       Document 0078
 DOCN  M9620078
 TI    Prospective evaluation of oropharyngeal findings in human
       immunodeficiency virus-infected patients with esophageal ulceration [see
       comments]
 DT    9602
 AU    Wilcox CM; Straub RF; Clark WS; Department of Medicine, Emory University
       School of Medicine,; Georgia, USA.
 SO    Am J Gastroenterol. 1995 Nov;90(11):1938-41. Unique Identifier :
       AIDSLINE MED/96048743
 CM    Comment in: Am J Gastroenterol 1995 Nov;90(11):1914-5
 AB    OBJECTIVE: Although the presence of oropharyngeal (OP) candidiasis plays
       an important role in the evaluation of human immunodeficiency virus
       (HIV)-infected patients with esophageal symptoms, there is little
       information on the utility of OP findings in patients with esophageal
       ulceration. METHODS: Over a 54-month period, all HIV-infected patients
       with esophageal ulceration had careful inspection of the oropharynx at
       the time of presentation with esophageal complaints and at endoscopy.
       HIV-infected patients without esophageal ulceration undergoing endoscopy
       during the last 30 months had OP findings similarly documented. OP
       ulceration ulceration was determined based on clinical, endoscopic, and
       histopathological findings. RESULTS: Of the 124 patients identified with
       esophageal ulcer, 14 (11%) had coexistent OP ulceration: herpes simplex
       virus, four; idiopathic esophageal ulcer, four; cytomegalovirus, three;
       herpes simplex virus and cytomegalovirus, two; idiopathic and
       cytomegalovirus, one. Four patients had OP ulcer without esophageal
       ulcer; only one of these patients had esophageal symptoms. All OP
       lesions healed with therapy for the esophageal ulcer. Twenty-eight
       patients with esophageal ulcer had OP candidiasis (23%); 21 of these
       patients (75%) also had Candida esophagitis. The sensitivity and
       specificity of OP ulcer for esophageal ulcer were 11% and 97%,
       respectively. The positive and negative predictive values of OP
       candidiasis for esophageal candidiasis were 90% and 82%, respectively.
       CONCLUSIONS: OP ulceration is uncommon in patients with esophageal
       ulceration, with the exception of herpes simplex virus esophagitis. OP
       candidiasis is common in patients with underlying esophageal ulcer,
       potentially resulting in diagnostic confusion. OP candidiasis appears to
       be a moderately useful diagnostic marker for Candida esophagitis.
 DE    AIDS-Related Opportunistic Infections/*DIAGNOSIS/EPIDEMIOLOGY/
       MICROBIOLOGY  Candidiasis/*DIAGNOSIS/EPIDEMIOLOGY  Candidiasis,
       Oral/*DIAGNOSIS/EPIDEMIOLOGY  Cytomegalovirus
       Infections/DIAGNOSIS/EPIDEMIOLOGY  Esophageal
       Diseases/DIAGNOSIS/EPIDEMIOLOGY/*MICROBIOLOGY  Esophagoscopy  Herpes
       Simplex/DIAGNOSIS/EPIDEMIOLOGY  Human  Oropharynx/MICROBIOLOGY/PATHOLOGY
       Pharyngeal Diseases/DIAGNOSIS/EPIDEMIOLOGY/MICROBIOLOGY  Predictive
       Value of Tests  Prevalence  Prospective Studies  Sensitivity and
       Specificity  Ulcer/DIAGNOSIS/EPIDEMIOLOGY/MICROBIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

