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Gut Sep 2015To present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2)... (Review)
Review
OBJECTIVE
To present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2) clinical distinction of dyspepsia caused by Helicobacter pylori from functional dyspepsia, (3) appropriate diagnostic assessment of gastritis and (4) when, whom and how to treat H. pylori gastritis.
DESIGN
Twenty-three clinical questions addressing the above-mentioned four domains were drafted for which expert panels were asked to formulate relevant statements. A Delphi method using an anonymous electronic system was adopted to develop the consensus, the level of which was predefined as ≥80%. Final modifications of clinical questions and consensus were achieved at the face-to-face meeting in Kyoto.
RESULTS
All 24 statements for 22 clinical questions after extensive modifications and omission of one clinical question were achieved with a consensus level of >80%. To better organise classification of gastritis and duodenitis based on aetiology, a new classification of gastritis and duodenitis is recommended for the 11th international classification. A new category of H. pylori-associated dyspepsia together with a diagnostic algorithm was proposed. The adoption of grading systems for gastric cancer risk stratification, and modern image-enhancing endoscopy for the diagnosis of gastritis, were recommended. Treatment to eradicate H. pylori infection before preneoplastic changes develop, if feasible, was recommended to minimise the risk of more serious complications of the infection.
CONCLUSIONS
A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.
Topics: Anti-Bacterial Agents; Consensus; Duodenitis; Gastritis; Global Health; Helicobacter Infections; Helicobacter pylori; Humans; International Classification of Diseases; Internationality; Japan; Practice Guidelines as Topic; Surveys and Questionnaires
PubMed: 26187502
DOI: 10.1136/gutjnl-2015-309252 -
Journal of Internal Medicine Mar 1992
Review
Topics: Drug Therapy, Combination; Duodenal Ulcer; Duodenitis; Helicobacter Infections; Helicobacter pylori; Humans
PubMed: 1556517
DOI: 10.1111/j.1365-2796.1992.tb00524.x -
Current Opinion in Gastroenterology Nov 2016Functional dyspepsia affects 10% of the population. Emerging data are beginning to unravel the pathogenesis of this heterogeneous disorder, and new data on treatment are... (Review)
Review
PURPOSE OF REVIEW
Functional dyspepsia affects 10% of the population. Emerging data are beginning to unravel the pathogenesis of this heterogeneous disorder, and new data on treatment are helping to guide evidence-based practice. In this review, the latest advances are summarized and discussed.
RECENT FINDINGS
The Rome IV criteria were published in 2016 and are similar to Rome III but further emphasize the subtypes (postprandial distress syndrome and epigastric pain syndrome) rather than focussing on the syndrome as a whole, and conclude that gastroesophageal reflux disease and irritable bowel syndrome are part of the functional dyspepsia spectrum. Environment is dominant in the pathogenesis. New data implicate herbivore pets and antibiotic exposure for a nongastrointestinal infection but require confirmation. Further experimental data suggest duodenal eosinophils and mast cells can alter enteric neuronal structure and function in functional dyspepsia.
SUMMARY
Advances in our understanding of functional dyspepsia are changing clinical practice.
Topics: Bacterial Infections; Diet; Duodenitis; Dyspepsia; Gastrointestinal Agents; Humans
PubMed: 27540688
DOI: 10.1097/MOG.0000000000000306 -
Annals of Diagnostic Pathology Dec 2020Mycobacterium avium-intracellulare complex (MAIC) is a nontuberculous opportunistic infection in immunocompromised patients. Involvement of the gastrointestinal tract...
Mycobacterium avium-intracellulare complex (MAIC) is a nontuberculous opportunistic infection in immunocompromised patients. Involvement of the gastrointestinal tract (GIT) is usually part of a disseminated disease in AIDS patients with a low CD4 count, however with standard antiretroviral therapy (ART), a localized presentation is more likely. It can affect any part of the GIT, mostly the duodenum and typically as patches. Incomplete or refractory ART for HIV-strains, therapy-related side effects, noncompliant or incomplete treatment to previous MAIC infections, superimposed complications and comorbid opportunistic infections may result in atypical clinical, endoscopic and histopathologic manifestations. We performed a retrospective review study retrieving cases of MAIC in duodenal endoscopic biopsy. We found five cases of MAIC in HIV/AIDS patients. They were males with an average age of 40-years. They showed different histopathologic features, variable patterns of MAIC-histiocytic infiltrates, and varying intensity of intracellular acid-fast positive bacilli. Enterocytes vacuolization and transepithelial elimination were also observed. Three cases were associated with cytomegalovirus and cryptococcal infections. A case was complicated by lymphangiectasia-associated protein-losing enteropathy. Initially, three cases were morphologically missed. Ziehl-Neelsen stain helped reach the correct diagnosis. Pathologists have an important role in patients' management by guiding clinicians to the correct diagnosis. Pathologists should be aware of these different histopathologic manifestations, their potential pitfalls, look for certain helpful clues complemented with multiple levels and special stains. In particular, AFB stains are mandatory in all mucosal biopsy specimens from HIV/AIDS patients regardless of their appearances.
