Subject(s)
Angioedema/chemically induced , Contrast Media/adverse effects , Duodenal Diseases/chemically induced , Iodine Compounds/adverse effects , Adolescent , Contrast Media/administration & dosage , Duodenal Diseases/diagnostic imaging , Female , Humans , Injections, Intravenous , Iodine Compounds/administration & dosage , Tomography, X-Ray Computed/methodsSubject(s)
Acenocoumarol/adverse effects , Anticoagulants/adverse effects , Duodenal Diseases/chemically induced , Gastric Outlet Obstruction/etiology , Hematoma/chemically induced , Acenocoumarol/administration & dosage , Administration, Oral , Aged , Anticoagulants/administration & dosage , Duodenal Diseases/complications , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/pathology , Gastric Outlet Obstruction/diagnostic imaging , Gastric Outlet Obstruction/pathology , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/pathology , Humans , Male , Tomography, X-Ray ComputedSubject(s)
Antitubercular Agents/adverse effects , Clofazimine/adverse effects , Duodenal Diseases/chemically induced , Jejunal Diseases/chemically induced , Adult , Color , Duodenal Diseases/diagnostic imaging , Endoscopy, Gastrointestinal , Female , Humans , Intestinal Mucosa/diagnostic imaging , Jejunal Diseases/diagnostic imaging , Narrow Band ImagingSubject(s)
Antineoplastic Agents, Immunological/adverse effects , Bevacizumab/adverse effects , Duodenal Diseases/chemically induced , Intestinal Fistula/chemically induced , Vascular Fistula/chemically induced , Venae Cavae , Aged , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy/methods , Duodenal Diseases/diagnostic imaging , Female , Humans , Intestinal Fistula/diagnostic imaging , Uterine Cervical Neoplasms/therapy , Vascular Fistula/diagnostic imaging , Venae Cavae/diagnostic imagingABSTRACT
BACKGROUND: Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can present as a benign lymphoid proliferation or a malignant lymphoma in patients taking MTX. Almost 50% of MTX-LPD cases show spontaneous remission after withdrawal of MTX treatment. Studies have suggested that the hyper-immune state of rheumatoid arthritis, the immunosuppressive state associated with MTX, and the carcinogenicity of the Epstein-Barr virus might contribute to MTX-LPD development. Although most cases of MTX-LPD occur at extranodal sites, few cases of MTX-LPD affecting the stomach and duodenum have been reported. To our knowledge, no other study has reported on the endoscopic observations of dramatic withdrawal and appearance of multiple digestive tract lesions in a short period of time. Herein, we report the clinical course and imaging findings of our case, which may be useful for understanding the pathological condition of MTX-LPD. CASE PRESENTATION: We describe the case of a 70-year-old woman with MTX-LPD of the stomach and duodenum. Disease regression was temporarily achieved after cessation of MTX treatment; however, it subsequently recurred, and complete response was only achieved after six cycles of rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (R-CHOP) chemotherapy. CONCLUSIONS: The first-choice therapy for patients taking MTX who develop suspected MTX-LPD should be the withdrawal of MTX treatment. Even after remission is achieved, patients should be kept under careful observation, and if the disease recurs, chemotherapy should be commenced promptly.
Subject(s)
Antirheumatic Agents/adverse effects , Duodenal Diseases/chemically induced , Lymphoproliferative Disorders/chemically induced , Methotrexate/adverse effects , Stomach Diseases/chemically induced , Aged , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Arthritis, Rheumatoid/drug therapy , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/drug therapy , Duodenal Diseases/pathology , Endoscopy, Digestive System , Female , Humans , Lymphoproliferative Disorders/diagnostic imaging , Lymphoproliferative Disorders/drug therapy , Lymphoproliferative Disorders/pathology , Prednisone/therapeutic use , Recurrence , Rituximab , Stomach Diseases/diagnostic imaging , Stomach Diseases/drug therapy , Stomach Diseases/pathology , Vincristine/therapeutic use , Withholding TreatmentSubject(s)
4-Hydroxycoumarins/adverse effects , Duodenal Diseases/chemically induced , Gastrointestinal Hemorrhage/chemically induced , Hematoma/chemically induced , Indenes/adverse effects , Pancreatitis/chemically induced , Vitamin K/antagonists & inhibitors , Acute Disease , Aged , Duodenum/blood supply , Female , Humans , Male , Middle Aged , Vitamin K/adverse effectsSubject(s)
Duodenal Diseases/chemically induced , Gastric Fistula/pathology , Gastrointestinal Hemorrhage/chemically induced , Ibuprofen/adverse effects , Peptic Ulcer/chemically induced , Pylorus/pathology , Aged , Analgesics, Non-Narcotic/adverse effects , Analgesics, Non-Narcotic/therapeutic use , Asthma/drug therapy , Back Pain/drug therapy , Duodenal Diseases/complications , Endoscopy , Gastric Fistula/surgery , Gastrointestinal Hemorrhage/pathology , Gastrointestinal Hemorrhage/therapy , Humans , Ibuprofen/therapeutic use , Laparotomy , Ligation , Male , Peptic Ulcer/complications , Prednisone/adverse effects , Prednisone/therapeutic use , Pylorus/surgery , Treatment OutcomeSubject(s)
