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Georgian Medical News Mar 2022Recurrent abdominal pain (RAP) and dyspepsia are common complaints in children. These symptoms are often associated with Helicobacter pylori (Hp) infection. The aim of...
Recurrent abdominal pain (RAP) and dyspepsia are common complaints in children. These symptoms are often associated with Helicobacter pylori (Hp) infection. The aim of the present study was to prospectively analyze clinical, endoscopic, and histological characteristics of Hp+ and Hp- children with RAP and/or dyspepsia. Patients aged 2-18 years with RAP and/or dyspepsia, referred for an upper endoscopy to Arabkir Medical Center - Institute of Child and Adolescent Health (Arabkir MC-ICAH) from November 2015 to December 2017, were involved in the study. Histology was assessed according to the updated Sydney system. Gastric and duodenal specimens were stained by modified Giemsa staining for Hp infection. One antral biopsy was cultured in Hp selective media. 150 patients were included into the study: 70.7% Hp+, 29.3% Hp-. Nausea and vomiting were significantly more common in Hp+ patients (p<0.05). Gastric nodularity (p=0.02), erosions in the stomach (p=0.056), and duodenal erosions (p=0.019) were more common in Hp+. Chronic active (p=0.027) and non-active gastritis (p=0.002), cumulative findings of metaplasia/dysplasia/atrophy in the stomach (p=0.014) and chronic non-active duodenitis (p=0.016), were significantly more common in Hp+ patients. Hp infection prevalence is high in Armenian children with dyspepsia and/or RAP. Clinical symptoms, endoscopic findings, and histopathological findings were significantly different in Hp+ patients as compared to Hp- patients.
Topics: Abdominal Pain; Adolescent; Armenia; Child; Duodenitis; Dyspepsia; Gastric Mucosa; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans
PubMed: 35417865
DOI: No ID Found -
Experimental Parasitology Aug 2022Visceral leishmaniasis is a neglected tropical disease caused by parasites belonging to the Leishmania genus that infect macrophages in different tissues such as the...
Visceral leishmaniasis is a neglected tropical disease caused by parasites belonging to the Leishmania genus that infect macrophages in different tissues such as the spleen, liver, lymph nodes, bone marrow, and intestine. Therefore, this study aimed to investigate the integrity of the intestinal tract and the nitrergic (NADPH-dp) and metabolically active (NADH-dp) myenteric neurons of the duodenum of golden hamsters infected with L. (L.) infantum. Therefore, thirty golden hamsters were divided into six groups (n = 5); three of them were infected with 2 × 10 promastigote forms of L. (L.) infantum by intraperitoneal route (Infected Group - IG) and three were inoculated with saline solution (control group - CG). After 30, 60 and 90 days post-infection (DPI) infected animals were euthanized and the liver, spleen and duodenum were collected to analyze tissue parasitism. The duodenum was processed using usual histological techniques to analyze the main changes that occurred during infection and histochemical techniques to phenotype myenteric neurons. Amastigote forms were observed in the spleen, liver, and duodenum during all experimental periods, and tissue parasitism in these organs increased significantly over time. At 30 DPI, reduction in muscle tunic, increase in the total intestinal wall and the number of goblet cells PAS+ was observed. At 60 DPI, an increase in intestinal crypts and intraepithelial lymphocytes was observed, and a reduction in intestinal villi was observed at 90 DPI, along with an increase in crypt size. Regarding neurons, an increase in the density of the NADPH-dp population was observed at 30 DPI, but at 60 and 90 DPI a significant reduction of this population was observed. In general, infection progression was observed to cause significant morphofunctional changes in the duodenum of infected hamsters.
Topics: Animals; Cricetinae; Duodenum; Leishmania infantum; Leishmaniasis, Visceral; Mesocricetus; NADP; Neurons
PubMed: 35780863
DOI: 10.1016/j.exppara.2022.108315 -
Hepato-gastroenterology May 2015Duodenal injuries do not often occur and are usually difficult to be diagnosed or treated.
BACKGROUND/AIMS
Duodenal injuries do not often occur and are usually difficult to be diagnosed or treated.
METHODOLOGY
To summarize the experience in managing duodenal injuries and determine some prognostic factors, we conducted a retrospective review on 42 cases of duodenal injuries including 17 traumatic (blunt 31.0%, penetrating 9.5%) and 25 iatrogenic (59.5%) ones, which were admitted to our hospital from 1993 to 2013.
