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

Severe necrotizing Candida esophagitis developed in two insulin-dependent diabetics after they received renal allografts. In each patient, the infection led to a perforation of the esophagus and was ultimately fatal despite aggressive medical and surgical management. The frequency and severity of Candida esophagitis seems to be higher in diabetics rather than in nondiabetic patients who received renal transplants. In these two diabetic transplant recipients, small doses of oral nystatin did not prevent Candida esophagitis. Appropriate diagnostic tests must be performed promptly when symptoms of odynophagia or dysphagia develop in these patients. In diabetic transplant recipients with documented candidiasis, decreased symptoms of esophagitis should not be relied on to indicate a response to therapy. Discontinuation of immunosuppressive drugs, as well as aggressive treatment with oral and parenterally absorbed antifungal agents, offer the best hope for preventing severe morbidity or mortality from the infection in these patients.
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PMID:Fatal Candida esophagitis in two diabetics after renal transplantation. 703 54

Dysphagia and retrosternal pain are common complaints in patients after cardiac operations, and most often they result from the median sternotomy and/or endotracheal intubation. Although Candida esophagitis is a recognized cause of similar symptoms, it is usually not suspected except in immunologically compromised hosts. This report describes the case histories of five patients, not immunosuppressed or cachectic, who developed persistent dysphagia during recovery from cardiac operations; four patients received only 4 days of preoperative and postoperative prophylactic antibiotic treatment with cefazolin (Kefzol) and cephalexin (Keflex). A nasogastric tube had been used for less than 24 hours in the postoperative period. The fifth patient developed symptoms following prolonged and varied antibiotic therapy. Candida esophagitis was diagnosed by a combination of coexisting oral candidiasis (5/5), roentgenographic appearance on barium swallow (5/5), endoscopy (4/4), and biopsy or culture (2/4). Initial therapy consisted of antireflux measures and antacids (4/5), cimetidine (4/5), oral nystatin in methylcellulose base (1,000,000 units every 4 hours) (4/5), and termination of other antibiotic therapy (1/5). These measures were effective in clearing the infection in only two patients. A third patient required prolonged massive oral nystatin therapy, and in two patients intravenous Amphotericin B was necessary to control infection. Two patients subsequently developed strictures which necessitated multiple esophageal dilatations. One of these patients developed endocarditis during home dilatation therapy. All patients are currently free of disease. Current measures utilized to recognize and treat the disease are discussed.
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PMID:Candida esophagitis following cardiac operation and short-term antibiotic prophylaxis. 743 63

Esophageal candidiasis, along with gastritis caused by cytomegalovirus--CMV--, is a common opportunistic infection in immunodepressed patients. A clinico-pathological description is made of a human immunodeficiency virus-positive female (group IV-C-2) with a history of odynophagia and dysphagia resistant to treatment. The light microscopy and immunohistochemical study of an endoscopic esophago-gastric biopsy allowed the diagnosis of moniliasic esophagitis associated with CMV-induced gastritis. Emphasis is placed on the efficacy of immunohistochemical techniques over other methods in diagnosing CMV infection.
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PMID:[Candida esophagitis and cytomegalovirus gastritis: optic and immunohistochemical diagnosis in an HIV+ patient]. 772 66

Significant hemorrhage from esophageal candidiasis in patients without a major bleeding diathesis is extremely uncommon. A case of recurrent, severe upper gastrointestinal bleeding due to hemorrhagic candidal esophagitis in a man with renal failure is described. Dysphagia, odynophagia, and retrosternal chest discomfort were all absent. Oral thrush was present only at the outset. Standard therapy for massive bleeding with blood products alone was not successful. Intravenous amphotericin eventually resulted in resolution.
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PMID:Massive upper gastrointestinal bleeding due to Candida esophagitis. 820 82

Endoscopic experience in patients with acquired immunodeficiency syndrome (AIDS) has rarely been reported in Taiwan. We present our experience in 9 AIDS patients (8 male and 1 female, age from 26 to 63 years) with 12 examinations. The risk factor of these patients were bisexual in 3, homosexual in 2, hemophilia in 1, drug abuse in 1, and paid-sex in 2. Odynophagia or dysphagia was the major complaints. Oral ulcers or/and thrush were noted in 8 patients. Endoscopic findings included negative (6/12), candidiasis (3/12), erosions (1/12), ulcers (1/12) and ulcer scar (1/12) in esophagus; negative (8/12), gastritis (1/12), erosions (1/12), ulcers (1/12) and Kaposi's sarcoma (1/12) in stomach; and negative (11/12) and duodenitis (1/12) in duodenum. Patients with esophageal candidiasis always had oral thrush. Dysphagia was highly correlated with positive endoscopic findings in esophagus. It is important for an endoscopist to identify clinical symptoms and to examine patient's oral cavity before an endoscopic examination. The endoscopist must keep himself from being infected by exposure to contaminated blood and secretion and avoid dissemination of this horrible disease by undisinfected instruments.
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PMID:Endoscopic examination in patients with acquired immunodeficiency syndrome: Taiwan experience. 840 71

Gastrointestinal (GI) symptoms are part of the most frequent complaints in HIV disease. A methodical effort is required to identify treatable syndromes. Progressive immunodeficiency is associated with increased prevalence of opportunistic or non-opportunistic infections and neoplasms. Dysphagia and odynophagia, in the majority due to candida esophagitis, are best evaluated by endoscopy. In the presence of diarrhea, upper GI endoscopy is indicated if evaluations of stool and endoscopy of the lower GI tract are negative and may uncover proximal small-bowel infection by Cryptosporidium, Microsporidium or Mycobacterium avium. HIV-associated neoplasias (Kaposi's sarcoma, non-Hodgkin lymphomas), not rarely affecting the upper GI tract and sometimes leading to obstruction or bleeding, are reliably diagnosed only by endoscopy. Since visible lesions mostly are nonspecific and normal-appearing mucosa may harbor pathogens, biopsies for pathology and cultures are crucial for correct diagnosis in GI diseases of HIV-infected patients.
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PMID:[Endoscopy of the upper gastrointestinal tract in HIV disease]. 865 96

