title: Giardia intestinalis in patients with nonulcer dyspepsia.
abstract: OBJECTIVE
  Giardiasis may present with dyspeptic symptoms that may mimic other gastrointestinal and/or biliary disorders. The objective of this study was to determine the prevalence of giardiasis in stool and duodenal aspirate of patients with NUD, assess symptomatic benefit of therapy, and compare the diagnostic tools for giardiasis utilizing stool and duodenal aspirates microscopic evaluation versus ELISA testing.
  
  
  METHODS
  109 Patients with endoscopic diagnosis of NUD out of 278 consecutive patients with dyspepsia were included. The severity of dyspepsia and the quality of life were assessed utilizing Rome II criteria and SF-36 for Quality of Life and concomitant stool and/or duodenal aspirate samples were submitted for ELISA antigen test for Giardia intestinalis. Those who tested positive for giardiasis (Group 1) were assigned to receive Tinidazole 2.0g. single dose plus omeprazole for 4weeks and the remaining patients (Group 2) omeprazole alone for 4weeks. One month after therapy, both groups were reassessed and Stool ELISA antigen test for G. intestinalis for Group 1, was performed.
  
  
  RESULTS
  ELISA testing of stool (19%) and duodenal aspirates (19%) had significantly better results than microscopic ones in stool (11%) or duodenal aspirates (7%). The two groups were well matched with respect to age, sex, initial results on the Glasgow Dyspepsia Severity Score, prevalence of previously prescribed antisecretory-drug therapy, prevalence of smoking, predominant symptom at presentation, and quality of life. The outcome of patients at 1month, on an intention-to-treat basis, showed that the symptoms were resolved (defined as a score of 0 or 1) in 17 of 21 patients (81%) in Group 1 as compared with 31 of 88 patients (35%) in Group 2 P<0.001. The scores in both groups were lower than those at base line and there was a highly statistically significant difference between both groups.
  
  
  CONCLUSIONS
  G. intestinalis as a cause of dyspepsia should be considered in patients with negative endoscopy and in those who remain symptomatic in spite of adequate treatment for known upper G.I. disorders. NUD associated with the presence of Giardia, had better symptomatic benefit (81%) with specific treatment than controls (35%). ELISA testing of stool (19%) and duodenal aspirates (19%) had significantly better results than microscopic ones in stool (11%) or duodenal aspirates (7%).
authors.affiliation: Department of Internal Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Abulhasan
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Elshazly
authors.forename: Mohamad
authors.initials: M
authors.lastname: Eida
authors.forename: Ayman
authors.initials: A
authors.lastname: Albadry
mesh_terms: D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004386:Duodenum / Q000469:parasitology; D004415:Dyspepsia / Q000469:parasitology*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000469:parasitology; D005260:Female; D016829:Giardia lamblia; D005873:Giardiasis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012720:Severity of Illness Index; D014011:Tinidazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D054328:Proton Pump Inhibitors; D014011:Tinidazole; D009853:Omeprazole
keywords: Enzyme-linked immunosorbent assay (ELISA); Giardia intestinalis; Non-ulcer dyspepsia (NUD)