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Chowdhury D. Mediastinal emphysema in the context of perforated gastric ulcer. World J Clin Cases 2024; 12:2479-2481. [DOI: 10.12998/wjcc.v12.i15.2479] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
In the context of mediastinal emphysema/pneumomediastinum, the main aetiologies are associated with oesophageal perforation, lung pathology or post head and neck surgery related. The main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase imaging. The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic. Oesophageal perforation (Boerhaave syndrome) is associated with Mackler’s triad in upto 50% of patients (severe retrosternal chest pain, pneumomediastinum, mediastinitis). Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.
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Affiliation(s)
- Debkumar Chowdhury
- Department of Emergency Medicine, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom
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2
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Song S, Guo W, Zou S, Zhou F, Luo M, Chen L, Liang K. Life-threatening gastrointestinal bleeding caused by cytomegalovirus-induced duodenal ulcer in a patient with AIDS: A case report. Heliyon 2024; 10:e30112. [PMID: 38737287 PMCID: PMC11087948 DOI: 10.1016/j.heliyon.2024.e30112] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Background The reasons for gastrointestinal bleeding among patients with acquired immune deficiency syndrome (AIDS) were complex. Here we present an unusual case of life-threatening gastrointestinal bleeding caused by a cytomegalovirus-induced duodenal ulcer in an AIDS patient. Case presentation A 31-year-old male with AIDS was admitted on July 18, 2023, complaining of abdominal pain for 38 days and intermittent hematochezia for 12 days. During his hospitalization, gastrointestinal endoscopy attributed gastrointestinal bleeding to a giant duodenal ulcer. Furthermore, cytomegalovirus(CMV) infection was confirmed as the reason for the ulcer through metagenomic next-generation sequencing (mNGs), hematoxylin-eosin(HE) staining, and immunohistochemistry (IHC) staining for the biopsy tissue. The patient's gastrointestinal bleeding was stopped by interventional embolization. Following a 4-week course of anti-CMV treatment, the giant duodenal ulcer was cured. Conclusions For AIDS patients with gastrointestinal bleeding, the CMV-induced gastrointestinal ulcer should be considered. Comprehensive mothods (mNGs, HE staining and IHC staining for biopsy tissue) were benefit for confirmed diagnosis. Beside anti-CMV treatment, the interventional embolization is a choice for hemostasis.
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Affiliation(s)
- Shihui Song
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
- Center for AIDS Research, Wuhan University, Wuhan, Hubei Province, China
| | - Wei Guo
- Department of Pathology, Wuhan University Taikang Medical School, School of Basic Medical Sciences, Wuhan, Hubei Province, China
- Pathology Department, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shi Zou
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
- Center for AIDS Research, Wuhan University, Wuhan, Hubei Province, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, Hubei Province, China
| | - Feng Zhou
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Hubei Clinical Center and Key Laboratory for Intestinal and Colorectal Diseases, Wuhan, Hubei Province,China
| | - Mingqi Luo
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Chen
- Infectious Immunology Department, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology,Wuhan, Hubei Province, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
- Center for AIDS Research, Wuhan University, Wuhan, Hubei Province, China
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, Hubei Province, China
- Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Zhang L, Song L, Cui C, Wang C, Zhang Y, Yao X, Liu D. Integrated models of population pharmacokinetics and exposure response to optimize dosage regimen for anaprazole sodium in duodenal ulcer. Eur J Pharm Sci 2024; 198:106781. [PMID: 38703917 DOI: 10.1016/j.ejps.2024.106781] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
Anaprazole sodium enteric-coated tablet is a novel proton pump inhibitor which has been approved for the treatment of duodenal ulcer. The aim of this study is to provide reliable information for the design of an optimal dosage regimen. Population pharmacokinetics and exposure-response models were integrated to evaluate the pharmacokinetic parameters and covariates of Anaprazole and its metabolite M21-1, and subsequently provided dosage suggestions based on clinical trials and simulation data. A pharmacokinetic model incorporating two-compartment for the parent drug and one-compartment for the metabolite, with both first-order and zero-order mixed absorption was used to describe the pharmacokinetics of Anaprazole and M21-1. Age emerged as a significant covariate affecting the elimination rate constant of M21-1, with clearance decreasing as age advances. No correlation was observed between the pharmacokinetics of Anaprazole or M21-1 and the adverse reactions under the current dosages. BMI might be the influence factor of the mild gastrointestinal adverse reactions. Meanwhile, Anaprazole had a good healing rate (94.0 %) in duodenal ulcer patients and the exposure-response analysis indicated that the cured results were not influenced by the exposure parameters of parent drug or metabolite. In conclusion, the drug is safe when dosing between 20 and 100 mg once a day.
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Affiliation(s)
- Lei Zhang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, 100191, PR China; Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China; Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, PR China
| | - Ling Song
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China; Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, PR China
| | - Cheng Cui
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China; Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, PR China
| | - Chunyang Wang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China
| | - Yi Zhang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China
| | - Xueting Yao
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China; Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, PR China.
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, 100191, PR China; Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, 100191, PR China.
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Saura R, Hagiwara SI, Hizuka K, Okamoto N, Etani Y. First case report of dichorionic diamniotic twins with chronic enteropathy associated with the SLCO2A1 gene. Clin J Gastroenterol 2024; 17:240-243. [PMID: 38289459 DOI: 10.1007/s12328-023-01912-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/16/2023] [Indexed: 03/24/2024]
Abstract
We report the case of twins diagnosed with chronic enteropathy associated with the SLCO2A1 gene (CEAS) based on characteristic ulcer findings, which required 8 years to diagnose. Both twins had similar symptoms, including anemia and growth failure but the gastrointestinal tract was not evaluated initially because of mild symptoms that were considered consistent with psychological etiology. The endoscopic findings of the firstborn child showed spiral ulcer scars and pseudodiverticulum formation without Helicobacter pylori infection or eosinophilic infiltration in the duodenum. Since the twins presented with ulcers of an unknown cause simultaneously and the first-born child had a spiral ulcer, CEAS was suspected. Genetic analysis and high levels of prostaglandin E major urinary metabolites in the urine led to a definitive diagnosis of CEAS.
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Affiliation(s)
- Ryutaro Saura
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Shin-Ichiro Hagiwara
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
| | - Keinosuke Hizuka
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Yuri Etani
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
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Kayamba V, Mubbunu M, Kelly P. Endoscopic diagnosis of gastric and oesophageal cancer in Lusaka, Zambia: a retrospective analysis. BMC Gastroenterol 2024; 24:122. [PMID: 38561688 PMCID: PMC10983744 DOI: 10.1186/s12876-024-03187-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION There are uncertainties surrounding the spectrum of upper gastrointestinal (UGI) diseases in sub-Saharan Africa. This is mainly due to the limitations of data collection and recording. We previously reported an audit of UGI endoscopic diagnoses in Zambia spanning from 1977 to 2014. We now have extended this analysis to include subsequent years, in order to provide a more comprehensive picture of how the diagnoses have evolved over 4 decades. METHODS We combined data collected from the endoscopy unit at the University Teaching Hospital (UTH) in Lusaka during a previous review with that collected from the beginning of 2015 to the end of 2021. Since 2015, an electronic data base of endoscopy reports at the UTH was kept. The electronic data base was composed of drop-down menus that allowed for standardised reporting of findings. Collected data were coded by two experienced endoscopists and analysed. RESULTS In total, the analysis included 25,849 endoscopic records covering 43 years. The number of endoscopic procedures performed per year increased drastically in 2010. With the exception of the last 2 years, the proportion of normal endoscopies also increased during the time under review. In total, the number of gastric cancer (GC) cases was 658 (3%) while that of oesophageal cancer (OC) was 1168 (5%). The number of GC and OC diagnoses increased significantly over the period under review, (p < 0.001 for both). For OC the increase remained significant when analysed as a percentage of all procedures performed (p < 0.001). Gastric ulcers (GU) were diagnosed in 2095 (8%) cases, duodenal ulcers (DU) in 2276 (9%) cases and 239 (1%) had both ulcer types. DU diagnosis showed a significantly decreasing trend over each decade (p < 0.001) while GU followed an increasing trend (p < 0.001). CONCLUSIONS UGI endoscopic findings in Lusaka, Zambia, have evolved over the past four decades with a significant increase of OC and GU diagnoses. Reasons for these observations are yet to be established.
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Nationalist Road, PO Box 50398, Lusaka, Zambia.
| | - Malambo Mubbunu
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Nationalist Road, PO Box 50398, Lusaka, Zambia
| | - Paul Kelly
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Nationalist Road, PO Box 50398, Lusaka, Zambia
- Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, E1 2AT, London, UK
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Mujadzic H, Noorani S, Riddle PJ, Wang Y, Metts G, Yacu T, Abougergi MS. Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization. Dig Dis Sci 2024:10.1007/s10620-024-08322-y. [PMID: 38446313 DOI: 10.1007/s10620-024-08322-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/09/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND GOALS Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting. METHODS Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients' demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis. RESULTS A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs. CONCLUSIONS The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.
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Affiliation(s)
- Hata Mujadzic
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Shayan Noorani
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Philip J Riddle
- Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA, USA
| | - Gracelyn Metts
- Department of Health Sciences, Clemson University, Clemson, SC, USA
| | - Tania Yacu
- Department of Health Sciences, Clemson University, Clemson, SC, USA
| | - Marwan S Abougergi
- Catalyst Medical Consulting, Huntingdon Valley, PA, USA.
- Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Hospital, INOVA Health, 3300 Gallows Road, Falls Church, VA, 22042, USA.
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Vu TVT, Smith BC, Chen R, Narendra A, Brown W. Management of a Proximal and Distal Staple Line Leak Following Sleeve Gastrectomy and a Concurrent Duodenal Ulcer by Emergency Laparoscopic Conversion to a Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:700-701. [PMID: 38110784 DOI: 10.1007/s11695-023-06997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Affiliation(s)
| | - Baxter Clyde Smith
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Richard Chen
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Aaditya Narendra
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Wendy Brown
- The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
- Centre for Obesity Research and Education, Monash University, Melbourne, VIC, Australia
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Rizzo AN, Seligson M, O'Brien W, Laczynski D, Rizzo A. Celiac artery occlusion from median arcuate ligament compression complicating a hemorrhagic duodenal ulcer repair. J Vasc Surg Cases Innov Tech 2024; 10:101371. [PMID: 38130365 PMCID: PMC10731594 DOI: 10.1016/j.jvscit.2023.101371] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
We present a case of a hemorrhagic duodenal ulcer complicated by occlusion of the celiac artery (CA) by acute median arcuate ligament (MAL) compression. Angiography revealed retrograde flow through the gastroduodenal artery (GDA) to the hepatic artery, with occlusion at the CA origin. This unique presentation required coordinated release of the MAL to reestablish antegrade CA flow before pyloroplasty and GDA ligation. The presence of preexisting MAL compression of the CA should be considered during the repair of bleeding duodenal ulcers through embolization or ligation of the GDA, because impaired CA perfusion could result in foregut ischemia.
