Bernal A, Gathe J, Piot D, Stenoien R, Clemmons J, Frazier R; International Conference on AIDS.
Int Conf AIDS. 1992 Jul 19-24; 8: 55 (abstract no. PuB 7038).
AMI Park Plaza Hospital, Special Diseases Unit, Houston, Texas.
OBJECTIVE: To investigate the prevalence and laboratory findings of delayed gastric emptying in patients with AIDS. BACKGROUND: The presence of nausea, vomiting, subjective and objective abdominal distention, as well as diarrhea is common in the digestive symptomatology of AIDS. These symptoms are also typical in the so-called pseudo-obstruction. Endoscopic appearance suggestive of pseudo-obstruction such as gastric bezoar as well as gastric stasis (greater than 200 ml) led to the present study. METHODS: Fourteen male homosexual patients referred with subjective evidence of pseudo-obstruction such as nausea, vomiting, and/or diarrhea underwent gastroscopy with an Olympus Videoscope GIF-100. They also had gastric emptying studies performed with a mixture of 2 mCi Tc 99m sulfur colloid with scrambled eggs. RESULTS: CD4 was less than 200 (M = 45 +/- 58) for all patients. Only one patient had CD4 greater than 110. Thirteen patients had delayed gastric emptying. One was normal by radioisotopic study; however, by endoscopy the patient showed manifested gastric stasis with four pills of Dulcolax remaining in the stomach after a sixteen hour period. Mean T1/2 for stomach emptying was 173 min (+/- 89) which is significantly (p less than .001) higher than the typical upper normal value (75 min). Two of the patients with prolonged delayed gastric emptying died within seven and eight days, respectively, of the study. CONCLUSIONS: There is a significant delay of gastric emptying in patients with advanced AIDS. This can be suspected at gastroscopy (bezoar, stasis 200 ml) or confirmed by gastric emptying studies with Tc 99m sulfur colloid. This motility disorder could explain in part the nearly universal presence of nausea and vomiting in patients with AIDS and could lead to pseudo-obstruction, bacteria overgrowth, and consequential malabsorption. The management of this motility disorder can be a major undertaking that includes: correction of electrolyte imbalance, "motility" drugs such as Reglan, Cisapride, Erythromycin, and Lupron, and antibiotic therapy for proven bacterial overgrowth. Recognition of this motility disorder in AIDS should lead to therapeutic trials in order to elucidate the best course of action.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Animals
- Cisapride
- Erythromycin
- Esophageal Sphincter, Lower
- Gastric Emptying
- Gastroparesis
- Humans
- Male
- Metoclopramide
- Prevalence
- Stomach
- Stomach Diseases
- Technetium Tc 99m Sulfur Colloid
Other ID:
UI: 102202036
From Meeting Abstracts