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World Journal of Gastroenterology Jul 2019Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. (Comparative Study)
Comparative Study
BACKGROUND
Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes.
AIM
To quantify and compare the association between CCDO and ICDO with outcome parameters.
METHODS
We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO ( = 27; atresia type 1-3, annular pancreas) and ICDO ( = 23; annular pancreas, web, Ladd´s bands).
RESULTS
In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO ICDO, < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group ( < 0.01).
CONCLUSION
CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.
Topics: Age Factors; Child; Child, Preschool; Digestive System Surgical Procedures; Duodenal Obstruction; Duodenum; Enteral Nutrition; Female; Gestational Age; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Laparoscopy; Male; Postoperative Period; Retrospective Studies; Treatment Outcome
PubMed: 31391773
DOI: 10.3748/wjg.v25.i28.3787 -
Schweizer Archiv Fur Tierheilkunde Nov 2022The hay producing plants, concentrate, straw and meadows could be contaminated by the aerosols of glyphosate based herbicide during spraying process of crops and...
The hay producing plants, concentrate, straw and meadows could be contaminated by the aerosols of glyphosate based herbicide during spraying process of crops and pre-harvest desiccation treatment of cereals. The aim of this study is to investigate the concentration of glyphosate in the duodenal fluid of horses with gastric ulcer syndrome. The stomach and duodenum of referred untreated horse patients (n=92) with colic, weight loss, diarrhoea, anemia or performance intolerance were endoscopically examined right after the admission. Duodenal fluid (40 ml) was collected from the duodenal region where the papilla duodeni major is located. Hematology and clinical chemistry data were examined. The concentration of glyphosate in serum and duodenal fluid samples were analysed using a competitive ELISA and control analysis had also been done with HPLC. Statistical differences between groups were determined by the non-parametric Mann-Whitney-test using a significant level of p≤0,05. Glyphosate was detected in all duodenal fluid (median 12,2 ng/ml; 1st quartile 4,0 ng/ml; 3rd quartile 19,3 ng/ml; min 0,6 ng/ml; max. 192,9 ng/ml) and blood samples (1,79 ng/ml; 1,0 ng/ml; 2,8 ng/ml; 0,2 ng/ml; 3,7 ng/ml) of all horses. Glyphosate concentrations of duodenal fluid samples are significantly higher than in blood samples (Mann Whitney U-test, p≤0,05). The concentration of glyphosate in the duodenal fluid was significantly higher in horses with squamous gastric disease (grade 4/4; n=11/92) compared to horses with normal squamous mucosa (grade 0/4, n=10/92) (median: 19,8 ng/ml versus 8,4 ng/ml). Horses with glandular gastric disease and a grade 4/4 (n=9/92) had higher concentrations of glyphosate in the duodenal fluid than horses with normal glandular mucosa (grade 0/4; n=9/92) (median: 19,2 versus 11,1). The Gamma-Glutamyltransferase (GGT) enzyme activity is significantly higher in the group of horses with lower concentration of glyphosate in the duodenal fluid (≤12,2 ng/ml) compared with the group with higher concentration of glyphosate (>12,2 ng/ml) (median 279,5 versus 101,9 U/L). During autumn the horses had higher concentrations of glyphosate in duodenal fluid (n=18; median 14,3) compared with lower concentrations in spring time (n=34; median 8,1 ng/ml). Horses kept around big cities had significantly higher concentrations of glyphosate in the duodenal fluid in comparison to horses living in the countryside (medians 17,8 ng/ml versus 7,5 ng/ml).
Topics: Horses; Animals; Stomach Ulcer; Horse Diseases; Carcinoma, Squamous Cell; Glyphosate
PubMed: 36325641
DOI: 10.17236/sat00374 -
Pediatrics and Neonatology Jan 2023
Topics: Humans; Duodenal Diseases; Gastrointestinal Hemorrhage; Hematoma
PubMed: 36002379
DOI: 10.1016/j.pedneo.2022.07.003 -
BMC Surgery May 2023Repairing of a duodenal perforation is a well accepted procedure, but clinically, approximately 4% of patients develop duodenal leaks after perforation repair,...
BACKGROUND
Repairing of a duodenal perforation is a well accepted procedure, but clinically, approximately 4% of patients develop duodenal leaks after perforation repair, increasing the risk of death. We retrospectively analyzed clinical data from 168 patients at our hospital to explore risk factors for duodenal leak after perforation repair and developed a nomogram for predicting postoperative duodenal leak.
METHODS
This retrospective case-control study totalled 168 patients undergoing repair of a duodenal perforation with omentopexy at the General Surgery Department, Dongnan Hospital of Xiamen University, from January 2012 to January 2022. The patients were divided into the non-leak group and the leak group. Risk factors were evaluated by analyzing the patient's sex, shock, diameter and anatomic position of the ulcer, use of NSAIDS and Glucocorticoid, history of drinking, diabetes, chronic diseases, age, time of onset of symptoms and lab tests.
