ESOPHAGEAL MOTILITY IN AIDS PATIENTS WITH SYMPTOMATIC OPPORTUNISTIC INFECTIONS OF THE ESOPHAGUS

Objectives: In patients with AIDS, esophageal symptoms are commonly du e to opportunistic esophageal infection with Candida, cytomegalovirus (CMV), herpes simplex virus (HSV), and HIV. Despite apparently appropr iate therapy against these pathogens, some patients continue to compla in of dysphagia or odynophagia. This study was designed to determine w hether such complaints were associated with a motility disorder of the esophagus. Methods: Sixteen patients underwent esophagoscopy and biop sy followed by esophageal manometry, performed using a 5-channel water perfused system (Synectics Medical, Inc., Irving, Texas). All patient s had odynophagia, and eight had dysphagia. Results: Identified infect ions included: Candida (11), HSV and Candida (1), CMV (3), and a giant ulcer presumably caused by HIV (1); one patient also had lymphoma. Se ven patients had normal esophageal motility, and in nine patients, a n onspecific motility disorder was found. After therapy, one of 10 patie nts had persistent odynophagia and dysphagia, and two had odynophagia only. At follow-up endoscopy, complete healing was demonstrated in six of eight patients with Candida. One of two patients with CMV and the patient with HSV also showed complete healing of the esophagus. Repeat esophageal motility studies were performed after therapy in 10 patien ts. Five had a persisting abnormality despite eradication of the patho gen (three Candida, one HSV, one CMV); in four, the previously identif ied motor abnormalities resolved after eradication of the infection (t hree Candida, one CMV). Conclusions: These findings suggest that a non specific motility disorder exists in AIDS patients with esophageal sym ptoms and may contribute to the persistence of symptoms despite approp riate therapy of esophageal opportunistic infections.