Gastrointestinal Problems 1261 Dysphagia

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There are various HIV-related causes of oesophageal inflammation.They present in a similar way with pain on swallowing. Oesophageal candidiasis is the commonest HIV-related cause of dysphagia. The diagnosis of other causes needs endoscopy, biopsy and a good laboratory.

Where there are no facilities for investigation of a known HIV-positive patient with dysphagia, treat empirically with an oral antifungal agent.

Where available, barium swallow shows characteristic appearances of fine mucosal ulceration. Upper gastrointestinal endoscopy shows white plaques and biopsy allows confirmation.

The table below shows the treatment of the causes of dysphagia.

Cause of dysphagia

Treatment

Adults Children

Candidal oesophagitis

Nystatin 4 times daily for 1-14 days

500000 units (OR Nystatin pessaries 100,000 units every 4 hours)

100000 units

Ketoconazole for 7-14 days

200 mg twice daily 3 mg/kg daily

OR fluconazole for 7-14 days

100 mg once daily

Not recommended under one year I-2mg/kg daily

Prophylaxis with nystatin pastilles OR

fluconazole for life

Herpes simplex

Acyclovir

800 mg orally five times daily for 7-10 days.

20 mg/kg (max. 800 mg) 4 times daily for 5 days

Cytomegalovirus

Treatment usually not available (intravenous ganciclovir or foscarnet) on account of expense.

Ulcers of unknown cause

Prednisolone for 2 weeks, then slowly taper to zero

40 mg daily

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