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The American Journal of Case Reports Jun 2024BACKGROUND The Over-the-Scope-Clip (OTSC) System is a class of endoscopic clips intended to provide improved strength and tissue capture compared to conventional...
BACKGROUND The Over-the-Scope-Clip (OTSC) System is a class of endoscopic clips intended to provide improved strength and tissue capture compared to conventional through-the-scope clips. These clips are generally safe and effective in managing many gastrointestinal conditions, with a low overall adverse event rate. Although the OTSC has been used to treat gastrointestinal bleeding and bowel perforations for many years, it often is relegated to second-line therapy and has only recently become a first-line hemostatic therapy for gastrointestinal bleeding. CASE REPORT Here, we present a unique adverse event of the OTSC causing iatrogenic ligation of the gastroduodenal artery (GDA). A 71-year-old man presented with 6 months of epigastric abdominal pain and 2 weeks of hematemesis, and was ultimately diagnosed with a bleeding duodenal ulcer. He underwent multiple endoscopic interventions to attempt to control the duodenal ulcer bleeding, including placement of the OTSC on a visible vessel. Soon after OTSC placement, he became hypotensive with recurrent hematochezia, and Interventional Radiology was consulted for endovascular management of the bleeding. Angiography showed the OTSC had been deployed across the midportion of the GDA from the duodenal lumen, effectively ligating the GDA, causing bleeding due to direct vascular injury. This bleeding was ultimately controlled with coil embolization. However, this iatrogenic ligation of the midportion of the GDA by the OTSC significantly complicated endovascular intervention to control the bleeding. CONCLUSIONS As the OTSC device becomes more commonly used in the endoscopy suite, it is important to share potential pitfalls that may be encountered in the clinical setting that impact not only endoscopists and patients, but other specialties as well.
Topics: Humans; Male; Aged; Ligation; Duodenum; Iatrogenic Disease; Surgical Instruments; Gastrointestinal Hemorrhage; Duodenal Ulcer
PubMed: 38853402
DOI: 10.12659/AJCR.943891 -
Endoscopy Dec 2024
The sword in the wall: managing biliary stents embedded in the duodenal wall following ERCP for biliary strictures after liver transplantation in an adult and a pediatric patient.
Topics: Humans; Liver Transplantation; Cholangiopancreatography, Endoscopic Retrograde; Stents; Constriction, Pathologic; Cholestasis; Male; Duodenum; Female; Adult
PubMed: 38848758
DOI: 10.1055/a-2329-2042 -
Acta Medica Portuguesa Jun 2024
Review
Topics: Humans; Male; Cysts; Duodenal Diseases; Duodenum; Middle Aged
PubMed: 38848700
DOI: 10.20344/amp.21273 -
Indian Journal of Pathology &... Jun 2024Helicobacter pylori (H. pylori) colonization affects the gastric microbiome, causing gastrointestinal (GI) diseases. Modern sequencing technology provides insights into...
BACKGROUND/AIM
Helicobacter pylori (H. pylori) colonization affects the gastric microbiome, causing gastrointestinal (GI) diseases. Modern sequencing technology provides insights into GI microbe interaction with H. pylori and their metabolic pathways in causing GI diseases. We aim to compare the gastric microbiota alteration due to H. pylori infection in patients suffering from GI diseases.
MATERIALS AND METHODS
Genomic DNA were isolated from gastric antrum tissue from 37 H.pylori-infected patients diagnosed with GERD, duodenal ulcers, and gastritis. We conducted the genomic library preparation and sequencing of the amplified product using 16S rRNA NGS analysis. Using microbiome analyst tool diversity analysis, random forest analysis and ANOVA were conducted to find out the comparison of microbial abundance. We have also conducted functional pathway prediction analysis using PICRUSt.
RESULTS
Metagenomic analysis shows high bacterial diversity in H. pylori-positive gastritis patients. Streptococcus infantis and Neisseria subflava were significantly higher in duodenal ulcer (DU) and gastritis groups. Acinetobacter lwoffii and Helicobacter pullorum were significantly high in the gastritis group only. The functional metabolic pathway analyses revealed that gastroesophageal reflux disease (GERD) samples were significantly enriched with the energy metabolism and xenobiotic biodegradation and metabolism pathways, whereas fructose-1,6-bisphosphatase III was found less in gastritis and DU groups.
CONCLUSION
There is a difference in microbiota composition in different disease outcomes. We found positive association between microbial diversity and H. pylori in gastritis group only, whereas negative association was found in DU and GERD groups. The functional metabolic pathway analysis revealed significant differences in various disease outcomes.
PubMed: 38847202
DOI: 10.4103/ijpm.ijpm_1015_23 -
Nigerian Journal of Clinical Practice May 2024Imaging is vital for assessing pancreaticobiliary diseases.
BACKGROUND
Imaging is vital for assessing pancreaticobiliary diseases.
