{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T05:34:59Z","timestamp":1774676099484,"version":"3.50.1"},"reference-count":17,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1989,2]]},"abstract":"<jats:p>Thirty of 81 consecutive HIV antibody positive patients referred with non-cryptosporidial diarrhoea had no potential infectious cause; most had AIDS related complex rather than the full blown syndrome. Opportunistic infections with cytomegalovirus (CMV), mycobacterium avium-intracellulare (MAI), and herpes simplex virus (HSV), which allowed a diagnosis of AIDS to be made, were found in 19 patients and were the presenting features of AIDS in five. Other potential pathogenic species included entamoeba, giardia, campylobacter, and salmonella (without septicaemia). Cytomegalovirus infection was often accompanied by abdominal pain. Severe weight loss (greater than 10 kg) at presentation was found in patients with CMV infection and MAI. Bloody diarrhoea was confined to the group with HSV procitis. Malignant causes of diarrhoea were rare. Two patients developed a squamous carcinoma of the anorectal margin and one a non-Hodgkin's lymphoma. In only two of 12 patients who had Kaposi's sarcoma was this considered as a cause of diarrhoea. Rigid sigmoidoscopy showed macroscopic abnormalities in over a third (32) of the 81 patients with non-cryptosporidial diarrhoea. Most commonly this was severe inflammation (17) or discrete ulceration (four) [three of whom had CMV colitis]. Kaposi's sarcoma was identified in 11 patients. Non-specific inflammation was seen histologically in 40 of the 60 patients with no sigmoidoscopic inflammatory changes. Barium enema only revealed an abnormality in a minority of the patients and a colonoscopy only revealed information additional to rigid sigmoidoscopy in two patients--one with CMV ulcers in the transverse colon and the other with evidence of Kaposi's sarcoma not seen in the rectum. Ten patients had a rectal biopsy examined by electron microscopy as no infective cause of diarrhoea was uncovered. In four of these microtubular structures which are commonly seen in viral infections were found and two had prelymphomatous changes and in one of these frank lymphoma has developed. We recommend multiple stool analysis, sigmoidoscopy and rectal biopsy as the initial investigations in these patients reserving tests of malabsorption, colonoscopy, and barium enema for the small number of more difficult cases.<\/jats:p>","DOI":"10.1136\/gut.30.2.195","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"195-200","source":"Crossref","is-referenced-by-count":72,"title":["Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients."],"prefix":"10.1136","volume":"30","author":[{"given":"G M","family":"Connolly","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Shanson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D A","family":"Hawkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J N","family":"Webster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B G","family":"Gazzard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1989,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1136\/gut.29.5.593","article-title":"Cryptosporidial diarrhoea in AIDS and its treatment","volume":"29","author":"Connolly, G.M.; Dryden, M.S.; Shanson, D.C.; Gazzard, B.G.","year":"1988","unstructured":"Connolly GM, Dryden MS, Shanson DC, Gazzard BG. Cryptosporidial diarrhoea in AIDS and its treatment. Gut 1988; 29: 593-7.","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"186","DOI":"10.7326\/0003-4819-102-2-186","article-title":"Salmonella infections in patients with the acquired immunodeficiency syndrome","volume":"102","author":"Jacobs, J.L.; Gold, J.W.M.; Murray, H.W.","year":"1985","unstructured":"Jacobs JL, Gold JWM, Murray HW, et al. Salmonella infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1985; 102: 186-8.","journal-title":"Ann Intern Med"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"184","DOI":"10.7326\/0003-4819-105-2-184","article-title":"Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome","volume":"105","author":"Hawkins, C.C.; Gold, J.W.M.; Whimbey, E.","year":"1986","unstructured":"Hawkins CC, Gold JWM, Whimbey E, et al. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1986; 105: 184-8.","journal-title":"Ann Intern Med"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1056\/NEJM198309083091002","article-title":"The polymicrobial origin of intestinal infections in homosexual men","volume":"309","author":"Quinn, T.C.; Stamm, W.E.; Goodell, S.E.","year":"1983","unstructured":"Quinn TC, Stamm WE, Goodell SE, et al. The polymicrobial origin of intestinal infections in homosexual men. N Engl J Med 1983; 309: 576-82.","journal-title":"N Engl J Med"},{"key":"ref_5","article-title":"Centres for disease control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome","unstructured":"Centres for disease control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987; 36 [Suppl]: No 1S."},{"key":"ref_6","article-title":"Enzyme immunoassay for detection of antibody to Human T cell lymphotropic type III [HTLV III] Lymphadenopathy virus [LAV]. Beckenham","year":"1987","unstructured":"(Enzyme immunoassay for detection of antibody to Human T cell lymphotropic type III [HTLV III] Lymphadenopathy virus [LAV]. Beckenham, Kent: Wellcome, 1987."