今日の臨床サポート

感染性食道炎、潰瘍

著者: 石村典久 島根大学 第2内科

監修: 木下芳一 兵庫県立姫路循環器病センター/製鉄記念広畑病院

著者校正/監修レビュー済:2020/10/01
患者向け説明資料

概要・推奨   

  1. カンジダ食道炎はエイズ患者における最も頻度の高い感染性食道炎の原因であり、約10~15の頻度で認められる。
  1. 臨床的にカンジダ食道炎が疑われる場合、内視鏡検査前に抗真菌薬による治療を開始して良い(推奨度1G)。
  1. 食道カンジダ症に対しては全身性抗真菌療法が強く推奨される(推奨度1G
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
石村典久 : 特に申告事項無し[2021年]
監修:木下芳一 : 講演料(アストラゼネカ,武田,大塚,第一三共)[2021年]

改訂のポイント:
  1. 定期レビューを行い、概要・推奨、疾患情報、治療について加筆修正を行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 感染性食道炎は、真菌・ウイルス・細菌などの感染により生じる食道粘膜病変である。
  1. 健常者で発症することは稀であり、悪性腫瘍、HIV感染症、臓器移植後、化学療法・副腎皮質ホルモン・免疫抑制薬投与患者など免疫能が低下した症例に合併することが多い。
  1. 感染源として頻度の高いものにカンジダ、サイトメガロウイルス(Cytomegalovirus、CMV)、単純ヘルペスウイルス(Herpes simplex virus、HSV)があり、頻度の低いものに結核菌が挙げられる。
  1. 日本での検討では内視鏡検査を施行した0.13%に感染性食道炎を認めた。内訳ではカンジダ食道炎0.064%、CMV食道炎0.053%、HSV食道炎0.015%であった[1]
  1. 消化管結核583例を集積した日本の検討では、罹患部位は大腸、回盲部、小腸が大半を占め、食道結核は8.9%であった[2]
  1. カンジダは口腔、消化管、皮膚、腟などに定着する常在菌であり、全身免疫機構の低下や局所感染防御機能の低下した状態で食道内に異常繁殖し、組織浸潤をして粘膜障害を来すことにより発現する。(参照: 食道カンジダ症 )
  1. CMV食道炎は、主にHIV患者で発症し、ほかの免疫不全患者での発症は稀である。
  1. HSVやCMVは、免疫能低下による潜伏したウイルスの再活性化によって臓器障害を起こす。
  1. 食道結核は肺結核、肺以外の結核合併例が多く、頭頚部または縦隔リンパ節結核の食道浸潤、穿破によって生じることが大半で原発性食道結核は極めて稀である。
問診・診察のポイント  
  1. 免疫不全状態で日和見感染症として生じることが多いため、免疫機能の低下を来す状態がないかを確認する。

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文献 

著者: M Bonacini, T Young, L Laine
雑誌名: Arch Intern Med. 1991 Aug;151(8):1567-72.
Abstract/Text STUDY OBJECTIVES: --To determine the prevalence of infectious agents in patients with human immunodeficiency virus infection and odynophagia or dysphagia; the utility of endoscopic, histologic, cytologic, and virologic testing for the diagnosis of esophagitis; and the yield of blind brushings of the esophagus in this setting.
DESIGN: --Prospective clinical case study.
SETTING: --Urban county hospital.
PATIENTS: --One hundred ten consecutive patients with esophageal symptoms and documented human immunodeficiency virus infection.
INTERVENTION: --Blind brushing of the esophagus via orogastric tube followed by endoscopy with esophageal brushing for fungal stain, Papanicolau smear, and viral cultures and esophageal biopsies for histologic examination and viral culture.
MAIN RESULTS: --Seventy-two (65%) of the 110 patients had a total of 100 esophageal infections. Thirty-three (30%) had Candida alone, 22 (20%) had Candida and cytomegalovirus, two (1.8%) had Candida with cytomegalovirus and herpes simplex virus, seven (6%) had cytomegalovirus alone, six (5%) had herpes simplex virus alone, and two (1.8%) had both viruses. Fifty of 55 patients with plaques alone had Candida, and two (4%) had only viral infection. Of 19 patients with erosions or ulcers, 11 (58%) had a viral infection, two (11%) had Candida alone, and six (30%) had no etiologic agent identified. The sensitivity of endoscopic brushings (95%) was better than that of histologic examination (70%) in the diagnosis of Candida esophagitis. Likewise, viral cultures of brushings or biopsy specimens were more sensitive (67%) than histologic examination (35%) for viral esophagitis. Blind brushing of the esophagus had a sensitivity and specificity for infectious esophagitis of 84% and 75%, respectively. Oral thrush had a sensitivity of 53% and a positive predictive value of 77% for Candida esophagitis.

