Frequency of Giardia lamblia infection in children with recurrent abdominal pain.

Introduction: To assess the frequency and causative role of Giardia lamblia infection in children with recurrent abdominal pain in our setup.

Methods: Prospective observational study of 239 children with recurrent abdominal pain was conducted at Department of Paediatrics, Postgraduate Medical institute, Hayatabad Medical Complex, Peshawar, from November 2004 to July 2006. Inclusion criteria was children from 4 to 14 years having recurrent abdominal pain defined as greater than three episodes of abdominal pain, in the last 3 months severe enough to affect the daily activities of the child. Fresh stool specimen was collected from each child for laboratory examination. Those with negative results had two other samples taken at different times. Positive cases were treated with metronidazole or tinidazole. Stool examination was repeated 1 week after the end of the treatment, followed by evaluation of complaints for the next 6 months.

Results: Seventy-four (30.96%) children were positive for giardiasis. Thirty-eight were positive in their first sample, while 27 and 9 were in their second and third samples respectively. Giardia cysts were positive in 93% and trophozoite in 7%. Mean age of positive cases was 86+/-47 months. The mean duration of pain was 158+/-64 days, with 42% having pain for more than 6 months. Abdominal cramps, nausea and vomiting, abdominal distension, flatulence/bloating, anorexia and weight loss were the main clinical symptoms observed. Poor health hygiene, poor toilet training, overcrowding, and low socioeconomic status were observed risk factors. Stools were negative for giardiasis one week after the end of treatment. Only 76% children returned for follow-up and all were free of any complaints.

Conclusion: A significant proportion of children with recurrent abdominal pain were infected with Giardia lamblia and this study supports its potential role in recurrent abdominal pain in children.