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S0140-6736(85)90136-9","article-title":"Which antiHTLV III\/LAV assays for screening and confirmation testing?","volume":"ii:","author":"Mortimer, P.P.; Parry, J.V.; Mortimer, J.Y.","year":"1985","unstructured":"Mortimer PP, Parry JV, Mortimer JY. Which antiHTLV III\/LAV assays for screening and confirmation testing? Lancet 1985; ii: 873-7.","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1128\/JCM.18.1.185-190.1983","article-title":"Techniques for the recovery and identification of cryptosporidium oocysts from stool specimens","volume":"18","author":"Garcia, L.S.; Bruckner, D.A.; Brewer, T.C.; Shimizu, R.Y.","year":"1983","unstructured":"Garcia LS, Bruckner DA, Brewer TC, Shimizu RY. Techniques for the recovery and identification of cryptosporidium oocysts from stool specimens. J Clin Microbiol 1983; 18: 185-90.","journal-title":"J Clin Microbiol"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1136\/jcp.36.12.1357","article-title":"Selective kirchner medium in the culture of specimens other than sputum for mycobacteria","volume":"36","author":"Mitchison, D.A.","year":"1983","unstructured":"Mitchison DA, et al. Selective kirchner medium in the culture of specimens other than sputum for mycobacteria. J Clin Pathol 1983; 36: 1357-61.","journal-title":"J Clin Pathol"},{"key":"ref_10","first-page":"421","article-title":"Enteropathy associated with the acquired immunodeficiency syndrome","volume":"1014","year":"1984","unstructured":"Kotler DP, Gaetz HP, Lange M, Klein EB, Holt PR. Enteropathy associated with the acquired immunodeficiency syndrome. Ann Intern Med 1984; 1014 421-8.","journal-title":"Ann Intern Med"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"619","DOI":"10.7326\/0003-4819-102-5-619","article-title":"Malabsorption and mucosal abnormalities of the small intestine in the acquired immune deficiency syndrome","volume":"102","author":"Gillin, J.S.; Shike, M.; Alcock, N.","year":"1985","unstructured":"Gillin JS, Shike M, Alcock N, et al. Malabsorption and mucosal abnormalities of the small intestine in the acquired immune deficiency syndrome. Ann Intern Med 1985; 102: 619-22.","journal-title":"Ann Intern Med"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0163-4453(88)93897-2","article-title":"Disseminated mycobacterium avium-intracellulare infection and red cell hypoplasia in patients with the acquired immunodeficiency syndrome","volume":"16","author":"Gardener, T.D.; Flanagan, P.; Dryden, M.S.; Costello, C.; Shanson, D.C.; Gazzard, B.G.","year":"1988","unstructured":"Gardener TD, Flanagan P, Dryden MS, Costello C, Shanson DC, Gazzard BG. Disseminated mycobacterium avium-intracellulare infection and red cell hypoplasia in patients with the acquired immunodeficiency syndrome. J Infect 1988; 16: 135-40.","journal-title":"J Infect"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1136\/gut.22.12.1035","article-title":"Sigmoidoscopic and microscopic appearance of the rectal mucosa in homosexual men","volume":"22","author":"McMillan, A.; Lee, F.D.","year":"1981","unstructured":"McMillan A, Lee FD. Sigmoidoscopic and microscopic appearance of the rectal mucosa in homosexual men. Gut 1981; 22: 1035-41.","journal-title":"Gut"},{"key":"ref_14","first-page":"9901","article-title":"Ultrastructural markers of AIDS","volume":"i:","author":"Sidhu, G.S.; Stahl, R.E.; El-Sadr, W.; Zolla-Pazner, S.","year":"1983","unstructured":"Sidhu GS, Stahl RE, El-Sadr W, Zolla-Pazner S. Ultrastructural markers of AIDS. Lancet 1983; i: 9901.","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/0016-5085(85)90145-3","article-title":"Electron microscopy of the intestine and rectum in acquired immunodeficiency syndrome","volume":"88","author":"Dobbins, W.O.; Weinstein, W.M.","year":"1985","unstructured":"Dobbins WO, Weinstein WM. Electron microscopy of the intestine and rectum in acquired immunodeficiency syndrome. Gastroenterology 1985; 88: 738-49.","journal-title":"Gastroenterology"},{"key":"ref_16","first-page":"221","article-title":"Significance of tubuloreticular inclusions in the pathobiology of human diseases","author":"Grimley, P.M.; Schaff, Z.S.","year":"1976","unstructured":"Grimley PM, Schaff ZS. Significance of tubuloreticular inclusions in the pathobiology of human diseases. In: Inochim HL, ed. Pathobiology annual. New York: Appleton-Century Crofts, 1976: 221-57."},{"key":"ref_17","first-page":"259","article-title":"Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms","volume":"i:","author":"Nelson, J.A.; Wiley, C.A.; Reynolds-Kohler, C.; Reese, C.E.; Margaretten, W.; Levy, J.A.","year":"1988","unstructured":"Nelson JA, Wiley CA, Reynolds-Kohler C, Reese CE, Margaretten W, Levy JA. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet 1988 i: 259-62.","journal-title":"Lancet"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.30.2.195","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T10:13:58Z","timestamp":1765620838000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.30.2.195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,2]]},"references-count":17,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1989,2,1]]},"published-print":{"date-parts":[[1989,2]]}},"alternative-id":["10.1136\/gut.30.2.195"],"URL":"https:\/\/doi.org\/10.1136\/gut.30.2.195","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1989,2]]}}}