Comparison of two corticosteroid regimens for the treatment of HIV-associated idiopathic esophageal ulcer.

Abstract

Although corticosteroids appear to be efficacious in the treatment of HIV-associated idiopathic esophageal ulcer, the optimal regimen remains undefined. Over a 41-month period, all patients with idiopathic esophageal ulcer defined by clinical, endoscopic, and pathological criteria were treated with a defined corticosteroid regimen. The initial 12 patients were treated with prednisone, 40 mg daily tapering to 10 mg/wk, for a 4-wk course of therapy, and 24 subsequent patients were treated with 40 mg daily for 2 wk. All patients were followed clinically, with most patients undergoing endoscopy at the completion of therapy and for recurrent esophageal symptoms. A symptomatic response was seen in 11 patients (92%) in the 4-wk regimen and 23 patients (96%) in the 2-wk regimen. A complete symptomatic response was seen in 10 patients (83%) in the 4-wk regimen, compared with 18 patients (75%) in the 2-wk regimen. A partial response was seen in the 2-wk regimen more often (five patients) than in the 4-wk regimen. Long-term follow-up in responders revealed relapse in two of nine patients (22%) in the 4-wk regimen compared with 12 of 23 (52%) in the 2-wk regimen (p = 0.10). Relapse occurred within 9 wk in all but one patient and was heralded by recurrent odynophagia. The prednisone regimen was well-tolerated, although opportunistic infections occurred in seven patients during or within 1 month of therapy. Prednisone therapy is highly efficacious for the treatment of idiopathic esophageal ulcer resulting in a rapid clinical response and endoscopic healing. A 2-wk course of therapy may be associated with a higher relapse rate than a 4-wk regimen. Relapse frequently occurs, usually within 2 months of therapy. The side effects profile appears acceptable.