RESULTS
The mortality rate was 23.8% (n = 10). Main cause of late death was multiple system organ failure and infection. Senility and high APACHE II score were both correlated with mortality rate (P < 0.01 and P < 0.05 respectively). High morbidity and mortality rate were more likely to be associated with those had long delays in treatment or injury in the second part of the duodenum (P < 0.05). The number of associated injuries affected mortality rate (P < 0.05). For traumatic injuries, the mechanism of injury, method of initial surgical management, Organ Injury Scale and Abbreviated Injury Scale were not related to patients' outcome (P > 0.05).
CONCLUSIONS
These findings indicated that early diagnosis and timely treatment were of great clinical value. Primary repair with an effective diversion was practicable. Age and APACHE II Score were the independent prognostic factors.
Topics: APACHE; Abdominal Injuries; Age Factors; Aged; China; Duodenum; Early Diagnosis; Female; Hospitals, University; Humans; Iatrogenic Disease; Male; Middle Aged; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Time Factors; Time-to-Treatment; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 26897945
DOI: No ID Found -
Cell Reports Sep 2021Gut microbial diversity decreases with aging, but existing studies have used stool samples, which do not represent the entire gut. We analyzed the duodenal microbiome in...
Gut microbial diversity decreases with aging, but existing studies have used stool samples, which do not represent the entire gut. We analyzed the duodenal microbiome in 251 subjects aged 18-35 (n = 32), 36-50 (n = 41), 51-65 (n = 96), and 66-80 (n = 82). Decreased duodenal microbial diversity in older subjects is associated with combinations of chronological age, number of concomitant diseases, and number of medications used, and also correlated with increasing coliform numbers (p < 0.0001). Relative abundance (RA) of phylum Proteobacteria increases in older subjects, with increased RA of family Enterobacteriaceae and coliform genera Escherichia and Klebsiella, and is associated with alterations in the RA of other duodenal microbial taxa and decreased microbial diversity. Increased RA of specific genera are associated with chronological age only (Escherichia, Lactobacillus, and Enterococcus), number of medications only (Klebsiella), or number of concomitant diseases only (Clostridium and Bilophila). These findings indicate the small intestinal microbiome changes significantly with age and the aging process.
Topics: Aging; Duodenum; Feces; Gastrointestinal Microbiome; Humans; Intestine, Small; Lactobacillus; Proteobacteria
PubMed: 34592155
DOI: 10.1016/j.celrep.2021.109765 -
Frontiers in Cellular and Infection... 2021Interactions between the gut microbiota and enteroendocrine cells play important role in irritable bowel syndrome (IBS). Reduced stem cell densities and their...
The Effects of Fecal Microbiota Transplantation on the Symptoms and the Duodenal Neurogenin 3, Musashi 1, and Enteroendocrine Cells in Patients With Diarrhea-Predominant Irritable Bowel Syndrome.
INTRODUCTION
Interactions between the gut microbiota and enteroendocrine cells play important role in irritable bowel syndrome (IBS). Reduced stem cell densities and their differentiation into enteroendocrine cells may cause abnormal densities of the duodenal enteroendocrine cells in IBS patients.
MATERIALS AND METHODS
We aimed to investigate the effects of fecal microbiota transplantation (FMT) on stem cell differentiation into enteroendocrine cells as detected by neurogenin 3, stem cells as detected by Musashi 1, and the enteroendocrine cells in the duodenum of IBS patients. The study included 16 IBS patients according to Rome III criteria. Four patients were excluded. The remaining patients (n = 12, four females and eight males) were divided according to the cause of IBS into post-infectious ( = 6) and idiopathic ( = 6) IBS. They completed the following questionnaires before and 3 weeks after FMT: IBS-Symptom Severity Scoring system (IBS-SSS) and IBS-Symptom Questionnaire (IBS-SQ). Feces donated by healthy relatives of the patients were transplanted gastroscope. Biopsies were taken from the descending part of the duodenum at baseline and 3 weeks after FMT. They were immunostained for neurogenin 3, Musashi 1, and all types of duodenal enteroendocrine cells and quantified by computerized image analysis. Microbiota analyses of feces collected just before and 3 weeks after FMT were performed using GA-map™ Dysbiosis test (Genetic Analysis AS, Oslo, Norway).
