Parente F, Cernuschi M, Rizzardini G, Lazzarin A, Valsecchi L, Bianchi Porro G
Department of Gastroenterology, L. Sacco Hospital, Milan, Italy.
Am J Gastroenterol. 1991 Dec;86(12):1729-34.
To determine the spectrum of esophageal disease responsible for dysphagia/odynophagia in AIDS patients not responding to current oral antifungals, we studied 49 consecutive patients whose esophageal symptoms failed to improve after a minimum of 3 wk of therapy with oral ketoconazole or fluconazole. An esophageal candidiasis resistant to oral antifungals was the most frequent disease found (22 single infections and four mixed with viruses). Viral esophagitis was identified in 13 cases (eight herpes simplex virus and five cytomegalovirus), and an esophagitis of unknown origin was documented in two patients. Other causes of symptoms included peptic esophagitis (four cases), esophageal stenosis (two cases), and Kaposi's sarcoma of the esophagus (one patient). Most patients with esophageal opportunistic infection experienced prompt relief of symptoms and complete endoscopic resolution on the specific antifungal (amphotericin B or fluconazole iv) or antiviral (acyclovir or gancyclovir iv) therapy, with the exception of those with concomitant fungal and viral infection who responded poorly to treatment. We conclude that most AIDS patients with dysphagia/odynophagia who do not respond to oral antifungals have an opportunistic infection of the esophagus. Nevertheless, specific antifungal or antiviral therapy is worthwhile, because it will eradicate, at least temporarily, the causative pathogens in most such patients.
为确定导致艾滋病患者吞咽困难/吞咽痛且对当前口服抗真菌药无反应的食管疾病谱，我们研究了49例连续患者，这些患者在口服酮康唑或氟康唑至少3周治疗后食管症状未改善。对口服抗真菌药耐药的食管念珠菌病是最常见的疾病（22例单一感染，4例与病毒混合感染）。13例患者确诊为病毒性食管炎（8例单纯疱疹病毒感染，5例巨细胞病毒感染），2例患者记录为病因不明的食管炎。症状的其他原因包括消化性食管炎（4例）、食管狭窄（2例）和食管卡波西肉瘤（1例）。大多数食管机会性感染患者在接受特定的抗真菌（两性霉素B或静脉注射氟康唑）或抗病毒（阿昔洛韦或更昔洛韦静脉注射）治疗后症状迅速缓解，内镜检查完全恢复，但合并真菌和病毒感染的患者对治疗反应较差。我们得出结论，大多数对口服抗真菌药无反应的艾滋病吞咽困难/吞咽痛患者患有食管机会性感染。然而，特定的抗真菌或抗病毒治疗是值得的，因为它至少能暂时根除大多数此类患者的致病病原体。