RESULT
One hundred fifty-six patients (92.9%) who did not develop leaks after repair of a duodenal perforation were included in the non-leak group, and 12 (7.1%) developed leaks were included in the leak group. In univariate analysis, there were significant differences between the two groups referring to age, shock, NSAIDs, albumin, and perforation size (P < 0.05). The area under the ROC curve for perforation diameter was 0.737, the p-value was 0.006, the optimal cutoff point was 11.5, sensitivity was 58.3%, and specificity was 93.6%, the positive predictive value is 41.1%, and the negative predictive value is 98.0%. In the internal validation of the performance of the nomogram, the C-index and AUC of the model were 0.896(95%CI 0.81-0.98), demonstrating that the nomogram model was well calibrated.
CONCLUSION
The study discussed the risk factors for postoperative duodenal leak in patients undergoing repair of a duodenal perforation, and a nomogram was constructed to predict the leak. Future prospective studies with large sample sizes and multiple centres are needed to further elucidate the risk of duodenal leak after repair of a duodenal perforation.
Topics: Humans; Retrospective Studies; Case-Control Studies; Prospective Studies; Duodenum; Duodenal Ulcer; Peptic Ulcer Perforation; Risk Factors
PubMed: 37165360
DOI: 10.1186/s12893-023-02005-7 -
Zhongguo Dang Dai Er Ke Za Zhi =... Apr 2022To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children.
OBJECTIVES
To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children.
METHODS
A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; =148) and secondary ulcer group (secondary group; =25). The clinical data were compared between the two groups.
RESULTS
A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (<0.05).
CONCLUSIONS
Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
Topics: Abdominal Pain; Child; Duodenal Ulcer; Endoscopy, Gastrointestinal; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Retrospective Studies; Ulcer
PubMed: 35527410
DOI: 10.7499/j.issn.1008-8830.2201003 -
Scientific Reports Sep 2022The treatment plan for non-ampullary duodenal neuroendocrine tumors (d-NETs) with diameters 1-2 cm remains controversial. We therefore aimed to compare the prognostic...
The treatment plan for non-ampullary duodenal neuroendocrine tumors (d-NETs) with diameters 1-2 cm remains controversial. We therefore aimed to compare the prognostic effects of endoscopic treatment and surgical resection on non-ampullary d-NETs with 1-2 cm diameters. A total of 373 eligible patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to match patients 1:1 according to clinicopathological characteristics. Disease-specific survival (DSS) and overall survival (OS) were calculated. Before PSM, there was no significant difference in DSS or OS (all P > 0.05), but the T stage, N stage, and TNM stage were significantly different between the two surgical methods (all P < 0.05). After 1:1 PSM, the differences in clinicopathological characteristics were significantly reduced (all P > 0.05). Survival analysis showed that tumor grade was correlated with DSS and that age was correlated with OS (all P < 0.05); however, the surgical method and other clinicopathological characteristics were not correlated with prognosis (all P > 0.05). Subgroup survival analysis of patients with T2N0M0 disease and tumors invading the lamina propria or submucosa showed that the 5-year DSS and OS rates were not significantly different according to the surgical approach (all P > 0.05). The surgical approach has no significant effect on the prognosis of patients with non-ampullary d-NETs with 1-2 cm diameters, especially those with T2N0M0 disease. This suggests that endoscopic treatment may be a preferred option for these patients.
Topics: Duodenal Neoplasms; Humans; Intestinal Neoplasms; Neuroendocrine Tumors; Pancreatic Neoplasms; SEER Program; Stomach Neoplasms
PubMed: 36097200
DOI: 10.1038/s41598-022-19725-0 -
Italian Journal of Pediatrics Jul 2017The aim of our study is to evaluate if in children with highly positive serology and HLA-DQ2/DQ8 (triple test, TT) and only extra-intestinal symptoms, it is possible to...
BACKGROUND
The aim of our study is to evaluate if in children with highly positive serology and HLA-DQ2/DQ8 (triple test, TT) and only extra-intestinal symptoms, it is possible to omit performing an intestinal biopsy for celiac disease (CD) diagnosis, as suggested by the new European Society for Pediatric Gastroenterology, Hepatology and Nutrition ESPGHAN guidelines.
METHODS
In this retrospective study a total of 105 patients, suspected of having CD because of extra-intestinal symptoms and showing serum tissue transglutaminase antibody (anti-tTG) and anti-endomysial antibody (EMA) measurements and HLA genotyping, were considered for the final analysis (33 boys and 72 girls; age range 1.5-17.6 years).
RESULTS
Histological findings confirmed diagnosis of CD in 97 (92.4%) patients. Forty-one patients (39%) showed anti-tTG >10 times normal values, positive EMA and positive HLA-DQ2/DQ8 (positive TT). All of them had a diagnosis of CD, therefore there were no false positive cases. Sixty-four patients were negative for the TT. In eight cases, CD was ruled out and these were considered true negative cases. In the remaining 56 negative TT patients, intestinal biopsy confirmed CD diagnosis and they were considered false negatives. Based on these results, specificity for the TT was 100% and sensitivity was 42.3%.
