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Lin F, Obeid A, Bhalala H, Patel N, Ge L, Modi R. Behcet's Disease Presenting as Pancolonic Ulcerations in a Patient With Kikuchi-Fujimoto Disease: A Rare Gastrointestinal Manifestation. ACG Case Rep J 2024; 11:e01455. [PMID: 39221232 PMCID: PMC11365614 DOI: 10.14309/crj.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/28/2024] [Indexed: 09/04/2024] Open
Abstract
Kikuchi-Fujimoto disease (KFD) is a rare and self-limiting disorder characterized by cervical lymphadenopathy and fever. In this report, we present a case of a 24-year-old man with known history of KFD who presented with lower gastrointestinal bleeding and acute blood loss anemia. Further evaluation with colonoscopy showed widespread ulcerations in the colon and terminal ileum with suspicion for Behcet's disease. Biopsy from the colonic mucosa and ileocecal valve demonstrated focal ulcer with cryptitis and lymphoid aggregates that can be seen in Behcet's syndrome; however, it lacks specificity and Behcet's disease is a clinical diagnosis. This case emphasizes the importance of including gastrointestinal bleeding as a potential manifestation due to Behcet's disease in patients diagnosed with KFD.
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Affiliation(s)
- Frank Lin
- Internal Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Ayah Obeid
- Internal Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Harsh Bhalala
- Internal Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Nishit Patel
- Internal Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Li Ge
- Internal Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Ronak Modi
- Internal Medicine, St. Luke's University Health Network, Bethlehem, PA
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2
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Li R, Chen Y, Zhang S, Peng L, Zhou J, Fei Y, Zhang W, Zhao Y, Zeng X. Clinical characteristics and long-term outcome of patients with gastrointestinal involvement in eosinophilic granulomatosis with polyangiitis. Front Immunol 2023; 13:1099722. [PMID: 36713417 PMCID: PMC9879136 DOI: 10.3389/fimmu.2022.1099722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This study aims to investigate clinical characteristics, potential risk factors, as well as long-term outcome in EGPA patients with GI involvement. Methods A total of 94 EGPA patients were included in this cohort study. We retrospectively reviewed the clinical data, treatment, and outcome of 21 EGPA patients with GI involvement and compared them with other 73 EGPA patients without GI involvement. Multivariate logistic regression was used to find potential risk factors associated with GI involvement in EGPA patients. Results Compared with EGPA patients without GI involvement, EGPA patients with GI involvement had higher level of hs-CRP (65.1 (24.5-138.9) vs. 21.3 (5.7-39.1) mg/L, p=0.005), higher grades of Birmingham vasculitis activity score (BVAS) (20 (13-29.5) vs. 12 (16-19), p=0.022), higher Five Factor Score (FFS) (1 (1-2) vs. 0 (0-1), p<0.001), and were more likely to have weight loss (66.7% vs. 38.4%, p=0.021) at baseline. In EGPA patients with GI involvement, the most common gastrointestinal symptoms were abdominal pain (90.5%) and diarrhea (42.9%). Weight loss was identified as a potential risk factor for GI involvement in EGPA patients (OR = 4.304, 95% CI 1.339-13.841). During follow-up, EGPA patients with GI involvement showed lower 1-year cumulative survival rate (75.2% vs. 100.0%, P <0.0001) and 3-year cumulative survival rate (67.7% vs. 100.0%, P<0.0001), lower long-term remission rate (33.3% vs. 86.3%, P<0.001), but higher 1-year cumulative relapse rate (19.2% vs. 3.8%, P=0.03) and 3-year cumulative relapse rate (54.6% vs. 13.1%, P<0.001) compared with patients without GI involvement. Conclusion EGPA patients with GI involvement had distinct features from those without GI involvement, including higher hs-CRP level, higher BVAS and FFS scores. EGPA patients with GI involvement showed lower cumulative survival rate, lower long-term remission rate and higher cumulative relapse rate compared with those without GI involvement.
