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Alimentary Pharmacology & Therapeutics Apr 2023Functional dyspepsia (FD) is one of the most frequent conditions in gastroenterological outpatient health care. Most recent research in FD has shifted its focus to... (Review)
Review
BACKGROUND
Functional dyspepsia (FD) is one of the most frequent conditions in gastroenterological outpatient health care. Most recent research in FD has shifted its focus to duodenal pathophysiological mechanisms, although current treatments still focus mainly the stomach.
AIM
The aim of the study was to provide a comprehensive overview of the pathophysiology of FD focusing on a paradigm shift from gastric towards duodenal mechanisms.
METHODS
We conducted a literature search in PubMed for studies describing mechanisms that could possibly cause FD.
RESULTS
The pathophysiology of FD remains incompletely understood. Recent studies show that duodenal factors such as acid, bile salt exposure and eosinophil and mast cell activation correlate with symptom pattern and burden and can be associated with gastric sensorimotor dysfunction. The evolving data identify the duodenum an interesting target for new therapeutic approaches. Furthermore, the current first-line treatment, that is proton pump inhibitors, reduces duodenal low-grade inflammation and FD symptoms.
CONCLUSION
Future research for the treatment of FD should focus on the inhibition of duodenal mast cell activation, eosinophilia and loss of mucosal integrity.
Topics: Humans; Dyspepsia; Duodenal Diseases; Duodenum; Eosinophilia; Eosinophils
PubMed: 36859629
DOI: 10.1111/apt.17414 -
Abdominal Radiology (New York) May 2020Groove or paraduodenal pancreatitis is an uncommon fibroinflammatory form of pancreatitis involving the anatomic space of the pancreatic groove located between the... (Review)
Review
Groove or paraduodenal pancreatitis is an uncommon fibroinflammatory form of pancreatitis involving the anatomic space of the pancreatic groove located between the C-loop of the duodenum and the head of the pancreas. Although in some patients there are distinctive clinical and imaging features of groove pancreatitis (GP), there is often significant overlap with other infiltrative processes involving the pancreatic groove such as pancreatic ductal adenocarcinoma or duodenal carcinoma. In this review, we summarize the most distinctive clinical and imaging aspects of GP and highlight some important distinguishing features that may aid in differentiating malignant lesions involving the pancreatic groove.
Topics: Carcinoma, Pancreatic Ductal; Diagnosis, Differential; Duodenal Diseases; Duodenal Neoplasms; Humans; Pancreatic Neoplasms; Pancreatitis, Chronic
PubMed: 31559471
DOI: 10.1007/s00261-019-02239-1 -
Digestive Endoscopy : Official Journal... Jul 2022Although post-bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the...
BACKGROUND
Although post-bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs).
METHODS
Data on duodenal ulcers with evidence of endoscopically-active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in-hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses.
RESULTS
Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically-confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in-hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in-hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs.
CONCLUSION
This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.
Topics: Duodenal Ulcer; Hemostasis, Endoscopic; Humans; Peptic Ulcer Hemorrhage; Recurrence; Retrospective Studies; Treatment Outcome; Ulcer
PubMed: 34609030
DOI: 10.1111/den.14160 -
Digestive and Liver Disease : Official... Sep 2019
Topics: Duodenal Diseases; Endosonography; Female; Humans; Lymphangiectasis, Intestinal; Middle Aged
PubMed: 31253488
DOI: 10.1016/j.dld.2019.05.037 -
Digestive Diseases and Sciences Apr 2023We describe the case of a 76-year-old woman with a spontaneous nephroduodenal fistula. The patient was initially evaluated for gastrointestinal and urinary symptoms... (Review)
Review
We describe the case of a 76-year-old woman with a spontaneous nephroduodenal fistula. The patient was initially evaluated for gastrointestinal and urinary symptoms associated with fever and anemia, after which she was admitted with the diagnosis of right chronic pyelonephritis, hydronephrosis, and renal lithiasis. The fistula was diagnosed incidentally by percutaneous pyelography during a right nephrostomy and was later confirmed with an abdominal CT scan. A multidisciplinary decision was made to surgically treat the fistula (right nephrectomy plus duodenal repair); the surgery had a short-term positive outcome. We report a systematic review of the literature related to spontaneous pyeloduodenal fistulæ and their treatments.
