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MEDICC Review Jan 2012INTRODUCTION Upper gastrointestinal endoscopy, traditionally performed in Cuba in specialized hospitals, was decentralized to the primary health care level in 2004 to...
INTRODUCTION Upper gastrointestinal endoscopy, traditionally performed in Cuba in specialized hospitals, was decentralized to the primary health care level in 2004 to make it more patient-accessible. OBJECTIVES Describe frequency and distribution of the principal symptomatic diseases of the upper gastrointestinal tract and their relation to the main risk factors associated with each in a sample of urban adults who underwent upper gastrointestinal endoscopy in primary care facilities in Havana in selected months of 2007. METHODS A multicenter cross-sectional study was conducted, including 3556 patients seen in the primary health care network of Havana from May through November 2007. The endoscopies were performed at the 22 polyclinics (community health centers) providing this service. Diagnostic quality and accuracy were assessed by experienced gastroenterologists using a validated tool. Patients responded to a questionnaire with clinical, epidemiologic, and sociodemographic variables. Univariate and multivariate analyses (unconditional logistical regression) were used to identify associated risk factors. The significance level was set at p < 0.05 (or confidence interval excluding 1.0). RESULTS The diagnoses were: gastritis (91.6%), duodenitis (57.8%), hiatal hernia (46.5%), esophagitis (25.2%), duodenal ulcer (15.8%), gastric ulcer (6.2%) and malignant-appearing lesions (0.4%). Overall prevalence of Helicobacter pylori infection was 58.4%. The main risk factors for duodenal ulcer were H. pylori infection (OR 2.70, CI 2.17-3.36) and smoking (OR 2.08, CI 1.68-2.58); and for gastric ulcer, H. pylori (OR 1.58, CI 1.17-2.15) and age ≥60 years (OR 1.78, CI 1.28-2.47). H. pylori infection was the main risk factor for gastritis (OR 2.29, CI 1.79-2.95) and duodenitis (OR 1.58, CI 1.38-1.82); and age ≥40 years for hiatal hernia (OR 1.57, CI 1.33-1.84). External evaluation was "very good" or "good" for 99.3% of endoscopic procedures and 97.9% of reports issued. CONCLUSIONS Gastrointestinal endoscopy performed in primary care yielded high quality results and important information about prevalence of the most common diseases of the upper GI tract and associated risk factors. This study provides a reference for new research and can inform objective recommendations for community-based interventions to prevent and control these diseases. The existence of a network of universally accessible diagnostic endoscopy services at the primary care level, will contribute to conducting further research. KEYWORDS Endoscopy, gastrointestinal diseases, upper GI tract, prevalence, risk factors, primary care, Cuba.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Cross-Sectional Studies; Cuba; Duodenitis; Endoscopy, Gastrointestinal; Esophagitis; Female; Gastritis; Gastrointestinal Diseases; Gastrointestinal Neoplasms; Helicobacter Infections; Helicobacter pylori; Hernia, Hiatal; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Primary Health Care; Risk Factors; Sex Factors; Stomach Ulcer; Surveys and Questionnaires; Young Adult
PubMed: 22334110
DOI: 10.37757/MR2012V14.N1.7 -
Archives of Disease in Childhood Nov 1990Twenty three children with coexistent duodenal ulcer and Helicobacter pylori infection were treated with either two weeks of amoxycillin (25 mg/kg/day) in addition to... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Twenty three children with coexistent duodenal ulcer and Helicobacter pylori infection were treated with either two weeks of amoxycillin (25 mg/kg/day) in addition to six weeks of cimetidine, or cimetidine alone. Endoscopy with antral and duodenal biopsies for urease test, microaerophilic culture, and histological studies were performed at entry, six weeks, 12 weeks, and at six months. Children with persistent H pylori infection at six weeks were given a further two weeks' course of amoxycillin. H pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children (46%) treated with amoxycillin. With failure of H pylori clearance at six months, only two out of six (33%) ulcers had healed and 50% of patients had experienced ulcer recurrence. In contrast, when H pylori remained cleared all ulcers healed and no ulcer recurred. Persistent H pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing. Detection and eradication of H pylori deserves particular attention in the routine management of duodenal ulceration in children.
