Giardia intestinalis in patients with nonulcer dyspepsia

ABSTRACT

Giardiasis may present with dyspeptic symptoms that may mimic other gastrointestinal and/or biliary disorders. The objective of this study was to determine the prevalence of giar-diasis in stool and duodenal aspirate of patients with NUD, assess symptomatic benefit of therapy, and compare the diagnostic tools for giardiasis utilizing stool and duodenal aspirates microscopic evaluation versus ELISA testing. 109 Patients with endoscopic diagnosis of NUD out of 278 consecutive patients with dyspepsia were included. The severity of dyspepsia and the quality of life were assessed utilizing Rome II criteria and SF-36 for Quality of Life and concomitant stool and/or duodenal aspirate samples were submitted for ELISA antigen test for Giardia intestinalis. Those who tested positive for giardiasis [Group 1] were assigned to receive Tinidazole 2.0 g. single dose plus omeprazole for 4 weeks and the remaining patients [Group 2] omeprazole alone for 4 weeks. One month after therapy, both groups were reassessed and Stool ELISA antigen test for G. intestinalis for Group 1, was performed. ELISA testing of stool [19%] and duodenal aspirates [19%] had significantly better results than microscopic ones in stool [11%] or duodenal aspirates [7%]. The two groups were well matched with respect to age, sex, initial results on the Glasgow Dyspepsia Severity Score, prevalence of previously prescribed antisecretory-drug therapy, prevalence of smoking, predominant symptom at presentation, and quality of life. The outcome of patients at 1 month, on an intention-to-treat basis, showed that the symptoms were resolved [defined as a score of 0 or 1] in 17 of 21 patients [81%] in Group 1 as compared with 31 of 88 patients [35%] in Group 2 P < 0.001. The scores in both groups were lower than those at base line and there was a highly statistically significant difference between both groups. G. intestinalis as a cause of dyspepsia should be considered in patients with negative endos-copy and in those who remain symptomatic in spite of adequate treatment for known upper G.I. disorders. NUD associated with the presence of Giardia, had better symptomatic benefit [81%] with specific treatment than controls [35%]. ELISA testing of stool [19%] and duodenal aspirates [19%] had significantly better results than microscopic ones in stool [11%] or duodenal aspirates [7%]