title: Gastrointestinal bleeding due to worm infestation, with negative upper gastrointestinal endoscopy findings: impact of enteroscopy.
abstract: OBJECTIVE
  In cases of hookworm and roundworm infestation, chronic occult bleeding is well known, but acute gastrointestinal bleeding is rarely described. We report five patients with worm infestation who presented with acute massive gastrointestinal bleeding.
  
  
  METHODS
  Over 1 year, we have encountered 15 patients with obscure gastrointestinal bleeding. All the patients had normal findings on upper gastrointestinal endoscopy. Push enteroscopy was performed in each patient and evaluation of the proximal 40-50 cm of the jejunum was done.
  
  
  RESULTS
  Five patients (four men, one woman; average age 50 yr, range 40-60) had worm infestation (two hookworm, three roundworm). All the patients had gastrointestinal bleeding (five had melena, one hematemesis, and two hematochezia) for a duration of 7-14 days. Hemoglobin ranged from 2.8 to 9 g/dl. Push enteroscopy revealed fresh blood in the jejunum, multiple erosions, and hookworms in two patients and roundworms in three patients. Hookworms were retrieved endoscopically in two patients whereas roundworms could be retrieved in only one patient. All the patients were treated with mebendazole (100 mg twice a day for 3 days), iron, and folic acid. Gastrointestinal bleeding subsided in all the patients.
  
  
  CONCLUSIONS
  In developing countries, worm infestation should be considered an important cause of obscure acute gastrointestinal bleeding. Evaluation of the jejunum using an enteroscope will result in more frequent diagnosis of worms as a cause of acute gastrointestinal bleeding which might have been classified as obscure gastrointestinal bleeding.
authors.affiliation: Dept. of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: B C
authors.initials: BC
authors.lastname: Sharma
authors.forename: D K
authors.initials: DK
authors.lastname: Bhasin
authors.forename: H S
authors.initials: HS
authors.lastname: Bhatti
authors.forename: G
authors.initials: G
authors.lastname: Das
authors.forename: K
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage; D001196:Ascariasis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D001707:Biopsy, Needle; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006725:Hookworm Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D000871:Anthelmintics