Gastrointestinal endoscopic pathology in patients seropositive for human immunodeficiency virus

Endoscopic pathological findings in human immunodeficiency virus (HIV)-positive patients have never been reported from the Midwest. We review the endoscopic and histologic findings in HIV-positive patients referred for endoscopy. The major symptoms that prompted referral to the gastroenterology service were: diarrhea (26%), esophageal symptoms (26%), abdominal pain (19%) and hematochezia (12%). One hundred and twenty-nine symptomatic episodes in 90 patients were retrospectively reviewed. Overall, a diagnosis was reached in 57% of the symptomatic episodes, but in only 32% was a specific infection or neoplasm detected. The most common lesions responsible for diarrhea, esophageal symptoms and pain were Histoplasma colitis, Candida esophagitis and cytomegalovirus colitis. The majority (81%) of the lesions were treatable. The diagnostic yield was significantly higher (44%) for evaluations of patients who were CDC class IV (median CD4, 30 cells/mm3), compared with 14% of patients of other classifications (median CD4, 424 cells/mm3). In addition, evaluation of diarrhea, esophageal symptoms and pain yielded a diagnosis in 41% of the episodes, vs. 11% for evaluation of other symptoms. We conclude that gastrointestinal symptoms are common in HIV-positive patients in the Kansas City area, but are often minor, and that specific infections or neoplasms are diagnosed more commonly in CDC class IV patients and in patients with diarrhea, esophageal symptoms and abdominal pain.