title: Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients: An Endoscopy-Based Cross-Sectional Study of 6011 Patients.
abstract: Upper gastrointestinal (GI) symptoms are common in both HIV and non-HIV-infected patients, but the difference of GI symptom severity between 2 groups remains unknown. Candida esophagitis and erosive esophagitis, 2 major types of esophagitis, are seen in both HIV and non-HIV-infected patients, but differences in GI symptoms that are predictive of esophagitis between 2 groups remain unknown. We aimed to determine whether GI symptoms differ between HIV-infected and non-HIV-infected patients, and identify specific symptoms of candida esophagitis and erosive esophagitis between 2 groups.We prospectively enrolled 6011 patients (HIV, 430; non-HIV, 5581) who underwent endoscopy and completed questionnaires. Nine upper GI symptoms (epigastric pain, heartburn, acid regurgitation, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia) were evaluated using a 7-point Likert scale. Associations between esophagitis and symptoms were analyzed by the multivariate logistic regression model adjusted for age, sex, and proton pump inhibitors.Endoscopy revealed GI-organic diseases in 33.4% (2010/6.011) of patients. The prevalence of candida esophagitis and erosive esophagitis was 11.2% and 12.1% in HIV-infected patients, respectively, whereas it was 2.9% and 10.7 % in non-HIV-infected patients, respectively. After excluding GI-organic diseases, HIV-infected patients had significantly (P < 0.05) higher symptom scores for heartburn, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia than non-HIV-infected patients. In HIV-infected patients, any symptom was not significantly associated with CD4 cell count. In multivariate analysis, none of the 9 GI symptoms were associated with candida esophagitis in HIV-infected patients, whereas dysphagia and odynophagia were independently (P < 0.05) associated with candida esophagitis in non-HIV-infected patients. However, heartburn and acid regurgitation were independently (P < 0.05) associated with erosive esophagitis in both patient groups. The internal consistency test using Cronbach's α revealed that the 9 symptom scores were reliable in both HIV (α, 0.86) and non-HIV-infected patients (α, 0.85).This large-scale endoscopy-based study showed that HIV-infected patients have greater GI symptom scores compared with non-HIV-infected patients even after excluding GI-organic diseases. None of the upper GI symptoms predict candida esophagitis in HIV-infected patients, but dysphagia and odynophagia predict candida esophagitis in non-HIV-infected patients. Heartburn and acid regurgitation predict erosive esophagitis in both patient groups.
authors.affiliation: From the Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo (YT, NN, TA, KS, HO, KW, TS, CY, JA); Ohta Nishinouchi Hospital, Fukushima (TS); Division of AIDS Clinical Center, National Center for Global Health and Medicine (TN, KW, SO); Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo (AM); and Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan (NU).
authors.forename: Yuta
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishijima
authors.forename: Koji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Tomonori
authors.initials: T
authors.lastname: Aoki
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Okubo
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.forename: Akio
authors.initials: A
authors.lastname: Mimori
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
mesh_terms: D000328:Adult; D002177:Candidiasis / Q000453:epidemiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004941:Esophagitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology*; D004945:Esophagoscopy; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index