Skip to main content
NCBI home page
Gut logoLink to Gut
. 1991 Sep;32(9):987–990. doi: 10.1136/gut.32.9.987

Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival.

F Parente 1, M Cernuschi 1, L Valsecchi 1, G Rizzardini 1, M Musicco 1, A Lazzarin 1, G Bianchi Porro 1
PMCID: PMC1379034  PMID: 1916503

Abstract

To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill.

Full text

PDF
987

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bianchi Porro G., Parente F., Cernuschi M. The diagnosis of esophageal candidiasis in patients with acquired immune deficiency syndrome: is endoscopy always necessary? Am J Gastroenterol. 1989 Feb;84(2):143–146. [PubMed] [Google Scholar]
  2. Carlson J. R., Bryant M. L., Hinrichs S. H., Yamamoto J. K., Levy N. B., Yee J., Higgins J., Levine A. M., Holland P., Gardner M. B. AIDS serology testing in low- and high-risk groups. JAMA. 1985 Jun 21;253(23):3405–3408. [PubMed] [Google Scholar]
  3. Connolly G. M., Hawkins D., Harcourt-Webster J. N., Parsons P. A., Husain O. A., Gazzard B. G. Oesophageal symptoms, their causes, treatment, and prognosis in patients with the acquired immunodeficiency syndrome. Gut. 1989 Aug;30(8):1033–1039. doi: 10.1136/gut.30.8.1033. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Di Carlo E. F., Amberson J. B., Metroka C. E., Ballard P., Moore A., Mouradian J. A. Malignant lymphomas and the acquired immunodeficiency syndrome. Evaluation of 30 cases using a working formulation. Arch Pathol Lab Med. 1986 Nov;110(11):1012–1016. [PubMed] [Google Scholar]
  5. Gelb A., Miller S. AIDS and gastroenterology. Am J Gastroenterol. 1986 Aug;81(8):619–622. [PubMed] [Google Scholar]
  6. Lane G. P., Lucas C. R., Smallwood R. A. The gastrointestinal and hepatic manifestations of the acquired immunodeficiency syndrome. Med J Aust. 1989 Feb 6;150(3):139–143. doi: 10.5694/j.1326-5377.1989.tb136393.x. [DOI] [PubMed] [Google Scholar]
  7. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976 Feb;103(2):226–235. doi: 10.1093/oxfordjournals.aje.a112220. [DOI] [PubMed] [Google Scholar]
  8. ROSENBERG S. A., DIAMOND H. D., JASLOWITZ B., CRAVER L. F. Lymphosarcoma: a review of 1269 cases. Medicine (Baltimore) 1961 Feb;40:31–84. doi: 10.1097/00005792-196102000-00002. [DOI] [PubMed] [Google Scholar]
  9. Ratner L. Human immunodeficiency virus-associated autoimmune thrombocytopenic purpura: a review. Am J Med. 1989 Feb;86(2):194–198. doi: 10.1016/0002-9343(89)90268-4. [DOI] [PubMed] [Google Scholar]
  10. René E., Marche C., Regnier B., Saimot A. G., Vilde J. L., Perrone C., Michon C., Wolf M., Chevalier T., Vallot T. Intestinal infections in patients with acquired immunodeficiency syndrome. A prospective study in 132 patients. Dig Dis Sci. 1989 May;34(5):773–780. doi: 10.1007/BF01540353. [DOI] [PubMed] [Google Scholar]
  11. René E., Marche C., Régnier B., Saimot A. G., Vittecoq B., Matheron S., Le Port C., Bricaire F., Bure A., Brun-Vezinet C. Manifestations digestives du syndrome d'immunodéficience acquise (SIDA): étude chez 26 patients. Gastroenterol Clin Biol. 1985 Apr;9(4):327–335. [PubMed] [Google Scholar]
  12. Rodgers V. D., Kagnoff M. F. Gastrointestinal manifestations of the acquired immunodeficiency syndrome. West J Med. 1987 Jan;146(1):57–67. [PMC free article] [PubMed] [Google Scholar]
  13. Rustgi V. K., Hoofnagle J. H., Gerin J. L., Gelmann E. P., Reichert C. M., Cooper J. N., Macher A. M. Hepatitis B virus infection in the acquired immunodeficiency syndrome. Ann Intern Med. 1984 Dec;101(6):795–797. doi: 10.7326/0003-4819-101-6-795. [DOI] [PubMed] [Google Scholar]
  14. Schneiderman D. J., Arenson D. M., Cello J. P., Margaretten W., Weber T. E. Hepatic disease in patients with the acquired immune deficiency syndrome (AIDS). Hepatology. 1987 Sep-Oct;7(5):925–930. doi: 10.1002/hep.1840070522. [DOI] [PubMed] [Google Scholar]
  15. Sherlock P. The gastrointestinal manifestations and complications of malignant lymphoma. Schweiz Med Wochenschr. 1980 Jul 8;110(27-28):1031–1036. [PubMed] [Google Scholar]
  16. Stites D. P., Casavant C. H., McHugh T. M., Moss A. R., Beal S. L., Ziegler J. L., Saunders A. M., Warner N. L. Flow cytometric analysis of lymphocyte phenotypes in AIDS using monoclonal antibodies and simultaneous dual immunofluorescence. Clin Immunol Immunopathol. 1986 Feb;38(2):161–177. doi: 10.1016/0090-1229(86)90135-2. [DOI] [PubMed] [Google Scholar]
  17. Urmacher C., Nielsen S. The histopathology of the acquired immune deficiency syndrome. Pathol Annu. 1985;20(Pt 1):197–220. [PubMed] [Google Scholar]
  18. Walsh C., Krigel R., Lennette E., Karpatkin S. Thrombocytopenia in homosexual patients. Prognosis, response to therapy, and prevalence of antibody to the retrovirus associated with the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Oct;103(4):542–545. doi: 10.7326/0003-4819-103-4-542. [DOI] [PubMed] [Google Scholar]
  19. Welch K., Finkbeiner W., Alpers C. E., Blumenfeld W., Davis R. L., Smuckler E. A., Beckstead J. H. Autopsy findings in the acquired immune deficiency syndrome. JAMA. 1984 Sep 7;252(9):1152–1159. [PubMed] [Google Scholar]
  20. Weller I. V. AIDS and the gut. Scand J Gastroenterol Suppl. 1985;114:77–89. doi: 10.3109/00365528509093769. [DOI] [PubMed] [Google Scholar]
  21. Ziegler J. L., Beckstead J. A., Volberding P. A., Abrams D. I., Levine A. M., Lukes R. J., Gill P. S., Burkes R. L., Meyer P. R., Metroka C. E. Non-Hodgkin's lymphoma in 90 homosexual men. Relation to generalized lymphadenopathy and the acquired immunodeficiency syndrome. N Engl J Med. 1984 Aug 30;311(9):565–570. doi: 10.1056/NEJM198408303110904. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES