Document 0400
 DOCN  M9590400
 TI    Esophageal ulceration in human immunodeficiency virus infection. Causes,
       response to therapy, and long-term outcome.
 DT    9509
 AU    Wilcox CM; Schwartz DA; Clark WS; Emory University School of Medicine,
       Atlanta, Georgia, USA.
 SO    Ann Intern Med. 1995 Jul 15;123(2):143-9. Unique Identifier : AIDSLINE
       MED/95297746
 AB    OBJECTIVE: To determine the causes of esophageal ulceration, the
       response rate to currently available therapies, and the long-term
       outcome in patients with human immunodeficiency virus (HIV) infection.
       DESIGN: Prospective cohort study. SETTING: An urban county hospital.
       PATIENTS: Consecutive patients with HIV infection and endoscopically
       detected esophageal ulceration during a 4-year period. INTERVENTION:
       Causes of ulcers were determined from clinical, endoscopic, and
       pathologic findings. Standard medical therapies for the identified
       causes were instituted, and ulcer healing was endoscopically confirmed
       when possible. MEASUREMENTS: Symptomatic and endoscopic response to
       therapy and long-term outcome, including survival. RESULTS: 100 patients
       with esophageal ulcer were identified. Ulcers caused by cytomegalovirus
       alone were the most common (n = 45); idiopathic ulcers were almost as
       frequent (n = 40). Herpes simplex virus esophagitis alone was identified
       as a cause in only 5 patients. Several potential causes of ulcer were
       found in 5 patients, including Candida esophagitis in 27 patients. Ten
       patients developed more than one cause of ulceration during long-term
       follow-up. Eighty-five patients had specific medical therapy for their
       identified disorders and had an overall response rate of 98%. Median
       survival from time of diagnosis was 8.9 months (range, 2 days to > 42
       months). A difference in median survival was found between patients with
       cytomegalovirus esophagitis and those with idiopathic esophageal ulcer
       (7.6 months compared with 13.1 months; P = 0.03). CONCLUSIONS: Given 1)
       the broad spectrum of causes of esophageal ulceration, 2) that each of
       these causes requires specific therapy, and 3) the apparent high
       response rate, it is important to do endoscopic evaluation with mucosal
       biopsy in patients with HIV infection so that a diagnosis can be
       established and appropriate therapy instituted. Despite effective
       therapy, long-term survival is poor; however, long-term remission and
       survival may occur in some patients.
 DE    Adult  AIDS-Related Opportunistic Infections/COMPLICATIONS  Esophageal
       Diseases/DRUG THERAPY/*ETIOLOGY/PATHOLOGY  Esophagitis/COMPLICATIONS
       Esophagoscopy  Human  HIV Infections/*COMPLICATIONS/MORTALITY
       Prospective Studies  Survival Analysis  Treatment Outcome  Ulcer/DRUG
       THERAPY/*ETIOLOGY/PATHOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).