Effect of electroacupuncture at "Zusanli" (ST 36) on duodenal mast cells, NGF and NTRK1 in rats with functional dyspepsia / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) on duodenal mast cells, nerve growth factor (NGF) and neurotrophic tyrosine kinase receptor type 1 (NTRK1), and to explore the mechanism of electroacupuncture at Zusanli (ST 36) on functional dyspepsia (FD).@*METHODS@#Sixty SPF-grade 10-day-old SD rats were randomly divided into a normal group, a model group, a ketotifen group and an EA group, 15 rats in each group. The FD model was prepared by iodoacetamide combined with rat tail clamping method in the model group, the ketotifen group and the EA group. The rats in the ketotifen group were injected intraperitoneally with ketotifen (1 mg•kg-1•d-1) for 7 days; the rats in the EA group were treated with EA at bilateral "Zusanli" (ST 36), with disperse-dense wave, frequency of 2 Hz/50 Hz and intensity of 0.5 mA, 20 min each time, once a day for 14 days. The gastric emptying rate and small intestinal propulsion rate in each group were observed; the morphology of duodenal mucosa was observed by HE staining; the toluidine blue staining was used to observe the number and degranulation of mast cells in duodenal mucosa; the protein and mRNA expressions of NGF, NTRK1 in duodenum were detected by Western blot and real-time PCR; the level of interleukin-1β (IL-1β) in duodenum was measured by ELISA.@*RESULTS@#Compared with the normal group, the gastric emptying rate and small intestinal propulsion rate in the model group were decreased (P<0.01); compared with the model group, the gastric emptying rate and small intestinal propulsion rate in the ketotifen group and the EA group were increased (P<0.01); the small intestinal propulsion rate in the EA group was higher than that in the ketotifen group (P<0.01). In the model group, local defects in duodenal mucosa were observed with a small amount of inflammatory cell infiltration; no obvious abnormality was found in duodenal mucosa of the other groups. Compared with the normal group, the mast cells of duodenal mucosa in the model group were increased significantly with significant degranulation; compared with the model group, the mast cells of duodenal mucosa in the ketotifen group and the EA group were decreased significantly, and the degranulation was not obvious. Compared with the normal group, the protein and mRNA expressions of NGF, NTRK1 as well as the level of IL-1β in duodenum in the model group were increased (P<0.01); compared with the model group, the protein and mRNA expressions of NGF, NTRK1 as well as the levels of IL-1β in duodenum in the ketotifen group and the EA group were decreased (P<0.01, P<0.05); compared with the ketotifen group, the mRNA expression of NGF, as well as the protein and mRNA expressions of NTRK1 in duodenum in the EA group were decreased (P<0.05, P<0.01).@*CONCLUSION@#EA at "Zusanli" (ST 36) could inhibit the activation of duodenal mast cells and regulate the expressions of NGF and its receptor to improve the low-grade inflammatory response of duodenum, resulting in treatment effect on FD.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients. .

Stanniocalcin-1 protects bovine intestinal epithelial cells from oxidative stress-induced damage

Chronic enteritis can produce an excess of reactive oxygen species resulting in cellular damage. Stanniocalcin-1(STC-1) reportedly possesses anti-oxidative activity, the aim of this study was to define more clearly the direct contribution of STC-1 to anti-oxidative stress in cattle. In this study, primary intestinal epithelial cells (IECs) were exposed to hydrogen peroxide (H2O2) for different time intervals to mimic chronic enteritis-induced cellular damage. Prior to treatment with 200 microM H2O2, the cells were transfected with a recombinant plasmid for 48 h to over-express STC-1. Acridine orange/ethidium bromide (AO/EB) double staining and trypan blue exclusion assays were then performed to measure cell viability and apoptosis of the cells, respectively. The expression of STC-1 and apoptosis-related proteins in the cells was monitored by real-time PCR and Western blotting. The results indicated that both STC-1 mRNA and protein expression levels positively correlated with the duration of H2O2 treatment. H2O2 damaged the bovine IECs in a time-dependent manner, and this effect was attenuated by STC-1 over-expression. Furthermore, over-expression of STC-1 up-regulated Bcl-2 protein expression and slightly down-regulated caspase-3 production in the damaged cells. Findings from this study suggested that STC-1 plays a protective role in intestinal cells through an antioxidant mechanism.

