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The Canadian Veterinary Journal = La... May 2018Duodenitis-proximal jejunitis (DPJ) is an inflammatory process of the proximal part of the small intestine and occurs sporadically in horses. It is clinically... (Review)
Review
Duodenitis-proximal jejunitis (DPJ) is an inflammatory process of the proximal part of the small intestine and occurs sporadically in horses. It is clinically characterized by an acute onset of ileus and nasogastric reflux leading to systemic signs of toxemia. This review discusses the definition of the disease, potential etiologic agents, clinical findings, epidemiological features, histopathologic and clinico-pathological findings, and medical management of this condition. spp., mycotoxins, and have all been associated with the disease but there is limited supporting evidence for any agent other than Particular attention, however, was given to etiological investigations and the data available to support the proposed etiological agents. The potential role of as the etiological agent of DPJ, possible pathogenesis, and recent efforts to support this hypothesis are highlighted, but it is recognized that there could be more than one agent that causes the disease.
Topics: Animals; Bacteria; Bacterial Infections; Duodenitis; Horse Diseases; Horses; Jejunal Diseases
PubMed: 29904204
DOI: No ID Found -
Surgical Pathology Clinics Sep 2020Although the features of lower gastrointestinal tract inflammation associated with ulcerative colitis and Crohn disease are generally familiar to pathologists, there is... (Review)
Review
Although the features of lower gastrointestinal tract inflammation associated with ulcerative colitis and Crohn disease are generally familiar to pathologists, there is less awareness of and familiarity with the manifestations of inflammatory bowel disease in the esophagus, stomach, and duodenum. Nonetheless, their diagnosis has therapeutic and possibly prognostic implications, potentially foretelling severe complications. The recognition that ulcerative colitis can affect gastrointestinal organs proximal to the large intestine and terminal ileum represents a revision of concepts ingrained among generations of physicians. This article reviews the pathologic features and clinical significance of esophagitis, gastritis, and duodenitis associated with inflammatory bowel disease.
Topics: Colitis, Ulcerative; Crohn Disease; Duodenitis; Esophagitis; Gastritis; Humans; Inflammatory Bowel Diseases
PubMed: 32773192
DOI: 10.1016/j.path.2020.05.003 -
Radiographics : a Review Publication of... 2020The duodenum, the first portion of the small bowel, is divided into four segments and extends to both retro- and intraperitoneal spaces. Some conditions arise primarily... (Review)
Review
The duodenum, the first portion of the small bowel, is divided into four segments and extends to both retro- and intraperitoneal spaces. Some conditions arise primarily from the duodenum, but it can be secondarily affected by processes that involve neighboring structures. When duodenal emergencies are not identified and treated promptly, they may result in high morbidity and mortality. Imaging plays an important role in the diagnosis of duodenal conditions in the acute setting. However, the radiologic findings can be subtle, and awareness of relevant patient history and clinical presentation is important as it may increase the index of suspicion and one's ability to diagnose these conditions. Duodenal peptic disease is common and can be complicated by bleeding and perforation. The duodenum can be secondarily involved by pancreatitis and gallbladder pathologic conditions and may be affected by iatrogenic complications following endoscopic procedures. Traumatic injuries to the duodenum are generally uncommon, with penetrating traumatic injury being the most frequent mechanism of injury. Duodenal vascular pathologic conditions such as aortoduodenal fistula are uncommon but can be life threatening. The knowledge of which pathologic condition can involve which duodenal segment can help the radiologist establish a differential diagnosis and achieve a more targeted imaging approach. RSNA, 2020.
Topics: Abdominal Injuries; Diagnosis, Differential; Duodenal Diseases; Duodenum; Emergencies; Humans
PubMed: 32870765
DOI: 10.1148/rg.2020200045 -
Ceskoslovenska Patologie 2022Duodenum is currently the most popular site to obtain samples of intestinal mucosa for recognition of a disorder leading to malabsorption. Although there are significant...
