Clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients

Abstract

Background: Human Immunodefi ciency Virus (HIV) infected patient frequently report upper gastrointestinal (GI) symptoms; however their prevalence and diagnostic approach is not well known. Objective: The objective of this study was to study clinical, endoscopic and histopathological changes in HIV infected patients with upper GI symptoms and their correlation with CD4 count. Materials and methods: We evaluated 50 HIV infected patients who presented to M.S. Ramaiah hospital with upper GI symptoms. All patients answered questionnaire assessing upper GI symptoms and underwent upper GI endoscopy. Mucosal biopsy was taken wherever mucosal abnormality seen. Results: In our study, the mean age of patients was 40.98 yrs, of which 80% were males. Vomiting (36%), epigastric pain (36 %), weight loss (34 %) and anorexia (34%) were the predominant symptoms. Esophagogastroduodenoscopy (EGD) fi ndings revealed-Oesophageal candidiasis in 28.0%, esophagitis in 22.0%, gastritis in 20.0 %, duodenitis in 14 %, normal upper GI mucosa in 18 % patients. Oesophageal candidiasis was the most common fi nding on histopathological examination and the mean CD4 count was 157.92 cells/μl. Conclusion: Vomiting, epigastric pain, weight loss and anorexia were most frequent symptoms. Oral candidiasis was the most common oral lesion. Oesophageal candidiasis, oesophagitis and oesophageal ulcers were the common fi ndings on EGD. Patient with CD4 count less than 200cells/μl had more frequent upper GI mucosal involvement than in patients with CD4 count more than 200. Majority of the patients with GI symptoms had upper GI mucosal changes and opportunistic infections. Thus endoscopic and histopathological evaluation is advisable for the early diagnosis and treatment of upper GI complications in patients with HIV infection.

Epidemiological Characteristics and Clinical Presentations of Hiv Patients Attending the Abbasia Fever Hospital

“…The commonest cause of esophageal symptoms was candidiasis, followed by cytomegalovirus infection which produced either diffuse esophagitis or discrete ulcerations (Wilcox and Saag, 2008). In the present study, weight loss was in 14% of HIV patients which was less than that reported by Ravikumar et al (2010) they found that weight loss was in 34% of HIV patients. This difference may be due to the fact that their pa samples suffered only from upper gastrointestinal symptoms.…”

Gastric Ulcers Due to Varicella-Zoster Reactivation

“…9 Clinically relevant VZV infections in HIV and AIDS patients involve the skin and central nervous system, whereas gastrointestinal involvement is rare. 9,15,16 Several studies examined HIV and AIDS patients with significant abdominal pain and found an overall low incidence of ulcers and no reported cases of VZV infection in the gastrointestinal tract upon endoscopic evaluation. [15][16][17][18] Myeloablative therapy in bone marrow and stem cell transplantation seems to predispose patients uniquely to gastritis caused by VZV.…”

The study of clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients

“…However other studies done by Ravikumar et al, showed CMV esophagitis in two (4.87%). 12 Vui heng chong and Chee chain Lim et al, demonstrated CMV Esophagitis in 11.2%, herpes simplex esophagitis in 3.2%. 9 Endoscopic findings like oesophageal ulcerations, gastric erosions, intestinal tuberculosis which have been reported by other authors like Ravikumar et al, Vui heng chong and Chee chain lim et al, were not seen in our patients.…”

“…Other workers like Ravikumar et al, studied fifty patients, candidiasis was seen in 28%, esophagitis in 22% and Gastritis in 20%. 12 Vui heng chong and Chee chain lim et al, showed among one hundred twenty five HIV positive patients, candidiasis was seen in 23.1%. 9 Elshazly MA et al, 74% showed changes in esophagus and 28% in stomach.…”

“…9 Endoscopic findings like oesophageal ulcerations, gastric erosions, intestinal tuberculosis which have been reported by other authors like Ravikumar et al, Vui heng chong and Chee chain lim et al, were not seen in our patients. 9,12 This was probably due to majority of patients being on HAART. Studies have shown regression of mucosal lesion with initiation of HAART therapy within 2-3 weeks.…”