ESOPHAGEAL DISEASE IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Up to 40% of patients with the acquired immunodeficiency syndrome may develop symptoms of esophageal disease. Candida esophagitis is respons ible for the majority of the cases of esophageal disease; cytomegalovi rus, herpes simplex, idiopathic esophageal ulcers, and Kaposi's sarcom a account for most of the remaining cases. Although endoscopy with eso phageal biopsy and brushing is the gold standard for the diagnosis of esophageal disease in the acquired immunodeficiency syndrome, we gener ally recommend initial empiric therapy with an antifungal agent in pat ients with esophageal symptoms. Since effective treatment is available for most cases of esophageal disease in the acquired immunodeficiency syndrome, we recommend endoscopic evaluation in patients who do not r espond to empiric therapy within 1 to 2 weeks.