Esophageal motility in AIDS patients with symptomatic opportunistic infections of the esophagus

Objectives: In patients with AIDS, esophageal symptoms are commonly due to opportunistic esophageal infection with Candida, cytomegalovirus (CMV), herpes simplex virus (HSV), and HIV. Despite apparently appropriate therapy against these pathogens, some patients continue to complain of dysphagia or odynophagia. This study was designed to determine whether such complaints were associated with a motility disorder of the esophagus. Methods: Sixteen patients underwent esophagoscopy and biopsy followed by esophageal manometry, performed using a 5-channel water perfused system (Synectics Medical, Inc., Irving, Texas). All patients had odynophagia, and eight had dysphagia. Results: Identified infections included: Candida (11), HSV and Candida (1), CMV (3), and a giant ulcer presumably caused by HIV (1); one patient also had lymphoma. Seven patients had normal esophageal motility, and in nine patients, a nonspecific motility disorder was found. After therapy, one of 10 patients had persistent odynophagia and dysphagia, and two had odynophagia only. At follow-up endoscopy, complete healing was demonstrated in six of eight patients with Candida. One of two patients with CMV and the patient with HSV also showed complete healing of the esophagus. Repeat esophageal motility studies were performed after therapy in 10 patients. Five had a persisting abnormality despite eradication of the pathogen (three Candida, one HSV, one CMV); in four, the previously identified motor abnormalities resolved after eradication of the infection (three Candida, one CMV). Conclusions: These findings suggest that a nonspecific motility disorder exists in AIDS patients with esophageal symptoms and may contribute to the persistence of symptoms despite appropriate therapy of esophageal opportunistic infections.