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Medicine Nov 2023Duodenal ulcer bleeding is a potentially life-threatening condition commonly caused by the erosion of the duodenal arteries.
RATIONALE
Duodenal ulcer bleeding is a potentially life-threatening condition commonly caused by the erosion of the duodenal arteries.
PATIENT CONCERNS
A 55-year-old male was referred to our hospital with abdominal pain for the past 3 days. Contrast-enhanced computed tomography of the abdomen revealed wall thickening in the descending part of the duodenum and a cystic lesion (27 × 19 mm) contiguous with the duodenum, with an accumulation of fluid. An esophagogastroduodenoscopy showed the significantly stenotic duodenum, which prevented passage of the endoscope and evaluation of the main lesion. Based on these findings, duodenal ulcer perforation and concomitant abscess formation were suspected. Two days after admission, he had massive hematochezia with bloody drainage from the nasogastric tube.
DIAGNOSES
Emergency angiography revealed duodenal ulcer bleeding from the gastroduodenal artery and the branch artery of the inferior pancreaticoduodenal artery and middle colic artery (MCA).
INTERVENTIONS
The patient was treated with transcatheter arterial embolization (TAE) of the gastroduodenal artery, the branch vessel of the inferior pancreaticoduodenal artery, and the main trunk of the MCA.
OUTCOMES
Hemostasis was achieved with TAE. The patient recovered uneventfully and undergone a gastro-jejunal bypass surgery for the duodenal stenosis 2 weeks after TAE. He was discharged without any abnormal complaints on postoperative day 12.
LESSONS
We have experienced a rare case of duodenal ulcer bleeding from a branch of the MCA. In patients with refractory upper gastrointestinal bleeding, careful evaluation of bleeding sites is recommended considering unexpected culprit vessels.
Topics: Male; Humans; Middle Aged; Duodenal Ulcer; Mesenteric Artery, Inferior; Peptic Ulcer Hemorrhage; Duodenum; Gastrointestinal Hemorrhage; Mesenteric Artery, Superior; Embolization, Therapeutic
PubMed: 37933022
DOI: 10.1097/MD.0000000000035955 -
Revista Espanola de Enfermedades... Nov 2023Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or...
Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or imaging tests as they are small and asymptomatic. In the case of symptomatic tumors, resection of the lesion is indicated. In lesions ≤2 cm, endoscopic resection can be chosen, reserving surgery for larger lesions or endoscopically inaccessible ones. We present the case of a patient with a history of vomiting and hyporexia of months of evolution who presented peptic ulcer perforation and underwent surgery. During follow-up, she presented intestinal obstruction due to pyloric stenosis. Given the impossibility of ruling out a neoplastic process with certainty in diagnostic tests, surgical resection (antrectomy) was decided with an anatomopathological finding of Brunner's gland hyperplasia.
Topics: Female; Humans; Hyperplasia; Brunner Glands; Duodenal Diseases; Intestinal Obstruction; Duodenum
PubMed: 36896921
DOI: 10.17235/reed.2023.9538/2023 -
European Journal of Pharmaceutical... Jul 2024Anaprazole sodium enteric-coated tablet is a novel proton pump inhibitor which has been approved for the treatment of duodenal ulcer. The aim of this study is to provide...
Anaprazole sodium enteric-coated tablet is a novel proton pump inhibitor which has been approved for the treatment of duodenal ulcer. The aim of this study is to provide reliable information for the design of an optimal dosage regimen. Population pharmacokinetics and exposure-response models were integrated to evaluate the pharmacokinetic parameters and covariates of Anaprazole and its metabolite M21-1, and subsequently provided dosage suggestions based on clinical trials and simulation data. A pharmacokinetic model incorporating two-compartment for the parent drug and one-compartment for the metabolite, with both first-order and zero-order mixed absorption was used to describe the pharmacokinetics of Anaprazole and M21-1. Age emerged as a significant covariate affecting the elimination rate constant of M21-1, with clearance decreasing as age advances. No correlation was observed between the pharmacokinetics of Anaprazole or M21-1 and the adverse reactions under the current dosages. BMI might be the influence factor of the mild gastrointestinal adverse reactions. Meanwhile, Anaprazole had a good healing rate (94.0 %) in duodenal ulcer patients and the exposure-response analysis indicated that the cured results were not influenced by the exposure parameters of parent drug or metabolite. In conclusion, the drug is safe when dosing between 20 and 100 mg once a day.
