title: Intestinal capillariasis in the 21st century: clinical presentations and role of endoscopy and imaging.
abstract: BACKGROUND
  Intestinal capillariasis is one of the common causes of malabsorption in the East. Reports emphasizing the roles of clinical, endoscopic and radiologic findings of intestinal capillariasis are limited.
  
  
  METHODS
  Retrospective review of medical records of 26 patients diagnosed with intestinal capillariasis at Siriraj Hospital, Bangkok, Thailand between 2001- 2013.
  
  
  RESULTS
  Clinical manifestations were chronic watery diarrhea (93%), chronic abdominal pain (70%), significant weight loss (92%), hypoalbuminemia (100%; 85% lower than 2.0 g/dL), and anemia (50%). The median duration of symptoms was 5.5 months (1-60 months). Parasites were found in stool in 15 patients (57%). In patients whose stool tests were initially negative, parasites were discovered in tissue biopsy from endoscopy in 1 from 10 esophagogastroduodenoscopies (EGD), 0 from 7 colonoscopies, 3 from 5 push enteroscopies, and 3 from 5 balloon-assisted enteroscopies (BAE). Endoscopic findings included scalloping appearance, mucosal cracking, and redness of mucosa. These endoscopic findings affected mostly at jejunum and proximal ileum. They were similar to celiac disease except duodenal involvement which is uncommon in capillariasis. Three patients underwent video capsule endoscopy (VCE) and typical abnormal findings were observed in all patients. Small bowel barium study showed fold thickening, fold effacement, and increased luminal fluid in 80% of patients, mainly seen at distal jejunum and ileum. CT findings were long segment wall thickening, enhanced wall, and fold effacement. Treatment with either albendazole or ivermectin cured all patients with most responding within 2 months.
  
  
  CONCLUSIONS
  In endemic area, intestinal capillariasis should be considered if patients develop chronic watery diarrhea accompanied by significant weight loss and severe hypoalbuminemia. Stool examination had quite low sensitivities in making diagnosis in our study. Deep enteroscopy with biopsy guided by imaging or VCE may improve diagnostic yield. Empirical therapy may also be justifiable due to the very good response rate and less side effects.
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. alimsrivilai@gmail.com.
authors.forename: Julajak
authors.initials: J
authors.lastname: Limsrivilai
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. supotpong@gmail.com.
authors.forename: Supot
authors.initials: S
authors.lastname: Pongprasobchai
authors.affiliation: Division of Diagnostic Radiology, Faculty of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. punpae@yahoo.com.
authors.forename: Piyaporn
authors.initials: P
authors.lastname: Apisarnthanarak
authors.affiliation: Division of Gastroenterology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sismt7281@yahoo.com.
authors.forename: Sathaporn
authors.initials: S
authors.lastname: Manatsathit
mesh_terms: D015746:Abdominal Pain / Q000469:parasitology; D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D002195:Capillaria; D053704:Capsule Endoscopy; D002908:Chronic Disease; D003967:Diarrhea / Q000469:parasitology; D016099:Endoscopy, Gastrointestinal; D017189:Enoplida Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013785:Thailand; D015431:Weight Loss; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D015766:Albendazole