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Affiliation(s)
- Anthony N. Rizzo
- Department of Surgery, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - Marc Seligson
- Vascular Surgery Department, Cleveland Clinic Akron General, Akron, OH
| | - William O'Brien
- General Surgery Department, Cleveland Clinic Foundation, Mayfield Heights, OH
| | - David Laczynski
- Vascular Surgery Department, Cleveland Clinic Foundation, Cleveland, OH
| | - Anthony Rizzo
- Vascular Surgery Department, Cleveland Clinic Foundation, Mayfield Heights, OH
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冯 敏, 陈 哲, 程 永. [A case of duodenal ulcer as prominent manifestation of IgG4-related disease]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:1125-1129. [PMID: 38101799 PMCID: PMC10724000] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 12/17/2023]
Abstract
A case of IgG4-related disease presented with a duodenal ulcer to improve the understan-ding of IgG4-related diseases was reported. A 70-year-old male presented with cutaneous pruritus and abdominal pain for four years and blackened stools for two months. Four years ago, the patient went to hospital for cutaneous pruritus and abdominal pain. Serum IgG4 was 3.09 g/L (reference value 0-1.35 g/L), alanine aminotransferase 554 U/L (reference value 9-40 U/L), aspartate aminotransferase 288 U/L (reference value 5-40 U/L), total bilirubin 54.16 μmol/L (reference value 2-21 μmol/L), and direct bilirubin 29.64 μmol/L (reference value 1.7-8.1 μmol/L) were all elevated. The abdominal CT scan and magnetic resonance cholangiopancreatography indicated pancreatic swelling, common bile duct stenosis, and secondary obstructive dilation of the biliary system. The patient was diagnosed with IgG4-related disease and treated with prednisone at 40 mg daily. As jaundice and abdominal pain improved, prednisone was gradually reduced to medication discontinuation. Two months ago, the patient developed melena, whose blood routine test showed severe anemia, and gastrointestinal bleeding was diagnosed. The patient came to the emergency department of Beijing Hospital with no improvement after treatment in other hospitals. Gastroscopy revealed a 1.5 cm firm duodenal bulb ulcer. After treatment with omeprazole, the fecal occult blood was still positive. The PET-CT examination was performed, and it revealed no abnormality in the metabolic activity of the duodenal wall, and no neoplastic lesions were found. IgG4-related disease was considered, and the patient was admitted to the Department of Rheumatology and Immunology of Beijing Hospital for further diagnosis and treatment. The patient had a right submandibular gland mass resection history and diabetes mellitus. After the patient was admitted to the hospital, the blood test was reevaluated. The serum IgG4 was elevated at 5.44 g/L (reference value 0.03-2.01 g/L). Enhanced CT of the abdomen showed that the pancreas was mild swelling and was abnormally strengthened, with intrahepatic and extrahepatic bile duct dilation and soft tissue around the superior mesenteric vessels. We pathologically reevaluated and stained biopsy specimens of duodenal bulbs for IgG and IgG4. Immunohistochemical staining revealed remarkable infiltration of IgG4-positive plasma cells into duodenal tissue, the number of IgG4-positive cells was 20-30 cells per high-powered field, and the ratio of IgG4/IgG-positive plasma cells was more than 40%. The patient was treated with intravenous methylprednisolone at 40 mg daily dosage and cyclophosphamide, and then the duodenal ulcer was healed. IgG4 related disease is an immune-medicated rare disease characterized by chronic inflammation and fibrosis. It is a systemic disease that affects nearly every anatomic site of the body, usually involving multiple organs and diverse clinical manifestations. The digestive system manifestations of IgG4-related disease are mostly acute pancreatitis and cholangitis and rarely manifest as gastrointestinal ulcers. This case confirms that IgG4-related disease can present as a duodenal ulcer and is one of the rare causes of duodenal ulcers.
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Affiliation(s)
- 敏 冯
- />北京医院风湿免疫科, 国家老年医学中心, 中国医学科学院老年医学研究院, 北京 100730Department of Rheumatology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - 哲 陈
- />北京医院风湿免疫科, 国家老年医学中心, 中国医学科学院老年医学研究院, 北京 100730Department of Rheumatology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - 永静 程
- />北京医院风湿免疫科, 国家老年医学中心, 中国医学科学院老年医学研究院, 北京 100730Department of Rheumatology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
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Tsuge M, Shigehara K, Uda K, Kawano S, Iwamuro M, Saito Y, Yashiro M, Ikeda M, Tsukahara H. Successful use of dupilumab for egg-induced eosinophilic gastroenteritis with duodenal ulcer: a pediatric case report and review of literature. Allergy Asthma Clin Immunol 2023; 19:103. [PMID: 38053199 DOI: 10.1186/s13223-023-00859-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Non-esophageal eosinophilic gastrointestinal disorder (non-EoE-EGID) is a rare disease in which eosinophils infiltrate parts of the gastrointestinal tract other than the esophagus; however, the number of patients with non-EoE-EGID has been increasing in recent years. Owing to its chronic course with repeated relapses, it can lead to developmental delays due to malnutrition, especially in pediatric patients. No established treatment exists for non-EoE-EGID, necessitating long-term systemic corticosteroid administration. Although the efficacy of dupilumab, an anti-IL-4/13 receptor monoclonal antibody, for eosinophilic esophagitis, has been reported, only few reports have demonstrated its efficacy in non-EoE EGIDs. CASE PRESENTATION A 13-year-old boy developed non-EoE-EGID with duodenal ulcers, with chicken eggs as the trigger. He was successfully treated with an egg-free diet, proton pump inhibitors, and leukotriene receptor antagonists. However, at age 15, he developed worsening upper abdominal pain and difficulty eating. Blood analysis revealed eosinophilia; elevated erythrocyte sedimentation rate; and elevated levels of C-reactive protein, total immunoglobulin E, and thymic and activation-regulated chemokines. Upper gastrointestinal endoscopy revealed a duodenal ulcer with marked mucosal eosinophilic infiltration. Gastrointestinal symptoms persisted even after starting systemic steroids, making it difficult to reduce the steroid dose. Subcutaneous injection of dupilumab was initiated because of comorbid atopic dermatitis exacerbation. After 3 months, the gastrointestinal symptoms disappeared, and after 5 months, the duodenal ulcer disappeared and the eosinophil count decreased in the mucosa. Six months later, systemic steroids were discontinued, and the duodenal ulcer remained recurrence-free. The egg challenge test result was negative; therefore, the egg-free diet was discontinued. Blood eosinophil count and serum IL-5, IL-13, and eotaxin-3 levels decreased after dupilumab treatment. The serum levels of IL-5 and eotaxin-3 remained within normal ranges, although the blood eosinophil counts increased again after discontinuation of oral prednisolone. CONCLUSIONS Suppression of IL-4R/IL-13R-mediated signaling by dupilumab may improve abdominal symptoms and endoscopic and histologic findings in patients with non-EoE-EGID, leading to the discontinuation of systemic steroid administration and tolerance of causative foods.
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Affiliation(s)
- Mitsuru Tsuge
- Department of Pediatric Acute Diseases, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kenji Shigehara
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Yukie Saito
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Masato Yashiro
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Masanori Ikeda
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Yahya H. Change in Prevalence and Pattern of Peptic Ulcer Disease in the Northern Savannah of Nigeria: An Endoscopic Study. Ann Afr Med 2023; 22:420-425. [PMID: 38358140 PMCID: PMC10775940 DOI: 10.4103/aam.aam_144_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2024] Open
Abstract
Background Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been observed in many parts of Africa including Nigeria. Aim This study aimed to provide an endoscopic update on PUD in the Northern Savannah of Nigeria and compare with past reports from the region and recent reports from Nigeria, Africa, and the rest of the world. Methods Upper gastrointestinal endoscopy records of consecutive patients diagnosed with PUD between January 2014 and September 2022 at an endoscopy unit of a tertiary institution in North-West Nigeria were retrieved and demographic data, types of peptic ulcer, and their characteristics were extracted and analyzed. Results Over a 9-year period, 171/1958 (8.7%) patients were diagnosed with PUD: mean age 48.8 years (range 14-85), 68.4% male, and 70% >40 years. 59.6% were gastric ulcers (GU), 31.6% duodenal ulcers (DU), and 8.8% were both. The mean age of patients with GU was slightly higher than those with DU (49.9 years vs. 46.6 years, P = 0.29); patients aged <40 years were significantly more likely to be diagnosed with DU than GU (54.7% vs. 33.9%, P = 0.016) while those >40 years significantly more GU than DU (74.6% vs. 54.7%, P = 0.016). There were no significant gender differences between GU and DU. Conclusion The prevalence and pattern of PUD in Northern Savannah of Nigeria have changed - patients were predominantly male and older, and GU predominated.
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Affiliation(s)
- Husain Yahya
- Department of Internal Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
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12
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Liu G, Meng Q, Li Y, Li Y, Jiao T, Zhao H, Dai B. Bleeding due to successive duodenal and rectal ulcers in an 81-year-old patient with severe COVID-19: a case report. BMC Geriatr 2023; 23:559. [PMID: 37710168 PMCID: PMC10500923 DOI: 10.1186/s12877-023-04283-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND In the early stages of the coronavirus disease 2019 (COVID-19) outbreak, the most widely recognised symptoms of the disease were fever, cough, shortness of breath, myalgia, and fatigue. However, in addition to these symptoms, COVID-19 can cause systemic symptoms outside the lungs. Older patients with severe COVID-19 often require admission to the intensive care unit (ICU). Acute rectal ulcer bleeding, characterised by painless, profuse haematochezia, caused by solitary or multiple rectal ulcers, is one of the main causes of severe haematochezia in patients with COVID-19 in the ICU. However, recurrent duodenal ulcer bleeding followed by rectal ulcer bleeding has not previously been reported in older patients during ICU treatment for severe COVID-19. CASES PRESENTATION Herein, we report the case of an 81-year-old woman admitted to the emergency department due to severe COVID-19 and transferred to the ICU 2 days later for treatment. During treatment in the ICU, the patient developed recurrent duodenal ulcer bleeding and underwent endoscopic electrocoagulation haemostasis and gastroduodenal artery embolisation. However, the night after the final haemostatic operation, due to rectal ulcer bleeding, the patient discharged bloody stools intermittently, which was effectively controlled using endoscopic electrocoagulation, topical medication, blood transfusion, and haemostatic drugs. CONCLUSIONS To the best of our knowledge, this is the first report of duodenal ulcer bleeding followed by rectal ulcer bleeding in an older patient with severe COVID-19 infection. This report creates awareness for clinicians about the multiple and complex gastrointestinal symptoms that may occur during COVID-19 treatment.
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Affiliation(s)
- Guanlin Liu
- Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qiang Meng
- Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, China.
| | - Yunwei Li
- Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yiling Li
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Taiwei Jiao
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hongwen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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13
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Sharma P, Phatak SM, Warikoo P, Mathur A, Mahant S, Das K, Das R. Crosstalk between Helicobacter pylori and gastrointestinal microbiota in various gastroduodenal diseases-A systematic review. 3 Biotech 2023; 13:303. [PMID: 37588796 PMCID: PMC10425313 DOI: 10.1007/s13205-023-03734-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
Gastroduodenal diseases have prevailed for a long time and more so due to dominance of gut bacteria Helicobacter pylori in most of the cases. But habitation by other gut microbiota in gastroduodenal diseases and the relationship between Helicobacter pylori and gastrointestinal microbiota in different gastroduodenal diseases is somewhat being unravelled in the current times. For this systematic review, we did a literature search of various gastroduodenal diseases and the effect on gut microbiota pertaining to it. A search of the online bibliographic databases PUBMED and PUBMED CENTRAL was carried out to identify articles published between 1977 and May 2022. The analysis of these selected studies highlighted the inhabitation of other gut microbiota such as Fusobacteria, Bacteroidetes, Streptococcaceae, Prevotellaceae, Fusobacteriaceae, and many others. Interplay between these microbiota and H. pylori have also been noted which suggested that gastroduodenal diseases and gut microbiota are intertwined by a symbiotic association regardless of the H. pylori status. The relationship between the gut microbiota and many gastroduodenal diseases, such as gastritis, gastric cancer, lymphomas, and ulcers, demonstrates the dysbiosis of the gut microbiota in both the presence and absence of H. pylori. The evolving ways for eliminating H. pylori are provided along with inhibiting qualities of other species on H. pylori. Most significant member of our gut system is Helicobacter pylori which has been associated with numerous diseases like gastric cancer, gastritis, duodenal ulcer.
