title: Republished research: Helminths: an unrecognised disease burden prevalent among migrants in the gastroenterology clinic.
abstract: OBJECTIVE
  To estimate the prevalence of, and implement a diagnostic strategy for, imported helminth infection in the gastroenterology clinic.
  
  
  METHODS
  A retrospective study of eosinophil count and probable tropical exposure (phase I) followed by a prospective study of parasitological investigation (phase II).
  
  
  METHODS
  Gastroenterology service of an inner London hospital.
  
  
  METHODS
  Adult patients newly attending general gastroenterology and inflammatory bowel disease clinics.
  
  
  METHODS
  In phase I, evidence of undiagnosed helminth infection was sought by analysing patient records for associations between eosinophil count and ethnicity. In phase II, a UK guideline for investigation of eosinophilia in migrants was implemented and diagnostic yield determined.
  
  
  METHODS
  In phase I, prevalence of eosinophilia was determined; in phase II, helminth prevalence and degree of eosinophilia before and after treatment were reported. Information on symptomatic response to treatment was recorded. Ethnicity was used as a proxy measure for tropical exposure.
  
  
  RESULTS
  426 new patients attended in a 12 month period. Eosinophilia was present in 27 (6.3%). 10/27 (37.0%) patients with eosinophilia were of African or Asian ethnicity whereas only 20% (85/426) of patients overall were from these ethnic groups (χ(2)=5.27, p=0.02). Following implementation of the protocol, 25/36 migrants with eosinophilia attended for parasitological investigations. Helminth infection was diagnosed in 10/25 (40%). Strongyloidiasis (six patients) and schistosomiasis (three patients) were the most common diagnoses. Median eosinophil count was 1.06×10(9)/l in those with helminths and 0.58×10(9)/l in those without (p=0.004). Eosinophil counts normalised in, and symptomatic improvement was reported by, most patients after treatment.
  
  
  CONCLUSIONS
  Eosinophilia is associated with African or Asian ethnicity in an inner city gastroenterology service. This association is probably explained by imported helminths, which are prevalent in this setting, may be a cause of gastrointestinal symptoms and is easily diagnosed and treated by standard protocols.
authors.affiliation: Department of Gastroenterology, University College London Hospital, UK. pjsmith@doctors.org.uk
authors.forename: P J
authors.initials: PJ
authors.lastname: Smith
authors.forename: B
authors.initials: B
authors.lastname: Theis
authors.forename: S
authors.initials: S
authors.lastname: McCartney
authors.forename: M
authors.initials: M
authors.lastname: Brown
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D000818:Animals; D001208:Asia / Q000208:ethnology; D017281:Cost of Illness; D004802:Eosinophilia / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D004804:Eosinophils; D005762:Gastroenterology / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006373:Helminthiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D008131:London / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D014171:Transients and Migrants / Q000706:statistics & numerical data