[A proposal for the classification of intestinal complications in giardiasis]

Two hundred children hospitalized in the National Institute of Gastroenterology were studied during the 1972-1980 period. The children, whose ages ranged between six months and ten years, presented chronic diarrhea in which Giardia lamblia was considered the causative agent. The diagnosis of parasitism was made with the detection of Giardia lamblia in the feces and/or duodenal content. A serum D-Xylose and jejunal biopsy were performed on all the patients and the histology of the mucosa was classified in keeping with the degree of atrophy according to Metayer and Laumonier. In our study we divided the patients into three groups: Group 1, parasitism due to Giardia lamblia in patients with a normal D-xylose and different degrees of atrophy of the jejunal mucosa, but with normal D-Xylose and Group 3, malabsorption due to Giardia lamblia, with a pathological D-Xylose and alterations in the intestinal mucosa. There were 35 cases in Group 1 (17.5%), 91 cases in Group 2 (45.5%) and 74 cases in Group 3 (37%). The predominant intestinal lesion was partial atrophy of the villi (143), 20 with subtotal atrophy of the villi and two with complete atrophy of the villi. It was shown that the host's response to infection by Giardia lamblia varies with differing effects on the structures and functioning of the jejunal mucosa. It is important to group patients with chronic diarrhea due to Giardia lamblia in this way since it allows for and individualized clinical approach and provides a prognosis in terms nutritional consequences resulting from possible persistence of the diarrhea and possible associated lactose intolerance.