PREDOMINANTLY GASTROINTESTINAL SYMPTOMS AND SIGNS IN 11 CONSECUTIVE AIDS PATIENTS WITH GASTROINTESTINAL LYMPHOMA - A MULTICENTER, MULTIYEARSTUDY INCLUDING 763 HIV-SEROPOSITIVE PATIENTS

Objectives: Gastrointestinal lymphoma is a distinct subgroup of lympho ma in HIV-seronegative patients. This study analyzes whether gastroint estinal lymphoma similarly forms a distinct clinical subgroup in HIV-s eropositive patients. Methods: Case control study of medical records o f 763 human immunodeficiency virus-seropositive patients admitted to t hree university hospitals from 1986 through 1992, including 22 with no n-Hodgkin's lymphoma. Eleven patients (50%) had gastrointestinal lymph oma, and 11 controls had extraintestinal lymphoma. Results: The clinic al presentation in patients with gastrointestinal lymphoma was dominat ed by gastrointestinal symptoms and signs and gastrointestinal complic ations. Common symptoms and signs included: change in bowel habits, gr oss or occult blood per rectum, involuntary weight loss, abdominal pai n, abdominal tenderness, peripheral lymphadenopathy, cachexia, and hep atosplenomegaly. Significant gastrointestinal complications during the presenting admission included gastrointestinal bleeding in five, inte stinal obstruction in one, and dysphagia from an esophageal stricture in one. Subsequent complications included a walled-off perforating gas tric ulcer in one and obstructive jaundice in one. In contrast, the co ntrol patients with extraintestinal lymphoma had significantly fewer g astrointestinal symptoms and gastrointestinal complications (p < 0.001 and p < 0.01, respectively, Fisher's exact test). Upper gastrointesti nal series or barium enema identified lymphomatous gastrointestinal le sions in all seven patients undergoing these tests. The pathologic dia gnosis was made from endoscopic biopsies in six of six patients underg oing panendoscopy, and two of three patients undergoing lower endoscop y. Tumor sites included stomach in six, colon in three, ileum in two, esophagus in two, and duodenum in one. Eight patients had extraintesti nal lesions at diagnosis, including four with extraabdominal extranoda l lesions. The outcome of gastrointestinal lymphoma was poor with all therapies (mean combined survival = 3.6 +/- 2.2 months), and was not s ignificantly different from that for the controls (mean survival = 4.1 +/- 2.7 months, Student's t test). Conclusions: This study suggests t hat gastrointestinal lymphoma in AIDS shares the poor prognosis and ag gressive features of extraintestinal lymphoma in AIDS, but has unique localizing features at presentation of predominantly gastrointestinal symptoms and signs, and frequent gastrointestinal complications.