Gastrointestinal Endoscopy
Volume 61, Issue 7 , Page 931, June 2005

Serologic test for the diagnosis of subclinical gastric anisakiasis

Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan

Article Outline

 

To the Editor:

We read with interest the article by Shiomi et al1 on a case of gastric anisakiasis in which the patient had an irregularly shaped ulcer that resembled early gastric cancer. They made the definitive diagnosis because of the detection of an Anisakis larva fragment in a biopsy specimen from the ulcer. However, only one of the 5 specimens incidentally contained a cross section of the larva in the muscle layer; a biopsy specimen of the muscle layer usually is difficult to obtain. Infiltration of eosinophils around the organism was absent, because the inflammation associated with the larva had subsided with time and had disappeared. Therefore, Anisakis larvae have rarely been confirmed in such condition.2, 3 Although they recommended that anisakiasis should be considered in a case of a gastric ulcerative lesion, suggesting gastric cancer without histopathologic findings of malignancy, they did not describe any further workup for the diagnosis.

A serologic test for the diagnosis of anisakiasis (sensitivity 70.4%, specificity 87.1%)4 has became commercially available.4, 5, 6, 7, 8 Enzyme-linked immunosorbent assay kits (Tomakomai Clinical Laboratory Center, Hokkaido, Japan) are used for the test of anti-Anisakis antibody (immunoglobulin [Ig] G and IgA).4 There were several reports of serologic detection of increased anti-Anisakis antibody in patients with gastric vanishing tumors.2, 3 Although gastric vanishing tumors are easily diagnosed by endoscopy, Anisakis larvae have rarely been observed. In such cases, a diagnosis of gastric anisakiasis was established on the basis of serologic findings.2 We, therefore, believe that the serologic test for Anisakis larvae should be considered in cases of gastric ulcerative lesions that resemble gastric cancers and is the key to the diagnosis of subclinical gastric anisakiasis.

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References 

  1. Shiomi M, Kamisako T, Yutani I, Yoshimoto R, Kudo M, Fujii R. Anisakis in a biopsy specimen from the edge of a gastric ulcer: report of a case. Gastrointest Endosc. 2004;60:854–856
  2. Fujisawa K, Matsumoto T, Yoshimura R, Ayabe S, Tominaga M. Endoscopic finding of a large vanishing tumor. Endoscopy. 2001;33:820
  3. Takeuchi K, Hanai H, Iida T, Suzuki S, Isobe S. A bleeding gastric ulcer on a vanishing tumor caused by anisakiasis. Gastrointest Endosc. 2000;52:549–551
  4. Okazaki M, Goto I, Kurokawa I. Studies on the detection of anti-Anisakis larvae antibodies by ELISA kits. [in Japanese] Medicine and Pharmacology. 1992;27:971–977
  5. Matsushita M, Okazaki K, Hajiro K, Takakuwa H. Lack of an association of anisakiasis and inflammatory fibroid polyps. Gastrointest Endosc. 1997;46:92–94
  6. Yagihashi A, Sato N, Takahashi S, Ishikura H, Kikuchi K. A serodiagnostic assay by microenzyme-linked immunosorbent assay for human anisakiasis using a monoclonal antibody specific for Anisakis larvae antigen. J Infect Dis. 1990;161:995–998
  7. Desowitz RS, Raybourne RB, Ishikura H, Kliks MM. The radioallergosorbent test (RAST) for the serologic diagnosis of human anisakiasis. Trans R Soc Trop Med Hyg. 1985;79:256–259
  8. Sakanari JA, Loinaz HM, Deardoff TL, Raybourne RB, McKerrow JH, Frierson JG. Intestinal anisakiasis: a case diagnosed by morphologic and immunologic methods. Am J Clin Pathol. 1988;90:107–113

PII: S0016-5107(05)00505-5

Refers to article:

  • Anisakis in a biopsy specimen from the edge of a gastric ulcer: report of a case

    Mikio Shiomi, Toshinori Kamisako, Itsuro Yutani, Rie Yoshimoto, Masatoshi Kudo, Ryouichi Fujii
    Gastrointestinal Endoscopy November 2004 (Vol. 60, Issue 5, Pages 854-856)

Gastrointestinal Endoscopy
Volume 61, Issue 7 , Page 931, June 2005

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