Human Immunodeficiency Virus-Associated Gastrointestinal Disease: Common Endoscopic Biopsy Diagnoses

The gastrointestinal (GI) tract is a major site of disease in HIV infection: almost half of HIV-infected patients present with GI symptoms, and almost all patients develop GI complications. GI symptoms such as anorexia, weight loss, dysphagia, odynophagia, abdominal pain, and diarrhea are frequent and usually nonspecific among these patients. Endoscopy is the diagnostic test of choice for most HIV-associated GI diseases, as endoscopic and histopathologic evaluation can render diagnoses in patients with non-specific symptoms. In the past three decades, studies have elucidated a variety of HIV-associated inflammatory, infectious, and neoplastic GI diseases, often with specific predilection for various sites. HIV-associated esophageal disease, for example, commonly includes candidiasis, cytomegalovirus (CMV) and herpes simplex virus (HSV) infection, Kaposi's sarcoma (KS), and idiopathic ulceration. Gastric disease, though less common than esophageal disease, frequently involves CMV, Mycobacterium avium-intracellulare (MAI), and neoplasia (KS, lymphoma). Small bowel biopsies and intestinal aspirates from HIV-infected patients often show HIV enteropathy, MAI, protozoa (Giardia, Isospora, Cryptosporidia, amebae, Microsporidia), and helminths (Strongyloides stercoralis). Colorectal biopsies demonstrate viral (CMV, HSV), bacterial (Clostridia, Salmonella, Shigella, Campylobacter), fungal (cryptococcosis, histoplasmosis), and neoplastic (KS, lymphoma) processes. Herein, we review HIV-associated GI pathology, with emphasis on common endoscopic biopsy diagnoses

Endoscopic Removal of an Impacted Needle with Syringe from the Esophagus

AbstractBackgroundIn adults, non-food foreign body ingestions occur more in denture users, incarcerated individuals, and in patients with psychiatric disorders or alcohol intoxication. The majority of the ingested foreign body will pass spontaneously. Sharp or pointed foreign body, animal or fish bones, and magnets increase the risk of perforation.PatientAn incarcerated patient with bipolar disorder swallowed a 14cm in length needle attached with a syringe three months prior to presentation. The needle penetrated the distal esophagus leading to mediastinitis.MethodsIn this video manuscript, we demonstrated endoscopic techniques on how to remove this 14cm long sharp object.ResultsThe foreign body was removed uneventfully and mediastinitis resolved with antibiotic treatment.ConclusionsEmergent endoscopy is indicated in (1) esophageal obstruction and the patient are unable to swallow secretions and (2) disk batteries and sharp-pointed foreign body in the esophagus

Endoscopic and Angiographic Diagnosis and Management of a Gastric Arteriovenous Malformation

AbstractIntroductionGastric arteriovenous malformation (AVM) is an uncommon cause of upper gastrointestinal (GI) bleeding.Methods and resultsWe describe a case of gastric AVM which was diagnosed endoscopically and successfully managed by endoclip application and percutaneous transarterial coil embolization.ConclusionsWe propose that these two minimally invasive technologies can be used to manage AVM in the gut: endoscopic therapy to control luminal bleeding and interventional radiology to define the full extent of the malformation and to decrease arterial pressure and flow to the point that hemostasis can occur, without creating symptomatic ischemia

Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology

Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient’s work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions

Transplantation of Gut Microbiota From High-Fat-Diet-Tolerant Cynomolgus Monkeys Alleviates Hyperlipidemia and Hepatic Steatosis in Rats.

Emerging evidence has been reported to support the involvement of the gut microbiota in the host's blood lipid and hyperlipidemia (HLP). However, there remains unexplained variation in the host's blood lipid phenotype. Herein a nonhuman primate HLP model was established in cynomolgus monkeys fed a high-fat diet (HFD) for 19 months. At month 19%, 60% (3/5) of the HFD monkeys developed HLP, but surprisingly 40% of them (2/5) exhibited strong tolerance to the HFD (HFD-T) with their blood lipid profiles returning to normal levels. Metagenomic analysis was used to investigate the compositional changes in the gut microbiota in these monkeys. Furthermore, the relative abundance of remarkably increased and became the dominant gut microbe in HFD-T monkeys. A validation experiment showed that transplantation of fecal microbiota from HFD-T monkeys reduced the blood lipid levels and hepatic steatosis in HLP rats. Furthermore, the relative abundance of significantly increased in rats receiving transplantation, confirming the successful colonization of the microbe in the host and its correlation with the change of the host's blood lipid profiles. Our results thus suggested a potentially pivotal lipid-lowering role of in the gut microbiota, which could contribute to the variation in the host's blood lipid phenotype. [Abstract copyright: Copyright © 2022 Gao, Rao, Wei, Xia, Huang, Tang, Hide, Zheng, Li, Zhao, Sun and Chen.