Timing and necessity of endoscopy in AIDS patients with dysphagia or odynophagia

BACKGROUND/AIMS: Dysphagia and odynophagia are common problems with signifi cant morbidity in acquired immunodeficiency syndrome (AIDS) patients. Endos copy in AIDS patients with esophageal symptoms is valuable for diagnosis, b ut the timing and necessity of routine endoscopy remains controversial. METHODOLOGY: We retrospectively studied 40 AIDS patients undergoing upper g astrointestinal endoscopy. Among them, 25 patients were enroled with dyspha gia and/or odynophagia and were put on empirical fluconazole treatment befo re endoscopic evaluation. RESULTS: Fourteen (56%) of 25 patients improved after fluconazole treatment , while II patients had persistent symptoms. Among the 14 patients with sym ptomatic improvement, 7 were found to have esophageal candidiasis which imp roved after continuation of fluconazole for 1-2 more weeks. The other 7 pat ients had a normal endoscopic appearance. In contrast, among II patients wi th persistent symptoms, there were 3 patients with azole-resistant candidia sis, 3 with cytomegalovirus esophagitis, 1 with herpes simplex virus esopha gitis with candidiasis, 1 with Kaposi's sarcoma, and 3 with idiopathic esop hageal ulcer. They were successfully treated with Amphotericin B, Ganciclov ir, Acyclovior, and oral steroids, except for the patient with Kaposi's sar coma. CONCLUSIONS: Routine endoscopy may not necessarily be indicated in every AI DS patient with dysphagia or odynophagia. Empirical fluconazole treatment c an improve symptoms in 50% of patients. It is only indicated when patients have persistent symptoms after empirical treatment. With endoscopic examina tion, etiologic agents other than common candidiasis can be determined and the patients can thus be put on specific treatment.