Endoscopy in acquired immunodeficiency syndrome patients with diarrhea andnegative stool studies

Background: Diarrhea is a frequent gastrointestinal symptom in patients wit h acquired immunodeficiency syndrome (AIDS) and is a major source of morbid ity and mortality. A stepwise diagnostic approach is often recommended to s earch for treatable causes. However, whether the stepwise diagnostic approa ch is adequate for planning treatment and whether specific treatment for in fectious etiologies will affect the survival of patients with AIDS remain u nknown. Methods: From March 1996 to September 1997, endoscopy was performed in AIDS patients with diarrhea, the etiology of which was not identified by noninv asive methods. Specific treatment was given according to the identified eti ologies and symptomatic treatment was given for those without definite diag nosis. The clinical symptoms, signs, and duration of follow-up were recorde d and survival patterns were analyzed. Results: Etiologic diagnoses were made in 26 of 40 patients (65%) who under went endoscopic studies. Amebic colitis and cytomegalovirus colitis were th e 2 leading causes of prolonged diarrhea in patients with AIDS. Thirty-five patients (87.5%) recovered after treatment. The difference in survival tim e after diarrhea between patients whose symptoms resolved after treatment a nd those who continued to have diarrhea was statistically significant (p < 0.001). Conclusions: Endoscopic studies were helpful for the diagnosis of prolonged diarrhea in AIDS patients who had negative stool studies and did not respo nd to 2 weeks of empiric treatment. Specific treatment according to the res ults of endoscopy may improve survival in these patients.