2607 Small Intestinal Helminths on a Capsule Endoscopy Capture

Abstract

INTRODUCTION: Intestinal helminth infection is a well known cause of occult GI bleed and iron deficiency anemia, most commonly seen in developing countries. With the introduction of capsule endoscopy in the diagnostic algorithm of occult GI bleed, reports of intestinal helminths identified during capsule study have been published. [1] We present the case of a patient with iron deficiency anemia and occult GI bleed found to have helminth infection. CASE DESCRIPTION/METHODS: A 77-year-old Puerto Rican female patient was sent for evaluation of iron deficiency anemia. She was asymptomatic, denying any melena, hematochezia or hematemesis. Her Hb was 8.1 mg/dL, MCV of 83 fL with low iron levels. Fecal occult blood test was positive. EGD and colonoscopy were negative. Outpatient video capsule showed helminths in the ileum, but unable to identify speciation. Multiple stool workups were negative for ova and parasites. Strongyloides serology was negative. Patient empirically received 400 mg of albendazole daily for 3 days and iron tablets. DISCUSSION: Helminth infection is most commonly seen in developing countries. Intestinal helminths are transmitted from the soil to the human intestine leading to inflammation of the small intestine or colon, ulcers, anemia secondary to iron and B12 deficiency, eosinophilia, and obscure gastrointestinal bleed. Diagnosis begins with microscopic examination of feces, blood test (serology and blood smear) and imaging ( X-ray, magnetic resonance imaging, and computed tomography).[2]. If worm burden is minimal, then concentrated feces with formalin is recommended. PCR has a higher sensitivity and specificity. When stool studies are negative with high suspicion of helminth infection or the patients present for evaluation of obscure gastrointestinal bleed, conventional endoscopy is the next sequential diagnostic measure. [2] The introduction of capsule endoscopy has assisted the diagnosis of helminth infection in patients with persistent symptoms or anemia and negative esophagoduodenoscopy and colonoscopy. Helminths identified in capsule endoscopy should be categorized and treated based on their macroscopic characteristics if stool studies are falsely negative. If identification is not possible, empiric treatment with monitoring of the response to anemia and repeat capsule endoscopy might be indicated.