Abstract
Opportunistic esophageal infections (Candida, cytomegalovirus, herpes simplex virus) and idiophatic esophageal ulcerations are commonly found in HIV patients. However, motility disorders of the esophagus have seldom been investigated in this population. The aim of this prospective study was to determine the presence of motility disorders in HIV patients with esophageal symptoms (with or without associated lesions detected by endoscopy) and in HIV patients without esophageal symptoms and normal esophagoscopy. Eigthteen consecutive HIV patients (10 male, 8 female, ages 20–44 years, mean age 33.5; 8 HIV positive and 10 AIDS) were studied prospectively. Nine patients complained of esophageal symptoms, e.g, dysphagia/odynophagia (group 1) and 9 had symptoms not related to esophageal disease, such as diarrhea, abdominal pain, or gastrointestinal bleeding (group 2). All patients underwent upper endoscopy; mucosal biopsies were taken when macroscopic esophageal lesions were identified or when the patients were symptomatic even if the esophageal mucosa was normal. Esophageal manometry was performed in the 18 patients, using a 4-channel water-perfused system according to a standardized technique. Sixteen of the 18 patients (88.8%) had baseline manometric abnormalities. In group 1, 8/9 patients had esophageal motility disorders: nutcracker esophagus in 1, hypertensive lower esophageal sphincter (LES) with incomplete relaxation in 2, nonspecific esophageal motility disorders (NEMD) in 3, diffuse esophageal spasm in 1, esophageal hypocontraction with low LES pressure in 1. Six of these 9 patients had lesions detected by endoscopy: CMV ulcers in 2, idiopathic ulcers in 1, candidiasis in 1, idiopathic ulcer + candidiasis in 1, nonspecific esophagitis in 1; and 3/9 had normal endoscopy and normal esophageal biopsies. In group 2, 8/9 patients had abnormal motility: hypertensive LES with incomplete relaxation in 1, nutcracker esophagus in 2, esophageal hypocontraction in 3, and NEMD in 2. All these patients had a normal esophageal mucosa at endoscopy. In conclusion, our findings suggest that HIV patients have esophageal motility disorders independent of esophageal symptoms and/or the presence of mucosal esophageal lesions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wilcox CM, Schwartz DA, Clark WS: Esophageal ulceration in human immunodeficiency infection: causes, response to therapy and long term outcome. Ann Intern Med 123:143-149, 1995
Baehr PH, McDonald GB: Esophageal infections: risk factors, presentation, diagnosis and treatment. Gastroenterology 106:509-532, 1991
Connolly GM, Forbes A, Gleeson JA, Gazzard BG: Investigation of upper gastrointestinal symptoms in patients with AIDS. AIDS 3:453-456, 1989
Connolly GM, Hawkins D, Harcourt-Webster JN, Parsons PA, Husain OA, Gazzard BG: Oesophageal symptoms, their causes, treatment and prognosis in patients with the acquired immunodeficiency syndrome. Gut 30:1033-1039, 1989
Fried RL, Brandt LJ, Kauvar D, Simon D: Esophageal motility in AIDS patients with symptomatic opportunistic infections of the esophagus. Am J Gastroenterol 89:2003-2005, 1994
Wilcox CM: Esophageal disease in the acquired immune deficiency syndrome: etiology, diagnosis and management. Am J Med 92:412-421, 1992
Bonacini M, Young T, Laine L: The causes of esophageal symptoms in human immunodeficiency virus infection: A prospective study of 110 patients. Arch Intern Med 151:1567-1572, 1991
Bonacini M, Young T, Laine L: Histopathology of human immunodeficiency virus associated esophageal disease. Am J Gastroenterol 88:549-551, 1993
Spechler SJ, Castell DO: Classification of oesophageal motility abnormalities. Gut 49:145-151, 2001
Freeman R, Roberts MS, Friedman LS, Broadbrige C. Autonomic function and human immunodeficiency virus infection. Neurology 88:680-682, 1990
Reeves-Darby VG, Mathias JR, Clench MH: Abnormal gastrointestinal motility in patients with human immunodeficiency syndrome. Gastroenterology 100(5):A608, 1991
Batman PA, Miller AR, Sedwick PM, Griffin GE: Autonomic denervation in jejunal mucosa of homosexual men infected with HIV. AIDS 5:1247-1252, 1991
Griffin GE, Miller A, Batman PA, Forster SM, Pinching AJ, Harris JR, Mathan MM: Damage to jejunal intrinsic autonomic nerves in HIV infection. AIDS 2:379-382, 1988
Bracco MME, Borda E, Galassi N, Pérez Bianco R, Sterin-Borda L: Autoantibodies in HIV-infected patients that modulate the cholinergic activity of heart and gut tissue. Autoimmunity 14:307-314, 1993
Goin JC, Sterin-Borda L, Bilder C, Monastra Varrica L, lantorno G, Castro Rios M, Borda E: Functional implications of circulating muscarinic cholinergic receptor autoantibodies in chagasic patients with achalasia. Gastroenterology 117:798-805, 1999