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Affiliation(s)
- Prateek Sharma
- Center for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, U.P. India
| | - Shravani M. Phatak
- Center for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, U.P. India
| | - Prisha Warikoo
- Center for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, U.P. India
| | - Akshita Mathur
- Center for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, U.P. India
| | - Shweta Mahant
- Center for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, U.P. India
| | - Kunal Das
- Department of Gastroenterology, Yashoda Super Speciality Hospital, Kaushambi, Ghaziabad, Uttar Pradesh India
| | - Rajashree Das
- Center for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, U.P. India
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14
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Acharyya BC, Mukhopadhyay M, Chakraborty H. Changing trend in the spectrum of upper gastrointestinal bleeding in children-A multicentre experience. Indian J Gastroenterol 2023; 42:562-568. [PMID: 36757638 DOI: 10.1007/s12664-022-01306-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/27/2022] [Indexed: 02/10/2023]
Abstract
In children, upper gastrointestinal bleeding (UGIB) is an uncommon, but potentially serious, condition with diverse etiologies. A prospective study had been undertaken to find out any changing trend in the etiology and outcome of pediatric UGIB in Eastern India. This retrospective analysis of case records of children, presenting in outpatient or emergency with hematemesis and/or melena from 2 tertiary GI centers of Kolkata, was undertaken to find out the etiologies of bleed and the outcome of management. A total of 180 children were evaluated including 30 (16.7%) infants. The predominant cause of GGIB was gastroduodenal ulcer and erosions (60%) followed by variceal bleeding (19.4%). Vascular lesions were detected in 4 (2%). Hyperplastic antral polyp was an unusual etiology in 3 (1.7%) infants. Various endotherapies were needed in 28% of cases. No mortality was noted. Melena, hemoglobin below 8 gm%, the need for volume replacement, and packed red blood cells transfusion on admission were associated with significant endoscopic lesions, which needed endotherapies. This study, comprising the largest cohort among Indian published series, found an etiology of pediatric upper GI bleed, different from the one, previously depicted. This may be a reflection either of regional variations or a changing trend over time.
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Affiliation(s)
- Bhaswati C Acharyya
- Department of Paediatric Gastroenterology, AMRI Hospitals, 230 Barakhola Lane, Purba Jadavpur, Kolkata, 700 099, India.
| | - Meghdeep Mukhopadhyay
- Department of Paediatric Gastroenterology, AMRI Hospitals, 230 Barakhola Lane, Purba Jadavpur, Kolkata, 700 099, India
| | - Hema Chakraborty
- Department of Histopathology, AMRI Hospitals, 230 Barakhola Lane, Purba Jadavpur, Kolkata, 700 099, India
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15
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Obeidat N, Heilat G, Ajam T, Al-Zoubi H. Perforated Stress Ulcer of the Duodenum: a Case of an Unexpected Diagnosis in a COVID-19 Patient Following Dilatation and Curettage Procedure. Med Arch 2023; 77:155-157. [PMID: 37260798 PMCID: PMC10227846 DOI: 10.5455/medarh.2023.77.155-157] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/12/2023] [Indexed: 06/02/2023] Open
Abstract
Background Stress ulcers in the upper gastrointestinal tract can arise from pathologies related to erosive or inflammatory insults in critically ill patients. The relationship between stressful bodily events and the ischemia and perforation of stress ulcers is poorly understood. Objective We present a case of perforated stress ulcer following an abortion that was treated by dilatation and curettage (D&C) and complicated by a coronavirus disease 2019 (COVID-19) infection. Case presentation A 40-year-old lady presented to the emergency room complaining of diffuse abdominal pain, she was recently diagnosed with an incomplete abortion and managed via a D&C procedure in an external hospital. A computed tomography (CT) scan was done at our center for the abdomen and pelvis, showing extensive pneumoperitoneum, which brought the radiologist's attention to suspect a small bowel perforation presumably accompanying a uterine perforation secondary to the D&C. There were no obvious signs of pelvic small bowel perforation in the initial CT images. The perforated duodenal stress ulcer was diagnosed the next day by a new CT scan following oral contrast ingestion and managed surgically by repair and omental patch, and no other bowel perforations were found upon surgical exploration. After the surgery, the patient was diagnosed with COVID-19, and her clinical status deteriorated gradually during the following week, and she passed away from a cardiac arrest. Conclusion It is unclear whether septic abortion or COVID-19 has resulted in stress ulcer perforation in our patient. This case report highlights the importance of raising early suspicion in the diagnosis of stress ulcer perforation in critically ill patients to reduce the risk of morbidity and mortality.
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Affiliation(s)
- Naser Obeidat
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ghaith Heilat
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarek Ajam
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamzeh Al-Zoubi
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Shen Q, Liu T, Wang S, Wang L, Wang D. Experience in diagnosis and treatment of duodenal ulcer perforation in children. BMC Pediatr 2023; 23:144. [PMID: 36997985 PMCID: PMC10061964 DOI: 10.1186/s12887-023-03957-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children's Health. METHODS Fifty-two children with duodenal perforation hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from January 2007 to December 2021 were retrospectively collected. According to the inclusion and exclusion criteria, patients with duodenal ulcer perforation were included in the group. They were divided into the surgery group and the conservative group according to whether they received surgery. RESULTS A total of 45 cases (35 males and 10 females) were included, with a median age of 13.0 (0.3-15.4) years. Forty cases (40/45, 88.9%) were over 6 years old, and 31 (31/45, 68.9%) were over 12 years old. Among the 45 cases, 32 cases (32/45, 71.1%) were examined for Helicobacter pylori (HP), and 25 (25/32, 78.1%) were positive. There were 13 cases in the surgery group and 32 cases in the conservative group, without a significant difference in age between the two groups (P = 0.625). All cases in the surgery group and the conservative group started with abdominal pain. The proportion of history time within 24 h in the two groups was 6/13 and 12/32 (P = 0.739), and the proportion of fever was 11/13 and 21/32 (P = 0.362). The proportion of pneumoperitoneum in the surgery group was higher than that in the conservative group (12/13 vs. 15/32, P = 0.013). The fasting days in the surgery group were shorter than those in the conservative group (7.7 ± 2.92 vs. 10.3 ± 2.78 days, P = 0.014). There was no significant difference in the total hospital stay (13.6 ± 5.60 vs14.8 ± 4.60 days, P = 0.531). The operation methods used in the surgery group were all simple sutures through laparotomy (9 cases) or laparoscopy (4 cases). All patients recovered smoothly after surgery. CONCLUSION Duodenal ulcer perforation in children is more common in adolescents, and HP infection is the main cause. Conservative treatment is safe and feasible, but the fasting time is longer than the surgery group. A simple suture is the main management for the surgery group.
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Affiliation(s)
- Qiulong Shen
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Tingting Liu
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Siwei Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Dayong Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.
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17
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Sivananthan A, Kerry G, Darzi A, Patel K, Patel N. Orientation in upper gastrointestinal endoscopy—the only way is up. World J Gastrointest Endosc 2023; 15:146-152. [PMID: 37034971 PMCID: PMC10080556 DOI: 10.4253/wjge.v15.i3.146] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/15/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Oesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal (UGI) tract. Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety. The reported location of UGI pathologies is crucial to post-endoscopic planning.
AIM To evaluate endoscopists’ ability to spatially orientate themselves within the UGI tract.
METHODS A cross sectional descriptive study elicited, using an anonymised survey, the ability of endoscopists to orientate themselves within the UGI tract. The primary outcome was percentage of correct answers from all surveyed; secondary outcomes were percentage of correct answers from experienced vs novice endoscopists. Pearson’s χ2 test was applied to compare groups.
RESULTS Of 188 respondents, 86 were experienced endoscopists having completed over 1000 endoscopies. 44.4% of respondents correctly identified the anterior stomach and 47.3% correctly identified the posterior of the second part of the duodenum (D2). Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly [61.6% vs 31.3%, X2 (1, n = 188) = 11.10, P = 0.001]. There was no significant difference between the two groups in identifying the posterior of D2.
CONCLUSION The majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract. Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised. This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk. We suggest the development of a consensus statement on endoscopic description.
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Affiliation(s)
- Arun Sivananthan
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Georgina Kerry
- Liver Intensive Care Unit, King’s College Hospital NHS Foundation Trust, London SE5 9RS, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Kinesh Patel
- Gastroenterology, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, United Kingdom
| | - Nisha Patel
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
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Roy AJ, Maut C, Gogoi HK, Ahmed SI, Kashyap A. A Review on Herbal Drugs Used in the Treatment of Peptic Ulcer. Curr Drug Discov Technol 2022:CDDT-EPUB-128207. [PMID: 36515023 DOI: 10.2174/1570163820666221212142221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND An ulcer is a condition characterized by inflammation, irritation, or erosion in the mucosal lining of the stomach or duodenum. Hence, peptic ulcer is the ulcer of both the stomach and the duodenum. 10% of the world's population is affected by chronic peptic ulcers. The formation of peptic ulcers depends on gastric juice pH and the decrease in mucosal defenses. Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) infection are the two significant factors disrupting mucosal resistance to injury. Indian herbal plants are exceptional for their ethnic, ethnobotanical, and ethno-pharmaceutical use. In this review, attempts have been made to gain information regarding some plants that may be used to treat or prevent peptic ulcers. The ultimate goal of peptic ulcer disease treatment is to reduce pain, cure ulcers, and prevent recurrence. OBJECTIVE The aim of the study was to gain knowledge about several common medicinal plants employed in Ayurveda or contemporary science for the treatment or prevention of peptic ulcers and some natural and simple approaches to cure ulcers using readily available herbs. METHOD The literature search was carried out using search engines, like Google Scholar, Scopus, PubMed, Medline, Springer, etc. Results: The extensive literature search showed natural herbs to have potential anti-ulcer activity, including cabbage, bananas, liquorice, fenugreek, garlic, Terminalia chebula, Acacia arabica, Aegle marmelos, Aloe vera, Allium sativum, Plantago ispagula, Mimosa pudica, Annona squamosa, Azadirachta indica, and Galega purpurea. CONCLUSION This study concluded several medicinal plants to effectively prevent or cure peptic ulcers caused by a variety of factors, including H. pylori, aspirin, indomethacin, alcohol, and others.
