Novel Case Report: A Previously Reported, but Pathophysiologically Unexplained, Association Between Collagenous Colitis and Protein-Losing Enteropathy May Be Explained by an Undetected Link with Collagenous Duodenitis.

Collagenous colitis (CC) is associated with non-bloody, watery diarrhea, which is pathophysiologically reasonable because normal colonic absorption (or excretion) of water and electrolytes can be blocked by the abnormally thick collagen layer in CC. However, CC has also been associated with six previous cases of protein-losing enteropathy (PLE), with no pathophysiologic explanation. The colon does not normally absorb (or excrete) amino acids/proteins, which is primarily the function of the small bowel. Collagenous duodenitis (CD) has not been associated with PLE. This work reports a novel case of CD (and CC) associated with PLE; a pathophysiologically reasonable mechanism for CD causing PLE (by the thick collagen layer of CD blocking normal intestinal amino acid absorption); and a novel association of PLE with severe COVID-19 infection (attributed to relative immunosuppression from hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and malnutrition from PLE).

Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori.

OBJECTIVE: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. MATERIAL AND METHODS: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. RESULTS: The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. CONCLUSION: pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications.

[Substantiation of the model of clinical and economic efficiency evaluation of prevention, treatment, and dispenserization of the patients with comorbidity. The example of patients with arterial hypertension and duodenitis].

OBJECTIVE: Introduction: Evidence based medicine requires reliant estimators of medical programs efficiency both in clinical and economical dimensions. It necessitates the substantiation of evaluation of assessment tools on the ground of clinical and economic theory. Developed model has advantage of direct link with classical economic analyses such as costutility, cost-efficiency, and cost-benefit. The aim was to substantiate the model of clinical and economic efficiency evaluation of medical program with allowance for comorbidity. PATIENTS AND METHODS: Materials and methods: Model developed on the premises of Zweifel & Breyer [1, 2], theoretical foundation based upon classical theory of moral hazard and consumer utility. Model describes equilibrium of patient's decision on the volume of medical services to consume. RESULTS: Results: We delivered the model development and equilibrium examination. Transformation of equilibrium model to cost-utility, cost-efficiency, and cost-benefit models displayed. There was also demonstrated the allowance for comorbidity with example of patients with duodenitis and arterial hypertension. CONCLUSION: Conclusions: Proffered model based on theoretical ground of moral hazard and consumer utility. There is a direct linkage with cost-utility, cost-efficiency, and cost-benefit models. For the purpose of better cognition of practical applicability we introduced model in the context of dispenserization of the patients with duodenitis and arterial hypertension.

Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori / Endoscopia digestiva alta aplicada em pediatria: hallazgos endoscópicos e histológicos incluyendo al Helicobacter pylory

Objective: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. Material and methods: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. Results: The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. Conclusion: pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications

Objetivo: Presentar y discutir los hallazgos endoscópicos e histológicos, así como la incidencia de Helicobacter pylori y otras enfermedades, indicaciones y características de endoscopia digestiva alta realizada en niños. Material y métodos: Fueron realizadas 225 endoscopias en niños de seis meses a 11 años (media de 7,69 años) a partir de febrero de 2013 hasta enero de 2016. En 200 pacientes, en las endoscopias diagnósticas se llevan a cabo biopsias seriadas (esófago, estómago y duodeno) en 120 de ellos. Resultados: La indicación de endoscopia fue diagnóstica en el 88,89% de los pacientes y en 26 pacientes se realizaron un procedimiento terapéutico. Los hallazgos endoscópicos más frecuentes fueron esofagitis en 49 pacientes, gastritis y duodenitis 84 y en 16 pacientes se diagnosticaron cuatro úlceras duodenales. En endoscopias terapéuticas fueron realizadas seis gastrostomías, catorce extracciones de cuerpos extraños, cinco pasajes de sonda nasogástrica y una dilatación esofágica. El estudio de H. pylori se realizó por el método histopatológico y fué positivo en 26 (13%) de 200 pacientes en los que se han buscado. Conclusión: La endoscopía pediátrica es un nicho importante de la endoscopía digestiva donde es importante enfatizar la relevancia de la estructura institucional que realiza estos procedimientos para conducirlos con seguridad y ser capaces de tratar las complicaciones posibles

[THE CORRECTION OF TROPHIC DISORDERS IN CHILDREN OF CHRONIC GASTRODUODENITIS WITH METHOD LOW-FREQUENCY LIGHT-MAGNETOTHERAPY].

