0071643192.pdf

ESOPHAGEAL DISORDERS

Infectious Esophagitis

Infectious esophagitis is usually seen in patients who are immunosuppressed,
ie, AIDS patients.

SYMPTOMS

Chest pain, odynophagia, dysphagia, symptoms of dehydration

EXAM

■ Oral lesions are not reliable diagnostic indicators.
■ Shoddy cervical lymphadenopathy

DIFFERENTIAL

■ Noninfectious esophagitis: Reflux, pill, caustic ingestion, radiation,
eosinophilic, autoimmune (eg, Crohn’s, Behçet’s)
■ Functional dyspepsia, esophageal stricture, mass lesion, motility disorders,
graft-versus-host disease
■ Cardiac disease

DIAGNOSIS

■ Endoscopy and biopsy
■ Viral infections (eg, CMV, HSV, EBV) and fungal infections are less com-
mon but may be seen in patients with severe immunosuppression.

TREATMENT

■ Treat or adjust underlying immunosuppression.
■ Candida albicans:Treatment depends on host immune status.
■ Immunocompetent patients: Topical therapy; nystatin swish and swal-
low five times a day ×7–14 days; test for HIV
■ Immunocompromised patients: Oral therapy, initially with flucona-
zole 100–200 mg/day; if the patient is unresponsive, consider increas-
ing fluconazole or giving itraconazole, other azoles, caspofungin, or
amphotericin
■ CMV: Ganciclovir 5 mg/kg IV BID ×3–6 weeks
■ HSV: Acyclovir 200 mg PO five times a day or valacyclovir 1000 g PO
BID
■ Idiopathic ulcers:Trial of prednisone

COMPLICATIONS

■ Dehydration, requiring admission for IV resuscitation
■ Stricture, malnutrition, hemorrhage

Inflammatory Esophagitis

This inflammatory response in the esophagus may be caused by medications
and pills, eg, bisphosphonates, tetracyclines (especially doxycycline), and
NSAIDs.

SYMPTOMS

Chest pain and odonyphagia

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Advanced AIDS (CD4 count

<200) should make you more

aware of the potential for

esophageal candidiasis.