic char- acteristics, and diagnostic methods (pathological or serological findings) were collected for further analysis. Among the patients with CMV esophagitis, the mean age was 59.94 years (range, 23–84 years). The male : female ratio was 1.67:1. Odynophagia and epigastralgia were common symptoms. Of the 16 patients, 3 (18.75%) were infected with the human immunodeficiency virus and 9 (56.25%) had an underlying malignancy, including lung cancer (6 patients), esophageal cancer (2 patients), gastric cancer (1 patient), ampulla of Vater cancer (1 patient), and lymphoma (1 patient). Six of the 9 patients (66.7%) with malignancy had been administered concurrent chemoradiotherapy (CCRT). In this study, patients with malignancy who had been administered CCRT were at increased risk for CMV esophagitis, which had not been reported before in the literature. CMV esophagitis should be considered as a potential treatment-related complication of CCRT. KEY WORDS: cytomegalovirus esophagitis, concurrent chemoradiotherapy, ulcer. INTRODUCTION Esophagitis is the second most common gastrointes- tinal (GI) manifestation of cytomegalovirus (CMV) infection after colitis. CMV esophagitis has been reported in patients who have undergone organ transplantation, are on long-term renal dialysis, or have human immunodeficiency virus (HIV) infection or a hematological malignancy. 1–6 Patients who are being administered immunosuppressive therapy or chemotherapy are also at increased risk for CMV infection and disease. CMV infection in the GI tract has various manifestations, such as difficulty in or painful swallowing (59%), nausea/vomiting (42%), abdominal pain (19%), weight loss (25%), and diar- rhea (20%). 7 The preferred diagnostic procedure is to perform endoscopy to identify any mucosal lesions and to obtain a tissue biopsy or sample using mucosal brushing. Our study aimed to investigate the clinical charac- teristics and manifestations of CMV esophagitis in patients who underwent diagnostic endoscopy. We found that patients with malignancy who had Address correspondence to: Dr Cheng-Tang Chiu, MD, Department of Gastroenterology and Hepatology, Chang Gung University, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Queishan, Taoyuan County 333, Taiwan. Email: ctchiu@adm.cgmh.org.tw *These authors (Hung-Wei Wang and Chia-Jung Kuo) share co-first authorship. Specific author contributions: Hung-Wei Wang, MD: acquisition of data, interpretation of data, and first draft of the manuscript. Chia-Jung Kuo, MD: interpretation of data, critical revision of the manuscript for importance, and study design and concept. Wey-Ran Lin, MD: contribution to conception. Chen-Ming Hsu, MD: contribution to conception. Yu-Pin Ho, MD: contribution to conception. Chun-Jung Lin, MD: contribution to conception. Ming-Yao Su, MD: contribution to conception. Cheng-Tang Chiu, MD: study design and concept, and contribution to conception. Chih-Liang Wang, MD: contribution to conception. Kuang-Hua Chen, MD: pathology of biopsy and contribution to conception. Diseases of the Esophagus (2015) ••, ••–•• DOI: 10.1111/dote.12340 © 2015 International Society for Diseases of the Esophagus 1 V C 2015 International Society for Diseases of the Esophagus 392 Diseases of the Esophagus (2016) 29, 392–399 DOI: 10.1111/dote.12340 Downloaded from https://academic.oup.com/dote/article/29/4/392/2328760 by guest on 22 July 2022