Topics: Adolescent; Amoxicillin; Child; Child, Preschool; Cimetidine; Drug Therapy, Combination; Duodenal Ulcer; Duodenitis; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Prospective Studies; Recurrence
PubMed: 2248531
DOI: 10.1136/adc.65.11.1212 -
The Kaohsiung Journal of Medical... Jun 2019This study examines the effects of environmental hazards, including tobacco, alcohol/alcohol flush response, areca nut, and Helicobacter pylori (H pylori) infection on...
This study examines the effects of environmental hazards, including tobacco, alcohol/alcohol flush response, areca nut, and Helicobacter pylori (H pylori) infection on upper digestive diseases. This is a multi-hospital-based endoscopy-survey cross-sectional study. Subjects were received upper endoscopies in outpatient clinics at four hospitals in Taiwan between 2008 and 2013. Biopsy-based methods or urea breath test were used confirm the status of H pylori infection. In total, 8135 subjects were analyzed. Higher cumulative amounts of alcohol consumption were at higher risk of Barrett's esophagus and esophageal squamous cell carcinoma (ESCC), higher cumulative amounts of tobacco consumption were at higher risk of peptic ulcer, and higher cumulative amounts of areca nut consumption were at higher risk of duodenitis. Alcohol flush response was significant risk for reflux esophagitis and Barrett's esophagus (adjusted odds ratio [aOR] = 1.18 and 1.32, 95% confidence interval [CI] = 1.07-1.31 and 1.06-1.65, respectively). H pylori infection was inversely associated with ESCC risk (aOR = 0.20, 95% CI = 0.10-0.40). In addition, H pylori infection was consistently and significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis (aOR = 5.51, 1.84, and 2.10, 95% CI = 4.85-6.26, 1.03-3.26, and 1.71-2.56, respectively). Besides the cumulative risk of alcohol, tobacco, and areca nut for Barrett's esophagus, ESCC, and peptic ulcer, respectively, presence of facial flushing was the significant risk for reflux esophagitis and Barrett's esophagus. H pylori infection was positively associated with peptic ulcer, gastric adenocarcinoma, and duodenitis, but inversely associated with ESCC.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Alcohol Drinking; Areca; Barrett Esophagus; Cross-Sectional Studies; Duodenitis; Endoscopy, Digestive System; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Female; Flushing; Gastrointestinal Tract; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Nuts; Peptic Ulcer; Risk Factors; Stomach Neoplasms; Taiwan; Tobacco Use
PubMed: 31001924
DOI: 10.1002/kjm2.12071 -
International Journal of Molecular... Dec 2021Proton pump inhibitors (PPI) may improve symptoms in functional dyspepsia (FD) through duodenal eosinophil-reducing effects. However, the contribution of the microbiome...
Proton pump inhibitors (PPI) may improve symptoms in functional dyspepsia (FD) through duodenal eosinophil-reducing effects. However, the contribution of the microbiome to FD symptoms and its interaction with PPI remains elusive. Aseptic duodenal brushings and biopsies were performed before and after PPI intake (4 weeks Pantoprazole 40 mg daily, FD-starters and controls) or withdrawal (2 months, FD-stoppers) for 16S-rRNA sequencing. Between- and within-group changes in genera or diversity and associations with symptoms or duodenal factors were analyzed. In total, 30 controls, 28 FD-starters and 19 FD-stoppers were followed. Mucus-associated was lower in FD-starters vs. controls and correlated with symptoms in FD and duodenal eosinophils in both groups, while correlated with eosinophils in controls. Although clinical and eosinophil-reducing effects of PPI therapy were unrelated to microbiota changes in FD-starters, increased was associated with duodenal PPI effects in controls and remained higher despite withdrawal of long-term PPI therapy in FD-stoppers. Thus, duodenal microbiome analysis demonstrated differential mucus-associated genera, with a potential role of in FD pathophysiology. While beneficial effects of short-term PPI therapy were not associated with microbial changes in FD-starters, increased and its association with PPIeffects in controls suggest a role for duodenal dysbiosis after long-term PPI therapy.
