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Page 4 of 5 Palma et al. Mini-invasive Surg 2018;2:1 I http://dx.doi.org/10.20517/2574-1225.2017.40

DISCUSSION
The gastric anisakiasis affects humans following consumption of raw or undercooked seafood. A detailed
food history is the key to the diagnosis because the patients develop the typical symptoms shortly after
ingestion of contaminated food. The clinical history can guide the diagnosis alerting the endoscopists
to look for a nematode during an upper endoscopy. In absence of a detailed anamnesis, the correlation
between the occurrence of gastrointestinal symptoms and raw fish ingestion could be very difficult. Gastric
anisakiasis can be suspected based on the typical presentation, which is an acute severe epigastric pain
[5]
few hours after the ingestion of infected fish. The symptoms usually develop within 12 h . Other clinical
manifestations include nausea, vomiting, and low grade fever. There are cases in which the patients present
with hematemesis from gastric ulceration [12-14] . In addition to these impressive clinical presentations, there
are some asymptomatic cases identified accidentally. The diagnosis could represent a challenging problem
if a correct sampling and conservation strategy were not adopted. Furthermore, as previously mentioned,
the gastric detection of nematode is not easily made because it could be confused with gastric mucus. Due
to the rare occurrence of this disease, inexperienced endoscopists may easily overlook larvae, because they
[15]
are usually hidden between the edematous gastric folds or blend in with the gastric mucosa . Thus, the true
incidence of the disease could be potentially higher than what is reported in the literature as cases can go
undiagnosed.

When the clinical presentation doesn’t suggest the Anisakis infection or lacks of a detailed food anamnesis
only an experienced endoscopist performing an accurate EGD can detect the nematode.

In the case we have reported, the diagnosis was casual and the parasite was detected during an accurate
EGD performed for a one-year history of epigastralgia in an obese patient, during a routine endoscopy
before surgery, in absence of gastrointestinal acute suggestive symptoms and detailed food history. This
report emphasizes the importance of investigating into raw fish ingestion before diagnostic upper endoscopy,
especially in patients with signs and symptoms compatible with Anisakis sp. infection. However, the accurate
and specific diagnosis of the etiological agents in human anisakiasis, should be performed by molecular
methodologies, which was impossible to carry out in the present study. Indeed, currently, specific and rapid
DNA assay tests such as the reverse transcription-polymerase chain reaction primers-probe systems are
available to be performed on fragments of larval nematodes and bioptic tissues removed by endoscopy, but
also on paraffine embedded parasites. Further, the immunoblotting assay of the patient serum, joined with
anamnestic investigation of the patient and use of the molecular methodologies, has been recommended in
the diagnosis of human anisakiasis.

DECLARATIONS
Authors’ contributions
Manuscript preparation and data acquisition: Palma R
Data analysis and parasitological classification: Mattiucci S
Literature search: Panetta C
Data acquisition: Raniolo M
Anatomopathological classification: Magliocca FM
Study design and definition of intellectual content: Pontone S

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.