What is the preferred endoscopic procedure for the evaluation of diarrhea in AIDS?
- The advantage of endoscopy is that it permits direct visualization of the mucosa and retrieval of tissue for histologic examination.
- The diagnostic yield of colonoscopy in HIV-infected patients with chronic diarrhea and negative stool studies ranges from 27% to 37%; in patients with AIDS, CMV is the most common etiologic factor identified.
- CMV colitis is usually present in the distal colon; however, isolated, right-sided CMV colitis has been reported.
- Therefore if CMV is suspected as the cause of diarrhea, a full colonoscopy is warranted, especially if sigmoidoscopy is negative.
- However, it is still not clear whether colonoscopy has a higher yield than flexible sigmoidoscopy for the detection of organisms other than CMV. E
- valuation with colonoscopy is prudent if right-sided abdominal complaints are also reported.
- The value of upper endoscopy and small bowel biopsy in the evaluation of chronic diarrhea has also been demonstrated, although specific treatment options for most small bowel pathogens are limited. S
- ome would obtain ileal biopsy at the time of colonoscopy rather than proceed with upper endoscopy and biopsy.
- The most commonly detected organisms involving the small bowel are cryptosporidia and microsporidia.
