Comparison of Two Corticosteroid Regimens for the Treatment of HIV‐associated Idiopathic Esophageal Ulcer

Academic Article

Abstract

  • Objective: Although corticosteroids appear to be efficacious in the treatment of HIV‐associated idiopathic esophageal ulcer, the optimal regimen remains undeflned. Methods: Over a 41‐month period, all patients with idiopathic esophageal ulcer defined hy clinical, endoscopic, and pathological criteria were treated with a defined corticosteroid regimen. The initial 12 patients were treated with prednisone, 40 mg daily tapering to 10 mg/wk, for a 4‐wk course of therapy, and 24 suhsequent patients were treated with 40 mg daily for 2 wk. All patients were followed clinically, with most patients undergoing endoscopy at the completion of therapy and for recurrent esophageal symptoms. Results: A symptomatic response was seen in 11 patients (92%) in the 4‐wk regimen and 23 patients (96%) in the 2‐wk regimen. A complete symptomatic response was seen in 10 patients (83%) in the 4‐wk regimen, compared with 18 patients (75%) in the 2‐wk regimen. A partial response was seen in the 2‐wk regimen more often (five patients) than in the 4‐wk regimen. Long‐term follow‐up in responders revealed relapse in two of nine patients (22%) in the 4‐wk regimen compared with 12 of 23 (52%) in the 2‐wk regimen (p= 0.10). Relapse occurred within 9 wk in all hut one patient and was heralded hy recurrent odynophagia. The prednisone regimen was well‐tolerated, although opportunistic infections occurred in seven patients during or within 1 month of therapy. Conclusions: Prednisone therapy is highly efficacious for the treatment of idiopathic esophageal ulcer resulting in a rapid clinical response and endoscopic healing. A 2‐wk course of therapy may he associated with a higher relapse rate than a 4‐wk regimen. Relapse frequently occurs, usually within 2 months of therapy. The side effects proflle appears acceptable. Copyright © 1994, Wiley Blackwell. All rights reserved
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    Author List

  • Wilcox CM; Schwartz DA
  • Start Page

  • 2163
  • End Page

  • 2167
  • Volume

  • 89
  • Issue

  • 12