PMID 1651690  Arch Intern Med. 1991 Aug;151(8):1567-72.
著者: C M Wilcox, R F Straub, W S Clark
雑誌名: Am J Gastroenterol. 1995 Nov;90(11):1938-41.
Abstract/Text OBJECTIVE: Although the presence of oropharyngeal (OP) candidiasis plays an important role in the evaluation of human immunodeficiency virus (HIV)-infected patients with esophageal symptoms, there is little information on the utility of OP findings in patients with esophageal ulceration.
METHODS: Over a 54-month period, all HIV-infected patients with esophageal ulceration had careful inspection of the oropharynx at the time of presentation with esophageal complaints and at endoscopy. HIV-infected patients without esophageal ulceration undergoing endoscopy during the last 30 months had OP findings similarly documented. OP ulceration ulceration was determined based on clinical, endoscopic, and histopathological findings.
RESULTS: Of the 124 patients identified with esophageal ulcer, 14 (11%) had coexistent OP ulceration: herpes simplex virus, four; idiopathic esophageal ulcer, four; cytomegalovirus, three; herpes simplex virus and cytomegalovirus, two; idiopathic and cytomegalovirus, one. Four patients had OP ulcer without esophageal ulcer; only one of these patients had esophageal symptoms. All OP lesions healed with therapy for the esophageal ulcer. Twenty-eight patients with esophageal ulcer had OP candidiasis (23%); 21 of these patients (75%) also had Candida esophagitis. The sensitivity and specificity of OP ulcer for esophageal ulcer were 11% and 97%, respectively. The positive and negative predictive values of OP candidiasis for esophageal candidiasis were 90% and 82%, respectively.
CONCLUSIONS: OP ulceration is uncommon in patients with esophageal ulceration, with the exception of herpes simplex virus esophagitis. OP candidiasis is common in patients with underlying esophageal ulcer, potentially resulting in diagnostic confusion. OP candidiasis appears to be a moderately useful diagnostic marker for Candida esophagitis.

PMID 7484995  Am J Gastroenterol. 1995 Nov;90(11):1938-41.
著者: Jose A Vazquez
雑誌名: HIV AIDS (Auckl). 2010;2:89-101. Epub 2010 Apr 28.
Abstract/Text Mucocutaneous candidiasis is frequently one of the first signs of human immunodeficiency virus (HIV) infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis (OPC) at some time during their illness. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole, voriconazole, posaconazole) have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. The systemic azoles, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A constant concern in these patients is relapse, which is dependent on the degree of immunosuppression commonly seen after topical therapy, rather than with systemic azole therapy. Candida esophagitis (CE) is also an important concern since it occurs in more than 10% of patients with AIDS and can lead to a decrease in oral intake and associated weight loss. Fluconazole has become the most widely used antifungal in the management of mucosal candidiasis. However, itraconazole and posaconazole have similar clinical response rates as fluconazole and are also effective alternative agents. In patients with fluconazole-refractory mucosal candidiasis, treatment options now include itraconazole solution, voriconazole, posaconazole, and the newer echinocandins (caspofungin, micafungin, and anidulafungin).

