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.