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Symptomatic giardiasis without diarrhea: further evidence to support the routine duodenal biopsy?
Andrew D Hopper1, Simon S Cross, Mark E McAlindon
1Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Background:
Worldwide, Giardia lamblia is the most common protozoan isolated from the GI tract. Patients with symptoms caused by giardiasis typically present with diarrhea, the absence of which may result in a low clinical index of suspicion for the diagnosis.
Methods:
A series of 6 patients with giardiasis presenting without diarrhea is reported. Five presented with atypical GI symptoms. In all 6 cases, diarrhea was absent. Upper GI pathology was suspected by the investigating clinician and EGD was therefore arranged.
Observations:
Five of the 6 patients improved with appropriate antibiotic treatment.
Conclusion:
This series of cases demonstrates the importance of considering G lamblia as a cause for GI symptoms even in the absence of diarrhea. Routine procurement of duodenal biopsy specimens is valuable for recognition of atypical presentations of patients with G lamblia and avoiding delays in diagnosis.