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Faust O, De Michele S, Koh JE, Jahmunah V, Lih OS, Kamath AP, Barua PD, Ciaccio EJ, Lewis SK, Green PH, Bhagat G, Acharya UR. Automated analysis of small intestinal lamina propria to distinguish normal, Celiac Disease, and Non-Celiac Duodenitis biopsy images. Comput Methods Programs Biomed 2023; 230:107320. [PMID: 36608429 DOI: 10.1016/j.cmpb.2022.107320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Celiac Disease (CD) is characterized by gluten intolerance in genetically predisposed individuals. High disease prevalence, absence of a cure, and low diagnosis rates make this disease a public health problem. The diagnosis of CD predominantly relies on recognizing characteristic mucosal alterations of the small intestine, such as villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis. However, these changes are not entirely specific to CD and overlap with Non-Celiac Duodenitis (NCD) due to various etiologies. We investigated whether Artificial Intelligence (AI) models could assist in distinguishing normal, CD, and NCD (and unaffected individuals) based on the characteristics of small intestinal lamina propria (LP). METHODS Our method was developed using a dataset comprising high magnification biopsy images of the duodenal LP compartment of CD patients with different clinical stages of CD, those with NCD, and individuals lacking an intestinal inflammatory disorder (controls). A pre-processing step was used to standardize and enhance the acquired images. RESULTS For the normal controls versus CD use case, a Support Vector Machine (SVM) achieved an Accuracy (ACC) of 98.53%. For a second use case, we investigated the ability of the classification algorithm to differentiate between normal controls and NCD. In this use case, the SVM algorithm with linear kernel outperformed all the tested classifiers by achieving 98.55% ACC. CONCLUSIONS To the best of our knowledge, this is the first study that documents automated differentiation between normal, NCD, and CD biopsy images. These findings are a stepping stone toward automated biopsy image analysis that can significantly benefit patients and healthcare providers.
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Affiliation(s)
| | - Simona De Michele
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, USA
| | - Joel Ew Koh
- Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - V Jahmunah
- Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | - Oh Shu Lih
- Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore
| | | | - Prabal Datta Barua
- Cogninet Australia, Sydney, NSW 2010, Australia; School of Management & Enterprise, University of Southern Queensland, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Edward J Ciaccio
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, USA
| | - Suzanne K Lewis
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, USA
| | - Peter H Green
- Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, USA; Department of Medicine, Celiac Disease Center, Columbia University Irving Medical Center, USA
| | - U Rajendra Acharya
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore; Department of Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Kecler-Pietrzyk A, Orsi G, Carthy J, Torreggiani WC. Enteritis and Severe Abdominal Pain as the First Presentation of Covid-19. Ir Med J 2020; 113:102. [PMID: 32816437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Presentation A male patient with no significant past medical history presented to emergency department with progressive in severity abdominal pain, associated with mild nausea and diarrhea. No other significant symptoms were reported. Diagnosis On investigation with CT, duodenojejunitis was diagnosed as the cause of abdominal pain. Lung basal changes were also visualized and subsequently proven to be secondary to Covid-19 infection. Treatment After few days of hospitalization and supportive treatment, the patient improved clinically and was discharged. Conclusion Covid-19 infection typically presents with respiratory symptoms associated with fever and myalgia. Anorexia, diarrhea and nausea have been reported. Severe abdominal pain is rare, particularly as the initial presenting compliant. It is important to be aware of the varied clinical presentations that may occur in Covid-19, including isolated gastrointestinal symptoms. This will allow to increase the timely detectability of infected patients and more effective contact control measures.
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Affiliation(s)
- A Kecler-Pietrzyk
- Department of Radiology, Tallaght University Hospital, Dublin 24, Ireland
| | - G Orsi
- Department of Surgery, Tallaght Univeristy Hospital, Dublin 24, Ireland
| | - J Carthy
- Department of Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - W C Torreggiani
- Department of Radiology, Tallaght University Hospital, Dublin 24, Ireland
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Coca DS, Santos CM, de Oliveira OSG, Pereira DA, Kiyoshi Furuya CJ, Artifon ELA. Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori. Rev Gastroenterol Peru 2018; 38:40-43. [PMID: 29791420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. MATERIAL AND METHODS Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. RESULTS The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. CONCLUSION pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications.
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Affiliation(s)
| | | | | | | | | | - Everson L A Artifon
- Endoscopy Service, Hospital Ana Costa. São Paulo, Brazil; Faculty of Medicine, University of São Paulo. São Paulo, Brazil
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Abstract
Cytomegalovirus (CMV) infection is a well-recognised complication of immunodeficiency, although the burden of CMV disease in immunocompetent adults is still unknown. We present the case of a 54-year-old male patient admitted due to severe diarrhoea, epigastric pain and fever. Initial diagnostic workup revealed pericardial and pleural effusion, enlarged abdominal lymph nodes and mild elevation of liver enzymes. CMV serology was IgM positive, and upper endoscopy revealed proximal enteritis. Histology and immunohistochemistry of duodenal samples confirmed CMV disease. An extensive investigation of possible immunodeficiency was conducted with positron emission tomography (PET) scan revealing an abnormal hypermetabolic pulmonary nodule. The patient underwent a right superior lobectomy which, on analysis, confirmed an atypical bronchopulmonary carcinoid tumour. We report this case to reinforce the importance of considering CMV infection as a differential diagnosis in apparent immunocompetent patients and to emphasise the importance of looking for any condition that may cause any degree of immune dysfunction.
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Affiliation(s)
- Dalila Costa
- Gastroenterology, Braga Hospital, Braga, Portugal
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | | | - Antónia Furtado
- Pathology, Vila Nova de Gaia/Espinho Medical Center, Vila Nova de Gaia, Portugal
| | - Andre Santa Cruz
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
- Internal Medicine, Braga Hospital, Braga, Portugal
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Akpınar MY, Oztas E, Ödemiş B, Aydog G, Akdogan O, Kuzu UB. Diffuse nodular duodenitis in a woman presenting with dyspepsia and weight loss. Acta Gastroenterol Belg 2017; 80:91. [PMID: 29364111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Duodenal nodularity is an uncommon endoscopic finding charac-trized by numerous visible mucosal nodules in the duodenum. It is important to consider giardiasis in patients with symptoms include abdominal pain, nausea, anorexia, diarrhea, vomiting, weight loss and abdominal distension. It is also important to remind giardiasis in patients with duodenal nodularity.
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Tonolini M. Reversible acute duodenitis as a complication of endoscopic biliary stenting. J Gastrointestin Liver Dis 2014; 23:8. [PMID: 24689087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Egorov VI, Butkevich AT, Sazhin AV, Iashina NI, Bogdanov SN, Lesin SV. [Duodenal pancreatic-preserving resections with common bile and pancreatic ducts replantation by cystic form of duodenal dystrophy]. Khirurgiia (Mosk) 2010:16-23. [PMID: 20823815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Two patients with cystic dystrophy of duodenum and chronic inflammation of duodenally ectopic pancreatic tissue were successfully operated on. Both cases clinically demonstrated abdominal pain and duodenal obstruction. Absence of substantial tissue changes in "main" pancreas allowed execution of pancreas-preserving operation. Thus, subtotal duodenectomy was performed in the first patient. The second patient had resection of vertical branch of the duodenum with intestinal fragment replacement. Extensive periorganic fibrosis in both cases substantially complicated verification of anatomic structures and dissection.
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Song K, Dominitz JA. Unusual gastrostomy-tube complication. Gastrointest Endosc 2006; 63:321-2; discussion 322. [PMID: 16427943 DOI: 10.1016/j.gie.2005.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 08/03/2005] [Indexed: 12/10/2022]
Affiliation(s)
- Kenneth Song
- Gastroenterology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
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Abstract
Peptic ulcer disease (PUD) can present with many complications including inflammation, ulceration and perforation. Improvements in CT have enabled better imaging of the gastroduodenal area. Three cases of complicated PUD detected on CT are presented with a brief review of the current literature.
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Affiliation(s)
- E Pun
- Ballarat Base Hospital, Department of Medical Imaging, Ballarat, Victoria, Australia.
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Affiliation(s)
- Rk Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Horton KM, Fishman EK. MDCT of the duodenum: technique and clinical applications. Crit Rev Comput Tomogr 2004; 45:309-34. [PMID: 15747573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Computed Tomography (CT) is useful for evaluation of both benign and malignant pathology involving the duodenum. CT can detect and stage duodenal malignancies as well as detect inflammatory conditions such as duodenitis. Careful CT technique is necessary to optimize detection of abnormalities. This includes the use of oral contrast, preferably water, as well as i.v. contrast. 3D imaging can improve disease detection and help with surgical planning. This article reviews the current role of CT in duodenal imaging, describes appropriate CT protocols and illustrates a wide variety of duodenal pathology.
