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