A novel nano-formulation of olmesartan medoxomil with improved delivery and efficacy in the treatment of indomethacin-induced duodenitis in rats

There are few studies addressing duodenal inflammation. This study was designed to investigate the effects of a recently developed biotechnological product, a nano-formulation of olmesartan medoxomil (OM) - olmesartan medoxomil zeinmersomes (OMZ) - for the treatment of indomethacin-induced duodenitis in rats. Adult male Wistar rats were given indomethacin (10 mg/kg/day) for four weeks. They were divided into a positive control group (PC, untreated) and two groups treated orally with 3 mg/kg per day of OM or OMZ for the last two weeks of the 4-week indomethacin-treatment. At end of the four weeks, blood and duodenum were collected. Duodenal homogenate was used for measurement of levels of myeloperoxidase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), malondialdehyde, reduced glutathione (GSH), and cleaved caspase-3. Duodenal sections were stained with H&E. Gene expressions of nuclear factor kappa B (NF-κB p65), Bcl-2-associated X protein (Bax), and B-cell lymphoma 2 (Bcl-2) by RT-PCR, and protein expression of survivin by western blot were assessed. Plasma and duodenal olmesartan concentrations were measured by high performance liquid chromatography mass spectrometry. The duodenitis rats showed significantly higher duodenal levels of myeloperoxidase, TNF-α, IL-6, malondialdehyde, and cleaved caspase-3, a significantly lower GSH level, and histopathological alterations. Moreover, they showed upregulated gene expressions of NF-κB p65 and Bax, downregulated gene expression of Bcl-2, decreased Bcl-2/Bax ratio, and lower protein expression of survivin. OMZ was more effective in protecting the duodenum from indomethacin-induced injuries compared to OM due to improved delivery, higher bioavailability, and better anti-inflammatory, antioxidant, and antiapoptotic effects. OMZ could be a better choice for hypertensive patients with non-steroidal anti-inflammatory drugs-induced duodenitis.

Duodenitis eosinofílica asociada a alergia alimentaria debutando como dolor visceral agudo en un adulto con vitíligo: reporte de un caso

La duodenitis eosinofílica tiene una prevalencia entre 5,1 a 8,2 por 100000 personas. Se desconocen los mecanismos moleculares subyacentes de la enfermedad, pero la hipersensibilidad (alergias estacionales y alimentarias) juega un papel importante en su patogénesis, la predisposición alérgica se encuentra en el 25-35% de los casos. El diagnóstico incluye manifestaciones clínicas, hallazgos imagenológicos y evidencia histológica de infiltración eosinofílica >20 eosinófilos por campo de alto poder. Realizamos un informe de caso clínico y revisión de literatura. Hombre de 25 años con vitíligo que consulta a urgencias refiriendo síntomas de dispepsia, vómitos y dolor abdominal de máxima intensidad, en el examen médico se localiza dolor abdominal superior, con paraclínicos normales excepto un recuento de eosinófilos >2000 células/ul, la ecografía abdominal fue normal, la endoscopia superior reveló pangastritis eritematosa y duodenitis con pliegues rígidos y engrosados, la colonoscopia mostró hemorroides grado I. Coproscópico seriado negativo para parásitos, IgE total, IgA e IgG en rango normal, se reportó IgG positivo a Toxoplasma gondii, perfil de autoinmunidad negativo. En los siguientes 4 días aumenta el dolor abdominal y el recuento de eosinófilos, con endoscopia control y tomografía abdomino-pélvica contrastada que muestran duodeno edematizado con reflujo biliar severo, reporte histopatológico con duodenitis crónica atrófica y con pruebas para alergenos alimentarios positivo a cereales (centeno, soja, cebada), Manihot esculenta, plátano verde, tomate, leche de vaca, naranja y piña. Se indicó dieta restrictiva e inhibidor de la bomba de protones (pantoprazol), control ambulatorio a los 45 días de resolución de los síntomas con recuento de eosinófilos en sangre normal. Se presenta un caso de duodenitis eosinofílica relacionada con alergia alimentaria con mecanismos IgE independientes en un varón joven con vitíligo, que debutó con cuadro clínico inusual de dolor visceral agudo y reflujo biliar, que se resolvió con dieta de eliminación y pantoprazol sin uso de corticoides.

Background: Eosinophilic duodenitis has a prevalence of 5.1 to 8.2 per 100000 persons. The underlying molecular mechanisms are unknown, but hypersensitivity (seasonal and food allergies, asthma, eczema) response plays a major role in its pathogenesis, allergic predisposition can be found up-to 25-35% of cases. The diagnosis includes clinical manifestation, imaging findings and histological evidence of eosinophilic infiltration >20 eosinophils per high-power field. This is a clinical case report. a 25-years old man with vitiligo consult to emergency department referring dyspepsia symptoms, vomiting and abdominal pain of maximal intensity, in the medical exam upper abdominal pain was found, blood laboratories were unremarkable except a high net eosinophil-count >2000 cells/ul, abdominal ultrasound were normal, upper endoscopy revealed duodenitis with rigid and thickened folds, colonoscopy show hemorrhoids grade I. Coproscopy exam was negative for parasites, total IgE, IgA and IgG were in normal range, a positive IgG to Toxoplasma gondii was reported, autoimmunity panel was negative. In the following 4 days the abdominal pain and eosinophils count increase, a new abdomin-pelvic tomography was done showing thickened duodenum with a new endoscopy showing marked edema in duodenum with severe biliary reflux with biopsies describing an atrophic chronic duodenitis. Allergy tests -skin prick and patch tests- were done resulting positive to cereals (rye, soy, barley), Manihot esculenta, green banana, tomato, cow milk, orange and pineapple. A restrictive diet and protons pump inhibitor was indicated, ambulatory control at 45 days after show symptoms resolution with a normal blood eosinophils count. Here is reported a case of eosinophilic duodenitis related to food allergy in a young man with vitiligo debuting with an unusual clinical presentation of acute visceral pain and biliary reflux which resolved with elimination diet and pantoprazole without use of corticoids, with both, IgE and non-IgE mechanisms playing important roles explaining food sensitization.

CARACTERIZAÇÃO DAS ENDOSCOPIAS DIGESTIVAS ALTAS REALIZADAS NO MUNICÍPIO DE MOSSORÓ-RN / CHARACTERIZATION OF HIGH DIGESTIVE ENDOSCOPIES PERFORMED IN THE MUNICIPALITY OF MOSSORÓ-RN

Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.

This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.

Upper Gastrointestinal Endoscopic Findings of Patients Presenting with Dyspepsia - A Tertiary Care Centre Experience

Introduction: Dyspepsia is a common presenting complaintencountered in the outpatient department of general medicineand is the most common indication for upper gastrointestinalendoscopy. Aim of the study was to evaluate Upper GastroIntestinal endoscopic findings in patients presenting withdyspepsia, to find the relative occurrence of individual findingsin different age groups and to compare with earlier studies.Material and methods: This was a retrospective,observational study in GITAM Institute of Medical Sciencesand Research, a tertiary care centre, Visakhapatnam, AndhraPradesh, India. Data on patients presenting with dyspepsiaand scheduled for upper gastrointestinal (UGI) endoscopybetween June 2018 and June 2019were collected.Results: Two hundred and seven patients with dyspepsia wereassessed by UGI endoscopy. Out of these,121 (58.4%) weremale and 86(41.5%) were female. The mean age was 43.8±14.2years. The endoscopic findings were GERD (15.4%), erosiveesophagitis (11.1%), gastritis (52.6%), duodenitis (3.3%),duodenal ulcer (4.8%), gastric ulcer (6.7%), hiatus hernia(10.2%), and mixed findings in 37.1% of patients. Gastriccancer was identified in 2.4% of patients. Endoscopy findingswere normal in 13(6.3%) patients.Conclusion: We conclude that dyspepsia is a commonindication for endoscopy. The frequency of male subjects ishigher and gastritis is the most common pathology followedby reflux esophagitis. These were associated with increasingage. GI malignancy was uncommon and higher in elderlypatients. The upper GI endoscopy is the best investigation toolfor evaluating dyspepsia. Though it is an invasive procedure,dyspeptic patients with alarm symptoms must be evaluatedwith upper GI endoscopy. Endoscopy can be avoided in mostyoung patients with dyspepsia without alarm features.

Remission of diffuse ulcerative duodenitis in a patient with ulcerative colitis after infliximab therapy: a case study and review of the literature

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.

Tissue Transglutaminase Antibody and Its Association with Duodenal Biopsy in Diagnosis of Pediatric Celiac Disease / 대한소아소화기영양학회지

PURPOSE: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. METHODS: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. RESULTS: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75–1). CONCLUSION: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75–1). This cut-off may be used in combination with clinical judgment to diagnose CD.

Duodenal pathologies in children: a single-center experience / Patologias duodenais em crianças: experiência de único centro

Abstract Objective Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. Method Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. Results Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p = 0.002, OR: 3.91, 95% CI: 1.59-9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). Conclusion Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.

Resumo Objetivo Foram feitos vários estudos com relação a patologias do estômago e esôfago na faixa etária pediátrica. Contudo, poucos estudos das patologias duodenais em crianças. Visamos a examinar as características clínicas, endoscópicas e histopatológicas, juntamente com a etiologia, das patologias duodenais em crianças. Método Foram investigados retrospectivamente pacientes entre 1 e 17 anos submetidos a esofagogastroduodenoscopia durante dois anos em nossa unidade. Os dados demográficos, clínicos e endoscópicos e a presença de patologias duodenais, gastrite e esofagite foram registrados com relação a todas as crianças. Resultados Das 747 crianças submetidas a endoscopia, 226 (30,3%) apresentaram patologia duodenal. A patologia também esteve presente no esôfago de 31,6% dos pacientes e no estômago de 58,4%. O nível de diarreia crônica foi maior nos pacientes com patologia duodenal, em comparação com os pacientes sem patologia duodenal (p = 0,002, RC: 3,91, IC de 95%: 1,59-9,57). Infecção por Helicobacter pylori foi mais comum em pacientes com patologia no duodeno (59,3%). Conclusão Foi detectada patologia duodenal em 30,3% de nossos pacientes. Um nível significativamente maior de diarreia crônica foi observado em indivíduos com patologias duodenais, em comparação aos sem patologia. A infecção por Helicobacter pylori esteve presente consideravelmente maior do que em estudos anteriores. Além disso, há uma fraca correlação entre a imagem endoscópica e a histologia de duodenite.

Identification of distinctive clinical significance in hospitalized patients with endoscopic duodenal mucosal lesions

BACKGROUND/AIMS: Duodenitis is not infrequent finding in patient undergoing endoscopy. However, hospitalized patients have a higher incidence of secondary duodenal mucosal lesions that might be related with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infection, tuberculosis, immunologic disorders, or other rare infections. We aimed to identify clinicopathologic features of duodenal mucosal lesions in hospitalized patients. METHODS: All hospitalized patients having duodenal mucosal lesions were identified by endoscopic registration data and pathologic data query from 2011 to 2014. The diagnostic index was designed to be sensitive; however, a detailed review of medical record and endoscopic findings was undertaken to improve specificity. Secondary duodenal lesion was defined as having specific reason to explain the duodenal lesion. RESULTS: Among 6,334 hospitalized patients have undergone upper endoscopy, endoscopic duodenal mucosal lesions was detected in 475 patients. Secondary duodenal lesions was 21 patients (4.4%) and the most frequent secondary cause was IBD (n = 7). The mean age of secondary group was significantly lower than that in primary group (42.3 ± 18.9 years vs. 58.5 ± 16.8 years, p = 0.00), and nonsteroidal anti-inflammatory drugs were less frequently used in secondary group, but there was no differences of gender or presence of Helicobacter pylori. The involvement of distal part of duodenum including postbulbitis or panduodenitis was more frequently detected in secondary group than in primary group. By multivariate regression analysis, younger age of 29 years and the disease extent were significant predictors for the secondary mucosal lesions. CONCLUSIONS: Secondary duodenal mucosal lesions with different pathophysiology, such as IBD or CMV infection, are rare. Disease extent and age seems the most distinctive feature of secondary duodenal mucosal lesions.

Relationship between the presence of helicobacter pylori with inflammatory endoscopic changes in gastroduodenal mucosa / Relação entre a presença do helicobacter pylori com alterações endoscópicas inflamatórias na mucosa gastroduodenal

ABSTRACT Background: The influence of Helicobacter pylori (HP) in inflammatory disorders of the digestive mucosa has been the subject of several studies since socioeconomic, personal and environmental factors were implicated in the bacteria transmission. Aim: To correlate the inflammatory endoscopic findings with HP infection and the onset of mucosal diseases mucous of the upper digestive tract. Method: Comparative observational study, in which were collected data from 2247 patients who underwent upper endoscopy and biopsies for HP with urease test. The patients were divided into two groups: HP+ and HP- (control) in which endoscopic findings were observed for the following changes: esophagitis, esophageal ulcer, gastritis, erosive gastritis, gastric ulcer, bulboduodenitis, bulbar ulcer and without disease. Results: As for esophagitis, there was little disparity in the distribution favorable to HP+ group (HP+ =67.11% and HP- =69.89%) and esophageal ulcer (HP+ =0% and HP- =0, 21%). Gastritis was favorable to HP- group (HP+ =78.34% and HP- =73.63%), as well as erosive gastritis (HP+ = 67,11% and HP- = 64,55%), in bulboduodenitis (HP+ =1,87% and HP- 1,23%), in gastric ulcer (HP+ =2,14% and HP- =2,03%) and in the absence of alterations in the HP+ group (4.81%) with the HP- control group (6,30%), in which there was little disproportion in favor of HP- group, but without statistical significance. As for the bulbar ulcer (HP +=10.16% and HP- =4.48%), there was statistically significant (p=0.00001). Conclusion: There is no difference between HP+ and HP- groups in inflammatory changes in endoscopic gastroduodenal mucosa, except for the relationship between HP and bulbar ulcer.

RESUMO Racional: A influência do Helicobacter pylori (HP) nas alterações inflamatórias das mucosas digestivas tem sido objeto de vários estudos uma vez que fatores socioeconômicos, pessoais e ambientais são implicados na transmissão da bactéria, facilitando-a. Objetivo: Relacionar os achados inflamatórios endoscópicos com a infecção pelo HP e o aparecimento de doenças mucosas do trato digestivo alto. Método: Estudo observacional comparativo, o qual foram coletados dados de 2247 pacientes submetidos à endoscopia digestiva alta e biópsias para HP com teste de urease. Os pacientes foram divididos em dois grupos: HP+ e o controle HP-dentro dos quais foram observados os achados endoscópicos referentes às seguintes alterações: esofagite, úlcera esofágica, gastrite, gastrite erosiva, úlcera gástrica, bulboduodenite, úlcera bulbar e sem doença. Resultados: Quanto à esofagite, observou-se pequena desproporção na distribuição, favorável ao grupo HP+ (HP+ =67,11% e HP- =69,89%) bem como na úlcera esofágica (HP+ =0% e HP- =0,21%). Na gastrite foi favorável ao grupo HP- (HP+ =78.34% e HP- =73.63%), assim como na gastrite erosiva (HP+ = 67,11% e HP- = 64,55%), na bulboduodenite (HP+ = 1,87% e HP- 1,23%), na úlcera gástrica (HP+ =2,14% e HP- =2,03%) e na ausência de alterações no grupo HP+ (4.81%) com o grupo controle HP- (6,30%), nos quais há pequena desproporção favorável ao grupo HP-, porém, sem significância estatística. Já quanto à úlcera bulbar (HP+ =10,16% e HP- =4,48%), houve significância estatística (p=0,00001). Conclusão: Não há diferenciação entre os grupos HP+ e HP- nas alterações endoscópicas inflamatórias na mucosa gastroduodenal, exceto para a relação entre HP e úlcera bulbar.

Analytical Study of Upper Gastrointestinal Endoscopy – 200 cases

Background: Esophagogastroduodenoscopy (EGD) is an important tool to visualize the upper part of the gastrointestinal tract up to the duodenum. It has the added advantage of being not only a diagnostic but also a therapeutic tool. It’s importance in follow up cases is also well documented. It has indeed become a cost effective and reliable tool to modern surgery. Materials and methods: Clinically symptomatic cases of upper GI tract were made to undergo Upper GI Endoscopy after an informed written consent. The study covered 200 patients who were then analysed for different parameters. Our study showed that majority of patients were in their 3rd decade with a male: female ratio of 2.03:1. Pain in abdomen was the main presenting complaint. Study showed that 62% of patients were smokers whereas 71% were non alcoholic. Gastritis was the prominent finding in 41 (20.5%) cases followed by Hiatus Hernia and Reflux Esophagitis in 19.5% and 13% respectively. The study was found to be normal in 28 cases (14%). This study was also able to detect rare findings like esophageal polyp and Mallory Weiss tear. Endoscopy was also done in post Gastojejunostomy patients to assess the stoma from within. Conclusion: Endoscopy has proved to be a valuable tool in diagnosing as well as therapeutically treating patients with various pathologies. Upper GI endoscopy correlated well with the sign and symptom presentations in majority of patients and proved superior to conventional radiological studies. Thus endoscopy is not only useful and superior to many radiological investigations, but also helpful in therapeutic interventions as well as in follow up cases.

Chronological Endoscopic and Pathological Observations in Russell Body Duodenitis

A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.

Herpes Simplex Virus Duodenitis Accompanying Crohn's Disease / 대한소화기학회지

Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastrointestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.

Duodenitis en pacientes con dispepsia: correlación endoscópica e histológica / Duodenitis in patients with dyspepsia: endoscopic and histological correlation

Introducción: la duodenitis es una condición frecuente, con el desarrollo de la endoscopia digestiva se han propuesto diferentes nomenclaturas para su descripción, sin una efectiva unanimidad de conceptos y la asociación clínica-histopatológica no está clara. Objetivo: evaluar la correlación endoscópica e histopatológica de la duodenitis en pacientes ambulatorios con síntomas de dispepsia. Pacientes y métodos: estudio descriptivo, prospectivo, de corte transversal y analítico. Se realizó endoscopia digestiva superior diagnóstica a 39 pacientes con síntomas de dispepsia de la consulta de Gastroenterología, con toma de muestra de mucosa duodenal para análisis histopatológico. Se estableció el grado de duodenitis según clasificación endoscópica ajustada (Sistema Sydney) y se determinó la correlación entre el grado de duodenitis endoscópica y el diagnóstico histopatológico. Resultados: se incluyeron 32 pacientes, 18 femeninos (56,25%) y 14 masculinos (43,75%). La media de edad fue 47,5 ±15,4 años; el síntoma predominante fue Epigastralgia (59,36%). Hubo concordancia de 100% entre las anormalidades endoscópicas y las alteraciones histopatológicas (p <0,01). Se obtuvo una sensibilidad de las alteraciones endoscópicas frente a las histopatológicas de 97% con especificidad de 100%. La relación entre los hallazgos endoscópicos y el reporte histopatológico fue estadísticamente significativa, p < 0,01, con una correlación positiva sustancial alta, c= 0,74. Conclusión: la endoscopia digestiva superior permitió evaluar y clasificar correctamente la presencia de duodenitis, con una alta correlación con el diagnóstico histopatológico.

Introduction: Duodenitis is a common condition, with the development of digestive endoscopy different nomenclatures have been proposed for their description, without an effective unanimity of concepts and the clinic-histopathological association is unclear. Objective: Evaluate the endoscopic and histopathological correlation of duodenitis in ambulatory patients with symptoms of dyspepsia. Patients and methods: Descriptive, prospective, cross-sectional and analytical study. Upper digestive diagnostic endoscopy was performed in 39 patients with symptoms of dyspepsia of the Gastroenterology consultation, with sampling of the duodenal mucosa for histopathological analysis. The degree of duodenitis was established according the adjusted endoscopic classification (Sydney System) and the correlation between the degree of endoscopic duodenitis and the histopathological diagnosis was determined. Results: 32 patients were included, 18 female (56.25%) and 14 male (43.75%). The mean age was 47.5 ± 15.4 years; the predominant symptom was Epigastric pain (59.36%). There was 100% concordance between the endoscopic abnormalities and the histopathological alterations (p < 0.01). The sensitivity of the endoscopic alterations compared to the histopathological was 97% and the specificity 100%. The relation between the endoscopic findings and the histopathological report was statistically significant, p < 0.01, with a high positive substantial correlation, c = 0.74. Conclusion: Upper digestive endoscopy allowed evaluate and correctly classify the presence of duodenitis, with a high correlation with the histopathological diagnosis.

A Case of Ischemic Duodenal and Jejunal Enteritis in a Patient with Chronic Splanchnic Disease / 대한내과학회지

Gastrointestinal ischemia happens by splanchnic artery stenosis, thrombus, or physiological vasoconstriction during a low-blood-stream state. However, even if arterial stenosis exists in the upper gastrointestinal tract, ischemic injury is very rare due to rich collateral circulation. The authors experienced 92-year-old female patient with vomiting, epigastric pain, and hematemesis. An electrocardiogram showed paroxysmal atrial fibrillation. The patient had diffuse and segmental mucosal edema, erythema, and hemorrhage in the second part of the duodenum on esophagogastroduodenoscopy (EGD). On abdomen computed-tomography angiography, stenosis of the celiac and superior mesenteric arteries was observed, and segmental concentric wall thickness was seen from the proximal second portion of the duodenum to the proximal jejunum. The patient was treated with PPI and fluid therapy for one week. At follow-up EGD, the mucosa had improved compared with the previous EGD examination. In conclusion, ischemic injury rarely affects the duodenum and jejunum; however, it can develop in the presence of inducing factors.

Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy / Perfil clínico, endoscópico e histopatológico de casos de duodenite parasitária diagnosticados por endoscopia digestiva alta

CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91 percent), abdominal pain (78 percent), diarrhea (78 percent) and weight loss (78 percent) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25 percent have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

CONTEXTO: Parasitas intestinais podem induzir alterações histopatológicas, que têm sido estudadas em subgrupos com diagnóstico firmado de parasitose. Não há estudo disponível com base mais ampla, sem diagnóstico prévio. OBJETIVO: Descrever os achados clínicos e histopatológicos de parasitoses diagnosticadas por biopsia em pacientes submetidos a endoscopia digestiva alta. MÉTODO: Laudos de biopsias realizadas de janeiro de 1995 a janeiro de 2009, no Complexo Hospitalar Professor Edgar Santos, hospital geral universitário localizado no nordeste brasileiro, foram revisados. Mil e dez laudos de biopsia duodenal foram revistos. Biopsias positivas para parasitas tiveram suas lâminas revisadas e fotografadas. Todos os blocos de biopsia selecionados como casos foram recuperados e revisados por experiente patologista. Dados clínicos, laboratoriais e endoscópicos foram coletados. RESULTADOS: Onze biopsias mostraram parasitas, incluindo casos de Cryptosporidium sp. e Strongyloides stercoralis. Vômitos (91 por cento), dor abdominal (78 por cento), diarreia (78 por cento) e perda ponderal (78 por cento) foram sintomas comuns. Setenta e cinco por cento apresentaram alterações na mucosa duodenal à endoscopia, enquanto 25 por cento não apresentaram modificações. Anemia e hipoalbuminemia foram importantes dados laboratoriais. Foi observada associação com infecção pelo HIV. Atrofia de vilosidades e epitélio reativo foram comuns nos casos de S. stercoralis. CONCLUSÕES: Nenhum achado endoscópico ou histopatológico foi patognomônico. Um por cento das biopsias duodenais por via endoscópica mostraram parasitas.

Relación endoscópica entre duodenitis inespecífica y sobrecrecimiento bacteriano del intestino delgado / Endoscopic relationship between non specific duodenitis and snall intestine bacterial overgrowth

Cuando aparece una proliferación de la flora de tipo colónico en el intestino delgado se producen alteraciones en la digestión y absorción intestinal, que clínicamente conforman el síndrome del Sobrecrecimiento Bacteriano del Intestino Delgado (SBID). En el SBID la concentración bacteriana aumenta hasta 107-109 UFC/ml en intestino delgado. El principio del test de hidrógeno espirado es la administración de un carbohidrato (Lactulosa, dxilosa, glucosa), que al ser degradado por las bacterias produce un aumento de los niveles de hidrógeno espirado en pacientes con SBID. Hipótesis: Si la duodenitis inespecífica se manifiesta clínicamente de manera similar al (SBID) entonces puede haber una relación entre ambas patologías. Métodos: Se realizó un estudio clínico descriptivo prospectivo de una muestra seleccionada quienes tuvieron como hallazgo en la endoscopia digestiva superior duodenitis inespecífica. Se usó Video endoscopio Olympus GIF-140, en dicha endoscopia se tomó biopsia del tejido duodenal con pinza. Posteriormente el paciente fue sometido a prueba de hidrógeno en aliento aire espirado con 10 gr de Lactulosa. Resultados: La prueba de Hidrógeno en aliento resultó positiva en 18 pacientes (29,5%) y negativo en 43 (70,5%) (p=1,000). La sensibilidad fue de 29,6% y Especificidad 71% (IC 95%). Conclusiones: 1) La prueba de Hidrógeno en aire espirado con Lactulosa es una prueba con poca sensibilidad pero específica para el Diagnóstico de SBID. 2) La prevalencia de duodenitis giardiásica fue del 11,5% en la población estudiada. 3) Los hallazgos histológicos referentes a las alteraciones de las vellosidades intestinales no están correlacionados con el SBID.

When a proliferation of the flora of type colonic appears in the small intestine they are caused by alterations in the digestion and intestinal absorption, which they make up clinically the syndrome of the Small Intestine Bacterial Overgrowth (SIBO). In SIBO the bacterial concentration increased to 107-109 UFC/ml in the small intestine. The origin of the exhaled hydrogen test is the administration of a carbohydrate (Lactulose, d-xylose, glucose), which when broken down by the bacteria produce an increase in the levels of the exhaled hydrogen in patients with SIBO. Hypothesis: If the non-specific duodenitis appears clinically similar in a way to (SIBO) then there may be a connection between both pathologies. Methods: We carried out a prospective descriptive clinical trial of a selected sample who had the finding of nonspecific duodenitis in the upper endoscopy. We used Video endoscope Olympus GIF-140, in that endoscopic was taken biopsy of the duodenal tissue with forceps. Subsequently, the patient was undergone of Breath-hydrogen test with 10 gr of lactulose. Results: the hydrogen breath test was positive in 18 patients (29.5%) and negative in 43 (70.5%) (p = 1.000). The sensitivity was 29.6% and specificity 71% (95%). Conclusions: 1) Hydrogen breath test with lactulose is less sensitive but specific for the diagnosis of SIBO. 2) The prevalence of giardiasic duodenitis was 11.5% in our trial. 3.) Histological findings regarding alterations of the intestinal villi are uncorrelated with SIBO.

Duodenitis por strongyloides stercoralis simulando lesion polipoide de duodeno / Strongyloides stercoralis Duodenitis by simulating polypoid lesion of duodenum

La Strongyloidiasis es una parasitosis intestinal producida por un nematodo de distribución mundial, es endémica en zonas tropicales, el parasito penetra a través de los pies en forma de larva filariforme presente en suelos infectados. Puede presentar manifestaciones Dermatológicas, Respiratorias y Gastrointestinales, siendo estas ultimas de variado espectro, que van desde síntomas vagos e inespecíficos hasta Enteritis Invasiva. Los métodos convencionales de examen de heces seriados o radiología no son lo suficientemente sensibles ni específicos. La endoscopia ha aumentado la posibilidad de hacer mejores diagnósticos, así como la biopsia gástrica y duodenal; de hecho se considera a los hallazgos endoscópicos como marcadores de severidad de la infección. Presentamos el caso de un paciente con síntomas dispépticos y hallazgos endoscópicos e histológicos de Duodenitis por Strongyloides Stercoralis. El paciente recibió tratamiento con Ivermectina.

The intestinal strongyloidiasis is a parasitic disease caused by a global distribution nematode endemic in tropical areas, penetrates through the feet in the form of larvae present in infested soil filariform. May present with dermatological, respiratory and gastrointestinal tracts, the latter being varied spectrum of symptoms ranging from vague to invasive enteritis. Conventional methods of serial stool examination, radiology are not sensitive enough nor specific. Endoscopy has increased the possibility of better diagnosis, as well as gastric and duodenal biopsy, in fact considered the endoscopic findings as markers of severity of infection. We report the case of a patient with dyspeptic symptoms with endoscopic and histological findings of Duodenitis for Strongyloides Stercoralis. He was treated with Ivermectin.

Acute Extensive Ischemic Gastroduodenitis in a Patient with End Stage Renal Disease: A Case Report / 대한신장학회지

Acute extensive ischemic gastroduodenitis is a very rare disease because the stomach and duodenum normally have enough blood supply to the upper gastrointestinal (GI) tract and the submucosal vascular plexus. The major causes of upper GI hemorrhage in end stage renal disease (ESRD) patients include erosive gastritis, erosive esophagitis, esophageal ulcer and peptic ulcer. Ischemic gastritis and duodenitis have been reported to be rare as a cause of upper GI bleeding in ESRD patients. We report a case of acute extensive ischemic gastroduodenitis caused by septic shock with severe mesenteric calcification in a patient with ESRD undergoing maintenance hemodialysis.

A case of ulcerative duodenitis accompanying ulcerative colitis / 대한내과학회지

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colonic mucosa that characteristically affects the rectum and involves the large bowel in a contiguous distribution. Upper gastrointestinal inflammation was not believed to be present in UC, but a few recent studies have reported a high incidence of gastroduodenal inflammation in patients with UC, although such occurrences are apparently rare and the stomach and duodenum are not generally considered target organs in UC. Here, we present the case of a 29.year.old man with UC who was found to have diffuse ulcerative duodenitis with endoscopic and histologic features identical to UC

Endoscopic and histopathological characteristics of chronic gastritis,duodenitis and peptic ulcer in children / 上海第二医科大学学报

Objective To investigate the relationship between the endoscopic characteristics of chronic gastritis,duodenitis,peptic ulcer and their histopathologic findings in children,and explore the relationship between Helicobacter pylori(Hp) infection and the severity of histopathologic changes of gastroduodenal mucosa in children. Methods Three hundreds and sixty-six children with chronic upper gastrointestinal symptoms who were examined by gastroscopy were enrolled.The gastric and duodenal mucosal biopsy specimens of all the patients were studied histopathologically. ResultsTypes of chronic gastroduodenal diseases in all these patients were: chronic gastritis(n=206,56.3%),chronic gastritis combined with duodenitis(n=112,30.6%),chronic gastritis combined with peptic ulcer(n=48,13.1%).There was chronic inflammation in gastric mucosa and duodenal bulb mucosa in all the cases examined by histopathologic examination.Hp infection was found in 106 cases(28.96%).The gastric mucosal inflammation was more severe in those with Hp infection than those without(P0.05).The were significant differences in the incidences of inflammation activity,atrophia and nodulus lymphaticus of gastric mucosa between those with Hp infection and those without(P