Investigating Dyspepsia in Clinical Practice - A Trap for Giardia

Introduction: Dyspepsia is a very common condition with significant morbidity and economic implications. Dyspeptic symptoms have heterogeneous pathogenic mechanisms, including several organic, systemic or extragastrointestinal causes, however, origin of the most cases of dyspepsia remains unclear. This study aimed to focus on potential causes in patients with nonspecific dyspeptic symptoms in absence of organic, systemic or biochemical and hematological findings that readily explain their symptoms.

Methods: We studied presence of persistent abdominal symptoms (heartburn, dull epigastric pain, epigastric cramps, epigastric fullness, flatulence, diarrhoea), weight loss. All patients (116 patients, 29 males/87 females) had normal laboratory tests, negative abdominal ultrasound evaluation and upper endoscopy findings. Presence of Giardia intestinalis (GI), Helicobacter pylori (HP) infection and coeliac disease (CD) was evaluated by obtaining biopsy samples and duodenal fluid aspiration during upper endoscopy. We determined the effect of eradication treatment on dyspepsia symptoms 2 months after therapy.

Results: HP infection was present in 28%, coeliac disease in 6%, GI infection was diagnosed in 27% patients GI and HP in 12%, CD and HP in 1%, GI and CD in 2%. None of these causes were presented in 39%. Most frequent symptoms were epigastric fullness (69%), dull epigastric pain (38%), heartburn (35%), flatulence (34%), abdominal cramps (31%) and diarrhoea (16%). We documented the remission of symptoms in 79% examined patients 2 month after eradication therapy.

Conclusion: The most common cause of dyspepsia was Helicobacter pylori infection and chronic giardiasis. Although H. pylori and coeliac disease are widely well known, we pointed out Giardia intestinalis as another possible cause of dyspepsia. Chronic giardiasis leads in selected individuals to dyspeptic symptomatology that mimics functional dyspepsia and irritable bowel syndrome. We recommend test for G. intestinalis infection in all patients with chronic dyspeptic complaints of unknown origin.