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Affiliation(s)
- Rongli Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Yingying Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Shangzhu Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Linyi Peng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China,*Correspondence: Jiaxin Zhou, ; Yunyun Fei,
| | - Yunyun Fei
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China,*Correspondence: Jiaxin Zhou, ; Yunyun Fei,
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), The Ministry of Education Key Laboratory, Beijing, China
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3
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Vigna C, Wang SH, Ore AS, Eickel G, Messaris E. Clash of the -itises: An Unexpected Case of Sigmoid Colon Vasculitis. ACG Case Rep J 2022; 9:e00927. [PMID: 36600787 PMCID: PMC9794293 DOI: 10.14309/crj.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/31/2022] [Indexed: 01/06/2023] Open
Abstract
Vasculitis is an inflammatory process of the blood vessels, characterized by leukocyte infiltration in the vessel wall and reactive damage to the mural structures. They have a wide clinical spectrum and can present in a localized or systemic manner. Colonic involvement primarily manifests as abdominal pain and rectal bleeding. Less commonly, it can be associated with colonic perforation or anastomotic leakage after colorectal surgery. We report a case of a 42-year-old man with a history of HIV and proctocolitis who presented with an unexpected vasculitis of the sigmoid colon.
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Affiliation(s)
- Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Stephen H. Wang
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Grant Eickel
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Amouei M, Momtazmanesh S, Kavosi H, Davarpanah AH, Shirkhoda A, Radmard AR. Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data. Insights Imaging 2022; 13:143. [PMID: 36057741 PMCID: PMC9440973 DOI: 10.1186/s13244-022-01284-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of intestinal vasculitis is often challenging due to the non-specific clinical and imaging findings. Vasculitides with gastrointestinal (GI) manifestations are rare, but their diagnosis holds immense significance as late or missed recognition can result in high mortality rates. Given the resemblance of radiologic findings with some other entities, GI vasculitis is often overlooked on small bowel studies done using computed tomography/magnetic resonance enterography (CTE/MRE). Hereon, we reviewed radiologic findings of vasculitis with gastrointestinal involvement on CTE and MRE. The variety of findings on MRE/CTE depend upon the size of the involved vessels. Signs of intestinal ischemia, e.g., mural thickening, submucosal edema, mural hyperenhancement, and restricted diffusion on diffusion-weighted imaging, are common in intestinal vasculitis. Involvement of the abdominal aorta and the major visceral arteries is presented as concentric mural thickening, transmural calcification, luminal stenosis, occlusion, aneurysmal changes, and collateral vessels. Such findings can be observed particularly in large- and medium-vessel vasculitis. The presence of extra-intestinal findings, including within the liver, kidneys, or spleen in the form of focal areas of infarction or heterogeneous enhancement due to microvascular involvement, can be another radiologic clue in diagnosis of vasculitis. The link between the clinical/laboratory findings and MRE/CTE abnormalities needs to be corresponded when it comes to the diagnosis of intestinal vasculitis.
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Affiliation(s)
- Mehrnam Amouei
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Sara Momtazmanesh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran
| | - Hoda Kavosi
- Department of Rheumatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Ali Shirkhoda
- Department of Radiological Science, University of California at Irvine, Irvine, USA
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St., Tehran, 14117, Iran.
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Decraene F, Blockmans D, Ferrante M. Severe Necrotizing Colitis in a 45-Year-Old Woman Without a Cardiovascular History. Gastroenterology 2022; 163:e1-e3. [PMID: 35149030 DOI: 10.1053/j.gastro.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Francesca Decraene
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Blockmans
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
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王 恩, 孙 梅. [Upper gastrointestinal ulcer in children: a clinical analysis of 173 cases]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:372-376. [PMID: 35527410 PMCID: PMC9044988 DOI: 10.7499/j.issn.1008-8830.2201003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/01/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children. METHODS A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups. RESULTS A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05). CONCLUSIONS Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
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Hori H, Fukuchi T, Sugawara H. "Comb and Target signs" in abdominal CT in patients with purpura. Eur J Intern Med 2022; 95:93-94. [PMID: 34690056 DOI: 10.1016/j.ejim.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/10/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Hiroshi Hori
- Division of internal Medicine, Minamiuonuma City Hospital, Minamiuonua City, Niigata 949-6680, Japan.
