ABSTRACT
Amyloidosis of the gastrointestinal tract is usually a systemic disease. Localized gastrointestinal amyloidosis without evidence of extraintestinal involvement or an associated plasma cell dyscrasia is uncommon and does not usually cause death. We report a case of a patient with localized gastrointestinal amyloidosis who presented with protein-losing enteropathy and a fatal upper gastrointestinal bleed (AU)
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Subject(s)
Humans , Male , Aged , Amyloidosis/diagnosis , Protein-Losing Enteropathies/diagnosis , Gastrointestinal Hemorrhage/etiology , Blood Transfusion , Administration, Intravenous , Proton Pump Inhibitors/therapeutic use , Hematemesis/etiology , Melena/etiologyABSTRACT
Amyloidosis of the gastrointestinal tract is usually a systemic disease. Localized gastrointestinal amyloidosis without evidence of extraintestinal involvement or an associated plasma cell dyscrasia is uncommon and does not usually cause death. We report a case of a patient with localized gastrointestinal amyloidosis who presented with protein-losing enteropathy and a fatal upper gastrointestinal bleed.
Subject(s)
Amyloidosis/complications , Gastrointestinal Diseases/complications , Gastrointestinal Hemorrhage/etiology , Protein-Losing Enteropathies/etiology , Aged , Amyloidosis/therapy , Blood Transfusion , Fatal Outcome , Gastrointestinal Diseases/therapy , Gastrointestinal Hemorrhage/therapy , Humans , Magnetic Resonance Imaging , Male , Protein-Losing Enteropathies/therapyABSTRACT
BACKGROUND: Irritable bowel syndrome (IBS) is classified into subtypes according to bowel habit. OBJECTIVE: To investigate whether there are differences in clinical features, comorbidities, anxiety, depression and body mass index (BMI) among IBS subtypes. METHODS: The study group included 113 consecutive patients (mean age: 48 ± 11 years; females: 94) with the diagnosis of IBS. All of them answered a structured questionnaire for demographic and clinical data and underwent upper endoscopy. Anxiety and depression were assessed by the Hospital Anxiety and Depression scale (HAD). RESULTS: The distribution of subtypes was: IBS-diarrhea (IBS-D), 46%; IBS-constipation (IBS-C), 32%, and mixed IBS (IBS-M), 22%. IBS overlap with gastroesophageal reflux disease (GERD), functional dyspepsia, chronic headache and fibromyalgia occurred in 65.5%, 48.7%, 40.7% and 22.1% of patients, respectively. Anxiety and/or depression were found in 81.5%. Comparisons among subgroups showed that bloating was significantly associated with IBS-M compared to IBS-D (odds ratio-OR-5.6). Straining was more likely to be reported by IBS-M (OR 15.3) and IBS-C (OR 12.0) compared to IBS-D patients, while urgency was associated with both IBS-M (OR 19.7) and IBS-D (OR 14.2) compared to IBS-C. In addition, IBS-M patients were more likely to present GERD than IBS-D (OR 6.7) and higher scores for anxiety than IBS-C patients (OR 1.2). BMI values did not differ between IBS-D and IBS-C. CONCLUSION: IBS-M is characterized by symptoms frequently reported by both IBS-C (straining) and IBS-D (urgency), higher levels of anxiety, and high prevalence of comorbidities. These features should be considered in the clinical management of this subgroup.
