Dig Deeper – Gastrointestinal Complications of Lyme disease

Simultaneous Gastrointestinal Infections in Children and Adolescents

Abstract:

Simultaneous infections were detected in the gastrointestinal tract of children and adolescents presenting with gastritis, duodenitis and/or colitis. Eighty-one consecutive patients presented with gastrointestinal complaints including abdominal pain (52/81), blood in the stool (16/81), gastroesophageal reflux (4/81), Celiac disease (3/81), Crohn’s disease (3/81), duodenal ulcer, (2/81) and failure to thrive (1/81). Endoscopy  confirmed the diagnoses of celiac disease and Crohn’s disease, and assessed the gastrointestinal mucosa for inflammation. Biopsies were analyzed for Borrelia burgdorferi, Bartonella spp, Mycoplasma fermentans, and Helicobacter pylori. Pathogens were either absent (n = 26, 33%) or were detected as single (n = 30, 37%), double (n = 19, 24%), or triple infections (n = 6, 8%) associated with gastritis and duodenitis or colitis at the site of the biopsy.

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Bells Palsy of the Gut

Abstract:

Bell’s palsy signifies paralysis of facial muscles related to inflammation of the associated seventh Cranial Nerve. Physicians may not realize that this syndrome is caused by the spirochetal agent of Lyme disease until proven otherwise. Whether it is a full or hemifacial paralysis, Bell’s palsy is cosmetically disfiguring when fully expressed. Sudden loss of normal facial expression terrifies patients who naturally fear they are having a stroke. When a smile is asked for, normal countenances warp into bizarre grimaces. The amount of tooth area exposed in this attempt to smile helps doctors evaluate the degree of paralysis and its change over time (Figure 1). In every case of Bell’s, doctors need to carefully investigate by history, physical, and laboratory work every shred of evidence that might suggest the presence of cryptic tertiary Lyme, a serious multisystem, gut and neuro-brain infection even though about half of fully diagnosed patients have no evidence whatsoever of having had a tick-bite.

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Persistence of Borrelia burgdorferi in GI tract

Abstract:

This study documents the persistence of B burgdorferi DNA in the gastrointestinal tract of pediatric patients who have already been treated with antibiotics for Lyme disease. Ten consecutive patients between the ages of 9 and 13 years presented with an erythema migrans (EM) rash, a positive western blot for Lyme disease, chronic abdominal pain, heartburn, or bright red blood in the stool. Endoscopy assessed the gastrointestinal (GI) mucosa for inflammation and biopsies were examined for B burgorferi using a Dieterle stain and with polymerase chain reaction (PCR) to the outer surface protein A (Osp A) of B burgdorferi. As controls, 10 consecutive patients with chronic abdominal pain were also tested by GI biopsies and PCR. B burgdorferi persisted in the GI tract in all 10 patients with Lyme disease as shown by the Dieterle stain of biopsies and with PCR. None of the control subjects’ biopsies were PCR positive for B burgdorferi. Chronic gastritis, chronic duodenitis, and chronic colitis were found in Lyme disease patients and associated with the detection of B burgdorferi in the GI tract despite prior antibiotic treatments. We have concluded that the DNA of B burgdorferi persisted in patients with Lyme disease even after antibiotic treatment.

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GI symptoms and Lyme disease

Abstract:

A clinical diagnosis of Lyme disease was made in 15 consecutive patients between the ages of 8 and 20 years who presented with a history of an erythema migrans rash followed by chronic gastrointestinal symptoms and multiple organ system complaints. Endoscopic evaluation was performed to assess the gastrointestinal mucosa and to obtain biopsies for the polymerase chain reaction (PCR) to the outer surface protein A (Osp A) of Borrelia burgdorferi. As age matched controls, 10 patients with biopsy-proven Crohn’s disease were also tested by PCR. The laboratories assessing the histopathology and performing the PCR were blinded to the diagnosis of all specimens.

The presence of B burgdorferi DNA in the gastrointestinal tract was confirmed by PCR in all of the patients with the clinical diagnosis of Lyme disease who had chronic gastrointestinal symptoms and in two control subjects with Crohn’s disease. Biopsy evidence of chronic gastritis, chronic duodenitis, and chronic colitis was found in patients with Lyme disease who had chronic gastrointestinal symptoms and was associated with the presence of B burgdorferi.

The chronic gastrointestinal symptoms that occured within 6 months of an erythema migrans rash and Lyme disease may be attributed to a direct effect or immune mediated response to B burgdorferi.

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GI pathology with Lyme disease

Abstract:

Ten children between the ages of 8 and 19 with Lyme disease presented with chronic gastrointestinal symptoms. Biopsy evidence of inflammation was found in the stomach, duodenum and colon. Pathologies included gastritis, duodenitis, gastric ulcer, colitis and a histopathology resembling Crohn’s disease. Spirochetes with the microscopic appearance of Borrelia were found in five patients with the chronic inflammatory conditions of the gastrointestinal tract. The inflammation may have been due to the spirochete itself, a reactive product related to their presence in the gastrointestinal tract, or a consequence of medications used to treat Lyme disease.

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CN MUP-Savely case study

Abstract:

“Sonia,” 37, came to me desperate for help. She looked thin and pale and was hunched over in obvious pain when I first met her. She had already been to several doctors, a gastroenterologist among them, and had submitted herself to numerous tests to find out what was causing her extreme abdominal distress. No answer had yet been provided, and she was at the end of her rope. My first thought was, Why does she think an NP will be able to figure out something that none of the specialists have?

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