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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastrointestinal infection due to cytomegalovirus occurs frequently in liver transplant recipients. Upper gastrointestinal cytomegalovirus infection is associated with subjective complaints of nausea, a sense of abdominal fullness, and occasionally emesis and/or dysphagia. In order to determine whether these symptoms reflect a disruption of the normal motility of the stomach, the following study was performed. Eleven individuals who were evaluated for liver transplantation were prospectively recruited and studied as follows: (1) upper gastrointestinal endoscopy with biopsy of the gastric antral mucosa; (2) viral culture of the gastric mucosa; (3) a histologic examination of the gastric mucosa; and (4) a radionuclide gastric emptying study was obtained before and 4-8 weeks following successful liver transplantation. Prior to liver transplantation, none had symptoms of nausea, vomiting, or epigastric fullness. All were culture-negative for cytomegalovirus. All had endoscopic and histologic evidence of portal hypertensive gastropathy but none had antral erosions or ulcers. All demonstrated normal gastric emptying of a liquid meal. Following liver transplantation, 6 remained free of gastric cytomegalovirus while 5 developed a culture-confirmed gastric cytomegalovirus infection. Those that developed a gastric cytomegalovirus infection also had more gastric symptoms, and more gastric histologic abnormalities. Moreover, those with a gastric cytomegalovirus infection demonstrated enhanced gastric retention of a liquid meal (P less than 0.01).
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PMID:Cytomegalovirus infection and gastric emptying. 132 20

The correlation of gastrointestinal symptoms and infections in 186 consecutive patients with human immunodeficiency virus (HIV) infection undergoing diagnostic endoscopy (oesophagogastroduodenoscopy, n = 124; colonoscopy, n = 37; both, n = 25) was investigated. Biopsy and stool samples were examined for infective agents. Only weight loss (p = 0.003) and dysphagia (p = 0.027) were more common in patients at stage CDC IV compared with earlier stages. In three of 27 patients at stage II/III and in 93 of 159 patients at stage IV an infective agent was identified in stool or gastrointestinal biopsy specimen (p < 0.001). Cytomegalovirus (n = 35), Candida sp (n = 28), M avium complex (n = 10), and Cryptosporidium (eight) were the most frequent agents detected. At stage IV, diarrhoea was more frequent in infected compared with non-infected patients (p = 0.006); however, an infective agent was also found in 39 of 82 patients at stage IV without diarrhoea. The frequency of gastrointestinal symptoms was not consistently increased in patients harbouring specific infective agents compared with non-infected patients. Our findings indicate that the pathogenic relevance of a gastrointestinal infection in HIV infected patients has to be verified and indirectly support the existence of an HIV associated enteropathy.
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PMID:Gastrointestinal symptoms in patients infected with human immunodeficiency virus: relevance of infective agents isolated from gastrointestinal tract. 132 82

Esophageal disease is a common complication and cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Opportunistic esophageal diseases may occur in patients with long-standing infection or may be the initial manifestation of HIV disease. Although a variety of both opportunistic and nonopportunistic disorders result in esophageal disease in this population, candidal esophagitis is the most common cause of symptomatic disease. Ulcerative esophagitis resulting from cytomegalovirus and idiopathic esophageal ulceration constitute the next most important etiologies. In contrast to other immunocompromised hosts, herpes simplex virus esophagitis appears to be relatively uncommon. Multiple simultaneously discovered esophageal disorders have been documented in up to 50% of patients. Opportunistic neoplasms are an infrequent cause of symptomatic disease. Candidal esophagitis may present with either dysphagia or odynophagia, and oropharyngeal candidiasis is usually present at the time of diagnosis. In contrast, ulcerative esophagitis is usually first manifested by moderate to severe odynophagia. Barium esophagography and upper endoscopy are the most commonly employed diagnostic modalities for the evaluation of the symptomatic patient. Although barium esophagography may identify specific abnormalities, this procedure appears to be relatively insensitive for the detection of mild candidal disease as well as nondiagnostic for ulcerative lesions when compared with endoscopy. In the HIV-infected patient with new-onset esophageal symptoms, an empiric trial of a systemically acting oral antifungal agent should probably be the initial management strategy. If the patient does not respond to standard therapy within 1 to 2 weeks, an endoscopic evaluation appears to be the most cost-effective diagnostic test given the diversity of potential disorders, the possibility of one or more co-pathogens or diseases, the potential for an immediate diagnosis, and the availability of mucosal biopsy to make a definite diagnosis of ulcerative or mass lesions. Given the presently available therapy for these diverse processes, establishing a definitive diagnosis in the symptomatic patient not responsive to empiric antifungal therapy is warranted.
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PMID:Esophageal disease in the acquired immunodeficiency syndrome: etiology, diagnosis, and management. 838 38

