Table of Contents  
Year : 2014  |  Volume : 7  |  Issue : 5  |  Page : 634  

Gastroscopic, Ankylostoma duodenale infestation and iron-deficiency anemia

Hainan Medical University, China; Faculty of Medicine, University of Nis, Serbia; Joseph Ayobabalola University, Nigeria

Date of Web Publication10-Sep-2014

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok - 10160, Thailand

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How to cite this article:
Wiwanitkit V. Gastroscopic, Ankylostoma duodenale infestation and iron-deficiency anemia. Med J DY Patil Univ 2014;7:634

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Wiwanitkit V. Gastroscopic, Ankylostoma duodenale infestation and iron-deficiency anemia. Med J DY Patil Univ [serial online] 2014 [cited 2022 Aug 11];7:634. Available from:

Ankylostoma duodenale infestation is a common nematode infestation and it can be seen around the world and is highly endemic in many tropical countries. [1] This worm infestation is considered a public health threat in certain parts of the world. The infestation can be responsible for chronic blood loss leading to anemia. [1] The iron deficiency anemia, which is the most common amongst anemias, can be caused by A. duodenale infestation. In general, the diagnosis of iron deficiency anemia is usually by hematological finding of microcytic anemia combined with low serum iron, ferritin levels. The stool examination for detection of hookworm ova can be a useful tool to investigate this cause of iron deficiency anemia, A. duodenale infestation. [2] The finding of parasite eggs in stool leads to the diagnosis of A. duodenale infestation.

Although the detection of stool parasite ova seems to be a simple medical laboratory investigation there are many concerns. First, different techniques of stool examinations can provide different yields. [3] In addition, false negative result is common. High rate of false negatives can be encountered in a patient despite examination of multiple samples. [4] Due to this, we might be missing many cases of A. duodenale infestation induced iron deficiency anemia. A report by Bamanikar et al. on using the gastroscopic diagnosis of A. duodenale infestation as a cause of iron-deficiency anemia is very interesting. [5] In fact, gastroscope can be helpful in diagnosis of intestinal parasite in some cases such as gastric strongyloidiasis. [6] However, the use of gastroscopic diagnosis of A. duodenale infestation is rarely mentioned. The main site of A. duodenale infestation is the small intestine which is difficult to assess by endocscopy. The gastric pathology due to A. duodenale infestation is seen as gastric erosion with active bleeding [7],[8] and the role of gastroscope can be useful in that case. [7],[9]

In conclusion when approaching a case of iron deficiency anemia, the investigation for possible A. duodenale infestation has to be done. This can start from simple stool examination. For the case with negative result, further investigation might be required if the patient presents clinical feature of chronic severe upper gastrointestinal bleeding. [9] Gastroscopy might be a diagnostic approach for that case. Nevertheless, in cases without clinical features of severe upper gastrointestinal bleeding, there is no indication for gastroscope. The trial treatment of iron deficiency anemia by simple iron supplementation accompanied with anti-hookworm drug administration is suggested for any patients in endemic area.

  References Top

1.Hotez PJ, Brooker S, Bethony JM, Bottazzi ME, Loukas A, Xiao S. Hookworm infection. N Engl J Med 2004;351:799-807.  Back to cited text no. 1
2.Stoltzfus RJ, Dreyfuss ML, Chwaya HM, Albonico M. Hookworm control as a strategy to prevent iron deficiency. Nutr Rev 1997;55:223-32.  Back to cited text no. 2
3.Uga S, Kimura D, Kimura K, Margono SS. Intestinal parasitic infections in Bekasi district, West Java, Indonesia and a comparison of the infection rates determined by different techniques for fecal examination. Southeast Asian J Trop Med Public Health 2002;33:462-7.  Back to cited text no. 3
4.Marti H, Koella JC. Multiple stool examinations for ova and parasites and rate of false-negative results. J Clin Microbiol 1993;31:3044-5.  Back to cited text no. 4
5.Bamanikar S, Bamanikar A, Sawlani V, Pandit D. Gastroscopic diagnosis of Ankylostoma duodenale infestation as a cause of iron-deficiency anemia. Med J Dr DY Patil Univ 2014;7:632-4.  Back to cited text no. 5
6.Shekhar KC, Krishnan R, Pathmanathan R, Fook CS. Gastric strongyloidiasis in a Malaysian patient. Southeast Asian J Trop Med Public Health 1997;28:158-60.  Back to cited text no. 6
7.Barakat M, Ibrahim N, Nasr A. In vivo endoscopic imaging of ancylostomiasis-induced gastrointestinal bleeding: Clinical and biological profiles. Am J Trop Med Hyg 2012;87:701-5.  Back to cited text no. 7
8.Thomas V, Jose T, Harish K, Kumar S. Hookworm infestation of antrum of stomach. Indian J Gastroenterol 2006;25:154.  Back to cited text no. 8
9.Rana SS, Bhasin DK, Sinha SK. Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointest Endosc 2008;68:1023.  Back to cited text no. 9


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