Topics: Humans; Duodenal Ulcer; Male; Middle Aged; Adult; Female; Models, Biological; Aged; 2-Pyridinylmethylsulfinylbenzimidazoles; Proton Pump Inhibitors; Young Adult; Adolescent; Dose-Response Relationship, Drug
PubMed: 38703917
DOI: 10.1016/j.ejps.2024.106781 -
VideoGIE : An Official Video Journal of... May 2024Video 1Management of an acute perforated duodenal ulcer.
Video 1Management of an acute perforated duodenal ulcer.
PubMed: 38766398
DOI: 10.1016/j.vgie.2024.01.006 -
Langenbeck's Archives of Surgery Apr 2024The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer. (Observational Study)
Observational Study
PURPOSE
The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer.
METHODS
A prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated.
RESULTS
Sixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up.
CONCLUSION
This study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.
Topics: Humans; Male; Female; Middle Aged; Prospective Studies; Aged; Biopsy; Adult; Gastric Mucosa; Aged, 80 and over; Gastroscopy; Stomach Neoplasms; Stomach Rupture
PubMed: 38676744
DOI: 10.1007/s00423-024-03325-9 -
GE Portuguese Journal of... Nov 2023Tuberculosis remains a public health concern in developing countries, as well as in developed countries as a result of immigration from endemic areas. Gastroduodenal and...
INTRODUCTION
Tuberculosis remains a public health concern in developing countries, as well as in developed countries as a result of immigration from endemic areas. Gastroduodenal and colorectal tuberculosis are rare manifestations of gastrointestinal infection.
CASE PRESENTATION
We present 2 cases of gastric, duodenal, and colorectal tuberculosis. The first case, a 17-year-old male with no medical record, presented with chronic diarrhea and abdominal pain. At endoscopy, he had multiple ulcers in the stomach, colon, and rectum, which were positive to . The second case was a 43-year-old HIV-positive male, with a history of intermittent fever, nausea, and vomiting. Upper gastrointestinal endoscopy revealed a deep ulcer on gastric fundus that tested positive to in the acid-fast bacilli staining.
DISCUSSION/CONCLUSION
Gastroduodenal and colorectal tuberculosis, although rare, should be considered in the differential diagnosis in both immunosuppressed and immunocompetent patients. An adequate tissue sample and appropriate diagnostic tests are essential for the diagnosis and prompt start of first-line antituberculosis agents.
PubMed: 38020816
DOI: 10.1159/000527203 -
BMC Gastroenterology Feb 2024A number of observational studies indicate that insomnia is linked to inflammatory digestive diseases (IDDs). However, the definite relationship between insomnia and...
BACKGROUND
A number of observational studies indicate that insomnia is linked to inflammatory digestive diseases (IDDs). However, the definite relationship between insomnia and IDDs remains unclear.
METHODS
We obtained the publicly available data from genome-wide association studies (GWAS) to conduct two-sample Mendelian randomization (MR) for association assessment. Five MR analysis methods were used to calculate the odds ratio (OR) and effect estimate, and the heterogeneity and pleiotropy tests were performed to evaluate the robustness of the variable instruments (IVs).
RESULTS
One exposure and twenty outcome datasets based on European populations were included in this study. Using the inverse variance weighted method, we found insomnia was closely correlated with esophageal ulcer (OR = 1.011, 95%CI = 1.004-1.017, p = 0.001) and abdominal pain (effect estimate = 1.016, 95%CI = 1.005-1.026, p = 0.003). Suggestive evidence of a positively association was observed between insomnia and duodenal ulcer (OR = 1.006, 95%CI = 1.002-1.011, p = 0.009), gastric ulcer (OR = 1.008, 95%CI = 1.001-1.014, p = 0.013), rectal polyp (OR = 1.005, 95%CI = 1.000-1.010, p = 0.034), haemorrhoidal disease (OR = 1.242, 95%CI = 1.004-1.535, p = 0.045) and monocyte percentage (effect estimate = 1.151, 95%CI = 1.028-1.288, p = 0.014). No correlations were observed among other IDDs, phenotypes and biomarkers.
CONCLUSIONS
Our MR study assessed the relationship between insomnia and IDDs/phenotypes/biomarkers in depth and revealed potential associations between insomnia and ulcers of the esophagus and abdominal pain.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Genome-Wide Association Study; Mendelian Randomization Analysis; Intestinal Diseases; Biomarkers; Abdominal Pain
PubMed: 38383296
DOI: 10.1186/s12876-024-03173-3 -
Frontiers in Pharmacology 2023This study aimed to develop a population pharmacokinetic (PopPK) model of ilaprazole in healthy subjects and patients with duodenal ulcer in Chinese and investigate the...
