Gastritis (inflammation of the stomach lining) is a common problem regardless of HIV status. Symptoms of gastritis include stomach pain, nausea, vomiting, decreased appetite, and, in severe cases, vomiting blood. Common causes of gastritis are non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen, major health stress (patients who are sick enough to be in an Intensive Care Unit), heavy alcohol use, and infection with the bacteria H pylori. H pylori doesn't cause problems for most people who have it. And it is no more common in people with HIV than in those without HIV. But the presence of H pylori can negatively affect treatment success for people with HIV.
The breakdown of the stomach or intestinal lining causes an ulcer. Ulcers are extremely common - 10% of adults have an ulcer at some point in their lives -- and they cause dull or gnawing pain in the upper abdomen. Contrary to popular belief, ulcers occur more frequently in the small intestine than in the stomach, and they are more commonly caused by NSAIDs, excessive acid production, or H pylori infection than by stress or too much coffee. An upper endoscopy is performed to diagnose ulcers, often accompanied by specialized testing for H pylori.
HIV gastropathy, a condition caused by decreased stomach acid secretion, makes affected patients more susceptible to bacterial infections like salmonella and shigella. These bacteria would normally be destroyed by acidic stomach contents. HIV gastropathy also decreases absorption of medications that require an acidic environment, such as Nizoral (ketoconazole) and Sporanox (itraconazole), two commonly-used antifungal drugs. There is no specific test for HIV gastropathy at this time, but your healthcare provider may make certain medication adjustments if he or she suspects this condition, such as switching to other drugs that don't depend on acid for absorption.
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