-
Current Medical Imaging 2022Diverticula are commonly observed in the duodenum. Duodenal Diverticulum (DD) usually does not give symptoms throughout life and is diagnosed by coincidence. However, it... (Observational Study)
Observational Study
BACKGROUND
Diverticula are commonly observed in the duodenum. Duodenal Diverticulum (DD) usually does not give symptoms throughout life and is diagnosed by coincidence. However, it may present with different symptoms in patients.
OBJECTIVE
This study aims to evaluate the prevalence of DD and Juxtapapillary Duodenal Diverticulum (JDD) and its association with other possible pathologies and to determine its clinical impact by using Computed Tomography (CT).
METHODS
This retrospective observational study, which was taken consecutively between the years of 2013-2020, was evaluated in the Radiology Department. The total number of cases was 4850 (male-2440; female-2410). CT images were evaluated by two experienced radiologists at the workstation. DD and JDD prevalence and clinical findings in the hospital registry system were examined.
RESULTS
The age of the patients included in the study ranged from 17 to 92 years (mean age 46.94±16.42). In patients with DD (female-130; male-101), mean age was 62.24 ± 12.69 (21-92). The prevalence of DD was 4.76% (n=231). The prevalence of JDD was 4.02% (n=195) and increased with age (p<0.01). The average diameter of the JDD was measured as 23.29±8.22 (9.5-55.3) mm. A significant positive correlation was found between age and DD diameter (p=0.039). DDs were found most commonly 84.42% (n=195) in the second segment of the duodenum as JDD. In patients with JDD, the mean diameter of choledochus and wirsung canal were 6.7 ± 2.4 (3-15.3) mm and 0.31 ± 0.1 (0.1-6.5) mm respectively. The choledochal diameter was correlated with the JDD size (p = 0.004). Cholelithiasis (n=56), choledocholithiasis (n=20), cholecystitis (n=52), diverticulitis (n=15), duodenitis (n=37), pancreatitis (n=5) and hiatal hernia (n=60) with JDD were observed. Periampullary carcinoma was detected in one patient.
CONCLUSION
Our study shows that cholelithiasis, choledocholithiasis, cholecystitis, diverticulitis, duodenitis, pancreatitis may be associated with JDD. Therefore, in contrast-enhanced abdominal CT scans taken for various reasons, investigation of the presence and characteristics of JDD and detection of pathologies that may be associated with JDD are important for patients to benefit from early diagnosis and treatment opportunities and to take precautions against possible complications.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cholecystitis; Choledocholithiasis; Diverticulitis; Diverticulum; Duodenal Diseases; Duodenitis; Female; Humans; Male; Middle Aged; Pancreatitis; Tomography, X-Ray Computed; Young Adult
PubMed: 34825876
DOI: 10.2174/1573405617666211126153042 -
Chirurgie (Heidelberg, Germany) Sep 2023Recommendations for the use of specific anastomotic techniques are not available in laparoscopic bariatric surgery. Recommendation criteria should consider the rate of... (Review)
Review
BACKGROUND
Recommendations for the use of specific anastomotic techniques are not available in laparoscopic bariatric surgery. Recommendation criteria should consider the rate of insufficiency, bleeding, tendency to stricture or ulceration as well as the impact on weight loss or dumping.
OBJECTIVE
This article gives a review of the available evidence on the anastomotic techniques of typical surgical procedures in laparoscopic bariatric surgery.
MATERIAL AND METHODS
The current literature was reviewed and is discussed regarding anastomotic techniques for Roux-en‑Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), single anastomosis sleeve ileal (SASI) bypass and biliopancreatic diversion with duodenal switch (BPD-DS).
RESULTS
Few comparative studies exist, except for the RYGB. In RYGB gastrojejunostomy, a complete manual suture was shown to be equivalent to a mechanical anastomosis. In addition, the linear staple suture showed slight advantages over the circular stapler in terms of wound infections and bleeding. The anastomosis technique of the OAGB and SASI can be performed entirely with a linear stapler or with suture closure of the anterior wall defect. There seems to be an advantage of manual anastomosis in BPD-DS.
CONCLUSION
Due to the lack of evidence, no recommendations can be made. Only in RYGB was there an advantage of the linear stapler technique with hand closure of the stapler defect compared to the linear stapler. In principle, prospective, randomized studies should be strived for.
Topics: Prospective Studies; Gastrectomy; Duodenum; Gastric Bypass; Bariatric Surgery
PubMed: 37367961
DOI: 10.1007/s00104-023-01907-9 -
Current Opinion in Gastroenterology May 2022Different markers are available to diagnose and monitor celiac disease (CeD); however, the concordance among them and their efficacy are still controversial. We aim at... (Review)
Review
PURPOSE OF REVIEW
Different markers are available to diagnose and monitor celiac disease (CeD); however, the concordance among them and their efficacy are still controversial. We aim at defining the efficacy of CeD biomarkers, their advantages and limits.