| | - Takahiko Fukuchi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
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Terra C, Ramos-Andrade D, Sá-Marques I, Brito J, Caseiro-Alves F, Curvo-Semedo L. Duodenal imaging on the spotlight: from A to Z. Insights Imaging 2021; 12:94. [PMID: 34232417 PMCID: PMC8263847 DOI: 10.1186/s13244-021-01045-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions. The majority of the gastrointestinal radiology literature has concentrated on the colon, stomach, and distal small bowel. The duodenum is often overlooked on imaging, namely on CT, but its anatomy (intra and retroperitoneal) and location in such close proximity to other viscera results in involvement by a multitude of primary and secondary processes, some of them exclusive to this bowel segment. While some conditions, like duplications, lipomas, and diverticula, are usually asymptomatic and are incidentalomas that have no pathologic significance, others are symptomatic and very relevant and should be recognized by every general radiologist: development conditions such as annular pancreas and gut malrotation; inflammatory processes such as ulcers and secondary involvement from pancreatitis; neoplastic conditions such as adenocarcinoma, lymphoma, or local extension from adjacent malignancies. They all can be reliably diagnosed with CT. In this article, we demonstrate the typical imaging features of various diseases involving the duodenum, such as developmental, traumatic, inflammatory, infectious, neoplastic, and postsurgical pathologic conditions in alphabetical order, focusing mainly on upper gastrointestinal series (UGIS) and CT but also some radiography, ultrasound, and magnetic resonance (MR) imaging.
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Affiliation(s)
- Carolina Terra
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Daniel Ramos-Andrade
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Ivo Sá-Marques
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Jorge Brito
- Centro Hospitalar do Algarve, Faro, Portugal
| | - Filipe Caseiro-Alves
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
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Osman K, Kendi AT, Maselli D. Isolated angioedema of the bowel caused by aspirin. Clin J Gastroenterol 2021; 14:1096-1102. [PMID: 33999375 PMCID: PMC8127855 DOI: 10.1007/s12328-021-01430-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
Angioedema is a self-limited, localized tissue swelling, resulting from fluid extravasation into interstitial spaces. It may occur in isolation or be accompanied by urticaria and/or anaphylaxis. The phenomenon has been linked to multiple medications, including non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme inhibitors (ACEIs). NSAID-induced angioedema is observed in < 0.3% of patients taking NSAIDs. While isolated visceral angioedema has been reported from ACEIs, it has not been documented from NSAID use, particularly aspirin usage. Here, we report a case of isolated visceral angioedema attributed to aspirin use.
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Affiliation(s)
- Karim Osman
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55902, USA.
- Department of Internal Medicine, Beth Israel Lahey Clinic, Burlington, MA, 01803, USA.
| | - Ayse Tuba Kendi
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55902, USA
| | - Daniel Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55902, USA
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10
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Systemic manifestations - do not forget the small bowel. Curr Opin Gastroenterol 2021; 37:234-244. [PMID: 33606400 DOI: 10.1097/mog.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Systemic diseases can afflict the small bowel (SB) but be challenging to diagnose. In this review, we aim to provide a broad overview of these conditions and to summarise their management. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is an important modality to investigate pathology in the SB. SB imaging can be complementary to SBCE for mural and extramural involvement and detection of multiorgan involvement or lymphadenopathy. Device assisted enteroscopy provides a therapeutic arm, to SBCE enabling histology and therapeutics to be carried out. SUMMARY SB endoscopy is essential in the diagnosis, management and monitoring of these multi-system conditions. Collaboration across SB centres to combine experience will help to improve the management of some of these rarer SB conditions.
