The study of clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients
Keywords:Candidiasis, HIV, PLHA, Upper GI endoscopy
Background: Opportunistic disorders are the most frequent GI complications of HIV infection and remain a major cause of morbidity and mortality in these patients. These disorders account for high prevalence of upper gastrointestinal symptoms such as dysphagia, odynophagia, retrosternal chest pain, abdominal pain and upper GI bleeding. Hence an attempt is being made to study clinical, endoscopic and biopsy changes in HIV patients with upper GI symptoms which helps us to make early diagnosis of upper GI disorders in HIV patients.
Methods: HIV positive patients above 14 yrs diagnosed on the basis of recent NACO criteria having Upper G.I. symptoms, attending OPD of Department of Medicine admitted in Wards. All fifty three patients with upper G.I. symptoms were subjected to detail history, thorough clinical examination, routine and special investigations and Upper G.I Endoscopy.
Results: Out of fifty three patients, nineteen (35.8%) cases had normal endoscopy. The most common finding was Antral Gastritis in fourteen (26.4%), followed by Candida esophagitis in twelve (22.6%), esophagitis in three (5.7%), candida esophagitis with antral gastritis in two (3.8%), duodenitis, varices and mass (ulcerated growth) in II part of Duodenum seen in one (1.9%) each.
Conclusions: The evaluation of specific gastrointestinal complaints must be based on an assessment of degree of immunosuppression. With the progression of immunodeﬁciency, EGD becomes a useful diagnostic modality for the early diagnosis of these opportunistic infections and other inﬂammatory conditions.
Sepkowitz KA. AIDS-the first 20 years. N Engl J Med. 2001;344:1764-72.
Centers for Disease Control and Prevention. Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41:1-19.
Robert J, MacNeal, James GH. Acute retroviral syndrome. Roy C, Ed. Dermatol Clin of North America .New Delhi. Elsevier. 2006:431-8.
Warner LC, Fisher BK. Cutaneous manifestations of the acquired immunodeficiency syndrome. Int J Dermatol. 1986;25:337-50.
National AIDS control organisation. Annual Report 2012-13. Clinical Epidemiological situation of HIV/AIDS.
Koch J, Lawrance S, Scott KF. Gastro Intestinal manifestation of HIV. HIV InSite Knowledge Base. 1998.
Wilcox MC. Endoscopy in AIDS: A pattern approach to diagnosis. VHJOE. 2005;4:1-7.
Cranston DR, Anton PA, Mcgowan. Gastro intestinal mucosal biopsyin HIV disease and AIDS. Gastro Intestinal Endoscopy Clinics North America. 2000;10:637-7.
Chong VH, Lim CC. Human immunodeficiency virus and endoscopy: experience of a general hospital in Singapore. J Gastroenterol Hepatol. 2005;20(5):722-6.
Elshazly MA, Serwadda DM, Freers J. Endoscopic study of African AIDS patients with upper gastrointestinal symptoms. East Afr Med J. 1994;71:496-500.
Corley DA, Cello JP, Koch J. Evaluation of upper gastrointestinal tract symptoms in patients infected with HIV infected patients. Am J Gastroenterol. 1999;94:2890-6.
Ravikumar VN, Rudresh K, Jalihal U, Satish R, Manjunath R. Clinical and endoscopic spectrum of upper gastrointestinal manifestations in HIV patients. Kathmandu Univ Med J. 2010;8:25-8.
Gupta A, Changra M, Agarwal CG, Mishra R, Tripati AK, Nag VL. Gastrointestinal Manifestation of HIV Disease. J Association of Physicians Ind. 2005;53:376.
Sakamoto M, Adachi T, Sagara H, Yoshikawa K. Gastrointestinal diseases associated with HIV infection. Kansenshogaku Zasshi. 2000;74:57-63.
Korać M, Brmbolić B, Salemović D, Ranin J, Stojsić Z, Jevtović D, Nikolić J. Diagnostic esophago-gastro-duodenoscopy (EGD) in patients with AIDS-related upper gastrointestinalabnormalities. Hepatogastroenterology. 2009;56:1675-8.
Olmos MA, Fanín A, Araya V, Piskorz E, Quesada EC, Magnanini F, et al. Endoscopic approach in HIV infected-patients with upper gastrointestinal symptoms. Acta gastroenterologica Latinoamericana. 2004;34(3):120-6.
Kotler DP, Shimada T, Snow G, Winson G, Chen W, Zhao M, et al. Effect of combination antiretroviral therapy upon rectal mucosal HIV RNA burden and mononuclear cell apoptosis. Aids. 1998;12(6):597-604.
Werneck-Silva AL, Prado IB. Dyspepsia in HIV-infected patients under highly active antiretroviral therapy. J Gastroenterol Hepatol. 2007;22:1712-6.
Mezzi G, Fugazza L, Lazza M, Corbellini A, Boni F, Benetti GP. Endoscopy of the upper digestive tract in anti-HIV positive subjects. Minerva Gastroenterol Dietol. 1997;43:65-9.