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Affiliation(s)
- Anup Jyoti Roy
- Girijananda Chowdhury Institute of Pharmaceutical Science, Hathkhowapara, Guwahati, Assam, 781017
| | - Chinmoy Maut
- Girijananda Chowdhury Institute of Pharmaceutical Science, Hathkhowapara, Guwahati, Assam, 781017
| | - Hemanta Kumar Gogoi
- Girijananda Chowdhury Institute of Pharmaceutical Science, Hathkhowapara, Guwahati, Assam, 781017
| | - Syed Isfaqul Ahmed
- Girijananda Chowdhury Institute of Pharmaceutical Science, Hathkhowapara, Guwahati, Assam, 781017
| | - Ankita Kashyap
- Girijananda Chowdhury Institute of Pharmaceutical Science, Hathkhowapara, Guwahati, Assam, 781017
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Aktas G, Ustaoglu M, Bakir T, Aslan R, Goren F, Bektas A. Analysis of the patients with nonvariceal upper gastrointestinal bleeding and comparison of Rockall and Glasgow-Blatchford scores. Indian J Gastroenterol 2022; 41:576-82. [PMID: 36571703 DOI: 10.1007/s12664-022-01290-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 07/31/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nonvariceal upper gastrointestinal bleeding (UGB) has important morbidity and mortality. Predicting high-risk patients for mortality and rebleeding is necessary for a treatment plan. In the present study, we aimed to define the epidemiological and etiological characteristics of patients presenting with nonvariceal UGB and to observe mortality and morbidity rates. We also aimed to compare Rockall and Glasgow-Blatchford scoring systems in predicting rebleeding and mortality. METHODS Subjects presenting with nonvariceal UGB over a 3-year period were included. Demographic characteristics, symptoms, and signs on physical examination, laboratory data, endoscopic signs and diagnosis, interventions during hospitalization and follow-up period were recorded. Glasgow-Blatchford and Rockall scores were calculated for every participant at the first day of the admission. RESULTS A total of 709 patients were enrolled in the study. A total of 490 of them (69.1%) were men. The mean age of the women and men was 60.7±1.2 and 58.6± 0.7 years, respectively. Melena was the most common presenting symptom. Duodenal ulcer (31%), gastric ulcer (20.7%), and erosive disease (17.6%) were the most common causes of bleeding. History of use of aspirin and/or nonsteroidal anti-inflammatory drug use were present in 63.7% of the subjects. All patients were followed up for 30th-day mortality. Overall, rebleeding and mortality rates were 11% and 7%, respectively. A Rockall score greater than 6 was the most important predictor of mortality (odds ratio:39.1) and rebleeding (odds ratio:4.7). CONCLUSION Nonvariceal UGB patients with a Rockall score greater than 6 should undergo aggressive endoscopic treatment and inpatient care.
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Chiang HC, Yang EH, Hu HM, Chen WY, Chang WL, Wu CT, Wu DC, Sheu BS, Cheng HC. An extended 36-week oral esomeprazole improved long-term recurrent peptic ulcer bleeding in patients at high risk of rebleeding. BMC Gastroenterol 2022; 22:439. [PMID: 36271335 DOI: 10.1186/s12876-022-02534-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with Rockall scores ≥6 have an increased risk of long-term peptic ulcer rebleeding. This study was aimed toward investigating whether an extended course of oral esomeprazole up to 1 year decreased ulcer rebleeding in such patients. METHODS We prospectively enrolled 120 patients with peptic ulcer bleeding and Rockall scores ≥6. After an initial 16-week oral proton pump inhibitor (PPI) treatment, patients were randomized to receive a 36-week course of oral twice-daily esomeprazole 20 mg (Group D, n = 60) or once-daily (Group S, n = 60). Thereafter, they were divided into the PPI-on-demand (n = 32) and PPI-discontinued (n = 77) subgroups. Our previous cohort with Rockall scores ≥6 served as the controls (Group C, n = 135); they received only an initial 8- to 16-week oral PPI. The primary and secondary outcomes were peptic ulcer rebleeding during the first year and the second year-and-thereafter, respectively. RESULTS For the primary outcome, groups D and S comprised a higher proportion of rebleeding-free than Group C (P = 0.008 and 0.03, log-rank test). The competing-risks regression analysis confirmed that extended PPI use and American Society of Anesthesiologists classification were independent factors contributing to the primary outcome. For the secondary outcome, PPI-on-demand had a borderline higher proportion of rebleeding-free than Group C (P = 0.07, log-rank test); however, only the Rockall score was the independent factor. CONCLUSIONS An extended 36-week course of oral esomeprazole 20 mg, twice- or once-daily for patients with Rockall scores ≥6 reduced ulcer rebleeding during the first year, but the effect needed to be further validated when PPIs were shifted to on-demand or discontinued thereafter (NCT02456012, 28/05/2015).
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Affiliation(s)
- Hsueh-Chien Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan
| | - Er-Hsiang Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100, Ziyou 1st Rd, Kaohsiung, 807377, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, 68, Zhonghua 3rd Rd, Kaohsiung, 801735, Taiwan
| | - Wei-Ying Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan
| | - Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist, Tainan, 704302, Taiwan
| | - Chung-Tai Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist, Tainan, 704302, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100, Ziyou 1st Rd, Kaohsiung, 807377, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100, Ziyou 1st Rd, Kaohsiung, 807377, Taiwan
| | - Bor-Shyang Sheu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist, Tainan, 704302, Taiwan
| | - Hsiu-Chi Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd, Tainan, 704302, Taiwan. .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist, Tainan, 704302, Taiwan. .,Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, North Dist, Tainan, 704302, Taiwan. .,Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, 125 Jhongshan Road, West Central Dist, Tainan, 700007, Taiwan.
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21
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Kadohisa M, Inomata Y, Sakisaka M, Sugawara Y, Hibi T. Massive duodenal ulcer bleeding due to the ruptured hepatic artery pseudoaneurysm after living donor liver transplantation. Surg Case Rep 2022; 8:199. [PMID: 36253636 PMCID: PMC9576833 DOI: 10.1186/s40792-022-01558-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The rupture of a hepatic artery pseudoaneurysm (HAP) is a rare but lethal complication after living donor liver transplantation (LDLT) and often manifests as acute gastrointestinal bleeding. CASE PRESENTATION This report describes three patients who experienced HAP after LDLT. These patients initially presented with active bleeding of a duodenal ulcer (DU) in the duodenal bulb, followed by diagnosis of the ruptured HAP by angiography. None of the patients had evidence of an active intra-abdominal infection or bile leakage preceding the rupture of HAP. All patients were initially treated by transcatheter arterial coil embolization (TAE). In all cases, TAE was successful for hemostasis but resulted in complete obstruction of the arterial inflow to the graft. Arterial revascularization by surgical reconstruction using the autologous arterial graft in one case and re-LDLT in another one was successfully performed. The other one succumbed to sepsis caused by later liver abscesses. CONCLUSION This is the first detailed case series of massive DU bleeding as a warning signal of ruptured HAP after LDLT. HAP should be included in the differential diagnosis when an LDLT recipient presents with gastrointestinal bleeding.
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Affiliation(s)
- Masashi Kadohisa
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan
| | - Yukihiro Inomata
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan ,Kumamotorousai Hospital, Kumamoto, Japan
| | - Masataka Sakisaka
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan ,Sakisaka Hospital, Kumamoto, Japan
| | - Yasuhiko Sugawara
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan
| | - Taizo Hibi
- grid.274841.c0000 0001 0660 6749Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto 860-8556 Japan
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22
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Alzerwi N. Post-bulbar duodenal ulcer with anterior perforation with kissing ulcer and duodenocaval fistula: A case report and review of literature. World J Clin Cases 2022; 10:9071-9077. [PMID: 36157647 PMCID: PMC9477055 DOI: 10.12998/wjcc.v10.i25.9071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A post-bulbar duodenal ulcer (PBDU) is an ulcer in the duodenum that is distal to the duodenal bulb. PBDU may coexist with a synchronous posterior ulcer in rare occurrences, resulting in a kissing ulcer (KU). Duodenocaval fistula (DCF) is another uncommon but potentially fatal complication related to PBDU. There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.
CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain, stiffness, and vomiting. The X-ray showed pneumoperitoneum, suggesting a perforated viscus. Laparotomy revealed a KU with anterior perforation and a DCF. After Kocherization, venorrahphy was used to control caval bleeding. Due to the critical condition of the patient, only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy. However, later, the patient developed obstructive jaundice and leakage, and two additional jejunal perforations were detected. Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer, neither primary repair nor pancreatic-free duodenectomy and ampulloplasty/ampullary reimplantation were considered viable; therefore, an emergency pancreaticoduodenectomy was performed, along with resection and anastomosis of the two jejunal perforations. The patient had a smooth recovery after surgery and was discharged after 27 d.
CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients, even in the most complex cases.
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Affiliation(s)
- Nasser Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Riyadh 66, Riyadh , Saudi Arabia
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23
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Sekiguchi H, Shinozaki S, Takezawa T, Osawa H, Miura Y, Lefor AK, Yamamoto H. Long-Term Outcomes in Patients with Post-Bulbar Ulcer Bleeding Compared to Bulbar Ulcer Bleeding in the Duodenum. Digestion 2022; 103:126-132. [PMID: 34551417 DOI: 10.1159/000519293] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. METHODS A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. RESULTS All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. CONCLUSIONS Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary.
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Affiliation(s)
- Hiromi Sekiguchi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Satoshi Shinozaki
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.,Shinozaki Medical Clinic, Utsunomiya, Japan
| | - Takahito Takezawa
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyuki Osawa
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshimasa Miura
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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24
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Zandeh-Rahimi Y, Panahi N, Hesaraki S, Shirazi-Beheshtiha SH. Protective Effects of Phoenixin-14 Peptide in the Indomethacin-Induced Duodenal Ulcer: An Experimental Study. Int J Pept Res Ther 2022; 28:43. [PMID: 35002587 DOI: 10.1007/s10989-021-10314-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 12/11/2022]
Abstract
Phoenixin-14 (PNX-14) is a newly identified neuropeptide with potential anti-inflammatory effects in the gastrointestinal tract. In this study, we evaluated the protective effect of PNX-14 against the formation of experimental indomethacin (IND)-induced duodenal ulcer. Thirty-two male Sprague-Dawley rats were randomly assigned to the four following study groups: (1) negative control (2) IND (7.5 mg/kg subcutaneous IND), (3) famotidine (FA) (7.5 mg/kg subcutaneous IND followed by 40 mg/kg intraperitoneal FA), and (4) PNX-14 (7.5 mg/kg subcutaneous IND followed by 50 µ/kg intraperitoneal PNX-14). Outcome measures included macroscopic evaluation of duodenal lesion, serum levels of IL-1ß, TNF-α, IL-6, and IL-12, and tissue biochemical parameters of oxidative stress, including malondialdehyde (MDA), myeloperoxidase (MPO) activity, superoxide dismutase (SOD) activity, and catalase activity. Results
The macroscopic grade of duodenal lesions were significantly smaller in the PNX-14 group than in the IND group (p < 0.001). Serum inflammatory cytokines were significantly increased in the IND group. PNX-14 treatment significantly decreased the serum levels of inflammatory cytokines (p < 0.0001). Oxidative contents (MDA and MPO activity) were significantly smaller in the PNX-14 group compared with the IND group (p < 0.0001), while anti-oxidative contents (SOD and catalase activity) were significantly more (p < 0.0001). PNX-14 was superior to FA in several anti-inflammatory properties, such as inhibiting the release of inflammatory cytokines and increasing the catalase activity. PNX-14 showed significant protective effects against the formation of IND-induced duodenal ulcers. These results suggest a promising therapeutic implication for PNX-14 in the treatment of gastrointestinal inflammatory disorders.
