Document 0702
 DOCN  M95A0702
 TI    Management of HIV-associated esophageal disease. 
 DT    9510
 AU    Belitsos PC; Johns Hopkins University, AIDS Service, Baltimore, MD.
 SO    AIDS Clin Care. 1995 Mar;7(3):19-22. Unique Identifier : AIDSLINE
       AIDS/95700062
 AB    Esophageal conditions due to fungal, ulcerative, and neoplastic causes
       often signal the onset of symptomatic HIV infection. Most cases are
       fungal and due to Candida albicans, which is characterized by esophageal
       inflammation causing pain on swallowing (dysphagia and odynophagia).
       Ulcerative esophageal disease is commonly associated with
       cytomegalovirus (CMV), idiopathic causes, and herpes simplex virus
       (HSV). CMV, characterized by odynophagia resulting from ulcerations in
       the distal third of the esophagus, is clinically indistinguishable from
       idiopathic ulceration. HSV is more widespread and abrupt than other
       ulcerative processes, and its erosive injury can cause painful
       swallowing, ulceration and oral cavity lesions. Patients with esophageal
       distress, low CD4 counts, and little possibility of other GI conditions
       most likely suffer from Candida infection and should immediately begin
       an empiric trial of antifungal therapy. If an individual's first bout of
       odynophagia does not respond to empiric oral azole therapy, the
       diagnosis of fungal esophagitis is probably incorrect and an upper
       endoscopic evaluation should be performed. Patients generally respond
       quickly and completely to treatment of a first episode of fungal
       esophagitis; therefore, neither primary prophylaxis nor long-term
       suppressive therapy are recommended due to the risk of infection with a
       resistant strain. Failure of patients on suppressive therapy to respond
       to antifungal medication usually indicates resistant fungal infection
       that may require treatment with intravenous amphotericin. If
       CMV-isolated esophagitis is diagnosed, the patient should begin
       intravenous ganciclovir, followed by IV foscarnet if the healing after
       three weeks is minimal.
 DE    Antifungal Agents/THERAPEUTIC USE  CD4 Lymphocyte Count
       Candidiasis/COMPLICATIONS/PHYSIOPATHOLOGY/THERAPY  Deglutition
       Disorders/COMPLICATIONS/THERAPY  Esophageal
       Diseases/COMPLICATIONS/MICROBIOLOGY/PHYSIOPATHOLOGY/  THERAPY
       Esophageal Neoplasms/COMPLICATIONS/THERAPY  Ganciclovir/THERAPEUTIC USE
       HIV Infections/*COMPLICATIONS  Human  Lymphoma,
       Non-Hodgkin's/ETIOLOGY/THERAPY  Sarcoma, Kaposi's/ETIOLOGY/THERAPY
       Ulcer/COMPLICATIONS/THERAPY  NEWSLETTER ARTICLE

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