Topics: Adult; Duodenum; Dysbiosis; Dyspepsia; Female; Gastrointestinal Microbiome; Humans; Male; Middle Aged; Porphyromonas; Proton Pump Inhibitors; Young Adult
PubMed: 34948413
DOI: 10.3390/ijms222413609 -
African Health Sciences Jun 2023To investigate the demographic features, primary endoscopic findings, and the status of Helicobacter Pylori (H. pylori) infection of the enrolled subjects who underwent...
BACKGROUND/OBJECTIVES
To investigate the demographic features, primary endoscopic findings, and the status of Helicobacter Pylori (H. pylori) infection of the enrolled subjects who underwent upper gastrointestinal endoscopy (UGIE) in the Zanzibar Archipelago, Tanzania.
METHODS
Between December 2013 and October 2021, a total of 3146 eligible participants were finally recruited in present retrospective cohort. Demographic information and endoscopic findings of each participant was retrieved. H. pylori infection was confirmed by rapid-urease test of gastric antral and body biopsies at endoscopy.
RESULTS
Among the recruited subjects, 1691 (53.76%) are females, remaining 1455 (46.24%) are males. The median age of this retrospective cohort was 40 years ranging from 8 to 97 years. The common identified endoscopic findings included gastro-duodenitis, normal endoscopic finding, peptic ulcer disease (PUD), esophagitis, esophagogastric varices, esophageal and gastric cancer, respectively. After adjustment for sex and age, a significant risk of gastric and/or duodenal ulcer (OR, 2.51; 95% CI, 1.82-3.48, P<0.001) and gastric cancer (OR, 3.49; 95% CI, 1.27-9.58, P=0.015) in H. positive group was observed. Stratified analysis indicated a significant relationship between duodenal ulcer with younger age (adjusted OR, 0.98; 95% CI, 0.97-0.99, p = 0.002), and the presence of H. pylori (OR, 2.01; 95% CI, 1.12-3.91, p= 0.021).
CONCLUSIONS
The present study revealed that gastro-duodenitis, PUD, and normal finding are the most common endoscopic diagnoses in Zanzibar. The presence of H. is significantly associated with duodenal ulcer and gastric cancer.
Topics: Male; Female; Humans; Adult; Duodenal Ulcer; Retrospective Studies; Tanzania; Duodenitis; Stomach Neoplasms; Esophageal Neoplasms; Peptic Ulcer; Helicobacter pylori; Endoscopy, Gastrointestinal; Helicobacter Infections
PubMed: 38223625
DOI: 10.4314/ahs.v23i2.45 -
Transplantation Proceedings Dec 2022Duodenal graft complications are not uncommon after pancreas transplant (PTx). Although direct visualization and biopsy of the duodenal graft are important for accurate...
Duodenal graft complications are not uncommon after pancreas transplant (PTx). Although direct visualization and biopsy of the duodenal graft are important for accurate diagnosis and management, endoscopic access is often limited in cases of enteric-drained PTx. Herein, we present a case of cytomegalovirus (CMV) graft duodenitis that was successfully diagnosed by transanal endoscopy using the double-balloon technique. The patient was a 54-year-old woman who underwent simultaneous pancreas and kidney transplant for type 1 diabetes mellitus and end-stage kidney disease. Enteric drainage was established by anastomosing the graft duodenum to her ileum. One month after the transplant, she developed fever and complained of lower abdominal pain. Graft duodenitis was suspected by laboratory test and imaging study results. Transanal double-balloon endoscopy was performed, and the biopsy specimen of the mucosa of the graft duodenum revealed CMV duodenitis without histopathologic findings of acute rejection. The postendoscopy course was uneventful. Treatment with ganciclovir was promptly initiated, and the CMV duodenitis was resolved with good function of the pancreas graft. In patients who undergo PTx with establishment of exocrine drainage by enteroanastomosis to the recipient ileum, transanal double-balloon endoscopy might be a feasible and safe technique for the surveillance of duodenal graft complications, including CMV duodenitis.