The results of a survey of school children with chronic gastroduodenitis when applying at an early period the medical rehabilitation with method low-frequency light-magnetotherapy. During treatment of hospital was evaluated vegetative-trophic status with methods of cardiointervalography and thermovision functional tests. In normalizes clinical parameters was correction in dynamics of the vegetative status in children, it confirms the effectiveness of the therapy. It is proved, that the use of low-frequency light-magnetotherapy has a positive effect on the vegetative--trophic provision an organism and normalizes the vegetative dysfunction.

Fulminant phlegmonitis of the esophagus, stomach, and duodenum due to Bacillus thuringiensis.

We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-virulence bacilli can cause lethal gastrointestinal phlegmonous gastritis in conditions of immunodeficiency.

Clinical features and treatment of ulcerative colitis-related severe gastroduodenitis and enteritis with massive bleeding after colectomy.

INTRODUCTION: Ulcerative colitis (UC) has been recognised as a systemic immune disorder that is not as restricted as colitis. UC-related gastrointestinal lesions with bleeding can develop soon after colectomy and can progress rapidly. Therefore, we considered the clinical features and treatment of these UC-related lesions. METHODS: We reviewed the patient data in our UC surgery database to evaluate its prevalence and features. RESULTS: We found 7/1,100 patients with UC-related lesions between January 2000 and April 2013. These lesions developed at a mean of 24 (range 8-480) days after colectomy. Six of the seven patients suffered from gastrointestinal bleeding as an initial symptom that rapidly developed into massive bleeding or perforations. All of the patients were diagnosed with pancolitis; at the time of colectomy, fulminant, severe, moderate, and mild colitis were presented by four, one, one, and one patients, respectively. All patients with enteritis had consecutively developed other infectious complications, including anastomotic leakage, pyoderma gangrenosum, wound infection, and pneumonia. Although patients with bleeding did not respond to treatment with corticosteroids, they responded well to infliximab soon after its administration. Although six of the seven patients showed cytomegalo virus re-activation in blood or pathological examinations, ganciclovir was not effective in its elimination. CONCLUSION: Although UC-related lesions with an unknown aetiology can occur after colectomy, immediate examination and treatment are required if gastrointestinal bleeding is found after surgery. Because gastrointestinal bleeding from UC-related lesions can worsen rapidly and may be related to mortality, early potent immunosuppressive therapy should be considered.

[Clinical and morphological substantiation of SMC-peloidotherapy for the management of duodenal pathology].

This study included 112 patients presenting with duodenal ulcer disease and 65 ones with chronic duodenitis treated with the use of sinusoidal modulated current (SMC) electrophoresis in combination with peloidotherapy (peat muds of the Uva health resort, Republic of Udmurtia). This treatment was shown to produce positive effect on the proliferative activity of duodenal epithelium.

[Treatment of chronic erosive gastroduodenitis in children with hypercapnic hypoxia].

Investigation of quality of life in pediatric patients--a simple, reliable and efficient way to assess the status of the child, which complements the clinical, laboratory and instrumental examination, which in turn helps to improve treatment outcomes. Given that the gastro-intestinal tract, the prevalence of the 2nd place among all the diseases of childhood, the definition of quality of life and its improvement in such patients is an integral part of treatment.

The role of histopathology in diagnosing protracted diarrhea of infancy.

Protracted diarrhea is used to describe infants with loose and frequent stools of sufficient severity to require nutritional support, most commonly parenteral nutrition. Despite similar clinical presentations, the causes of protracted diarrhea in infants are varied and diverse in management and prognosis. The following cases represent the two more common causes of protracted diarrhea in young infants in the developed world - allergic and autoimmune enteropathy. Both patients demonstrate diagnostic challenges related to clinical and/or laboratory features. These cases illustrate the important role histological assessment plays in determining the correct diagnosis, treatment course and prognosis in infants with protracted diarrhea.

[Case with diffuse duodenitis and enteritis following total colectomy for ulcerative colitis].

