       Document 0262
 DOCN  M9640262
 TI    Chronic unexplained diarrhea in human immunodeficiency virus infection:
       determination of the best diagnostic approach [see comments]
 DT    9604
 AU    Wilcox CM; Schwartz DA; Cotsonis G; Thompson SE 3rd; Department of
       Medicine, Emory University School of Medicine,; Atlanta, Georgia, USA.
 SO    Gastroenterology. 1996 Jan;110(1):30-7. Unique Identifier : AIDSLINE
       MED/96120989
 CM    Comment in: Gastroenterology 1996 Jan;110(1):296-8
 AB    BACKGROUND & AIMS: Chronic unexplained diarrhea is a common complication
       of human immunodeficiency virus infection, although the best diagnostic
       approach is unknown. The purpose of our study was to evaluate the
       clinical use of endoscopy for the evaluation of this problem. METHODS:
       Patients infected with human immunodeficiency virus with chronic
       unexplained diarrhea underwent upper endoscopy to the jejunum followed
       by colonoscopy. RESULTS: Forty-eight patients were evaluated. A
       potential cause of diarrhea was found in 21 patients (44%; 95%
       confidence interval, 30%-58%). Colonoscopy with biopsy identified an
       etiology in 13 patients, including cytomegalovirus colitis alone in 9.
       In all but 1 patient with colonic disease, the diagnosis was made by
       biopsy of the rectosigmoid colon. Upper endoscopy with biopsy identified
       microsporidiosis in 7 patients and cryptosporidiosis in 2 patients.
       Logistic regression analysis identified weight loss and duration of
       diarrhea (P < 0.001) as the only independent predictors for diagnosis.
       No patient without weight loss and a CD4 lymphocyte count of > 100/mm3
       had a diagnosis established. Of the 25 patients without a diagnosis in
       whom long-term follow-up was available, improvement or spontaneous
       resolution of diarrhea occurred in 9 (38%). CONCLUSIONS: Clinical
       parameters are helpful in predicting which patients may benefit from
       endoscopic examination.
 DE    Adult  Chronic Disease  Cohort Studies
       Diarrhea/*COMPLICATIONS/*DIAGNOSIS/DRUG THERAPY  Endoscopy
       Feces/MICROBIOLOGY  Forecasting  Human  HIV Infections/*COMPLICATIONS
       Male  Survival Analysis  Treatment Outcome  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