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Affiliation(s)
- Karen M Horton
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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Abstract
OBJECTIVE To evaluate (99m)Tc-HMPAO leukocyte scintigraphy as an investigation for inflammatory bowel disease (IBD). STUDY DESIGN Scintigraphy was performed in 95 children undergoing investigation for IBD in a tertiary Gastroenterology Department. Diagnosis was based on conventional investigations including small bowel barium contrast radiology (BCR), upper gastrointestinal endoscopy (UGIE), colonoscopy, and endoscopic biopsy (the "gold standards"). IBD was confirmed in 73 (57 Crohn's disease; 10 ulcerative colitis; 6 indeterminate colitis) and excluded in 22 (controls). Scintigraphy was (1) evaluated as a screening test, (2) compared with individual conventional tests, (3) assessed for each gut segment. RESULTS Screening test: sensitivity 0.75 (95% CI, 0.63-0.85), specificity 0.82 (95% CI, 0.59-0.94), PPV 0.93, NPV 0.5. Comparison with BCR: sensitivity 0.87 (95% CI, 0.72-0.96), specificity 0.57 (95% CI, 0.39-0.73), PPV 0.69, NPV 0.2. Comparison with UGIE: specificity 0.9 (95% CI, 0.79-0.96), NPV 0.13 (sensitivity and PPV unavailable). Comparison with colonoscopy: sensitivity 0.57 (95% CI, 0.41-0.73), specificity 0.71 (95% CI, 0.54-0.85), PPV 0.71, NPV 0.42. Comparison with biopsies paralleled that with endoscopy. False negatives were especially common (NPV< or =0.2) in the proximal gut. CONCLUSIONS (99m)Tc-HMPAO leukocyte scintigraphy should not be relied on as a screening test for IBD because false negative results are common. This method is especially unreliable at detecting disease in the proximal gut.
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Affiliation(s)
- Lena Grahnquist
- Institute of Child Health, University of Birmingham and Department of Gastroenterology, Birmingham Children's Hospital NHS Trust, Birmingham, United Kingdom
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Abstract
OBJECTIVE To investigate the use of (99m)Tc-HMPAO (hexamethyl propylene amine oxime) leucocyte scintigraphy as a non-invasive screening test for inflammatory bowel disease. PATIENTS 10 children with suspected Crohn's disease, in whom routine investigation using barium contrast radiology, upper gastrointestinal endoscopy, colonoscopy, and mucosal biopsies had identified severe gastroduodenal and/or jejunal involvement. DESIGN (99m)Tc-HMPAO leucocyte scintigraphic studies performed in each of these cases were assessed by a radiologist who was blinded to the disease distribution. RESULTS In nine cases there was no scintigraphic evidence of inflammation in the proximal gastrointestinal tract. The 10th child had both gastroduodenal and jejunal involvement, but scintigraphy only revealed faint jejunal positivity. CONCLUSIONS (99m)Tc-HMPAO leucocyte scintigraphy should not be depended upon as a screening test for Crohn's disease. False negative results are likely in cases with Crohn's disease confined to the proximal gastrointestinal tract.
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Affiliation(s)
- S M Davison
- Department of Gastroenterology, Birmingham Children's Hospital and Institute of Child Health, University of Birmingham, Clinical Research Block, Whittall Street, Birmingham B4 6NH, UK
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Alfonso V, Ripollés T, García G, Jordán M, Moreno-Osset E. [Duodenal diverticulitis]. Gastroenterol Hepatol 2000; 23:105-6. [PMID: 10726394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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del Val Gómez MF, Gallardo F, Carbó J, Cobo J, García-Samaniego J. [Gastroduodenal uptakes in the scans with 67Ga of the HIV infected patients studied for un-affiliated fever]. Rev Esp Med Nucl 1999; 18:336-9. [PMID: 10562662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
UNLABELLED This work aimed to assess the significance of abnormal gastroduodenal uptake in the 67Ga scintigraphy of HIV patients who have been studied for fever of unknown origin. The examinations of 12 patients who had had a normal panedoscopy when the 67Ga scan was done, were selected. One out of 7 patients without gastroduodenal 67Ga uptake was diagnosed of non-specific gastritis. Five patients had abnormal gastroduodenal involvement in the 67Ga scan. One of them was diagnosed of high grade lymphoma. The other 4 patients were diagnosed of mycobacteriosis. CONCLUSIONS Although controversy exists in the literature, the current study shows a high correlation between abnormal gastroduodenal uptake in the 67GA scan of HIV (+) patients and the presence of gastroduodenal disease.
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Affiliation(s)
- M f del Val Gómez
- Servicio de Medicina Nuclear, Hospital Carlos III, Madrid, 28029, España
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Affiliation(s)
- D W Gelfand
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Affiliation(s)
- A Mong
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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Catalano D. [Helicobacter pylori and gastroduodenal radiology]. Radiol Med 1998; 95:276-7. [PMID: 9676202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
PURPOSE To determine the accuracy of barium studies in the diagnosis of duodenitis in children. MATERIALS AND METHODS Seventy-five children (45 boys and 30 girls; mean age, 9 years) underwent upper gastrointestinal (GI) examinations. Twenty-four of the children had biopsy-proved duodenitis, and 51 were healthy control subjects. Radiologic findings were reviewed by two experienced, blinded observers and correlated with endoscopic and histologic results. Duodenal mucosal-fold thickness was measured on spot radiographs (20% magnification), and the extent of disease was evaluated. RESULTS Of 15 children with mild duodenitis, 13 had normal radiologic findings and 11 had normal findings at esophagogastroduodenoscopy. Of nine children with severe duodenitis, all had friability or ulceration at endoscopy and mucosal-fold thickening of greater than or equal to 4 mm (> or = 3 mm in one infant aged less than 1 year) at upper GI examination. Mucosal-fold thickening was diffuse in patients with celiac, autoimmune, and adenovirus disease and was proximal in patients with peptic ulcer and Crohn disease. Of 51 control subjects, 50 had normal radiologic results, while 47 had normal endoscopic results. The sensitivity of upper GI examination for mild and severe duodenitis combined was 46% with a specificity of 98%, whereas endoscopy had a sensitivity of 54% and specificity of 92%. CONCLUSION Mucosal-fold thickening was a specific sign of duodenitis in children and should be investigated. Upper GI examination yielded results similar to those at endoscopy.
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Affiliation(s)
- F R Long
- Department of Radiology, Columbus Children's Hospital, OH 43205-2696, USA
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Affiliation(s)
- D W Gelfand
- Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, NC 27157, USA
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Poggioli G, Stocchi L, Laureti S, Selleri S, Marra C, Salone MC, Cavallari A. Duodenal involvement of Crohn's disease: three different clinicopathologic patterns. Dis Colon Rectum 1997; 40:179-83. [PMID: 9075753 DOI: 10.1007/bf02054984] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to assess clinical and pathologic features of duodenal Crohn's disease (CD) and address its management according to different patterns of disease. METHODS Twelve cases of duodenal involvement in CD are reported out of 336 patients treated between 1978 and 1993. They represent 3.6 percent of all cases. Three patients had a duodenal fistula, and nine had an intrinsic duodenal lesion. The duodenal fistula was in all cases a manifestation of recurrent CD involving an ileocolic anastomosis and the third portion of the duodenum. RESULTS Treatment consisted of resection of the fistula's source and primary closure of duodenal breach. Of nine patients with intrinsic CD, five had stenosis and the remaining four had peptic ulcer-like lesions. Duodenal stenosis was treated with strictureplasty in three cases and duodenojejunostomy in two. No patient with ulcer-like lesions underwent surgery. CONCLUSIONS Differences encountered in intrinsic duodenal lesions apparently reflect two different clinical patterns. Stenosis is not usually associated with multifocal disease and is often the first evidence of disease. Ulcer-like lesions are not specific; they do not evolve into stenosis as do ulcers in other sites of the disease, spontaneously disappear and relapse, and do not require surgery, except for complications. They are always associated with other locations of the disease.
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Affiliation(s)
- G Poggioli
- Clinica Chirurgica 2, Policlinico S. Orsola, Bologna, Italy
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Bertoli M, Casoni S, Grazioli S, Capra S. [Perforation of a duodenal diverticulum. Report of a case with CT diagnosis]. Radiol Med 1995; 90:825-7. [PMID: 8685472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M Bertoli
- Cattedra di Radiologia, Università di Brescia
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Gelfand DW. Radiological diagnosis of duodenitis. Radiol Clin North Am 1994; 32:1253-8. [PMID: 7972711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- D W Gelfand
- Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Abstract
A 22-year-old patient with eosinophilic gastroenteritis with predominantly submucosal and muscular involvement is presented. The benefits of CT, using water as an orally administered contrast agent, are stressed, because CT enabled the authors to suggest a full thickness biopsy, after mucosal biopsies had remained repeatedly negative.
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Affiliation(s)
- L Van Hoe
- Department of Radiology, University Hospitals K. U. Leuven, Belgium
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Lichtenstein JE. Inflammatory conditions of the stomach and duodenum. Radiol Clin North Am 1993; 31:1315-33. [PMID: 8210352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Upper gastrointestinal inflammatory processes are exceedingly common and have a wide spectrum of causes and manifestations. The broad category of acid-peptic disease incorporates the most common and important conditions. Concepts of pathophysiology of gastritis and duodenitis and their relationship to ulcers and neoplasm continue to evolve. The role of infection, especially H. pylori, remains under intense investigation. The spectrum of gastroduodenal inflammation in the immunocompromised host continues to expand and becomes increasingly important. A variety of granulomatous processes, both infectious and idiopathic, involve the upper gastrointestinal tract in overlapping patterns. Although investigation of ulcers and syphilis occupied the attention of the earliest gastrointestinal radiologists, related problems continue to challenge today's radiologic imagers, clinicians, and investigators.
