Giardiasis in dyspeptic patients

Öz

Background and Aims: The etiology of functional (nonulcer) dyspepsia is unknown and many factors are suspected. Giardia lamblia is the most common protozoan isolated from the gastrointestinal tract, and chronic giardiasis is considered as a cause of dyspepsia. Our aim was to determine the frequency of giardiasis in patients undergoing upper gastrointestinal endoscopy for dyspepsia and to compare with results of stool examination by microscopy. Materials and Methods: One hundred and four dyspeptic patients (63 F, 41 M, aged 17-80 years) were included in the study. Duodenal aspirates were collected in all and simultaneous stool examinations for Giardia lamblia were done. Results: Belching was the most prominent symptom in patients with dyspepsia (52.9%). Giardia positivity was 8.7% in duodenal aspirates (1 trophozoite, 8 cysts) and 3.8% in stool examination simultaneously. There was a male predominance (12% vs 6%). All patients with giardiasis had epigastric pain or abdominal discomfort. Following the appropriate antiparasite treatment, dyspeptic complaints were improved in all Giardia-positive patients. Conclusions: There was no significant difference between the two methods statistically. This study suggests that duodenal aspirates for giardiasis may be unnecessary if stool examination with new techniques is used for diagnosis. If repeated stool examination results in negative findings, but the diagnosis is still suspected, upper gastrointestinal endoscopy with biopsies and duodenal aspirate is a reasonable alternative for diagnosis.

Anahtar Kelimeler

• Key words: Giardiasis, dyspepsia, endoscopy, duodenal aspirate

Dispepsili hastalarda Giardiazis sıklığı

Öz

Giriş ve Amaç: Fonksiyonel veya ülser dışı nedenlere bağlı dispepsi etyolojisi tam olarak bilinmemekte ve birçok faktör suçlanmaktadı r. Giardia lamblia sindirim kanalından en fazla izole edilen protozoan olup, kronik giardiasis dispepsi nedenlerindendir. Bu çalışmada amacımız, dispepsi nedeniyle üst gastrointestinal endoskopi yapı lan hastalarda giardiazis sıklığını belirlemek ve sonuçları eş zamanlı yapılan mikroskopik dışkı incelemeleri ile karşılaştırmaktı. Gereç ve Yöntem: Yüz dört dispeptik hasta (63 K, 41 E, 17-80 yaş) çalışmaya alındı. Giardia lamblia araştırılması için bütün hastalardan duodenal aspiratlar toplandı ve eş zamanlı mikroskobik dışkı incelemeleri de yapıldı. Bulgular: Geğirme dispeptik hastalarda en fazla yakı nılan semptomdu (%52,9). Giardia pozitifliği duodenal aspiratta %8,7 (1 trofozoit, 8 kist) iken eş zamanlı dışkı incelemelerinde %3,8 bulundu. Erkeklerde daha fazlaydı (%12?ye karşı %6). Bütün giardiazisli hastalarda epigastrik ağrı veya karında rahatsızlık hissi vardı. Uygun antiparaziter tedaviyi takiben giardia pozitif tüm hastalardaki dispeptik yakınmalar kayboldu. Sonuç: İki yöntem arasında istatistiksel olarak anlamlı bir fark yoktu. Bu çalışma giardiazis tanısı için eğer tanı değeri yüksek yeni tekniklerle dışkı incelemesi yapılabiliyorsa duodenal aspirat almanın gereksiz olabileceğini düşündürdü. Ancak tanıdan kuvvetle şüphelenildiği halde tekrarlanan dışkı incelemeleri negatif sonuç veriyorsa biyopsi ve duodenal aspiratları n alınabildiği üst gastrointestinal endoskopi tanıda dikkate değer bir seçenektir.

Anahtar Kelimeler

• Giardiazis, dispepsi, endoskopi, duodenal aspirat

Kaynakça

1. McQuaid KR. Dyspepsia. In: Feldman M, Friedman LS, Sleisenger MH. Editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Pathophysiology, diagnosis, management. Section 2. Approach to patients with symptoms and signs. Ch 7. 7th ed. Philadelphia. Saunders, 2002; 105-16.
2. Pickering LK. Giardia lamblia (Giardiasis). In: Long SS, Pickering LK, Prober CG. Editors. Principles and Practice of Pediatric Infectious Diseases. Section D. Human parasites and vectors. 2nd ed. Philadelphia. Churchill Livingston 2003; 1275-9.
3. Yakoob J, Jafri W, Abid S, et al. Giardiasis in patients with dyspeptic symptoms. World J Gastroenterol 2005; 11: 6667-70.
4. Kerlin P, Ratnaike RN, Butler R, et al. Prevalence of giardiasis: a study at upper-gastrointestinal endoscopy. Am J Dig Dis 1978; 23: 940-2.
5. Oberhuber G, Stolte M. Symptoms in patients with giardiasis undergoing upper gastrointestinal endoscopy. Endoscopy 1997; 29: 716-20.
6. Zafar MN, Baqai R, Lodi TZ, et al. Giardia lamblia in patients undergoing upper G.I. endoscopy. (Abstract) J Pak Med Assoc 1991; 41: 74-5.
7. Grazioli B, Matera G, Laratta C, et al. Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia: A prospective study. World J Gastroenterol 2006; 12(12): 1941-4.
8. D’Anchino M, Orlando D, De Feudis. L. Giardia lamblia infections become clinically evident by eliciting symptoms of irritable bowel syndrome. J Infect 2002; 45: 169-72.

