CMV esophagitis: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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*[[Special:MyLanguage/Cytomegalovirus|Cytomegalovirus]] (CMV) gastrointestinal disease is an uncommon but serious complication of [[Special:MyLanguage/AIDS|AIDS]]. | *[[Special:MyLanguage/Cytomegalovirus|Cytomegalovirus]] (CMV) gastrointestinal disease is an uncommon but serious complication of [[Special:MyLanguage/AIDS|AIDS]]. | ||
*The diagnosis of CMV gastrointestinal disease should be suspected in patients with CD4 cell counts <50 cells/microL who present with symptoms of esophagitis, gastritis, enteritis, or colitis. | *The diagnosis of CMV gastrointestinal disease should be suspected in patients with CD4 cell counts <50 cells/microL who present with symptoms of esophagitis, gastritis, enteritis, or colitis. | ||
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==Clinical Features== | ==Clinical Features== <!--T:3--> | ||
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*[[Special:MyLanguage/Odynophagia|Odynophagia]] | *[[Special:MyLanguage/Odynophagia|Odynophagia]] | ||
*[[Special:MyLanguage/Dysphagia|Dysphagia]] | *[[Special:MyLanguage/Dysphagia|Dysphagia]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:5--> | ||
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==Evaluation== | ==Evaluation== <!--T:6--> | ||
==Management== | ==Management== <!--T:7--> | ||
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**[[Special:MyLanguage/Ganciclovir|Ganciclovir]]: 5mg/kg/dose IV q12h | **[[Special:MyLanguage/Ganciclovir|Ganciclovir]]: 5mg/kg/dose IV q12h | ||
**[[Special:MyLanguage/Foscarnet|Foscarnet]]: 60mg/kg/dose q8h or 90mg/kg/dose q12h | **[[Special:MyLanguage/Foscarnet|Foscarnet]]: 60mg/kg/dose q8h or 90mg/kg/dose q12h | ||
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==Disposition== | ==Disposition== <!--T:9--> | ||
==See Also== | ==See Also== <!--T:10--> | ||
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*[[Special:MyLanguage/Cytomegalovirus (CMV) infection|Cytomegalovirus (CMV) infection]] | *[[Special:MyLanguage/Cytomegalovirus (CMV) infection|Cytomegalovirus (CMV) infection]] | ||
==External Links== | ==External Links== <!--T:12--> | ||
==References== | ==References== <!--T:13--> | ||
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<references/> | <references/> | ||
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[[Category:ID]] [[Category:GI]] | [[Category:ID]] [[Category:GI]] | ||
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Latest revision as of 12:26, 7 January 2026
Background
- Cytomegalovirus (CMV) gastrointestinal disease is an uncommon but serious complication of AIDS.
- The diagnosis of CMV gastrointestinal disease should be suspected in patients with CD4 cell counts <50 cells/microL who present with symptoms of esophagitis, gastritis, enteritis, or colitis.
- The incidence of CMV gastrointestinal disease has decreased substantially since antiretroviral therapy (ART) became available
Clinical Features
- Odynophagia
- Dysphagia
- Fever
- Nausea
- Substernal burning pain
Differential Diagnosis
Esophagitis Types
- Inflammatory
- GERD
- Allergic (eosinophilic)
- Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV
- CMV esophagitis
- aphthous ulceration
- Medication-induced (i.e. "pill") esophagitis, common culprits:
- Doxycycline
- Tetracycline
- Clindamycin
- NSAIDs
- ASA
- Bisphosphonates
- Ferrous sulfate
- Potassium chloride
- Ascorbic acid
CMV Diseases
Evaluation
Management
- Ganciclovir: 5mg/kg/dose IV q12h
- Foscarnet: 60mg/kg/dose q8h or 90mg/kg/dose q12h
- Valganciclovir: 900mg PO twice daily
- May be used for induction therapy, in place of intravenous ganciclovir, in patients who can tolerate and absorb oral medications
- The recommended duration of therapy for CMV gastrointestinal disease in patients with AIDS is 3-6 weeks
- Chronic maintenance therapy is not recommended for CMV gastrointestinal disease unless there is concurrent retinitis or recurrent gastrointestinal disease after induction therapy has been discontinued.
Disposition
See Also