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; Adult; Duodenum; Endoscopy, Digestive System; HIV Infections; Humans; Male; Mycobacterium avium-intracellulare Infection; Retrospective Studies
PubMed: 33069083
DOI: 10.1016/j.anndiagpath.2020.151638 -
Digestive Diseases and Sciences Nov 2008A low curability of ulcers infected with Candida has been reported in the literature. The aim of the study reported here was to investigate experimentally whether...
A low curability of ulcers infected with Candida has been reported in the literature. The aim of the study reported here was to investigate experimentally whether Candida infection affects the healing of ulcers. Candida albicans (the Candida group) or saline (the control group) was administered intragastrically into rats with a cysteamine-induced duodenal ulcer. The duodenal lesions, vascular endothelial growth factor A (VEGF-A) and proliferating cell nuclear antigen (PCNA) were assessed. On Day 7 post-administration, 70.4% rats of the Candida group had a duodenal ulcer compared with 33.3% in the control group (P < 0.05). The duodenal ulcer in the Candida group was significantly larger and deeper than that in the control group. The number of VEGF-A- and PCNA-positive cells was smaller and the area of VEGF-A expression was lower in the Candida group. Using a rat model, we have demonstrated that Candida infection can delay the wound healing process of duodenal ulcers by means of a low expression of VEGF-A and PCNA.
Topics: Animals; Candida albicans; Candidiasis; Cysteamine; Disease Models, Animal; Duodenal Ulcer; Duodenum; Male; Proliferating Cell Nuclear Antigen; Rats; Rats, Wistar; Time Factors; Vascular Endothelial Growth Factor A; Wound Healing
PubMed: 18622701
DOI: 10.1007/s10620-008-0385-9 -
Journal of Clinical Pathology Aug 2021Evaluate the rate and significance of () involving duodenal foveolar metaplasia of chronic peptic duodenitis (CPD).
AIMS
Evaluate the rate and significance of () involving duodenal foveolar metaplasia of chronic peptic duodenitis (CPD).
METHODS
We identified 100 biopsy cases of CPD with synchronous stomach biopsies. All 200 were reviewed for histological changes (eg, chronic gastritis, acute inflammation) and underwent immunohistochemical staining for . Results were correlated with patient age, sex, endoscopy indication and findings on stomach biopsy.
RESULTS
Cases included 49 men and 51 women, with a median age of 56 years. Reflux or dysphagia was the most common symptom. Chronic gastritis was present in 46 stomach biopsies, with 54 within normal limits. Twelve stomach biopsies showed , all of which showed gastritis. Two duodenal biopsies (2%) demonstrated organisms on immunohistochemistry, both from patients with gastritis.
CONCLUSIONS
Routine examination of CPD samples for appears unnecessary if a stomach biopsy is available for review.
Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Duodenitis; Duodenum; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metaplasia; Middle Aged; Stomach; Young Adult
PubMed: 32934104
DOI: 10.1136/jclinpath-2020-206844 -
Endoscopy Feb 1994
Topics: Animals; Duodenitis; Humans; Intestinal Diseases, Parasitic; Male; Middle Aged; Strongyloides stercoralis; Strongyloidiasis
PubMed: 8026386
DOI: 10.1055/s-2007-1008965 -
The Journal of Infection Dec 2007After a large waterborne outbreak of Giardia infection in Bergen, some patients experienced persisting abdominal symptoms despite metronidazole treatment. This study...
OBJECTIVES
After a large waterborne outbreak of Giardia infection in Bergen, some patients experienced persisting abdominal symptoms despite metronidazole treatment. This study aimed at investigating possible causes for their symptoms.
