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1.
Acta Gastroenterol Belg ; 86(3): 474-480, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37814563

RESUMO

Microscopic colitis is part of the differential diagnosis of chronic watery diarrhea. Colonoscopy discloses a normal looking mucosa, therefore its diagnosis is based on histology of colonic biopsies. Two main phenotypes are distinguished: collagenous colitis and lymphocytic colitis. A third entity, incomplete microscopic colitis or unspecified microscopic colitis has been reported in the literature. It affects preferentially women over 60 years of age and its association with certain drugs is increasingly established. In case of suspected drug-induced microscopic colitis, identification of the responsible drug is a key to management. After discontinuation of the suspected drug, the gold standard of treatment is budesonide both for induction and for maintenance in case of clinical relapse, as is often the case after discontinuation. Therapy with immunomodulators, biologics, or surgery is reserved for refractory forms of microscopic colitis after multidisciplinary consultation. Through the clinical case of colitis on olmesartan, we will review the latest recommendations on drug-induced microscopic colitis.


Assuntos
Colite Colagenosa , Colite Linfocítica , Colite Microscópica , Feminino , Humanos , Pessoa de Meia-Idade , Colite Colagenosa/induzido quimicamente , Colite Colagenosa/diagnóstico , Colite Colagenosa/tratamento farmacológico , Colite Linfocítica/induzido quimicamente , Colite Linfocítica/diagnóstico , Colite Linfocítica/complicações , Colite Microscópica/induzido quimicamente , Colite Microscópica/diagnóstico , Colite Microscópica/tratamento farmacológico
2.
Acta Gastroenterol Belg ; 84(4): 666-668, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965050

RESUMO

Potassium binders (Kayexalate® and Sorbisterit®) are commonly used to treat hyperkaliemia. They are made of sodium or calcium polystyrene sulfonate. Their use is associated with multiple adverse effects including ileocolonic (or more rarely upper digestive tract) injuries which can lead to necrosis or perforations. This side effect is mostly seen in patients with chronic kidney disease or constipation. It presents with abdominal pain, diarrhea or hematochezia. The diagnosis is made when the histo-logical analysis of samples from the erythematous or ulcerated digestive wall finds polystyrene sulfonate crystals embedded in the mucosa. This diagnosis can be suspected by taking a careful initial drug inventory, if the clinician is aware of this rare but serious adverse effect. The lack of specificity of clinical symptoms and endoscopic lesions makes this inventory even more essential. Treatment is mainly supportive and requires cessation of the drug, while surgery is inevitable in the most severe cases.


Assuntos
Hiperpotassemia , Insuficiência Renal Crônica , Hemorragia Gastrointestinal , Humanos , Úlcera/diagnóstico , Úlcera/etiologia
3.
Acta Gastroenterol Belg ; 84(4): 660-662, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965048

RESUMO

We present here two hepatocellular carcinoma (HCC) patients with gastrointestinal tract involvement (GITI). Hemorrhage due to duodenal involvement was the inaugural event of the HCC for the first patient. Dysphagia due to HCC recurrence in the oesophagus four years after left hepatectomy was the call symptom for the second. As incidence of HCC increases, and overall survival improves, incidence of GITI in HCC patients is expected to increase.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirurgia , Esôfago , Trato Gastrointestinal , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
4.
Rev Med Brux ; 37(5): 432-435, 2016.
Artigo em Francês | MEDLINE | ID: mdl-28525212

RESUMO

Tuberous sclerosis is an autosomal dominant genetic disorder that is characterized by epilepsy, mental retardation and facial angiofibromas. Usually, the disease is diagnosed in childhood but there are frustrates form of tuberous sclerosis with or without genetic mutation. This clinical case about a man who is diagnosed a colonic polyposis, a rectal adenocarcinoma and a tuberous sclerosis.


La sclérose tubéreuse de Bourneville (STB) est une maladie génétique autosomique dominante qui se manifeste principalement par la triade épilepsie, retard mental et angiofibromes faciaux. Généralement, elle est diagnostiquée dans l'enfance, mais il existe des formes cliniques frustres avec ou sans mutations génétiques. La recherche d'autres manifestations cliniques peut aider au diagnostic notamment l'atteinte intestinale. Notre cas clinique rapporte la découverte d'une polypose intestinale et d'un cancer du rectum chez un patient méconnu de sa maladie génétique. L'intérêt est de voir, à partir de la littérature, la fréquence de la polypose colique ainsi que du cancer colorectal dans la STB et de se poser la question d'un dépistage systématique dans cette population.


