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Modern Pathology : An Official Journal... Jan 2015Duodenal lymphocytosis is a nonspecific finding that is being detected with heightened frequency. Although increased intraepithelial lymphocytosis with normal villous... (Review)
Review
Duodenal lymphocytosis is a nonspecific finding that is being detected with heightened frequency. Although increased intraepithelial lymphocytosis with normal villous architecture classically corresponds to grade 1 of the Marsh classification, many other conditions have been reported to be associated with this histologic pattern. In this article, we offer a broad review of the associations of isolated increased intraepithelial lymphocytosis with celiac and nonceliac gluten sensitivity, as well as of the broadening nonceliac etiologies.
Topics: Duodenal Diseases; Duodenum; Humans; Lymphocytosis
PubMed: 25560597
DOI: 10.1038/modpathol.2014.135 -
Journal of Medical Case Reports Oct 2023Plasmablastic lymphoma is a rare type of non-Hodgkin lymphoma that generally presents an aggressive clinical course. It is strongly associated with human immunodeficency... (Review)
Review
BACKGROUND
Plasmablastic lymphoma is a rare type of non-Hodgkin lymphoma that generally presents an aggressive clinical course. It is strongly associated with human immunodeficency virus (HIV) infection, and the most common site of involvement is the oral cavity. Although extraoral PBL has been reported in several places, small intestine involvement is extremely rare.
CASE PRESENTATION
Here, we describe an exceptionally rare case of a 24-year-old immunocompetent Asian Male patient with newly diagnosed plasmablastic lymphoma of the duodenum. The patient was admitted to our oncology facility due to the patient's clinical course, which included persistent vomiting, hematemesis, weight loss, and generalized weakness. Computed tomography of the abdomen (triphasic) of the patient showed thickness at the 2nd part of the duodenum measuring 2.6 cm in width and 16 cm in length blocking the pancreatic and common bile ducts by entering the second section of the duodenum. The biopsy specimen's pathological investigation indicated abnormal cells with plasmacytoid characteristics and a high proliferation index. The diagnosis of PBL was confirmed by immunohistochemical profiling. Supportive therapies like blood transfusions, antacids, and antiemetics were started to manage the patient's symptoms. Palliative radiation was also anticipated for the lesion site.
CONCLUSIONS
Duodenal involvement to the extent seen in our patient is exceptionally rare and, to the best of our knowledge, has hardly been described. The main goal of the article is to review the literature and report a case.
Topics: Humans; Male; Young Adult; Adult; Plasmablastic Lymphoma; Lymphoma, Large-Cell, Immunoblastic; Duodenum; Lymphoma, Non-Hodgkin; Disease Progression
PubMed: 37777745
DOI: 10.1186/s13256-023-04143-1 -
Internal Medicine (Tokyo, Japan) May 2024Objective Diffuse mucosal inflammation in the duodenum, distinct from peptic ulcer disease, has been repeatedly reported in patients with ulcerative colitis (UC). The...
Objective Diffuse mucosal inflammation in the duodenum, distinct from peptic ulcer disease, has been repeatedly reported in patients with ulcerative colitis (UC). The pathogenesis of this complication remains uncertain; however, colectomy for medically refractory UC appears to trigger duodenitis. Cases in which colectomy was performed for UC were analyzed to characterize UC-related duodenitis after colectomy. Methods A retrospective case-control study of UC-related duodenitis that developed after colectomy in medically refractory UC between January 2011 and June 2020 was conducted. UC-related duodenitis was diagnosed based on typical clinical, endoscopic, and histological findings, and no duodenitis was endoscopically defined by the normal duodenal mucosa. Clinical and laboratory data, disease severity, and medications used were collected and compared between the UC-related and non-duodenitis cases. Results Ten UC-related duodenitis and 35 non-duodenitis cases were identified among 45 patients with UC who underwent esophagogastroduodenoscopy after colectomy. Disease severity, defined by the C-reactive protein level and partial Mayo score prior to colectomy, was significantly higher in duodenitis patients than in non-duodenitis patients. In comparison to non-duodenitis patients, duodenitis patients more frequently received rescue therapies with calcineurin inhibitors or anti-tumor necrosis factor (TNF)-α agents at the time of colectomy (100% vs. 65.7%). Conclusion Patients with UC with higher disease activity, especially those who require rescue therapies with calcineurin inhibitors and anti-TNF-α agents, may be prone to developing UC-related duodenitis after colectomy.
