ABSTRACT
INTRODUCTION: Tropical sprue is a postinfective malabsorption syndrome that occurs in some tropical endemic areas. CASE REPORT: A 65-year-old Caucasian patient, with no significant past medical history, living in Cambodia for 10 years, presented with a 23 kg weight loss and chronic diarrhea. Clinical examination was unremarkable. Laboratory tests showed a moderate nutritional deficiency syndrome. The upper gastrointestinal endoscopy showed duodenal villous atrophy and histological analysis confirmed subtotal villous atrophy with important intraepithelial lymphocytosis. The diagnosis of tropical sprue was considered on the epidemiological, clinical and biological context, and the absence of other cause of villous atrophy. A three-month duration treatment with antibiotics, folic acid and vitamin B12 was initiated. The clinical course was favorable with disappearance of diarrhea in 15 days. One year later, the patient had resumed his usual weight, and laboratory tests and duodenal biopsies were normal. CONCLUSION: The diagnosis of tropical sprue should be systematically discussed in any malabsorption syndrome with villous atrophy in a patient living or having lived in the tropics.
Subject(s)
Sprue, Tropical , Aged , Cambodia , Humans , Male , Sprue, Tropical/diagnosis , Sprue, Tropical/drug therapyABSTRACT
Esophageal adenocarcinoma and its precursor Barrett's esophagus are increasing in incidence in western populations. Gastroesophageal reflux and high body mass index (BMI) are known risk factors. Studies about Barrett's esophagus in obese patients have emphasised the role of central adiposity as a stronger risk factor than BMI in the development of specialized intestinal metaplasia and subsequently esophagus adenocarcinoma. The proinflammatory impact of adipocytokines of the abdominal fat associated with the metabolic syndrome is also relevant. Except cardiovascular diseases, type 2 diabetes and non alcoholic steatohepatitis, abdominal obesity and metabolic syndrome are responsible of an increase of prevalence of esophageal adenocarcinoma, but also other cancer sites. In this review, we study the up to date main epidemiologic and physiopathologic data concerning this association that could be important in future for a preventive action in obese patients, especially when metabolic syndrome is present.
Subject(s)
Gastroesophageal Reflux/complications , Obesity/complications , Adenocarcinoma/etiology , Esophageal Neoplasms/etiology , Esophagitis, Peptic/etiology , Gastroesophageal Reflux/epidemiology , Humans , Obesity/epidemiologyABSTRACT
The association of microscopic colitis with celiac disease is rare. A case of microscopic colitis associated with celiac disease and following administration of venlafaxine in a 67-year-old patient is described. The pathophysiologic hypotheses of such an association are discussed.
Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Celiac Disease/chemically induced , Celiac Disease/complications , Colitis, Microscopic/chemically induced , Colitis, Microscopic/complications , Cyclohexanols/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Aged , Biopsy , Colitis, Microscopic/diagnosis , Colitis, Microscopic/pathology , Colon/pathology , Colonoscopy , Depressive Disorder/drug therapy , Humans , Male , Venlafaxine HydrochlorideABSTRACT
Sporadic colonic juvenile polyps are uncommon in adults. We report three cases for which clinical manifestations were presence of occult blood in the stool, rectal bleeding or chronic diarrhea. Two of these polyps occurred in the caecum which is an uncommon localisation. Endoscopic characteristics of these polyps were indistinguishable from adenomas. Endoscopic resection was complicated in one case by bleeding.
Subject(s)
Colonic Polyps/diagnosis , Adult , Aged , Colonic Polyps/surgery , Diarrhea/etiology , Endoscopy, Gastrointestinal , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Occult Blood , RectumABSTRACT
OBJECTIVE: To report the mechanism of diarrhoea in patients with subacute colonic pseudo-obstruction, profuse secretory diarrhoea and hypokalemia. PATIENTS: Five consecutive patients who developed colonic pseudo-obstruction, profuse watery diarrhoea and severe hypokalemia. Investigations excluded mechanical intestinal obstruction. Usual cause of diarrhoea were ruled out. Abdominal distension and diarrhoea improved simultaneously in all cases after colonoscopic decompression or intravenous neostigmine. RESULTS: Faecal ionograms showed a low osmotic gap and high faecal potassium concentration explaining the hypokalemia: 100 to 180 mEq/kg (usually inferior than 50 mEq/l in case of secretory diarrhoea) and low faecal sodium concentrations. Potassium salts were the only factor identified as the driving osmotic force for the diarrhoea. CONCLUSION: Secretory diarrhoea is classically due to chloride active secretion with passive sodium secretion or to inhibition of sodium absorption. In five cases of Ogilvie's syndrome we evidenced an original mechanism of secretory diarrhoea due to active potassium secretion responsible of a profound hypokalemia. This novel type of diarrhoea may be a hallmark of colonic pseudo-obstruction due to colonic distension.
