Intestinal capillariasis in the 21stcentury: clinical presentations and role of endoscopy and imaging

BMC Gastroenterology

Research Article

Piyaporn Apisarnthanarak¹  Supot Pongprasobchai²  Sathaporn Manatsathit²  Julajak Limsrivilai² 

[1] Division of Diagnostic Radiology, Faculty of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand;Division of Gastroenterology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand;

关键词: Intestinal capillariasis;    Clinical presentation;    Enteroscopy;    Video capsule endoscopy;    Imaging;    Treatment;   

DOI  :  10.1186/s12876-014-0207-9

 received in 2014-08-23, accepted in 2014-11-27,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundIntestinal 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.MethodsRetrospective review of medical records of 26 patients diagnosed with intestinal capillariasis at Siriraj Hospital, Bangkok, Thailand between 2001- 2013.ResultsClinical 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.ConclusionsIn 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.

【 授权许可】

CC BY   
© Limsrivilai et al.; licensee BioMed Central Ltd. 2014