{'fraction_non_alphanumeric': 0.0260933480338111, 'fraction_numerical': 0.013230429988974642, 'mean_word_length': 5.116853932584269, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Oesophageal ulcers in HIV‐infected patients

DEAR SIR, we have read with interest the recent review that appeared in the February issue of the journal (J Intern Med 1993: 233: 107-110) that thoroughly discusses opportunistic infections of the oesophagus in AIDS patients. We agree that oesophageal symptoms are very frequent in HIV-infected patients. However, a subject not discussed by the authors is that of idiopathic oesophageal ulcerations associated with HIV infection. The appearance of idiopathic oesophageal ulcerations associated with HIV virus is not uncommon, not only in acute infection [ l ] but also in other stages of HIV infection, especially advanced cases [2]. Idiopathic ulcers have also been described in HIV-infected patients in oral and rectal mucosa [3, 41. We have recently had the opportunity to care of three patients who presented with dysphagia and a characteristically severe retrosternal pain on swallowing. All the patients belonged to stage IV-C1 HIV infection, had CD4 counts below 50 mm and were on anti-retroviral therapy. Oesophagoscopy revealed the presence of well-circumscribed ulcerations in the mid-lower oesophagus, with normal areas of mucosa surrounding them. There was no evidence of hiatal hernia or peptic disease. The presence of Candida oesophagitis, herpes virus, CMV or Epstein-Barr virus infection was ruled out by means of culture of biopsy specimens. A pathologic study of biopsy material did not disclose inclusion bodies or malignant cells. The diagnosis of idiopathic oesophageal HIV-associated ulcers was thus entertained, and two patients were put on prednisone 0.5 mg kg-I day-' with a favourable response in one of them. The non-responding patient and the third patient were treated with thalidomide at doses ranging from 100 to 300 mg a day for 10 days. Pain disappeared in both patients on the third and fourth days of therapy, respectively. After a follow-up period ranging from 2 to 6 months, recurrence of ulcerations has not been detected. Idiopathic oesophageal ulcerations, aside from other more frequent opportunistic infections, should always be considered in HIV-infected patients with oesophageal-related symptoms, mainly in those with advanced stages of the disease. The diagnosis of idiopathic oesophageal ulcerations must necessarily rule out other oesophageal diseases. Corticosteroid therapy may be useful [2] and thalidomide has been very effective in isolated reports of HIV-associated ulcerations [3,4] , and in our own experience. In addition, we have successfully treated oral ulcerations associated with HIV infection with thalidomide. Usually, only short courses of therapy are needed and thus severe adverse effects are very uncommon.