Bashir R M, Wilcox C M
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
J Clin Gastroenterol. 1996 Dec;23(4):292-8. doi: 10.1097/00004836-199612000-00011.
The yield of upper gastrointestinal endoscopy (esophago-gastroduodenoscopy; EGD) in human immunodeficiency virus (HIV)-infected patients based on presenting symptoms has not been well studied. We studied consecutive patients with documented HIV infection undergoing EGD at a large innercity hospital between August 1, 1990 and December 31, 1993; all had presenting symptoms and indications for EGD prospectively recorded at the time of EGD. All endoscopic abnormalities were routinely subjected to biopsy, and extensive histopathological evaluation was performed. EGD was considered helpful when the findings stimulated specific therapeutic intervention other than antifungal or antacid medications. The specific indications for EGD in 156 patients were as follows: esophageal symptoms, 102 patients (65%); abdominal pain, 18 (12%); upper gastrointestinal bleeding, 25 (16%); refractory nausea and vomiting, 11 (7%). Overall, pathologic findings were identified in 116 patients (74%): in refractory esophageal symptoms, 82%; upper gastrointestinal bleeding, 92%; abdominal pain, 39%; nausea and vomiting, 27%. EGD with biopsy identified a specifically treatable opportunistic disorder other than Candida in 80 patients (51%), including idiopathic esophageal ulcer (22%) or viral esophagitis and/or duodenitis (29%). EGD was not helpful in 22.3% of cases, those involving Candida (12.3%) and peptic ulcer disease (PUD)-related causes (10%). The mean CD4 count of patients with opportunistic pathologic findings (24/mm3, n = 79) was significantly lower than that of patients with PUD/gastroesophageal reflux disease (GERD) (167/mm3, n = 9) or negative EGDs (165/mm3, n = 35). Overall, the results of EGD influenced patient management in 78% of cases. We conclude that selective symptom-specific use of EGD, particularly in patients with esophageal symptoms refractory to antifungal therapy or gastrointestinal bleeding, usually identifies specifically treatable abnormalities, whereas EGD is less useful for the evaluation of abdominal pain or nausea and vomiting.
基于现有症状，尚未对人类免疫缺陷病毒（HIV）感染患者进行上消化道内镜检查（食管胃十二指肠镜检查；EGD）的检出率展开充分研究。我们对1990年8月1日至1993年12月31日期间在一家大型市中心医院接受EGD检查的连续HIV感染确诊患者进行了研究；所有患者均有现有症状，且在进行EGD检查时前瞻性记录了EGD的适应证。所有内镜异常均常规进行活检，并开展广泛的组织病理学评估。当检查结果促使采取除抗真菌或抗酸药物之外的特定治疗干预措施时，EGD被视为具有帮助作用。156例患者进行EGD检查的具体适应证如下：食管症状，102例患者（65%）；腹痛，18例（12%）；上消化道出血，25例（16%）；难治性恶心和呕吐，11例（7%）。总体而言，116例患者（74%）发现了病理结果：难治性食管症状患者中，检出率为82%；上消化道出血患者中，为92%；腹痛患者中，为39%；恶心和呕吐患者中，为27%。经活检的EGD检查在80例患者（51%）中发现了除念珠菌病之外的可特异性治疗的机会性疾病，包括特发性食管溃疡（22%）或病毒性食管炎和/或十二指肠炎症（29%）。在22.3%的病例中，EGD检查并无帮助，这些病例涉及念珠菌病（12.3%）和消化性溃疡病（PUD）相关病因（10%）。出现机会性病理结果的患者的平均CD4细胞计数（24/mm³，n = 79）显著低于患有PUD/胃食管反流病（GERD）的患者（167/mm³，n = 9）或EGD检查结果为阴性的患者（165/mm³，n = 35）。总体而言，在78%的病例中，EGD检查结果影响了患者的治疗管理。我们得出结论，针对特定症状选择性地使用EGD检查，尤其是在对抗真菌治疗无效的食管症状患者或胃肠道出血患者中，通常能发现可特异性治疗的异常情况，而EGD检查对评估腹痛或恶心和呕吐的作用较小。
