title: Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas.
abstract: OBJECTIVE
  Upper endoscopy has been suggested as a valuable tool in the diagnosis of giardiasis. The aim of this study was to compare two methods based on endoscopy, i.e. microscopy of duodenal fluid and histology, with a fluorescent-antibody assay for the detection of Giardia lamblia cysts in stool specimens. The role of endoscopy in the identification of other causes of chronic diarrhea acquired during travel abroad was also evaluated.
  
  
  METHODS
  Thirty-one patients (9 F, 22 M, median age 39 years, range 19-63 years) with persistent diarrhea after returning from tropical or subtropical areas agreed to undergo upper gastrointestinal endoscopy before and after treatment. Lower gastrointestinal endoscopy was subsequently performed. Three stool samples from each patient were examined using the direct fluorescent-antibody assay (DFA) for the detection of G. lamblia, and by routine methods for other protozoal and bacterial enteric pathogens. Each patient underwent upper endoscopy and biopsies and duodenal fluid samples were taken. In 12 patients a further lower endoscopy was performed.
  
  
  RESULTS
  In 16 patients G. lamblia was detected in stool samples by DFA (relative sensitivity: 100%). Histology of duodenal biopsies and microscopy of duodenal fluids allowed diagnosis of giardiasis to be made in only 8, and 3 patients, respectively (relative sensitivities: 21% and 44%). Besides giardiasis, upper endoscopic examination revealed an alternative diagnosis (tropical sprue), whereas six additional diagnoses were made by colonoscopy. In six patients the cause of chronic diarrhea remained unclear.
  
  
  CONCLUSIONS
  Compared to stool examinations using DFA, upper endoscopy is less sensitive for the diagnosis of giardiasis. In patients with negative stool examinations, lower endoscopy yields relevant diagnoses more often than upper endoscopy.
authors.affiliation: Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Medical Clinic I (Gastroenterology, Infectious Diseases, and Rheumatology), Berlin, Germany. ulliwahn@arcor.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wahnschaffe
authors.forename: Ralf
authors.initials: R
authors.lastname: Ignatius
authors.forename: Christoph
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: Oliver
authors.initials: O
authors.lastname: Liesenfeld
authors.forename: Marion
authors.initials: M
authors.lastname: Muehlen
authors.forename: Thomas
authors.initials: T
authors.lastname: Jelinek
authors.forename: Gerd-Dieter
authors.initials: GD
authors.lastname: Burchard
authors.forename: Thomas
authors.initials: T
authors.lastname: Weinke
authors.forename: Gundel
authors.initials: G
authors.lastname: Harms
authors.forename: Harald
authors.initials: H
authors.lastname: Stein
authors.forename: Martin
authors.initials: M
authors.lastname: Zeitz
authors.forename: Reiner
authors.initials: R
authors.lastname: Ullrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000818:Animals; D001604:Berlin; D002908:Chronic Disease; D003967:Diarrhea / Q000469:parasitology*; D004386:Duodenum / Q000469:parasitology; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000469:parasitology; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005766:Gastrointestinal Contents / Q000469:parasitology; D005873:Giardiasis / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013182:Sprue, Tropical / Q000150:complications / Q000175:diagnosis / Q000469:parasitology; D014195:Travel; D014329:Tropical Climate