title: Idiopathic esophageal ulceration in acquired immunodeficiency syndrome: successful treatment with misoprostol and viscous lidocaine.
abstract: 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.
authors.affiliation: Division of Gastroenterology, University of Medicine and Dentistry of New Jersey-University Hospital and New Jersey Medical School, Newark 07103, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Adeoti
authors.forename: K J
authors.initials: KJ
authors.lastname: Vega
authors.forename: E Z
authors.initials: EZ
authors.lastname: Dajani
authors.forename: B W
authors.initials: BW
authors.lastname: Trotman
authors.forename: P C
authors.initials: PC
authors.lastname: Kloser
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000287:Administration, Topical; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D004935:Esophageal Diseases / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage*; D012189:Retrospective Studies; D013535:Suspensions; D014456:Ulcer / Q000150:complications / Q000188:drug therapy*; D014783:Viscosity
chemical_list: D000779:Anesthetics, Local; D000897:Anti-Ulcer Agents; D004338:Drug Combinations; D013535:Suspensions; D016595:Misoprostol; D008012:Lidocaine