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Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging

BACKGROUND: Intestinal capillariasis is one of the common causes of malabsorption in the East. Reports emphasizing the roles of clinical, endoscopic and radiologic findings of intestinal capillariasis are limited. METHODS: Retrospective review of medical records of 26 patients diagnosed with intesti...

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Autores principales: Limsrivilai, Julajak, Pongprasobchai, Supot, Apisarnthanarak, Piyaporn, Manatsathit, Sathaporn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271459/
https://www.ncbi.nlm.nih.gov/pubmed/25492259
http://dx.doi.org/10.1186/s12876-014-0207-9
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author Limsrivilai, Julajak
Pongprasobchai, Supot
Apisarnthanarak, Piyaporn
Manatsathit, Sathaporn
author_facet Limsrivilai, Julajak
Pongprasobchai, Supot
Apisarnthanarak, Piyaporn
Manatsathit, Sathaporn
author_sort Limsrivilai, Julajak
collection PubMed
description BACKGROUND: Intestinal capillariasis is one of the common causes of malabsorption in the East. Reports emphasizing the roles of clinical, endoscopic and radiologic findings of intestinal capillariasis are limited. METHODS: Retrospective review of medical records of 26 patients diagnosed with intestinal capillariasis at Siriraj Hospital, Bangkok, Thailand between 2001- 2013. RESULTS: Clinical manifestations were chronic watery diarrhea (93%), chronic abdominal pain (70%), significant weight loss (92%), hypoalbuminemia (100%; 85% lower than 2.0 g/dL), and anemia (50%). The median duration of symptoms was 5.5 months (1-60 months). Parasites were found in stool in 15 patients (57%). In patients whose stool tests were initially negative, parasites were discovered in tissue biopsy from endoscopy in 1 from 10 esophagogastroduodenoscopies (EGD), 0 from 7 colonoscopies, 3 from 5 push enteroscopies, and 3 from 5 balloon-assisted enteroscopies (BAE). Endoscopic findings included scalloping appearance, mucosal cracking, and redness of mucosa. These endoscopic findings affected mostly at jejunum and proximal ileum. They were similar to celiac disease except duodenal involvement which is uncommon in capillariasis. Three patients underwent video capsule endoscopy (VCE) and typical abnormal findings were observed in all patients. Small bowel barium study showed fold thickening, fold effacement, and increased luminal fluid in 80% of patients, mainly seen at distal jejunum and ileum. CT findings were long segment wall thickening, enhanced wall, and fold effacement. Treatment with either albendazole or ivermectin cured all patients with most responding within 2 months. CONCLUSIONS: In endemic area, intestinal capillariasis should be considered if patients develop chronic watery diarrhea accompanied by significant weight loss and severe hypoalbuminemia. Stool examination had quite low sensitivities in making diagnosis in our study. Deep enteroscopy with biopsy guided by imaging or VCE may improve diagnostic yield. Empirical therapy may also be justifiable due to the very good response rate and less side effects.
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spelling pubmed-42714592014-12-20 Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging Limsrivilai, Julajak Pongprasobchai, Supot Apisarnthanarak, Piyaporn Manatsathit, Sathaporn BMC Gastroenterol Research Article BACKGROUND: Intestinal capillariasis is one of the common causes of malabsorption in the East. Reports emphasizing the roles of clinical, endoscopic and radiologic findings of intestinal capillariasis are limited. METHODS: Retrospective review of medical records of 26 patients diagnosed with intestinal capillariasis at Siriraj Hospital, Bangkok, Thailand between 2001- 2013. RESULTS: Clinical manifestations were chronic watery diarrhea (93%), chronic abdominal pain (70%), significant weight loss (92%), hypoalbuminemia (100%; 85% lower than 2.0 g/dL), and anemia (50%). The median duration of symptoms was 5.5 months (1-60 months). Parasites were found in stool in 15 patients (57%). In patients whose stool tests were initially negative, parasites were discovered in tissue biopsy from endoscopy in 1 from 10 esophagogastroduodenoscopies (EGD), 0 from 7 colonoscopies, 3 from 5 push enteroscopies, and 3 from 5 balloon-assisted enteroscopies (BAE). Endoscopic findings included scalloping appearance, mucosal cracking, and redness of mucosa. These endoscopic findings affected mostly at jejunum and proximal ileum. They were similar to celiac disease except duodenal involvement which is uncommon in capillariasis. Three patients underwent video capsule endoscopy (VCE) and typical abnormal findings were observed in all patients. Small bowel barium study showed fold thickening, fold effacement, and increased luminal fluid in 80% of patients, mainly seen at distal jejunum and ileum. CT findings were long segment wall thickening, enhanced wall, and fold effacement. Treatment with either albendazole or ivermectin cured all patients with most responding within 2 months. CONCLUSIONS: In endemic area, intestinal capillariasis should be considered if patients develop chronic watery diarrhea accompanied by significant weight loss and severe hypoalbuminemia. Stool examination had quite low sensitivities in making diagnosis in our study. Deep enteroscopy with biopsy guided by imaging or VCE may improve diagnostic yield. Empirical therapy may also be justifiable due to the very good response rate and less side effects. BioMed Central 2014-12-10 /pmc/articles/PMC4271459/ /pubmed/25492259 http://dx.doi.org/10.1186/s12876-014-0207-9 Text en © Limsrivilai et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Limsrivilai, Julajak
Pongprasobchai, Supot
Apisarnthanarak, Piyaporn
Manatsathit, Sathaporn
Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
title Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
title_full Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
title_fullStr Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
title_full_unstemmed Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
title_short Intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
title_sort intestinal capillariasis in the 21(st) century: clinical presentations and role of endoscopy and imaging
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271459/
https://www.ncbi.nlm.nih.gov/pubmed/25492259
http://dx.doi.org/10.1186/s12876-014-0207-9
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