Topics: Female; Humans; Aged; Urinary Fistula; Intestinal Fistula; Duodenal Diseases; Duodenum; Nephrectomy
PubMed: 36805907
DOI: 10.1007/s10620-023-07828-1 -
Expert Review of Gastroenterology &... 2023Well-differentiated gastric, duodenal, and rectal neuroendocrine neoplasms (NETs) are rare diseases usually managed by endoscopic treatment. Although several endoscopic... (Review)
Review
INTRODUCTION
Well-differentiated gastric, duodenal, and rectal neuroendocrine neoplasms (NETs) are rare diseases usually managed by endoscopic treatment. Although several endoscopic techniques are available, the number of patients with incomplete (R1) resection is significant.
AREAS COVERED
This review focuses on the meaning of incomplete R1 findings after endoscopic resection in type I gastric NETs; nonfunctioning, non-ampullary duodenal NETs; and small rectal NETs. Data were identified by MEDLINE database search without publication date limitation.
EXPERT OPINION
An incomplete R1 finding may have no significant impact on a patient's clinical outcome, particularly in small G1 type I gastric NETs, which have an indolent course. A 'stepwise approach,' which uses more advanced endoscopic techniques, or minimally invasive surgery may be justified to achieve complete margin-free resection. This approach must balance the tumor features and the procedure-related risk of complications, particularly in the duodenum, where the role of deep endoscopic resections is limited due to the thin duodenal wall. Gastric and rectal NETs that are incompletely removed after initial resection are more easily amenable to deep endoscopic techniques. However, this might not be necessary for patients with comorbidities, elderly, or both due to the uncertainty of how R1 finding impacts a patient's clinical outcome.
Topics: Humans; Aged; Neuroendocrine Tumors; Duodenal Neoplasms; Endoscopy; Stomach Neoplasms; Endoscopic Mucosal Resection; Rectal Neoplasms; Treatment Outcome; Retrospective Studies
PubMed: 37497604
DOI: 10.1080/17474124.2023.2242261 -
Cancer Causes & Control : CCC Apr 2020Studies suggest that peptic ulcer and periodontal disease are positively associated with bladder cancer risk. These two factors are likely to share common biologic...
PURPOSE
Studies suggest that peptic ulcer and periodontal disease are positively associated with bladder cancer risk. These two factors are likely to share common biologic mechanisms such as inflammation and dysbiosis. We examined the joint association of peptic ulcer (gastric/duodenal) and periodontal disease on bladder cancer risk.
METHODS
We conducted a prospective analysis among 45,185 men (563 invasive bladder cancer cases) in the Health Professionals Follow-Up Study (follow-up 1986-2016). History of ulcer and periodontal disease was self-reported at baseline and updated during the follow-up. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI) for the joint associations of ulcers (gastric, duodenal) and periodontal disease, adjusting for age and other potential confounders. We tested for interaction using the Wald test for product terms.
RESULTS
Compared with men having no history of ulcer and periodontal disease, men with a history of peptic ulcer only (HR 1.22, 95% CI 0.90-1.66) and men with a history of periodontal disease only (HR 1.19, 95% CI 0.98-1.46) were associated with higher risk of invasive bladder cancer. The highest bladder cancer risk was observed in men with a history of both peptic ulcer and periodontal disease (HR 1.52, 95% CI 1.05-2.20). Similar results were found when we stratified by ulcer types. The interactions between ulcer and periodontal disease were not statistically significant for all ulcer types (p-interaction ≥ 0.59).
CONCLUSION
We did not find sufficient evidence for interaction between gastric/duodenal ulcers and periodontal disease on bladder cancer risk.