PMID 22096388  HIV AIDS (Auckl). 2010;2:89-101. Epub 2010 Apr 28.
著者: Milos Korać, Branko Brmbolić, Dubravka Salemović, Jovan Ranin, Zorica Stojsić, Djordje Jevtović, Jelena Nikolić
雑誌名: Hepatogastroenterology. 2009 Nov-Dec;56(96):1675-8.
Abstract/Text BACKGROUND/AIMS: Gastrointestinal (GI) diseases are common among patients infected with human immunodeficiency virus (HIV), and may involve the entire GI tract. The aim of the article is to investigate the prevalence of various upper gastrointestinal abnormalities in patients with AIDS.
METHODOLOGY: Diagnostic esophago-gastro-duodenoscopy (EGD) was performed in cohort of AIDS patients (total 186) including non-ART, mono and/or dual ART and HAART treated subgroups. Clinical presentation, level of immunosupression and presence of H. pylori infection was also considered.
RESULTS: Endoscopic findings included normal (29), esophageal candidiasis (22), esophageal erosions (16), gastritis/duodenitis (135), gastric/duodenal ulcers (7), erosions (6) and infiltration/tumor in the stomach (5). Thirty-nine patients (20.4%) had opportunistic infections/tumors including candida esophagitis, CMV esophagitis, CMV gastritis, gastric non-Hodgkin's lymphoma (NHL) and gastric cryptosporidiosis. H. pylori infection was present in 25.8% of patients, and majority (89.6%) had chronic non-atrophic gastritis. These patients had a higher mean CD4 count compared with H. pylori negative patients (403.5 vs. 226.9 CD4+ cells/microL, p = 0.001). Patients who received HAART had significantly higher frequency of H. pylori infection then non-ART treated patients (p = 0.048).
CONCLUSION: Candidiasis was the marker of advanced immunodeficiency, and H. pylori was more common in patients with higher CD4 cell counts on ART, which may suggest that this infection could be an unusual presentation of immune restoration inflammatory syndrome.

PMID 20214216  Hepatogastroenterology. 2009 Nov-Dec;56(96):1675-8.
著者: J A Underwood, J W Williams, R F Keate
雑誌名: Dis Esophagus. 2003;16(2):66-9.
Abstract/Text 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.

PMID 12823199  Dis Esophagus. 2003;16(2):66-9.
著者: A Chocarro Martínez, F Galindo Tobal, G Ruiz-Irastorza, A González López, F Alvarez Navia, C Ochoa Sangrador, M I Martín Arribas
雑誌名: Eur J Clin Microbiol Infect Dis. 2000 Feb;19(2):96-100.
Abstract/Text The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis, 15 of whom had esophageal complaints and 48 of whom suffered from another previous chronic disease (17 had cancer). In addition, 20 patients had previously been treated with antibiotics, 13 with steroids and 14 with omeprazole. In the multivariate analysis, neoplasm (odds ratio, 5.50; 95% confidence interval, 1.94-15.56) and therapy with antibiotics (odds ratio, 11.97; 95% confidence interval, 3.82-37.45), steroids (odds ratio, 35.52; 95% confidence interval, 3.90-324.01) or omeprazole (odds ratio, 18.23; 95% confidence interval, 4.67-71.03) were all associated with esophageal candidiasis. These data suggest that Candida esophagitis tends to occur in patients with chronic diseases, most of whom have been previously treated with antibiotics, steroids or omeprazole. The findings support the hypothesis that treatment with omeprazole favors the development of esophageal candidiasis.

PMID 10746494  Eur J Clin Microbiol Infect Dis. 2000 Feb;19(2):96-100.・・・
著者: A J Larner, R Lendrum
雑誌名: Gut. 1992 Jun;33(6):860-1.
Abstract/Text Oesophageal candidiasis was diagnosed incidentally at endoscopy in two patients receiving omeprazole therapy. There were no other predisposing factors for the development of candidiasis. The infection was resolved rapidly by anti-candidal therapy and by stopping omeprazole. These findings suggest that gastric acid secretion and physiological reflux of acid into the oesophagus may play a protective role in preventing candida infection.

PMID 1624174  Gut. 1992 Jun;33(6):860-1.
著者: G M Connolly, A Forbes, J A Gleeson, B G Gazzard
雑誌名: AIDS. 1989 Jul;3(7):453-6.
Abstract/Text Double contrast barium radiology and upper gastrointestinal endoscopy were compared prospectively on 45 occasions in patients infected with HIV who presented with upper gastrointestinal symptoms. In 40 cases, a definite pathological diagnosis was reached and in four cases no organic basis for symptoms could be found. A correct and complete diagnosis was made on visual endoscopic criteria in 43 cases (95.5%) but in only 14 cases (31.1%) from barium studies alone. Radiology showed no abnormality in 22 cases where pathological changes were documented (oesophageal candidiasis in 21 cases). Where pathological confirmation of diagnosis existed (40 cases), endoscopy (without pathological support) had a sensitivity of 97.5% and a specificity of 100% compared with the sensitivity and specificity of 25 and 100% for barium studies. The difference between the sensitivities of the two methods was highly significant (P less than 0.005). The combination of oral candidiasis and upper gastrointestinal symptoms without dysphagia or weight loss was so strongly associated with uncomplicated oesophageal candidiasis (negative predictive value 93%; P less than 0.025), that this is supported as a basis for therapy without the need for further investigation, although if upper gastrointestinal investigation is required, endoscopy should be the method of choice.

