Gane E J, Thomas M G, Nicholson G I, Lane M R
Gastroenterology Department, Auckland Hospital.
N Z Med J. 1992 Nov 25;105(946):475-6.
To determine the diagnostic accuracy of upper gastrointestinal endoscopy in a selected group of patients with HIV infection, who had severe symptoms unresponsive to empirical treatment.
We reviewed all patients with HIV infection, who had undergone upper gastrointestinal endoscopy at Auckland Hospital. Specific diagnoses were based on the endoscopic appearances and on the histological and microbiological examination of endoscopic biopsies taken from the oesophagus, stomach and duodenum.
A definitive diagnosis was reached in 16 of the 21 patients endoscoped, of whom 13 had a good clinical response to treatment. The median survival was three months. The most common diagnosis was oesophageal candidiasis seen in six patients, all of whom responded to treatment with a median survival of six months. Invasive cytomegalovirus gastrointestinal disease was seen in three patients, none of whom had positive blood cultures for cytomegalovirus. All responded to intravenous ganciclovir. Three patients with severe diarrhoea had opportunistic infection of the small bowel. All three had advanced AIDS with a median survival of less than one month.
Upper gastrointestinal endoscopy has a high diagnostic yield in patients with HIV infection with oesophageal symptoms which fail to respond to antifungal therapy, or with severe weight loss and diarrhoea and it should be considered in these patients because excellent palliation may be possible.
确定上消化道内镜检查对一组选定的HIV感染患者的诊断准确性，这些患者有严重症状且对经验性治疗无反应。
我们回顾了所有在奥克兰医院接受过上消化道内镜检查的HIV感染患者。具体诊断基于内镜表现以及取自食管、胃和十二指肠的内镜活检组织的组织学和微生物学检查。
接受内镜检查的21例患者中有16例得到明确诊断，其中13例对治疗有良好的临床反应。中位生存期为三个月。最常见的诊断是食管念珠菌病，见于6例患者，所有患者对治疗均有反应，中位生存期为6个月。3例患者出现侵袭性巨细胞病毒胃肠道疾病，所有患者的巨细胞病毒血培养均为阴性。所有患者对静脉注射更昔洛韦均有反应。3例严重腹泻患者出现小肠机会性感染。所有3例患者均患有晚期艾滋病，中位生存期不到1个月。
上消化道内镜检查对有食管症状且对抗真菌治疗无反应或有严重体重减轻和腹泻的HIV感染患者具有较高的诊断率，对于这些患者应考虑进行内镜检查，因为可能实现良好的姑息治疗效果。
