GASTROINTESTINAL MANIFESTATIONS OF THE STRONGYLOIDIASIS

Abstract
Strongyloidiasis should be included in the list of conditions causing protein losing enteropathy and malabsorption syndrome. It should also be suspected in patients having abdominal symptoms associated with bronchopneumonia, with or without pulmonary changes in the chest roentgenogram. In the lungs it may produce infiltrates resembling bronchopneumonia, tuberculosis or chronic pulmonary disease. In the stomach and duodenum, nodular defects due to intramural granuloma formation, thickening or effacement of mucosal folds, ulcerations and narrowing of the lumen with rigidity may be present. When the colon is involved the findings can mimic ulcerative or granulomatous colitis. An interesting feature is reflux into the biliary tract. This may be a diagnostic sign of strongyloidiasis, particularly when associated with the above described findings. However, this feature appears not to be unique for the strongyloidiasis, as it is also reported in regional enteritis of the duodenum. Although the possibility of filling of the biliary tract through a fistulous communication has not been definitely ruled out in regional enteritis, it may well be due to incompetence of the sphincter of Oddi secondary to the rigidity caused by granulomatous process. Therefore, it is believed that visualization of the biliary and/or pancreatic ducts associated with changes in the duodenum as described is merely a sign of a granulomatous disease of the duodenum and may probably be seen in other granulomatous processes involving the latter. Every effort should be made to eliminate the possibility of this disease on suspected patients before institution of corticosteroid therapy, since the latter may prove to be fatal even in carriers.

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