PMID 2504250  AIDS. 1989 Jul;3(7):453-6.
著者: R D McBane, J B Gross
雑誌名: Gastrointest Endosc. 1991 Nov-Dec;37(6):600-3.
Abstract/Text The unexpected diagnosis of herpetic esophagitis in a patient with nausea led us to review our experience with this disease. Review of our records from 1979 to 1989 produced 23 cases proven by endoscopic culture or microscopic examination (Cowdry-type A inclusions), the largest such series reported to date. Twenty-two of the 23 patients were immunocompromised. Odynophagia and chest pain were each present in half of the cases, but 26% of patients had neither. Gastrointestinal bleeding was attributable to herpetic esophagitis in 30%. Thirty percent of patients had disseminated herpes simplex infection and 70% had simultaneous infections with other organisms. Endoscopic findings included nonspecific inflammation, discrete ulcers, coalescent ulcers, and pseudomembranous esophagitis. Herpes virus was not suspected endoscopically as the cause of esophagitis in 30% of cases. Culture was slightly more sensitive than microscopic examination for diagnosis (89% vs. 76%), but both methods should be employed in any immunocompromised patient with esophagitis.

PMID 1756917  Gastrointest Endosc. 1991 Nov-Dec;37(6):600-3.
著者: M López-Dupla, P Mora Sanz, V Pintado García, E Valencia Ortega, P L Uriol, M A Khamashta, A G Aguado
雑誌名: Am J Gastroenterol. 1992 Dec;87(12):1771-6.
Abstract/Text The medical records of 114 consecutive HIV-infected patients with oropharyngeal and esophageal candidiasis, in whom esophagoscopy was performed, were reviewed. Esophageal candidiasis and isolated oral candidiasis were found in 75% and 25% of patients, respectively. Esophageal candidiasis was the AIDS-defining illness in 65 patients and dysphagia was the commonest symptom, but asymptomatic Candida esophagitis was observed in 43% of them. Symptoms were present in six patients with oropharyngeal candidiasis; three of them had a normal esophagoscopy and the other three had acute nonfungal esophagitis. Invasive fungal esophagitis was confirmed by biopsy in 47/74 patients (64%). The patients with esophageal candidiasis had lower CD4+ cell counts (129/microliter) and CD4:CD8 ratios (0.23) than those with oropharyngeal candidiasis (CD4 179/microliter; CD4:CD8 0.35). Thirty-six patients with esophageal candidiasis were treated with fluconazole, 100 mg/daily, for 28 days, and another 34 patients received the same dose for 10 days. A similar efficacy was seen in both regimens, but a higher incidence of oropharyngeal fungal colonization and liver dysfunction was observed in the longer therapy (p < 0.001). We conclude that asymptomatic C. esophagitis is common in HIV-infected patients. Patients with oropharyngeal candidiasis may complain of esophageal symptoms; it could be due to superficial C. infection or another not-identified opportunistic infection. More severe immunologic impairment was required to develop esophageal candidiasis than oropharyngeal candidiasis. A short course of 10 days of fluconazole therapy could be the standard regimen for the treatment of C. esophagitis in AIDS.

PMID 1449139  Am J Gastroenterol. 1992 Dec;87(12):1771-6.
著者: B E Kodsi, C Wickremesinghe, P J Kozinn, K Iswara, P K Goldberg
雑誌名: Gastroenterology. 1976 Nov;71(5):715-9.
Abstract/Text A prospective study of candida esophagitis was undertaken to determine the spectrum of this disease in a general hospital. During 1 year, in 370 consecutive endoscopies, 27 patients with Candida esophagitis were detected. The diagnosis was established by finding white plaques on endoscopy, yeast organisms on microscopic examination of a direct smear from the plaques, and a serum agglutinin titer of at least 1:160. Of these 27 patients, 14 had esophageal symptoms. Twelve patients were reendoscoped after nystatin or nystatin and flucytosine therapy. Nine patients showed absence of lesions, a negative smear, and disappearance of symptoms. Control patients had no plaques on endoscopy, no yeast organisms on microscopical examination of esophageal brushings, and a positive titer in 4 to 17% of cases. A minimal agglutinin titer of 1:160 was found in 4 to 12% of two additional groups on controls. Absence of titer precluded a diagnosis of Candida esophagitis.