Quantitative immunohistochemical analysis of duodenal ghrelin cells after sleeve gastrectomy in Wistar rats / Análise imunoistoquímica quantitativa das células de grelina duodenais após gastrectomia vertical em ratos Wistar

PURPOSE: Sleeve gastrectomy (SG) removes substantial part of the gastric mucosa, which produces ghrelin. This reduction is expected to force other organs, such as the duodenum, to compensate by increasing the number of ghrelin-producing cells. The purpose of this study was to evaluate whether this response occurs. METHODS: Twelve adult male, Wistar rats underwent SG and were reoperated 30 or 60 days after the initial surgery. During the second surgery, a segment of the duodenum was resected to count ghrelin cells using immunohistochemistry. In six animals, SG was not performed, and the duodenal segment served as a control for ghrelin cell counts. The ghrelin cell index (GCI), which is the number of ghrelin cells divided by the number of villi in each segment, was measured and used in statistical analysis by one-way analysis of variance (ANOVA). RESULTS:There were increases in the absolute numbers of cells 30 and 60 days after SG, but statistical analysis by ANOVA showed no significant difference between the groups. CONCLUSION: A compensatory increase in the number of duodenal immunopositive ghrelin cells did not occur as a response to sleeve gastrectomy.

OBJETIVO: A gastrectomia vertical (GV) remove a maior parte das células produtoras de grelina. Esta redução poderia induzir o duodeno a produzir mais células de grelina de forma compensadora. O objetivo deste trabalho foi estudar se esta compensação ocorre. MÉTODOS: Doze ratos Wistar, machos, foram submetidos à GV e reoperados 30 e 60 dias depois (grupos 30D e 60D) quando um segmento de duodeno foi ressecado para contagem de células de grelina por imunoistoquímica. Em seis animais não foi realizada a GV e um segmento de duodeno foi ressecado para contagem de células de grelina por imunoistoquímica (grupo controle). O índice de células de grelina (ICG), que é o número de células imunopositivas para grelina dividido pelo número de vilosidades do segmento foi calculado e utilizado na análise estatística pelo teste da análise de variância (ANOVA). RESULTADOS: Houve aumento no número absoluto de células 30 e 60 dias depois da gastrectomia vertical, mas a análise estatística por ANOVA não mostrou diferenças significantes entre os grupos. CONCLUSÃO: Não foi observado aumento compensatório no número de células de grelina duodenais após a gastroplastia vertical.

Immunohistochemical studies on duodenum, spleen and liver in mice: distribution of ferroportin and prohepcidin in an inflammation model / Estudios inmunohistoquímicos en duodeno, bazo e hígado de ratón: distribución de ferroportina y prohepcidina en un modelo de inflamación

Duodenum, spleen and liver have a crucial role in iron balance on the whole organism and are the major sites of Ferroportin (FPN) expression. Specific regulations between FPN and hepcidin are responsible for changes seen in physiopathological conditions such as inflammation. We studied in vivo effects of turpentine oil-induced acute inflammation on FPN expression, and its relation with prohepcidin and iron mobilization. Immunohistochemical procedures were performed using rabbit anti-mouse FPN and prohepcidin antibodies with goat-labeled polymer-HRP anti-rabbit (DAB) as secondary antibody. Plasma and tissular iron were also studied. Our results showed a notable expression and redistribution of duodenal FPN to basolateral membrane in turpentine-treated mice, compared with supranuclear and the weak basolateral expression observed in healthy mice. Red pulp macrophages of healthy mice showed FPN-hemosiderin co-localization, compared with turpentine-treated mice which showed lack of FPN. In liver of healthy mice, FPN was seen in Kupffer cells, whereas in turpentine-treated mice decreased. In addition, we observed an increment of hepatic pro-hepcidin with a significant hypoferremia. Our findings demonstrated that acute inflammation induced a differential distribution of FPN, showing a cell type specific response. In macrophages, increased hepatic prohepcidin induced degradation of FPN, resulting in hypoferremia. In enterocytes, the redistribution observed of duodenal FPN reflects a different regulation in this tissue. The observed response of the proteins studied may be part of a cyclical pattern of systemic effects of acute inflammation on mouse tissue.

