# Study finds Giardia infection accounted for 6.5% of patients with IBS & dyspepsia



## Talissa (Apr 10, 2004)

World J Gastroenterol. 2006 Mar "AIM:To evaluate the prevalence of Giardia lamblia (G. lamblia) infection in patients with irritable bowel syndrome (IBS) and dyspepsia and to establish which is the most accurate test to diagnose the infection in this setting. CONCLUSION: In this consecutive series, diagnosis of G. lamblia infection accounted for 6.5% of patients with IBS and dyspepsia. Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed."http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsumFull text~http://www.wjgnet.com/1007-9327/12/1941.asp


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## eric (Jul 8, 1999)

Its hard to know what diagnostic requirements were met with this study in regards to manning rome 1 or rome 2 other then" due to symptoms of IBS"This is also a prevalance study. Not a cause study.Out of One hundred and thirty-seven patients , 9 had Giardia lamblia infection.This also might be, I am not sure, higher in different countries then others.Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed.In that new IBS presentation Dr Drossman, was talking about the calprotectin stool tests to sperate IBS from inflammtion in organic diseases and IBD. ITs looking like its going to be very useful in testing and seperating out some conditions.


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## Talissa (Apr 10, 2004)

If you read the full text, you'll see they were quite rigorous, and conservative, on how they chose IBS patients. They used Rome II criteria....Here's another study from 2002 where they used Rome I~*Giardia lamblia infections become clinically evident by eliciting symptoms of irritable bowel syndrome.*"OBJECTIVES: Giardia lamblia infection is often asymptomatic. Its main, but not well understood, symptom is diarrhea. An outbreak of giardiasis in our town allowed us to test the hypothesis that patients with symptomatic infection are, actually, patients with Irritable Bowel Syndrome (IBS) exacerbated by giardiasis. METHODS: We studied 100 patients with symptomatic giardiasis. Eighty-two of them were also affected by IBS, according to the "Rome 1992 Criteria". They were randomized in four groups, two of which (A and







, made up of 41 patients each, included the subjects with giardiasis and IBS, whereas the remaining two (C and D), made of up of 9 patients each, included subjects with giardiasis only. The groups A and C were treated with metronidazole, whereas groups B and D were treated with drugs commonly used for IBS, but inactive against the parasite. RESULTS: According to a single blind protocol, the treatment with metronidazole was ineffective in the groups with giardiasis and IBS. Instead, the treatment for IBS ameliorated the symptoms in these patients. On the contrary, the groups without IBS improved only with metronidazole. CONCLUSIONS: The large majority of patients with symptomatic giardiasis are affected by IBS and are not cured by antiparasite treatment."http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum


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## Talissa (Apr 10, 2004)

ps, it's true the 6.5% study was performed in Italy...Re:


> quote:In that new IBS presentation Dr Drossman, was talking about the calprotectin stool tests to sperate IBS from inflammtion in organic diseases and IBD. ITs looking like its going to be very useful in testing and seperating out some conditions.


Haven't we known this for some time? With the exception of separating IBS from "organic" diseases that is. The low-grade inflammation in IBS makes it organic, doesn't it?...My high calprotectin level, but not high enough to technically be "IBD", sure feels organic!!


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## eric (Jul 8, 1999)

They are now finding specifc problems that they maybe able to specifically target in IBS. Inflammation being ONE of them in some IBSers.In the presentation DR DRossman said about have IBSers have inflammation of specific cells. The PROCESS of the inflammation is REALLY important.Inflammation cannot be the marker, although it helps. It would be good if they could find a biological marker. And"What Is It?Giardiasis is an intestinal illness caused by infection with the parasite Giardia lamblia, which lives in contaminated water. Although the illness most often occurs in developing countries, giardiasis is also a common cause of waterborne illness in the United States. A person can remain infected with Giardia until the infection is diagnosed and treated. In developing areas of the world, it is common for more than 20% of a country's population to have ongoing Giardia infection. In the United States, only 1 or 2 out of every 10,000 people have Giardia in a typical year, but the infection is found in about 1 out of 3 people who have prolonged diarrhea symptoms if they have traveled recently to a developing country."http://www.intelihealth.com/IH/ihtIH/WSAOL...9339/31164.html


