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Prevalence and Predictors of Giardia in the United States

Abstract

Background

Infection with Giardia lamblia is a common cause of diarrheal disease in the developing and industrialized world.

Aims

We aimed to assess the prevalence of giardiasis in the United States (US) among patients with duodenal biopsies, investigating demographic and clinical factors associated with this condition.

Methods

We conducted a cross-sectional study of patients with duodenal biopsies submitted to a national pathology laboratory between January 2, 2008, and December 31, 2015. The prevalence of giardiasis was calculated and categorized by the following patient sociodemographic and clinical data: age, sex, ethnicity, endoscopy indication, season, year, urban–rural setting, region, and presence of H. pylori and atrophic gastritis.

Results

Among all patients (n = 432,813), the mean age was 52.2 years. The prevalence of giardiasis was 0.11%. Patients with giardiasis were more likely to be male (57.8 vs. 34.1%, p < 0.0001). Among patients who had a gastric biopsy (n = 363,788), those with giardiasis were more likely to be colonized with H. pylori (25.7 vs. 9.4%, p < 0.0001). There was no statistically significant association with age, endoscopy indication, urban–rural setting, ethnicity, season, or the presence of atrophic gastritis. On multivariate analysis, male sex, Southern region, and the presence of H. pylori were independently associated with giardiasis.

Conclusions

To our knowledge, this is the largest study to date to assess predictors of giardiasis in the US. We found that male sex, being colonized with H. pylori, and residing in the Southern US are independently associated with giardiasis infection.

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Fig. 1

Abbreviations

AIDS:

Acquired immunodeficiency syndrome

CDC:

Centers for Disease Control

CI:

Confidence interval

EGD:

Esophagogastroduodenoscopy

HIV:

Human immunodeficiency virus

OR:

Odds ratio

US:

United States

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Author’s contribution

HMZ, PHRG, RMG, KOT, and BL were involved in study concept and design. RMG and KOT acquired the data. HMZ, PHRG, RMG, KOT, and BL analysed and interpreted the data and critically revised the manuscript for important intellectual content. HMZ and BL drafted the manuscript and involved in statistical analysis. BL supervised the study. All authors approve the final manuscript submitted and they approve the authorship list.

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Correspondence to Benjamin Lebwohl.

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Conflict of interest

All authors declare that they have no conflicts of interest and nothing to declare.

Ethics approval

This analysis was submitted to the Institutional Review Board of Columbia University and was deemed non-human subjects research, since all data were de-identified prior to being provided to the investigators.

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Zylberberg, H.M., Green, P.H.R., Turner, K.O. et al. Prevalence and Predictors of Giardia in the United States. Dig Dis Sci 62, 432–440 (2017). https://doi.org/10.1007/s10620-016-4447-0

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  • DOI: https://doi.org/10.1007/s10620-016-4447-0

Keywords

  • Giardia
  • Endoscopy
  • Epidemiology
  • Diarrhea