RECENT FINDINGS
CeD diagnostic criteria are widely accepted, being a positive serology and duodenal atrophy (according to the Marsh-Oberhuber score) the main hallmarks. Flow cytometry and other molecular biomarkers support the diagnosis of refractory CeD. On the other side, CeD monitoring is less defined, as the biomarkers are not always reliable. To date, the reference standard to detect mucosal healing is represented by duodenal histology, but its timing and significance are debated. Novel scores may better define the trend of mucosal damage and MicroRNAs are among the innovative noninvasive biomarkers. The assessment of a correct gluten-free diet (GFD) is another aspect of CeD monitoring, based upon questionnaires and recently developed tools such as dosage of urinary or faecal gluten immunogenic peptides.
SUMMARY
Clinicians lack of a widely acknowledged tools to monitor CeD and GFD. Here, we present the efficacy of the most used markers.
Topics: Biomarkers; Celiac Disease; Diet, Gluten-Free; Duodenum; Glutens; Humans
PubMed: 35645020
DOI: 10.1097/MOG.0000000000000825 -
Endocrine Practice : Official Journal... Jan 2023After a high-fat and high-sugar diet, the duodenal mucosa of rodents proliferate and trigger the signal of insulin resistance, which may be the cause of type 2 diabetes... (Review)
Review
OBJECTIVE
After a high-fat and high-sugar diet, the duodenal mucosa of rodents proliferate and trigger the signal of insulin resistance, which may be the cause of type 2 diabetes (T2D). In response to this phenomenon, researchers have designed the duodenal mucosal resurfacing (DMR) procedure, mainly through the hydrothermal ablation procedure, to restore the normal mucosal surface, thereby correcting this abnormal metabolic signal. This article aims to understand the changes in duodenum before and after the onset or treatment of T2D, and the potential mechanisms of DMR procedure.
METHODS
A literature search of PubMed and Web of Science was conducted using appropriate keywords.
RESULTS
Both animal and clinical studies have shown that the villus thickness, intestinal cells, glucose transporters, enteric nerves, and gut microbiota and their metabolites in the duodenum undergo corresponding changes before and after the onset or treatment of T2D. These changes may be related to the pathogenesis of T2D. DMR procedure may produce beneficial glycemic and hepatic metabolic effects by regulating these changes.
CONCLUSION
The duodenum is an important metabolic signaling center, and limiting nutrient exposure to this critical region will have powerful metabolic benefits. The DMR procedure may regulate glycemic and hepatic parameters through various mechanisms, which needs to be further confirmed by a large number of animal and clinical studies.
Topics: Animals; Diabetes Mellitus, Type 2; Blood Glucose; Duodenum; Insulin Resistance; Liver
PubMed: 36309189
DOI: 10.1016/j.eprac.2022.10.177 -
Digestive Diseases and Sciences Aug 2023The small intestinal bacterial overgrowth (SIBO) in acute pancreatitis correlates with the severity of the disease. However, corresponding studies on the microbial...
OBJECTIVE
The small intestinal bacterial overgrowth (SIBO) in acute pancreatitis correlates with the severity of the disease. However, corresponding studies on the microbial composition of the duodenal mucosa of patients are uncommon.
METHODS
Duodenal mucosal biopsies were collected by gastroscopy from 16 patients with mild acute pancreatitis (the Ap group) and 16 healthy individuals (the control group) and subjected to histological studies as well as bacterial 16S rRNA gene sequencing. Caerulein and L-arginine were used to induce mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP) in mice, respectively, and their pancreas and duodenum were collected for histological studies.
RESULTS
H&E analysis displayed no significant pathological damage in the descending duodenum of patients with acute pancreatitis compared with that of the controls. Immunofluorescence and Real-time PCR revealed that the expressions of tight junction proteins (TJPs) in duodenal mucosa were decreased in acute pancreatitis. The results of the alpha diversity analysis revealed no significant difference between the two groups, while LEfSe and the random forest revealed a few differences, indicating that the descending duodenum mucosal microbiota changed slightly in patients with mild acute pancreatitis. We observed the pathological changes and the expression of TJPs in the duodenum in the three groups of mice and found that SAP mice had more severe pathological damage in the duodenum. Furthermore, the expression of TJPs in the duodenum was lower in the MAP and SAP groups of mice compared to control mice, but it was similar in both groups.
CONCLUSION
Patients with mild acute pancreatitis had mild duodenal barrier dysfunction and slight changes in duodenal mucosal microbiota.
