Читать книгу The Esophagus - Группа авторов - Страница 174

HIV infection of the esophagus can lead to the development of giant esophageal ulcers indistinguishable from those caused by CMV esophagitis. Double‐contrast esophagrams typically reveal one or more large, ovoid or diamond‐shaped ulcers surrounded by a radiolucent rim of edema, sometimes associated with a cluster of small satellite ulcers [95, 96] (Figure 6.50). The diagnosis is established by obtaining endoscopic biopsy specimens, brushings, or cultures from the esophagus to rule out CMV esophagitis as the cause of the ulcers. Unlike CMV ulcers, HIV‐related esophageal ulcers usually heal markedly on treatment with oral steroids [95, 96]. Thus, endoscopy is required in HIV‐positive patients with giant esophageal ulcers to differentiate esophagitis caused by HIV and CMV, so appropriate therapy can be instituted.