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Current Opinion in Gastroenterology Nov 2015Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge... (Review)
Review
PURPOSE OF REVIEW
Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge holds the prospect that targeted therapy may more optimally manage subsets of these patients with functional dyspepsia.
RECENT FINDINGS
An understanding of gut-to-brain and brain-to-gut pathways in functional dyspepsia is expanding. Minimal mucosal inflammation with eosinophils (and in some cases mast cells) characterized by ultrastructural changes in the duodenum appears to be present in a substantial subgroup of functional dyspepsia patients as identified now by investigators globally. Although antibiotic therapy targeting Helicobacter pylori appears to be effective in a small proportion of functional dyspepsia patients, eradication therapy may be more effective in functional dyspepsia patients with microscopic duodenal inflammation, a potentially important finding needing to be confirmed. This may suggest that the effects of antibiotics for functional dyspepsia are not simply mediated by the eradication of gastric H. pylori, but have other antibacterial effects (e.g., on the duodenal microbiome). Abnormal visceral sensory function plays a key role not only in the manifestations of functional dyspepsia but also in peptic ulcer disease.
SUMMARY
The pathophysiologic concepts underlying functional dyspepsia and related treatment approaches are shifting from a focus on H. pylori, acid suppression or modulation of motility toward new models. New evidence suggests that minimal duodenal inflammation plays a role in symptom generation in at least a proportion of patients with otherwise unexplained symptoms. This is a paradigm shift and ultimately may change the treatment of many patients with functional gastrointestinal disorders.
Topics: Anti-Bacterial Agents; Duodenitis; Dyspepsia; Endoscopy, Gastrointestinal; Environment; Gastrointestinal Diseases; Genetic Predisposition to Disease; Helicobacter Infections; Helicobacter pylori; Humans; Risk Factors
PubMed: 26444826
DOI: 10.1097/MOG.0000000000000219 -
Archives of Disease in Childhood Aug 2016Environmental enteric dysfunction (EED) has been recognised as an important contributing factor to physical and cognitive stunting, poor response to oral vaccines,... (Review)
Review
Environmental enteric dysfunction (EED) has been recognised as an important contributing factor to physical and cognitive stunting, poor response to oral vaccines, limited resilience to acute infections and ultimately global childhood mortality. The aetiology of EED remains poorly defined but the epidemiology suggests a multifactorial combination of prenatal and early-life undernutrition and repeated infectious and/or toxic environmental insults due to unsanitary and unhygienic environments. Previous attempts at medical interventions to ameliorate EED have been unsatisfying. However, a new generation of imaging and '-omics' technologies hold promise for developing a new understanding of the pathophysiology of EED. A series of trials designed to decrease EED and stunting are taking novel approaches, including improvements in sanitation, hygiene and nutritional interventions. Although many challenges remain in defeating EED, the global child health community must redouble their efforts to reduce EED in order to make substantive improvements in morbidity and mortality worldwide.
Topics: Child; Duodenitis; Endoscopy, Gastrointestinal; Enteritis; Environment; Gastrointestinal Microbiome; Global Health; Growth Disorders; Health Status; Humans; Intestinal Mucosa; Jejunal Diseases; Microscopy, Confocal
PubMed: 26933151
DOI: 10.1136/archdischild-2015-309534 -
Medicine, Science, and the Law Jul 2021
Topics: Adult; Autopsy; Diabetic Ketoacidosis; Duodenitis; Endocarditis; Esophagitis; Humans; Male; Necrosis
PubMed: 33283621
DOI: 10.1177/0025802420976998 -
Radiologic Clinics of North America Jul 2015Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in association with other solid organ injuries. Findings of pancreatic and... (Review)
Review
Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in association with other solid organ injuries. Findings of pancreatic and duodenal trauma on computed tomography and MR imaging are often nonspecific, and high levels of clinical suspicion and understanding of mechanism of injury are imperative. Familiarity with the grading schemes of pancreatic and duodenal injury is important because they help in assessing for key imaging findings that directly influence management. This article presents an overview of imaging of blunt and penetrating pancreatic and duodenal injuries, including pathophysiology, available imaging techniques, and variety of imaging features.
Topics: Abdominal Injuries; Diagnosis, Differential; Duodenum; Humans; Pancreas; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 26046509
DOI: 10.1016/j.rcl.2015.02.009 -
Journal of the International... 2017Helminthic infection and HIV have been reported to coexist, particularly in sub-Saharan African patients living with HIV. Strongyloidiasis is one of the most common...
Helminthic infection and HIV have been reported to coexist, particularly in sub-Saharan African patients living with HIV. Strongyloidiasis is one of the most common helminths, usually leading to cutaneous and gastrointestinal (GI) symptoms. In the immunocompromised host, this infection can lead to strongyloidiasis hyperinfection syndrome (SHS), not common in HIV-infected patients. Immune reconstitution inflammatory syndrome (IRIS) can follow the initiation of antiretroviral therapy (ART), with a variety of presentations. The authors present here a 32-year-old HIV-infected female who was recently diagnosed with AIDS, started ART, and recovered from SHS. Her upper endoscopy revealed severe duodenitis but no causal agent per biopsy or stool examination. After receiving symptomatic therapy, she showed improvement, a course of events that fit the diagnosis of GI-related IRIS.
