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.