Topics: Humans; Acute Disease; RNA, Ribosomal, 16S; Pancreatitis; Duodenum; Intestinal Mucosa; Tight Junction Proteins; Microbiota
PubMed: 37258979
DOI: 10.1007/s10620-023-07948-8 -
The American Surgeon Apr 2023Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal...
BACKGROUND
Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center.
METHODS
A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted.
RESULTS
After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy.
CONCLUSION
Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.
Topics: Humans; Male; Adult; Female; Retrospective Studies; Duodenum; Duodenal Diseases; Abdominal Injuries; Wounds, Nonpenetrating; Hematoma
PubMed: 33596103
DOI: 10.1177/0003134821995054 -
Annual International Conference of the... Jul 2023The primary function of the duodenum is to undertake chemical digestion by ensuring that the partially digested food received from the stomach is well-mixed with the...
The primary function of the duodenum is to undertake chemical digestion by ensuring that the partially digested food received from the stomach is well-mixed with the enzymes and chemicals secreted into it. However, little is known about the anatomical variations in the shape of the duodenum within humans, and thus the effect of duodenum shape on the flow and mixing occurring within the lumen has not been studied. In this work, a methodology for analyzing shape variations in the normal duodenal anatomy has been developed and applied to a publicly available dataset of abdominal CT images. This method does not require the placement of landmarks as it is based on the underlying tubular 'C' shape of the duodenum. The average duodenal length and radius of this dataset (consisting of 34 subjects) were 212.8 ± 38 mm and 10.8 ± 2.5 mm respectively. A Principal Component Analysis (PCA) was conducted on a sample of 34 duodenums after normalizing their lengths and the first five principal components were found to contribute to 82 % of the total variation. The first shape component (accounting for 42 % of overall variation) consisted of variations in the radius along the duodenum with no deformations normal to the central plane, and the subsequent shape modes consisted of twists in the centerline either in and out of the central plane, and radial variations at either the inlet or outlet. This is the first study to analyze shape variations in the human duodenum and the results can be combined with flow modeling to analyze the effect of shape on the flow and mixing occurring within the duodenum.Clinical relevance- The methods developed in this study can be used by clinicians to diagnose abnormalities in an individual's duodenum shape.
Topics: Humans; Duodenum; Stomach
PubMed: 38083606
DOI: 10.1109/EMBC40787.2023.10340464 -
Digestive Endoscopy : Official Journal... May 2022
Topics: Duodenal Neoplasms; Duodenum; Endoscopy; Humans; Neoplasms, Glandular and Epithelial
PubMed: 35014079
DOI: 10.1111/den.14215 -
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 -
Human Genetics Aug 2023Leveraging genome-wide association statistics generated from a large study of amyotrophic lateral sclerosis (ALS; 29,612 cases and 122,656 controls) and UK Biobank (UKB;...
Leveraging genome-wide association statistics generated from a large study of amyotrophic lateral sclerosis (ALS; 29,612 cases and 122,656 controls) and UK Biobank (UKB; 4,024 phenotypes, up to 361,194 participants), we conducted a phenome-wide analysis of ALS genetic liability and identified 46 genetically correlated traits, such as fluid intelligence score (r = - 0.21, p = 1.74 × 10), "spending time in pub or social club" (r = 0.24, p = 2.77 × 10), non-work related walking (r = - 0.25, p = 1.95 × 10), college education (r = - 0.15, p = 7.08 × 10), "ever diagnosed with panic attacks (r = 0.39, p = 4.24 × 10), and "self-reported other gastritis including duodenitis" (r = 0.28, p = 1.4 × 10). To assess the putative directionality of these genetic correlations, we conducted a latent causal variable analysis, identifying significant genetic causality proportions (gĉp) linking ALS genetic liability to seven traits. While the genetic component of "self-reported other gastritis including duodenitis" showed a causal effect on ALS (gĉp = 0.50, p = 1.26 × 10), the genetic liability to ALS is potentially causal for multiple traits, also including an effect on "ever being diagnosed with panic attacks" (gĉp = 0.79, p = 5.011 × 10) and inverse effects on "other leisure/social group activities" (gĉp = 0.66, p = 1 × 10) and prospective memory result (gĉp = 0.35, p = 0.005). Our subsequent Mendelian randomization analysis indicated that some of these associations may be due to bidirectional effects. In conclusion, this phenome-wide investigation of ALS polygenic architecture highlights the widespread pleiotropy linking this disorder with several health domains.
Topics: Humans; Amyotrophic Lateral Sclerosis; Genome-Wide Association Study; Duodenitis; Phenotype; Gastritis; Mendelian Randomization Analysis
PubMed: 36773064
DOI: 10.1007/s00439-023-02525-5