El duodeno, bazo e hígado desempeñan un rol clave en el balance de Fe del organismo y son los mayores sitios de expresión de ferroportina (FPN). Regulaciones específicas entre FPN y hepcidina son las responsables de los cambios observados en condiciones fisiopatológicas como la inflamación. Nuestro objetivo fue estudiar los efectos in vivo de la inflamación aguda inducida con turpentina sobre la expresión de FPN y su relación con prohepcidina y la movilización de hierro. Los procedimientos inmunohistoquímicos fueron desarrollados utilizando anticuerpos anti FPN y prohepcidina de ratón, desarrollados en conejo y un polímero conjugado con anticuerpos secundarios anti conejo desarrollado en cabra (HRP-DAB). Se evaluaron los niveles de Fe plasmático y tisular. Nuestros resultados mostraron una clara expresión y redistribución de FPN duodenal hacia la membrana basolateral en ratones tratados con turpentina, con respecto a la expresión perinuclear y leve expresión basolateral observada en ratón sano. Macrófagos de la pulpa roja esplénica mostraron co-localización de FPN y hemosiderina, comparado con la ausencia de expresión en ratón tratado con turpentina. En hígado de ratón sano, se observó expresión de FPN en células de Kupffer, mientras que en ratón tratado con turpentina la expresión fue menos evidente. Además, observamos un aumento en la expresión de prohepcidina hepática con una hipoferremia significativa. Nuestros resultados demostraron que la inflamación aguda indujo una distribución diferencial de FPN, mostrando una respuesta específica del tipo celular. En macrófagos, el aumento de prohepcidina hepática indujo degradación de FPN, resultando en hipoferremia. En enterocitos, la redistribución observada de FPN duodenal, refleja una regulación diferente en este tejido. La respuesta observada de las proteínas estudiadas podría ser parte de un patrón cíclico de efectos sistémicos de la inflamación aguda en tejidos murinos.

O efeito do consumo crônico de etanol na absorção duodenal de ferro em camundongos / The effect of chronic ethanol consumption on duodenal absorption of iron in mice

CONTEXTO: Os indivíduos alcoolistas apresentam aumento da concentração hepática de ferro e os mecanismos responsáveis por essa deposição são ainda desconhecidos. Apesar da extensa literatura existente sobre a absorção de ferro nos diferentes estados patológicos, os efeitos do consumo prolongado do etanol não estão totalmente esclarecidos. OBJETIVOS: Determinar a absorção de ferro no duodeno de camundongos após consumo prolongado de etanol, com relação ao controle de camundongos normais. MÉTODOS: Foram utilizados 10 camundongos machos da raça Swiss, distribuídos em dois grupos: grupo 1 (n = 5) - controle e grupo 2 (n = 5) - consumo de água com etanol, como única fonte de água ofertada. Os animais foram acompanhados durante 120 dias. Decorrido esse período, isolou-se o duodeno e pela parte oral de cada alça, infundiu-se solução salina contendo ascorbato de ferro II na concentração de 0,016 mg de ferro elemento. O efluente foi coletado nos tempos 20, 40, 60, 80, 100 e 120 minutos. Os resultados foram analisados pelo teste Mann-Whitney e Kruskal-Wallis, com significância para P<0,05. RESULTADOS: Não houve diferença entre a absorção duodenal de ferro dos grupos 1 e 2, assim como na curva de absorção. CONCLUSÕES: Conclui-se que, nas condições deste experimento, o consumo prolongado de etanol não alterou a absorção de ferro.

