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Endoscopic examinations including capsule endoscopy did not reveal any obstructing lesion, but a delayed small bowel transit time of the capsule. Duodenal histology revealed Marsh 3a villous atrophy. Secondary causes of intestinal pseudo-obstruction and villous atrophy were investigated. <jats:italic>Giardia lamblia<\/jats:italic> trophozoites were found in the stools and in the duodenal biopsies. The patient\u2019s symptoms quickly resolved after metronidazole treatment with complete normalisation of duodenal histology.<\/jats:p>","DOI":"10.1136\/bcr-2022-252319","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T11:05:25Z","timestamp":1667387125000},"page":"e252319","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Intestinal pseudo-obstruction caused by <i>Giardia lamblia<\/i> infection"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8817-144X","authenticated-orcid":false,"given":"Tommaso","family":"Pessarelli","sequence":"first","affiliation":[{"name":"Universit\u00e0 degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Basilisco","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa","family":"Spina","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirella","family":"Fraquelli","sequence":"additional","affiliation":[{"name":"Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"2025082712243309000_15.11.e252319.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.50.1.37"},{"key":"2025082712243309000_15.11.e252319.2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i30.5634"},{"key":"2025082712243309000_15.11.e252319.3","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1097\/MCG.0000000000001047","article-title":"Pathophysiology, diagnosis, and management of chronic intestinal pseudo-obstruction","volume":"52","author":"Downes","year":"2018","journal-title":"J Clin Gastroenterol"},{"key":"2025082712243309000_15.11.e252319.4","doi-asserted-by":"crossref","first-page":"288","DOI":"10.2188\/jea.JE20120173","article-title":"Epidemiology and clinical experience of chronic intestinal pseudo-obstruction in Japan: a nationwide epidemiologic survey","volume":"23","author":"Iida","year":"2013","journal-title":"J Epidemiol"},{"key":"2025082712243309000_15.11.e252319.5","first-page":"39","volume-title":"Common problems in ambulatory pediatrics: specific clinical problems","volume":"Volume 2","author":"Leung","year":"2011"},{"key":"2025082712243309000_15.11.e252319.6","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809990744"},{"key":"2025082712243309000_15.11.e252319.7","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.cll.2015.02.010","article-title":"Infections by intestinal Coccidia and Giardia duodenalis","volume":"35","author":"Cama","year":"2015","journal-title":"Clin Lab Med"},{"key":"2025082712243309000_15.11.e252319.8","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.rvsc.2020.09.034","article-title":"Giardia duodenalis in humans and animals - Transmission and disease","volume":"135","author":"Dixon","year":"2021","journal-title":"Res Vet Sci"},{"key":"2025082712243309000_15.11.e252319.9","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00033-10"},{"key":"2025082712243309000_15.11.e252319.10","doi-asserted-by":"crossref","first-page":"S154","DOI":"10.1007\/s00436-003-0924-4","article-title":"Prevalence of Giardia spp. in dogs and humans in northern and central Italy","volume":"90 Suppl 3","author":"Capelli","year":"2003","journal-title":"Parasitol Res"},{"key":"2025082712243309000_15.11.e252319.11","doi-asserted-by":"crossref","unstructured":"Hill DR , Nash TE . 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