Topics: Humans; Colitis, Ulcerative; Duodenitis; Male; Female; Retrospective Studies; Middle Aged; Colectomy; Adult; Case-Control Studies; Severity of Illness Index; Aged; Postoperative Complications; Endoscopy, Digestive System; C-Reactive Protein
PubMed: 37839884
DOI: 10.2169/internalmedicine.2134-23 -
BMJ Case Reports Feb 2018Dieulafoy's lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying epithelium without primary ulceration or erosion. The lesion... (Review)
Review
Dieulafoy's lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying epithelium without primary ulceration or erosion. The lesion predominantly occurs in the proximal stomach but it is also reported in extragastric sites. The pathogenesis and precipitating factors are poorly understood. Patients frequently present with gastrointestinal haemorrhage that can range from being self-limited to massive life threatening. Although there are no standard guidelines, endoscopy has significantly impacted the diagnosis and management. This review outlines our current understanding of the epidemiology of and risk factors for Dieulafoy's lesion of the duodenum, the pathophysiology of this disorder, and currently available approaches to diagnosis and management.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Duodenal Diseases; Duodenum; Endoscopy, Gastrointestinal; Female; Humans; Infant; Male; Middle Aged; Risk Factors; Young Adult
PubMed: 29472423
DOI: 10.1136/bcr-2017-223246 -
Clinical Journal of Gastroenterology Jun 2023Spontaneous retroperitoneal hematoma is rare and can cause duodenal obstruction. We report four cases of spontaneous retroperitoneal hematoma with duodenal obstruction,... (Review)
Review
Spontaneous retroperitoneal hematoma is rare and can cause duodenal obstruction. We report four cases of spontaneous retroperitoneal hematoma with duodenal obstruction, wherein endoscopic ultrasound was useful for diagnosis. The patients complained of vomiting with stable vital signs. Computed tomography, esophagogastroduodenoscopy, and endoscopic ultrasound findings were similar in all cases. Contrast-enhanced computed tomography revealed a low-density mass around the 2nd to 3rd part of the duodenum. Esophagogastroduodenoscopy showed an edematous, reddish, but non-neoplastic duodenal mucosa with stenosis of the lumen. Endoscopic ultrasound revealed a low-echoic mass around the duodenum and high-echoic floating matter suggesting debris and anechoic areas that indicated a liquid component. These findings suggested hematomas or abscesses. Although pseudoaneurysm of the pancreaticoduodenal artery was suspected in Case 3, we chose conservative treatment because the aneurysm was small. In Case 4, median arcuate ligament syndrome was suspected on angiography. No aneurysms or arteriovenous malformations were found; thus, endovascular embolization was not performed. The patients were treated conservatively and discharged within 3-5 weeks. English literature queries on spontaneous retroperitoneal hematoma with duodenal obstruction in MEDLINE revealed 21 cases in 18 studies. The clinical features of these patients and the present four cases have been discussed.
Topics: Humans; Duodenal Obstruction; Duodenum; Hematoma; Aneurysm; Endosonography; Gastrointestinal Hemorrhage
PubMed: 36959407
DOI: 10.1007/s12328-023-01780-3 -
Alimentary Pharmacology & Therapeutics Feb 2001Sildenafil shows an intense and prolonged inhibitory effect on the smooth muscle cells of corpus cavernosum arterioles by blocking phosphodiesterase-type 5, which... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Sildenafil shows an intense and prolonged inhibitory effect on the smooth muscle cells of corpus cavernosum arterioles by blocking phosphodiesterase-type 5, which inactivates the nitric oxide-stimulated cyclic guanosine monophosphate.
AIM
To investigate whether this inhibitory effect is also displayed on the musculature of the gastroduodenal tract.
METHODS
In 16 normal subjects, antroduodenal motility was recorded by means of a low-compliance manometric system. Ten minutes after the appearance of a phase III of the migrating motor complex, a tablet of sildenafil 50 mg, dissolved in 20 mL of water, was infused in the gut of eight patients, or a placebo in the other eight patients, randomly and in a double-blind manner, continuing the recording for 90 min. The frequency and amplitude of antral and duodenal waves, measured during the first 60 min after infusion in the two groups, were compared statistically. In addition, the duration of antral and duodenal phases I, and the number of phases III occurring during the whole 90 min after infusion, were compared in the two groups.
RESULTS
Antral and duodenal wave frequency and amplitude were significantly lower during the first 60 min after sildenafil administration. Both antral and duodenal phases I were significantly longer after sildenafil than after placebo, and the number of phases III which occurred during the 90 min after sildenafil was significantly lower than after placebo.
CONCLUSIONS
Sildenafil inhibits interdigestive motor activity of the antrum and duodenum.
