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Gut Mar 2004The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most...
BACKGROUND
The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most polyposis patients.
AIMS
To describe the long term natural history of duodenal adenomatosis in FAP and evaluate if cancer prophylactic surveillance of the duodenum is indicated.
METHODS
A prospective five nation study was carried out in the Nordic countries and the Netherlands.
PATIENTS
A total of 368 patients were examined by gastroduodenoscopy at two year intervals during the period 1990-2001.
RESULTS
At the first endoscopy, 238 (65%) patients had duodenal adenomas at a median age of 38 years. Median follow up was 7.6 years. The cumulative incidence of adenomatosis at age 70 years was 90% (95% confidence interval (CI) 79-100%), and of Spigelman stage IV 52% (95% CI 28-76%). The probability of an advanced Spigelman score increased during the study period (p<0.0001) due to an increasing number and size of adenomas. Two patients had asymptomatic duodenal carcinoma at their first endoscopy while four developed carcinoma during the study at a median age of 52 years (range 26-58). The cumulative incidence rate of cancer was 4.5% at age 57 years (95% CI 0.1-8.9%) and the risk was higher in patients with Spigelman stage IV at their first endoscopy than in those with stages 0-III (p<0.01).
CONCLUSIONS
The natural course of duodenal adenomatosis has now been described in detail. The high incidence and increasing severity of duodenal adenomatosis with age justifies prophylactic examination, and a programme is presented for upper gastrointestinal endoscopic surveillance.
Topics: Adenomatous Polyposis Coli; Adolescent; Adult; Aged; Child; Disease Progression; Duodenal Diseases; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Intestinal Polyposis; Male; Middle Aged; Neoplasm Staging; Population Surveillance; Prospective Studies
PubMed: 14960520
DOI: 10.1136/gut.2003.027771 -
American Journal of Surgery Jan 1996Surgical management of distal duodenal pathology is challenging because of the duodenum's retroperitoneal location and its shared blood supply with the pancreas. For...
BACKGROUND
Surgical management of distal duodenal pathology is challenging because of the duodenum's retroperitoneal location and its shared blood supply with the pancreas. For infra-ampullary pathology, surgical treatment may include local excision, pancreaticoduodenectomy, or pancreas-sparing duodenectomy (PSD).
PATIENTS AND METHODS
We retrospectively reviewed the management of 24 patients with infra-ampullary duodenal pathology treated by PSD between 1985 and 1994 at The Johns Hopkins Hospital.
RESULTS
There were 16 men and 8 women with a mean age of 51.2 +/- 4.4 years. The indications for elective PSD in 19 patients were neoplasms (n = 15), Crohn's disease (n = 2), and other (n = 2). Of the neoplasms, 13 were malignant (11 adenocarcinoma, 1 lymphoma, 1 liposarcoma) and 2 were being (1 villous adenoma, 1 benign stromal tumor). Five patients had PSD as an emergency procedure for penetrating trauma. The mean follow-up is 24.2 +/- 5.8 months (range 1 to 122). In the group undergoing elective PSD, the mean length of operation was 5.3 +/- 0.4 hours, and the estimated blood loss was 569 +/- 121 mL. In the entire series, there was 1 postoperative death from an anastomotic leak and 1 reexploration for anastomotic bleeding. Pancreas-sparing duodenectomy in patients with trauma or benign duodenal pathology resulted in a good outcome in all. In those 11 patients with duodenal adenocarcinoma, 7 have died, 2 have had recurrences, and 2 are disease free. Actuarial and disease-free, 2-year survival rates in the 11 patients with duodenal adenocarcinoma were 33% and 14%, respectively.
CONCLUSIONS
Pancreas-sparing duodenectomy is a safe and effective treatment in patients with distal duodenal benign neoplasms or trauma, and PSD appears to have limited effectiveness for malignant distal duodenal pathology.
