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Archives of Pathology & Laboratory... Sep 2023Eosinophilic diseases of the gastrointestinal tract (EGIDs), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) are rarely suspected clinically and...
CONTEXT.—
Eosinophilic diseases of the gastrointestinal tract (EGIDs), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) are rarely suspected clinically and infrequently detected by pathologists.
OBJECTIVE.—
To determine whether histories of allergic or eosinophilic disorders and requests to rule out EoG and EoD affect pathologists' awareness of eosinophils in gastrointestinal biopsies.
DESIGN.—
Thirty-one community-based pathologists were given 16 sets of biopsies from gastric and duodenal mucosa with elevated eosinophils, Helicobacter pylori gastritis, atrophic gastritis, normal stomach and duodenum, lymphocytosis, and celiac disease. Participants were assigned to 3 groups: group A did not receive histories of allergic or eosinophilic conditions; group B received similar histories plus a clue of possible allergic or eosinophilic conditions; and group C received the same histories as B and was asked to rule out EoG/EoD. A list of gastric and duodenal diagnoses and a space for comments were provided. Results were analyzed descriptively.
RESULTS.—
Pathologists correctly diagnosed most noneosinophilic gastrointestinal disorders, indicating competence in gastrointestinal pathology. With respect to EoG and EoD, pathologists in group C performed significantly better that those in groups A and B. The combined odds ratio with 95% CI was 12.34 (2.87-53.04), P < .001, for A versus C and 4.02 (1.60-10.09), P < .02, for B versus C.
CONCLUSIONS.—
Most pathologists neither reported gastric/duodenal eosinophilia nor diagnosed EoG/EoD, even when provided histories of eosinophilic disorders. Requests to rule out EoG/EoD resulted in only 4 of 11 participants evaluating and counting eosinophils in some cases. Simple evidence-based histopathologic criteria are needed before pathologists can be expected to consider and diagnose EGIDs.
Topics: Humans; Pathologists; Eosinophilia; Gastritis; Duodenum; Duodenitis
PubMed: 36399607
DOI: 10.5858/arpa.2022-0204-OA -
World Journal of Gastroenterology Dec 2016() is a gastric human pathogen associated with acute and chronic gastritis, 70% of all gastric ulcers, 85% of all duodenal ulcers, and both forms of stomach cancer,... (Review)
Review
() is a gastric human pathogen associated with acute and chronic gastritis, 70% of all gastric ulcers, 85% of all duodenal ulcers, and both forms of stomach cancer, mucosal-associated lymphoid tissue (MALT) lymphoma and adenocarcinoma. Recently, attention has focused on possible relationship between presence of certain virulence factor and -associated diseases. Some contradictory data between this bacterium and related disorders has been observed since not all the colonized individuals develop to severe disease. The reported diseases plausibility related to specific virulence factors became an interesting story about this organism. Although a number of putative virulence factors have been identified including cytotoxin-associated gene a () and , there are conflicting data about their actual participation as specific risk factor for -related diseases. Duodenal ulcer promoting gene a () is a virulence factor of that is highly associated with duodenal ulcer development and reduced risk of gastric cancer. The prevalence of in strains isolated from western countries is relatively higher than in strains from Asian countries. Current confusing epidemiological reports will continue unless future sophisticated and molecular studies provide data on functional and complete cluster in infected individuals. This paper elucidates available knowledge concerning role of in virulence of after a decade of its discovery.
Topics: Antigens, Bacterial; Asia; Bacterial Proteins; Duodenal Ulcer; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Stomach Neoplasms; Virulence Factors
PubMed: 28028359
DOI: 10.3748/wjg.v22.i46.10118 -
Gut and Liver May 2017Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning.... (Review)
Review
Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux. The pretest probability of FD in a patient who presents with classical FD symptoms and no alarm features is high, approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as a diagnosis. One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T cells, signaling intestinal inflammation, and increased cytokines have been detected in the circulation, and elevated tumor necrosis factor-α levels have been significantly correlated with increased anxiety. Postinfectious gastroenteritis is a risk factor for FD. Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD- eradication. Treatment of duodenal eosinophilia is under investigation.
Topics: Diagnosis, Differential; Duodenal Diseases; Dyspepsia; Eosinophilia; Gastroesophageal Reflux; Heartburn; Helicobacter Infections; Helicobacter pylori; Humans; Postprandial Period; Symptom Assessment
PubMed: 28452210
DOI: 10.5009/gnl16055 -
Singapore Medical Journal Jun 2018
Topics: Aged; Biopsy; Duodenal Diseases; Duodenum; Endoscopy; Gastric Fistula; Humans; Male; Pylorus
PubMed: 29974123
DOI: 10.11622/smedj.2018073 -
Neurogastroenterology and Motility Mar 2018Upper gastrointestinal symptoms in children are common and motility disorders are considered in the differential diagnosis. High resolution esophageal manometry (HRM)... (Review)
Review
BACKGROUND
Upper gastrointestinal symptoms in children are common and motility disorders are considered in the differential diagnosis. High resolution esophageal manometry (HRM) has revolutionized the study of esophageal physiology, and the addition of impedance has provided new insights into esophageal function. Antroduodenal motility has provided insight into gastric and small bowel function.
PURPOSE
This review highlights some of the recent advances in pediatric esophageal and antroduodenal motility testing including indications, preparation, performance, and interpretation of the tests. This update is the second part of a two part series on manometry studies in children (first part was on anorectal and colonic manometry [Neurogastroenterol Motil. 2016;29:e12944]), and has been endorsed by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the American Neurogastroenterology and Motility Society (ANMS).
Topics: Consensus; Duodenal Diseases; Esophageal Motility Disorders; Gastrointestinal Motility; Humans; Manometry
PubMed: 29178261
DOI: 10.1111/nmo.13239 -
BMC Gastroenterology Feb 2022The purpose of this study was to investigate the diagnosis and treatment experience of traumatic duodenal ruptures in children.