We have reviewed 28 esophageal biopsies from 28 patients with the acquired immune deficiency syndrome (AIDS), over a 1-yr period. Indications for esophageal biopsy were dysphagia persisting after antifungal therapy and/or radiologic evidence of esophageal ulcer. We compared the frequency of detecting cytomegalovirus (CMV) infection on hematoxylin and eosin (H&E) stain with immunoperoxidase staining for CMV antigens. Five biopsies were positive for CMV by H&E stain and immunoperoxidase. Infected cells could often be identified in the granulation tissue and, in one severe case, in stromal papillae of the intact mucosa. Squamous cells were never positive. Thirteen biopsies consisted only of squamous epithelium, and all of these were negative by both techniques. Among the remaining 10 cases, no CMV inclusions were identified by H&E. Three of these biopsies displayed staining for viral antigens. In all cases positive by immunoperoxidase, numerous cells positive for viral antigens did not display any of the CMV-specific morphologic diagnostic criteria. Other coexisting diagnoses included candidiasis, Kaposi's sarcoma, and malignant lymphoma. We conclude 1) CMV infection of the esophagus is common in AIDS patients with esophageal ulcer or esophagitis resistant to antifungal therapy; 2) multiple infections or neoplasms may coexist; 3) since CMV apparently does not infect squamous epithelium and only rarely endothelium in stromal papillae, deep biopsies are necessary for diagnosis; and 4) immunoperoxidase staining is required for maximum diagnostic yield.
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PMID:Cytomegalovirus esophagitis in AIDS: diagnosis by endoscopic biopsy. 165 84

A 49-year-old man with the acquired immune deficiency syndrome (AIDS) developed epigastric pain, nausea, vomiting, and gastrointestinal bleeding secondary to a cytomegalovirus (CMV)-induced ulceration in the distal esophagus and proximal stomach. All symptoms improved on treatment with ganciclovir. However, 1 month later severe dysphagia led to discovery of a fibrous stricture in the area of the healed ulcer. The dysphagia was controlled by esophageal dilation. Ulcerative lesions caused by CMV can heal with ganciclovir treatment but, as with other esophageal ulcers, healing may be associated with fibrosis and stricture.
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PMID:Esophageal stricture after cytomegalovirus ulcer treated with ganciclovir. 166 46

16 HIV seropositive patients among the 180 treated at the Hospital Muniz and the Hospital Posadas in Buenos Aires between December 1988 and December 1989 were referred to the Hospital Posadas Endoscopy Service for esophageal studies. The 16 patients were prospectively studies by means of fiberoscopy, radiology, biopsies, virology, mycology, and brush cytology. Early treatment is of utmost importance because opportunistic infections may aggravate the general condition, increase immune system effects, and probably permit greater replication of HIV, in addition to producing symptoms. 14 patients were male and 2 female. Ages ranged from 18 to 41 and averaged 32 years. 10 were male homo- or bisexuals and the other 6 were intravenous drug users. 14 of the patients consulted because of specifically esophageal symptoms. 12 reported dysphagia, 8 odynophagia, and 6 retrosternal pain. 9 patients presented various symptoms. 15 of the 16 symptomatic patients had some pathology related to HIV. The remaining case presented a small submucus tumor and gastroesophageal reflux. The symptoms had appeared between 10 days and 1 year prior to study. Symptoms did not provide accurate diagnostic clues. 11 cases of esophageal candidiasis were diagnosed endoscopically by isolated or confluent white plaques. 3 patients classified as grade 1 or 2 on the basis of the intensity and density of plaques had mild symptoms, and 8 classified as grade 3 or 4 had more severe symptoms. 7 of the 11 patients also had oral candidiasis. 4 of 6 patients presenting ulcerative pathology were diagnosed virologically with herpes simplex virus type 2. Herpetic ulcers were single or multiple and were deep with slightly raised edges. No ulcers attributable to cytomegalovirus were diagnosed. 4 of the 11 patients with candidiasis also had ulcers, in 2 cases herpetic. The studies indicated a change in the stage of HIV infection following Centers for Disease Control criteria in 10 cases. AIDS was diagnosed in 7 cases based on esophageal findings. Endoscopic study and the samples obtained guided treatment in the 16 patients. In 1 case a repeat endoscopy led to a change in treatment. It is recommended that endoscopy be performed in all patients with esophageal symptoms. Radiology was relatively ineffective, with 50% of diagnoses in error. Histopathology required multiple biopsies and was less sensitive than endoscopy and cytology. Cytology was highly specific and sensitive.
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PMID:[Esophageal pathology in patients with the AIDS virus. Etiology and diagnosis]. 182 Jun 92