METHODS
Over a 15 month period, 124 referred patients were evaluated in a prospective cohort analysis with a standardised investigation including duodenal biopsies and aspirate, blood tests and faecal parasite and calprotectin tests. Recovered subjects were recruited for symptom analysis.
RESULTS
Persisting Giardia duodenalis infection was found in 40 patients (32.3%). Duodenal biopsies showed signs of inflammation in 57 patients (47.1%). Microscopic duodenal inflammation was present in 34 (87.2%) of the Giardia positive and 23 (28.0%) of the Giardia negative patients. There were significant associations between persistent Giardia positivity, microscopic duodenal inflammation and a positive calprotectin test. Duodenal aspirate and duodenal biopsies performed poorly in diagnosis of persistent giardiasis.
CONCLUSIONS
In patients with persisting symptoms after metronidazole treated Giardia infection we commonly found chronic Giardia infection and microscopic duodenal inflammation, especially in illness duration less than 7 months. Both these findings subsided over time. Increasingly, investigations could not determine a definite cause for the persistent symptoms. The very long-term post-giardiasis diarrhoea, bloating, nausea and abdominal pain documented here need further study.
Topics: Animals; Biopsy; Cohort Studies; Disease Outbreaks; Duodenitis; Duodenoscopy; Duodenum; Feces; Giardia; Giardiasis; Humans; Inflammation; Metronidazole; Prospective Studies
PubMed: 17964658
DOI: 10.1016/j.jinf.2007.09.004 -
Journal of Clinical Pathology Nov 2006The introduction of endoscopy of the upper digestive tract as a routine diagnostic procedure has increased the number of duodenal biopsy specimens. Consequently, the... (Review)
Review
The introduction of endoscopy of the upper digestive tract as a routine diagnostic procedure has increased the number of duodenal biopsy specimens. Consequently, the pathologist is often asked to evaluate them. In this review, a practical approach to the evaluation of a duodenal biopsy specimen is discussed. An overview of the handling of specimens is given and the normal histology and commonly encountered diseases are discussed. Finally, a description of commonly seen infections is provided, together with an algorithmic approach for diagnosis.
Topics: Algorithms; Biopsy; Celiac Disease; Diagnosis, Differential; Duodenal Diseases; Duodenitis; Duodenum; Humans; Infections; Intestinal Mucosa
PubMed: 16679353
DOI: 10.1136/jcp.2005.031260 -
Infection Oct 2022Duodenal involvement in COVID-19 is poorly studied. Aim was to describe clinical and histopathological characteristics of critically ill COVID-19 patients suffering from...
PURPOSE
Duodenal involvement in COVID-19 is poorly studied. Aim was to describe clinical and histopathological characteristics of critically ill COVID-19 patients suffering from severe duodenitis that causes a significant bleeding and/or gastrointestinal dysmotility.
METHODS
In 51 critically ill patients suffering from SARS-CoV-2 pneumonia, severe upper intestinal bleeding and/or gastric feeding intolerance were indications for upper gastrointestinal endoscopy. Duodenitis was diagnosed according to macroscopic signs and mucosal biopsies. Immunohistochemistry was performed to detect viral specific protein and ACE2. In situ hybridization was applied to confirm viral replication.
RESULTS
Nine of 51 critically ill patients (18%) suffering from SARS-CoV-2 pneumonia had developed upper GI bleeding complications and/or high gastric reflux. Five of them presented with minor and four (44%) with severe duodenitis. In two patients, erosions had caused severe gastrointestinal bleeding requiring PRBC transfusions. Immunohistochemical staining for SARS-CoV-2 spike protein was positive inside duodenal enterocytes in three of four patients suffering from severe duodenitis. Viral replication could be confirmed by in situ hybridization.
CONCLUSION
Our data suggest that about 8% of critically ill COVID-19 patients may develop a severe duodenitis presumably associated with a direct infection of the duodenal enterocytes by SARS-CoV-2. Clinical consequences from severe bleeding and/or upper gastrointestinal dysmotility seem to be underestimated.
Topics: Angiotensin-Converting Enzyme 2; COVID-19; Critical Illness; Duodenitis; Humans; Infant, Newborn; SARS-CoV-2; Spike Glycoprotein, Coronavirus; Tropism
PubMed: 35182354
DOI: 10.1007/s15010-022-01769-z