What is the treatment for anisakiasis?

Treatment of Anisakiasis

The definitive treatment for anisakiasis is endoscopic removal of the Anisakis larvae, which is both diagnostic and curative. This approach allows for direct visualization, extraction of the parasite, and immediate resolution of symptoms 1.

Diagnostic Approach

When anisakiasis is suspected (based on symptoms like abdominal pain, nausea, vomiting after consuming raw or undercooked fish, or visualization of a worm in vomit):

• Endoscopy: First-line diagnostic and therapeutic approach

  • Allows direct visualization of larvae attached to gastric mucosa
  • Enables immediate removal using biopsy forceps
  • Provides definitive diagnosis and treatment in one procedure 1, 2

• Serological testing: May be helpful in chronic cases or when larvae cannot be visualized

  • Detection of specific IgE to Anisakis simplex
  • Particularly useful for allergic manifestations 3

Treatment Algorithm

Acute Gastric Anisakiasis

1. Urgent endoscopy with removal of larvae

   • Complete removal of the parasite is curative
   • Most patients recover promptly after removal 2

2. Supportive care

   • Manage symptoms (pain, nausea, vomiting)
   • Hydration if needed

Intestinal Anisakiasis

1. Conservative management for uncomplicated cases

   • Larvae typically die within 2 weeks
   • Symptomatic treatment for pain and discomfort

2. Surgical intervention if complications develop

   • Required for cases with intestinal obstruction, perforation, or peritonitis
   • Necessary when larvae migrate to organs like liver, pancreas, or omentum 2

Allergic Manifestations

1. Standard anti-allergy treatment for allergic reactions

   • Antihistamines
   • Corticosteroids if severe
   • Epinephrine for anaphylaxis 3

2. Patient education about avoiding future exposure

   • Strict avoidance of raw or undercooked marine fish and squid

Special Considerations

• Albendazole may be considered as an adjunctive therapy in cases where endoscopic removal is not possible, though evidence for its efficacy is limited 4

• Pregnant patients: Endoscopic removal is preferred; pharmacological treatments should be avoided if possible

• Immunocompromised patients: May require more aggressive management due to risk of complications

Prevention

Prevention is critical and should be emphasized to all patients:

• Thermal treatment of fish before consumption:

  • Cooking to >60°C for at least 1 minute, OR
  • Freezing to -20°C for at least 24 hours 1, 5

• Avoid consumption of raw or undercooked marine fish or squid

• Public education about risks associated with raw fish consumption 6

Follow-up

• Clinical follow-up in 2-4 weeks to ensure resolution of symptoms
• Repeat endoscopy only if symptoms persist
• Advise patients to permanently avoid raw or undercooked fish

Common Pitfalls

• Misdiagnosis as appendicitis, peptic ulcer, or other abdominal conditions
• Delayed diagnosis leading to complications
• Incomplete removal of larvae during endoscopy
• Failure to educate patients about prevention of future infections

Anisakiasis is an emerging disease worldwide, with increasing incidence related to the growing popularity of raw fish dishes. Prompt recognition, endoscopic intervention, and patient education are essential components of effective management.