Gastroesophageal reflux, dysphagia, and odynophagia are common complaints in the SCT patient. Severe mucositis extending down into the esophagus is common in patients receiving methotrexate for GVHD prophylaxis, and is usually treated with narcotics and TPN until it resolves. If given before initiation of the preparative regimen, sulcralfate 1 g given as an elixir 4 times a day may decrease the incidence of mucositis (Castagna et al, 2001). Dysphagia and odynophagia may result from infectious esophagitis and/or acute GVHD. Upper endoscopy should be pursued to rule out infectious esophagitis caused by herpes simplex versus, CMV, or candida. The absence of oral candidiasis should not exclude an evaluation of the esophagus for candida esophagitis. Reflux symptoms are exacerbated in those patients who develop gastroparesis, and therefore gastric acid antisecretory therapy should be instituted.
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