Histopathological Study of Upper Gastrointestinal Tract for Helicobacter Pylori and Giardiasis in Egyptian Children

Background: G.lamblia is a common worldwide parasitic infection which colonizes the upper part of small intestine causing giardiasis. Aim of the Work: This study aims to detect gastric giardiasis in children receiving antacid drugs and undergoing upper endoscopy at El Mounira Children Hospital, Cairo University. In addition to study the effect of H.pylori on colonization of gastric mucosa by G.lamblia trophozoites and assess the associated histopathological changes in gastric and duodenal mucoca. Subjects and Methods: 100 patients (1 to 15 years of age) of both sexes (60% males & 40% females) were classified into group I includes 70 patients receiving antacid drugs and group II includes 30 patients not receiving antacid drugs. All patients were subjected to history taking, clinical examination, stool analysis, endoscopy, gastric and intestinal biopsy taking and detection of Giardia coproantigen in stool by ELISA. Biopsies were stained with Haematoxylin & Eosin, Giemsa and Masson trichrome stains. Results: Abdominal pain, flatulence, vomiting and diarrhea constituted the most frequent complains among studied population. In 58% of cases upper endoscopy was normal while endoscopic findings included distal oesophagitis (20%), esophageal varices (14%), gastritis (8%), duodenitis (8%) and gastric ulcer (2%). G.lamblia trophozoite was detected in 5.7% of cases combined with H.pylori in group I and associated with chronic gastritis (75%), lymphocytic gastritis (50%), metaplasia (50%) and atrophic gastritis (25%). G.lamblia was evident in 16% of stool samples, 11% of duodenal biopsies and 20% of antigen detection by ELISA. Intestinal giardiais (11%) was associated with chronic inflammatory infiltrate (88.9%), flatting and shorting of villi (66.7%) and duodenitis (22.2%). H.pylori was detected in 43% of cases associated with chronic gastritis (15%), metaplasia (15%), lymphocytic gastritis (14%), erosive gastritis (5%) and atrophic gastritis (4%). Conclusions: Marked suppression of gastric acid secretion encourages colonization of gastric mucosa by G.lamblia Correspondence to: Dr. Hala N. Hosni, The Department of Pathology, Faculty of Medicine, Cairo University trophozoite especially in the presence of H.pylori, chronic atrophic gastritis, metaplasia or lymphocytic gastritis.