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Current Opinion in Gastroenterology Nov 2015Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge... (Review)
Review
PURPOSE OF REVIEW
Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge holds the prospect that targeted therapy may more optimally manage subsets of these patients with functional dyspepsia.
RECENT FINDINGS
An understanding of gut-to-brain and brain-to-gut pathways in functional dyspepsia is expanding. Minimal mucosal inflammation with eosinophils (and in some cases mast cells) characterized by ultrastructural changes in the duodenum appears to be present in a substantial subgroup of functional dyspepsia patients as identified now by investigators globally. Although antibiotic therapy targeting Helicobacter pylori appears to be effective in a small proportion of functional dyspepsia patients, eradication therapy may be more effective in functional dyspepsia patients with microscopic duodenal inflammation, a potentially important finding needing to be confirmed. This may suggest that the effects of antibiotics for functional dyspepsia are not simply mediated by the eradication of gastric H. pylori, but have other antibacterial effects (e.g., on the duodenal microbiome). Abnormal visceral sensory function plays a key role not only in the manifestations of functional dyspepsia but also in peptic ulcer disease.
SUMMARY
The pathophysiologic concepts underlying functional dyspepsia and related treatment approaches are shifting from a focus on H. pylori, acid suppression or modulation of motility toward new models. New evidence suggests that minimal duodenal inflammation plays a role in symptom generation in at least a proportion of patients with otherwise unexplained symptoms. This is a paradigm shift and ultimately may change the treatment of many patients with functional gastrointestinal disorders.
Topics: Anti-Bacterial Agents; Duodenitis; Dyspepsia; Endoscopy, Gastrointestinal; Environment; Gastrointestinal Diseases; Genetic Predisposition to Disease; Helicobacter Infections; Helicobacter pylori; Humans; Risk Factors
PubMed: 26444826
DOI: 10.1097/MOG.0000000000000219 -
Journal of Cystic Fibrosis : Official... Jul 2013In cystic fibrosis (CF) patients a duodenal impaired bicarbonate secretion and unbuffered gastric acid are always described and the development of duodenal ulceration is...
BACKGROUND
In cystic fibrosis (CF) patients a duodenal impaired bicarbonate secretion and unbuffered gastric acid are always described and the development of duodenal ulceration is uncommon (CF paradox). Helicobacter pylori (HP) infection is the main cause for duodenal ulceration and its prevalence in CF patients is controversial.
AIM
The objective of this study is to evaluate HP prevalence, gastric histology, and duodenal ulceration in adult FC patients.
METHODS
32 adult CF patients were submitted to (13)C-urea breath test and serum immunoblotting test for HP diagnosis. Among them, 20 patients were submitted to endoscopy.
RESULTS
19/32 (68%) patients showed positive serology. Endoscopy showed erosive duodenitis (15%), and duodenal ulcer scar in 10%. On duodenal histology, 94.5%, showed active inflammation and 66.7% gastric metaplasia.
CONCLUSION
HP infection prevalence in adult CF patients was similar to that of general Brazilian population. CF patients have all the duodenal spectrum of alterations, including duodenal ulcer. CF paradox may not exist.
Topics: Adolescent; Adult; Aged; Cystic Fibrosis; Duodenal Ulcer; Duodenitis; Endoscopy, Gastrointestinal; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Prevalence; Young Adult
PubMed: 23206871
DOI: 10.1016/j.jcf.2012.11.001 -
Brazilian Journal of Medical and... Jul 2007Whether the regression of gastric metaplasia in the duodenum can be achieved after eradication of Helicobacter pylori is not clear. The aim of the present study was to...
Whether the regression of gastric metaplasia in the duodenum can be achieved after eradication of Helicobacter pylori is not clear. The aim of the present study was to investigate the relationship between H. pylori infection and gastric metaplasia in patients with endoscopic diffuse nodular duodenitis. Eighty-six patients with endoscopically confirmed nodular duodenitis and 40 control patients with normal duodenal appearance were investigated. The H. pylori-positive patients with duodenitis received anti-H. pylori triple therapy (20 mg omeprazole plus 250 mg clarithromycin and 400 mg metronidazole, all twice daily) for one week. A control endoscopy was performed 6 months after H. pylori treatment. The H. pylori-negative patients with duodenitis received 20 mg omeprazole once daily for 6 months and a control endoscopy was performed 2 weeks after treatment. The prevalence of H. pylori infection was 58.1%, and the prevalence of gastric metaplasia was 57.0%. Seventy-six patients underwent endoscopy again. No influence on the endoscopic appearance of nodular duodenitis was found after eradication of H. pylori or acid suppression therapy. However, gastric metaplasia significantly decreased and complete regression was achieved in 15/28 patients (53.6%) 6 months after eradication of H. pylori, accompanied by significant improvement of other histological alterations. Only mild chronic inflammation, but not gastric metaplasia, was found in the control group, none with H. pylori infection in the duodenal bulb. Therefore, H. pylori infection is related to the extent of gastric metaplasia in the duodenum, but not to the presence of diffuse nodular duodenitis.