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Gendreau S, Porcher R, Thoreau B, Paule R, Maurier F, Goulenok T, Frumholtz L, Bernigaud C, Ingen-Housz-Oro S, Mekinian A, Audemard-Verger A, Gaillet A, Perard L, Samson M, Sonneville R, Arlet JB, Mirouse A, Kahn JE, Charpentier J, Hachulla É, Hummel A, Pires T, Carron PL, Durel CA, Jourde W, Puechal X, Lega JC, Sarrot-Reynauld F, Tieulie N, Diot E, Guillevin L, Terrier B. Characteristics and risk factors for poor outcome in patients with systemic vasculitis involving the gastrointestinal tract. Semin Arthritis Rheum 2021; 51:436-441. [PMID: 33711774 DOI: 10.1016/j.semarthrit.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastrointestinal (GI) involvement was described to be a poor prognostic factor in systemic necrotizing vasculitis. Its prognostic significance may vary according to clinical presentation and vasculitis subtype. AIMS This study investigated risk-factors associated to poor outcome in GI-involvement of vasculitis. METHODS Patients with systemic vasculitis as defined by the 2012 Chapel Hill Consensus Conference and presenting with GI involvement were retrospectively included. Baseline characteristics, treatments and outcome were recorded. Primary endpoint was a composite of admission to intensive care unit (ICU), emergency surgical procedure, or death. RESULTS Two hundred and thirteen patients were included. Vasculitis were distributed as follows: 41% IgA vasculitis, 27% ANCA-associated vasculitis, 17% polyarteritis nodosa (PAN), and 15% other vasculitis. Eighty-three (39%) patients fulfilled the composite primary endpoint within 6 months. Predictive factors associated with the primary endpoint included PAN subtype (OR 3.08, 95% CI 1.29-7.34), performance status (OR 1.40, 1.05-1.87), use of morphine (OR 2.51, 0.87-7.24), abdominal guarding (OR 3.08, 1.01-9.37), ileus (OR 2.29, 0.98-5.32), melena (OR 2.74, 1.17-6.42), increased leukocytes (per G/L, OR 1.05, 1.00-1.10), low hemoglobin (per g/dL, OR 0.80, 0.71-0.91) and increased CRP (log mg/L, OR 1.21, 0.94-1.56). A risk prediction model for the achievement of primary endpoint had a very good performance [C-statistics 0.853 (0.810 to 0.895], and for overall survival as well. CONCLUSIONS Vasculitis presenting with GI involvement have a poor outcome in more than one third of cases. An easy-to-use risk prediction model had a very good performance to predict the admission to ICU, emergency surgical procedure, or death.
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Affiliation(s)
- Ségolène Gendreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Raphael Porcher
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Hôtel-Dieu, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - François Maurier
- Department of Internal Medicine, Hôpital Sainte-Blandine De Metz, Metz, France
| | - Tiphaine Goulenok
- Department of Internal Medicine, Hôpital Bichat - Claude-Bernard, AP-HP, Paris, France
| | - Laure Frumholtz
- Department of Dermatology, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, AP-HP, Paris, France
| | | | - Antoine Gaillet
- Intensive-care unit, Hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - Laurent Perard
- Department of Internal Medicine, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Maxime Samson
- Department of Clinical Immunology and Internal Medicine, CHU de Dijon, Dijon, France
| | - Romain Sonneville
- Intensive-care unit, Hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - Jean-Benoît Arlet
- Department of Internal Medicine, Hôpital européen Georges Pompidou, AP-HP, Paris, France
| | | | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Hôpital Ambroise Paré, AP-HP, Boulogne, France
| | | | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, Lille, France
| | - Aurélie Hummel
- Department of Nephrology, Hôpital Necker, AP-HP, Paris, France
| | - Thomas Pires
- Department of Internal Medicine, CHU Bordeaux, Bordeaux, France
| | | | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | - Wendy Jourde
- Department of Internal Medicine, CHU Bordeaux, Bordeaux, France
| | - Xavier Puechal
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Jean-Christophe Lega
- Department of Internal Medicine, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | | | | | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France.
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Alpuim Costa D, Modas Daniel P, Vieira Branco J. The Role of Hyperbaric Oxygen Therapy in Pneumatosis Cystoides Intestinalis-A Scoping Review. Front Med (Lausanne) 2021; 8:601872. [PMID: 33681242 PMCID: PMC7926085 DOI: 10.3389/fmed.2021.601872] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts within gastrointestinal tract wall from esophagus to rectum, with preferential involvement of large and small intestine. PCI is rare with an estimated incidence of 0.03 to 0-2% in general population. PCI can be distinguished into idiopathic (15%) or secondary (85%) and the clinical picture ranges from completely asymptomatic to life-threatening intraabdominal complications. Although etiology of PCI appears to be multifactorial, the exact pathophysiology is poorly understood and two main theories have been proposed (mechanical and bacterial). Over the last decades, an enormous therapeutic armamentarium was considered in PCI's management, including hyperbaric oxygen therapy (HBOT). Treatment comprises conservative treatment in mild cases to surgery in highly symptomatic and complicated PCI. In the late 70s, HBOT started to be used in selected cases of PCI not responding to conservative measures. Since then, several case reports, case series, and reviews have been published in the literature with variable outcomes. The overall response rate and complete response were 92.1% (n = 82/89) and 65.2% (n = 58/89), respectively, with a median follow-up of 7 months. Furthermore, HBOT is extremely safe, with few reported complications in the literature when used for PCI. Nevertheless, a randomized, controlled, and double-blind clinical trial is unlikely to occur given the rarity of PCI, logistical issues of HBOT, and methodological considerations related to adequate blinding with a sham-controlled group. HBOT in combination with personalized diet and antibiotics may be beneficial for moderate to severe PCI in patients with no indication for emergency exploratory laparotomy. The purpose of this article is to synthesize the existing data, analyse results of previous studies, identify gaps in knowledge, and discuss PCI' management, including the proposal of an algorithm, with a special focus on HBOT.
