The Spectrum of Gastrointestinal Manifestations in Lyme
Fried, Martin D.; Abel, M; Pietruccha, D.; Bal, A.
Free AccDepartment of Pediatrics Jersey Shore Medical
Neptune, New Jersey
Purpose: To describe the GI manifestations of Lyme
Methods: Twenty two consecutive patients between the ages
8 and 20 years presented with a history of chronic
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
(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
tract was confirmed by PCR for B. burgdorferi DNA
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
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.