PMID 964563  Gastroenterology. 1976 Nov;71(5):715-9.
著者: Peter G Pappas, Carol A Kauffman, David R Andes, Cornelius J Clancy, Kieren A Marr, Luis Ostrosky-Zeichner, Annette C Reboli, Mindy G Schuster, Jose A Vazquez, Thomas J Walsh, Theoklis E Zaoutis, Jack D Sobel
雑誌名: Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16.
Abstract/Text It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.
PMID 26679628  Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/・・・
著者: L Laine, R H Dretler, C N Conteas, C Tuazon, F M Koster, F Sattler, K Squires, M Z Islam
雑誌名: Ann Intern Med. 1992 Oct 15;117(8):655-60.
Abstract/Text OBJECTIVE: To determine the clinical and endoscopic response of candida esophagitis to antifungal therapy and to compare the two oral antifungal agents, fluconazole and ketoconazole.
DESIGN: Multicenter, randomized, double-blind trial.
SETTING: Fifteen U.S. centers including university, private practice, and county hospital settings.
PATIENTS: A total of 169 patients with the acquired immunodeficiency syndrome (AIDS); odynophagia, dysphagia, or retrosternal pain; white esophageal plaques at endoscopy; and pseudohyphae on esophageal brushings or biopsies.
INTERVENTION: Patients were randomly assigned to fluconazole (100 mg/d) or ketoconazole (200 mg/d). Doses were doubled at week 1 or 2 if no symptomatic improvement had occurred during the preceding week. Therapy was continued for 2 weeks after resolution of symptoms or for a maximum of 8 weeks.
MEASUREMENTS: Patients were clinically evaluated weekly, and laboratory tests were done every 2 weeks. Endoscopy was repeated within 5 days after the end of therapy.
RESULTS: A total of 143 patients were clinically evaluable (assessed within 7 days after therapy), and 129 patients were endoscopically evaluable (endoscopy repeated after therapy). Endoscopic cure occurred in 91% of patients treated with fluconazole and in 52% of those given ketoconazole for a difference of 39% (95% Cl, 24% to 52%; P less than 0.001). Esophageal symptoms resolved in 85% of fluconazole-treated patients and in 65% of ketoconazole-treated patients for a difference of 20% (Cl, 6% to 34%; P = 0.006). Intention-to-treat analyses also yielded statistically significant differences for the comparisons listed above. Side effects were minimal and comparable in the two groups; only one patient in each group had therapy discontinued for adverse effects that were possibly related to the study medications.
CONCLUSIONS: Fluconazole is associated with significantly greater rates of endoscopic and clinical cure than ketoconazole in patients with AIDS and candida esophagitis. Both drugs appear to be safe and well tolerated.

PMID 1308663  Ann Intern Med. 1992 Oct 15;117(8):655-60.
著者: G Barbaro, G Barbarini, W Calderon, B Grisorio, P Alcini, G Di Lorenzo
雑誌名: Gastroenterology. 1996 Nov;111(5):1169-77. doi: 10.1053/gast.1996.v111.pm8898629.
Abstract/Text BACKGROUNDS & AIMS: Contrasting opinions exist about the pharmacological treatment of esophageal candidiasis in patients with acquired immunodeficiency syndrome (AIDS). The aim of this study was to assess the long-term efficacy of fluconazole and itraconazole treatment.
METHODS: This study evaluated 2213 human immunodeficiency virus-positive patients at first episode of esophageal candidiasis diagnosed by endoscopy; 1105 received fluconazole and 1108 received itraconazole. The endoscopic and clinical response to treatment was assessed periodically until the end of the follow-up period (1 year).
RESULTS: At week 2, endoscopic cure occurred in 81.2% of patients treated with fluconazole and in 65.6% of patients treated with itraconazole (P < 0.001). Clinical cure was observed in 81.5% of patients treated with fluconazole and in 75.2% of patients treated with itraconazole (P < 0.001). At the end of the follow-up period, endoscopic and clinical cure were observed in 96% of patients treated with fluconazole and in 95.6% of patients treated with itraconazole (P = 0.788), with similar differences by intention-to-treat analysis (93.6% vs. 93.3%; P = 0.853). Treatment failure was observed in 22.3% of fluconazole-treated patients and in 26.6% of itraconazole-treated patients (P = 0.022).
CONCLUSIONS: Fluconazole and itraconazole are provided with good long-term therapeutic efficacy in the treatment of Candida esophagitis in patients with AIDS. Fluconazole is associated with a higher rate of cure than itraconazole in short-term treatment.

