Diagnostic management of epigastric pain in Uganda

180 patients who attended the out patient department of Hoima Hospital (Uganda) complaining of epigastric pain were studied in order to verify the cause and to assess the most effective diagnostic method. All the patients underwent the following examinations: stool examination for parasites; upper digestive tract endoscopy; ultrasound scan of liver; spleen; pancreas and kidneys. The results suggest that the main causes of epigastric pain in Uganda are: intestinal parasitosis (27 per cent); gastrointestinal upper tract lesions with endoscopic signs of disease (44.5 per cent) and non-ulcer dyspepsia (28.4 per cent). The best approach to epigastric pain is first of all to rule out the presence of parasites in the stool. Upper digestive tract endoscopy is useful as a second step in the diagnosis while ultrasound examination does not add important information

Diagnosis and Treatment of Infectious and Cryptogenic Diarrhoea in Patients with AIDS

Chronic diarrhoea is a common complication in HIV-infected patients. With an overall frequency of 30to 90. In the majority of cases a specific pathogen can be identified; but in 15-35of patients the diagnostic evaluation is unrewarding. Although many explanations have been proposed; the mechanisms of cryptogenic diarrhoea remains still uncertain. A stepwise diagnostic work-up is generally recommended; but the necessity of performing invasive procedures; such as gastrointestinal endoscopy and co-lonscopy; is contraversial stoll studies however; do not permit the detection of all treatable pathogens. Thus; for patients with persistent diarrhoea whose stool cultures and parasitologic examination are negative a comprehensive diagnostic evaluation seems advisable. From January 1990 to December 1992; we observed 130 patients with chronic diarrhoea out of a total of 374 AIDS patients (34.8). Enteric pathogens were identified in 90 patients (69.2). The frequency distribution was as follows: Cryptosporidium spp 68.9; Giardia lambia 21.1. Cryptomegalovirus 13.3; Salmonella ssp. 10; Mycobacterium avium complex 3.3; Isospora belli 2.2; Clostridium difficile 2.2. Mixed infections were present in 13.1of patients. The pathogenic role of Microsporidia however; could not be evaluated since electron microscopic examination was not performed in all cryptogenic cases. specific treatment is always preferable to empiric antimicrobial therapy; considering the variety of infectious agents and the high incidence of mixed infections. Patients with diarrhoea due to pathogens for which effective antimicrobial treatment is lacking and refractory to anti-motility agents may benefit from therapy with somatostatin analogues; although temporarily