Patients with
acquired immunodeficiency syndrome (
AIDS) frequently have
diarrhea and
weight loss. We prospectively examined the upper and lower gastrointestinal tracts in 22
AIDS patients, although severe medical problems often precluded full evaluation. Ninety-six percent (21 of 22) lost weight, and 55% (12 of 22) had
diarrhea. The mean (+/- SD)
weight loss was 34 +/- 19 lb.
Steatorrhea was found in 4 of 14 patients, and
D-xylose tests were abnormal in 8 of 14 patients. Mean
serum albumin was 3.3 +/- 0.8 g/dl. A significantly diminished plasma
selenium level, which can influence immune function, was noted in these
AIDS patients. Gastrointestinal
infections were identified in 45% of patients. Although
diarrhea and malabsorption were more common in the infected group,
weight loss and
albumin were similar in those with and without demonstrated
infections. Flexible sigmoidoscopy showed that of 15 patients, there were two with
Kaposi's sarcoma, 10 normals, and three with nonspecific endoscopic changes of
colitis.
Infection was documented in all patients with
colitis. Panendoscopy of the upper gastrointestinal tract was positive for
AIDS-related pathology in five of 10 patients, including two with
Kaposi's sarcoma, one with Candida
esophagitis, one with herpetic
esophagitis, and one with gastroduodenitis (biopsy positive for cryptosporidia); five patients had a normal-appearing tract. Small bowel or colonic biopsies frequently showed nonspecific inflammatory changes, although pathogens were identified in six patients (27% of all biopsies). We conclude that a wide variety of gastrointestinal pathology, which includes infectious agents,
neoplasms, and inflammatory changes, may occur in
AIDS patients. Therefore,
AIDS patients, particularly those with
diarrhea or
weight loss, deserve an intensive evaluation for remediable lesions of their gastrointestinal tracts.