PMID 8898629  Gastroenterology. 1996 Nov;111(5):1169-77. doi: 10.1053・・・
著者: R Ally, D Schürmann, W Kreisel, G Carosi, K Aguirrebengoa, B Dupont, M Hodges, P Troke, A J Romero, Esophageal Candidiasis Study Group
雑誌名: Clin Infect Dis. 2001 Nov 1;33(9):1447-54. doi: 10.1086/322653. Epub 2001 Sep 26.
Abstract/Text The efficacy, safety, and tolerability of voriconazole and fluconazole were compared in 391 immunocompromised patients with mycology- and biopsy-proven esophageal candidiasis. Primary efficacy analysis (256 patients) of esophageal treatment as assessed by esophagoscopy revealed success rates of 98.3% with voriconazole and 95.1% with fluconazole. The 95% confidence interval for the difference in success rates ranged from -1.0% to 7.5%. The overall safety and tolerability of both antifungals were acceptable. Fewer patients discontinued voriconazole treatment because of insufficient clinical response (4 patients [2.0%] vs. 5 patients [2.6%]). More patients discontinued voriconazole than fluconazole treatment because of laboratory test abnormalities (7 patients [3.5%] vs. 2 patients [1.0%]) or treatment-related adverse events (5 patients [2.5%] vs. 1 patient [0.5%]). The most frequent adverse events (23%) with voriconazole were mild, transient visual disturbances. Voriconazole (200 mg, b.i.d.) was shown to be at least as effective as fluconazole in the treatment of biopsy-proven esophageal candidiasis in immunocompromised patients.

PMID 11577374  Clin Infect Dis. 2001 Nov 1;33(9):1447-54. doi: 10.1086・・・
著者: N T E de Wet, A J Bester, J J Viljoen, F Filho, J M Suleiman, E Ticona, E A Llanos, C Fisco, W Lau, D Buell
雑誌名: Aliment Pharmacol Ther. 2005 Apr 1;21(7):899-907. doi: 10.1111/j.1365-2036.2005.02427.x.
Abstract/Text AIM: To determine efficacy and safety of intravenous micafungin vs. intravenous fluconazole in the treatment of oesophageal candidiasis.
METHODS: A total of 523 patients > or =16 years with documented oesophageal candidiasis were randomized (1:1) in this controlled, non-inferiority study to receive either micafungin (150 mg/day) or fluconazole (200 mg/day). Response was evaluated clinically and endoscopically. Post-treatment assessments were performed at 2 and 4 weeks after discontinuation of therapy.
RESULTS: Median duration of therapy was 14 days. For the primary end-point of endoscopic cure, treatment difference was -0.3% (micafungin 87.7%, fluconazole 88.0%). Documented persistent invasive disease at the end of therapy was reported in 2.7% and 3.9% of patients, respectively. Both 84.8% of micafungin and 88.7% of fluconazole patients remained recurrence free at 4-weeks post-treatment. The overall therapeutic response rate was 87.3% for micafungin and 87.2% for fluconazole. The incidence of drug-related adverse events was 27.7% for micafungin and 21.3% for fluconazole. Six (2.3%) micafungin- and two (0.8%) fluconazole-treated patients discontinued therapy; rash was the most common event leading to discontinuation.
CONCLUSION: Intravenous micafungin (150 mg daily) is well tolerated and as efficacious as intravenous fluconazole (200 mg daily) in the primary treatment of oesophageal candidiasis, achieving high rates of clinical and endoscopic cure.

PMID 15801925  Aliment Pharmacol Ther. 2005 Apr 1;21(7):899-907. doi: ・・・

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