Duodenal Diseases , Duodenum , Hydralazine/adverse effects , Pigmentation Disorders , Aged , Duodenal Diseases/chemically induced , Duodenal Diseases/metabolism , Duodenal Diseases/pathology , Duodenum/metabolism , Duodenum/pathology , Female , Humans , Hydralazine/administration & dosage , Pigmentation Disorders/chemically induced , Pigmentation Disorders/metabolism , Pigmentation Disorders/pathologySubject(s)
Angiotensin II Type 1 Receptor Blockers/adverse effects , Diarrhea/chemically induced , Duodenal Diseases/chemically induced , Imidazoles/adverse effects , Malabsorption Syndromes/chemically induced , Tetrazoles/adverse effects , Diarrhea/diagnosis , Diarrhea/physiopathology , Duodenal Diseases/diagnosis , Duodenal Diseases/physiopathology , Humans , Malabsorption Syndromes/diagnosis , Malabsorption Syndromes/physiopathology , Risk Factors , Weight Loss/drug effectsSubject(s)
Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Duodenal Diseases/epidemiology , Imidazoles/administration & dosage , Imidazoles/adverse effects , Microvilli/pathology , Prescriptions/statistics & numerical data , Tetrazoles/administration & dosage , Tetrazoles/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Duodenal Diseases/chemically induced , Female , Humans , Male , Middle Aged , Prevalence , United States/epidemiology , Young AdultABSTRACT
Teduglutide (TG) is approved for the treatment of parenteral nutrition (PN)-dependent adult patients with short bowel syndrome (SBS). Its well-known adverse effect is expedited growth of colon polyps and potential formation of new polyps. Apart from animal studies, de novo development of duodenal polyps in a patient during TG therapy has not been reported in the literature. We report a case of a 71-year-old man with SBS on TG who developed multiple new duodenal polyps that were found incidentally during a diagnostic endoscopy. Furthermore, an accelerated growth of duodenal polyps was noted while on TG therapy, suggesting a potential trophic effect of TG on these polyps. There are no current recommendations for the surveillance of intestinal polyps in patients on TG therapy, but we recommend exercising caution and possible need for surveillance based on this case report.
Subject(s)
Duodenal Diseases/chemically induced , Gastrointestinal Agents/adverse effects , Intestinal Polyps/chemically induced , Peptides/adverse effects , Short Bowel Syndrome/drug therapy , Aged , Duodenal Diseases/pathology , Duodenoscopy , Duodenum/pathology , Gastrointestinal Agents/therapeutic use , Humans , Intestinal Polyps/pathology , Male , Parenteral Nutrition , Peptides/therapeutic useSubject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antidotes/therapeutic use , Antithrombins/adverse effects , Dabigatran/adverse effects , Duodenal Diseases/chemically induced , Gastrointestinal Hemorrhage/chemically induced , Aged , Atrial Fibrillation/drug therapy , Duodenal Diseases/therapy , Embolization, Therapeutic , Gastrointestinal Hemorrhage/therapy , Humans , Male , Treatment FailureSubject(s)
Anticonvulsants/adverse effects , Carbamazepine/analogs & derivatives , Celiac Disease/diagnosis , Duodenal Diseases/chemically induced , Epilepsies, Partial/drug therapy , Piracetam/analogs & derivatives , Adult , Anticonvulsants/therapeutic use , Carbamazepine/adverse effects , Diagnosis, Differential , Drug Substitution , Duodenal Diseases/diagnosis , Duodenal Diseases/pathology , Humans , Levetiracetam , Male , Oxcarbazepine , Piracetam/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Olmesartan Medoxomil/adverse effects , Antibodies, Antinuclear/analysis , Celiac Disease/chemically induced , Atrophy/chemically induced , Diarrhea/chemically induced , Duodenal Diseases/chemically induced , Methylprednisolone/therapeutic use , Diagnosis, Differential , Collagenous Sprue/complications , Collagenous Sprue/pathology , Endoscopy, Digestive System/instrumentation , Endoscopy, Digestive System/methods , Weight Loss , HLA-DQ Antigens/analysis , Immunohistochemistry/methods , CD4 Antigens/analysisSubject(s)
Antihypertensive Agents/adverse effects , Celiac Disease/diagnosis , Duodenal Diseases/chemically induced , Duodenal Diseases/diagnosis , Imidazoles/adverse effects , Intestinal Mucosa/pathology , Tetrazoles/adverse effects , Atrophy/chemically induced , Atrophy/diagnosis , Diagnosis, Differential , Diarrhea/etiology , Duodenal Diseases/complications , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: The association between olmesartan and an enteropathy histologically indistinguishable from untreated celiac disease has recently been described. However, pathogenetic mechanisms leading to villous atrophy, prevalence, natural history and genetic background of this condition have not yet been defined. PATIENTS: We describe here two cases of olmesartan-associated enteropathy and discuss some aspects of the natural history of this condition. RESULTS: In both patients, an infectious episode seems to have triggered the severe malabsorption syndrome which led them to hospitalization. High titer positive antinuclear antibodies with homogeneous pattern were found. CONCLUSIONS: Our reports add to a growing body of evidence suggesting that olmesartan-associated enteropathy should be considered in the presence of villous atrophy and negative celiac serology and in the diagnostic algorithm of non-responsive celiac disease.
