Which conditions should be included in the differential diagnoses of esophagitis in patients with HIV infection?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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Other causes of small superficial ulcers in the upper or middle esophagus include drug-induced esophagitis and Crohn disease. However, these entities usually can be differentiated from infectious esophagitis on the basis of the clinical history.

Diagnosis of cytomegalovirus esophagitis

Because herpetic ulcers rarely become as large as those of infectious esophagitis, the presence of one or more giant ulcers suggests the possibility of cytomegalovirus (CMV) esophagitis in patients with AIDS. However, in patients who are positive for human immunodeficiency virus (HIV), giant esophageal ulcers can also be caused by HIV (see below).

Other causes of giant esophageal ulcers include nasogastric intubation; endoscopic sclerotherapy; caustic injuries; and oral medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), potassium chloride, and quinidine. However, the correct diagnosis can almost always be suggested on the basis of the clinical history.

See Cytomegalovirus Esophagitis for complete information on this topic.

Diagnosis of HIV esophagitis

Because most HIV ulcers are indistinguishable from CMV ulcers on the basis of the clinical and radiographic criteria, CMV esophagitis must be excluded by means of endoscopy before a diagnosis of HIV esophagitis can be established. Biopsy specimens, brushings, and/or viral cultures from the esophagus may be needed.

Differentiating between these infections is essential because most cases of HIV esophagitis dramatically respond to treatment with oral steroids, whereas CMV esophagitis is treated with relatively toxic antiviral agents such as ganciclovir (see Cytomegalovirus Esophagitis). Endoscopy is required for a definitive diagnosis before patients are treated.

Diagnosis of tuberculous esophagitis

Erosion of caseating nodes into the esophagus may result in the development of longitudinal or transverse sinus tracts or esophageal-airway fistulas. Similar tracts and fistulas may be seen in patients with radiation esophagitis, Crohn disease, trauma, or esophageal cancer. However, in these patients, the clinical history usually suggests the correct diagnosis.

Intrinsic tuberculosis is extremely rare and is characterized by mucosal plaques, ulcers, strictures, and fistulas. The development of dysphagia, coughing, or choking during swallowing suggests the possibility of esophageal involvement or fistula formation in a patient with tuberculosis.

Diagnosis of eosinophilic esophagitis

A noninfectious form of esophagitis that may require differentiation from infectious esophagitis is eosinophilic esophagitis. [51] The majority of patients with this disorder present with intermittent difficulty in swallowing solid food. On barium studies, eosinophilic esophagitis typically produces a series of concentric rings in the esophagus.

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