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Affiliation(s)
- J E Lichtenstein
- Department of Radiology, University of Cincinnati College of Medicine, Ohio
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Geller LI, Rybalka ED, Geller AL, Goldabin VI. [Drug effects on gallbladder motility (based on dynamic ultrasonic data)]. TERAPEVT ARKH 1993; 65:46-9. [PMID: 9133011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ultrasound registration of changes in gallbladder volume by the method of cylinder sum allows reliable means of studying gallbladder contractility in response to pharmacological load. Cerucal increased this activity in chronics with gastroduodenitis and diabetes mellitus, pentagastrin reduced the gallbladder volume. In duodenal ulcer patients a single dose of dalargin dilated the gallbladder for a short time, while in course treatment did not influence it. Gastrocepin inhibited motor activity of gallbladder as well as corinfar.
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Zalev AH, Prokipchuk EJ. Crohn's disease of the proximal small intestine: radiologic findings in 55 patients. Can Assoc Radiol J 1992; 43:170-8. [PMID: 1596759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Radiographs of the upper gastrointestinal tract and the small bowel of 55 patients were reviewed to identify changes associated with proximal enteric Crohn's disease. Five patients had gastroduodenitis, 18 duodenitis, 14 jejunitis and 18 jejunoileitis. Nineteen had previously undergone ileocecal resection. The terminal ileum was spared in 11 of the 36 patients who had not undergone ileocecal resection; of these, 9 had jejunoileitis, 1 jejunitis and 1 jejunitis secondary to colitis with colojejunal fistulas. In just over 80% of the patients with jejunal disease and all the patients with primary jejunal disease in whom the terminal ileum was spared, the condition developed before the patients reached 30 years of age. Duodenal disease was not associated with any particular age group, and duodenitis was invariably a "skip" lesion in patients with disease of the terminal ileum. The diagnosis of proximal enteric Crohn's disease depended on the presence of one or more characteristic lesions in the jejunum or terminal ileitis associated with a duodenal or jejunal abnormality. Ulceration occurred in 88% of the patients with a diseased terminal ileum but was less common in patients with a diseased duodenum (occurring in 43%), jejunum (in 53%) or proximal ileum (in 57%). Fistulas in the terminal ileum complicate ulceration in 10% to 26% of patients, and sinuses complicate ulceration slightly more often, but proximal enteric fistulas or sinuses occurred in only four (7%) of the patients described here.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A H Zalev
- Department of Radiology, University of Toronto, Ont
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Merine D, Jones B, Ghahremani GG, Hamilton SR, Bayless TM. Hyperplasia of Brunner glands: the spectrum of its radiographic manifestations. Gastrointest Radiol 1991; 16:104-8. [PMID: 2016018 DOI: 10.1007/bf01887320] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Radiographic features of the duodenal mucosa were analyzed in a series of 26 patients in whom the diagnosis of Brunner gland hyperplasis (BGH) had been established by endoscopic biopsies. The observed mucosal patterns could be classified into five categories: (1) focal BGH causing a solitary submucosal adenoma or a cluster of sessile polyps in the otherwise smooth duodenal bulb surface (five cases); (2) diffuse BGH manifested by a myriad of small and uniform mucosal elevations (six cases); (3) multifocal BGH producing large and well-demarcated polygonal masses (six cases); (4) BGH with concomitant acute and/or chronic duodenitis showing marked thickening and nodularity of duodenal folds (four cases); or (5) BGH with predominant erosive duodenitis, leading to ulcerations (five cases). These radiographic findings showed a good correlation with the endoscopic and histopathologic manifestations of BGH and the frequently coexistent duodenitis.
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Affiliation(s)
- D Merine
- Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
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29
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Abstract
The authors performed a retrospective study of 50 patients with endoscopically diagnosed duodenitis who had undergone double-contrast upper gastrointestinal (GI) examinations. Duodenitis was diagnosed on the original radiographic reports in six of 37 patients (16%) with mild-to-moderate duodenitis, five of 13 patients (38%) with severe duodenitis, and 11 of 50 patients (22%) with all grades of duodenitis on endoscopy. Subsequent analysis of the films revealed one or more radiologic signs of duodenitis (including folds more than 4 mm in thickness, mucosal nodularity, bulbar deformity, and erosions) in 18 of 37 patients (49%) with mild-to-moderate duodenitis, eight of 13 patients (62%) with severe duodenitis, and 26 of 50 patients (52%) with all grades of duodenitis on endoscopy. In a separate part of the study, the authors identified another 20 patients with radiographically diagnosed duodenitis who had undergone endoscopic examinations. Nine of those 20 patients (45%) had duodenitis on endoscopy. Subsequent analysis of the films revealed one or more signs of duodenitis in 17 patients from this group. Nine of the latter patients (53%) had duodenitis on endoscopy. Using established radiologic criteria for duodenitis, our rate of false-positive and false-negative radiologic diagnoses still was about 50%. Thus, the double-contrast upper GI examination is a relatively unreliable technique for diagnosing duodenitis.