9. Gupta SK, Croffie JM, Pfefferkorn MD, et al. Diagnostic yield of duodenal aspirate for G. lamblia and comparison to duodenal mucosal biopsies. Dig Dis Sci 2003; 48: 605-7.
10. Suzuki HU, de Morais MB, Medeiros EH, et al. Diagnostic limitations of the isolation of trophozoites of Giardia lamblia in duodenal aspirates. (Abstract) Arq Gastroenterol 1994; 31: 69-74.
11. Oguto EO, Kanja C, Kang’ethe SK, et al. Prevalence of intestinal parasites in Kenyans with dyspepsia. (Abstract) East Afr Med J 1998; 75: 16-8.
12. Wahnschaffe U, Ignatus R, Loddenkemper C, et al. Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas. Scand J Gastroenterol 2007; 42: 391-6.
13. Goka AKJ, Rolston DDK, Mathan VI, et al. The relative merits of faecal and duodenal juice microscopy in the diagnosis of giardiasis. Trans R Soc Trop Med Hyg 1990; 84: 66-7.
14. Cusack MA, O’Mahony S, Woodhouse K. Giardia in older people. Age and Ageing 2001; 30: 419-21.
15. Carr MF, Ma J, Green PH. Giardia lamblia in patients undergoing endoscopy: lack of evidence for a role in nonulcer dyspepsia. Gastroenterology 1988; 95: 972-4.
16. Coşkun S. İlkokul öğrencilerinde intestinal parazitler. (Özet) Mikrobiyol Bul 1991; 25: 367-72.
17. Köksal I, Malkoç CH, Özergin O ve ark. Trabzon’da ilkokul öğrencilerinde bağ›rsak parazitlerinin prevalans› ve parazitli hastalarda eğitimin önemi. (Özet) Mikrobiyol Bul 1992; 26: 155-62.
18. Özçelik S, Değerli S. Giardiasis in Turkey. In: Proceedings of the 10th National Parasitology Congress, 8-12 September 1997, Ankara, Turkey; 179.
19. Çaksen H, Batun ME, Üstünbaş HB. Prevalences of intestinal parasitosis in children living in central region of Turkey. East Afr Med J 2002; 79: 669.
20. Demirçeken F, Tosun MS, Özgür Ö ve ark. Çocuk Gastroenteroloji Polikliniğinde tan› alan Giyardiyaz olgular›. IV. Ulusal Sindirim Yolu İle Bulaşan İnfeksiyonlar Simpozyumu Kitab›, 16-20 May›s 2005, Mersin, Türkiye; 408.
21. Hopper AD, Cross SS, McAlindon ME, et al. Symptomatic giardiasis without diarrhea: further evidence to support the routine duodenal biopsy? Gastrointest Endosc 2003; 58: 120-2.
22. Allison MC, Green EL, Bhattacharya DN, et al. A microscopic and immunodiagnostic search for giardiasis in patients with gastrointestinal disorders. Scan J Gastroenterol 1988; 23: 209-12.
23. Aziz H, Beck CE, Lux MF, et al. A comparison study of different methods used in the detection of Giardia lamblia. Clin Lab Sci 2001; 14: 150-4.
24. Guy RA, Xiao C, Horgen PA. Real-time PCR assay for detection and genotype differentiation of Giardia lamblia in stool specimens. J Clin Microbiol 2004; 42:3317-20.
25. Taylan AÖ, Mungan M, K›l›ç S ve ark. Giardiasis tan›s›nda Giardia/Cryptosporidium DFA yönteminin kullan›m›. IV. Ulusal Sindirim Yolu İle Bulaşan İnfeksiyonlar Simpozyumu Kitab›, 16-20 May›s 2005, Mersin, Türkiye; 344.
26. Giboda M, Hildebrand T. Detection of giardia intestinalis in duodenal aspirates and in the stool. (Abstract) Folia Parasitol 1983; 30: 181-3.