Disturbed gastric motor activity in patients with human immunodeficiency virus infection

Human immunodeficiency virus (HIV) infection is accompanied by a wide spectrum of disorders that affect the central and peripheral nervous system. Damage to the peripheral and central nervous system, including its autonomic division, may become manifest at any stage of the disease.

Twenty HIV-positive patients with abdominal complaints like dyspepsia, dysphagia, vomiting, and nausea underwent several function tests to determine oesophageal motility, gastric motor and electric activity, and gastric emptying rate. The CDC (Center for Disease Control) classification was used to determine the stage of the disease, which varied from B2 to C3. Before gastric motility examinations all patients underwent endoscopy of the upper gastrointestinal (GI) tract, and none of them showed any morphologic changes of the stomach or oesophagus. Biopsy specimens taken during upper GI endoscopy did not show any histologic alterations of the gastric or oesophageal mucosa.

Manometry of the antrum showed an unchanged postprandial (after 200 ml liquid, caloric meal) motility index (MI) when compared with the fasting period (mean fed MI, 174 +/- 43; mean fasting MI, 136 +/- 51). The same was seen for frequency, amplitude, and duration of antral contractions. The electrogastrographic recordings showed basal rhythm of 3 cpm, and no significant changes of the electric pattern were observed postprandially. The amplitude of electric oscillations (power content) significantly increased postprandially when compared with the fasting period. The gastric emptying rate of liquids, measured by means of the 13C-acetate breath test, was faster in HIV patients than in healthy controls. On the other hand, in HIV patients the scintigraphically determined emptying rate of solids was significantly delayed compared with the normal values. There were no significant differences in the oesophageal motility pattern with regard to the amplitude, duration, and propagation of peristaltic waves when compared with the values obtained from healthy volunteers.

Our results suggest that HIV-associated visceral neuropathy may present already in relatively early stages of infection and may contribute to abdominal symptoms that occur frequently in these patients.