Topics: Adult; Aged; Case-Control Studies; Chronic Disease; Clarithromycin; Drug Therapy, Combination; Duodenitis; Duodenoscopy; Duodenum; Female; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metaplasia; Metronidazole; Middle Aged; Omeprazole; Severity of Illness Index
PubMed: 17653441
DOI: 10.1590/s0100-879x2006005000117 -
Digestive Diseases and Sciences Apr 2012To evaluate the microscopic histopathological changes in duodenal tissue and its relationship to the severity of symptoms in patients with functional dyspepsia while...
AIM
To evaluate the microscopic histopathological changes in duodenal tissue and its relationship to the severity of symptoms in patients with functional dyspepsia while taking the effect of Helicobacter pylori (H. pylori) infection into account.
METHODS
Several gastric and duodenal biopsy specimens were obtained in 217 patients with functional dyspepsia and were evaluated for H. pylori infection and histopathological changes. Severity of symptoms was assessed by Leeds Dyspepsia Questionnaire (LDQ) and its relationship to histopathological changes and H. pylori infection status was assessed.
RESULTS
Helicobacter pylori infection was associated with presence and severity of microscopic duodenitis (p < 0.001). In H. pylori-infected patients, the presence of microscopic duodenitis was independent of microscopic gastritis (p = 0.74). Severity of dyspepsia symptoms was not higher in H. pylori-infected patients than non-infected patients (p = 0.15), but in the presence of H. pylori infection and microscopic gastritis, microscopic duodenitis significantly worsened the LDQ symptom severity score (p < 0.001). In multivariate analysis, the odds of experiencing severe symptoms in patients with severe microscopic duodenitis was 2.22 times greater than in individuals with very mild, mild, or moderate duodenitis.
CONCLUSIONS
Microscopic duodenitis in H. pylori-infected patients may play a major role in producing and aggravating symptoms in FD patients and may be a determinant factor to consider in whether to treat H. pylori infection in functional dyspepsia.
Topics: Adolescent; Adult; Aged; Duodenitis; Duodenum; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Stomach; Young Adult
PubMed: 22080417
DOI: 10.1007/s10620-011-1960-z -
The Canadian Veterinary Journal = La... May 2018Duodenitis-proximal jejunitis (DPJ) is an inflammatory process of the proximal part of the small intestine and occurs sporadically in horses. It is clinically... (Review)
Review
Duodenitis-proximal jejunitis (DPJ) is an inflammatory process of the proximal part of the small intestine and occurs sporadically in horses. It is clinically characterized by an acute onset of ileus and nasogastric reflux leading to systemic signs of toxemia. This review discusses the definition of the disease, potential etiologic agents, clinical findings, epidemiological features, histopathologic and clinico-pathological findings, and medical management of this condition. spp., mycotoxins, and have all been associated with the disease but there is limited supporting evidence for any agent other than Particular attention, however, was given to etiological investigations and the data available to support the proposed etiological agents. The potential role of as the etiological agent of DPJ, possible pathogenesis, and recent efforts to support this hypothesis are highlighted, but it is recognized that there could be more than one agent that causes the disease.
Topics: Animals; Bacteria; Bacterial Infections; Duodenitis; Horse Diseases; Horses; Jejunal Diseases
PubMed: 29904204
DOI: No ID Found -
Gut Jun 2003There is no direct evidence for an animal model of Helicobacter pylori induced duodenal ulcer.
BACKGROUND
There is no direct evidence for an animal model of Helicobacter pylori induced duodenal ulcer.
AIM
In this study we evaluated the roles of bacterial strain and age of experimental animals in induction of duodenitis and duodenal ulcer in Mongolian gerbils after H pylori infection.
METHODS
Specific pathogen free Mongolian gerbils were inoculated orally with three bacterial strains (H pylori ATCC 43504, TN2GF4, and K-6, a clinical isolate from a patient with gastric cancer in our clinic). These strains have both the cagA gene and VacA. Five week old gerbils were used to emulate prematurity infection and 14 week old animals were used as mature test subjects. Animals were observed for 12 weeks after inoculation. Interleukin 8 (IL-8) production in gastric epithelial cells (MKN74) after coculture with the H pylori strains was measured by ELISA.
RESULTS
Gastritis and gastric ulcers were found in all gerbils infected with the three strains. However, duodenitis and gastric metaplasia were seen more frequently in gerbils infected with TN2GF4 and K-6 strains than in the ATCC 43504 infected or control groups (p<0.05). Superficial duodenal ulcers with severe duodenitis and gastric metaplasia were found in two gerbils inoculated at 14 weeks with the TN2GF4 strain but none at five weeks. The TN2GF4 strain stimulated significantly higher levels of IL-8 than ATCC 43504 and K6 strains (p=0.0039).