Subject(s)
Irritable Bowel Syndrome/diagnosis , Adult , Anxiety/diagnosis , Anxiety/etiology , Body Mass Index , Brazil/epidemiology , Comorbidity , Constipation/etiology , Depression/diagnosis , Depression/etiology , Diarrhea/etiology , Dyspepsia/epidemiology , Female , Fibromyalgia/epidemiology , Gastroesophageal Reflux/epidemiology , Headache/epidemiology , Humans , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/epidemiology , Irritable Bowel Syndrome/psychology , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
Background: Irritable bowel syndrome (IBS) is classified into subtypes according to bowel habit. Objective: To investigate whether there are differences in clinical features, comorbidities, anxiety, depression and body mass index (BMI) among IBS subtypes. Methods: The study group included 113 consecutive patients (mean age: 48 ± 11 years; females: 94) with the diagnosis of IBS. All of them answered a structured questionnaire for demographic and clinical data and underwent upper endoscopy. Anxiety and depression were assessed by the Hospital Anxiety and Depression scale (HAD). Results: The distribution of subtypes was: IBS-diarrhea (IBS-D), 46%; IBS-constipation (IBS-C), 32%, and mixed IBS (IBS-M), 22%. IBS overlap with gastroesophageal reflux disease (GERD), functional dyspepsia, chronic headache and fibromyalgia occurred in 65.5%, 48.7%, 40.7% and 22.1% of patients, respectively. Anxiety and/or depression were found in 81.5%. Comparisons among subgroups showed that bloating was significantly associated with IBS-M compared to IBS-D (odds ratio-OR-5.6). Straining was more likely to be reported by IBS-M (OR 15.3) and IBS-C (OR 12.0) compared to IBS-D patients, while urgency was associated with both IBS-M (OR 19.7) and IBS-D (OR 14.2) compared to IBS-C. In addition, IBS-M patients were more likely to present GERD than IBS-D (OR 6.7) and higher scores for anxiety than IBS-C patients (OR 1.2). BMI values did not differ between IBS-D and IBS-C. Conclusion: IBS-M is characterized by symptoms frequently reported by both IBS-C (straining) and IBS-D (urgency), higher levels of anxiety, and high prevalence of comorbidities. These features should be considered in the clinical management of this subgroup (AU)
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Irritable Bowel Syndrome/diagnosis , Diarrhea/etiology , Constipation/etiology , Body Mass Index , Comorbidity , Anxiety/diagnosis , Depression/etiology , Brazil/epidemiology , Endoscopy/methods , Gastroesophageal Reflux/epidemiology , Headache/epidemiology , Dyspepsia/epidemiologyABSTRACT
BACKGROUND/AIMS: This prospective study investigated the performance of pre-endoscopy and the complete Rockall scores in predicting the occurrence of adverse outcomes and the need for endoscopic or surgical intervention in patients with nonvariceal upper gastrointestinal bleeding. METHODS: All 656 consecutive patients who underwent endoscopy due to nonvariceal upper gastrointestinal bleeding between 2007 and 2011 were included. Receiver operating characteristic (ROC) curves were plotted for the outcomes of therapeutic intervention, rebleeding and death. The discriminative accuracy of the risk scores was assessed by the area under the ROC curve. RESULTS: Endoscopic treatment was performed in 55.2% of the patients. Rebleeding and mortality rates were 7.6 and 3.8%, respectively. The pre-endoscopy Rockall scores showed unsatisfactory accuracy in predicting the need for intervention, rebleeding or death, as shown by the respective area under the ROC curve values of 0.52, 0.52 and 0.65. The accuracy of the complete Rockall score in predicting rebleeding was poor (area under ROC: 0.52), but it was higher for mortality (area under ROC: 0.69). CONCLUSIONS: The pre-endoscopy Rockall score was not useful for predicting the need for therapeutic intervention or adverse outcomes. The complete Rockall score showed an acceptable performance in predicting mortality, but was unable to predict rebleeding.
Subject(s)
Gastrointestinal Hemorrhage/therapy , Gastrointestinal Neoplasms/complications , Adult , Aged , Aged, 80 and over , Area Under Curve , Brazil , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/mortality , Hemostasis, Endoscopic , Humans , Male , Mallory-Weiss Syndrome/complications , Middle Aged , Needs Assessment , Peptic Ulcer Hemorrhage/mortality , Peptic Ulcer Hemorrhage/therapy , Predictive Value of Tests , Prospective Studies , ROC Curve , Recurrence , Time FactorsABSTRACT
Background. Fecal immunochemical tests (FITs) have been used for colorectal cancer (CRC) screening in several countries. There is lack of information concerning diagnostic performances of this method in Brazil. Methods. Patients scheduled for elective colonoscopy provided one stool sample one week before colonoscopy. The accuracy of a qualitative FIT for detection of CRC and advanced adenomas was determined. Results. Overall 302 patients completed the study. Among them, 53.5% were high risk patients referred for screening or surveillance. Nine (3%) CRCs and 11 (3.6%) advanced adenomas were detected by colonoscopy. Sensitivity and specificity for CRC were, respectively, 88.9% and 87.6%. For advanced adenomas, sensitivity was 63.6% and specificity 87.6%. Conclusion. Our results showed good sensitivity and specificity of the FIT for detecting advanced neoplasias. This method may be a valuable tool for future screening programs in Brazil.
