The diagnosis of esophageal candidiasis in patients with acquired immune deficiency syndrome: is endoscopy always necessary?

Oral and esophageal candidiasis represents a common infection in patients with acquired immune deficiency syndrome (AIDS). Because the relationship between the infection in both sites is not well known, we submitted to routine upper digestive endoscopy 57 patients with AIDS. Furthermore, we evaluated the diagnostic accuracy of oral candidiasis and esophageal symptoms as markers of Candida esophagitis. Oral and esophageal candidiasis were found in 52% and 48% of patients, respectively, whereas symptoms of esophageal origin were referred to by 60% of patients successively documented to have an esophageal infection. The sensitivity of esophageal symptoms and oral candidiasis alone, as indexes of an esophageal infection, was 60% and 88%, and their specificity was 100% and 81%, respectively. The combination of these two parameters improved their degree of diagnostic accuracy (sensitivity 93%, and specificity 100%), whereas the predictive value of their simultaneous presence or absence was 100% and 96%, respectively. These results document that routine endoscopy to verify the presence of esophageal candidiasis in all of the patients with AIDS is unnecessary; it could be reserved for selected subgroups such as those with esophageal symptoms despite systemic antifungal treatment, and for patients with AIDS-related complex presenting oral candidiasis without symptoms of esophageal origin.