الفهرس 
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Abstract
Summary
G. lamblia is a cosmopolitan parasite with a worldwide distribution and the most common protozoan isolated from gastrointestinal tract. It is a parasite of the small intestine occurring endemically in certain areas and one of the causes of waterborne outbreaks.
The parasite is commonly found in children in developing countries and in travelers to endemic regions. It causes infections varying from asymptomatic to protracted and severe disease. The clinical aspects of giardiasis are largely nonspecific. The most common symptoms are diarrhea, abdominal pain, bloating, flatulence and weight loss resulting from malabsorption. These symptoms may overlap those of patients with other gastrointestinal disorders like IBS. By definition, patients with IBS do not have a physiological cause for their illness, but some studies have shown that a significant number of patients who have been given the diagnosis of IBS proved to have infection with G. lamblia.
Some researchers had found that the lack of a certain known etiologic factor for IBS, the similarity of symptoms between IBS and chronic giardiasis and the large number of undiagnosed G. lamblia infections suggests the possibility of causal link between them. Furthermore, evidence for PI-IBS secondary to low grade inflammation was demonstrated years before. The persistent low grade inflammation was associated with faecal persistence of G. lamblia cysts.
Inflammatory conditions of the intestines produce mediators, such as bradykinins and 5-HT that inducing visceral hypersensitivity and increased motor responses in IBS patients. Moreover Giardia infection causes alteration in the intraluminal intestinal state, causing a synergy between gastrointestinal disorders such as IBS and Giardia growth. However, patients with IBS have a visceral hypersensitivity which can be readily increased by actual colon and rectal distension with gases which caused by disaccharide intolerance following giadiasis infection.
The aim of the present study is to evaluate the prevalence of G. lamblia infection in IBS patients, to study the possible association between giardiasis and IBS, to treat the patients with the recommended nutritive supplements in conjunction to the conventional therapeutic measures and follow up of those patients with a regularly planned assessment. The present study was carried out on 160 IBS-D patients attending the outpatient clinic of internal medicine department at Beni Suief University Hospital. Patients were with age ranging from 18 to 50 years old. They included 73 males and 87 females.
Different diagnostic techniques were used for detection of G.lamblia in stool specimens. The samples were examined by direct microscopy using saline and iodine wet mounts as a direct smear. Also concentration technique using formalin ether sedimentation method was used. Permanent staining techniques were conducted using trichrome stain. Mono-Giardia ICT for coproantigenic detection of G. lamblia was used. Evaluation of H. pylori infection was performed by using H. pylori stool Ag card test. Duodenal aspiration with examination of the material obtained by direct wet mount and permanent trichrome strained smear was carried out.
The present work showed the following results:
Among the 160 patients subjected to the study G.lamblia was found in 45 individuals (28.13%).
The 45 patients positive for G.lamblia were 18 males (40%) and 27 females (60%).
The gastrointestinal manifestations varied between the 45 patients. The main complain among patients was mild to severe watery offensive diarrhea met with Rome II Criteria of IBS in the 45 cases (100%), vomiting was found in 40 cases (88.88%), abdominal flatulence in 33 cases (73.33%), nausea in 31 cases (68.88%), inefficient defecation in 23 cases (51.11%) and anorexia in 15 cases (33.33%). To a lesser extent weight loss and generalized fatigue were presented in 10 cases for each (22.22%).
History taken from the studied subjects revealed that 10 male patients were smokers (22.22%) and 12 infected female patients were complaining of severe premenstrual symptoms (26.67%).
It was found that the direct simple smear detected 32 positive cases (20%). Each of formol ether concentration method and trichrome staining technique detected 36 positive cases (22.5%). Regarding Giardia ICT, it gave 42 positive cases (26.25%). Duodenal fluid examination detected 15 cases only (9.38%).
It was found that out of the 45 patients positive for giardiasis, 29 patients (64.44%) had H. pylori in their stool. Regarding the other intestinal parasitic infections which reported in some infected patients, it was found that B. hominis was detected in 20 cases (44.44%), Entamoeba coli was reported in 23 cases (51.11%), Ascaris lumbricoidies was seen in three cases (6.67%) and Hymenolepis nana was reported in two cases (4.44%).
Using the treatment protocol in the present study, showed that group (A) who was treated with tinidazole (fasigyn), seven out of ten patients improved by treatment (70%), in group (B) who was treated by probiotics (lacteol fort) there were nine improved patients out of ten (90%). In group (C) who was treated by wheat germ oil capsules the improvement was reported in eight patients (80%) among ten. According to group (D1) who was treated by combination therapy of tinidazole and probiotics the improvement by treatment occurred in four patients (80%), in group (D2) who was treated by tinidazole and wheat germ oil capsules improvement was reported in three patients (60%) and finally in group (D3) who received tinidazole, probiotics and wheat germ oil capsules, all the five patients were improved by treatment (100%).
It is recommended that all patients with IBS undergo routine parasitological investigations to rule out protozoan parasites as the causative agents of the clinical symptoms. It is also recommended that the nutritional treatment should be considered the first line of giardiasis treatment. It is concluded that ingestion of wheat germ and probiotics can aid in clearance of giardiasis infection.