Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas

Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas

doi:10.1080/00365520600881193

Cited by 30 publications

(24 citation statements)

References 18 publications

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“…Colonoscopy has been considered in the evaluation of the patient with persistent diarrhea. In a recent study looking at the diagnostic value of endoscopy for the diagnosis of giardiasis or other intestinal diseases in patients with persistent diarrhea returning from tropical or subtropical areas, lower endoscopy (colonoscopy or sigmoidoscopy) yielded relevant diagnoses more oft en than upper endoscopy ( 163 ). Th is study, however, suff ers from a small sample size insofar as only 31 patients with persistent diarrhea were examined and thus the additional value of such procedures cannot be recommended.…”

Section: Summary Of Evidencementioning

confidence: 82%

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Riddle

DuPont

Connor

2016

American Journal of Gastroenterology

318

250

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Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings. Am J Gastroenterol 2016; 111:602-622; doi: 10.1038/ajg.2016 A follow-up survey where 3,568 respondents (median age 51) were asked at random about illness in the previous 7 days or previous month found that recall bias had an important eff ect on estimates of acute gastrointestinal illness ( 10 ). Using a 7-day exposure window, the estimated incidence of acute diarrhea was 1.6 episodes per person-year, compared with 0.9 episodes per person-year if asked about illness within the preceding month. Other population-based studies from Canada and western European countries using varied methodologies estimate annual incidence between 0.1 to 3.5 episodes per person-year ( 11 18. Antibiotic chemoprophylaxis has moderate to good effectiveness and may be considered in high-risk groups for short-term use. (Strong recommendation, high level of evidence) TD, traveler's diarrhea.

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Section: Summary Of Evidencementioning

confidence: 82%

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Riddle

DuPont

Connor

2016

American Journal of Gastroenterology

318

250

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“…Some authors have reported that the yields of the microscopic examination of duodenal aspirates vary from 0.7 to 47.6% [32] . However, some diagnostic limitations for the isolation of G. intestinalis trophozoites in duodenal aspirates have been reported by Wahnschaffe et al [33], who detected G. intestinalis in duodenal aspirates examined by direct fluorescent-antibody assays in only 3 patients, whereas 16 patients demonstrated the faecal excretion of Giardia cysts.…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of <b><i>Giardia intestinalis</i></b> in Patients with Dyspepsia

Fouad¹,

Esmat²,

Basyoni

et al. 2014

Digestion

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Background/Aims:Giardia intestinalis triggers symptoms of functional dyspepsia. The aim of this study was to distinguish genotypes of G. intestinalis isolated from dyspeptic patients to evaluate their correlation with dyspeptic symptoms. Methods: In total, 120 dyspeptic subjects were investigated by upper endoscopy, including gastric and duodenal biopsies for histopathological examination, and parasitological examination of their stools and duodenal aspirates was performed. The patients were classified into five groups: group I (G. intestinalis) included 19 patients, group II (Helicobacter pylori) included 36 patients, group III (coeliac disease) included 3 patients, group IV (mixed G. intestinalis and H. pylori infection) included 4 patients, and group V (unexplained aetiology) included 58 patients. Genotyping of G. intestinalis was performed for groups I and IV using PCR-RFLP. The urease test was performed for H. pylori. Serum anti-gliadin, anti-endomysial and anti-transglutaminase antibody estimation was performed for the diagnosis of coeliac disease. Results: Genotype A of G. intestinalis was detected in the stool samples of 68.42% (13/19) and the duodenal aspirates of 42.1% (8/19) of dyspeptic patients harbouring the parasite. Genotype B was detected in 31.58% (6/19) of cases in stool samples and in 3 cases in duodenal aspirates. Conclusions:H. pylori, G. intestinalis and coeliac disease are common causes of dyspepsia. G. intestinalis genotype A demonstrated a greater association with dyspeptic symptoms.

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“…122 The sensitivity of duodenal aspirates taken during upper endoscopy is low (20%), and its routine use for diagnosis of infection is of questionable value. 123 In patients with a non-acidic gastric environment secondary to acid suppressive therapy, gastric surgery, duodenogastric reflux, Helicobacter pylori infection, and atrophic gastritis, giardiasis rarely may involve the stomach; in one such case, markedly erythematous antral mucosa with small, patchy, cotton-like lesions was described. 124 Histologic findings Giardiasis typically is diagnosed via stool examination, fecal immunoassays, and/or tissue biopsy.…”

Section: Endoscopic Findingsmentioning

confidence: 98%

Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics

Ali

Arnold

Singhi

et al. 2014

Gastrointestinal Endoscopy

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Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas

Abstract: Compared to stool examinations using DFA, upper endoscopy is less sensitive for the diagnosis of giardiasis. In patients with negative stool examinations, lower endoscopy yields relevant diagnoses more often than upper endoscopy.

Cited by 30 publications

References 18 publications

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Molecular Identification of <b><i>Giardia intestinalis</i></b> in Patients with Dyspepsia

Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics

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