VZV in the Enteric Nervous System: Pathogenesis and Consequences

What this Trial Is About

Varicella zoster virus (VZV), known for causing chickenpox and shingles, can also infect nerve cells in the digestive system, leading to a condition called enteric shingles. Researchers found that a chronic active VZV infection in the esophagus may be linked to achalasia, a severe disorder that affects the movement of food from the esophagus to the stomach. This study aims to explore whether treating VZV can improve achalasia symptoms, identify genetic factors related to VZV reactivation in the esophagus, and understand the role of mast cells in this condition. Participants with achalasia who test positive for VZV DNA in their saliva will receive valacyclovir, an antiviral medication, taken three times daily for two months. Those who benefit from this treatment will be offered the Shingrix vaccine in two doses during the same period. The study will assess how antiviral therapy affects achalasia symptoms and esophageal function, compare viral loads between achalasia types, and investigate the involvement of mast cells in VZV reactivation. Throughout the study, participants will undergo tests including timed barium swallow and esophageal manometry to evaluate esophageal function. Researchers will monitor viral activity, genetic markers, and symptoms related to achalasia over four months to one year. The main outcome is the response of VZV-associated achalasia to antiviral treatment within four months, with additional measures tracking viral load differences, genetic findings, and mast cell activity over one year. The total participation period extends up to a year to fully understand the treatment effects and disease mechanisms.

VZV in the Enteric Nervous System: Pathogenesis and Consequences