Topics: Ampulla of Vater; Anastomosis, Surgical; Blood Loss, Surgical; Crohn Disease; Duodenal Diseases; Duodenal Neoplasms; Duodenum; Emergencies; Female; Humans; Male; Methods; Middle Aged; Postoperative Complications; Retrospective Studies
PubMed: 8554153
DOI: 10.1016/S0002-9610(99)80075-0 -
British Medical Journal Dec 1965
Topics: Duodenal Diseases; Duodenal Ulcer; Dyspepsia; Humans; Inflammation
PubMed: 5850462
DOI: No ID Found -
Chang Gung Medical Journal Sep 2002Secondary aortoenteric fistula (SAF) is now recognized as an uncommon but exceedingly important complication of abdominal aortic reconstruction. The complication often...
Secondary aortoenteric fistula (SAF) is now recognized as an uncommon but exceedingly important complication of abdominal aortic reconstruction. The complication often occurs months to years after the original surgery. The main clinical manifestation of the disease is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. The mortality is high if no prompt operation. We present a case of secondary aortoduodenal fistula (SADF) found 20 days after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. Even immediate exploratory laparotomy was performed, the patient died 48 hrs after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with SAF will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life-threatening event.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Diseases; Duodenal Diseases; Humans; Intestinal Fistula; Male; Postoperative Complications; Vascular Fistula
PubMed: 12479626
DOI: No ID Found -
Journal of Korean Medical Science Jul 2012We assessed whether the presence of juxtapapillary duodenal diverticula (JPDD) risks biliary stone disease and recurrence. In total, 695 patients who underwent ERCP were...
We assessed whether the presence of juxtapapillary duodenal diverticula (JPDD) risks biliary stone disease and recurrence. In total, 695 patients who underwent ERCP were divided into two groups: biliary stone disease (group I, n = 523) and non-stone biliary diseases (group II, n = 172). Additionally, for a control group (group III), 80 age-matched healthy subjects underwent side-view duodenoscopy. In group I, rates of post-ERCP pancreatitis, cannulation failure, and disease recurrence in two-year follow up were compared according to the presence of JPDD. In results, the incidence of JPDD in group I (42.4%) was significantly higher than in group II (16.3%) and III (18.8%). The frequencies of JPDD were increased with age in all groups, and reached statistical significance in group I. In group I, rates of post-ERCP pancreatitis were significantly higher in patients with JPDD (18.5%) compared to JPDD negative (12.6%). The cannulation failure rate was also higher in patients with JPDD (9.9%) compared to JPDD negative (5.3%). Recurrence rate was higher in patients with JPDD (25.3%) compared to JPDD negative (9.2%). In conclusion, JPDD develops with aging and risks biliary stone formation. JPDD also seems to be associated with post-ERCP pancreatitis, cannulation failure and biliary stone recurrence.
Topics: Adult; Age Factors; Aged; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis; Diverticulum; Duodenal Diseases; Duodenoscopy; Female; Follow-Up Studies; Gallstones; Humans; Incidence; Male; Middle Aged; Pancreatitis; Recurrence; Risk Factors; Sphincterotomy, Endoscopic
PubMed: 22787373
DOI: 10.3346/jkms.2012.27.7.772 -
Medicine Dec 2014The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare... (Review)
Review
The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare entity, there are only 5 reports showing invasive giardiasis. A pediatric female patient with chronic abdominal pain, diarrhea, or pasty stools, without fever, was seen in the Gastroenterology and Nutrition Service. The stool studies were negative for pathogens and lactose hydrogen breath test was positive. The presumptive clinical diagnosis was giardiasis and the patient was empirically treated with nitazoxanide. But, the patient persisted with abdominal pain and pasty stools. Endoscopy was indicated to search for Helicobacter and Giardia. Guardian and patient gave written informed consent. Hematological profile was normal. The endoscopy was performed under general anesthesia and the biopsies and duodenal aspirate were obtained. The microscopic analyses of duodenal fluid showed Giardia trophozoites. Electron microscopic analysis was negative for Helicobacter pylori, but Giardia trophozoites with a typical crescent shape within the tissue were found. The patient was treated with tinidazole, subsequent tests showed that lactose absorption was normal, stool examinations were negative for Giardia and abdominal pain had stopped. This case suggest that intraepithelial giardiasis could be a common entity but unseen because the giardiasis diagnosis is usually made on fecal samples. Future studies are necessary to determine the role of intraepithelial trophozoites in giardiasis pathogenic mechanisms.