CONTEXT: Alcoholists present an increase of iron hepatic concentration, although the responsible mechanisms for this deposition are still unknown. Despite the extensive literature related on the iron absorption in different pathological conditions, the effect of chronic ethanol consumption are still not conclusive and not completely understood. OBJECTIVE: To verify the effect of chronic ethanol ingestion on duodenal absorption of iron. METHODS: Ten male Swiss mice were divided into two groups: group 1 (n = 5) - control, and group 2 (n = 5) - water consumption with ethanol, as only water source. The animals were followed during 120 days. After this period, the duodenum was isolated and saline solution containing ascorbate of iron II in the 0,016 concentration of mg of iron element was infused. The effluent was collected in times 20, 40, 60, 80, 100 and 120 minutes. The results were analyzed by Mann-Whitney and Kruskal-Wallis tests. The significance was set for P<0.05. RESULTS: No difference was found between iron absorption as well as iron absorption curves in groups 1 and 2. CONCLUSION: The chronic consumption of ethanol did not alter iron absorption.

Infl uence of dietary calcium content on intestinal permeability in rat.

Background & objectives: Agents that increase the permeability of intestinal epithelium promote the absorption of nutrients by the gut. High calcium concentration in the gut has been shown to enhance passive transport of glucose in the rat intestine. An increase in the permeability of the intestinal epithelium may account for this observation. The present study was aimed at monitoring the permeability of intestine of rats fed high or low calcium diets. Methods: Everted intestinal sacs were used to study transports of substances across the gut. While radioactive and non radioactive calcium isotopes were employed to study the active transport and passive transport of calcium, transport of labelled mannitol was taken as a measure of passive permeability. Results: High calcium diet increased the passive transport of mannitol and calcium while decreasing the active transport of calcium by the everted gut sacs. Interpretation & conclusion: Passive mechanisms are enhanced by high calcium diet, while low calcium diet favours active transport. Calcium in the diet may be affecting intestinal transport.

Gene chip analyses reveal differential genetic responses to iron deficiency in rat duodenum and jejunum

Previous studies revealed novel genetic changes in the duodenal mucosa of iron-deprived rats during post-natal development. These observations are now extended to compare the genetic response to iron deficiency in the duodenum versus jejunum of 12-wk-old rats. cRNA samples were prepared from the duodenal and jejunal mucosa of three groups each of control and iron-deficient rats and hybridized with RAE 230A and 230B gene chips (Affymetrix). Stringent data reduction strategies were employed. Results showed that several genes were similarly induced in both gut segments, including DMT1, Dcytb, transferrin receptor 1, heme oxygenase 1, metallothionein, the Menkes copper ATPase (ATP7A), tripartitie motif protein 27, and the sodium-dependent vitamin C transporter. However, a subset of genes showed regulation in only one or the other gut segment. In duodenum only, gastrokine 1, trefoil factor 1 and claudin 2 were induced by iron-deficiency. Other genes previously identified were only regulated in the duodenum. Overall, these studies demonstrate similarities and distinct differences in the genetic response to iron deprivation in the duodenum versus jejunum and provide evidence that more distal gut segments also may play a role in increasing iron absorption in iron-deficiency anemia.

Effect of oophorectomy on expression of calcium sensing receptor mRNA in rat duodenal mucosa.

Calcium sensing receptor (CaR) in duodenal mucosa may be involved in active calcium absorption. Estrogen deficiency results in decreased intestinal calcium absorption. Effects of bilateral oophorectomy (OVX) have been studied on calcium homeostasis, bone mineral density (BMD) and CaR mRNA levels in duodenal mucosa at 4 weeks in adult female Sprague Dawley rats and compared with those in sham-operated and control group. There was no significant change in serum corrected calcium, inorganic phosphorous, calcidiol and intact parathyroid hormone in all the three groups. OVX rats had a significant decline in serum estrogen (E2) levels and alkaline phosphatase. They also had a significant decrease in BMD (DXA) at lumbar spine in vivo, and proximal and distal tibia in vitro while there was no significant change in serum E2 and BMD parameters in sham-operated and control rats. Northern blot analysis revealed no significant change in the CaR mRNA expression in duodenal mucosa in all three groups. The results suggests that CaR mRNA expression in duodenal mucosa is not affected by physiological circulating concentrations of estradiol in rats.