Subject(s)
Antihypertensive Agents/adverse effects , Duodenal Diseases/chemically induced , Duodenal Diseases/pathology , Imidazoles/adverse effects , Intestinal Mucosa/pathology , Tetrazoles/adverse effects , Aged , Atrophy/chemically induced , Humans , Intestinal Mucosa/drug effects , Male , Middle AgedSubject(s)
Duodenal Diseases/chemically induced , Duodenum/pathology , Imidazoles/adverse effects , Tetrazoles/adverse effects , Aged , Angiotensin II Type 1 Receptor Blockers/administration & dosage , Angiotensin II Type 1 Receptor Blockers/adverse effects , Dose-Response Relationship, Drug , Duodenal Diseases/diagnosis , Duodenoscopy , Duodenum/drug effects , Female , Follow-Up Studies , Humans , Hypertension/drug therapy , Imidazoles/therapeutic use , Olmesartan Medoxomil , Tetrazoles/therapeutic useABSTRACT
An 88-year-old woman on long-term intravitreal bevacizumab presented with acute gastrointestinal hemorrhage. She was stabilized and underwent nonrevealing upper endoscopy. She continued to require intermittent blood transfusions, and resulting computed tomography of the abdomen revealed an aortoduodenal fistula. The patient was undergoing treatment for her macular degeneration with intravitreal bevacizumab, an angiogenesis inhibitor frequently used to treat solid organ malignancies. Systemic administration has been associated with serious adverse events, including gastrointestinal hemorrhage, perforation, and fistula formation. Intravitreal bevacizumab has been used off-label to treat macular degeneration, but data on the safety of this therapy are limited. Given her lack of other risk factors, the authors postulate a potential association between intravitreal bevacizumab and aortoduodenal fistula formation in this patient.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Aortic Diseases/chemically induced , Bevacizumab/adverse effects , Duodenal Diseases/chemically induced , Intestinal Fistula/chemically induced , Vascular Fistula/chemically induced , Aged , Aged, 80 and over , Bevacizumab/administration & dosage , Female , Humans , Intravitreal Injections , Macular Degeneration/drug therapyABSTRACT
BACKGROUND: Regional chemotherapy is used successfully in the treatment of both primary and secondary malignancies, in particular of the peritoneal surface and the liver, and is currently explored as an attractive approach for patients with locally advanced pancreatic ductal adenocarcinoma. To establish the feasibility and toxicity of regional intra-arterial gemcitabine delivered as a 24-h continuous infusion to the pancreas as a novel treatment option for patients with locally advanced PDAC a phase I clinical trial was conducted. METHODS: Between April 2011 and September 2013 six patients with biopsy confirmed, borderline or unresectable pancreatic adenocarcinoma, and having received at least one line of systemic chemotherapy, underwent vascular redistribution of the inflow to the head of the pancreas by arterial coil embolization followed by perfusion catheter placement within the splenic artery. Patients were treated with increasing doses of gemcitabine administered by continuous splenic arterial infusion over 24 h with inter-patient and intra-patient dose escalation scheme. The primary endpoint was toxicity of the intra-arterial gemcitabine regimen and to establish the maximum tolerated dose. RESULTS: Catheter placement and gemcitabine infusion was successful in all patients enrolled to date (n = 6). Four out of six patients experienced catheter tip migration requiring replacement or revision. Patients received a median of four doses of 24-h gemcitabine infusion. Two patients developed grade 3 and 4 duodenal ischemia and upper gastrointestinal bleeding. Median overall survival was 15.3 months and median time to progression was 3 months. Three patients (50 %, n = 3/6) progressed systemically. Two patients had stable disease >4 months following treatment and underwent pancreaticoduodenectomy. CONCLUSIONS: While technically feasible to treat locally advanced pancreatic ductal adenocarcinoma, prolonged regional pancreatic perfusion with gemcitabine following pancreatic arterial redistribution carries a high risk for gastrointestinal toxicity. Shorter infusion schedules with frequent on treatment evaluations should be considered for future clinical trials.