Association of Gastric Hypoacidity with Opportunistic Enteric Infections in Patients with AIDS

Abstract

To determine the relation and possible significanceof gastric hypoaciditity to chronic diarrhea in AIDS, patients with and without chronic (>1 month) diarrhea underwent fasting gastric juice pH measurement and microbiologic study and upper and lower endoscopy with biopsy. All 8 patients with diarrhea and high gastric pH (>3; mean, 6.1 ± 1.0) had gastric bacterial overgrowth (>10⁴ bacteria/mL) along with opportunistic enteropathogens in the duodenum or rectosigmoid, but only 1 of 6 patients with diarrhea and gastric pH in the normal range (⩽3; mean, 1.9 ± 0.7) had overgrowth or an opportunistic enteropathogen. By contrast, all but 1 of 9 controls (AIDS patients without diarrhea) had normal fasting gastric pH (mean, 2.9 ± 1.5). Overall, the presence of gastric hypoacidity was associated with identification of opportunistic enteropathogens (P = .035). Thus, gastric hypoacidity is associated with quantitative bacterial overgrowth and opportunistic enteric infections and may be etiologically important in the pathophysiology of the chronic diarrhea seen in some AIDS patients.