**6.1 Treatment of fungal esophagitis**

Antifungal drugs are normally used in the treatment of candidiasis in the throat, mouth or esophagus. The treatments for are categorized thus [18]:


An antifungal medication that is applied to the inside of the mount between seven to 14 days is normally used in the treatment of mild to moderate infections of the throat or mouth. These drugs include clotrimazole, miconazole or nystatin. The most common treatment for severe fungal infections is fluconazole, which is an antifungal medicine that is taken by mouth or administered intravenously. If the patient does not respond to fluconazole, a different antifungal drug should be prescribed. The treatment for *Candida* esophagitis is fluconazole. However, another type of antifungal medication should be given to people who cannot tolerate fluconazole or who do not respond to the treatment with it.

It is important to note that treatment option chosen for a patient will depend on the severity of infection and the extent of the host defense impairment. For exam0ple, majority of immonocompetent people with fungal esophagitis can be treated with a topical antifungal medicine, which do not have adverse side effects, have only few or even any drug to drug interactions as the drugs are not absorbable in nature.

#### **6.2 Treatment of HSV esophagitis**

HSV esophagitis diagnosed at endoscopy can be treated with medications such as acyclovir (Zovirax); valacyclovir (Valtrex); famiciclovir (Valtrex), an acyclovir analog; and foscamet (for acyclovir-resistant cases). Pain relief medicines bought over the counter at pharmacies may also help in relieving pain caused be HPV esophagitis. Long term prescription of antiviral drugs can also be used in the prevention of the development of recurrent outbreaks of HSV esophagitis.

#### **6.3 Treatment of CMV esophagitis**

CMV is similar to HSV, as it is member of the *herpesviridae* family of viruses. Induction therapy for three to six weeks is used in the treatment of CMV esophagitis, but the optimal period of the treatment not yet well defined. The maintenance treatment for CMV is controversial. Overall, intravenously administered ganciclovir 5 mg/kg or foscarnet 90 mg/kg is the recommended treatment for induction therapy. As both ganciclovir and foscarnet are potent viral agents that have significant bone marrow and renal toxicities, extra care should be taken before they are prescribed to patients, by taking careful medical and drug histories form the patients, including any side effects they had had in the past.

It is also important to note that HIV esophagitis is treated differently from CMV esophagitis, but the two diseases cannot be simply separated on the basis of the clinical and radiographic results. Hence endoscopic investigation should be undertaken for a confirmatory diagnosis before patients are treatment in order to achieve a better clinical outcome. In addition, endoscopy has over 95% sensitivity in the diagnosis of CMV esophagitis.

#### **6.4 Treatment of HIV esophagitis**

HIV esophagitis is treated with oral corticosteroid therapy normally for over one month with antiretroviral therapy for HIV in contrast to CMV esophagitis.

#### **6.5 Treatment of VZV esophagitis**

Acyclovir, famciclovir or foscarnet (for acyclovir-resistant cases) are typically used in the treatment of VZV esophagitis.

#### **6.6 Treatment of EBV esophagitis**

Acyclovir is used in the treatment of EBV esophagitis. In order to suppress oral hairy leukoplaria, long term maintenance therapy may also be required for the patient.

#### **6.7 Treatment of HPV esophagitis**

No treatment is normally required, as HPV esophagitis is usually asymptomatic. Some medicines such as systemic interferon alfa, bleomycin and etoposide have been used in patients' treatments with variable outcomes.

#### **6.8 Treatment of** *M. tuberculosis* **esophagitis**

In the immunocompetent people, standard antituberculous therapy has been used in the treatment of mycobacterium tuberculosis esophagitis.
