Small intestinal transit, absorption, and permeability in patients with AIDS with and without diarrhoea

Background-Diarrhoea in AIDS is associated with anorexia and weight loss. T he importance of gastrointestinal transit in such symptoms has not been add ressed. Aims-To assess jejunal to caecal transit times in subjects with AIDS relate d diarrhoea and weight loss and correlate these with measures of absorptive capacity and intestinal permeability. Methods-Jejunal to caecal transit times were assessed in 20 seronegative co ntrols and 60 HIV seropositive subjects from serum analysis of 3-O-methyl-D -glucose and sulphapyridine after ingestion of the monosaccharide and sulph asalazine in aqueous solution. The method also allows an estimation of gast ric emptying times for Liquids. Intestinal absorptive capacity and permeabi lity were assessed by a combined test using 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose. Results-Gastric emptying was significantly delayed in all groups of patient s with AIDS. Mean jejunal to caecal transit times were not significantly di fferent between controls (246 (62) minutes) and patients without diarrhoea (AIDS, well: 278 (103) minutes; AIDS, wasting: 236 (68) minutes), cytomegal ovirus colitis (289 (83) minutes), pathogen negative diarrhoea (192 (100) m inutes), or microsporidiosis (190 (113) minutes), although 30% of patients had values below the control range. Patients with cryptosporidiosis differe d significantly from controls (135 (35) minutes, p<0.0001), seven of 10 hav ing rapid transit times. Absorptive capacity was reduced and intestinal per meability significantly increased in AIDS, but did not correlate significan tly with transit times. Conclusion-Small bowel transit is accelerated in many patients with AIDS, p articularily in protozoal diarrhoea, but is not the sole explanation for ma labsorption of monosaccharides.