RESULTS
The total scores for IBS-SSS and IBS-SQ were significantly improved 3 weeks after receiving FMT, = 0.0009 and <0.0001, respectively. The stem cell densities of neurogenin 3 increased significantly following FMT ( = 0.0006) but not for Musashi 1 ( = 0.42). The cell densities of chromogranin A, cholecystokinin, gastric inhibitory peptide, serotonin, and somatostatin, but not for secretin, have significantly changed in both IBS groups after 3 weeks from receiving FMT.
CONCLUSION
More than two-thirds of IBS patients experienced improvement in their symptoms parallel to changes in the enteroendocrine cells densities 3 weeks after FMT. The changes in the enteroendocrine cell densities do not appear to be caused by changes in the stem cells or their early progenitors rather by changes in the differentiation progeny as detected by neurogenin 3. The study was retrospectively registered at ClinicalTrials.gov (ID: NCT03333291).
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, identifier NCT03333291.
Topics: Diarrhea; Duodenum; Enteroendocrine Cells; Fecal Microbiota Transplantation; Feces; Female; Humans; Irritable Bowel Syndrome; Male; Norway
PubMed: 34055657
DOI: 10.3389/fcimb.2021.524851 -
Gut Nov 2014
Topics: Adult; Antiprotozoal Agents; Celiac Disease; Colon; Duodenum; Giardiasis; Humans; Ileum; Male; Metronidazole
PubMed: 25107558
DOI: 10.1136/gutjnl-2014-307924 -
BMJ Case Reports Nov 2022A woman in her 40s presented with malaise, nausea, reduced appetite, abdominal distention, loose stools and weight loss. Symptoms had started 6 months earlier and...
A woman in her 40s presented with malaise, nausea, reduced appetite, abdominal distention, loose stools and weight loss. Symptoms had started 6 months earlier and worsened in the last 2 weeks. CT enterography showed hypotonic dilated small bowel loops in absence of any mechanical obstruction. 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. trophozoites were found in the stools and in the duodenal biopsies. The patient's symptoms quickly resolved after metronidazole treatment with complete normalisation of duodenal histology.
Topics: Female; Humans; Giardiasis; Giardia lamblia; Duodenum; Intestinal Pseudo-Obstruction; Atrophy
PubMed: 36323453
DOI: 10.1136/bcr-2022-252319 -
Digestive Diseases (Basel, Switzerland) 2023The aim of this study was to investigate outcomes of patients with duodenal Brunner's gland adenomas (BGAs) that were treated endoscopically.
INTRODUCTION
The aim of this study was to investigate outcomes of patients with duodenal Brunner's gland adenomas (BGAs) that were treated endoscopically.
METHODS
We identified 71 consecutive patients treated at our center with endoscopic submucosal dissection (ESD) for their duodenal tumors diagnosed pathologically as BGAs over the period between January 1, 2011 and December 31, 2021. We retrospectively analyzed our experience and short- and long-term outcomes of ESD therapy on patients with BGAs.
RESULTS
Among 71 BGA patients with an average age of 57 ± 11.7 years (range: 30-82), 48 (67.6%) were male and 23 (32.4%) were female. The accuracy of preoperative diagnosis with endoscopic ultrasonography was 44.0% (22/50). The H. pylori infection was found in 29 patients (29/71, 40.8%). The median size of BGAs was 1.5 cm (interquartile range [IQR] 0.8-2.7 cm). The most common location was the duodenum bulb (50/71, 64.8%). For the ESD procedure, the median operation time was 15.0 min (IQR 9.5-25.5 min). The en bloc and the complete resection rates were 97.2% and 92.3%, respectively. ESD-related mild acute obstructive pancreatitis was present in 2 patients (2/4, 50%) with BGAs located in the ampulla region. During the follow-up period, 1 patient with a positive peripheral margin experienced tumor recurrence 2 years after the initial ESD. There was no disease-related death for the cohort.
CONCLUSION
ESD was an effective and safe therapeutic option for BGA patients with excellent outcomes. Long-term follow-up is needed.
