Publication: Intestinal capillariasis in the 21st century: clinical presentations and role of endoscopy and imaging
Issued Date
2014
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Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Gastroenterology. Vol. 14, (2014), 207
Suggested Citation
Julajak Limsrivilai, Supot Pongprasobchai, Piyaporn Apisarnthanarak, Sathaporn Manatsathit Intestinal capillariasis in the 21st century: clinical presentations and role of endoscopy and imaging. BMC Gastroenterology. Vol. 14, (2014), 207. doi:10.1186/s12876-014-0207-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2659
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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.