Esophageal lesions occurring in patients with HIV infection have received great attention in current literature. The spectrum of infections has been better defined by two large prospective studies. A double-blind multicenter trial showed that fluconazole is more effective than ketoconazole in the short-term treatment of esophageal candidiasis and therefore should be regarded as the drug of choice for this condition. Controlled trials should confirm the favorable preliminary results obtained with continuous low-dose administration of ketoconazole and fluconazole as prophylaxis for recurrent esophageal candidiasis. The problem of drug-induced esophageal injury has also received great attention, and concomitant aspirin use is now regarded as a potential cause of refractoriness to treatment in patients with peptic esophagitis. “Natural” drugs and “diet pills” have been suspected of being the cause of esophageal problems. Finally, several systemic conditions with associated esophageal involvement have been reviewed.