Topics: Aged; Duodenal Ulcer; Follow-Up Studies; Humans; Male; Middle Aged; Peptic Ulcer; Periodontal Diseases; Proportional Hazards Models; Prospective Studies; Risk; United States; Urinary Bladder Neoplasms
PubMed: 32060837
DOI: 10.1007/s10552-020-01274-4 -
Clinical Radiology Apr 2022Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through... (Review)
Review
Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through herniation of the internal layers of the bowel wall through the muscularis propria. Peri-ampullary duodenal diverticula are a well-recognised example; however, the importance of more distal SBD in the jejunum and ileum is underappreciated, and they are under-reported on cross-sectional imaging. SBD are a known cause of anaemia, malabsorption, and diarrhoea, and there are myriad complications of SBD and Meckel's diverticula, which range in severity from inflammation and perforation to haemorrhage, tumour formation, and obstruction. Before the advent of computed tomography (CT), SBD were readily diagnosed on fluoroscopic oral contrast studies; however, radiologists are less comfortable with their cross-sectional imaging appearances. This imaging review combines our experience of multiple proven cases, with illustrative diagrams and radiological images of SBD to provide distinct imaging characteristics, allowing for confident diagnosis of SBD and their numerous complications. We discuss the importance of SBD as a cause of benign, non-surgical pneumoperitoneum. We additionally provide important pitfalls to be aware of such as SBD masquerading as other abnormalities.
Topics: Diverticulum; Duodenal Diseases; Humans; Ileum; Intestine, Small; Jejunum; Tomography, X-Ray Computed
PubMed: 35012738
DOI: 10.1016/j.crad.2021.12.003 -
Digestive Diseases and Sciences Jul 2022We report a case of a 73-year-old woman affected by Lemmel's syndrome, a rare type of obstructive jaundice caused by a periampullary duodenal diverticulum. The patient...
We report a case of a 73-year-old woman affected by Lemmel's syndrome, a rare type of obstructive jaundice caused by a periampullary duodenal diverticulum. The patient was admitted to the Emergency Department for pneumonia associated with mild epigastric pain and vomiting. While hospitalized for antibiotic treatment, the appearance of jaundice led us to discover a periampullary duodenal diverticulum by endoscopy and CT scan. The jaundice was successfully managed endoscopically with removal of food debris from the diverticulum.
Topics: Abdominal Pain; Aged; Diverticulum; Duodenal Diseases; Female; Humans; Jaundice; Jaundice, Obstructive; Syndrome
PubMed: 35650417
DOI: 10.1007/s10620-022-07571-z -
American Journal of Surgery Mar 2021Duodenal complications of necrotizing pancreatitis (NP) are challenging and understudied. We sought to characterize the demographics and clinical course of NP patients...
BACKGROUND
Duodenal complications of necrotizing pancreatitis (NP) are challenging and understudied. We sought to characterize the demographics and clinical course of NP patients with duodenal complications.
METHODS
Single institution retrospective review of 687 NP patients treated from 2005 to 2018.
RESULTS
Duodenal complications developed in 40 (6%) patients including fistula in 11 (2%) and stricture in 29 (4%) patients. Patients with duodenal complications had increased computed tomography severity index (CTSI), degree of glandular necrosis, organ failure, infected necrosis, and disease duration. Mortality from NP was increased in patients with duodenal fistula (36%) compared to patients with duodenal stricture (7%) and patients without duodenal complications (9%). Surgical management of duodenal complications was required in 9/11 (82%) patients with fistula and 17/29 (59%) patients with stricture.
CONCLUSIONS
Duodenal complications occurred in 6% of necrotizing pancreatitis patients. Sixty five percent of patients with duodenal complications required surgical correction. Duodenal fistula was associated with increased mortality.
Topics: Adult; Aged; Duodenal Diseases; Female; Humans; Incidence; Intestinal Fistula; Intestinal Obstruction; Male; Middle Aged; Pancreatitis, Acute Necrotizing; Postoperative Complications; Retrospective Studies; Survival Rate
PubMed: 33218676
DOI: 10.1016/j.amjsurg.2020.11.022