A fatal case of acute pancreatitis is reported. On account of difficulty in eating caused by persistent dysphagia and heartburn, the clinical condition of a 39-year-old man who had been a heavy drinker deteriorated rapidly. He was taken to a hospital in an ambulance in an unconscious state. Based on the endoscopic examination and blood chemistry data, the diagnosis of hemorrhagic esophagitis and hepatic failure was made. Treatment including fluid infusion was unsuccessful and he died on the second hospital day. Based on a strong suspicion that the pathologic change in the esophagus may have been chemical esophagitis caused by corrosives of some type, the police ordered an administrative autopsy. The postmortem examination revealed marked necrosis in the pancreas and in the abdominal fatty tissue including the omentum and the mesentery. The necrotic areas in the pancreas were accompanied by only a slight degree of hemorrhage. The cause of death was diagnosed as acute pancreatitis. The pathologic change in the esophagus was identified as Candida esophagitis. Alcohol abuse and malnutrition caused by esophagitis were both considered to be factors which lead to the acute fatal pancreatitis.
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PMID:Death caused by undiagnosed acute pancreatitis. 869 55

Thirty-one patients with malignancy and endoscopy-confirmed symptomatic esophageal candidiasis were randomly assigned to receive oral fluconazole, 200 mg once daily, or intravenous amphotericin B, 0.3 mg/kg, over 1-4 weeks. Clinical efficacy was determined weekly and follow-up esophageal endoscopy with biopsy and culture performed whenever possible. Both agents produced rapid resolution of symptoms, especially dysphagia and odynophagia. All 13 evaluable patients in the fluconazole group and 10/12 treated with amphotericin had clinical improvement. Endoscopy showed eradication of the fungus in all 11 patients undergoing repeat endoscopy, with cure or improvement of esophagitis. The incidence of adverse effects attributable to treatment was higher in the amphotericin group. The efficacy of oral fluconazole in esophageal candidiasis appears to be equivalent to that of amphotericin, with fewer adverse reactions.
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PMID:Fluconazole versus amphotericin B in the treatment of esophageal candidiasis in cancer patients. 880 99

In Taiwan, numbers of patients with the acquired immunodeficiency syndrome (AIDS) have been increasing in recent years. We present esophageal disease of different causes in 5(16%) heterosexual men among 31 AIDS patients over a 5-year period. Major symptoms included mild dysphagia in 4 (80%) patients and odynophagia in 3 (60%) patients. The duration of symptoms varied from 3 days to 6 months. The symptoms occurred before the diagnosis of AIDS in 3 patients. At esophagogastroduodenoscopy (endoscopy), all 5 patients had esophagitis and/or esophageal ulcers proved by histopathologic evaluation. Four had Candida esophagitis, 3 had cytomegalovirus esophagitis/ulcers and 2 had idiopathic esophageal ulcerations (IEU). Three patients had different esophagitis/ulcers at the same time or during follow-up. The median CD4 lymphocyte count at the time of diagnosis of esophageal disease was 12.2 cells/mm3 (range, 3 to 35 cells/mm3). The endoscopic pictures of the different causes of esophagitis/ ulcers lack uniformity in number, size and appearance. These observations make a conclusion that all AIDS patients with an esophageal disease should undergo endoscopy with biopsy to obtain a definitive diagnosis.
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PMID:Clinical experience of esophageal ulcers and esophagitis in AIDS patients. 895 56

Myasthenia gravis (MG) is a rare complication of allogeneic bone marrow transplantation (BMT). We present the 11th case in the medical literature, a 23-year-old female 100 months post-allogeneic bone marrow transplantation for acute myelogenous leukemia (AML). After discontinuation of immunosuppression for chronic graft-versus-host disease (GVHD) involving skin, gastrointestinal tract and lacrimal glands, the patient developed severe, progressive dysphagia initially attributed to esophageal candidiasis. With the development of muscle weakness, ptosis, and dysphonia the diagnosis of generalized myasthenia gravis was suspected, and confirmed by elevated anti-acetylcholine receptor antibody titer and a positive edrophonium challenge. Prednisone and pyridostigmine produced improvement, and thymectomy was performed without pathologic evidence of thymoma. Recurrent post-operative respiratory distress required transient mechanical ventilation. Twenty-seven months after diagnosis, the patient requires maintenance prednisone to control symptoms of myasthenia gravis. The clinical features of all reported cases of MG post-allogeneic BMT are reviewed, and universal features include an association with decreasing immunosuppression, the presence of other manifestations of chronic GVHD, anti-acetylcholine receptor antibodies, and the absence of an associated thymoma. HLA Cw1, Cw7 and DR2 were identified at frequencies significantly above that expected from HLA antigen prevalance studies, and may be markers for increased risk of developing MG post-allogeneic BMT. No statistically significant associations with HLA A2, B7, B35 or donor-recipient sex mismatch were present. Reinstitution of immunosuppression and standard therapies for myasthenia gravis were effective in the majority of cases. The role of thymectomy in this population remains unclear.
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PMID:Myasthenia gravis in association with allogeneic bone marrow transplantation: clinical observations, therapeutic implications and review of literature. 915 70


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