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September 1973

Chronic and Recurrent Diarrhea in American Servicemen in Vietnam: An Evaluation of Etiology and Small Bowel Structure and Function

Author Affiliations

Danang, South Vietnam

From the Department of Medicine, Naval Support Activity Station Hospital, and the US Naval Medical Research Unit No. 2, Danang Detachment, Danang, Republic of South Vietnam. Dr. Butler is now with Johns Hopkins Hospital, Baltimore; Dr. Middleton is now with the Medical College of Virginia, Richmond; Dr. Earnest is now with the San Francisco Medical Center; and Dr. Strickland is now with the London School of Hygiene and Tropical Medicine, London, England.

Arch Intern Med. 1973;132(3):373-377. doi:10.1001/archinte.1973.03650090055010

Seventy American servicemen in Vietnam had diarrhea of at least two weeks' duration with no evidence of infection with Entamoeba histolytica or Shigella species. The majority had malabsorption as shown by D-xylose absorption, fecal fat excretion, and results of Schilling tests. Jejunal biopsy revealed jejunitis in ten patients; their D-xylose absorption and vitamin B12 excretion levels were significantly lower than those of patients without jejunitis. Fourteen patients had bacterial contamination of the jejunum, and 11 patients harbored the intestinal helminths hookworm or Strongyloides stercoralis; Giardia lamblia was present in 25 patients who had more severe jejunitis and malabsorption than patients without G lamblia. The frequent occurrence of intestinal parasites and the favorable responses in 91% of patients to regimens that included appropriate antiparasitic drugs suggests that intestinal parasitosis, especially giardiasis, was a common cause of diarrhea in these patients.

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