IDIOPATHIC ESOPHAGEAL ULCERATION IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME - SUCCESSFUL TREATMENT WITH MISOPROSTOL AND VISCOUS LIDOCAINE

Objective: Esophageal ulceration is a common and important cause of mo rbidity in patients with acquired immunodeficiency syndrome (AIDS). Af ter known causes are excluded, a subgroup remains with unexplained eso phageal ulceration, known as idiopathic esophageal ulceration (IEU). T he current therapy of IEU includes corticosteroids or, less frequently , thalidomide, although no placebo-controlled trials have been reporte d. The aim of this retrospective study was to determine the outcome of treating IEU with misoprostol and viscous lidocaine. Methods: A retro spective review of esophageal ulceration in AIDS identified seven subj ects with IEU at our institution. IEU in these subjects was treated su ccessfully with misoprostol, 200 mu g, crushed and suspended in 2% vis cous lidocaine, 15 mi, given or ally a.c. and h.s. for 4 wk. Results: All patients reported symptomatic improvement within 2-3 days and comp lete resolution of their symptoms within 15 days. Healing of esophagea l ulcerations was confirmed in five of seven subjects at a repeat endo scopy 8-12 wk later. Conclusions: Misoprostol, an antiulcer drug, has GI cytoprotective properties, and viscous lidocaine, a topical anesthe tic, coats mucosal surfaces. We speculate that misoprostol when delive red topically is 3-6 times more effective than when delivered systemic ally. Considering the rapid resolution of symptoms, healing of ulcers, and lack of side effects, we believe that misoprostol crushed and sus pended in viscous lidocaine should be considered for further evaluatio n in prospective, placebo-controlled trials of IEU. (C) 1998 by Am. Co ll. of Gastroenterology.