Topics: Humans; Female; Middle Aged; Cytomegalovirus; Duodenitis; Transplant Recipients; Pancreas Transplantation; Cytomegalovirus Infections; Drainage; Duodenum; Endoscopy, Gastrointestinal; Pancreas; Postoperative Complications
PubMed: 36411093
DOI: 10.1016/j.transproceed.2022.10.037 -
Clinical and Translational... Jan 2024Consensus is lacking regarding the number of eosinophils (eos) required for the diagnosis of eosinophilic gastritis (EoG) and eosinophilic duodenitis (EoD). In addition,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Consensus is lacking regarding the number of eosinophils (eos) required for the diagnosis of eosinophilic gastritis (EoG) and eosinophilic duodenitis (EoD). In addition, thresholds that require multiple high-power fields (HPFs) may not be practical for clinical use, resulting in delayed or missed diagnoses. This pooled analysis of 4 prospective studies assessed thresholds for multiple and single HPFs used to diagnose EoG and EoD.
METHODS
Studies included the phase 2 ENIGMA1, the phase 3 ENIGMA2, an EoG/EoD prevalence study and a healthy volunteer study. Eos were quantified in the epithelium and lamina propria for controls and symptomatic participants. Symptomatic participants were further divided by histologic diagnosis of EoG/EoD. Peak eos counts were assessed, and the area under the receiver operating characteristic curve was analyzed to identify eos cutoffs for detection of EoG/EoD using the Youden index and sensitivity and specificity equality approaches.
RESULTS
Based on the highest specificity analysis in 740 patients, the optimal eos threshold was determined to be 20 eos/HPF in 5 gastric HPFs for EoG (71% sensitivity and 94% specificity) and 33 eos/HPF in 3 duodenal HPFs for EoD (49% sensitivity and 100% specificity). For single-field analysis, the optimal eos thresholds were 33 eos/HPF (EoG) and 37 eos/HPF (EoD), both corresponding to 93% sensitivity and 93% specificity.
DISCUSSION
Highly specific single gastric and duodenal HPF thresholds may have more clinical applicability than thresholds requiring multiple HPFs and could better facilitate development of practical histopathologic guidelines to aid pathologists and clinicians in the detection and diagnosis of EoG and/or EoD.
Topics: Humans; Eosinophils; Prospective Studies; Duodenitis; Eosinophilia; Enteritis; Gastritis
PubMed: 37870521
DOI: 10.14309/ctg.0000000000000656 -
The Turkish Journal of Pediatrics 2023Subacute and chronic long-term effects of coronavirus disease 2019 (COVID-19) in different organ systems have been studied in post-COVID patients recently. COVID-19 may...
BACKGROUND
Subacute and chronic long-term effects of coronavirus disease 2019 (COVID-19) in different organ systems have been studied in post-COVID patients recently. COVID-19 may cause gastrointestinal (GI) system findings due to the presence of its receptor, angiotensin converting enzyme type 2 (ACE2), which is extensively expressed in the GI tract. In this study, we aimed to evaluate the post-infectious histopathological alterations of COVID-19 in pediatric patients who had GI symptoms.
METHODS
Fifty-six specimens of upper endoscopic biopsies (including esophagus, stomach, bulbus and duodenum) obtained from seven patients and 12 specimens of lower endoscopic biopsies obtained from one patient who had GI symptoms after having COVID-19 (proven by polymerase chain reaction [PCR]) were evaluated as the study group. Forty specimens from five patients presenting with similar complaints but without COVID-19 were selected as the control group. All biopsy materials were immunohistochemically stained with the anti-SARS-CoV-2S1 antibody.