Short-term androgen deprivation does not alter CaR and VDR mRNA expression in duodenal mucosa in male rats.

Androgen deprivation is associated with decline in intestinal calcium absorption. The effect of androgen on CaR and VDR intestinal mucosa has not yet been studied. Calcium homeostasis, a real bone mineral density (aBMD, dual energy X-ray absorptiometry) and expression of CaR and VDR mRNA in duodenal mucosa of orchidectomized (ORX) and sham operated (Sham) adult Sprague Dawley rats at 4 week have been studied. There was no significant difference in serum calcium, alkaline phosphatase, calcidiol and calcitriol levels between both the groups. Serum testosterone (T) (ng/dl) and inorganic phosphorous (iP) (mg/dl) levels were significantly lower in ORX rats. As compared to sham rats, ORX rats had significant decline in in-vitro aBMD at proximal, middle and distal tibia, proximal, mid and distal femur and femoral neck (P < 0.05). Northern blot analysis revealed no significant alteration in the CaR and VDR mRNA expression in duodenal mucosa in ORX rats. CaR and VDR mRNA expression in duodenal mucosa is therefore, not affected by physiological concentrations of testosterone in rats.

Comparison of duodenal and jejunal disaccharidase levels in patients with non ulcer dyspepsia.

AIMS: This study was conducted to compare the duodenal and jejunal disaccharidase levels in the same individual with duodenal ulcer or non ulcer dyspepsia. METHODS: Thirty seven patients (duodenal ulcer--11, non-ulcer dyspepsia--26) were included in the study. Endoscopic biopsy samples were obtained from jejunum and duodenum using pediatric colonofibroscope. RESULTS: Levels of jejunal disaccharidases were significantly higher than the duodenal disaccharidases. CONCLUSIONS: An estimate of jejunal disaccharidases can be had by multiplication of duodenal disaccharidased by a factor 1.48 for lactase, 1.50 for sucrase and 1.56 for maltase.

Evidence for oxidant stress in chronic pancreatitis.

BACKGROUND: Oxidant stress leading to lipid peroxidation is reported to be the common link in the pathogenesis of chronic pancreatitis irrespective of etiology. AIM: To look for evidence of lipid peroxidation in duodenal juice in patients with chronic pancreatitis. METHODS: 19 patients with chronic pancreatitis (14 tropical, 5 alcoholic) and 19 age- and sex-matched subjects with abdominal pain without any cause were studied. Contents were aspirated from the second part of the duodenum during gastroduodenoscopy. Malonyl dialdehyde (MDA) levels were measured in duodenal juice by the thiobarbituric acid method. RESULTS: MDA levels were higher in patients than in the control group (mean [SD] 42.6 [17.0] vs 29.2 [11.7] nmol/mL; p < 0.05). On linear and multiple regression analysis, none of the disease factors correlated with duodenal juice MDA levels. CONCLUSIONS: Lipid peroxidation products are increased in patients with chronic tropical and alcoholic pancreatitis.

Actividad mitotica de los enterocitos de las criptas duodenales en ratones portadores de un hepatocarcinoma / Mitotic activity of duodenal-crypt enterocytes in mice with hepatocarcinoma

La presencia de tumores injertados en el ratón generalmente provoca modificaciones de la proliferación de sus poblaciones celulares normales. En el presente trabajo se analiza la actividad mitótica (AM) de los enterocitos de las criptas duodenales del ratón injertado con el hepatocarcinoma ES12a. Se utilizan ratones C3H/S hembras de 28 días de edad, estandarizados para análisis de periodicidad, distribuidos en dos grupos: testigos y portadores del tumor injertado. Animales de ambos grupos se reparten en seis lotes [n = 6-10] que se sacrifican cada cuatro horas después de recibir una dosis de 2 mug/g de colchicina. Muestras de duodeno se fijan en formol tamponado al 10 por ciento y se procesan para la determinación de la actividad mitótica. Se controlan, por animal, los enterocitos correspondientes a 20 criptas, seccionadas longitudinalmente, registrando las células con metafase y su localización topográfica. A partir de estos valores se determinan los índices mitóticos (metafases colchicínicas x 1000 núcleos) de toda la cripta y de cada zona previamente establecida. Con estas cifras se define la X + SEM de cada lote. Las diferencias a comparar se analizan utilizando la prueba de "t"de Student. Los resultados demuestran que la presencia del tumor ES12a ejerce tanto un efecto inhibitorio sobre la AM de los enterocitos, como un desfasamiento de la curva circadiana de este parámetro de crecimiento.