AIM
The aim of the study was to investigate the spectrum and pattern of pancreaticobiliary diseases in adult Nigerians using magnetic resonance cholangiopancreatography (MRCP).
METHODS
This was a retrospective, descriptive cross-sectional study. The electronic radiological records of 110 adult Nigerians who had undergone MRCP were reviewed. The MRCP images were evaluated for bile duct dilatation, intraluminal filling defects, strictures, calculi, and other abnormalities.
RESULTS
There were 45 males (40.9%) and 65 females (59.1%) aged 18-83 years, with a mean age of 51.93 ± 15.22 years. Jaundice (59.1%) and right hypochondrial pain (31.8%) were the most common presenting complaints. Gallstones (32.7%), common bile duct strictures (15.5%), choledocholithiasis (11.8%), pancreatic head carcinoma (10.9%), and gallbladder carcinoma (2.7%) were the most frequent abnormalities. There was biliary obstruction in 56.4% of participants, mostly at the distal and proximal common bile duct. Other findings include hepatomegaly (23.6%), hepatic cysts (6.4%), hepatic steatosis (0.9%), duodenal wall thickening (1.8%), and ascites (5.5%). MRCP was normal in 25 (22.7%) participants.
CONCLUSION
Gallstones were the predominant pathology of the various pancreaticobiliary diseases, while Pancreatic head and gallbladder carcinoma were the most common malignant diseases.
Topics: Humans; Male; Female; Middle Aged; Adult; Aged; Cross-Sectional Studies; Retrospective Studies; Cholangiopancreatography, Magnetic Resonance; Nigeria; Aged, 80 and over; Adolescent; Young Adult; Pancreatic Diseases; Biliary Tract Diseases; West African People
PubMed: 38842708
DOI: 10.4103/njcp.njcp_619_23 -
Endoscopy Dec 2024
Topics: Humans; Endoscopic Mucosal Resection; Duodenal Neoplasms; Adenoma; Male; Phenotype; Female; Middle Aged; Gels
PubMed: 38838732
DOI: 10.1055/a-2325-2143 -
GigaScience Jan 2024Hepatic steatosis is the initial manifestation of abnormal liver functions and often leads to liver diseases such as nonalcoholic fatty liver disease in humans and fatty...
Hepatic steatosis is the initial manifestation of abnormal liver functions and often leads to liver diseases such as nonalcoholic fatty liver disease in humans and fatty liver syndrome in animals. In this study, we conducted a comprehensive analysis of a large chicken population consisting of 705 adult hens by combining host genome resequencing; liver transcriptome, proteome, and metabolome analysis; and microbial 16S ribosomal RNA gene sequencing of each gut segment. The results showed the heritability (h2 = 0.25) and duodenal microbiability (m2 = 0.26) of hepatic steatosis were relatively high, indicating a large effect of host genetics and duodenal microbiota on chicken hepatic steatosis. Individuals with hepatic steatosis had low microbiota diversity and a decreased genetic potential to process triglyceride output from hepatocytes, fatty acid β-oxidation activity, and resistance to fatty acid peroxidation. Furthermore, we revealed a molecular network linking host genomic variants (GGA6: 5.59-5.69 Mb), hepatic gene/protein expression (PEMT, phosphatidyl-ethanolamine N-methyltransferase), metabolite abundances (folate, S-adenosylmethionine, homocysteine, phosphatidyl-ethanolamine, and phosphatidylcholine), and duodenal microbes (genus Lactobacillus) to hepatic steatosis, which could provide new insights into the regulatory mechanism of fatty liver development.
Topics: Animals; Chickens; Gastrointestinal Microbiome; Fatty Liver; Liver; Transcriptome; Genome; Metabolome; Poultry Diseases
PubMed: 38837944
DOI: 10.1093/gigascience/giae023 -
Scientific Reports Jun 2024Crohn's disease is an inflammatory condition of the intestine characterized by largely unknown etiology and a relapse remission cycle of disease control. While possible...
Crohn's disease is an inflammatory condition of the intestine characterized by largely unknown etiology and a relapse remission cycle of disease control. While possible triggers have been identified, research is inconsistent on the precise cause of these relapses, especially in the under-researched pediatric population. We hypothesized that patients in remission would have persistent microbial and inflammatory changes in small intestinal tissue that might trigger relapse. To this end, we analyzed intestinal biopsy samples from six patients with pediatric Crohn's disease in remission and a control group of 16 pediatric patients with no evident pathogenic abnormality. We identified compositional microbiota differences, including decreases in the genera Streptococcus and Actinobacillus as well as increases in Oribacterium and Prevotella in patients with controlled Crohn's disease compared to controls. Further, a histologic analysis found that patients with controlled Crohn's disease had increased epithelial integrity, and decreased intraepithelial lymphocytes compared with controls. Additionally, we observed increased peripheral CD4 T cells in patients with pediatric Crohn's disease. These results indicate that markers of intestinal inflammation are responsive to Crohn's disease treatment, however the interventions may not resolve the underlying dysbiosis. These findings suggest that persistent dysbiosis may increase vulnerability to relapse of pediatric Crohn's disease. This study used a nested cohort of patients from the Bangladesh Environmental Enteric Dysfunction (BEED) study (ClinicalTrials.gov ID: NCT02812615 Date of first registration: 24/06/2016).
