Colonic Trichuris trichiura infection presenting as iron deficiency anemia in adult population, in an endemic area, Kashmir (India).

Background: Trichuris trichiura infection causing abdominal symptoms with iron deficiency anemia is common in children but presentation as occult blood loss with iron deficiency anemia in adults is infrequent. Aim: To define the role of colonic Trichuris trichiura in causing iron deficiency anemia in adult population. Methods: A total of 160 consecutive adult patients of undefined iron deficiency anemia underwent upper and lower gastrointestinal endoscopy. Those having colonic trichuriasis were treated with mebendazole 100 mg BD for 5 days and followed for 24 weeks for improvement in hemoglobin.64 multislice CT enterography, jejunal biopsy and anti endomysial antibody estimation were done to rule out small bowel and celiac disease in these patients. Results: Upper and lower gastrointestinal endoscopy revealed positive findings in 87/160 (54.3%).Thirty two patients had colonic trichuriasis, mean (SD) age 49± 13.5 years. None of these patients had any abdominal symptoms. Trichuris trichiura involved caecum in 8(25%), caecum and ascending colon in 23(71.8%), caecum, ascending colon and transverse colon in 1 patient (3.1%).Colonoscopy revealed hemorrhages at the site of attachment of worm with erythema, edema, and erosions. Nineteen (52.8%) patients had positive fecal occult blood. Colonic biopsy revealed eosinophilic infiltration in 10/32(31.2%) patients. Repeat colonoscopy at 4 weeks revealed eradication of infection and resolution of colitis. The mean (SD) hemoglobin level at baseline, 6, 12, 18 and 24 weeks was [9.1± 0.6], [11.1±1.6 P=0.02], [11.6±1.5 P= 0.001], [11.7± 1.5 P=0.02], [12.4± 1.7 P= 0.02] gm/dl respectively. Conclusions: Colonic trichuriasis manifests as iron deficiency anemia in adults in endemic zone.