Gockel H R, Gockel I, Drescher D G, Müller H, Schad A, Kittner J M, Rossmann H, Lang H
Klinik für Allgemein- und Abdominalchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Chirurg. 2011 Nov;82(11):1021-6. doi: 10.1007/s00104-011-2140-6.
Esophageal involvement in the context of opportunistic infections in human immunodeficiency virus (HIV) positive patients is a frequent phenomenon. However, worldwide esophageal achalasia has been described only twice in HIV-infected patients.We report the case of a 44-year-old Caucasian patient with HIV and Hepatitis C virus (HIV/HCV) coinfection who, within 2.5 years, displayed a progressive symptomatology with dysphagia, retrosternal pain, regurgitation as well as a considerable loss of weight before achalasia was finally diagnosed. Treatment was performed primarily surgically by means of laparoscopic Heller myotomy with an anterior 180° semifundoplication according to Dor.Histopathology of the specimens taken from the lower esophageal sphincter high-pressure zone proved alterations with abundant connective tissue and only scarce parts of the smooth muscular system without inflammatory infiltrations. In addition, the ganglia cells of the myenteric plexus as well as the interstitial cells of Cajal were significantly reduced. Interestingly, specific gene sequences of the hepatitis C virus could be detected in the esophageal tissue specimen. In contrast, analysis of specific HIV-gene sequences in the same tissue revealed a negative result.The possible but previously unknown relationship between esophageal achalasia and coinfection with HIV and HCV, also described as neurotropic viruses, will be discussed.
在人类免疫缺陷病毒（HIV）阳性患者的机会性感染背景下，食管受累是一种常见现象。然而，全球范围内仅报道过两例HIV感染患者发生食管贲门失弛缓症。我们报告了一例44岁的白种人患者，该患者同时感染了HIV和丙型肝炎病毒（HIV/HCV），在2.5年的时间里，患者出现了进行性症状，包括吞咽困难、胸骨后疼痛、反流以及体重显著减轻，最终被诊断为贲门失弛缓症。主要通过腹腔镜下Heller肌切开术及根据Dor法进行的180°前位半胃底折叠术进行手术治疗。取自食管下括约肌高压区的标本组织病理学检查证实存在改变，结缔组织丰富，平滑肌系统仅存稀少部分，无炎性浸润。此外，肌间神经丛的神经节细胞以及Cajal间质细胞显著减少。有趣的是，在食管组织标本中可检测到丙型肝炎病毒的特定基因序列。相比之下，对同一组织中特定HIV基因序列的分析结果为阴性。本文将讨论食管贲门失弛缓症与HIV和HCV合并感染（也被称为嗜神经病毒）之间可能存在但此前未知的关系。