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Affiliation(s)
- M S Levine
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104
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30
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Goldmann A, Schnarkowski P, Büchler M, Friedrich JM. [A rare case of a peripapillary adenomyoma with accompanying duodenitis]. Rontgenpraxis 1991; 44:247-8. [PMID: 1948438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A Goldmann
- Abteilung für Röntgendiagnostik, Universität Ulm
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31
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Sharma P, Sundqvist K. [Isolated gastroduodenal Crohn disease]. Lakartidningen 1991; 88:1893-5. [PMID: 2051864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P Sharma
- Kirurgiska kliniken, Lasarettet i Lund
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32
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Fernandez-Melone JH, Triadafilopoulos G, Chandler JG. Nodular duodenitis and single duodenal nodules. Am Surg 1990; 56:175-7. [PMID: 2316939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Duodenal nodules are an uncommon endoscopic finding generally thought to indicate duodenal inflammation. This study examines the incidence and histologic correlates of multiple and single duodenal nodules in 2,966 consecutive male patients who underwent esophagogastroduodenoscopy during the past five years. Five per cent had duodenal nodules. When two or more discrete nodules, with or without apical ulceration, were present, the finding was termed nodular duodenitis, which was seen five and one-half times more frequently than single nodules. There were 127 patients with nodular duodenitis (4.3%); seven had chronic renal disease and 33 (26%) had concomitant peptic ulcer disease. Biopsies showed either normal mucosa or histologic aberrations typical of nonspecific duodenitis. Single nodules were seen in only 23 patients (0.8%). Biopsies of these nodules revealed benign or malignant tumors in five instances and infrequently showed only normal mucosa. It is concluded that nodular duodenitis is a visually distinct, morphologic variant of nonspecific duodenitis bearing some yet-to-be-defined relationship to peptic ulcer disease. Single nodules are much less likely to represent duodenitis and, in fact, they have significant neoplastic potential, mandating biopsy whenever they are found.
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33
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Reuther G, Bargon G. [Value and reliability of hypotonic duodenography in chronic pancreatitis]. Rontgenblatter 1990; 43:72-7. [PMID: 2320871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence of pathologic duodenal abnormalities in patients suffering from chronic recurrent pancreatitis is derived from a retrospective analysis of 128 hypotonic duodenographies. The value of established diagnostic criteria and the present indication for a hypotonic duodenography in chronic pancreatitis are determined.
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Affiliation(s)
- G Reuther
- Zentrums für Radiologie, Universität Ulm
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34
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Tomei E, Picarelli A, Diacinti D, Gentile F, Francone A. [Radiological study of the duodenum in celiac disease in adults]. Radiol Med 1988; 76:198-200. [PMID: 3175071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Celiac disease (CD) is the most common form of malabsorption in childhood when it presents with diarrhea and growth failure, a jejunal biopsy is considered the first diagnostic investigation by some authors. In adulthood, clinical symptoms of CD may mimic several different disease, such as peptic ulcer and IBS, and the first diagnostic investigation is an upper GI series. Radiological features of duodenum and small bowel were evaluated in twenty patients with adult onset celiac disease. Sign of duodenitis such as thickened folds, mucosal nodules, dilatation of duodenum and erosions were observed in 19 out of our 20 patients (95%); particularly, thickened folds in 17 (85%), nodularity in 16 (80%), duodenal dilatation in 12 (60%) and erosions in 4 (20%). In celiac disease the lesions are more severe in the upper part of small bowel, and duodenitis may be the unique sign of CD. Duodenitis may be part of a disease involving the entire small bowel; so, a duodenitis observed in the upper gastrointestinal tract requires the study of the entire small bowel--which seems to be very important in the case of celiac disease.
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Affiliation(s)
- E Tomei
- Servizio di Radiologia, Università La Sapienza, Roma
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35
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Newman LH, Wellinger JR, Present DH, Aufses AH. Crohn's disease of the duodenum associated with pancreatitis: a case report and review of the literature. Mt Sinai J Med 1987; 54:429-32. [PMID: 3309634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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36
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Levine MS. Crohn's disease of the upper gastrointestinal tract. Radiol Clin North Am 1987; 25:79-91. [PMID: 3823395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Involvement of the upper gastrointestinal tract by Crohn's disease is being recognized with increasing frequency. Gastroduodenal disease is more common, although esophageal disease is now noted infrequently as well. There is nearly always concomitant involvement of the small bowel or colon. Initial phases of the disease are manifested as superficial inflammatory changes of the mucosa but can progress to scarring and stenosis. Optimum double-contrast technique is necessary to detect these early lesions.