Topics: Adult; Double-Blind Method; Duodenum; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Pyloric Antrum; Sildenafil Citrate; Sulfones
PubMed: 11148432
DOI: 10.1046/j.1365-2036.2001.00917.x -
Yakugaku Zasshi : Journal of the... 2016The umami taste amino acid, glutamate acts as a signaling molecule in multiple cellular systems in the body, including the brain and gastrointestinal tract. Therefore,... (Review)
Review
The umami taste amino acid, glutamate acts as a signaling molecule in multiple cellular systems in the body, including the brain and gastrointestinal tract. Therefore, glutamate may affect appetite by modulating gastrointestinal motility as well as through taste perception. In this study, we examined the effect of glutamate on gastric emptying and duodenal motility, by using rapid magnetic resonance imaging (MRI). Ten healthy male volunteers participated in the measurements. Abdominal coronal MR images were successively acquired after ingestion of a liquid meal with and without monosodium L-glutamate (MSG). Image analysis was performed with a homemade segment software, in which respiratory motions were cancelled automatically by minimizing an energy function, thereby allowing participants breathe freely during MRI measurements. In two out of 10 participants, gastric emptying slowed down, while in the remaining eight participants, gastric residual volume decreased to 84% without MSG, and to 73% with MSG after 60 min. The inclusion of MSG enhanced duodenal motility, judging from changes in, 1) the magnitude of the duodenal area, 2) the center of gravity, and 3) the mean velocity of the wall motions. The third parameter most significantly indicated the excitatory effect of MSG on duodenum motility (3-7 fold increase). In conclusion, the present observations of rapid MRI indicate that MSG accelerates gastric emptying by facilitating duodenal motility, at least in healthy subjects with positive responses to MSG. This suggests the possible use of MSG as a prokinetic nutrient for improving the quality of life in hospitalized patients after a clinical assessment.
Topics: Animals; Duodenum; Energy Metabolism; Gastric Emptying; Gastrointestinal Motility; Glutamates; Humans; Magnetic Resonance Imaging; Male; Rats; Signal Transduction; Sodium Glutamate; Stimulation, Chemical; Stomach; Taste
PubMed: 27725383
DOI: 10.1248/yakushi.16-00057-3 -
Gut Sep 1993Duodenitis and gastric metaplasia, which is often colonised by Helicobacter pylori (H pylori), are increasingly recognised for their importance in the pathogenesis of... (Comparative Study)
Comparative Study
Duodenitis and gastric metaplasia, which is often colonised by Helicobacter pylori (H pylori), are increasingly recognised for their importance in the pathogenesis of duodenal ulcers. The situation is not clear in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs), who have a higher risk of peptic ulceration. The aim of this study was to identify the duodenal histological abnormalities in the presence or absence of NSAIDs, H pylori, and duodenal ulceration. Endoscopic duodenal biopsy specimens were taken from healthy looking mucosa of 172 patients (74 took NSAIDs, and 98 did not). Duodenitis was graded according to the degree of neutrophilic and plasma cell infiltration, villus height, Brunner's gland prolapse, and gastric metaplasia. The activity of duodenitis was dependent on the neutrophilic infiltration. A global score covering all the above factors was constructed, and H pylori in both the stomach and duodenum, was also assessed. The results showed that duodenitis with varying degrees of neutrophilic infiltration and gastric metaplasia was found in 20 patients (27%) taking NSAIDs, compared with 56 patients (57%) not taking NSAIDs (chi 2 = 16.24, p < 0.001). This degree of duodenitis was also found in 20 of 25 patients (80%) with duodenal ulcers, regardless of NSAID intake (chi 2 = 15.38, p < 0.001). Gastric metaplasia was identified in 20 patients (27%) receiving NSAIDs and 38 (39%) not receiving NSAIDs. Duodenal H pylori was only seen in patients with gastric metaplasia 10 (50%) receiving NSAIDs, and 34 (89%) not receiving NSAIDs. H pylori positive gastritis, and the combination of active duodenitis and gastric metaplasia were independent predictors of duodenal ulceration. It is concluded that active duodenitis is less common in patients taking NSAIDs but is strongly associated with gastric metaplasia, H pylori positive gastritis, and duodenal ulceration. These findings are relevant to the pathogenesis and treatment of duodenal ulcers in patients taking NSAIDs.
Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Duodenal Ulcer; Duodenitis; Duodenum; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Mucosa; Male; Metaplasia; Middle Aged
PubMed: 8406146
DOI: 10.1136/gut.34.9.1162 -
Brazilian Journal of Medical and... 2023There are few studies addressing duodenal inflammation. This study was designed to investigate the effects of a recently developed biotechnological product, a...
