Celiac Disease Imitated by Giardiasis

Véghelyi, P

doi:10.1001/archpedi.1939.01990040158011

Cited by 13 publications

(7 citation statements)

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“…Mechanical blockage of the brush border by numerous parasites was sug gested (33), but much of the brush border is not covered by organisms (26), the majority being unattached in the mucus layer. Mechanical irritation of mucosa by organisms may be important but has not been proven.…”

Section: (22)mentioning

confidence: 99%

Giardiasis

Smith¹,

Wolfe²

1980

Annu. Rev. Med.

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Further ANNUAL REVIEWS PATHOGENESISEpidemiologic and experimental data suggest that individuals and various strains of experimental animals (21) differ in their susceptibility to infection, and that strains of G. lamblia differ in virulence. Immunocompromised individuals are partiCUla rl y likely to develop serious long-lasting infection Annu. Rev. Med. 1980.31:373-383. Downloaded from www.annualreviews.org Access provided by University of Waterloo on 02/05/15. For personal use only.

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Section: (22)mentioning

confidence: 99%

Giardiasis

Smith¹,

Wolfe²

1980

Annu. Rev. Med.

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“…Infection with Giardia may be associated with clinical and/or laboratory features suggestive of malabsorption, the extent of which is variable. This has been observed in children (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and in adults (21, 23 -32). Geographically, giardiasis-associated malabsorption in adults has a wider distribution than that associated with tropical sprue (32).…”

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confidence: 67%

Malabsorption in Giardiasis

Poley,

Rosenfield

1982

J. pediatr. gastroenterol. nutr.

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SummaryInvestigations of the small bowel mucosa by scanning and transmission electron microscopy are reported in two coetaneous children with giardiasis. Serum immunoglobulins and mucosal architecture by light microscopy were normal in both, as well as activities of lactase, sucrase, and maltase. One of the children had suggestive evidence of malabsorption. Scanning and transmission electron microscopic examination of biopsied mucosa of the child with malabsorption suggested the following: increased secretory activity in crypts and increased cell damage, producing excess mucus containing extruded cytoplasm. It is hypothesized that the physicochemical properties of the mucoid material permitted ready interaction with the mucosal surface, the biochemical qualities of which could have been altered by the presence of the parasites. Close adherence of this mucoid layer to the surface gave it the aspect of a pseudomembrane which, by covering wide areas of the mucosal surface, probably functioned as an effective luminal barrier for nutrients. This pseudomembrane was not seen by light microscopy. Excessive secretion of mucus, its physicochemical and immunologic properties, and mueus‐mucosal surface interaction could have been engendered by genetic and environmental factors, which need further study. Although some mucus was present in the mucosa of the other child, it was confined to the base of the villi, and did not cover the mucosal surface. The presence of a luminal barrier (mucoid pseudomembrane) may be added to the list of mechanisms implicated in causing malabsorption in giardiasis.

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“…Even though the intimate mechanism of mucosal damage is still unclear (21,22), most of the evidence so far available would indicate that Giardia brings about a nonspecific damage to the mucosa of the infection site. This damage may be caused by mechanical covering of the mucosa by the parasite (23,24) or by the mucous barrier that it elicits (21), or by aggression of the mucosa with or without epithelial invasion (21,(25)(26)(27). In any event, therefore, it is not surprising that lactase activity [which is greater in the proximal areas of the small intestine (28,29)] is impaired .…”

Section: Discussionmentioning

confidence: 99%

Lactose Malabsorption in Children with Symptomatic Giardia lamblia Infection

Mantovani,

Guandalini,

Ecuba

et al. 1989

J. pediatr. gastroenterol. nutr.

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An investigation was carried out on 61 children suffering from symptomatic giardiasis with the object of verifying the incidence and entity of lactose malabsorption. Furthermore, the possibility of a substitutive yogurt diet was verified in the lactose malabsorbers. The subjects, all children older than 1 year, were studied according to a schedule that included a lactose hydrogen breath test (BT) performed prior to therapy and a further BT 60 days following therapy. The subjects were divided in two groups: group A, 40 children, received a dose of 250 ml of cow's milk; group B, 21 children, received a stress dose of 2 g/kg lactose (max 50 g). Those subjects who were lactose malabsorbers at the 60 day follow‐up were also given a BT at 75 days, and in the case of persistent malabsorption, a further BT was performed after 24 h with the administration of yogurt (450 g containing 12.1 g of lactose). Furthermore, 40 subjects matched for age and sex but without any GI complaints served as controls. The results showed lactose malabsorption to be frequent in children with Giardia lamblia symptomatic infection. According to the BT with a standard lactose load, all patients were malabsorbers; when testing lactose absorption with 250 ml of cow's milk, 45% of patients were found to be malabsorbers. In the latter subjects, the oral load of yogurt was uniformly well tolerated and gave rise to no H2 increment on the BT. We conclude that the occurrence of lactose malabsorption of nutritional relevance is common in children suffering or having suffered from giardiasis. Such children, however, may benefit from the administration of yogurt, whose lactose appears to be well absorbed.

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Celiac Disease Imitated by Giardiasis

Cited by 13 publications

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Giardiasis

Giardiasis

Malabsorption in Giardiasis

Lactose Malabsorption in Children with Symptomatic Giardia lamblia Infection

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