Small intestinal HIV-associated enteropathy: evidence for panintestinal enterocyte dysfunction.
To characterize the absorptive defect of AIDS enteropathy, we have used a D-xylose kinetic model of proximal absorption and correlated these findings with Schilling's test for cobalamin absorption, measurements of distal intestinal function. In addition, we compared findings between duodenal and jejunal biopsy and aspirations to determine whether additional information can be obtained by sampling the more distal site. Twelve consecutive patients with AIDS who had 3 to 14 loose bowel movements per day and two stool study results negative for pathogens, were admitted for study. D-xylose testing with oral and intravenous doses was used to determine the rate constants for D-xylose absorption, Ka, and the rate constant for nonabsorptive loss, Ko. Duodenal and distal duodenal-jejunal endoscopic aspirations and biopsies were also performed. Minimal histologic abnormalities were seen in either the proximal or distal biopsy sites. There were no significant differences in mucosal blunting, abnormalities of the enterocytes, lamina propria infiltrate, or presence of microorganisms between duodenal and distal duodenal-jejunal sites. Seventy-five percent had no identifiable pathogens. Ten of 12 patients had diminished Ka, elevated Ko, or both. Two patients had a normal Ka and Ko. Eight of 10 had an abnormal Schilling's test result. Percentage weight loss correlated negatively with Ka (r = 0.75; p = 0.013) and with Schilling's test results (r = 0.65; p = 0.043. Ka correlated positively with Schilling's test results (r = 0.82; p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Medicine, Northwestern University Medical School, Chicago, IL.
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Carlson
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Yokoo
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Craig
D000042:Absorption; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D001706:Biopsy; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D007421:Intestine, Small; D007422:Intestines / Q000473:pathology / Q000503:physiopathology*; D008875:Middle Aged; D012546:Schilling Test; D014994:Xylose / Q000493:pharmacokinetics
D014994:Xylose