Subject(s)
Colonic Pseudo-Obstruction/complications , Colonic Pseudo-Obstruction/metabolism , Diarrhea/metabolism , Feces/chemistry , Hypokalemia/etiology , Potassium/analysis , Potassium/metabolism , Aged , Aged, 80 and over , Humans , MaleABSTRACT
PURPOSE: Anemia in patients with alcoholic liver cirrhosis is a common issue. The diagnosis could be difficult because of the multiplicity of causes, usually associated, and specificities in the diagnostic approach. This subject has not been reviewed for almost two decades. We propose a review based upon analysis of the literature and our clinical experience. CURRENT KNOWLEDGE AND KEY POINTS: Because of the alcoholism and the biological consequences of the liver disease, laboratory findings, especially the mean corpuscular volume, should be interpreted with caution in the diagnostic approach. Despite these drawbacks, the diagnosis of anemia is detailed according to the usual plan: normocytic, macrocytic and microcytic anemias. Finally, we propose practical guidelines. FUTURE PROSPECTS AND PROJECTS: Further prospective studies should assess the real burden of nutritional deficiencies, easily treatable. The prognostic significance of hemolytic anemias in patients with alcoholic liver cirrhosis should be studied.
Subject(s)
Anemia/diagnosis , Liver Cirrhosis, Alcoholic/complications , Acute Disease , Anemia/epidemiology , Anemia/etiology , Anemia, Hemolytic/diagnosis , Diagnosis, Differential , Hemorrhage/complications , Humans , Liver Cirrhosis, Alcoholic/epidemiology , Practice Guidelines as TopicABSTRACT
Diverticulitis involving the right colon is uncommon in the Occident; only one case for every 300 cases of appendicitis occurs in Western countries compared to a ratio of 1/40-1/180 in Asia. The preferential localization of diverticula in the right colon among Asiatics is probably due to genetic factors. In Asia as in the West, a right colon diverticulum is more likely to cause hemorrhage than diverticulitis. The peak age of symptoms is 40-45 years and the sex ratio is 1:1. The patient most commonly presents with symptoms suggestive of acute appendicitis, acute localized peritonitis, or, more rarely, a psoas abscess. Clinical exam reveals an inflammatory mass in the right lower quadrant in 30% of cases; diffuse peritonitis, large abscesses, and fistulae are rare. Helical CT scan is the best tool for establishing the diagnosis and also helps to rule out other possible etiologies in the differential diagnosis-particularly a perforated right colon cancer. In noncomplicated cases with convincing evidence for the diagnosis by CT scan, a conservative (non-surgical) treatment with antibiotics is possible; a later stage colonoscopy will rule out other colonic lesions. More commonly, the correct diagnosis is only made after embarking on an appendectomy via a McBurney incision; the surgical strategy thereafter depends on the level of suspicion regarding the diagnosis and the extent and complexity of the diverticulitis. Therapeutic options may be conservative (appendectomy), limited (diverticulectomy, or extensive (ileocecal resection or right hemicolectomy). For complicated disease (abscess, localized perforation), an aggressive surgical approach is warranted. Surgical strategies need to be validated, particularly in the light of the increasing use of the laparoscopic approach for suspected appendicitis.
Subject(s)
Colonic Diseases , Diverticulitis , Colon/physiology , Colonic Diseases/diagnosis , Colonic Diseases/epidemiology , Colonic Diseases/physiopathology , Colonic Diseases/therapy , Diagnosis, Differential , Diverticulitis/diagnosis , Diverticulitis/epidemiology , Diverticulitis/physiopathology , Diverticulitis/therapy , HumansSubject(s)
Stomach Neoplasms/diagnosis , Aged , Gastrectomy , Gastroscopy , Humans , Male , Prognosis , Radiography, Abdominal , Stomach Neoplasms/complications , Stomach Neoplasms/diagnostic imaging , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Stomach Ulcer/diagnostic imaging , Stomach Ulcer/etiology , Tomography, X-Ray ComputedABSTRACT
We report a case of Castleman disease in the mesentery localized to a 58 year-old man. The mass is hypervascular on CT, which can suggest the diagnostic before surgery.
