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Zand Irani M, Eslick GD, Brown G, Talley NJ. Letter: eosinophilic duodenitis and increased intraepithelial lymphocytes in rumination syndrome - more evidence. Aliment Pharmacol Ther 2023; 57:1353-1354. [PMID: 37161636 DOI: 10.1111/apt.17481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Mudar Zand Irani
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
| | - Guy D Eslick
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
| | - Georgia Brown
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicholas J Talley
- NHMRC Centre for Research Excellence in Digestive Health, Hunter Medical Research Institute (HMRI), The University of Newcastle, Callaghan, New South Wales, Australia
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Gocht A, Schumacher U. Description of the normal gastric mucosa in anatomy education: How many leukocytes are acceptable? Clin Anat 2023; 36:441-446. [PMID: 36349467 DOI: 10.1002/ca.23976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
Textbooks covering normal human histology illustrate an allegedly normal gastric mucosa containing significant infiltrates of mononuclear cells in the lamina propria. This standard description seems to conflict with the pathologist's criterion for normality, which specifies only a few or a complete absence of inflammatory cells. Eventually, both anatomists and pathologists face the dilemma: how much infiltrate should their students and medical colleagues be told is acceptable for the gastric mucosa to be classified as normal? Summarizing the suggestions of experts in gastroenterology and our own experience, a simple approach could be to accept no more than five mononuclear and plasma cells per high power field as normal (400-fold magnification with a field area of 0.24 mm2 ). The divergence of views on this topic illustrates the need for anatomists and pathologists to find a consensus about the definition of "normal" tissues.
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Affiliation(s)
- Andreas Gocht
- Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.,Institut für Anatomie und Experimentelle Morphologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Udo Schumacher
- Institut für Anatomie und Experimentelle Morphologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Medical School Berlin, Berlin, Germany
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Nikaki K, Sifrim D. Rumination Syndrome "Real Prevalence": A Need to Increase Awareness, Early Recognition, and Specific Management. Gastroenterology 2022; 162:696-697. [PMID: 34902363 DOI: 10.1053/j.gastro.2021.12.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022]
Affiliation(s)
| | - Daniel Sifrim
- Wingate Institute for Neurogastroenterology, Queen Mary University of London, London, UK.
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Issa A, Edwards J, Singh M, Friesen C, Edwards S. Presence of Increased Mast Cells in Infants and Children with Volume and Variety Limited Intake. Nutrients 2022; 14:nu14020365. [PMID: 35057546 PMCID: PMC8780193 DOI: 10.3390/nu14020365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Reports indicate patients with feeding difficulties demonstrate signs of inflammation on biopsies, notably eosinophilia, but it is unknown whether mast cell density contributes to variety or volume limitation symptoms. The aim of our study was to evaluate eosinophil and mast cell density of EGD biopsies in pediatric patients with symptoms of decreased volume or variety of ingested foods. Methods: We conducted a single-center, retrospective chart review of EMRs for all new feeding clinic patients between 0 and 17 years of age. Patients were categorized by symptoms at the initial visit as well as eosinophil and mast cell densities in those with EGD biopsies. Ten patients were identified as controls. Results: We identified 30 patients each with volume and variety limitation. Antral mast cell density was increased in 32.1% of variety-limited patients, 37.5% of volume limited patients, and in no controls; Duodenal mast cell density was increased in 32.1% of variety-limited patients, 40.6% of volume-limited patients, and in no controls. Conclusions: In both variety- and volume-limited patients, antral and duodenal mast cell densities were increased. These associations warrant further investigation of the mechanism between mast cells and development of feeding difficulties, allowing more targeted pediatric therapies.
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Affiliation(s)
- Amy Issa
- Division of Gastroenterology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Jensen Edwards
- School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA;
| | - Meenal Singh
- Division of Gastroenterology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA; (M.S.); (C.F.)
| | - Craig Friesen
- Division of Gastroenterology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA; (M.S.); (C.F.)
- School of Medicine, University of Missouri at Kansas City, Kansas City, MO 64108, USA
| | - Sarah Edwards
- Division of Gastroenterology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA; (M.S.); (C.F.)
- School of Medicine, University of Missouri at Kansas City, Kansas City, MO 64108, USA
- Correspondence:
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Wauters L, Ceulemans M, Vanuytsel T. Duodenum at a crossroads: Key integrator of overlapping and psychological symptoms in functional dyspepsia? Neurogastroenterol Motil 2021; 33:e14262. [PMID: 34561921 DOI: 10.1111/nmo.14262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
The study of the interaction between gastrointestinal (GI) function and psychological features is a complex and developing field. The bidirectional communication between the gut and the brain or gut-brain axis is considered as a pivotal player in the pathogenesis of the highly prevalent functional GI disorders, including irritable bowel syndrome and functional dyspepsia (FD), which have been redefined as disorders of gut-brain interaction. However, the mechanisms through which changes in the gut alter brain functioning, feelings, and behavior remain unclear. Based on the presence of duodenal pathology in adult FD patients, Ronkainen et al. provide the first prospective evidence for duodenal eosinophils potentially driving anxiety. Also in this edition, associations between gastroduodenal pathology and rumination syndrome, which may coexist with FD, have now been confirmed in children by Friesen et al. Together these findings confirm not only the potential role of duodenal alterations in determining overlapping upper GI but also psychological symptoms, which result from bidirectional and complex interactions. In this review, we provide an overview of the recent advances in this field and highlight the novel contributions of the original studies of Ronkainen et al. and Friesen et al. to this topic.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Matthias Ceulemans
- Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
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Martinez M, Rathod S, Friesen HJ, Rosen JM, Friesen CA, Schurman JV. Rumination Syndrome in Children and Adolescents: A Mini Review. Front Pediatr 2021; 9:709326. [PMID: 34490165 PMCID: PMC8416921 DOI: 10.3389/fped.2021.709326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Rumination syndrome involves recurrent regurgitation of food and is believed to be underdiagnosed with patients experiencing long delays in diagnosis. It can be associated with significant social consequences, high rates of school absenteeism, and medical complications such as weight loss. The primary aims of the current review are to assess the literature regarding prevalence, pathophysiology, and treatment outcomes with a focus on neurotypical children and adolescents. Results: Population studies in children/adolescents, 5 years of age or older, range from 0 to 5.1%. There are fewer studies in clinical settings, but the prevalence appears to be higher in patients with other gastrointestinal symptoms, particularly chronic vomiting. While physiologic changes that occur during a rumination episode are well-described, the underlying cause is less well-defined. In general, rumination appears to have similarities to other functional gastrointestinal disorders including dysmotility, possibly inflammation, and an interaction with psychologic function. While diaphragmatic breathing is considered the mainstay of treatment, pediatric data demonstrating efficacy is lacking, especially as an isolated treatment. Conclusion: Pediatric rumination syndrome remains greatly understudied, particularly regarding treatment. There is a need to better define prevalence in both the primary care and subspecialty clinical settings, especially in patients presenting with vomiting or apparent gastroesophageal reflux. There is a need to determine whether treatment of co-morbid conditions results in improvement of rumination. Diaphragmatic breathing needs to be studied and compared to other competing responses.
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Affiliation(s)
- Marc Martinez
- Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Sandeep Rathod
- Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Hunter J. Friesen
- University of Kansas School of Medicine, Kansas City, MO, United States
| | - John M. Rosen
- Division of Gastroenteology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Craig A. Friesen
- Division of Gastroenteology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Jennifer V. Schurman
- Division of Gastroenteology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
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