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Does Giardia lamblia cause villous atrophy in children?: A retrospective cohort study of the histological abnormalities in giardiasis.
J Pediatr Gastroenterol Nutr. 2009 Sep; 49(3):304-8.JP

Abstract

OBJECTIVE

To determine the prevalence and type of histological abnormalities in duodenal mucosa associated with Giardia lamblia in children who undergo esophago-gastroduodenoscopy.

MATERIALS AND METHODS

Duodenal biopsies containing G lamblia were retrieved from all paediatric patients who had undergone endoscopy in our centre in the last 20 years. These biopsies were scored for histological abnormalities by a single pathologist using a semiquantative scale and staged according to the Marsh criteria. In those with a Marsh stage above 0, the presence of coeliac disease was investigated.

RESULTS

After excluding all patients with concomitant coeliac disease, 4 out of 32 (13%) patients had a biopsy showing crypt hyperplasia and 1 out of 32 (3%) had partial villous atrophy. No intraepithelial lymphocytosis was found. In our cohort, 2 patients with giardiasis and mild histological abnormalities were diagnosed with coeliac disease only after a repeated endoscopy and serology were performed; in 1 of them after a delay of 5 years. Other histological abnormalities frequently observed were increased eosinophilic infiltration of the lamina propria (35%) and lymph follicle formation (35%). Infiltration of neutrophilic and eosinophilic granulocytes in the epithelial layer was observed less frequently (16% and 9%, respectively).

CONCLUSIONS

Villous atrophy, intraepithelial lymphocytosis and/or crypt hyperplasia are rare in children with giardiasis who undergo esophagogastroduodenoscopy. Therefore, other causes, particularly coeliac disease, should always be suspected. This study, however, suggests that giardiasis can cause chronic mucosal inflammation, often of an eosinophilic nature, in these children.

Authors+Show Affiliations

Department of Pediatric Gastroenterology and Nutrition, Amsterdam Medical Centre, The Netherlands. b.g.koot@amc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19525873

Citation

Koot, Bart G P., et al. "Does Giardia Lamblia Cause Villous Atrophy in Children?: a Retrospective Cohort Study of the Histological Abnormalities in Giardiasis." Journal of Pediatric Gastroenterology and Nutrition, vol. 49, no. 3, 2009, pp. 304-8.
Koot BG, ten Kate FJ, Juffrie M, et al. Does Giardia lamblia cause villous atrophy in children?: A retrospective cohort study of the histological abnormalities in giardiasis. J Pediatr Gastroenterol Nutr. 2009;49(3):304-8.
Koot, B. G., ten Kate, F. J., Juffrie, M., Rosalina, I., Taminiau, J. J., & Benninga, M. A. (2009). Does Giardia lamblia cause villous atrophy in children?: A retrospective cohort study of the histological abnormalities in giardiasis. Journal of Pediatric Gastroenterology and Nutrition, 49(3), 304-8. https://doi.org/10.1097/MPG.0b013e31818de3c4
Koot BG, et al. Does Giardia Lamblia Cause Villous Atrophy in Children?: a Retrospective Cohort Study of the Histological Abnormalities in Giardiasis. J Pediatr Gastroenterol Nutr. 2009;49(3):304-8. PubMed PMID: 19525873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Giardia lamblia cause villous atrophy in children?: A retrospective cohort study of the histological abnormalities in giardiasis. AU - Koot,Bart G P, AU - ten Kate,Fiebo J W, AU - Juffrie,Mohammad, AU - Rosalina,Ina, AU - Taminiau,Jan J A M, AU - Benninga,Marc A, PY - 2009/6/16/entrez PY - 2009/6/16/pubmed PY - 2009/11/11/medline SP - 304 EP - 8 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 49 IS - 3 N2 - OBJECTIVE: To determine the prevalence and type of histological abnormalities in duodenal mucosa associated with Giardia lamblia in children who undergo esophago-gastroduodenoscopy. MATERIALS AND METHODS: Duodenal biopsies containing G lamblia were retrieved from all paediatric patients who had undergone endoscopy in our centre in the last 20 years. These biopsies were scored for histological abnormalities by a single pathologist using a semiquantative scale and staged according to the Marsh criteria. In those with a Marsh stage above 0, the presence of coeliac disease was investigated. RESULTS: After excluding all patients with concomitant coeliac disease, 4 out of 32 (13%) patients had a biopsy showing crypt hyperplasia and 1 out of 32 (3%) had partial villous atrophy. No intraepithelial lymphocytosis was found. In our cohort, 2 patients with giardiasis and mild histological abnormalities were diagnosed with coeliac disease only after a repeated endoscopy and serology were performed; in 1 of them after a delay of 5 years. Other histological abnormalities frequently observed were increased eosinophilic infiltration of the lamina propria (35%) and lymph follicle formation (35%). Infiltration of neutrophilic and eosinophilic granulocytes in the epithelial layer was observed less frequently (16% and 9%, respectively). CONCLUSIONS: Villous atrophy, intraepithelial lymphocytosis and/or crypt hyperplasia are rare in children with giardiasis who undergo esophagogastroduodenoscopy. Therefore, other causes, particularly coeliac disease, should always be suspected. This study, however, suggests that giardiasis can cause chronic mucosal inflammation, often of an eosinophilic nature, in these children. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/19525873/Does_Giardia_lamblia_cause_villous_atrophy_in_children:_A_retrospective_cohort_study_of_the_histological_abnormalities_in_giardiasis_ L2 - https://doi.org/10.1097/MPG.0b013e31818de3c4 DB - PRIME DP - Unbound Medicine ER -