Related Experiment Videos
Prospective endoscopic characterization of cytomegalovirus esophagitis in AIDS
C M Wilcox1, R F Straub, D A Schwartz
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303.
Abstract:
Cytomegalovirus (CMV) esophagitis is an important cause of esophageal ulceration in patients with the acquired immunodeficiency syndrome. However, the endoscopic appearance of these lesions has not been well characterized. During a 3-year period, we identified 141 CMV esophageal ulcerations endoscopically in 33 patients. CMV esophagitis was the index diagnosis of human immunodeficiency virus (HIV) infection in 8 patients. Odynophagia was almost uniformly present, although gastrointestinal bleeding was the initial manifestation in 5 patients. Multiple ulcers were identified in 58% of patients. Giant ulcers were seen in 28%, whereas 43% of the lesions were less than 1 cm in greatest dimension. The majority of the lesions were located in the middle to distal section of the esophagus. The ulcers were characterized as either shallow or of intermediate depth in 74% of patients; deep ulcers were seen in 8%; diffuse erosive disease was found in 6%; and the ulcers had a "heaped up" appearance in 12%. In contrast to reports from previous studies, CMV esophageal disease appeared highly variable endoscopically. Multiple, well-circumscribed ulcerations were the most common endoscopic findings, although lesions could vary in number, size, and appearance. As this lack of uniformity may cause CMV esophagitis to be confused with other conditions characterized by esophageal ulceration, all HIV-infected patients with esophageal ulceration should undergo endoscopy with biopsy so that a definitive diagnosis can be obtained.
Insights
Cytomegalovirus (CMV) esophagitis causes esophageal ulcers in patients with acquired immunodeficiency syndrome (AIDS). Endoscopic findings are highly variable, necessitating biopsy for accurate diagnosis in HIV-infected individuals.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) esophagitis is a significant cause of esophageal ulceration in individuals with acquired immunodeficiency syndrome (AIDS).
- The endoscopic presentation of CMV esophagitis has historically been poorly defined, leading to potential diagnostic challenges.
Purpose of the Study:
- To characterize the endoscopic appearance of Cytomegalovirus (CMV) esophagitis in patients with acquired immunodeficiency syndrome (AIDS).
- To highlight the variability in endoscopic findings and emphasize the importance of biopsy for diagnosis.
Main Methods:
- A retrospective analysis of endoscopic findings in 33 patients with confirmed Cytomegalovirus (CMV) esophagitis over a 3-year period.
- Detailed documentation of ulcer number, size, depth, location, and morphology.
Main Results:
- 141 CMV esophageal ulcerations were identified; 58% of patients had multiple ulcers, and 28% had giant ulcers.
- Lesion appearance varied significantly, with shallow to intermediate depth ulcers being most common (74%).
- CMV esophagitis was the initial diagnosis for human immunodeficiency virus (HIV) infection in 8 patients.
Conclusions:
- Cytomegalovirus (CMV) esophagitis exhibits a highly variable endoscopic appearance, contrasting with previous reports.
- The diverse morphology necessitates endoscopic biopsy for definitive diagnosis in all human immunodeficiency virus (HIV)-infected patients presenting with esophageal ulceration.