Topics: Child; Duodenal Diseases; Endoscopy, Gastrointestinal; Female; Giardiasis; Humans; Intestinal Mucosa; Microscopy, Electron
PubMed: 25546671
DOI: 10.1097/MD.0000000000000277 -
Jornal Brasileiro de Nefrologia 2018The incidence of gastrointestinal disorders among patients with chronic kidney disease (CKD) is high, despite the lack of a good correlation between endoscopic findings...
INTRODUCTION
The incidence of gastrointestinal disorders among patients with chronic kidney disease (CKD) is high, despite the lack of a good correlation between endoscopic findings and symptoms. Many services thus perform upper gastrointestinal (UGI) endoscopy on kidney transplant candidates.
OBJECTIVES
This study aims to describe the alterations seen on the upper endoscopies of 96 kidney-transplant candidates seen from 2014 to 2015.
METHODS
Ninety-six CKD patients underwent upper endoscopic examination as part of the preparation to receive kidney grafts. The data collected from the patients' medical records were charted on Microsoft Office Excel 2016 and presented descriptively. Mean values, medians, interquartile ranges and 95% confidence intervals of the clinic and epidemiological variables were calculated. Possible associations between endoscopic findings and infection by H. pylori were studied.
RESULTS
Males accounted for 54.17% of the 96 patients included in the study. Median age and time on dialysis were 50 years and 50 months, respectively. The most frequent upper endoscopy finding was enanthematous pangastritis (57.30%), followed by erosive esophagitis (30.20%). Gastric intestinal metaplasia and peptic ulcer were found in 8.33% and 7.30% of the patients, respectively. H. pylori tests were positive in 49 patients, and H. pylori infection was correlated only with non-erosive esophagitis (P = 0.046).
CONCLUSION
Abnormal upper endoscopy findings were detected in all studied patients. This study suggested that upper endoscopy is a valid procedure for kidney transplant candidates. However, prospective studies are needed to shed more light on this matter.
Topics: Adult; Cross-Sectional Studies; Duodenal Diseases; Endoscopy, Gastrointestinal; Esophageal Diseases; Female; Humans; Kidney Transplantation; Male; Middle Aged; Renal Insufficiency, Chronic; Stomach Diseases
PubMed: 29771269
DOI: 10.1590/2175-8239-JBN-3829 -
Brazilian Journal of Medical and... Jul 2006Ureases are enzymes from plants, fungi and bacteria that catalyze the hydrolysis of urea to form ammonia and carbon dioxide. While fungal and plant ureases are... (Review)
Review
Ureases are enzymes from plants, fungi and bacteria that catalyze the hydrolysis of urea to form ammonia and carbon dioxide. While fungal and plant ureases are homo-oligomers of 90-kDa subunits, bacterial ureases are multimers of two or three subunit complexes. We showed that some isoforms of jack bean urease, canatoxin and the classical urease, bind to glycoconjugates and induce platelet aggregation. Canatoxin also promotes release of histamine from mast cells, insulin from pancreatic cells and neurotransmitters from brain synaptosomes. In vivo it induces rat paw edema and neutrophil chemotaxis. These effects are independent of ureolytic activity and require activation of eicosanoid metabolism and calcium channels. Helicobacter pylori, a Gram-negative bacterium that colonizes the human stomach mucosa, causes gastric ulcers and cancer by a mechanism that is not understood. H. pylori produces factors that damage gastric epithelial cells, such as the vacuolating cytotoxin VacA, the cytotoxin-associated protein CagA, and a urease (up to 10% of bacterial protein) that neutralizes the acidic medium permitting its survival in the stomach. H. pylori whole cells or extracts of its water-soluble proteins promote inflammation, activate neutrophils and induce the release of cytokines. In this paper we review data from the literature suggesting that H. pylori urease displays many of the biological activities observed for jack bean ureases and show that bacterial ureases have a secretagogue effect modulated by eicosanoid metabolites through lipoxygenase pathways. These findings could be relevant to the elucidation of the role of urease in the pathogenesis of the gastrointestinal disease caused by H. pylori.
