A case of duodenal ulcer as prominent manifestation of IgG4-related disease / 北京大学学报(医学版)

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.

Comparison of Efficacy and Safety between Octreotide and Somatostatin in the Treatment of Liver Cirrho-sis and Upper Digestive Tract Hemorrhage:a Meta-analysis / 中国药师

Objective:To compare the efficacy and safety of octreotide and somatostatin in the treatment of liver cirrhosis and up-per digestive tract hemorrhage. Methods:The randomized controlled trails ( RCTs) on the comparison between octreotide and soma-tostatin in the treatment of liver cirrhosis and upper digestive tract hemorrhage were searched from Cochrane Library, PubMed, Med-line, Embase, China National Knowledge Infrastructure(CNKI), VIP China Science and Technology Journal Database and Wanfang database (till February 2017). The randomized controlled trails meeting the inclusion criteria were collected and the quality of included RCTs was assessed according to the Cochrane Collaboration system review, and then Meta -analysis was performed using RevMan 5. 3 software after data extraction and bias risk assessment. Results:A total of 11 RCTs were included. Meta-analysis showed the efficacy of octreotide group was similar to that of somatostatin group (OR=1. 10, 95%CI:0. 79-1. 53, P=0. 56). The levels of blood transfu-sion and hemostasis of octreotide group were higher than those of somatostatin group (MD=0. 68, 95%CI:0. 54-0. 82, P<0. 01 and MD=6. 26, 95%CI:4. 89-7. 63, P<0. 01). The risk of abdominal pain in octreotide group was lower than that in somatostatin group (OR=0. 43, 95%CI:0. 22-0. 86, P=0. 02). The other adverse reactions were similar in both groups. Conclusion:The efficacy of octreotide is similar to that of somatostatin in the treatment of liver cirrhosis and upper digestive tract hemorrhage, and the effect of som-atostatin is quicker than that of octreotide with less blood transfusion. The adverse reactions are similar in both groups, except that oct-reotide has a lower risk of abdominal pain. The long-term safety of octreotide still needs to be confirmed by performing higher quality and large-sample RCTs.

Clinical efficacy of somatostatin combined with ulinastatin in the treatment of upper gastrointestinal hemorrhage and its effects on IL-2, IL-6 and TNF-α / 中国生化药物杂志

Objective To investigate the clinical efficacy of somatostatin combined with ulinastatin in patients with upper gastrointestinal bleeding and the effects of interleukin -2 (IL-2), interleukin -6 (IL-6) and tumor necrosis factor (TNF-). Methods From May 2015 to June 2017, 90 patients with gastrointestinal bleeding were treated in the first people's hospital in Wenling, which were divided into the control group (n=45) and the observation group (n=45) by random number method. The control group was treated with simple somatostatin, and the observation group was treated with ulinastatin on the basis of the control group. Results The curative effect in the observation group was significantly better than that in the control group (P<0.05). Conclusion Somatostatin combined with ulinastatin in the treatment of patients with upper gastrointestinal bleeding is effective and helpful to improve the levels of IL-2, IL-6 and TNF- alpha, so it is worthy of popularization and application.

Dignosis of SPECT in lower digestive tract hemorrhage / 中国普通外科杂志

Objective To determine the diagnostic value of SPECT in lower digestive tract hemorrhage (LDTH). Methods Of the 24 LDTH cases,16 were tested by gastric mucosa imaging ,4 by 99m Tc PHA imaging,and the other 4 by 99m Tc RBC imaging.All the patients' diagnosis were confirmed by surgery and pathology. Results The sensitivity and the specificity of the gastric mucosa imaging were 100%(16/16) and 93.7%(15/16),respectively. The sensitivity of the 99m Tc PHA imaging and the 99m Tc RBC imaging was 75.0%(3/4) and 75.0 %(3/4), respectively, but had no specificity. Conclusions SPECT has very high sensitivity and specificity in the diagnosis of Meckel's diverticulum. 99m Tc PHA imaging and 99m Tc RBC imaging may help to determine the position of bleeding in unkown causes of LDTH.

DSA diagnosis and interventional therapy for non-neoplastic lower digestive tract hemorrhage / 介入放射学杂志

Objective To study the clinical value of DSA diagnosis and interventional therapy for non-neoplastic lower digestive tract hemorrhage. Methods Non-neoplastic lower digestive tract hemorrhage were diagnosed in 21 patients. Eight cases underwent embolization with gelfoam and 13 cases with infusion of pitressin. Results Intestinal angiodysplasia was found in 14 cases, colonic diverticulum in 2 and hemorrhage of unknown cause in 5. Hemorrhage in all patients was stopped after the interventional therapy with no serious complications. During the follow-up of 25～74 months, intestinal angiodysplasia bleeding recurred in 4 patients. Conclusions DSA is very helpful in the diagnosis of non-neoplastic lower digestive tract hemorrhage and interventional therapy is safe and effective for the stoppage of the bleeding.