A 25-year-old-woman with four years history of pancolonic ulcerative colitis (UC) underwent laparoscopy-assisted restorative proctocolectomy. She developed postoperatively abdominal pain, high fever, bloody diarrhea. Computed tomography showed thickening of duodenal and small intestinal wall, and endoscopic examination revealed diffuse mucosal edema, redness, erosion and ulceration involving duodenum, small intestine and ileal pouch that was similar in appearance to UC. She experienced massive melena five times and was successfully treated by transcatheter arterial embolization. Some antibiotics and prednisolone failed to decrease activity of the lesion but the symptoms and endoscopic findings improved since intravenous dexamethasone injection.

Serious duodenitis concomitant with graft dysfunction following renal transplantation.

A 48-year-old woman underwent a renal transplantation from her sister. The graft functioned immediately. She received induction immunosuppressive therapy, including basiliximab, tacrolimus hydrate, mycophenolate mofetil and methylprednisolone. Her urinary output decreased on the first postoperative morning. Plasma exchange for 3 days and conversion from tacrolimus hydrate to cyclosporine partially improved graft function. Graft biopsies on the fifth postoperative day suggested an acute humoral rejection. On the seventh postoperative day, she experienced high fever, disorientation, hypertension and severe upper abdominal pain with a bulk of bloody stool. Graft function deteriorated again. Gastrointestinal fibroscopy showed severe duodenitis with bleeding. Following seven successive daily plasma exchanges with hemodialysis and reconversion to low dose tacrolimus hydrate, the systematic symptoms and graft function gradually improved. Two years after transplantation, graft function was good with a serum creatinine level of 1.0 mg/dL. The patient did not experience any further gastrointestinal symptoms.

[Efficacy of SMC-electrophoresis of peat mud in primary chronic duodenitis].

Sinusoidal modulated current (SMC) electrophoresis of peat mud was used as monotherapy of primary chronic duodenitis in Uva sanatorium. A total of 65 patients with primary chronic duodenitis received SMC electrophoresis of peat mud diluted with distilled water. The effect was followed up with fibrogastroduodenoscopy and target biopsy of duodenal mucosa with further study of its morphological structure and element composition, acid-producing function of the stomach, hormonal profile, collagen metabolism. Positive changes were observed in clinical-endoscopic and morphological picture of the disease which is explained by favourable shifts in hormonal status and normalization of collagen metabolism in duodenal mucosa.

Targeted drug delivery for refractory hemorrhagic Crohn disease.

Focal gastrointestinal inflammation and hemorrhage is a common problem associated with Crohn disease. The present report describes a case of chronic hemorrhage from an inflamed duodenum that was refractory to all endoscopic and systemic therapies, which was successfully treated with chemoembolization of the pancreaticoduodenal arcade with use of corticosteroids and gelatin sponge. The application of chemoembolization techniques need not be limited to treatment of malignancies.

[Ozone therapy in gastroduodenal pathology associated with Helicobacter pylori].

Three methods of ozone therapy (intravenous injection of ozonized physiologic saline, oral intake of ozonized low-mineral water and combination of the two treatments) were compared by efficacy in 215 patients with gastroduodenal pathology associated with Helicobacter pilori. All the techniques of ozone therapy proved effective in relation to regress of clinical symptoms, regeneration processes, eradication of Helicobacter pylori, but the combined regimen was the best.

[Laser therapy and famotidine in complex restorative treatment of primary chronic gastroduodenitis]. / Lazeroterapiia i famotidin v kompleksnom vosstanovitel'nom lechenii pervichnogo khronicheskogo gastroduodenita.

Primary chronic gastroduodenitis (PCG) is one of the most frequent diseases of the gastrointestinal tract. Timely and efficient treatment of patients with PCG promotes ulcer prevention. In this connection, an urgent problem of restorative medicine is to develop medical programs with active introduction of pharmacophysiotherapeutic complexes, in particular, laser therapy and anti-secretory preparation (famotidine) that increase therapeutic efficacy of treatment of this disease. To this end, we give results of treatment of 50 patients with primary chronic gastroduodenitis (26 having undergone laser therapy only, and 24 having had a combination of laser therapy and famotidine), which demonstrated that the complex action method has a more adequate effect on pathogenetic components in this disease than monotherapy.