Topics: AIDS-Related Opportunistic Infections; Adult; Anti-Retroviral Agents; Duodenum; Female; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Strongyloidiasis
PubMed: 27733639
DOI: 10.1177/2325957416673149 -
Singapore Medical Journal Jun 2018
Topics: Aged; Biopsy; Duodenal Diseases; Duodenum; Endoscopy; Gastric Fistula; Humans; Male; Pylorus
PubMed: 29974123
DOI: 10.11622/smedj.2018073 -
Abdominal Imaging Dec 2014The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range... (Review)
Review
The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range from congenital anomalies to traumatic, inflammatory, and neoplastic entities. The duodenum may be overlooked on cross-sectional imaging due to its location and small size. Duodenal pathologies may, therefore, be missed or wrongly diagnosed. Knowledge about duodenal pathologies and optimal imaging techniques can increase diagnostic yield and permit optimal patient management. Conventionally, the duodenum was evaluated with upper GI studies on fluoroscopy; however, endoluminal evaluation is better performed with endoscopy. Additionally, a broad array of cross-sectional imaging modalities permits comprehensive assessment of the duodenum and surrounding viscera. While endoscopic sonography is increasingly used to locally stage duodenal malignancies, MDCT remains the primary modality widely used in the detection and characterization of duodenal abnormalities. MRI is used as a "problem solving" modality in select conditions. We present a comprehensive review of duodenal abnormalities with an emphasis on accurate diagnosis and management.
Topics: Adult; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Duodenal Diseases; Duodenum; Female; Fluoroscopy; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Tomography, X-Ray Computed; Young Adult
PubMed: 24811767
DOI: 10.1007/s00261-014-0157-2 -
Annals of Diagnostic Pathology Jun 2019Russell body gastritis is considered as a rare, benign, incidental finding characterized by dense accumulation of plasma cells containing Russell bodies in the lamina... (Review)
Review
INTRODUCTION
Russell body gastritis is considered as a rare, benign, incidental finding characterized by dense accumulation of plasma cells containing Russell bodies in the lamina propria. In this study, clinical and histopathological features of 12 cases of Russell body gastritis/duodenitis were presented.
MATERIALS AND METHODS
Clinical data, histopathological findings including Helicobacter pylori infection, Sydney system classification, Russell body density and immunohistochemical findings were evaluated in 11 gastric and 1 duodenal mucosal biopsy from 11 patients.
RESULTS
Six cases were male, 5 were female and the mean age was 72 (44-87). The most common site was antrum (10/12), one case was located in cardia and one in heterotopic gastric mucosa of duodenal bulb. H. pylori was detected in half of the cases. One of the cases was accompanied by gastric tubular adenoma, one by gastric well-differentiated adenocarcinoma and one by plasma cell neoplasm. In all cases, globules were positive with PAS stain.
CONCLUSION
Russell body gastritis must be kept in mind while reporting endoscopic biopsies because this entity may be misdiagnosed as signet ring carcinoma and may be associated with neoplasms. Absence of nuclear atypia, mucin stains, cytokeratins, plasma cell and hematolymphoid antigen markers are useful in differential diagnosis. Associated H. pylori infection, as well as rarely carcinomas, adenomas and plasma cell neoplasms, may be observed.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Duodenitis; Duodenum; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Plasma Cells; Stomach
PubMed: 31031217
DOI: 10.1016/j.anndiagpath.2019.04.003 -
Expert Opinion on Therapeutic Targets Jun 2020: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders and is classified into postprandial distress and epigastric pain syndrome.... (Review)
Review
: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders and is classified into postprandial distress and epigastric pain syndrome. Despite the recognition of duodenal inflammation as a potential trigger of symptoms, only limited anti-inflammatory therapies exist.: This narrative review summarizes the recent advances in the pathophysiology and treatment of FD; it identifies potential therapeutic targets and gaps in the field. An electronic literature search was conducted in Pubmed up to 31st of December 2019.: There is compelling evidence for the role of duodenal inflammation and the eosinophil-mast cell axis in the pathogenesis of dyspeptic symptoms. Traditional prokinetic drugs and neuromodulators target gastric dysmotility and visceral hypersensitivity but are hampered by limited efficacy and side effects. Independent of acid suppression, the anti-inflammatory action of proton pump inhibitors, which remain the first-line therapy in FD, may also explain their therapeutic effect. Other existing and newly established anti-inflammatory drugs should be investigated while trials including probiotics and selective antibiotics should examine the host microbiome and immune activation. Targeted treatments for potential causes of duodenal pathology, such as impaired permeability and dysbiosis, are likely to emerge in the future.
Topics: Abdominal Pain; Animals; Anti-Inflammatory Agents; Duodenitis; Dyspepsia; Gastrointestinal Agents; Humans; Molecular Targeted Therapy
PubMed: 32249629
DOI: 10.1080/14728222.2020.1752181 -
Journal of Pediatric Gastroenterology... Dec 2016
Topics: Child; Duodenal Ulcer; Duodenitis; Duodenum; Gastritis; Humans
PubMed: 27472477
DOI: 10.1097/MPG.0000000000001358