Duodenal adenocarcinoma might be the cause of intractable nausea and vomiting in patient with coeliac disease

Coeliac disease [CD] is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease [CD]. We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year, presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy

[Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in ARDS patients hospitalized in ICU]

About 20% of patients who are hospitalized in ICU have ALI/ARDS. Their feeding is usually via enteral nutrition. Delayed gastric emptying [DGE] is a major problem in patients with enteral nutrition, and they are at increased risk for aspiration and subsequent development of pneumonia. The purpose of this study was to evaluate the effect of Ginger extract on DGE and developing nosocomial pneumonia in patients with adult respiratory distress syndrome [ARDS] who are hospitalized in intensive care unit [ICU]. In this double- blind randomized clinicl trial, thirty two ARDS patients, who were on mechanical ventilation and fed via nasogastric tube, were randomly divided two groups. Experimental group [n=16] received ginger extract, and control group [n=16] received coconut oil. The amount of feeding tolerated at the first 48 hours of feeding and within study period, nosocomial pneumonia, number of ICU free days, number of ventilator free days and morality were evaluated during 21 days of intervention. Nosocomial pneumonia was significantly less frequent in the ginger extract group [6.3% in the ginger extract group versus 31.3% in the control group. p= 0.07]. There was no significant difference between two groups in mortality rate. The mean number of ventilator free days was 11.25 +/- 4.73 days in ginger group versus 7.18 +/- 5 days in control group [p=0.02]. The mean number of ICU free days was 4.43 +/- 3.5 days in control group versus 7.06 +/- 3.2 days in ginger group [P=0.04]. This study showed that gastric feed supplementation with ginger extract might reduce DGE and help to reduce the incidence of ventilator associated pneumonia [VAP] in ARDS patients