There are few studies addressing duodenal inflammation. This study was designed to investigate the effects of a recently developed biotechnological product, a nano-formulation of olmesartan medoxomil (OM) - olmesartan medoxomil zeinmersomes (OMZ) - for the treatment of indomethacin-induced duodenitis in rats. Adult male Wistar rats were given indomethacin (10 mg/kg/day) for four weeks. They were divided into a positive control group (PC, untreated) and two groups treated orally with 3 mg/kg per day of OM or OMZ for the last two weeks of the 4-week indomethacin-treatment. At end of the four weeks, blood and duodenum were collected. Duodenal homogenate was used for measurement of levels of myeloperoxidase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), malondialdehyde, reduced glutathione (GSH), and cleaved caspase-3. Duodenal sections were stained with H&E. Gene expressions of nuclear factor kappa B (NF-κB p65), Bcl-2-associated X protein (Bax), and B-cell lymphoma 2 (Bcl-2) by RT-PCR, and protein expression of survivin by western blot were assessed. Plasma and duodenal olmesartan concentrations were measured by high performance liquid chromatography mass spectrometry. The duodenitis rats showed significantly higher duodenal levels of myeloperoxidase, TNF-α, IL-6, malondialdehyde, and cleaved caspase-3, a significantly lower GSH level, and histopathological alterations. Moreover, they showed upregulated gene expressions of NF-κB p65 and Bax, downregulated gene expression of Bcl-2, decreased Bcl-2/Bax ratio, and lower protein expression of survivin. OMZ was more effective in protecting the duodenum from indomethacin-induced injuries compared to OM due to improved delivery, higher bioavailability, and better anti-inflammatory, antioxidant, and antiapoptotic effects. OMZ could be a better choice for hypertensive patients with non-steroidal anti-inflammatory drugs-induced duodenitis.
Topics: Rats; Male; Animals; Olmesartan Medoxomil; NF-kappa B; Rats, Wistar; Survivin; Peroxidase; Caspase 3; Tumor Necrosis Factor-alpha; Indomethacin; Interleukin-6; Duodenitis; bcl-2-Associated X Protein; Anti-Inflammatory Agents; Malondialdehyde
PubMed: 37255094
DOI: 10.1590/1414-431X2023e12665 -
World Journal of Gastroenterology Sep 2013To investigate the diversity of Helicobacter pylori (H. pylori) genotypes and correlations with disease outcomes in an Iranian population with different gastroduodenal...
AIM
To investigate the diversity of Helicobacter pylori (H. pylori) genotypes and correlations with disease outcomes in an Iranian population with different gastroduodenal disorders.
METHODS
Isolates of H. pylori from patients with different gastroduodenal disorders were analyzed after culture and identification by phenotypic and genotypic methods. Genomic DNA was extracted with the QIAamp DNA mini kit (Qiagen, Germany). After DNA extraction, genotyping was done for cagA, vacA (s and m regions), iceA (iceA1 , iceA2 ) and babA with specific primers for each allele using polymerase chain reaction (PCR). All patients' pathologic and clinical data and their relation with known genotypes were analyzed by using SPSS version 19.0 software. χ² test and Fisher's exact test were used to assess relationships between categorical variables. The level of statistical significance was set at P < 0.05.
RESULTS
A total of 71 isolates from 177 patients with different gastroduodenal disorders were obtained. Based on analysis of the cagA gene (positive or negative), vacA s-region (s1 or s2), vacA m-region (m1 or m2), iceA allelic type (iceA1 and iceA2 ) and babA gene (positive or negative), twenty different genotypic combinations were recognized. The prevalence of cagA, vacA s1 , vacA s2 , vacA m1 , vacA m2 , iceA1 , iceA2 , iceA1+iceA2 and babA were 62%, 78.9%, 19.7%, 21.1%, 78.9%, 15.5%, 22.5%, 40.8% and 95.8%, respectively. Interestingly, evaluation of PCR results for cagA in 6 patients showed simultaneous existence of cagA variants according to their size diversities that proposed mixed infection in these patients. The most prevalent genotype in cagA-positive isolates was cagA⁺/vacAs1m2 /iceA1 +A2 /babA+ and in cagA-negative isolates was cagA⁻/vacAs1m2 /iceA-/babA+. There were no relationships between the studied genes and histopathological findings (H. pylori density, neutrophil activity, lymphoid aggregation in lamina propria and glandular atrophy). The strains which carry cagA, vacAs1/m1 , iceA2 and babA genes showed significant associations with severe active chronic gastritis (P = 0.011, 0.025, 0.020 and 0.031, respectively). The vacAs1 genotype had significant correlation with the presence of the cagA gene (P = 0.013). Also, babA genotype showed associations with cagA (P = 0.024). In the combined genotypes, only cagA⁺/vacAs1m1 /iceA2 /babA+ genotype showed correlation with severe active chronic gastritis (P = 0.025).
CONCLUSION
This genotyping panel can be a useful tool for detection of virulent H. pylori isolates and can provide valuable guidance for prediction of the clinical outcomes.
Topics: Adhesins, Bacterial; Adult; Age Factors; Aged; Aged, 80 and over; Antigens, Bacterial; Bacterial Outer Membrane Proteins; Bacterial Proteins; Duodenitis; Female; Gastritis; Genotype; Helicobacter pylori; Humans; Iran; Male; Middle Aged; Stomach; Virulence Factors; Young Adult
PubMed: 24039362
DOI: 10.3748/wjg.v19.i34.5685