DIAGNOSTIC YIELD OF DUODENAL BIOPSY AND ASPIRATE IN AIDS-ASSOCIATED DIARRHEA

Objectives: To evaluate the diagnostic yield of performing duodenal bi opsies and aspirates in AIDS patients with chronic diarrhea. Methods: Retrospective review of esophagogastroduodenoscopy (EGD) records from January 1993 to March 1995 to identify those patients who underwent EG D for evaluation of AIDS associated diarrhea and had a duodenal biopsy and/or aspirate. Biopsies were examined for pathogens using routine h istology and special stains, viral culture, and electron microscopy. D uodenal aspirates were evaluated for ova and parasites. All patients h ad previous negative stool studies. Pathology laboratory charges (hosp ital and professional fees) for each test and charges per positive tes t were determined. Results: Of the 57 patients included in this study, 56 had a duodenal biopsy and 42 had a duodenal aspirate. An establish ed pathogen was identified in only 15 (26%) patients. One patient had both Mycobacterium avium complex and microsporidia. Pathogens were ide ntified in seven patients by hematoxylin and eosin stain, in three pat ients by acid-fast bacillus stain, and in six patients by electron mic roscopy. No pathogens were identified with Gomori's methenamine silver stain (44 patients), duodenal aspirate for ova and parasites (46 pati ents), immunoperoxidase stains (4 patients), or viral culture (4 patie nts). Cryptosporidia were identified in six, microsporidia in five, My cobacterium avium complex in three, and Giardia lamblia and adenovirus each in one patient. Conclusions: In this series, the diagnostic yiel d of EGD with duodenal biopsy and aspirate in AIDS associated diarrhea was low. Pathogens were identified in 26% of patients; predominantly Cryptosporidium organisms and microsporidia. The routine performance o f aspiration of duodenal contents for parasite examination and stainin g of duodenal tissue with Gomori's methenamine silver stain for fungal identification are not recommended. One should consider obtaining tis sue for electron microscopy whenever duodenal biopsies are performed. The utility of EGD in AIDS associated diarrhea may improve as more eff ective therapies become available.