Topics: Humans; Male; Female; Middle Aged; Aged; Duodenal Neoplasms; Endoscopic Mucosal Resection; Brunner Glands; Retrospective Studies; Neoplasm Recurrence, Local; Duodenum; Treatment Outcome; Adenoma; Pancreatitis
PubMed: 37591214
DOI: 10.1159/000531231 -
Journal of the College of Physicians... Apr 2022We share our experience of a two-way vacuum-assisted closure (VAC) technique that allows patients to heal when generalised peritonitis develops because of a recurrent...
We share our experience of a two-way vacuum-assisted closure (VAC) technique that allows patients to heal when generalised peritonitis develops because of a recurrent duodenal leak. Two patients underwent omentoplasty for duodenal ulcer perforation and one patient underwent antrectomy, gastrojejunostomy, and tube duodenostomy. Two-way VAC was performed by taking an abdominal fluid culture and washing the abdomen with 6-12 litres of warm saline. Two-way VAC exchange pro-cedures were continued every 3 days and total parenteral nutrition was administered until cessation of the duodenal re-leak. The two-way VAC application was terminated when improvement in the re-leak was macroscopically detected. The subcutaneous layer was dissected from the anterior abdominal wall fascial layer, and the abdominal skin was closed without tension. The patients were subsequently discharged. Controlling the primary source is often difficult when treating duodenal re-leaks, and two-way VAC can localise the source of the peritonitis and remove toxic peritoneal material. Key Words: Open abdomen, Vacuum-assisted closure, Severe peritonitis, Duodenal leak.
Topics: Abdominal Wall; Duodenal Ulcer; Duodenum; Humans; Negative-Pressure Wound Therapy; Peritonitis
PubMed: 35632999
DOI: 10.29271/jcpsp.2022.Supp1.S15 -
Obesity Surgery Aug 2023Classical gastrointestinal anastomoses are formed with sutures and/or metal staples, resulting in significant bleeding and leak rates. This study evaluated the... (Clinical Trial)
Clinical Trial
PURPOSES
Classical gastrointestinal anastomoses are formed with sutures and/or metal staples, resulting in significant bleeding and leak rates. This study evaluated the feasibility and safety of the novel magnet anastomosis system (MS) to create a side-to-side duodeno-ileal (DI) diversion for weight loss and type 2 diabetes (T2D) resolution.
MATERIALS AND METHODS
Patients with severe obesity (body mass index (BMI) ≥ 35 kg/m with/without T2D (HbA1 ≥ 6.5%)) underwent the study procedure, a side-to-side MS DI diversion, with a standard sleeve gastrectomy (SG). A linear magnet was delivered by flexible endoscopy to a point 250 cm proximal to the ileocecal valve; a second magnet was positioned in the first part of the duodenum; the bowel segments containing magnets were apposed, initiating gradual anastomosis formation. Laparoscopic assistance was used to obtain bowel measurements, obviate tissue interposition, and close mesenteric defects.
RESULTS
Between November 22 and 26, 2021, 5 female patients (mean weight 117.6 ± 7.1 kg, BMI (kg/m) 44.4 ± 2.2) underwent side-to-side MS DI + SG. All magnets were successfully placed, expelled without re-intervention, and formed patent durable anastomoses. Total weight loss at 12 months was 34.0 ± 1.4% (SEM); excess weight loss, 80.2 ± 6.6%; and BMI reduction, 15.1. Mean HbA1 (%) dropped from 6.8 ± 0.8 to 4.8 ± 0.2; and glucose (mg/dL), from 134.3 ± 17.9 to 87.3 ± 6.3 (mean reduction, 47.0 mg/dL). There was no anastomotic bleeding, leakage, obstruction, or infection and no mortality.
CONCLUSIONS
Creation of a side-to-side magnetic compression anastomosis to achieve duodeno-ileostomy diversion in adults with severe obesity was feasible and safe, achieved excellent weight loss, and resolved type 2 diabetes at 1-year follow-up.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT05322122.
Topics: Adult; Female; Humans; Anastomosis, Surgical; Diabetes Mellitus, Type 2; Duodenum; Gastrectomy; Gastric Bypass; Glycated Hemoglobin; Magnetic Phenomena; Magnets; Obesity; Obesity, Morbid; Retrospective Studies; Weight Loss
PubMed: 37393568
DOI: 10.1007/s11695-023-06708-x