BACKGROUND
The purpose of this study was to investigate the diagnosis and treatment experience of traumatic duodenal ruptures in children.
METHODS
Clinical data were collected from four children suffering from a traumatic duodenal rupture who were admitted to and treated by our hospital from January 2012 to December 2020. The early diagnosis and treatment, surgical plan, postoperative management, complications, and prognosis of each child were analyzed. The key points and difficulties of the diagnosis and treatment for this type of injury are summarized.
RESULTS
One child had an extreme infection caused by drug-resistant bacteria, which resulted in severe complications, including wound infection, dehiscence, and an intestinal fistula. One child developed an anastomotic stenosis after the duodenostomy, which improved following an endoscopic balloon dilatation. The other two children had no relevant complications after their operations. All four patients were cured and discharged from hospital. The average hospital stay was 48.25 ± 26.89 days. The follow-up period was 0.5 to 1 year. No other complications occurred, and all children had a positive prognosis.
CONCLUSIONS
The early identification of a duodenal rupture is essential, and surgical exploration should be carried out proactively. The principles of damage-control surgery should be followed as much as possible during the operation. Multidisciplinary cooperation and management are both important to reduce the occurrence of postoperative complications and improve cure rates.
Topics: Anastomosis, Surgical; Child; Dilatation; Duodenal Diseases; Duodenum; Humans; Postoperative Complications; Retrospective Studies
PubMed: 35151250
DOI: 10.1186/s12876-022-02136-w -
Revista Espanola de Enfermedades... Feb 2022An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests...
An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests showed no remarkable findings. Upper endoscopy revealed a sessile lesion (Paris 0-IIa) in the anterior wall of the duodenal bulb, with smooth surface and slightly ulcerated at the top.
Topics: Aged, 80 and over; Duodenal Neoplasms; Duodenum; Gastroscopy; Humans; Male
PubMed: 34607439
DOI: 10.17235/reed.2021.8349/2021 -
Revista Espanola de Enfermedades... Dec 2021We present the case of a 72-year-old male with upper gastrointestinal bleeding. He had been discharged from hospital two weeks before after severe COVID-19 infection,...
We present the case of a 72-year-old male with upper gastrointestinal bleeding. He had been discharged from hospital two weeks before after severe COVID-19 infection, treated with lopinavir-ritonavir (L-R), hydroxychloroquine, tocilizumab, and methylprednisolone. On presentation, he was in hypovolemic shock. Esophagogastroduodenoscopy showed an ulcer in the third duodenal portion, which was sclerosed and hemodynamic stability was recovered. A scan was performed as it was in an atypical location for ulcers, showing an aortic aneurysm in close relationship to the duodenum, suggesting a primary aortoenteric fistula (PAEF).
Topics: Aged; Aortic Diseases; COVID-19; Duodenal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; SARS-CoV-2; Vascular Fistula
PubMed: 34488422
DOI: 10.17235/reed.2021.8272/2021 -
World Journal of Gastroenterology Feb 2015Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable. It is higher... (Review)
Review
Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable. It is higher in regions where the diet is based on milled rice, refined wheat or maize, yams, cassava, sweet potato, or green bananas, and is lower in regions where the staple diet is based on unrefined wheat or maize, soya, certain millets or certain pulses. Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against both gastric and duodenal ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs). It also promoted ulcer healing. The lipid from the pulse, Dolichos biflorus, horse gram which was highly protective was used to identify the fractions with protective activity in the lipid. The protective activity lay in the phospholipid, sterol and sterol ester fractions. In the phospholipid fraction phosphatidyl choline (lethicin) and phosphatidyl ethanolamine (cephalin) were predominant. In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol, stigmasterol, and an unidentified isomer of β-sitosterol. The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration, both singly and in combination. This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers. A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.
Topics: Animals; Cytoprotection; Diet; Dietary Fats; Dietary Fiber; Disease Models, Animal; Duodenal Ulcer; Duodenum; Gastric Mucosa; Phospholipids; Phytosterols; Plant Oils; Rats; Stomach; Stomach Ulcer
PubMed: 25663757
DOI: 10.3748/wjg.v21.i5.1377 -
BMC Gastroenterology Aug 2016Infection with Helicobacter pylori is associated with severe digestive diseases including chronic gastritis, peptic ulcer disease, and gastric cancer. Successful...
BACKGROUND
Infection with Helicobacter pylori is associated with severe digestive diseases including chronic gastritis, peptic ulcer disease, and gastric cancer. Successful eradication of this common gastric pathogen in individual patients is known to prevent the occurrence of peptic ulcer disease and gastric cancer.
DISCUSSION
With half of the world's population being infected with H, pylori and only few antibiotics result in an effective eradication, a successful antibiotic driven worldwide eradication program seems unlikely. In addition, H. pylori eradication is not always beneficial as it has been described that eradication can be associated with an increased frequency of other disorders such as pediatric asthma, inflammatory bowel diseases and Barrett's Esophagus. We have to accept that eradication of this infection is a two-edged sword that is both useful and harmful and we should therefore focus our H. pylori eradication policy toward selectively identify and destroy only the virulent strains.
CONCLUSION
In order to still be able to effectively treat H. pylori infections in the future we need an alternative diagnostic/treatment algorithm. This would involve a shift towards more precise and enhanced disease predicting diagnosis that tries to identify patients with chance of developing severe diseases such as gastric cancer, rather than the current regime that is geared towards find and destroy all H. pylori.
Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Duodenal Ulcer; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Stomach Neoplasms; Stomach Ulcer
PubMed: 27520775
DOI: 10.1186/s12876-016-0496-2