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## Talissa (Apr 10, 2004)

Hey Eric,LOL. I think you should run for office! Lots of info, just no answer to my Q... I'm not even sure why you brought up inflammation here on this thread, but I'd love to know the answer to this, so as long as it was brought up...Maybe I just didn't ask clearly enough. I'll rephrase being more specific.An organic disease is defined as one which exhibits structural changes in body organ/s. Abnormalty of structure. And PI IBS for certain exhibits chronic low-grade inflammation that looks to be characterized by Th1-driven intestinal inflammation. (proinflammatory) Just like IBD is, but to a lesser degree...Ie, inc'd IL1, TNF-a, IL6, IL8, IL12, & even nitric oxide, & so on.So why are "the experts" still calling IBS functional when there are structural changes present, as in organic disease? Changes just like in IBD, but not to the same extent....Or else they couch in terms like~"The results of this study have shown that patients with acute gastroenteritis, who go on to develop IBS, have a higher expression of IL-1ÃŸ mRNA compared with infected patients who do not develop IBS. This is in keeping with the clinical observation that patients with a more severe infective gastroenteritis are more likely to develop IBS post infection.3,4 A correlation is also available from animal studies showing that attenuation of the host response to the initial infection reduces the magnitude of post-infective gut dysfunction.6 *Taken together, these observations suggest that, in addition to previously identified behavioural determinants, organic factors are important in the development of IBS post infection.*"http://gut.bmjjournals.com/cgi/content/full/52/4/523


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## Talissa (Apr 10, 2004)

One lone voice in the woods(my hero)~John Hunter, MD, FCRPDirector or GastroenterologyAddenbrooke's HospitalCambridge, United Kingdom "I.B.S. is organic. That is, all sufferers will eventually be found to have measurable, unique pathologic defects.When that happy day arrives, the term 'IBS' will no longer be used and each patient will receive a more precise diagnosis."http://www.immunopharma.nl/html/profession...indigestion.aspMaybe no one wants to change the name...


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## Talissa (Apr 10, 2004)

Well, meanwhile, back to Giardia~FDA"Giardiasis is the most frequent cause of non-bacterial diarrhea in North America....Normally illness lasts for 1 to 2 weeks, but there are cases of chronic infections lasting months to years. Chronic cases, both those with defined immune deficiencies and those without, are difficult to treat....This organism is implicated in 25% of the cases of gastrointestinal disease and may be present asymptomatically. The overall incidence of infection in the United States is estimated at 2% of the population. The disease mechanism is unknown, with some investigators reporting that the organism produces a toxin while others are unable to confirm its existence. The organism has been demonstrated inside host cells in the duodenum, but most investigators think this is such an infrequent occurrence that it is not responsible for disease symptoms. Mechanical obstruction of the absorptive surface of the intestine has been proposed as a possible pathogenic mechanism, as has a synergistic relationship with some of the intestinal flora....Giardiasis is most frequently associated with the consumption of contaminated water. Five outbreaks have been traced to food contamination by infected or infested food handlers, and the possibility of infections from contaminated vegetables that are eaten raw cannot be excluded. Cool moist conditions favor the survival of the organism."http://www.cfsan.fda.gov/~mow/chap22.html


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## eric (Jul 8, 1999)

> quote:So why are "the experts" still calling IBS functional when there are structural changes present, as in organic disease?


"Irritable bowel syndrome, or IBS, is generally classified as a "functional" disorder. A functional disorder refers to a disorder or disease where the primary abnormality is an altered physiological function (the way the body works), rather than an identifiable structural or biochemical cause. It characterizes a disorder that generally can not be diagnosed in a traditional way; that is, as an inflammatory, infectious, or structural abnormality that can be seen by commonly used examination, x-ray, or blood test."http://www.aboutibs.org/index.html But the answer to your question is they don't have a biological marker in ALL IBSers yet. Something they can pinpoint in all IBSers. They now have abnormalities they can see with a microscope which they can now start to target individually. They have learned a great deal in the last five years especially, but its so complex, they still have much to learn.They have come close a few times to possible markers.


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