Esophageal strictures complicating ulcerative esophagitis in patients with AIDS

Abstract

Objective: Esophageal strictures have been reported to complicate opportunistic esophageal infections in human immunodeficiency virus (HIV)-infected patients, although the etiology, prevalence, and incidence of strictures after these infections have not been studied.

Methods: HIV-infected patients undergoing upper endoscopy for clinical indications over a 7.5-yr period were prospectively identified. The cause of esophageal ulceration was defined by previously proposed criteria. Endoscopic re-examination was performed in most patients after treatment, and long term clinical follow-up was obtained. An esophageal stricture was defined as circumferential luminal narrowing of > or = 30% at endoscopy and/or barium esophagography.

Results: A total of 160 HIV-infected patients were identified with esophageal ulcer. Of these patients, 13 (8%; 95% CI 4-12%) developed esophageal strictures. Strictures were identified at the time of initial endoscopy in three patients (cytomegalovirus [CMV] in one patient and gastroesophageal reflux disease in two), and at the site of ulcer healing or persistence in the other patients (four, CMV; four, idiopathic; one, herpes simplex virus [HSV]; one, CMV/HSV). Long term follow-up did not identify any additional patients who developed an esophageal stricture.

Conclusion: Esophageal strictures infrequently complicate ulcerative esophagitis caused by opportunistic infections in HIV-infected patients.