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25
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Kobayashi K, Murayama M, Sugasawa H, Nishikawa M, Nishiyama K, Takeo H. Duodenal stenosis associated with an ectopic opening of the common bile duct into the duodenal bulb: a case report. Surg Case Rep 2021; 7:257. [PMID: 34914022 PMCID: PMC8677856 DOI: 10.1186/s40792-021-01351-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Ectopic opening of the common bile duct is a rare congenital biliary anomaly. Herein, we present a case of duodenal stenosis with ectopic opening of the common bile duct into the duodenal bulb. Case presentation A 54-year-old man was referred with fever, nausea, and vomiting. He had experienced epigastric pain several times over the past 30 years. Endoscopy showed a post-bulbar ulcer, a submucosal tumor of the duodenum, and a small opening with bile secretion. Contrast duodenography revealed duodenal stenosis and bile reflux with a common bile duct deformity. Pancreatoduodenectomy was performed because of the clinical suspicion of a biliary neoplasm or groove pancreatitis. The resected specimen showed an ectopic opening of the common bile duct into the duodenal bulb and no tumor. Conclusions Ectopic opening of the common bile duct into the duodenal bulb is complicated by a duodenal ulcer, deformity, and stenosis mimicking groove pancreatitis or pancreatic tumors. Although rare, we should be aware of this anomaly for an accurate diagnosis.
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Affiliation(s)
- Kazuki Kobayashi
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan.
| | - Michinori Murayama
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Makoto Nishikawa
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Kiyoshi Nishiyama
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Hiroaki Takeo
- Department of Diagnostic Pathology, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
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26
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Xu S, Yang SX, Xue ZX, Xu CL, Cai ZZ, Xu CZ. Duodenal ulcer caused by coil wiggle after digital subtraction angiography-guided embolization: A case report. World J Clin Cases 2021; 9:10315-10322. [PMID: 34904105 PMCID: PMC8638030 DOI: 10.12998/wjcc.v9.i33.10315] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/08/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute gastrointestinal bleeding (GIB) is a life-threatening medical emergency with high morbidity and mortality. Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates. Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery, which is a rare complication, have not previously been reported in a patient with right intrathoracic stomach.
CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago, resulting in right intrathoracic stomach. He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay. Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils. After 15 mo, the patient was re-admitted with a chief complaint of melena for 2 d, esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb, leading to a deep ulcer. Bleeding was controlled after conservative treatment. Seven months later, duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils, and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding. Mild melena recurred once during the long-term follow-up.
CONCLUSION Although rare, coil wiggle after interventional therapy requires careful attention, effective precautionary measures, and more secure alternative treatment methods.
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Affiliation(s)
- Sheng Xu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Shou-Xing Yang
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhan-Xiong Xue
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Chang-Long Xu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhen-Zhai Cai
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Chang-Zhao Xu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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27
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Hung TH, Huang JW. Severe duodenal ulcer behaves like gastroduodenal intussusception. Ann R Coll Surg Engl 2021; 104:e14-e16. [PMID: 34730406 DOI: 10.1308/rcsann.2021.0067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intestinal intussusception is uncommon in adults. As a retroperitoneal structure, gastroduodenal intussusception is extremely rare. The leading cause of intussusception is reported to be a tumour, either benign or malignant. The case presented may be the first of gastroduodenal intussusception resulting from severe peptic ulcer. A 64-year-old man was admitted with epigastralgia, appetite loss and melena for 1 week. He had history of peptic ulcer and reflux esophagitis for 9 years, caused by Helicobacter pylori infection; eradication therapy had been performed 5 years previously. This time, an abdominal computed tomography scan showed duodenogastric intussusception and gastric outlet obstruction. Preoperative biopsy failed for complete obstruction; thus, the patient underwent Whipple procedure for complete resection under impression of malignancy. The postoperative course was uneventful. Pathological findings for the specimen showed gastric and duodenal ulcer. Progressive peptic ulcer after eradication therapy is rarely seen, and eradication therapy is used widely to treat H. pylori infection. The eradication rate is extremely high in Taiwan for lower first-line antibiotic as clarithromycin resistance is low due to a policy restricting antimicrobial usage. Early eradication therapy is highly recommended for patients with H. pylori infection. We emphasise the importance of regular follow-up for the non-significant correlation of severity of gastric ulcer with clinical symptoms. When ulceration progresses or non-invasive treatments fail early surgical interventions should be applied to these anatomic alterations.
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Affiliation(s)
- T H Hung
- Kaohsiung Medical University, Taiwan.,Kaohsiung Medical University Hospital, Taiwan
| | - J W Huang
- Kaohsiung Municipal Siaogang Hospital, Taiwan
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28
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Konishi T, Fujiogi M, Michihata N, Kumazawa R, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Outcomes of Nonoperative Treatment for Gastro duodenal Ulcer Perforation: a Nationwide Study of 14,918 Inpatients in Japan. J Gastrointest Surg 2021; 25:2770-2777. [PMID: 33825122 DOI: 10.1007/s11605-021-05003-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastroduodenal ulcer perforation is a common abdominal emergency that may be curable without surgical repair in non-elderly patients with localized and stable symptoms. However, the outcomes of nonoperative approaches have rarely been described. METHODS Using a Japanese national inpatient database, we identified 14,918 patients with gastroduodenal ulcer perforation who were hospitalized and received nonoperative treatment from July 2010 to March 2017. We categorized these patients into three groups according to age: 18 to 64 years (young group, n=8407), 65 to 74 years (old group, n=2616), and ≥75 years (old-old group, n=3895). We investigated the characteristics, treatments, and outcomes in each group. RESULTS Most of the patients were men (71%), and the median patient age was 62 years (interquartile range, 47-75 years). The old and old-old groups had more comorbidities than the young group. Whereas most patients were administered proton pump inhibitors and various antibiotics (96% and 90%, respectively), only 58% of patients underwent gastric tube placement. Surgical repair >3 days after admission was performed in 7.1% of all patients (6.3% vs. 7.9% vs. 5.5%, P<0.001). The old and old-old groups showed higher mortality (1.4% vs. 8.3% vs. 18%, P<0.001) and morbidity (6.6% vs. 15% vs. 17%, P<0.001) than the young group. The median length of stay was almost 2 weeks (13 vs. 17 vs. 20 days, P<0.001). DISCUSSION Unlike previous studies, many patients aged >65 years received nonoperative treatment in this nationwide cohort. Our findings provide useful information for clinicians and patients hospitalized for gastric ulcer perforation.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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29
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Ulbricht J, Madea B, Doberentz E. Case report: fatal bleeding from a duodenal ulcer-Dieulafoy's lesion? Int J Legal Med 2021; 136:203-208. [PMID: 34668070 PMCID: PMC8813751 DOI: 10.1007/s00414-021-02721-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022]
Abstract
A 46-year-old man was admitted to the hospital by ambulance due to syncope. A standard blood screening showed a normal Hb value. The man had known hemorrhoids and a single fresh rectal bleeding earlier at home. On the following morning, the patient suddenly required resuscitation within a few minutes and subsequently died. Autopsy revealed a fatal hemorrhage with blood loss in the stomach and small and large intestines and a mucosal defect of the duodenum. After autopsy, the question arose whether the cause of death might have been a rare Dieulafoy’s lesion—aim of this case report was to clarify the diagnosis.
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Affiliation(s)
- Julia Ulbricht
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
| | - Burkhard Madea
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Elke Doberentz
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany
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30
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Ozaka S, Inoue K, Okajima T, Tasaki T, Ariki S, Ono H, Ando T, Daa T, Murakami K. Monomorphic epitheliotropic intestinal T-cell lymphoma presenting as melena with long-term survival: A case report and review of literature. World J Gastroenterol 2021; 27:6501-6510. [PMID: 34720538 PMCID: PMC8517785 DOI: 10.3748/wjg.v27.i38.6501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/01/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare primary intestinal T-cell lymphoma, previously known as enteropathy-associated T-cell lymphoma type II. MEITL is an aggressive T-cell lymphoma with a poor prognosis and high mortality rate. The known major complications of MEITL are intestinal perforation and obstruction. Here, we present a case of MEITL that was diagnosed following upper gastrointestinal bleeding from an ulcerative duodenal lesion, with recurrence-free survival for 5 years.
CASE SUMMARY A 68-year-old female was admitted to our hospital with melena and mild anemia. An urgent esophagogastroduodenoscopy (EGD) revealed bleeding from an ulcerative lesion in the transverse part of the duodenum, for which hemostatic treatment was performed. MEITL was diagnosed following repeated biopsies of the lesion, and cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy was administered. She achieved complete remission after eight full cycles of CHOP therapy. At the last follow-up examination, EGD revealed a scarred ulcer and 18Fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography showed no abnormal FDG accumulation. The patient has been in complete remission for 68 mo after initial diagnosis.
CONCLUSION To rule out MEITL, it is important to carefully perform histological examination when bleeding from a duodenal ulcer is observed.
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Affiliation(s)
- Sotaro Ozaka
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5593, Japan
| | - Kunimitsu Inoue
- Department of Gastroenterology, Almeida Memorial Hospital, Oita 870-1195, Japan
| | - Tomoya Okajima
- Department of Gastroenterology, Almeida Memorial Hospital, Oita 870-1195, Japan
| | - Takako Tasaki
- Department of Gastroenterology, Almeida Memorial Hospital, Oita 870-1195, Japan
| | - Shimpei Ariki
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5593, Japan
| | - Hideki Ono
- Department of Gastroenterology, Almeida Memorial Hospital, Oita 870-1195, Japan
| | - Takeaki Ando
- Department of Hematology, Almeida Memorial Hospital, Oita 870-1195, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Oita University, Oita 879-5593, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita 879-5593, Japan
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31
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Azzopardi M, Paris JL, Sladden D. Prophylactic use of proton pump inhibitors post-cardiac surgery. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34726935 DOI: 10.12968/hmed.2021.0339] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS/BACKGROUND Gastrointestinal bleeding significantly increases morbidity and mortality rates postoperatively in patients undergoing cardiac surgery. The prophylactic prescribing of proton pump inhibitors post-cardiac surgery is currently a class IIa recommendation of the European Association of Cardio-Thoracic Surgery. METHOD A retrospective review of patients who underwent cardiac surgery between July and December 2019 in the authors' hospital was carried out, using discharge summaries. New treatment charts were introduced with a pre-printed proton pump inhibitor included in the 'regular medication' section of the treatment chart and two reaudits were performed using the same methodology. RESULTS Before the intervention, 47% were prescribed omeprazole postoperatively, compared to 74% (P<0.001) and 66% (P=0.008) in the first and second reaudits respectively. Gastrointestinal bleeding was more common pre-intervention (4% vs 1% respectively; P=0.10). CONCLUSIONS This intervention resulted in a statistically significant improvement in the prescription of postoperative omeprazole and a decrease in gastrointestinal bleeds. However, other risk factors such as diabetes mellitus, arteriosclerosis and procedure urgency may have contributed to the absence of statistical significance in the latter.
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Affiliation(s)
- Matthew Azzopardi
- Cardiothoracic Surgery Department, Mater Dei Hospital, Imsida, Malta
| | - Jean-Luc Paris
- Cardiothoracic Surgery Department, Mater Dei Hospital, Imsida, Malta
| | - David Sladden
- Cardiothoracic Surgery Department, Mater Dei Hospital, Imsida, Malta
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Lopes RN, Akuri MC, da Silva MFG, Puchnick A, Regacini R. Sickle cell anemia with perforated duodenal ulcer as a complication: when to suspect this rare entity? Radiol Case Rep 2021; 16:3139-3142. [PMID: 34457103 PMCID: PMC8377549 DOI: 10.1016/j.radcr.2021.07.039] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/20/2022] Open
Abstract
Perforated duodenal peptic ulcers are often not considered when making a differential diagnosis of abdominal pain, especially in the context of sickle cell disease, and cases have not been frequently described in the literature. This study reports the case of a 14 year-old girl with sickle cell anemia complicated with duodenal ulcer perforation, focusing mainly on the imaging aspects. Abdominal CT should be considered as a method for this diagnosis and it requires the knowledge of this entity and its characteristic imaging findings.