This study aimed to develop a population pharmacokinetic (PopPK) model of ilaprazole in healthy subjects and patients with duodenal ulcer in Chinese and investigate the effect of potential covariates on pharmacokinetic (PK) parameters. Pharmacokinetic data from 4 phase I clinical trials and 1 phase IIa clinical trial of ilaprazole were included in PopPK analysis. Phoenix NLME 8.3 was used to establish a PopPK model and quantify the effects of covariate, such as demographic data, biochemical indicators and disease state on the PK parameters of ilaprazole. The final model was evaluated by goodness-of-fit plots, bootstrap analysis, and visual predictive check. A two-compartment model with first-order elimination successfully described the pharmacokinetic properties of ilaprazole. In the final PopPK model, body weight and sex were identified as statistically significant covariates for volume of peripheral compartment (V) and clearance of central compartment (CL), respectively, and disease status was also screened as a significant covariate affecting both CL and V. The validation results demonstrated the good predictability of the model, which was accurate and reliable. This is the first population pharmacokinetics study of ilaprazole in the Chinese, and the PopPK model developed in this study is expected to be helpful in providing relevant PK parameters and covariates information for further studies of ilaprazole.
PubMed: 38269273
DOI: 10.3389/fphar.2023.1306222 -
Experimental and Clinical... Mar 2024Donor safety is paramount in living donor liver transplantation. However, there remains a risk of postoperative complications for some donors. Here, we provide a... (Comparative Study)
Comparative Study
OBJECTIVES
Donor safety is paramount in living donor liver transplantation. However, there remains a risk of postoperative complications for some donors. Here, we provide a comprehensive assessment of donor morbidity by a single team with 17 years of experience at a single center.
MATERIALS AND METHODS
We retrospectively reviewed 453 donor hepatectomies of living donor liver transplants at Kumamoto University from August 2000 to March 2017. Posterior segment graft cases were excluded in this study.
RESULTS
The donors were classified by graft type as follows: right lobe (n = 173), left lobe (n = 149), and left lateral segment (n = 131). The overall complication rate was 29.8%, and the severe complication (Clavien-Dindo grade IIIa or higher) rate was 9.1%. The most frequent complication was bile leakage, with an overall incidence of 13.9% and severe incidence of 4.6%. Among the 3 types of graft, there were no significant differences in bile leakage with any Clavien-Dindo grade. However, upper gastrointestinal complications, such as a duodenal ulcer and gastric stasis, were related to left lobe donation.
CONCLUSIONS
There were no significant differences in the incidence of postoperative donor complications, except upper gastrointestinal complications, among the 3 types of graft.
Topics: Humans; Living Donors; Retrospective Studies; Liver Transplantation; Hepatectomy; Female; Male; Japan; Risk Factors; Treatment Outcome; Adult; Time Factors; Middle Aged; Incidence; Postoperative Complications; Young Adult; Risk Assessment
PubMed: 38695591
DOI: 10.6002/ect.2024.0026 -
Clinical and Translational Radiation... Jul 2023To examine the role of proton beam therapy (PBT) in the treatment of extrahepatic biliary tract cancer (EBC).
BACKGROUND AND PURPOSE
To examine the role of proton beam therapy (PBT) in the treatment of extrahepatic biliary tract cancer (EBC).
METHODS AND MATERIALS
We analyzed the data accumulated in the Proton-Net database, which prospectively registered all individual patient data treated with PBT in all Japanese proton institutions from May 2016 to June 2019. The primary endpoint was overall survival (OS), and the secondary endpoints were local control (LC), progression-free survival (PFS), and toxicity.
RESULTS
Ninety-three patients with unresectable and/or recurrent EBC were treated with PBT using a median prescribed dose of 67.5 Gy (RBE) (range, 50-72.6 Gy) in 25 (22-30 fractions). With a median follow-up of 16.3 months, the median survival time was 20.1 months and the 2-year OS was 37.8%. Two-year PFS and LC rates were 20.6% and 66.5%, respectively. Poor liver function (Child-Pugh B, C), a narrower distance between the tumor and digestive tract (2 cm >), and a larger tumor diameter (2 cm <) were identified as poor prognostic factors for OS. PBT-related grade 3 ≤ acute and late adverse events occurred in 5.4% and 4.3% of patients, respectively, including one gastrointestinal late toxicity (duodenal ulcer).
CONCLUSIONS
This is the largest prospectively accumulated series of PBT for EBC, and PBT showed favorable outcomes with acceptable toxicity profiles.
PubMed: 37234735
DOI: 10.1016/j.ctro.2023.100634