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Chronic unexplained diarrhea in human immunodeficiency virus infection: determination of the best diagnostic approach.

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.