Clinical findings and risk factors for Candida esophagitis in outpatients.

We retrospectively reviewed 18 patients with endoscopically discovered Candida esophagitis to more fully characterize this entity and identify predisposing conditions. Candida esophagitis was defined by the presence of fungal mycelia on brush cytology. Only two patients had an associated malignancy. Other possible predisposing risk factors were acid suppressive therapy (14 patients), prior gastric surgery (five), mucosal barrier injury (four), inhaled steroid use (four), oral steroid use (three), esophageal motility disorders (three), rheumatologic disorders (three), prior antibiotic use (two) and diabetes mellitus (two). The majority of patients had more than one proposed risk factor. Ten (56%) were treated with antifungal therapy. Thus, Candida esophagitis was infrequently seen in patients with associated malignancy. Prospective evaluation of predisposing conditions and treatment is recommended.

Lichen planus esophagitis: report of three patients treated with oral tacrolimus or intraesophageal corticosteroid injections or both.

Clinically significant involvement of the esophagus is uncommon in patients who have lichen planus, a common disorder of squamous epithelium. In three patients who had oral, cutaneous, and esophageal lichen planus, endoscopic intralesional esophageal injection of corticosteroids (in all three patients) and oral tacrolimus (FH506) (in two patients) resulted in improvement in dysphagia, a less frequent need for dilation, and improvement in esophageal inflammation.

Ileocolonic anastomotic ulcers: a case series and review of the literature.

OBJECTIVE: Although gastric anastomotic ulcers have been well described, there are only a few reports in the literature, mostly in the pediatric population, of ulcers occurring at colonic anastomotic sites. Our aim was to determine the clinical profile of postoperative colonic anastomotic ulcers in adult patients undergoing colonoscopy at our institution. METHODS: We performed a retrospective review of colonoscopies done at our institution between 1993 and 1997. RESULTS: Six patients with colonic anastomotic ulcers were identified; all had ileocolonic anastomoses. All patients presented with iron deficiency anemia with evidence of gastrointestinal (GI) blood loss and this was the indication for colonoscopy. The age at the time of ileocolonic anastomoses ranged from birth to 74 yr and age at the time of colonoscopy ranged from 24 to 76 yr. The interval between surgery and detection of anastomotic ulcer ranged from 15 months to 28 yr. Only two patients had a possible etiology: one with previous small bowel Crohn's disease, and the other with significant nonsteroidal antiinflammatory drugs (NSAID) use and evidence of small-bowel ulcers in the adjacent ileum as well. Three of the patients had previously undergone surgical resection and revision of the anastomosis without benefit; the ulcers recurred at the new anastomosis and continued to bleed. CONCLUSIONS: Ulcers can develop at sites of ileocolonic anastomoses. The commonest presentation is with iron deficiency anemia due to occult blood loss. The etiology of the ulcer, in most patients, remains speculative. The therapeutic approach to these ulcers is to discontinue all NSAIDs, treat underlying inflammatory bowel disease, if present, and supplement with oral iron. Surgery should be reserved for life-threatening bleeds or for anemia refractory to oral iron therapy.

Gastric acid secretion in HIV-1 infection.

It has been suggested that AIDS patients may have reduced gastric acid output. This is of concern because gastric acid may be required for absorption of oral antifungal agents that are important in AIDS management. The cause as well as the progression of reduced gastric acid output in AIDS patients is unclear. This study investigated gastric acid output in relation to the stage of non-AIDS HIV-1-infected patients. No statistical difference was found between nine control and 26 male HIV-infected subjects in basal acid output, maximal acid output, peak acid output, or fasting serum gastrin, regardless of stage. Likewise, no relationship between stage of HIV infection and gastric acid output was determined. We conclude that there is no impairment in basal and maximally stimulated gastric acid secretion in non-AIDS HIV-1-infected males. In addition, the clinical stage of non-AIDS HIV-1 infection has no effect on gastric acid secretion.

Listeria monocytogenes meningitis.

Presented is the case of a 42-year-old, previously healthy man with meningitis secondary to Listeria monocytogenes. Following lumbar puncture, empiric therapy with intravenous penicillin was started and he was hospitalized. Subsequently L monocytogenes was proven to be the causative organism and antibiotic therapy was changed to ampicillin and gentamicin. The patient's condition improved. He was discharged and continues to do well. There was no evidence at any time of underlying predisposition to infection. Listeria meningitis in healthy patients and in patients with underlying disease is discussed, along with possible implications about choice of empiric antibiotics.