Histomorphometric study of changes in duodenal mucosa of patients presenting with Giardiasis

Abstract

Context: Giardia lambia is a common intestinal protozoon with a higher prevalence rate in tropical countries as compared to the Western world. Histological changes occur in duodenal mucosa in cases of chronic giardiasis that may be similar to celiac disease or tropical sprue. Aim: As the prevalence of giardiasis is high in our country, the present study was undertaken to study the changes in duodenal mucosa of patients with asymptomatic giardiasis and endoscopically normal duodenum. Study Design: The study included 47 duodenal biopsies out of 372 total cases of endoscopic biopsies examined, in which trophozoites of Giardia were identified. A detailed histo-morphological study of these cases was carried out and the histological findings were evaluated. The major histopathological features as observed in cases of giardiasisi.e inflammation, increased intra epithelial lymphocytes (IELs) and villous abnormalities were compared between patients without giardiasis and those with giardiasis. Statistical Analysis Used: P-value using chi-square test was calculated. Results: P-value was found to be significant for inflammation and villous abnormalities whereas increased IEL's were found to be an insignificant histological parameter. Conclusion: Although the histological features associated with giadiasis were non-specific, a higher incidence of villous changes with increased IEL's was found. This study highlighted the importance of identification of Giardia trophozoites in duodenal biopsies to avoid misdiagnosis of celiac disease or tropical sprue which may have similar clinical and histological features but have different management strategies.