Fifty to eighty per cent of patients with AIDS-related complex or AIDS have gastrointestinal symptoms, the most common being dysphagia, diarrhea, or perianal lesions. The symptomatology varies from a mild "gay bowel syndrome" to a severe "diarrhea wasting syndrome". In patients with lymphadenopathy syndrome and AIDS the mucosal CD4/CD8 ratio is decreased, and the IgA-producing plasma cells of the mucosa are diminished in number as compared with HIV-negative controls. AIDS enteropathy, the etiology of which remains unclear, seems to be associated with direct infection of the intestinal mucosal cells with HIV. Clinical and therapeutic aspects of some opportunistic infections, such as Candida albicans, cytomegalovirus, and Herpes simplex virus-infection are discussed in this part.
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PMID:[Gastrointestinal manifestations of AIDS. 1: Basic considerations and viral infections]. 185 16

To determine the spectrum of esophageal disease responsible for dysphagia/odynophagia in AIDS patients not responding to current oral antifungals, we studied 49 consecutive patients whose esophageal symptoms failed to improve after a minimum of 3 wk of therapy with oral ketoconazole or fluconazole. An esophageal candidiasis resistant to oral antifungals was the most frequent disease found (22 single infections and four mixed with viruses). Viral esophagitis was identified in 13 cases (eight herpes simplex virus and five cytomegalovirus), and an esophagitis of unknown origin was documented in two patients. Other causes of symptoms included peptic esophagitis (four cases), esophageal stenosis (two cases), and Kaposi's sarcoma of the esophagus (one patient). Most patients with esophageal opportunistic infection experienced prompt relief of symptoms and complete endoscopic resolution on the specific antifungal (amphotericin B or fluconazole iv) or antiviral (acyclovir or gancyclovir iv) therapy, with the exception of those with concomitant fungal and viral infection who responded poorly to treatment. We conclude that most AIDS patients with dysphagia/odynophagia who do not respond to oral antifungals have an opportunistic infection of the esophagus. Nevertheless, specific antifungal or antiviral therapy is worthwhile, because it will eradicate, at least temporarily, the causative pathogens in most such patients.
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PMID:Opportunistic infections of the esophagus not responding to oral systemic antifungals in patients with AIDS: their frequency and treatment. 196 17

Over the next several decades the gastroenterologist practicing anywhere in the world will be confronted with patients with AIDS-related gastrointestinal disorders. Universal body substance isolation precautions should be practiced, however, in dealing with all patients, including those outside traditional 'risk' groups for AIDS. Principal among these precautions are using gloves for personnel involved in procedures and high-level disinfection or sterilization for all endoscopy equipment. Endoscopic procedures should be planned well in advance with special attention to endoscope selection and transport media availability. Organ-associated symptoms are reviewed, especially dysphagia, odynophagia, hemorrhage, diarrhea, and abdominal pain. Opportunistic infections and malignancies often present characteristic endoscopic appearances such as that seen for cytomegalovirus ulceration or Kaposi's sarcoma. AIDS-related biliary disorders should also be recognized, principally sclerosing cholangitic or papillary stenosis.
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PMID:AIDS and the gastroenterologist. 223 76

Neuronal intranuclear hyaline inclusion disease (NIHID) has been recognized in 14 patients. It usually occurs in the first and second decades but has been seen in the sixth. Both sexes are affected by this sporadic multisystem degenerative disorder that has involved the central and peripheral nervous systems with fibrillar and granular intranuclear inclusions. NIHID appears to be several variants of a multisystem degenerative disease as illustrated by the combination of a spontaneous, degenerative central and peripheral nervous system disorder with neuronal intranuclear inclusions and severe atherosclerotic coronary artery disease in a 23-year-old white man. Beginning at 11 years of age, this patient had experienced diffuse muscle spasms, dysarthria, dysphagia, tremors, ataxia, oculogyric crises, progressive muscle weakness, and atrophy. At autopsy, neuronal intranuclear hyaline inclusions and neuronal loss were seen in his brain, brainstem, cerebellum, spinal cord, bowel, bladder, and esophagus. These fibrillary and granular Cowdry type A and B intraneuronal inclusions were consistent with the diagnosis of NIHID associated with severe coronary atherosclerosis.
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PMID:Neuronal intranuclear hyaline inclusion disease associated with premature coronary atherosclerosis. 244 45


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