Comparison of duodenal with jejunal biopsy and aspirate in chronic human immunodeficiency virus-related diarrhea.
OBJECTIVE
In human immunodeficiency virus (HIV)-infected patients with chronic unexplained diarrhea, upper endoscopy with small bowel biopsy and aspirate is often performed to identify treatable pathogens. The purpose of this study was to compare the diagnostic yield of duodenal with jejunal biopsy and aspirate.


METHODS
All HIV-infected patients with chronic unexplained diarrhea who were evaluated by upper endoscopy at Bellevue Hospital Center between January 1992 and January 1997 were identified. Data were collected by reviewing patient charts, endoscopy reports, and pathology records.


RESULTS
During the 5-yr study period, 442 patients underwent upper endoscopy with sampling of the duodenum (N=173) or jejunum (N=269). A pathogen was identified in 123 patients (27.8%). Microsporidia was the most common organism detected (12.2%). The diagnostic yield of jejunal biopsy and aspirate was significantly higher than that obtained from the duodenum (32.3% vs 20.8%, p=0.009). Small bowel aspirates detected a pathogen in only 1.8% of patients evaluated, and there was no difference in the yield of duodenal and jejunal aspirates (1.3% vs 2.1%, p=0.7). Patients with a CD4 count of < 100 cells/mm3 were significantly more likely to have a pathogen identified than those with higher CD4 counts (38.8% vs 7.1%,p < 0.0001).


CONCLUSIONS
Upper endoscopy with small bowel biopsy and aspirate identifies a pathogen in 27.8% of individuals with HIV-related chronic unexplained diarrhea. In this patient population, jejunal biopsies acquired by enteroscopy are superior to those obtained from the duodenum. Small bowel aspirates are of little value in the workup of chronic HIV-related diarrhea.
Division of Gastroenterology, New York University Medical Center, Bellevue Hospital, and Department of Veterans Affairs Medical Center, New York 10010, USA.
E J
EJ
Bini
E H
EH
Weinshel
Z
Z
Gamagaris
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D001707:Biopsy, Needle; D016022:Case-Control Studies; D003967:Diarrhea / Q000209:etiology* / Q000473:pathology; D004386:Duodenum / Q000473:pathology*; D005260:Female; D019053:HIV Enteropathy / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D007419:Intestinal Secretions / Q000382:microbiology / Q000469:parasitology; D007583:Jejunum / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies