Résumé
Background and study aims: gastric biopsies are recommended in patients with iron deficiency anaemia to identify atrophic gastritis. However, in practice, only duodenal biopsies are routinely performed. The aim of our study was to determine the value of gastric biopsies in iron deficiency anaemia
Patients and methods: a prospective study including all patients referred for gastrointestinal endoscopy for iron deficiency anaemia from May 2008 to September 2014 was performed. All patients having endoscopic lesions which may explain occult bleeding were excluded, as well as patients using non-steroidal anti-inflammatory drugs or anticoagulation treatment. Two fundic biopsies, two antral biopsies, and one biopsy from the lesser curve were taken in all patients. Following entities were particularly looked for: chronic gastritis, Helicobacter pylori infection, intestinal metaplasia, endocrine hyperplasia and villous atrophy. In cases where intestinal metaplasia was present in the fundus and associated with endocrine hyperplasia and glandular atrophy, immunohistochemical study was performed to confirm autoimmune gastritis
Results: one hundred seventy-seven patients [mean age 50 years, range: 15-90] were included. Chronic gastritis was found in 149 cases [84%]. Infection by Helicobacter pylori was found in 107 cases [60%]. Fundic intestinal metaplasia was observed in 25 patients [14%] and was associated with Helicobacter pylori infection in 52% of cases. Atrophic gastritis was observed in 14 cases [8%] and autoimmune gastritis was confirmed in 5 cases by immunohistochemical study. One patient had on gastric biopsy a carcinoma with signet ring cells
Conclusion: intestinal metaplasia was frequently observed and was mostly related to Helicobacter pylori infection. These patients require monitoring, especially if they are young because it represents a pre neoplastic condition. However, in our study autoimmune gastritis often described in the literature in case of iron deficiency anaemia was rarely seen raising the question of relative cost-efficiency of fundic biopsies during iron deficiency anaemia
Résumé
Introduction: Cutaneous metastasis of gastric tumors are very rare. Their topography is generally near to the primitive tumor, in the abdominal wall but rarely in cervical region
Aim: the aim of our study was to describe the topography and the clinic-pathological characteristics of cutaneous metastasis of ring cells gastric adenocarcinoma. Observation1: Our first patient is aged of 33 years has epigastralgias and vomiting. Gastric adenocarcinoma with independent cells was diagnosed by gastroscopy and gastric biopsy made for gastric pain and loss of weigh. During hospitalization, he developed 4 cutaneous nodes localized in cervical region. Cutaneous biopsy with histological examination confirmed the metastatic nature of the nodes. Patient was addressed in oncology unit in order to begin palliative systemic chemotherapy. Observation 2: Our second patient is a women aged of 4 3years who had surgical resection for independent cell gastric carcinoma diagnosed by gastroscpy and biopsy for gastric pain and loss of weigh. She had total gastrectomy without any complications and was addressed in oncology unit for adjuvant chemotherapy. After 2 years, she developed peritoneal carcinosis and cutaneous abdominal nodes. Cutaneous metastasis were confirmed by histological examination of cutaneous biopsy and the patient died within one month
Conclusion: Cutaneous metastasis of gastric cancer and especially ring cell adenocarcinoma are rare but do occur. They must be early diagnosed because they modify therapeutic options. Their prognosis remains poor
Résumé
Background: Biliary obstruction together with bacterial colonization of the bile duct may lead to development of acute cholangitis. The reported incidence of infectious complications may reach up to 10%. Nevertheless, no antibiotic prophylaxis is administered routinely, prior to endoscopic therapeutic procedures
Aim: To investigate the presence and degree of biliary bacterial colonization during endoscopic retrograde cholangiopancreatography [ERCP] in patients with biliary obstruction. Furthermore, we evaluated antibiotic therapy regimens, which would cover the bacterial species obtained by ERCP and subsequent culture in each patient.
Methods:Forty-four patients with biliary obstruction who underwent an ERCP with biliary drainage were prospectively included. The primary indication of ERCP was choledocholithiasis [48%], followed by benign biliary strictures [32%] and malignant bile duct obstruction [18%]. Bile cultures were obtained by means of bile aspiration via the cannulation catheter. Aerobic and anaerobic cultures were prepared from all obtained specimens and the isolated organisms were identified. In the case of positive cultures, an in-vitro resistance test for different antibiotics was performed
Results: The overall positive rate of bile culture was 93%. The organisms cultured were Escherichia coli [26.8%], Enterococcus [17%], Klebsiella [14.6%], Enterobacter [14.6%] and Pseudomonas [9.7%] in decreasing order. In-vitro testing of different antibiotics was carried out in these 41 isolates. Imipenem showed the best antimicrobial activity [sensitivity, 100%], followed by colistin [94%], tobramycin [93%], amikacin [89.6%], gentamycin [85.2%] and ceftazidin [82%]. Amoxicillin/clavulanic acid and ofloxacin were less sensitive [66% and 60% respectively]. Ceftazidin was the most effective antibiotic on Escherichia coli [sensitivity 83%]. Multi-resistant organisms were noted in 22% of the cases
Conclusions: Escherichia coli was found to be the pathogen most frequently detected in bile following endoscopic interventions in the biliary tract. Enterococci and Klebsiella were found in bile cultures with an incidence exceeding 10%. In view of the in-vitro test results, amoxicillin/clavulanic acid or quinolons are not suitable antibiotics for the prophylaxis of biliary infections. Moreover, Gram-positive bacteria such as Enterococcus are emerging as causative microorganisms. If these organisms are isolated, antimicrobial drugs should be replaced by narrower-spectrum antimicrobials
Résumé
Background: Nodular lymphoid hyperplasia of the gastrointestinal tract, recurrent acute pulmonary infections and autoimmune disease are well-recognized complications of common variable immunodeficiency
Aim: We aimed to focus on clinical presentation and differential diagnosis of diffuse nodular lymphoid and hyperplasia of the gastrointestinal tract coexisting with hypogammaglobulinemia
Case-report: We report the case of nodular lymphoid hyperplasia associated with pernicious anaemia in a young man with hypogammaglobulinemia and a long history of pulmonary infections
Conclusion: The considerable point was a mismatch primary clinical diagnosis of familial adenomatous polyposis, due to prominent polyplike endoscopic appearance of the lesions throughout the digestive tract