title: Symptomatic giardiasis without diarrhea: further evidence to support the routine duodenal biopsy?
abstract: BACKGROUND
  Worldwide, Giardia lamblia is the most common protozoan isolated from the GI tract. Patients with symptoms caused by giardiasis typically present with diarrhea, the absence of which may result in a low clinical index of suspicion for the diagnosis.
  
  
  METHODS
  A series of 6 patients with giardiasis presenting without diarrhea is reported. Five presented with atypical GI symptoms. In all 6 cases, diarrhea was absent. Upper GI pathology was suspected by the investigating clinician and EGD was therefore arranged.
  
  
  METHODS
  Five of the 6 patients improved with appropriate antibiotic treatment.
  
  
  CONCLUSIONS
  This series of cases demonstrates the importance of considering G lamblia as a cause for GI symptoms even in the absence of diarrhea. Routine procurement of duodenal biopsy specimens is valuable for recognition of atypical presentations of patients with G lamblia and avoiding delays in diagnosis.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hopper
authors.forename: Simon S
authors.initials: SS
authors.lastname: Cross
authors.forename: Mark E
authors.initials: ME
authors.lastname: McAlindon
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000818:Animals; D001707:Biopsy, Needle; D003967:Diarrhea; D004386:Duodenum / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016829:Giardia lamblia / Q000302:isolation & purification*; D005873:Giardiasis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D008795:Metronidazole