CONCLUSIONS
On the basis of the present study, diagnosis of CD can be reliably performed without a duodenal biopsy in children with only extra-intestinal symptoms.
Topics: Adolescent; Biopsy; Celiac Disease; Child; Duodenal Diseases; Enzyme-Linked Immunosorbent Assay; Female; Genotype; Humans; Italy; Male; Polymerase Chain Reaction; Retrospective Studies
PubMed: 28709446
DOI: 10.1186/s13052-017-0377-5 -
Annals of the Royal College of Surgeons... Jan 2022Intestinal intussusception is uncommon in adults. As a retroperitoneal structure, gastroduodenal intussusception is extremely rare. The leading cause of intussusception...
Intestinal intussusception is uncommon in adults. As a retroperitoneal structure, gastroduodenal intussusception is extremely rare. The leading cause of intussusception is reported to be a tumour, either benign or malignant. The case presented may be the first of gastroduodenal intussusception resulting from severe peptic ulcer. A 64-year-old man was admitted with epigastralgia, appetite loss and melena for 1 week. He had history of peptic ulcer and reflux esophagitis for 9 years, caused by infection; eradication therapy had been performed 5 years previously. This time, an abdominal computed tomography scan showed duodenogastric intussusception and gastric outlet obstruction. Preoperative biopsy failed for complete obstruction; thus, the patient underwent Whipple procedure for complete resection under impression of malignancy. The postoperative course was uneventful. Pathological findings for the specimen showed gastric and duodenal ulcer. Progressive peptic ulcer after eradication therapy is rarely seen, and eradication therapy is used widely to treat infection. The eradication rate is extremely high in Taiwan for lower first-line antibiotic as clarithromycin resistance is low due to a policy restricting antimicrobial usage. Early eradication therapy is highly recommended for patients with infection. We emphasise the importance of regular follow-up for the non-significant correlation of severity of gastric ulcer with clinical symptoms. When ulceration progresses or non-invasive treatments fail early surgical interventions should be applied to these anatomic alterations.
Topics: Duodenal Ulcer; Humans; Intussusception; Male; Middle Aged; Stomach Diseases
PubMed: 34730406
DOI: 10.1308/rcsann.2021.0067 -
PloS One 2018The objective of this study was to examine the association of peptic ulcer disease (PUD), including gastric ulcer and duodenal ulcer, with obesity-related indices,... (Clinical Trial)
Clinical Trial
OBJECTIVES
The objective of this study was to examine the association of peptic ulcer disease (PUD), including gastric ulcer and duodenal ulcer, with obesity-related indices, nutrients, and blood parameters in Korean adults.
METHODS
Data were obtained from the Second-Fourth Korean National Health and Nutrition Examination Survey (KNHANES II-IV). Binary logistic regression was carried out to analyze the association between PUD and all variables in the crude analysis; in a subsequent analysis, adjustments were made for age, region, house type, number of snacks per day, and number of household members.
RESULTS
PUD exhibited the highest association with age in both men and women among all variables used in this study. In men, only body mass index was associated with PUD in both the crude and adjusted analyses. PUD was associated with weight, height, and fat in the crude analysis, but these associations disappeared after adjustment for confounders. Vitamin B2, hemoglobin, and glucose were related to PUD, but these associations became nonsignificant in the adjusted analysis. Water, vitamin C, and potassium were not associated with PUD in the crude analysis but were associated with PUD after adjustment for confounders. In women, systolic blood pressure and height were associated with PUD. PUD was also related to waist circumference, the waist-to-height ratio, fat, and cholesterol, but these associations became nonsignificant after adjustment for confounders. Vitamin C, protein, niacin, sodium, energy, vitamin B2, vitamin B1, and aspartate aminotransferases were associated with PUD in only the crude analysis. PUD was not associated with diastolic blood pressure, water, vitamin A, or glucose, but these factors were associated with the disease in the adjusted analysis.
CONCLUSION
Older age was a risk factor for PUD in Korean adults, and the association of PUD with most nutrients and anthropometric indices may differ according to gender.
Topics: Adult; Aged; Aged, 80 and over; Body Mass Index; Cross-Sectional Studies; Duodenal Ulcer; Humans; Male; Middle Aged; Nutritional Status; Obesity; Republic of Korea; Retrospective Studies; Stomach Ulcer; Waist Circumference; Waist-Height Ratio
PubMed: 30440018
DOI: 10.1371/journal.pone.0207373 -
The New England Journal of Medicine Nov 2017
Topics: Abdominal Pain; Aged, 80 and over; Duodenal Diseases; Female; Humans; Intestinal Perforation; Pneumoperitoneum; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 29141173
DOI: 10.1056/NEJMicm1613914