ABSTRACT
Celiac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. The key treatment in these patients is a gluten-free diet, because most complications are more common when dietary compliance is poor. The most serious complication of celiac disease is the development of neoplasms (the most common of which is enteropathy-associated T-cell lymphoma). However, a number of reports have indicated an increased prevalence of ulcerative jejunitis and extraintestinal manifestations, including chronic hepatitis, fibrosing lung disease, and epilepsy syndromes. We report the case of a 53-year-old-man with long-standing diarrhea; because celiac disease was not suspected, the patient developed celiac-associated T-cell lymphoma and mesenteric panniculitis.
Subject(s)
Celiac Disease/complications , Intestinal Neoplasms/etiology , Lymphoma, T-Cell, Peripheral/etiology , Panniculitis, Peritoneal/etiology , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Atrophy , Celiac Disease/diagnosis , Celiac Disease/diet therapy , Cyclophosphamide/administration & dosage , Diarrhea/etiology , Disease Progression , Doxorubicin/administration & dosage , Gastrointestinal Hemorrhage/etiology , Humans , Intestinal Mucosa/pathology , Male , Middle Aged , Prednisone/administration & dosage , Remission Induction , Vincristine/administration & dosageABSTRACT
La enfermedad celíaca se produce por la ingesta de gluten en niños y adultos genéticamente susceptibles, y es la intolerancia alimentaria grave más común en los países occidentales. La eliminación del gluten presente en la dieta es obligatoria en estos pacientes, ya que la mayoría de las complicaciones que pueden presentarse son más frecuentes en caso de incumplir el tratamiento. El desarrollo de neoplasias constituye la complicación más grave de la celiaquía (el más frecuente es el linfoma de células T asociado a enteropatía), pero se han descrito otras, como la yeyunoileítis ulcerativa, y manifestaciones extraintestinales, como la hepatitis crónica, la enfermedad pulmonar fibrosante, el síndromes de epilepsia, etc. Presentamos el caso de un varón de 53 años de edad con síndrome diarreico de muy larga evolución, en el que no se sospechó una enfermedad celíaca y se complicó con un linfoma intestinal de células T asociado a enteropatía y una paniculitis mesentérica
Celiac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. The key treatment in these patients is a gluten-free diet, because most complications are more common when dietary compliance is poor. The most serious complication of celiac disease is the development of neoplasms (the most common of which is enteropathy-associated T-cell lymphoma). However, a number of reports have indicated an increased prevalence of ulcerative jejunitis and extraintestinal manifestations, including chronic hepatitis, fibrosing lung disease, and epilepsy syndromes. We report the case of a 53-year-old-man with long-standing diarrhea; because celiac disease was not suspected, the patient developed celiac-associated T-cell lymphoma and mesenteric panniculitis
Subject(s)
Humans , Male , Middle Aged , Lymphoma, T-Cell/etiology , Intestinal Neoplasms/etiology , Celiac Disease/complications , Panniculitis, Peritoneal/etiology , Lymphoma, T-Cell/pathology , Intestinal Neoplasms/pathology , Diarrhea/etiology , Panniculitis, Peritoneal/pathologyABSTRACT
BACKGROUND: The BioEnterics Intragastric Balloon (BIB) has been proposed as an adjuvant therapy for the short-term treatment of obesity. The temporal pattern of BIB-induced satiety and whether this effect is mediated by modification of ghrelin levels is unknown. METHODS: Patients with treatment-resistant morbid obesity were invited to participate in a randomized, double-blind, sham-controlled trial of 4-month duration. Anthropometric and biochemical parameters, estimation of energy intake, and pre- and postprandial evaluation of satiety were required monthly. Ghrelin response after a standard mixed meal was scheduled prior to and 4 weeks after the endoscopic procedure. RESULTS: 21 out of 22 enrolled patients completed the study (17 women, 5 men; 35.9 +/- 9.9 years; BMI 50.4 +/- 7.8 kg/m2). Pre-intervention weight decreased from 143.8 +/- 31.2 kg to 131.1 +/- 32.6 kg in Group Balloon (P < 0.001) and from 138.8 +/- 24.5 kg to 129.9 +/- 25.6 kg in Group Sham (P < 0.01) at the end of the study. Weight loss was not significantly different in Group Balloon and Group Sham at any time-point of the follow-up. Only patients from Group Balloon showed a temporary increased pre- and postprandial satiety, which was maximal at 4 weeks after the intervention. Total area under the curve, fasting and postprandial plasma ghrelin were not significantly different between groups at inclusion or 4 weeks after follow-up. No correlation was found between any of the satiety scores at any time-point with their comparable ghrelin levels. CONCLUSION: BIB induces a temporary sense of satiety in morbidly obese patients which is not mediated by modification of fasting or postprandial levels of plasma ghrelin.
