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Diagnostic and Interventional Imaging Oct 2017Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However,... (Review)
Review
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
Topics: Adenocarcinoma; Adenoma; Arteriovenous Malformations; Brunner Glands; Choristoma; Diverticulum; Duodenal Diseases; Duodenum; Gastrointestinal Stromal Tumors; Hamartoma; Hemangioma; Humans; Hyperplasia; Intestinal Polyposis; Leiomyoma; Lipoma; Lymphoma; Magnetic Resonance Imaging; Neuroendocrine Tumors; Pancreas; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal
PubMed: 28185840
DOI: 10.1016/j.diii.2017.01.004 -
The Korean Journal of Gastroenterology... Apr 2013Duodenal ulcers occur relatively frequently in adolescents, like in adults, and may relate to Helicobacter pylori infection and duodenal gastric metaplasia (DGM). This...
BACKGROUND/AIMS
Duodenal ulcers occur relatively frequently in adolescents, like in adults, and may relate to Helicobacter pylori infection and duodenal gastric metaplasia (DGM). This study investigated the association between H. pylori infection and DGM in healthy adults aged 20-29.
METHODS
Between 1995 and 2005, endoscopic biopsies of the duodenum, antrum and body were taken from healthy, young volunteers, who were first-year medical students, faculty staff, residents, and research assistants of Gyeongsang National University in Jinju, Korea. Urease tests were performed and the extent of DGM and histopathological grades according to the Updated Sydney System were determined.
RESULTS
In total, 662 subjects were enrolled (429 males and 233 females). The median age was 22.3 years. The overall incidence of DGM was 11.5% but DGM was more frequent in males (15.4%) than in females (4.3%) (p<0.0001). While H. pylori positivity rates changed significantly during the 1995-2005 period (p<0.01), the incidences of DGM did not. DGM was observed in 7.2% and 14.9% of subjects who were and were not colonized with H. pylori, respectively. DGM was also associated with less severe chronic gastritis and the absence of active gastritis in both the antrum and body, and the absence of follicles in the antrum (p<0.05).
CONCLUSIONS
These findings suggested that DGM is not rare in healthy young adults and is unrelated to gastric H. pylori infection.
Topics: Adult; Age Factors; Duodenum; Female; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metaplasia; Pyloric Antrum; Severity of Illness Index; Sex Factors; Young Adult
PubMed: 23624732
DOI: 10.4166/kjg.2013.61.4.191 -
Current Opinion in Gastroenterology Nov 2013To review recent developments in the field of gastroduodenal mucosal defense. (Review)
Review
PURPOSE OF REVIEW
To review recent developments in the field of gastroduodenal mucosal defense.
RECENT FINDINGS
Research in the field of gastroduodenal mucosal defense has focused on continued elucidation of molecular mechanisms that protect the mucosa and influence healing at the cellular level. Review of literature over the past year reveals focus on familiar processes such as superoxide dismutase, nitric oxide, heme oxygenase-1, neutrophil infiltration, cysteamine, mucin, hydrogen sulfide, ghrelin, adiponectin and the influence of Helicobacter pylori, but also brings into light new processes such as the balance between apoptosis and cellular proliferation, as well as the influence of other organ systems such as the bone marrow and central nervous system on the gastrointestinal tract.
SUMMARY
These new published findings contribute to our overall understanding of gastroduodenal defense and suggest innovative avenues of future research and possible novel therapeutic targets.
Topics: Apoptosis; Cell Proliferation; Duodenum; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Hormones; Humans; Inflammation; Intestinal Mucosa; Mesenchymal Stem Cells; Mucins; Oxidative Stress
PubMed: 24100725
DOI: 10.1097/MOG.0b013e328365d42e -
BMC Gastroenterology Feb 2022The purpose of this study was to investigate the diagnosis and treatment experience of traumatic duodenal ruptures in children.
BACKGROUND
The purpose of this study was to investigate the diagnosis and treatment experience of traumatic duodenal ruptures in children.
METHODS
Clinical data were collected from four children suffering from a traumatic duodenal rupture who were admitted to and treated by our hospital from January 2012 to December 2020. The early diagnosis and treatment, surgical plan, postoperative management, complications, and prognosis of each child were analyzed. The key points and difficulties of the diagnosis and treatment for this type of injury are summarized.
RESULTS
One child had an extreme infection caused by drug-resistant bacteria, which resulted in severe complications, including wound infection, dehiscence, and an intestinal fistula. One child developed an anastomotic stenosis after the duodenostomy, which improved following an endoscopic balloon dilatation. The other two children had no relevant complications after their operations. All four patients were cured and discharged from hospital. The average hospital stay was 48.25 ± 26.89 days. The follow-up period was 0.5 to 1 year. No other complications occurred, and all children had a positive prognosis.
CONCLUSIONS
The early identification of a duodenal rupture is essential, and surgical exploration should be carried out proactively. The principles of damage-control surgery should be followed as much as possible during the operation. Multidisciplinary cooperation and management are both important to reduce the occurrence of postoperative complications and improve cure rates.
Topics: Anastomosis, Surgical; Child; Dilatation; Duodenal Diseases; Duodenum; Humans; Postoperative Complications; Retrospective Studies
PubMed: 35151250
DOI: 10.1186/s12876-022-02136-w -
Nature May 2019The intestinal immune system has the challenging task of tolerating foreign nutrients and the commensal microbiome, while excluding or eliminating ingested pathogens....