Effect of cerebellar modulation on gastroduodenal PGE2 and 5-HT content of rat.

Nodular cerebellar lesion decreased PGE2 and 5-HT content of gastroduodenal tissue along with a decrease in enterochromaffin (EC) cell count. On the other hand, when nodular lesioned rats were subjected to vestibular stimulation, both PGE2 and 5-HT content of gastroduodenal tissue and EC cell count increased, suggesting nodular cerebellar influence on PGE2 and 5-HT content of gastroduodenal tissue.

Avaliaçäo da absorçäo do ferro proteinsuccinilato em diferentes condiçöes bioquímicas gástricas e duodenais / Evaluation of the absorption of iron-protein-succinylate in different gastric and duodenal biochemical conditions

O ferro proteinsuccinilato é um novo preparado de ferro adequado à administraçäo oral. Esta molécula näo libera íons de ferro no pH gástrico (o que melhora a tolerabilidade do produto), mas somente a nível duodenal. A absorçäo do ferro do ferro proteinsuccinilato foi relatada por outros autores que notaram um aumento dos níveis séricos de ferro após a administraçäo oral do composto. Com o mesmo método estudamos a absorçä do ferro do ferro proteinsuccinilato antes e após um período de tratamento de seis semanas com ranitidina, um antagonista dos receptores H2 da histamina (300mgh/dia), em indivíduos com úlcera duodenal. O tratamento con ranitidina näo modificou a absorçäo do ferro do ferro proteinsuccinilato

Characterization of the receptors responsible for the diphasic effect of bradykinin in rat duodenum

The response of the rat duodenum to bradykinin (BK) consists of relaxant and contractile components, which have been atributed to different receptor types. To characterize the receptor responsible for this diphasic response we studied the effects of BK analogues known to act on B1 or B2 receptors in other systems. DesArg**9-Leu**8-BK and Thi**5,**8DPhe**7-BK presented only relaxant and only contractile effects, respectively, whereas DArgOHyp883Thi**5,**8DPhe**7-BK was a potent antagonist of the relaxation (but not of the contraction) induced by BK. Our results show that the relaxant and contractile components of the rat duodenum's response to BK are due to B2 and B1 receptor subtypes, respectively

Valor del frotis de la mucosa duodenal por endoscopia en el diagnóstico de la giardiasis del adulto / Value of smear of duodenal mucosa by endoscopy in the diagnosis of giardiasis of adult

Se estudiaron 100 pacientes con síntomas digestivos altos remitidos al Servicio de Gastroenterología del Hospital General Docente "Agostino Neto" de Guantánamo. A todos los pacientes se les realizó intubación duodenal y toma de muestra para frotis mediante endoscopia del tracto digestivo superior por cuatro procedimientos diferentes. Se encontró parasitismo intestinal por Giardia lamblia en 39 pacientes. La sensibilidad encontrada con el empleo de los diferentes métodos fue: frotis biopsia de la segunda porción del duodeno 92,3 % frotis biopsia del bulbo duodenal 79,5 %, intubación duodenal 20,5 %, frotis directo del raspado con cepillo de mucosa duodenal 2,6 %, frotis teñido del raspado con cepillo de mucosa duodenal 6,0 %. Los hallazgos endoscópicos en estos pacientes sugieren una vinculación etiológica entre el parasitismo por Giardia lambia y la duodenitis crónica agudizada y aguda. Se destaca el valor de la fibroendoscopia en la aplicación de métodos para el diagnóstico de la giardiasis