Assuntos
Adenocarcinoma/complicações , Polipose Adenomatosa do Colo/complicações , Neoplasias Retais/complicações , Esclerose Tuberosa/complicações , Adenocarcinoma/genética , Adenocarcinoma/patologia , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/patologia , Análise Mutacional de DNA , Genes APC , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/genética , Neoplasias Retais/patologia , Esclerose Tuberosa/genética , Esclerose Tuberosa/patologia , Proteína 1 do Complexo Esclerose Tuberosa , Proteína 2 do Complexo Esclerose Tuberosa , Proteínas Supressoras de Tumor/genética
5.
Acta Gastroenterol Belg ; 76(2): 235-40, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23898562

RESUMO

BACKGROUND AND STUDY AIMS: Complicated Acute Colonic Diverticulitis (ACD) is usually treated by parenteral way thus keeping the bowel at rest. To date there are no clear recommendations regarding the route of nutrition administration. We study the safety of early feeding by oral energetic fiber-free liquid diet in non-surgical complicated ACD patients. PATIENTS AND METHODS: From February 2008 to October 2011, 25 patients were admitted with complicated ACD and took part in this prospective study. Surgical and medical assessments were performed at admission. Initial treatment was given with perfusion, intravenous antibiotics and hydric diet. Within 72 hours of admission, antibiotic therapy was switched to oral administration for 5 up to 15 days depending on the progression of the disease. At the same time the patient received oral liquid fiber-free feeding. Solid but fiber-free diet was introduced 24h hours before discharge. RESULTS: 25 cases of ACD were complicated with covered perforation and/or abscess. Mean hospitalisation time was 10A.4 days. 23 cases had good recovery and discharged, while 1 case progressed to colonic stenosis during hospitalisation, requiring a sigmoidectomy with a one-time anastomosis with good recovery. One patient relapsed his abscess during hospitalisation despite CT guided drainage and required sigmoidectomy with transient ileostomy. The mean daily treatment and nutrition cost for the non-surgical 23 patients was 30 euros. CONCLUSIONS: Early enteral nutrition in complicated ACD is feasible, not harmful, and reduce both, mean hospitalization time and treatment cost. Further studies comparing enteral with parenteral nutrition are necessary to confirm our hypothesis.


Assuntos
Doença Diverticular do Colo/dietoterapia , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibras na Dieta , Doença Diverticular do Colo/diagnóstico , Nutrição Enteral/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
6.
Acta Gastroenterol Belg ; 53(4): 402-8, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-2096588

RESUMO

The authors make a review of the literature and of their personal experience about the possible mechanisms of action and the beneficial therapeutic effects of ursodeoxycholic acid in primary biliary cirrhosis. They postulate that owing to its hydrophilic properties, ursodeoxycholic acid is more efficiently absorbed by the ileum than the other bile acids, so replacing the other bile acids in the bile acid pool, and that ursodeoxycholic acid is less toxic for hepatocytes than the other bile acids accumulating in the plasma and is also a choleretic.


Assuntos
Cirrose Hepática Biliar/tratamento farmacológico , Ácido Ursodesoxicólico/uso terapêutico , Ácidos e Sais Biliares/metabolismo , Doença Crônica , Humanos , Cirrose Hepática Biliar/metabolismo
7.
Gastrointest Endosc ; 35(6): 490-8, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2599291

RESUMO

Endoscopic therapy was attempted in 24 patients with spontaneous or postoperative persistent biliary fistulas. Endoscopic retrograde cholangiography demonstrated the site of the fistula in 22 cases. Sphincterotomy or biliary stent placement resulted in rapid resolution of the fistula in 16 of 24 patients. Failures were attributed to exclusion of the injured intrahepatic bile duct in two cases, insufficient dilation of a bile duct stricture in one, the large size of the bile duct defect in two, and associated lesions in three (cirrhosis, arterial trauma, subhepatic abscess). Endoscopic management of biliary fistulae requires: (1) visualization of the location of the fistula by retrograde cholangiography especially in case of an intrahepatic lesion, (2) prior percutaneous drainage of associated subhepatic or subphrenic abscesses, and (3) appropriate relief of distal biliary obstruction in order to reduce the intraductal biliary pressure. The outcome is uncertain when endoprostheses are used to bridge large bile duct defects.


Assuntos
Fístula Biliar/terapia , Doenças Biliares/cirurgia , Endoscopia , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/cirurgia , Ductos Biliares/lesões , Fístula Biliar/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Endoscópios , Feminino , Humanos , Fígado/lesões , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Próteses e Implantes
8.
Endoscopy ; 19(2): 76-8, 1987 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3569152

RESUMO

We describe a patient who developed an esophageal adenocarcinoma 25 years after esophagomyotomy for achalasia. The tumor arose in a Barrett's esophagus, suggesting gastroesophageal acid reflux following the Heller procedure.


Assuntos
Adenocarcinoma/etiologia , Acalasia Esofágica/cirurgia , Neoplasias Esofágicas/etiologia , Esôfago/cirurgia , Adenocarcinoma/patologia , Idoso , Esôfago de Barrett/complicações , Acalasia Esofágica/complicações , Neoplasias Esofágicas/patologia , Esofagoscopia , Humanos , Masculino , Métodos , Complicações Pós-Operatórias , Fatores de Tempo
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