Gastrointestinal

The Spectrum of Gastrointestinal Manifestations in Lyme Disease

Fried, Martin D.; Abel, M; Pietruccha, D.; Bal, A.

Free AccDepartment of Pediatrics Jersey Shore Medical Center,

Neptune, New Jersey

Purpose: To describe the GI manifestations of Lyme

Methods: Twenty two consecutive patients between the ages of

8 and 20 years presented with a history of chronic gastrointestinal

symptoms coupled with multiple organ system complaints.

A clinical diagnosis of Lyme disease was made. Endoscopic

evaluation was performed to assess the gastrointestinal

mucosa and to obtain biopsies for polymerase chain reaction

(PCR) to the outer surface protein A (Osp A) of Borrelia

burgdorferi. As controls, ten patients with biopsy proven

Crohn's disease were also tested by PCR.

The laboratory performing the PCR analysis was blinded

to the diagnosis of all specimens they received.

Results: The presence of Lyme disease in the gastrointestinal

tract was confirmed by PCR for B. burgdorferi DNA in

14 of 20 patients with the diagnosis of Lyme and in two

of the control subjects with Crohn's disease. Biopsy

evidence of gastritis, duodenitis and colitis was found

in Lyme patients and associated with the detection of

B. burgdorferi in the GI tract.

Conclusion: In patients living in an endemic area for Lyme

disease who present with abdominal pain, acid reflux,

chronic diarrhea or blood in the stool, Lyme should be

considered as part of the differential diagnosis. In the

absence of an erythema migrans rash or blood test

confirmation of Lyme, diagnosis can be provided by

PCR analysis of gastrointestinal biopsies.