Abstract

FERNANDEZ, Saturnino; LECUNA, Vicente  and  RUIZ, Maria Elena. Comparación en el tracto digestivo superior entre los hallazgos endoscópicos y la biopsia en pacientes con síndrome de inmunodeficiencia adquirida (sida) con más de 200 células cd4 y menos de 200 células cd4. Gen [online]. 2007, vol.61, n.1, pp.14-20. ISSN 0016-3503.

The digestive tract is one of the systems more frequently affected in patients with AIDS; practically all of these patients suffer alterations of the digestive tract at some point during their disease. The objective of this study was to identify the injuries in the esophagus, stomach and duodenum reaching its second portion, in patients with AIDS who presented/displayed greater than 200 CD4 cells per mililiter,and to compare it with those patients that presented/displayed less than 200 CD4 cells per mililiter, performing an upper endoscopy and correlating the results with the histopathology findings by means of biopsies of the esophagus, stomach and duodenum. Methods: a total of 57 patients were evaluated in a prospective and longitudinal mode from November of 2000 to August of 2003, distributed in 43 male patients (74, 50%) and 14 female (25.50%). Inclusion criteria: Symptoms or signs of gastrointestinal disease of the upper GI tract; To have a diagnosis of AIDS; To have a history at the University Hospital and to stay in control at our institution; Consent for the study and to obtain biopsies; Not rejecting the upper GI endoscopy. Results and Conclusions: 1.When comparing patients with AIDS <200 CD4/ mililiter cells with patients with >200 CD4/mililiter cells we found statistically significant differences between both groups in the esophagus with respect to endoscopic findings and biopsies, for this reason we recommend routine esophageal biopsies in patients with AIDS and CD4 less than 200 cellsmililiter 2.The most frequent findings in esophagus in both groups of patients,with less than 200 CD4/mililiter cells and >200 CD4/mililiter cells are compatible with gastroesophageal reflux. 3.The most frequent pathology found in patients with <200 CD4/mililiter cells was candidiasis, as reported in Literature. 4.The most frequent pathology found in patients with >200 CD4/mililiter cells was esophagitis A and B according to Los Angeles's classification. 5.The most frequent endoscopic finding at the stomach in the patients with <200 CD4 cells/mililiter and >200 CD4 cellsmm3 was erosive gastropathy and the biopsies were compatible with active chronic gastritis, with no statistically significant difference. 6.The most frequent endoscopic finding at the duodenum in the patients with <200 CD4 cellsmililiter and >200 CD4 cellsmililiter was mild erosive duodenitis in both groups and at biopsy, chronic duodenitis, not existing a statistically significant difference. 7.At the duodenum in two patients with <200 CD4 cells /mililiter we found Whipple´s disease despite the endoscopic aspect of the mucosa which was normal in one of them and with a mild duodenitis in the other. This allow us to propose that in patients with less than 200 CD4 cells /mililiter biopsies must be routenely taken independently from the endoscopic aspect of the mucosa.