The intestinal immune system has the challenging task of tolerating foreign nutrients and the commensal microbiome, while excluding or eliminating ingested pathogens. Failure of this balance leads to conditions such as inflammatory bowel diseases, food allergies and invasive gastrointestinal infections. Multiple immune mechanisms are therefore in place to maintain tissue integrity, including balanced generation of effector T (T) cells and FOXP3 regulatory T (pT) cells, which mediate resistance to pathogens and regulate excessive immune activation, respectively. The gut-draining lymph nodes (gLNs) are key sites for orchestrating adaptive immunity to luminal perturbations. However, it is unclear how they simultaneously support tolerogenic and inflammatory reactions. Here we show that gLNs are immunologically specific to the functional gut segment that they drain. Stromal and dendritic cell gene signatures and polarization of T cells against the same luminal antigen differ between gLNs, with the proximal small intestine-draining gLNs preferentially giving rise to tolerogenic responses and the distal gLNs to pro-inflammatory T cell responses. This segregation permitted the targeting of distal gLNs for vaccination and the maintenance of duodenal pT cell induction during colonic infection. Conversely, the compartmentalized dichotomy was perturbed by surgical removal of select distal gLNs and duodenal infection, with effects on both lymphoid organ and tissue immune responses. Our findings reveal that the conflict between tolerogenic and inflammatory intestinal responses is in part resolved by discrete gLN drainage, and encourage antigen targeting to specific gut segments for therapeutic immune modulation.
Topics: Animals; CD4 Antigens; Cell Differentiation; Cell Movement; Cell Polarity; Dendritic Cells; Duodenum; Female; Lymph Nodes; Male; Mice; Mice, Inbred C57BL; Mouth; Rats; Rats, Wistar; Stromal Cells; T-Lymphocytes
PubMed: 30988509
DOI: 10.1038/s41586-019-1125-3 -
BMJ Case Reports Jan 2014
Topics: Abdominal Pain; Duodenal Diseases; Duodenum; Gastritis; Gram-Positive Bacterial Infections; Humans; Jaundice; Male; Metaplasia; Middle Aged; Sarcina
PubMed: 24419638
DOI: 10.1136/bcr-2013-201185 -
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 -
World Journal of Gastroenterology Mar 2022Research on celiac disease (CD) in northwest China is still in its infancy. At present, large-sample data on the epidemiological, clinical, and pathological...
BACKGROUND
Research on celiac disease (CD) in northwest China is still in its infancy. At present, large-sample data on the epidemiological, clinical, and pathological characteristics of CD are limited.
AIM
To investigate the epidemiological, clinical, and pathological characteristics of CD in northwest China.
METHODS
The clinical data of 2884 patients with gastrointestinal (GI) symptoms were retrospectively analyzed. Total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) IgA levels were examined in all patients. Gastroscopy and colonoscopy were performed in patients with positive anti-tTG IgA and deficient total IgA levels. Atrophy of the duodenal and ileal villi was examined and histopathological examinations were performed. The modified Marsh-Oberhuber classification system was used to grade villous atrophy in the duodenum or distal ileum. The patients' () infection status was compared in terms of clinical presentation and Marsh grade. Statistical analyses were performed using the t-test or chi-square test.
RESULTS
Among the 2884 patients, 73 were positive for serum anti-tTG IgA, and 50 were diagnosed with CD. The CD detection rate was significantly higher in Kazakhs (4.39%) than in Uyghurs (2.19%), Huis (0.71%), and Hans (0.55%). The main symptoms of CD were chronic diarrhea, anorexia, anemia, fatigue, weight loss, sleep disorders, osteopenia, and osteoporosis. The body mass index of patients with CD was significantly lower than that of patients without CD. A total of 69 patients with positive serum anti-tTG IgA and two patients with deficient total IgA levels underwent GI endoscopy. Endoscopy revealed crypt hyperplasia and/or duodenal villous atrophy, mainly manifested as nodular mucosal atrophy, grooves, and fissures. The difference in infection rates was not statistically significant between CD and non-CD patients but was significantly different among CD patients with different Marsh grades.
CONCLUSION
Among the patients with GI symptoms in northwestern China, the prevalence of CD was more in the Uyghur and Kazakh populations. infection may be associated with CD severity.
Topics: Atrophy; Autoantibodies; Celiac Disease; Duodenum; Helicobacter Infections; Humans; Immunoglobulin A; Retrospective Studies; Transglutaminases
PubMed: 35431514
DOI: 10.3748/wjg.v28.i12.1272 -
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 May 2009Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most...
Whipple's disease was initially described in 1907. Over the next century, the clinical and pathological features of this disorder have been better appreciated. Most often, weight loss, diarrhea, abdominal and joint pain occur. Occasionally, other sites of involvement have been documented, including isolated neurological disease, changes in the eyes and culture-negative endocarditis. In the past decade, the responsible organism Tropheryma whipplei has been cultivated, its genome sequenced and its antibiotic susceptibility defined. Although rare, it is a systemic infection that may mimic a wide spectrum of clinical disorders and may have a fatal outcome. If recognized, prolonged antibiotic therapy may be a very successful form of treatment.
Topics: Anti-Bacterial Agents; Biopsy; Diagnosis, Differential; Duodenum; Humans; Nervous System Diseases; Tropheryma; Whipple Disease
PubMed: 19418579
DOI: 10.3748/wjg.15.2078