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Affiliation(s)
- Raquel Nascimento Lopes
- Radiologist resident of the Departament of Radiology – Escola Paulista de Medicina (EPM) – Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 – São Paulo, SP, Brazil
| | - Marina Cristina Akuri
- Radiologist resident of the Departament of Radiology – Escola Paulista de Medicina (EPM) – Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 – São Paulo, SP, Brazil
| | - Marília Ferreira Gomes da Silva
- Radiologist resident of the Departament of Radiology – Escola Paulista de Medicina (EPM) – Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 – São Paulo, SP, Brazil
| | - Andrea Puchnick
- Educational and research coordinator of the Departament of Radiology – EPM – UNIFESP, Rua Napoleão de Barros, SP, Brazil
| | - Rodrigo Regacini
- Adjunct Professor of the Departament of Radiology – EPM – UNIFESP, Rua Napoleão de Barros, SP, Brazil
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Singh SP, Ahuja V, Ghoshal UC, Makharia G, Dutta U, Zargar SA, Venkataraman J, Dutta AK, Mukhopadhyay AK, Singh A, Thapa BR, Vaiphei K, Sathiyasekaran M, Sahu MK, Rout N, Abraham P, Dalai PC, Rathi P, Sinha SK, Bhatia S, Patra S, Ghoshal U, Poddar U, Mouli VP, Kate V. Management of Helicobacter pylori infection: The Bhubaneswar Consensus Report of the Indian Society of Gastroenterology. Indian J Gastroenterol 2021; 40:420-444. [PMID: 34219211 DOI: 10.1007/s12664-021-01186-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
The Indian Society of Gastroenterology (ISG) felt the need to organize a consensus on Helicobacter pylori (H. pylori) infection and to update the current management of H. pylori infection; hence, ISG constituted the ISG's Task Force on Helicobacter pylori. The Task Force on H. pylori undertook an exercise to produce consensus statements on H. pylori infection. Twenty-five experts from different parts of India, including gastroenterologists, pathologists, surgeons, epidemiologists, pediatricians, and microbiologists participated in the meeting. The participants were allocated to one of following sections for the meeting: Epidemiology of H. pylori infection in India and H. pylori associated conditions; diagnosis; treatment and retreatment; H. pylori and gastric cancer, and H. pylori prevention/public health. Each group reviewed all published literature on H. pylori infection with special reference to the Indian scenario and prepared appropriate statements on different aspects for voting and consensus development. This consensus, which was produced through a modified Delphi process including two rounds of face-to-face meetings, reflects our current understanding and recommendations for the diagnosis and management of H. pylori infection. These consensus should serve as a reference for not only guiding treatment of H. pylori infection but also to guide future research on the subject.
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Affiliation(s)
- Shivaram Prasad Singh
- Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753 007, India.
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Medical Centre, No. 1 Ramachandra Nagar, Porur, Chennai, 600 116, India
| | - Amit Kumar Dutta
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, 632 004, India
| | - Asish K Mukhopadhyay
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, 700 010, India
| | - Ayaskanta Singh
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Babu Ram Thapa
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kim Vaiphei
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India
| | - Malathi Sathiyasekaran
- Department of Pediatric Gastroenterology, Kanchi Kamakoti Childs Trust Hospital, Chennai, 600 034, India
| | - Manoj K Sahu
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Niranjan Rout
- Department of Pathology, Acharya Harihar Post Graduate Institute of Cancer, Manglabag, Cuttack, 753 007, India
| | - Philip Abraham
- P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Cadel Road, Mahim, Mumbai, 400 016, India
| | - Prakash Chandra Dalai
- Gastro and Kidney Care Hospital, IRC Village, Nayapalli, Bhubaneswar, 751 015, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and B Y L Nair Charitable Hospital, Dr Anandrao Laxman Nair Marg, Mumbai, 400 008, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Shobna Bhatia
- Department of Gastroenterology and Hepatobiliary Sciences, Sir HN Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Prarthana Samaj, Girgaon, Mumbai, 400 004, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Patrapada, Bhubaneswar, 751 019, India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605 006, India
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Takami T, Takihara H, Yasuda K, Kasyu N, Yoshitake H, Shintani H, Kataoka N, Yamaguchi T, Makimoto S. Subdiaphragmatic abscess due to penetration of a duodenal ulcer successfully treated with endoscopic transgastric drainage: a case report. J Med Case Rep 2021; 15:396. [PMID: 34304731 PMCID: PMC8311959 DOI: 10.1186/s13256-021-02970-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 06/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Subdiaphragmatic abscesses are sometimes caused by intraabdominal infections. We report a case of endoscopic ultrasound-guided transgastric drainage. CASE PRESENTATION A 75-year-old Asian man was referred to our hospital for treatment for upper gastrointestinal bleeding. On admission, blood tests showed a marked inflammatory response, and abdominal computed tomography showed free air in the abdominal cavity and a left subdiaphragmatic abscess. Therefore, the patient was diagnosed with an intraabdominal abscess associated with a perforated duodenal ulcer. Because he did not have generalized peritonitis, fasting and antibiotic treatment were the first therapies. However, because of the strong pressure on the stomach associated with the abscess and difficulty eating, we performed endoscopic ultrasound-guided transgastric drainage. After treatment, the inflammatory response resolved, and food intake was possible. The patient's condition remains stable. CONCLUSIONS Drainage is the basic treatment for subdiaphragmatic abscesses; however, percutaneous drainage is often anatomically difficult, and surgical drainage is common. We suggest that our success with endoscopic ultrasound-guided transgastric drainage in this patient indicates that this approach can be considered in similar cases and that it can be selected as a minimally invasive treatment method.
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Affiliation(s)
- Tomoya Takami
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan.
| | - Hiroshi Takihara
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Koji Yasuda
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Nozomi Kasyu
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Hiroyuki Yoshitake
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Hiroshi Shintani
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Naoki Kataoka
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Tomoyuki Yamaguchi
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Shinichiro Makimoto
- Department of General Surgery, Gastroenterology, Kishiwada Tokushukai Hospital, 4-27-1 Kamoricho, Kishiwada, Osaka, 596-0042, Japan
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Jiao J, Zhang L. Liver Involvement by Perforated Peptic Ulcer: A Systematic Review. Journal of Clinical and Translational Pathology 2021; 1:2-8. [PMID: 34927172 PMCID: PMC8681229 DOI: 10.14218/jctp.2021.00007] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Liver penetration by a confined perforation of peptic ulcer is a rare but severe event. Its clinical and pathological features are unclear. METHODS In total, 41 qualified English publications were identified using the PubMed database and one in-house case. RESULTS Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). The presence of hepatocytes was the clue of diagnosis for 19 cases. The median ages of the patients were 64.5 years (95% Confidence Intervals [CI] 53.40-71.90) for duodenal ulcer and 65.5 years (95% CI: 59.23-70.95) for gastric ulcer, respectively. The male to female ratio was 1.5:1 for duodenal ulcers and 2:1 for gastric ulcers. Patients with liver involvement of a perforated gastric ulcer were more likely to have a larger ulcer (median largest dimension, 4.75 cm versus 2.5 cm, p = 0.014). Female patients with liver involvement of a gastric ulcer were older than male patients (median age 72 versus 60 years, p = 0.045). There were no differences in gender, region (Asia, Europe, America versus others), use of non-steroidal anti-inflammatory drugs (n = 15), H. Pylori positivity (n = 10), possible history of peptic ulcer disease (n = 19) or mortality (n = 32) between duodenal and gastric ulcers. CONCLUSIONS Careful histologic examination, clinicopathological correlation, and immunohistochemistry are critical to establish the diagnosis and avoid misdiagnosing liver involvement as malignancy.
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Affiliation(s)
- Jingjing Jiao
- Department of Pathology, Princeton Medical Center, Plainsboro, NJ, USA
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical Center, Plainsboro, NJ, USA
- Department of Biological Sciences, Rutgers University Newark, NJ, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Chemical Biology, Rutgers Ernest Mario School of Pharmacy, Piscataway, NJ, USA
- Correspondence to: Lanjing Zhang, Department of Pathology, Princeton Medical Center, 1 Plainsboro Rd., Plainsboro, NJ 08563, USA. Tel: +1-609-853-6833, Fax: +1-609-853-6841,
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Abstract
Background Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment. Summary This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined. Key Messages Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.
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Affiliation(s)
- Markus Mille
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Thomas Engelhardt
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Albrecht Stier
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
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Dadfar A, Edna TH. Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years. World J Gastroenterol 2020; 26:5302-5313. [PMID: 32994689 PMCID: PMC7504248 DOI: 10.3748/wjg.v26.i35.5302] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/23/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease.
AIM To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years.
METHODS This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases (ICD), revision 8, ICD-9, and ICD-10 codes for perforated gastric and duodenal ulcers. We reviewed the medical records of the patients to retrieve data. Vital statistics were available for all patients. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Relative survival analysis was performed to compare long-term survival over the four decades.
RESULTS Two hundred and nine patients were evaluated, including 113 (54%) men. Forty-six (22%) patients were older than 80 years. Median age increased from the first to the last decade (from 63 to 72 years). The incidence rate increased with increasing age, but we measured a decline in recent decades for both sexes. A significant increase in the use of acetylsalicylic acid, from 5% (2/38) to 18% (8/45), was observed during the study period. Comorbidity increased significantly over the 40 years of the study, with 22% (10/45) of the patients having an American Society of Anaesthesiologists (ASA) score 4-5 in the last decade, compared to 5% (2/38) in the first decade. Thirty-nine percent (81/209) of the patients had one or more postoperative complications. Both 100-day mortality and long-term survival were associated with ASA score, without significant variations between the decades.
CONCLUSION Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.
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Affiliation(s)
- Aydin Dadfar
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway
| | - Tom-Harald Edna
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway
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Saribas S, Demiryas S, Yilmaz E, Uysal O, Kepil N, Demirci M, Caliskan R, Dinc HO, Akkus S, Gareayaghi N, Kirmusaoglu S, Ozbey D, Tokman HB, Koksal SS, Tasci I, Kocazeybek B. Association between human leukocyte antigen gene polymorphisms and multiple EPIYA-C repeats in gastrointestinal disorders. World J Gastroenterol 2020; 26:4817-4832. [PMID: 32921959 PMCID: PMC7459208 DOI: 10.3748/wjg.v26.i32.4817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/02/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polymorphisms of human leukocyte antigen (HLA) genes are suggested to increase the risk of gastric cancer (GC).
AIM To investigate the HLA allele frequencies of patients with GC relative to a control group in terms of CagA+ multiple (≥ 2) EPIYA-C repeats.
METHODS The patient group comprised 94 patients [44 GC and 50 duodenal ulcer (DU) patients], and the control group comprised 86 individuals [(50 non-ulcer dyspepsia patients and 36 people with asymptomatic Helicobacter pylori (H. pylori)]. Polymerase chain reaction was performed for the amplification of the H. pylori cagA gene and typing of EPIYA motifs. HLA sequence-specific oligonucleotide (SSO) typing was performed using Lifecodes SSO typing kits (HLA-A, HLA-B HLA-C, HLA-DRB1, and HLA-DQA1-B1 kits).
RESULTS The comparison of GC cases in terms of CagA+ multiple (≥ 2) EPIYA-C repeats showed that only the HLA-DQB1*06 allele [odds ratio (OR): 0.37, P = 0.036] was significantly lower, but significance was lost after correction (Pc = 0.1845). The HLA-DQA1*01 allele had a high ratio in GC cases with multiple EPIYA-C repeats, but this was not significant in the univariate analysis. We compared allele frequencies in the DU cases alone and in GC and DU cases together using the same criterion, and none of the HLA alleles were significantly associated with GC or DU. Also, none of the alleles were detected as independent risk factors after the multivariate analysis. On the other hand, in a multivariate logistic regression with no discriminative criterion, HLA-DQA1*01 (OR = 1.848), HLA-DQB1*06 (OR = 1.821) and HLA-A*02 (OR = 1.579) alleles were detected as independent risk factors for GC and DU.
CONCLUSION None of the HLA alleles were detected as independent risk factors in terms of CagA+ multiple EPIYA-C repeats. However, HLA-DQA1*01, HLA-DQB1*0601, and HLA-A*2 were independent risk factors with no criterion in the multivariate analysis. We suggest that the association of these alleles with gastric malignancies is not specifically related to cagA and multiple EPIYA C repeats.
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Affiliation(s)
- Suat Saribas
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Suleyman Demiryas
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Erkan Yilmaz
- Department of Organ Transplantation, HLA Laboratory, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Omer Uysal
- Deparment of Biostatistics, Medical School of Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Nuray Kepil
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Mehmet Demirci
- Department of Medical Microbiology, Beykent University Medical Faculty, Istanbul 34520, Turkey
| | - Reyhan Caliskan
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Harika Oyku Dinc
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Seher Akkus
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Nesrin Gareayaghi
- Center for Blood, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34360, Turkey
| | - Sahra Kirmusaoglu
- Department of Molecular Biology and Genetics, T.C. Halic University, Faculty of Arts & Sciences, Istanbul 34381, Turkey
| | - Dogukan Ozbey
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Hrisi B Tokman
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Serdar S Koksal
- Department of Public Health, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Ihsan Tasci
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
| | - Bekir Kocazeybek
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul 34098, Turkey
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Alam J, Sarkar A, Karmakar BC, Ganguly M, Paul S, Mukhopadhyay AK. Novel virulence factor dupA of Helicobacter pylori as an important risk determinant for disease manifestation: An overview. World J Gastroenterol 2020; 26:4739-4752. [PMID: 32921954 PMCID: PMC7459207 DOI: 10.3748/wjg.v26.i32.4739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/23/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is a microaerophilic, Gram-negative, human gastric pathogen found usually in the mucous lining of stomach. It infects more than 50% of the world’s population and leads to gastroduodenal diseases. The outcome of disease depends on mainly three factors: Host genetics, environment and bacterial factors. Among these, bacterial virulence factors such as cagA, vacA are well known for their role in disease outcomes. However, based on the global epidemiological results, none of the bacterial virulence (gene) factors was found to be associated with particular diseases like duodenal ulcer (DU) in all populations. Hence, substantial importance has been provided for research in strain-specific genes outside the cag pathogenicity island, especially genes located within the plasticity regions. dupA found within the plasticity regions was first demonstrated in 2005 and was proposed for duodenal ulcer development and reduced risk of gastric cancer in certain geographical regions. Due to the discrepancies in report from different parts of the world in DU development related to H. pylori virulence factor, dupA became an interesting area of research in elucidating the role of this gene in the disease progression. In this review, we shed light on the detailed information available on the polymorphisms in dupA and their clinical relevance. We have critically appraised several pertinent studies on dupA and discussed their merits and shortcomings. This review also highlights dupA gene as an important biomarker for DU in certain populations.
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Affiliation(s)
- Jawed Alam
- Division of Infectious Diseases, Institute of Life Science, Bhubaneswar 751023, India
| | - Avijit Sarkar
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Bipul Chandra Karmakar
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Mou Ganguly
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Sangita Paul
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Asish K Mukhopadhyay
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
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40
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Abstract
Background: Gastrointestinal stromal tumors (GISTs), although exceedingly rare, are the most common mesenchymal tumors in the gastrointestinal (GI) tract. GISTs are often asymptomatic; approximately 10% are found incidentally on imaging or endoscopy for other indications, although GI bleeding, intestinal obstruction, and perforation can occur. We present a case of upper GI bleeding from a duodenal GIST. Proton-pump inhibitor (PPI) therapy resulted in complete endoscopic ulcer healing, yet a discrete mass lesion was identified on endoscopic ultrasound (EUS). Case Report: A 70-year-old female presented with upper GI bleeding, and a duodenal ulcer was identified with esophagogastroduodenoscopy (EGD). Computed tomography (CT) scan of the abdomen and pelvis showed duodenal bulb thickening without clear mass. The ulcer was treated with 1:10,000 concentration epinephrine, injected in 4 quadrants around the ulcer base. The patient's GI bleeding resolved, and she was discharged with a referral for outpatient EUS follow-up. One month later, EUS showed resolution of the ulcer after PPI therapy but also showed a lesion consistent with GIST that was confirmed by cytologic analysis. The patient was started on imatinib therapy and had no further bleeding. Conclusion: Initial EGD and CT findings could have easily been attributed to duodenal peptic ulcer disease for which follow-up endoscopy is not routinely recommended given the low risk of malignancy. However, because of the high index of suspicion on the part of the referring physicians, duodenal GIST was diagnosed. This case extends the spectrum of the presentation, evaluation, and diagnosis of GISTs and stresses the importance of keeping this rare disease on the provider's differential, even after routine workup shows no findings of tumor.
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Chiarello MM. An Invited Commentary on "Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality (a nationwide prospective cohort study)" [Int. J. Surg. 2019; Epub ahead of print]. Int J Surg 2019; 72:242-243. [PMID: 31765845 DOI: 10.1016/j.ijsu.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Michela Chiarello
- Department of Surgery, General Surgery Operative Unit, "San Giovanni di Dio" Hospital, Crotone, Italy.
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Jiang ZH, Liu SH, Xiao Y, Cao W, Zhou WX, Zhang W, Wu D. [The 471st case: duodenal ulcer, mucor infection, and elevated IgG(4)]. Zhonghua Nei Ke Za Zhi 2019; 58:861-864. [PMID: 31665870 DOI: 10.3760/cma.j.issn.0578-1426.2019.11.020] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mucor infection is rarely reported in non-immunocompromised population, especially in isolated gastrointestinal tracts. IgG(4)-related diseases (IgG(4)-RD) have been recognized in recent years, but secondary causes of IgG(4) elevation should be differentiated. We reported a young man with duodenal mass and ulcer and high serum IgG(4) level. Histological biopsy of the mass revealed positive mucor mycelium and infiltration of IgG(4) positive plasma cells. Serum IgG(4) decreased to normal range after surgical resection and systemic antifungal treatment. This case suggests that isolated mucor mycosis infection can develop in the digestive tract and mimics as IgG(4)-related disease.
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Affiliation(s)
- Z H Jiang
- Department of Health Care & International Medical Services, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S H Liu
- Department of Clinical Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Y Xiao
- Department of Clinical Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - W Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - W X Zhou
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - W Zhang
- Department of Immunology and Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - D Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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43
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Archampong TN, Asmah RH, Richards CJ, Martin VJ, Bayliss CD, Botão E, David L, Beleza S, Carrilho C. Gastro-duodenal disease in Africa: Literature review and clinical data from Accra, Ghana. World J Gastroenterol 2019; 25:3344-3358. [PMID: 31341360 PMCID: PMC6639557 DOI: 10.3748/wjg.v25.i26.3344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
Gastroduodenal disease (GDD) was initially thought to be uncommon in Africa. Amongst others, lack of access to optimal health infrastructure and suspicion of conventional medicine resulted in the reported prevalence of GDD being significantly lower than that in other areas of the world. Following the increasing availability of flexible upper gastro-intestinal endoscopy, it has now become apparent that GDD, especially peptic ulcer disease (PUD), is prevalent across the continent of Africa. Recognised risk factors for gastric cancer (GCA) include Helicobater pylori (H. pylori), diet, Epstein-Barr virus infection and industrial chemical exposure, while those for PUD are H. pylori, non-steroidal anti-inflammatory drug (NSAID)-use, smoking and alcohol consumption. Of these, H. pylori is generally accepted to be causally related to the development of atrophic gastritis (AG), intestinal metaplasia (IM), PUD and distal GCA. Here, we perform a systematic review of the patterns of GDD across Africa obtained with endoscopy, and complement the analysis with new data obtained on pre-malignant gastric his-topathological lesions in Accra, Ghana which was compared with previous data from Maputo, Mozambique. As there is a general lack of structured cohort studies in Africa, we also considered endoscopy-based hospital or tertiary centre studies of symptomatic individuals. In Africa, there is considerable heterogeneity in the prevalence of PUD with no clear geographical patterns. Furthermore, there are differences in PUD within-country despite universally endemic H. pylori infection. PUD is not uncommon in Africa. Most of the African tertiary-centre studies had higher prevalence of PUD when compared with similar studies in western countries. An additional intriguing observation is a recent, ongoing decline in PUD in some African countries where H. pylori infection is still high. One possible reason for the high, sustained prevalence of PUD may be the significant use of NSAIDs in local or over-the-counter preparations. The prevalence of AG and IM, were similar or modestly higher over rates in western countries but lower than those seen in Asia. . In our new data, sampling of 136 patients in Accra detected evidence of pre-malignant lesions (AG and/or IM) in 20 individuals (14.7%). Likewise, the prevalence of pre-malignant lesions, in a sample of 109 patients from Maputo, were 8.3% AG and 8.3% IM. While H. pylori is endemic in Africa, the observed prevalence for GCA is rather low. However, cancer data is drawn from country cancer registries that are not comprehensive due to considerable variation in the availability of efficient local cancer reporting systems, diagnostic health facilities and expertise. Validation of cases and their source as well as specificity of outcome definitions are not explicit in most studies further contributing to uncertainty about the precise incidence rates of GCA on the continent. We conclude that evidence is still lacking to support (or not) the African enigma theory due to inconsistencies in the data that indicate a particularly low incidence of GDD in African countries.
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Affiliation(s)
- Timothy N Archampong
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra Box 4236, Ghana
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Richard H Asmah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra Box 4236, Ghana
| | - Cathy J Richards
- Department of Histopathology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Vicki J Martin
- Department of Histopathology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Christopher D Bayliss
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Edília Botão
- Department of Pathology, Maputo Central Hospital, Maputo POBox 1164, Mozambique
| | - Leonor David
- Department of Pathology, Medical Faculty of the University of Porto, Porto 4200-465, Portugal
- Institute of Molecular Pathology and Immunology at the University of Porto (Ipatimup), Porto 4200-465, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto 4200-465, Portugal
| | - Sandra Beleza
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo POBox 257, Mozambique
- Department of Pathology, Maputo Central Hospital, Maputo POBox 1164, Mozambique
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44
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Pyo JH, Lee H, Kim JE, Choi YH, Kim TJ, Min YW, Min BH, Lee JH, Rhee PL, Yoo H, Kim K, Kim JJ. Obesity and Risk of Peptic Ulcer Disease: A Large-Scale Health Check-Up Cohort Study. Nutrients 2019; 11:E1288. [PMID: 31174419 DOI: 10.3390/nu11061288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023] Open
Abstract
The association between obesity and peptic ulcer disease (PUD) is inconclusive. To evaluate the association of obesity and metabolically healthy obesity (MHO) with PUD risk, we performed a retrospective cohort study of 32,472 subjects without PUD at baseline who underwent repeated health examinations. Participants were stratified by body mass index (BMI) and metabolically healthy state. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard modelling. During the follow-up period, 1940 PUD cases occurred. PUD, particularly gastric ulcer (GU), had significantly higher cumulative incidence in obese subjects compared to non-obese subjects (p value < 0.001). The HR for developing GU was 1.32 (95% CI, 1.16-1.49; p value <0.001); after adjusting for confounding factors (lifestyle, metabolic, and Helicobacter pylori status), the association was no more significant (p value = 0.789). For duodenal ulcer (DU), cumulative incidence between obese and non-obese groups was not significantly different (p value = 0.464). The risk of developing DU in the obese group was not significantly different from the non-obese group (HR 0.95; 95% CI, 0.83-1.09; p value = 0.469) and consistently showed no association after adjusting for metabolic parameters (p value = 0.199). Furthermore, MHO subjects had no increase in GU or DU risks. In this large cohort study, PUD risk was not associated with obesity or MHO.
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45
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Fatahi G, Talebi Bezmin Abadi A, Peerayeh SN, Forootan M. Carrying a 112 bp-segment in Helicobacter pylori dupA may associate with increased risk of duodenal ulcer. Infect Genet Evol 2019; 73:21-25. [PMID: 30981881 DOI: 10.1016/j.meegid.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/27/2018] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
The discovery of Helicobacter pylori in 1983 challenged researchers around the world to identify this pathogen's major virulence factors. The main rationale for this kind of research was to identify a biomarker associated with specific diseases following H. pylori colonization. Among different investigated virulence factors, duodenal ulcer promoting gene A (dupA) has been found to be associated with duodenal ulcer (DU), but its effect was different in various geographical regions. To determine the prevalence of dupA, we applied both classic primer pairs and our newly developed primers producing a highly conserved segment in PCR method. In our survey, 143 (47%) H. pylori isolates were obtained from 304H. pylori-colonized individuals [age range of 19-92; 113 (37%) males with the mean age of 50 and 191 (63%) females with the mean age of 49]. The presence of the dupA gene was investigated by using the different specific primers. The prevalence of the 112 bp segment isolated from H. pylori strains recovered from DU, GU and atrophy groups were significantly higher (81%, p value = .002, 64%, p = .065, 68% and p = .047 38%, respectively) than our control group, where the prevalence of the 112 bp segment was only 38%. Interestingly, a significant relationship was observed between the occurrence of DU and the presence of the 112 bp segment [p = .002; OR: 6.98; (95% CI: 1.94-25.00)]. Taken as a whole, we believe the 112 bp region of H. pylori dupA may serve as the first detected biomarker for the early detection of DU in patients admitted to hospitals.
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Affiliation(s)
- Golzar Fatahi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amin Talebi Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Shahin Najar Peerayeh
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mojgan Forootan
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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46
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Parisio EM, Camarlinghi G, Nardone M, De Carolis E, Mattei R, Sanguinetti M. Gastrointestinal basidiobolomycosis in a patient suffering from duodenal ulcer with perforation: First case report from Italy. New Microbiol 2019; 42:125-128. [PMID: 30994179] [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] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 06/09/2023]
Abstract
Gastrointestinal basidiobolomycosis (GIB), an unusual fungal infection caused by the fungus Basidiobolus ranarum, is rarely reported in the medical literature. GIB is difficult to diagnose because its clinical presentation is non-specific and has no identifiable risk factors. We report here the first case of GIB diagnosed in Italy in a patient suffering from a duodenal ulcer with perforation. The patient was successfully treated with itraconazole. The absence of non-specific signs and symptoms of GIB may delay a definitive diagnosis and treatment. A microbiological investigation should always be requested in order to reach a rapid and definitive diagnosis and to rule out other intestinal diseases.
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Affiliation(s)
- Eva Maria Parisio
- Operative Unit of Chemical-Clinical and Microbiological Analysis; San Luca Hospital Usl Toscana Nord Ovest, Lucca, Italy
| | - Giulio Camarlinghi
- Operative Unit of Chemical-Clinical and Microbiological Analysis; San Luca Hospital Usl Toscana Nord Ovest, Lucca, Italy
| | - Maria Nardone
- Operative Unit of Chemical-Clinical and Microbiological Analysis; San Luca Hospital Usl Toscana Nord Ovest, Lucca, Italy
| | - Elena De Carolis
- Institute of Microbiology, Catholic University of the Sacred Heart, Polyclinic University Foundation Agostino Gemelli, IRCCS, Rome, Italy
| | - Romano Mattei
- Operative Unit of Chemical-Clinical and Microbiological Analysis; San Luca Hospital Usl Toscana Nord Ovest, Lucca, Italy
| | - Maurizio Sanguinetti
- Institute of Microbiology, Catholic University of the Sacred Heart, Polyclinic University Foundation Agostino Gemelli, IRCCS, Rome, Italy
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Uchida D, Kawai Y, Kato H, Okada H. Acute pancreatitis associated with massive bleeding due to a duodenal ulcer. Clin J Gastroenterol 2019; 12:301-306. [PMID: 30694427 DOI: 10.1007/s12328-019-00942-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
A 74-year-old man presented to the emergency department with acute abdominal pain in addition to anemia and melena, which were suspected to be due to gastrointestinal bleeding. Computed tomography (CT) revealed a blood-filled duodenum and acute pancreatitis. We prioritized treatments for pancreatitis, as the vital signs were stable, and temporary hemostasis was achieved. Two days later, esophagogastroduodenoscopy revealed a duodenal ulcer with an exposed vessel, and endoscopic hemostasis was performed. We urge clinicians to consider the possibility of pancreatitis associated with massive bleeding due to a duodenal ulcer.
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Affiliation(s)
- Daisuke Uchida
- Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
| | - Yoshinari Kawai
- Department of Gastroenterology, Onomichi Municipal Hospital, Hiroshima, Japan
| | - Hironari Kato
- Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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Kim HS, Kim HK, Kim WH, Hong SP, Cho JY. Huge Intramural Duodenal Hematoma Complicated with Obstructive Jaundice following Endoscopic Hemostasis. Korean J Gastroenterol 2019; 73:39-44. [PMID: 30690957 DOI: 10.4166/kjg.2019.73.1.39] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/03/2022]
Abstract
Intramural hematoma of the duodenum is a relatively unusual complication associated with the endoscopic treatment of bleeding peptic ulcers. Intramural hematomas are typically resolved spontaneously with conservative treatment alone. We report a case of an intramural duodenal hematoma following endoscopic hemostasis with epinephrine injection therapy, which was associated with transient obstructive jaundice in a patient undergoing hemodialysis. The patient developed biliary sepsis due to obstruction of the common bile duct secondary to the huge hematoma. He was treated with fluoroscopy-guided drainage catheter insertion, which spontaneously resolved the biliary sepsis through conservative treatment in 6 weeks. Fluoroscopy-guided drainage may impact the treatment of intramural hematomas that involve life-threatening complications.
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Affiliation(s)
- Hak Su Kim
- Department of Gastroenterology and Hepatology, Incheon Sarang Hospital, Incheon, Korea
| | - Hee Kyoung Kim
- Department of Gastroenterology and Hepatology, Cheonggu Sungsim Hospital, Seoul, Korea
| | - Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Joo Young Cho
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Molina-Castro S, Garita-Cambronero J, Malespín-Bendaña W, Une C, Ramírez V. Virulence factor genotyping of Helicobacter pylori isolated from Costa Rican dyspeptic patients. Microb Pathog 2019; 128:276-280. [PMID: 30654009 DOI: 10.1016/j.micpath.2019.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Costa Rica is one of the countries with the highest incidence and mortality rates for gastric cancer. Helicobacter pylori infection rates are high in the whole country. We have previously shown that H. pylori CagA+ is significantly associated with atrophic gastritis (AG) of the antrum in a dyspeptic population. The aim of this work is to determine if other H. pylori virulence factors (vacA, dupA, oipA, iceA and babA2) are associated with atrophic gastritis (AG) or duodenal ulcer (DU). METHODS The presence of virulence genes in Costa Rican H. pylori isolates was analyzed by PCR in 151 cultured strains from patients with dyspeptic symptoms. Endoscopic and histopathological diagnoses were available. Odds-ratio and 95% confidence intervals for AG patients vs. non-atrophic gastritis (NAG) or DU patients vs. no duodenal ulcer (NDU) patients were calculated. RESULTS Amongst the studied isolates, 82% had the cagA+, 76.2% had the vacA s1m1, 97.0% had the oipA+, 21.0% had the icea1, 79.0% had the iceA2, 44.0% had the babA2+ and 76.0% the dupA+ genotypes. Infection with H pylori cagA+, dupA+, oipA+, iceA, babA2+, and vacA s1m1 genotypes was not associated with AG risk. The frequency of the dupA gene was 78.7 and 60.9% in isolates from patients with NDU and DU, respectively, and its presence was significantly associated with decreased risk of duodenal ulcer [odds-ratio: 0.33, p = 0.024, confidence interval 95% (0.11-0.85)]. CONCLUSION H. pylori dupA genotype is inversely associated with DU risk in this population.
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Affiliation(s)
- Silvia Molina-Castro
- Institute for Health Research (INISA), University of Costa Rica, San Pedro, 11501, San José, Costa Rica; School of Medicine, University of Costa Rica, San Pedro, 11501, San José, Costa Rica.
| | - Jerson Garita-Cambronero
- Institute for Health Research (INISA), University of Costa Rica, San Pedro, 11501, San José, Costa Rica.
| | - Wendy Malespín-Bendaña
- Institute for Health Research (INISA), University of Costa Rica, San Pedro, 11501, San José, Costa Rica.
| | - Clas Une
- Institute for Health Research (INISA), University of Costa Rica, San Pedro, 11501, San José, Costa Rica.
| | - Vanessa Ramírez
- Institute for Health Research (INISA), University of Costa Rica, San Pedro, 11501, San José, Costa Rica.
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50
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Watanabe K, Hikichi T, Nakamura J, Hashimoto M, Takagi T, Suzuki R, Sugimoto M, Konno N, Takasumi M, Sato Y, Irie H, Kimura T, Kenjo A, Marubashi S, Obara K, Ohira H. Successful Endoscopic Closure Using Polyglycolic Acid Sheets with Fibrin Glue for Nonhealing Duodenal Ulcer with Perforation after Proton Beam Therapy of Liver Tumor. Case Rep Gastroenterol 2019; 12:679-685. [PMID: 30631252 PMCID: PMC6323404 DOI: 10.1159/000494918] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022] Open
Abstract
We describe the first case of a nonhealing duodenal ulcer with perforation after proton beam therapy (PBT) of a liver tumor that was successfully treated endoscopically using polyglycolic acid (PGA) sheets with fibrin glue. A 69-year-old man received PBT for a liver tumor. Esophagogastroduodenoscopy (EGD) 3 months after PBT revealed a duodenal ulcer. A proton pump inhibitor was administered for 7 weeks, and the ulcer healed. Six months after the EGD, recurrence of the duodenal ulcer with perforation occurred. An emergency open surgery with placement of the omental patch was performed. However, 5 days after the surgery, because the EGD revealed a perforation site in the duodenal ulcer that was not closed, the conservative treatment was continued. Twenty-eight days after the surgery, EGD revealed that the perforation size had increased. Therefore, we conducted endoscopic closure therapy using PGA sheets with fibrin glue. Eleven days after the closure procedure, the EGD showed that the perforation site was filled with granulation tissue and was closed. Forty-nine days after the procedure, EGD revealed that the ulcer had healed. This endoscopic closure treatment was effective for a nonhealing duodenal ulcer with perforation after PBT of a liver tumor.
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Affiliation(s)
- Ko Watanabe
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoki Konno
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Katsutoshi Obara
- Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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