Duodenum is currently the most popular site to obtain samples of intestinal mucosa for recognition of a disorder leading to malabsorption. Although there are significant overlaps between histological findings described in various non-neoplastic diseases of the duodenum, recognition of one of the six basic morphologic patterns, namely coeliac disease-like pattern, active chronic duodenitis, acute GvHD-like pattern, enteritis with predominant eosinophilic infiltration, enteritis with predominant infiltration by macrophages, and non-inflammatory enteropathy, usually allows diagnostic separation, especially if subtle histological details, clinical setting and serological investigation are taken into account.
Topics: Biopsy; Celiac Disease; Duodenitis; Duodenum; Enteritis; Humans; Intestinal Mucosa
PubMed: 35882543
DOI: No ID Found -
Pediatric Radiology Aug 2016Ultrasound is well suited for examining the pediatric duodenum, given the small size of the patients, the lack of ionizing radiation and high-resolution imaging... (Review)
Review
Ultrasound is well suited for examining the pediatric duodenum, given the small size of the patients, the lack of ionizing radiation and high-resolution imaging potential. Technical considerations, normal anatomy, congenital and acquired pathology of the duodenum, and the advantages and limitations of US are discussed and illustrated in this review.
Topics: Child; Duodenal Diseases; Duodenum; Humans; Ultrasonography
PubMed: 27003134
DOI: 10.1007/s00247-016-3564-4 -
Journal of Gastrointestinal Surgery :... Jun 2021
Topics: Cysts; Duodenal Diseases; Duodenum; Humans
PubMed: 33443687
DOI: 10.1007/s11605-020-04890-2 -
American Journal of Surgery Apr 2023Complex duodenal trauma is a rare injury with an incidence of 1-4.7% of all abdominal trauma. Historically, varied approaches have been used in the management of these... (Review)
Review
INTRODUCTION
Complex duodenal trauma is a rare injury with an incidence of 1-4.7% of all abdominal trauma. Historically, varied approaches have been used in the management of these complex injuries and the prevention of complications. This is a review of the current management methodology of complex duodenal injury.
METHODS
A review of the medical literature to include the past and current management of duodenal trauma was performed. Google scholar (1970-2022) and PubMed (1970-2022) were searched using the keywords: complex duodenal trauma, surgical management, and duodenal complications.
DISCUSSION
Complex duodenal trauma can be classified using the AAST grading scale as those encompassing grades III-V. Multiple studies and review articles characterize the difficulty in managing complex duodenal injuries. The tenets of operative management of duodenal trauma include the decision for damage control, resection of non-viable tissue, restoring gastrointestinal continuity, diversion of gastrointestinal contents, bile and pancreatic enzymes, allowing the repair to heal, and providing feeding access. The variety of both historic and current approaches attempt to address these tenets. The incidence of complications are as high as 65% with the most common complications including abscess formation, suture line dehiscence and fistula formation. The overall mortality ranges from 5 to 30%.
CONCLUSIONS
Many different approaches and strategies have been proposed to repair complex duodenal injuries, all of which address important tenets of its management. The risk of complications remains high, therefore, it is vital to have a thoughtful and multidisciplinary approach when treating these injuries.
Topics: Humans; Retrospective Studies; Duodenum; Abdominal Injuries
PubMed: 36588016
DOI: 10.1016/j.amjsurg.2022.12.016 -
International Journal of Surgical... Apr 2017
Topics: Duodenal Diseases; Duodenum; Humans; Iron; Male; Middle Aged; Pigmentation
PubMed: 27670354
DOI: 10.1177/1066896916671196 -
Archives of Pathology & Laboratory... Jan 2018- Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is... (Review)
Review
CONTEXT
- Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is essential for patient care. Celiac disease is a common clinical concern, but pathologists need to be aware of other conditions of the duodenum that mimic celiac disease.
OBJECTIVE
- To review the normal histologic features of duodenal mucosa and describe the clinical and histologic findings in celiac disease and its mimics, listing the differentiating features of biopsies with villous atrophy and epithelial lymphocytosis.
DATA SOURCES
- The study comprises a literature review of pertinent publications as of November 30, 2016.