Topics: Humans; Crohn Disease; Dysbiosis; Female; Male; Child; Adolescent; Gastrointestinal Microbiome; Duodenum; Inflammation; Case-Control Studies
PubMed: 38830904
DOI: 10.1038/s41598-024-63299-y -
Nitric Oxide : Biology and Chemistry Jun 2024Endogenous hydrogen sulfide (HS) plays an important role in bone metabolism. However, the exact role of HS in intestinal calcium and phosphorus absorption and its...
Endogenous hydrogen sulfide (HS) plays an important role in bone metabolism. However, the exact role of HS in intestinal calcium and phosphorus absorption and its potential in preventing and treating primary osteoporosis remains unknown. Therefore, this study aimed to investigate the potential of HS in promoting intestinal calcium and phosphorus absorption and alleviating primary osteoporosis. We measured the apparent absorptivity of calcium, femoral bone density, expression and sulfhydration of the duodenal endoplasmic reticulum protein of 57 kDa (ERp57), duodenal cystathionine γ-lyase (CSE) expression, and serum HS content in adult and old CSE-knockout and wild-type mice. We also assessed intracellular reactive oxygen species (ROS) and Ca content in CSE-overexpressing or knockout intestinal epithelial cell (IEC)-6 cells. In senile mice, CSE knockout decreased endogenous HS, ERp57 sulfhydration, and intestinal calcium absorption and worsened osteoporosis, which were partially reversed by GYY4137, an HS donor. CSE overexpression in IEC-6 cells increased ERp57 sulfhydration, protein kinase A and C activity, and intracellular Ca, whereas CSE knockout exerted the opposite effects. Furthermore, hydrogen peroxide (HO) stimulation had similar effects as in CSE knockout, which were reversed by pretreatment with sodium hydrosulfide before HO stimulation and restored by DL-dithiothreitol. These findings suggest that HS attenuates primary osteoporosis by preventing ROS-induced ERp57 damage in intestinal epithelial cells by enhancing ERp57 activity and promoting intestinal calcium absorption, thereby aiding in developing therapeutic interventions to prevent osteoporosis.
PubMed: 38830571
DOI: 10.1016/j.niox.2024.05.004 -
World Journal of Gastroenterology May 2024Autoimmune enteropathy (AIE) is a rare disease whose diagnosis and long-term prognosis remain challenging, especially for adult AIE patients.
BACKGROUND
Autoimmune enteropathy (AIE) is a rare disease whose diagnosis and long-term prognosis remain challenging, especially for adult AIE patients.
AIM
To improve overall understanding of this disease's diagnosis and prognosis.
METHODS
We retrospectively analyzed the clinical, endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023, whose diagnosis was based on the 2007 diagnostic criteria.
RESULTS
Diarrhea in AIE patients was characterized by secretory diarrhea. The common endoscopic manifestations were edema, villous blunting and mucosal hyperemia in the duodenum and ileum. Villous blunting (100%), deep crypt lymphocytic infiltration (67%), apoptotic bodies (50%), and mild intraepithelial lymphocytosis (69%) were observed in the duodenal biopsies. Moreover, there were other remarkable abnormalities, including reduced or absent goblet cells (duodenum 94%, ileum 62%), reduced or absent Paneth cells (duodenum 94%, ileum 69%) and neutrophil infiltration (duodenum 100%, ileum 69%). Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies. All patients received glucocorticoid therapy as the initial medication, of which 14/16 patients achieved a clinical response in 5 (IQR: 3-20) days. Immunosuppressants were administered to 9 patients with indications of steroid dependence (6/9), steroid refractory status (2/9), or intensified maintenance medication (1/9). During the median of 20.5 months of follow-up, 2 patients died from multiple organ failure, and 1 was diagnosed with non-Hodgkin's lymphoma. The cumulative relapse-free survival rates were 62.5%, 55.6% and 37.0% at 6 months, 12 months and 48 months, respectively.
CONCLUSION
Certain histopathological findings, including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies, might be potential diagnostic criteria for adult AIE. The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications, which highlights the need for early diagnosis and novel medications.
Topics: Humans; Female; Male; Retrospective Studies; Adult; Middle Aged; Prognosis; Biopsy; Glucocorticoids; Polyendocrinopathies, Autoimmune; Ileum; Duodenum; Diarrhea; Intestinal Mucosa; Immunosuppressive Agents; Aged; Young Adult; Endoscopy, Gastrointestinal
PubMed: 38817655
DOI: 10.3748/wjg.v30.i19.2523