CONCLUSIONS
When injected into adult Mongolian gerbils, a specific strain (TN2GF4) of H pylori can induce duodenitis with gastric metaplasia and superficial duodenal ulcers. Induction of duodenal ulcer in an animal model fulfills the requirements of Koch's postulates for establishing a role for H pylori as a causative agent.
Topics: Age Factors; Animals; Coculture Techniques; Disease Models, Animal; Duodenal Ulcer; Duodenitis; Gastric Mucosa; Gerbillinae; Helicobacter Infections; Helicobacter pylori; Interleukin-8; Male; Metaplasia
PubMed: 12740333
DOI: 10.1136/gut.52.6.797 -
World Journal of Gastroenterology Oct 2006The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have... (Review)
Review
The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured, have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease, and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur. Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.
Topics: Case-Control Studies; Duodenal Ulcer; Duodenum; Gastric Acid; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Mucosa; Prevalence; Recurrence
PubMed: 17072972
DOI: 10.3748/wjg.v12.i40.6413 -
Scandinavian Journal of... 1991Helicobacter pylori is a unique pathogen and the leading cause of chronic gastric inflammation. For many individuals the organism is of low virulence, causing only mild... (Review)
Review
Helicobacter pylori is a unique pathogen and the leading cause of chronic gastric inflammation. For many individuals the organism is of low virulence, causing only mild inflammation and generating few, if any, dyspeptic symptoms. For those with more severe inflammation, H. pylori infection may be causal in the generation of dyspeptic symptoms. H. pylori infection appears to be the dominant factor in peptic ulcer disease. Events considered to be of importance are a disturbed gastrin homeostasis and the development of gastric metaplasia in the bulb. The most important argument in support of the dominant role of H. pylori in duodenal ulcer disease is the markedly reduced ulcer relapse after successful eradication. Eradication proves to be difficult, presumably because of the peculiar habitat of the organism. Currently the best pharmacologic approach is triple therapy, combining a bismuth salt, metronidazole, and amoxycillin or tetracycline.
Topics: Chronic Disease; Duodenitis; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer
PubMed: 1775918
DOI: 10.3109/00365529109098219 -
Revista Clinica Espanola Apr 1995Biopsy samples obtained by endoscopy to diagnose infection by H. pylori usually come from the antral region. Nevertheless, there are few reports documenting the... (Comparative Study)
Comparative Study
Biopsy samples obtained by endoscopy to diagnose infection by H. pylori usually come from the antral region. Nevertheless, there are few reports documenting the prevalence of infection at duodenal level. OBJECTIVE. To investigate the prevalence of H. pylori infection in duodenal bulb in different endoscopic diagnosis. METHODS. 331 patients with the following endoscopic diagnosis were studied: normal appearance (n = 55), gastritis (87), gastric ulcer (49), duodenal ulcer (120), and duodenitis (20). At endoscopy, different samples from duodenal bulb were obtained (apart from gastric fundus, body and antrum), which were processed for microbiology (Gram stain and culture) and histology (hematoxilin-eosin). RESULTS. Patients with duodenal ulcer or duodenitis had the highest H. pylori infection rate at duodenal bulb (47.7% and 65%, respectively). Differences were significant when compared with normal appearance (14.5%; p < 0.001) and gastritis (25%; p < 0.05). In all patients with H. pylori at duodenal bulb this organism was also detected at antral region. CONCLUSIONS. 1) The highest prevalence rates for H. pylori infection in duodenal bulb were found in patients with duodenal ulcer or duodenitis. 2) Diagnosis of H. pylori infection should not be based on the duodenal bulb samples alone, as this sample yields high false-negative results.
Topics: Adult; Aged; Biopsy; Duodenal Diseases; Duodenoscopy; Duodenum; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Prevalence; Spain
PubMed: 7784655
DOI: No ID Found -
Journal of the International... 2017Helminthic infection and HIV have been reported to coexist, particularly in sub-Saharan African patients living with HIV. Strongyloidiasis is one of the most common...
Helminthic infection and HIV have been reported to coexist, particularly in sub-Saharan African patients living with HIV. Strongyloidiasis is one of the most common helminths, usually leading to cutaneous and gastrointestinal (GI) symptoms. In the immunocompromised host, this infection can lead to strongyloidiasis hyperinfection syndrome (SHS), not common in HIV-infected patients. Immune reconstitution inflammatory syndrome (IRIS) can follow the initiation of antiretroviral therapy (ART), with a variety of presentations. The authors present here a 32-year-old HIV-infected female who was recently diagnosed with AIDS, started ART, and recovered from SHS. Her upper endoscopy revealed severe duodenitis but no causal agent per biopsy or stool examination. After receiving symptomatic therapy, she showed improvement, a course of events that fit the diagnosis of GI-related IRIS.
Topics: AIDS-Related Opportunistic Infections; Adult; Anti-Retroviral Agents; Duodenum; Female; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Strongyloidiasis
PubMed: 27733639
DOI: 10.1177/2325957416673149