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37
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Nacchiero M, Margari A, Pizzolato D, Cortese AM, Bonomo GM. [Endoscopic evaluation of nonspecific gastrointestinal disorders]. Recenti Prog Med 1986; 77:176-9. [PMID: 3715183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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38
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Abstract
Potential radiologic findings of duodenitis were investigated in 272 patients, 157 with endoscopically diagnosed duodenitis and 115 endoscopically normal controls. The study assessed the value of four signs: folds more than 4 mm thick, mucosal nodules, bulbar deformity, and erosions. The most sensitive signs were thickened folds (72.0%) and nodularity (48.4%), while demonstration of erosions was the least sensitive (10.8%). Overall sensitivity (77.7%) approximated that for the radiologic diagnosis of peptic ulcer or esophagitis. Radiologic specificity (76.5%) was in the same range.
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39
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Mironov SP, Kasatkin IN, Mironova ES. [Cholescintigraphy of gastroduodenal pathology in children]. Med Radiol (Mosk) 1985; 30:30-3. [PMID: 4079689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The results of cholescintigraphy with 99mTc-HIDA in 245 children were analysed. The relationship of a latent time period with the state of the stomach-duodenum system was revealed. The specificity of this index was 82%, sensitivity 70%, accuracy 75% and pathology predictability 85%. The scintigraphic picture of a duodenobulbar reflux in the form of a RP "depot" in the ascending and upper horizontal part of the duodenum manifested itself with the specificity of 90% and predictability of pathology in 75%. Duodenogastric refluxes were revealed with the specificity of 94%, accuracy of 88% and pathology predictability of 90%. A low specificity of 34 and 43% was associated with a possibility of reflux detection in the lower horizontal part of the duodenum only.
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40
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Koroliuk IP, Bugakov OA, Shinkin VM. [Improved method of x-ray examination of the duodenum]. Vestn Rentgenol Radiol 1985:13-8. [PMID: 4013058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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41
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Abstract
"Duodenitis" remains a controversial area in clinical medicine. This review discusses the various methods of diagnosis (histology, radiology, endoscopy) and concludes that "endoscopic duodenitis" is a definite clinical entity. Studies are presented on the changes in duodenitis in relation to peptic ulcer disease, and it is concluded that "endoscopic duodenitis" is unlikely to be the cause of symptoms unless accompanied by a peptic ulcer.
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42
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Abstract
Small (1-4 mm) hexagonal filling defects were found on air-contrast studies of the duodenal bulb in three patients with unresponsive (atypical) celiac disease. Multiple biopsies confirmed both celiac disease and peptic duodenitis. Stimulated acid outputs determined in two patients were in the peptic ulcer range. Cimetidine therapy led to improved absorption in all three patients. Repeat upper gastrointestinal series and endoscopy in one patient showed no evidence of nodularity or peptic duodenitis, indicating that these changes may be reversible. Peptic disease may contribute to nodularity in the duodenal bulb and relative lack of response to a gluten-free diet of some patients with celiac disease. The finding of tiny nodules in the duodenal bulb in a patient with malabsorption should lead to consideration of celiac disease as a primary diagnosis with peptic duodenitis as an aggravating factor.
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43
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Abstract
A patient with Crohn's disease which involved the duodenum presented with recurrent pancreatitis. His upper gastrointestinal series demonstrated spontaneous reflux of barium into the pancreatic duct. The literature is reviewed and a probable mechanism for this very unusual occurrence is suggested.