Topics: Animals; Canavalia; Dose-Response Relationship, Drug; Duodenal Diseases; Eicosanoids; Helicobacter Infections; Helicobacter pylori; Humans; Plant Proteins; Stomach Diseases; Toxins, Biological; Urease
PubMed: 16862275
DOI: 10.1590/s0100-879x2006000700002 -
Internal Medicine (Tokyo, Japan) Nov 2023A 59-year-old woman presented with a chief complaint of melena. She had no abdominal findings, such as tenderness or tapping pain. Laboratory tests revealed a white...
A 59-year-old woman presented with a chief complaint of melena. She had no abdominal findings, such as tenderness or tapping pain. Laboratory tests revealed a white blood cell count of 5,300 cells/μL and C-reactive protein level of 0.07 mg/dL. Inflammation and anemia (hemoglobin 12.4 g/dL) were denied. Contrast-enhanced computed tomography (CT) revealed multiple duodenal diverticula and air surrounding a descending duodenal diverticulum. Based on these findings, duodenal diverticular perforation (DDP) was suspected. Oral food intake was stopped, and nasogastric tube feeding and conservative treatment with cefmetazole, lansoprazole, and ulinastatin were begun. On day 8 of hospitalization, follow-up CT revealed the disappearance of the air surrounding the duodenum, and the patient was discharged on day 19 after the resumption of oral feeding.
Topics: Female; Humans; Middle Aged; Duodenal Diseases; Intestinal Perforation; Duodenum; Diverticulum; Conservative Treatment
PubMed: 36948615
DOI: 10.2169/internalmedicine.1211-22 -
Revista Espanola de Enfermedades... Feb 2018Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract....
BACKGROUND
Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract. The aim of the current study was to evaluate the incidence of gastroduodenal abnormalities during small bowel capsule endoscopy and its impact on patient diagnosis and management.
PATIENTS AND METHODS
This study is a retrospective analysis of data from 2,217 consecutive capsule endoscopy procedures performed at a single tertiary-care center between January 2008 and February 2016. Patient baseline characteristics, gastroduodenal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed.
RESULTS
Two thousands and two hundred seventeen patients were finally included in the analysis. One thousand and seventy patients were male (48.2%) and the mean age was 56.1 ± 19.5 years (range: 12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Gastroduodenal abnormalities were detected by capsule endoscopy in 696 (31.4%) of 2,217 patients. The most common types of missed gastric and duodenal lesions found were gastric erosions (35.4%), findings suggestive of chronic gastritis (22.9%), duodenal erosions (28.1%) and duodenal erythema (23.5%). This information had a clinical or diagnostic impact of 26.2% and a therapeutic impact of 15.5%.
CONCLUSION
Capsule endoscopy detects not only small bowel lesions but also some gastroduodenal lesions that may be overlooked during an initial gastroscopy. Therefore, all gastroduodenal images should be read during small bowel capsule endoscopy as it may provide relevant information that result in changes in patient management.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Capsule Endoscopy; Child; Duodenal Diseases; Female; Gastroscopy; Humans; Incidence; Male; Middle Aged; Peptic Ulcer; Retrospective Studies; Stomach Diseases; Young Adult
PubMed: 29152990
DOI: 10.17235/reed.2017.5114/2017