CONCLUSIONS
- Celiac disease is a common cause of abnormal duodenal histology. However, many of the histologic features found in the duodenal biopsy of patients with celiac disease are also present in other conditions that affect the small bowel. Diagnostic precision may be enhanced by obtaining a careful patient history and by ancillary laboratory testing, particularly for the presence of antitissue transglutaminase antibodies.
Topics: Angiotensin II Type 1 Receptor Blockers; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Blind Loop Syndrome; Celiac Disease; Duodenitis; Graft vs Host Disease; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Intestinal Mucosa; Milk Hypersensitivity; Polyendocrinopathies, Autoimmune; Soybean Proteins
PubMed: 28758791
DOI: 10.5858/arpa.2016-0608-RA -
Journal For Immunotherapy of Cancer Jun 2020Rare cases of immune checkpoint inhibitor (ICI)-associated celiac disease (ICI-CeD) have been reported, suggesting that disruption of tolerance mechanisms by ICIs can...
BACKGROUND
Rare cases of immune checkpoint inhibitor (ICI)-associated celiac disease (ICI-CeD) have been reported, suggesting that disruption of tolerance mechanisms by ICIs can unmask celiac disease (CeD). This study aims to characterize the clinicopathological and immunophenotypic features of ICI-CeD in comparison to ICI-associated duodenitis (ICI-Duo) and usual CeD.
METHODS
A medical and pathological records search between 2015 and 2019 identified eight cases of ICI-CeD, confirmed by tTG-IgA. Nine cases of ICI-Duo, 28 cases of moderate CeD, as well as 5 normal controls were used as comparison groups. Clinical information was collected from the electronic medical records. Immunohistochemistry for CD3, CD8, T-cell receptor gamma/delta (γδ), programmed death ligand 1 (PD-L1), and programmed death 1 (PD-1) were performed, with quantification of intraepithelial lymphocyte (IEL) subsets in three well-oriented villi. CD68, PD-L1, and PD-1 were assessed as a percentage of lamina propria surface area infiltrated by positive cells. Statistical significance was calculated by the Student's t-test and Fisher's exact test.
RESULTS
The eight patients with ICI-CeD (F:M=1:3) and nine patients with ICI-Duo (F:M=5:4) presented similarly with diarrhea (13/17) and abdominal pain (11/17) after a median of 1.6 months on ICI therapy. In patients with ICI-CeD, tTG-IgA ranged from 104 to >300 IU/mL. Histological findings in ICI-CeD and ICI-Duo were similar and included expansion of the lamina propria, active neutrophilic duodenitis, variably increased IELs, and villous blunting. Immunohistochemistry showed that the average number of IELs per 100 enterocytes is comparable between ICI-CeD and ICI-Duo, with increased CD3 CD8 T cells compared with normal duodenum but decreased γδ T cells compared with CeD. Average PD-L1 percentage was 9% in ICI-CeD and 18% in ICI-Duo, in comparison to <1% in CeD and normal duodenum; average PD-1 percentage was very low to absent in all cases (<3%). On follow-up, five patients with ICI-CeD improved on a gluten-free diet (GFD) as the sole therapeutic intervention (with down-trending tTG-IgA) while the other three required immunosuppression. All patients who developed ICI-Duo received immunosuppression with variable improvement in symptoms.
CONCLUSIONS
ICI-CeD resembles ICI-Duo clinically and histologically but shares the serological features and response to gluten withdrawal with classic CeD. Immunophenotyping of IELs in ICI-CeD and ICI-Duo also shows similar CD3, CD8, γδ T cell subsets, and PD-L1 populations, all of which differed quantitatively from usual CeD. We conclude that ICI-CeD is biologically similar to ICI-Duo and is likely a variant of ICI-Duo, but treatment strategies differ, with ICI-CeD often improving with GFD alone, whereas ICI-Duo requires systemic immunosuppression.
Topics: Abdominal Pain; Adult; Aged; Biopsy; Celiac Disease; Diagnosis, Differential; Diarrhea; Duodenitis; Female; Humans; Immune Checkpoint Inhibitors; Immune Tolerance; Intestinal Mucosa; Intestine, Small; Male; Microvilli; Middle Aged; Retrospective Studies
PubMed: 32581063
DOI: 10.1136/jitc-2020-000958