Subject(s)
Castleman Disease/diagnosis , Mesentery , Peritoneal Diseases/diagnosis , Anorexia/etiology , Biopsy , Castleman Disease/complications , Castleman Disease/surgery , Colonoscopy , Diagnosis, Differential , Dyspepsia/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Peritoneal Diseases/complications , Peritoneal Diseases/surgery , Tomography, X-Ray Computed , UltrasonographyABSTRACT
We compared, in a cross-over study, the toxicity of 300 mg enteric-coated aspirin with regular aspirin used for the prevention of cardiovascular events. In terms of endoscopic haemorrhagic lesions, enteric-coated aspirin is less gastrotoxic than regular aspirin.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Aspirin/pharmacology , Duodenum/drug effects , Stomach/drug effects , Abdominal Pain/chemically induced , Adult , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Aspirin/adverse effects , Cross-Over Studies , Dose-Response Relationship, Drug , Double-Blind Method , Duodenum/pathology , Endoscopy, Gastrointestinal , Female , Gastric Mucosa/drug effects , Gastric Mucosa/pathology , Humans , Male , Severity of Illness Index , Stomach/pathology , Tablets, Enteric-CoatedSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cyclooxygenase Inhibitors/adverse effects , Gastric Mucosa/drug effects , Ibuprofen/adverse effects , Lactones/adverse effects , Peptic Ulcer/chemically induced , Sulfonamides/adverse effects , Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthritis, Rheumatoid/drug therapy , Celecoxib , Cyclooxygenase Inhibitors/administration & dosage , Cyclooxygenase Inhibitors/therapeutic use , Duodenoscopy , Esophagoscopy , Gastroscopy , Humans , Ibuprofen/administration & dosage , Ibuprofen/therapeutic use , Lactones/administration & dosage , Lactones/therapeutic use , Osteoarthritis/drug therapy , Peptic Ulcer/diagnosis , Placebos , Pyrazoles , Sulfonamides/administration & dosage , Sulfonamides/therapeutic use , Sulfones , Time FactorsSubject(s)
Adenoma/diet therapy , Adenoma/prevention & control , Calcium, Dietary/administration & dosage , Colorectal Neoplasms/diet therapy , Colorectal Neoplasms/prevention & control , Dietary Fiber/administration & dosage , Intestinal Polyps/diet therapy , Intestinal Polyps/prevention & control , Neoplasm Recurrence, Local/diet therapy , Neoplasm Recurrence, Local/prevention & control , Humans , Multicenter Studies as Topic , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Impaired intestinal function could account for diarrhoea and weight loss, which are common features of advanced human immunodeficiency virus (HIV) infection. METHODS: We assessed intestinal permeability to lactulose and mannitol and absorption of D-xylose in 96 HIV-infected patients (group I: asymptomatic subjects (CDC-A); group II: symptomatic subjects (CDC-B or C) without body weight loss and/or diarrhoea; group III: 25 acquired immunodeficiency syndrome (AIDS) patients (CDC-C) with severe body weight loss and/or diarrhoea) and 10 healthy subjects as controls. RESULTS: An incremental decrease in urinary D-xylose recoveries was observed, with all groups statistically different from each other. Impaired intestinal permeability was only found in patients of group III (statistically different from all other groups). CONCLUSIONS: These findings suggest a loss of intestinal functional absorptive surface as HIV disease progresses. This process may be present at the early stage of infection. Impaired intestinal permeability is observed later in AIDS patients when digestive signs are present, particularly diarrhoea.
Subject(s)
HIV Infections/physiopathology , Intestinal Absorption/physiology , Adult , Aged , Body Mass Index , CD4 Lymphocyte Count , Creatinine/blood , Diarrhea/complications , Diarrhea/metabolism , Female , HIV Infections/complications , HIV Infections/immunology , Humans , Intestinal Absorption/immunology , Intestinal Mucosa/metabolism , Lactulose/metabolism , Lactulose/urine , Male , Mannitol/metabolism , Mannitol/urine , Middle Aged , Nutritional Status/physiology , Serum Albumin/metabolism , Weight Loss , Xylose/metabolism , Xylose/urineSubject(s)
Dyspepsia/etiology , Helicobacter pylori/isolation & purification , Amoxicillin/pharmacology , Amoxicillin/therapeutic use , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Anti-Ulcer Agents/pharmacology , Anti-Ulcer Agents/therapeutic use , Clarithromycin/pharmacology , Clarithromycin/therapeutic use , Dyspepsia/drug therapy , Dyspepsia/microbiology , Female , Helicobacter pylori/drug effects , Humans , Male , Omeprazole/pharmacology , Omeprazole/therapeutic use , PrevalenceSubject(s)
Acquired Immunodeficiency Syndrome/complications , Duodenal Ulcer/epidemiology , Helicobacter Infections/epidemiology , Helicobacter pylori/isolation & purification , Stomach Ulcer/epidemiology , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/microbiology , Duodenal Ulcer/complications , Duodenal Ulcer/microbiology , Gastric Acidity Determination , Helicobacter Infections/complications , Helicobacter Infections/microbiology , Humans , Prevalence , Serologic Tests , Stomach Ulcer/complications , Stomach Ulcer/microbiologyABSTRACT
OBJECTIVES: Endoscopic sclerotherapy is effective to prevent bleeding of oesophageal varices but is associated with frequent adverse effects. Endoscopic ligation represents a new endoscopic alternative treatment to sclerotherapy. The purpose of this study was to assess efficacy and safety of endoscopic variceal ligation in 50 consecutive patients with cirrhosis who had recently bled from oesophageal varices. METHODS: Patients were followed from 6 to 1140 days (median 310 days). Nine patients were bleeding actively when ligation was performed. RESULTS: Eleven patients (22%) had 13 recurrent bleedings requiring blood transfusion during follow-up. Six recurrences occurred during the first month (3 from bleeding varices, 3 treatment-induced); seven recurrences occurred latter (6 from bleeding varices, 1 treatment-induced). Varices were eradicated in 33 patients (66% of all patients, 82% of patients who survived more than 30 days). Variceal eradication was achieved in 2-9 endoscopic ligation sessions (median 3). Eighteen patients died during the study; one died from bleeding. No patient developed major complications; five patients only complained of mild dysphagia for 24 to 48 hours. CONCLUSION: Endoscopic ligation is a safe and effective method to prevent recurrent bleeding from oesophageal varices.