RESULTS
In all biopsies of the study group, anti-SARS-CoV-2S1 antibody was detected with moderate cytoplasmic positivity in epithelial cells and inflammatory cells in the lamina propria. No staining was observed in the control group. Epithelial damage, thrombus, or no other specific findings were detected in the GI tract biopsies of any of the patients.
CONCLUSIONS
The virus antigen was detected immunohistochemically in the stomach and duodenum, but not in the esophagus, even months after infection and causes gastritis and duodenitis. No specific histopathological finding was observed from non-COVID-19 gastritis/duodenitis. Therefore, the post-COVID-19 GI system involvement should be kept in mind in patients presenting with dyspeptic symptoms even if several months have passed.
Topics: Humans; Child; Duodenitis; COVID-19; Gastritis; Biopsy
PubMed: 37395961
DOI: 10.24953/turkjped.2022.1039 -
Biochemical and Biophysical Research... Aug 2007Finding UDP-glucuronosyltransferases (UGT) require protein kinase C-mediated phosphorylation is important information that allows manipulation of this critical system.... (Comparative Study)
Comparative Study
Finding UDP-glucuronosyltransferases (UGT) require protein kinase C-mediated phosphorylation is important information that allows manipulation of this critical system. UGTs glucuronidate numerous aromatic-like chemicals derived from metabolites, diet, environment and, inadvertently, therapeutics to reduce toxicities. As UGTs are inactivated by downregulating PKCs with reversibly-acting dietary curcumin, we determined the impact of gastro-intestinal glucuronidation on free-drug uptake and efficacy using immunosuppressant, mycophenolic acid (MPA), in mice. Expressed in COS-1 cells, mouse GI-distributed Ugt1a1 glucuronidates curcumin and MPA and undergoes irreversibly and reversibly dephosphorylation by PKC-specific inhibitor calphostin-C and general-kinase inhibitor curcumin, respectively, with parallel effects on activity. Moreover, oral curcumin-administration to mice reversibly inhibited glucuronidation in GI-tissues. Finally, successive oral administration of curcumin and MPA to antigen-treated mice increased serum free MPA and immunosuppression up to 9-fold. Results indicate targeted inhibition of GI glucuronidation in mice markedly improved free-chemical uptake and efficacy using MPA as a model.
Topics: Animals; COS Cells; Chlorocebus aethiops; Curcumin; Disease Models, Animal; Drug Delivery Systems; Duodenitis; Glucuronosyltransferase; Immunosuppressive Agents; Mice; Mycophenolic Acid; Protein Kinase C; Treatment Outcome
PubMed: 17586469
DOI: 10.1016/j.bbrc.2007.05.224 -
Journal of Clinical Pathology Oct 1981Measurements of villus height, villus area, together with counts of epithelial cells in individual villi, were performed on endoscopic duodenal biopsies from five groups...
Measurements of villus height, villus area, together with counts of epithelial cells in individual villi, were performed on endoscopic duodenal biopsies from five groups of patients: controls, ulcer-associated duodenitis, mild and severe non-specific (non-ulcerative) duodenitis, cimetidine healed ulcer-associated duodenitis and cimetidine healed non-specific duodenitis. The objectives of the study were two-fold: to establish if epithelial cell count correlated with simpler measurements of villus height or area; and to compare the findings in ulcer-associated and in non-specific duodenitis. Villus area correlated well with epithelial cell count per villus (r = 0.96); villus height correlated less well (r = 0.66). When compared with controls, there was a significant decrease in the epithelial cell count per villus in ulcer-associated and severe non-specific duodenitis, but this was confined to the visually inflamed area of the duodenal bulb. After healing of inflammation with cimetidine villus height, area, and epithelial cell count returned to values similar to those in controls. This study confirms that the effects of ulcer-associated and severe non-specific duodenitis on duodenal villi are identical.
Topics: Cell Count; Cimetidine; Duodenal Ulcer; Duodenitis; Duodenum; Epithelium; Humans; Intestinal Mucosa
PubMed: 7309898
DOI: 10.1136/jcp.34.10.1181