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44
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Zukerman GR, Mills BA, Koehler RE, Siegel A, Harter HR, DeSchryver-Kecskemeti K. Nodular duodenitis. Pathologic and clinical characteristics in patients with end-stage renal disease. Dig Dis Sci 1983; 28:1018-24. [PMID: 6354649 DOI: 10.1007/bf01311731] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This prospective study evaluated the radiographic, endoscopic, histologic, and clinical characteristics of nodular duodenitis found in 17 of 50 (34%) patients with end-stage renal disease. By comparison, nodular duodenitis was noted in only 23 of 557 (4%) consecutive endoscopies in a general medical population. Endoscopic nodular duodenitis consisted of two or more nodules, 2.5-7.0 mm in diameter, with apical erythema, with or without tip erosions. Eight patients had nodules in the bulb only, eight had diffuse duodenal nodules, and a single patient had nodules only in the second portion of the duodenum. Single-contrast barium x-rays were sensitive in detecting the nodules only when they were 5 mm or greater in diameter. Some degree of inflammatory infiltrate was found in 14 of 17 (82%) of the patients with nodular duodenitis; 10 of 17 had a moderate to severe histologic grade compared to 3 of 18 (P = 0.015) patients with a normal endoscopic appearance to the duodenum. Several patients with endoscopic nodular duodenitis, in whom biopsies were taken both of the nodule and surrounding mucosa, were found to have a focal histologic lesion which consisted of villous blunting and thickening due to fibrosis and a chronic inflammatory infiltrate or lymphoid aggregate in the stroma. A higher incidence of peptic ulcers occurred in the nodular duodenitis group (3 of 17) compared to the remainder of the group (0 of 33) during a mean follow-up of 38 months (P = 0.03). Resolution of the nodules occurred in six patients following successful renal transplant (four patients) and following vagotomy and pyloroplasty (two patients).(ABSTRACT TRUNCATED AT 250 WORDS)
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45
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Hörmann M, Lammer J. [Gastroduodenal Crohn disease--a case report]. Rontgenblatter 1983; 36:222-4. [PMID: 6622953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of gastroduodenal Crohn's disease is presented by describing the acute phase and findings after one year. Typical signs are the localisation in the region of the antrum-pylorus-bulbus, as well as the paving-stone relief pattern and the pseudo-post-Billroth-I sign.
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46
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Abstract
The radiological and endoscopic findings are described in 214 patients with 252 lesions in whom endoscopy had been requested by a radiologist either to confirm or clarify a radiological opinion. There was radiological and endoscopic agreement about the presence or absence of oesophagitis in 73% of patients, but there was agreement about the presence or absence of duodenitis in only 48%. There were only two cases of early gastric cancer, and no early gastric cancers were found in a group of 43 patients on whom endoscopy had been specifically requested because of an abnormal gastric mucosal pattern. Endoscopy failed to detect 13% of gastric ulcers at the initial endoscopic examination.
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47
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Kurtz B, Steinhardt HJ, Malchow H. [The radiological and endoscopic appearances of Crohn's disease of the upper gastro-intestinal tract (author's transl)]. ROFO-FORTSCHR RONTG 1982; 136:124-8. [PMID: 6212423 DOI: 10.1055/s-2008-1056012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Involvement of the upper gastrointestinal tract (oesophagus, stomach, duodenum, jejunum) accounted for 13% of endoscopically proven Crohn's disease in patients at the University Clinic, Tübingen between 1973 and 1980. The basis for the diagnosis was the presence of epitheloid granulomas. The diagnosis was suspected in 26% of patients on endoscopic appearances alone. In these two groups, the appearances were similar, consisting of atypical or linear ulcers, cobble-stone lesions, chronic erosions, aphthous ulcers, stenoses, coarsening of the mucosa and areas of engorgement and granularity. Most patients were also examined radiologically. The radiological findings correspond with the endoscopic observations. Using a double contrast technique, mucosal changes could be demonstrated which, up to now, were only seen by endoscopy. If these findings are observed either radiologically or endoscopically, it is essential to examine the distal portions of the gut.
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48
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Trüber E, Kirchmaier CM, Wurbs D. [Nonocclusive mesenteric ischemia (author's transl)]. Radiologe 1981; 21:391-5. [PMID: 7280220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This report intends to emphasize the importance of selective angiography in nonocclusive mesenteric ischemia (NMI). In a 67-year-old male with abdominal pain and weight loss the diagnosis of NMI was made angiographically after enteroclysis had shown extensive ulcerative jejunitis. In this condition, where constriction and obliteration of vasa recta of the superior mesenteric artery are present, operation is contraindicated. Current status of still incomplete understanding of the disease is discussed.
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49
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Mazurin AV, Popov VG, Zaprudnov AM, Popov VI. [Current aspects of assessing the functional state of the hepatobiliary system in gastroduodenal diseases in children]. Pediatriia 1981:7-11. [PMID: 6974339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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50
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Blain F, Le Guyader J, Brousse A, Saliou J, Bellet M. [Double contrast radiological exploration of the major duodenal papilla (author's transl)]. J Radiol 1980; 61:483-93. [PMID: 7463390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The major duodenal papilla can be outlined in 75% of cases by double contrast examination. It is composed of an oval-shaped nodule covered by a mucous cap which is prolonged into a frenum in its lower part. Its mean dimensions are 11 X 7 X 6 mm. Many variations are observed, and these are analyzed as well as the features suggesting pathological modifications. These may arise from inflammation: during the course of primary or secondary (ulcer, pancreatitis) duodenitis, or be related to a stone blocked in the region of the ampulla. Tumors in this region are rare, and are usually malignant tumors, the characteristics and extension of which can be determined from radiological images. Use of this radiological technique as a preliminary step enables a complete study of the upper digestive tract to be conducted at the same time.
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