Clinical Experience of Esophageal Ulcers and Esophagitis in AIDS Patients

後天免疫不全症候群病人之食道炎及食道潰瘍其臨床經驗

楊旻達(Mm-Ta Yang) ； 柯富聰(Fu-Tsong Ko) ； 鄭乃源(Nai-Yuan Cheng) ； 林光洋(Kuang-Yane Lin) ； 王朝欣(Chaur-Shine Wang) ； 蕭泉豹(Chuan-Pau Siauw) ； 施麗順(Li-Shun Shih) ； 廖學聰(Say-Tsung Liao)

《The Kaohsiung Journal of Medical Sciences》 12卷11期 (1996/11) Pp. 624-629

https://doi.org/10.6452/KJMS.199611.0624

摘要

在台灣，後天免疫不全症候群病人近年來愈來愈多見，市立仁愛醫院在最近5位男性異性戀病患有不同原因之食道疾病。主要的症狀包括4例有經微吞嚥困難，3例有吞嚥疼痛。症狀持續時從3天到6個月不等；症狀出現時間有3例在診斷為後天免疫不全症候群之前。5位病人都接受1至4次上消化道內視鏡檢查，5例都有食道炎或食道潰瘍，並經病理檢查證實。其中出現念珠球菌食道炎有4例，巨細胞病毒食道炎1例，巨細胞病毒食道潰瘍2例，特異性食道潰瘍2例。有3例先後或同時出現兩種不同病灶。診斷食道病變時之平均CD4淋巴球數目為12.2（3-35）cells/mm^3。內視鏡表徵包括病灶數目，大小及外觀上不能區分個別病灶之致病原因。所以，本研究認為所有後天免疫不全症候群病人之食道疾病，需依賴內視鏡檢查併行組織切片病理分析，才能得到一個正確診斷。

並列摘要

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/mm^3). 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.

並列關鍵字

acquired immunodeficiency syndrome ； cytomegalovirus esophagitis ； idiopathic esophageal ulceration