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Idiopathic esophageal ulceration in acquired immunodeficiency syndrome: successful treatment with misoprostol and viscous lidocaine.


Am J Gastroenterol. 1998 Nov;93(11):2069-74. Unique Identifier :

OBJECTIVE: Esophageal ulceration is a common and important cause of morbidity in patients with acquired immunodeficiency syndrome (AIDS). After known causes are excluded, a subgroup remains with unexplained esophageal ulceration, known as idiopathic esophageal ulceration (IEU). The current therapy of IEU includes corticosteroids or, less frequently, thalidomide, although no placebo-controlled trials have been reported. The aim of this retrospective study was to determine the outcome of treating IEU with misoprostol and viscous lidocaine. METHODS: A retrospective review of esophageal ulceration in AIDS identified seven subjects with IEU at our institution. IEU in these subjects was treated successfully with misoprostol, 200 microg, crushed and suspended in 2% viscous lidocaine, 15 ml, given orally a.c. and h.s. for 4 wk. RESULTS: All patients reported symptomatic improvement within 2-3 days and complete resolution of their symptoms within 15 days. Healing of esophageal ulcerations was confirmed in five of seven subjects at a repeat endoscopy 8-12 wk later. CONCLUSIONS: Misoprostol, an antiulcer drug, has GI cytoprotective properties, and viscous lidocaine, a topical anesthetic, coats mucosal surfaces. We speculate that misoprostol when delivered topically is 3-6 times more effective than when delivered systemically. Considering the rapid resolution of symptoms, healing of ulcers, and lack of side effects, we believe that misoprostol crushed and suspended in viscous lidocaine should be considered for further evaluation in prospective, placebo-controlled trials of IEU.

JOURNAL ARTICLE Acquired Immunodeficiency Syndrome/*COMPLICATIONS Administration, Topical Adult Anesthetics, Local/*ADMINISTRATION & DOSAGE Anti-Ulcer Agents/*ADMINISTRATION & DOSAGE Case Report Drug Combinations Esophageal Diseases/COMPLICATIONS/*DRUG THERAPY Female Human Lidocaine/*ADMINISTRATION & DOSAGE Male Middle Age Misoprostol/*ADMINISTRATION & DOSAGE Retrospective Studies Suspensions Ulcer/COMPLICATIONS/*DRUG THERAPY Viscosity


Information in this article was accurate in February 28, 1999. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.