Wilcox C M, Straub R F, Alexander L N, Clark W S
School of Medicine, Division of Digestive Diseases, Grady Memorial Hospital, Atlanta, Georgia, USA.
Am J Med. 1996 Dec;101(6):599-604. doi: 10.1016/s0002-9343(96)00303-8.
To determine the etiologies of esophageal symptoms in human immunodeficiency virus (HIV)-infected patients failing antifungal treatment.
Between August 1, 1990 and December 31, 1994, all HIV-infected patients seen at a large inner-city hospital who had esophageal complaints despite being on antifungal therapy were prospectively evaluated for the cause of symptoms. Thus, the population studied included patients given empiric antifungal therapy for esophageal symptoms and patients who developed symptoms while on long-term antifungal therapy. Endoscopy was performed in all patients. The cause of symptoms was determined by the clinical, endoscopic, and pathologic findings, and follow-up after treatment.
Over the 53-month study period, 74 patients failing empiric antifungal therapy were identified. The majority (77%) of these patients had esophageal ulcers; 25 patients had idiopathic ulcers and 24 had cytomegalovirus. In 2 patients, Candida was present with other causes of ulcerative esophagitis. Candida esophagitis alone was diagnosed in only 3 patients. No endoscopic abnormalities were observed in 14 patients (19%). An additional 24 patients developed esophageal symptoms while receiving antifungal therapy; endoscopic findings in these patients included ulceration in 16 (67%), Candida esophagitis alone in 2, and normal in 6. Empirically treated patients in whom odynophagia was not the only symptom, those with dysphagia alone, and those with a CD4 count > 100/mm3 were less likely to have an endoscopic diagnosis.
Esophageal ulceration is the most common cause of esophageal symptoms in HIV-infected patients failing empiric antifungal therapy and those developing symptoms while receiving antifungal agents. Given these findings, endoscopy should be the test of choice for these nonresponders, rather than escalating the dose of antifungal agent, adding other empiric treatments, or performing barium esophagography.
确定接受抗真菌治疗但失败的人类免疫缺陷病毒（HIV）感染患者出现食管症状的病因。
在1990年8月1日至1994年12月31日期间，前瞻性评估了一家大型市中心医院中所有尽管接受抗真菌治疗但仍有食管不适症状的HIV感染患者的症状病因。因此，研究人群包括因食管症状接受经验性抗真菌治疗的患者以及在长期抗真菌治疗期间出现症状的患者。所有患者均接受了内镜检查。根据临床、内镜和病理检查结果以及治疗后的随访情况确定症状病因。
在为期53个月的研究期间，共确定了74例经验性抗真菌治疗失败的患者。这些患者中的大多数（77%）患有食管溃疡；25例为特发性溃疡，24例为巨细胞病毒感染。2例患者中，念珠菌与其他溃疡性食管炎病因并存。仅3例患者被诊断为单纯念珠菌性食管炎。14例患者（19%）未观察到内镜异常。另外24例患者在接受抗真菌治疗期间出现食管症状；这些患者的内镜检查结果包括16例（67%）有溃疡，2例为单纯念珠菌性食管炎，6例正常。经验性治疗的患者中，吞咽痛不是唯一症状的患者、仅吞咽困难的患者以及CD4细胞计数>100/mm³的患者内镜诊断的可能性较小。
食管溃疡是接受经验性抗真菌治疗失败以及接受抗真菌药物治疗期间出现症状的HIV感染患者食管症状的最常见原因。鉴于这些发现，对于这些治疗无反应的患者，内镜检查应作为首选检查，而不是增加抗真菌药物剂量、添加其他经验性治疗或进行食管钡餐造影。