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Affiliation(s)
- Diogo Alpuim Costa
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisbon, Portugal
- Centro de Investigação Naval (CINAV), Base Naval Do Alfeite, Portuguese Navy, Almada, Portugal
- CUF Oncology, Haematology and Oncology Department, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Pedro Modas Daniel
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisbon, Portugal
- Centro de Investigação Naval (CINAV), Base Naval Do Alfeite, Portuguese Navy, Almada, Portugal
| | - João Vieira Branco
- Centro de Medicina Subaquática e Hiperbárica (CMSH), Portuguese Navy, Lisbon, Portugal
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Huang BB, Han LC, Liu GF, Lv XD, Gu GL, Li SQ, Chen L, Wang HQ, Zhan LL, Lv XP. Infliximab is effective in the treatment of ulcerative colitis with dermatomyositis: A case report. World J Gastroenterol 2020; 26:7425-7435. [PMID: 33362394 PMCID: PMC7739156 DOI: 10.3748/wjg.v26.i46.7425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/11/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Joint, skin, oral cavity, and eye lesions are the most common extraintestinal manifestations of ulcerative colitis that can occur before or after its onset. The cases of ulcerative colitis with dermatomyositis (DM) are rare. In this study, we report a rare case of ulcerative colitis with DM that was effectively treated with infliximab.
CASE SUMMARY The patient was a 57-year-old female with a 2-year history of DM. The patient was admitted to hospital with abdominal pain, diarrhea, and blood in stool lasting for more than 2 mo. Colonoscopy revealed multiple erosions and ulcers in the entire colon and rectum. Pathological sections showed chronic inflammatory cell infiltration, especially neutrophil infiltration, in the colonic mucosa; therefore, the patient was diagnosed with ulcerative colitis. Preparations of 5-aminosalicylic acid was added to her treatment based on the original treatment for DM, but its effect was unsatisfactory. The patient’s discomfort was relieved after infliximab treatment.
CONCLUSION Infliximab can improve DM in the treatment of ulcerative colitis. Specialists need to raise awareness about patients with inflammatory bowel disease who have rare extraintestinal manifestations.
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Affiliation(s)
- Bin-Bin Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Li-Chun Han
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Geng-Feng Liu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Dan Lv
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Guang-Li Gu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shi-Quan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Lan Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hui-Qin Wang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ling-Ling Zhan
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Ping Lv
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Adult-Onset Immunoglobulin A Vasculitis. ACG Case Rep J 2020; 7:e00306. [PMID: 32337300 PMCID: PMC7162119 DOI: 10.14309/crj.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV), formerly Henoch–Schönlein purpura vasculitis, is a vasculitis commonly seen in children and only rarely described in adult patients. IgAV can present as arthralgia, rash, discolored urine, acute kidney injury, and gastrointestinal symptoms. We present a case of a 56-year-old man who presented with 1 month of worsening abdominal pain followed by a bilateral lower extremity rash. Laboratory evaluation indicated an acute kidney injury. Computed tomography and colonoscopy revealed terminal ileitis while kidney biopsy confirmed a diagnosis of IgAV.
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15
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Cicero G, Ascenti G, Bottari A, Catanzariti F, Blandino A, Mazziotti S. MR enterography: what is next after Crohn's disease? Jpn J Radiol 2019; 37:511-517. [PMID: 30968265 DOI: 10.1007/s11604-019-00838-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/01/2019] [Indexed: 01/11/2023]
Abstract
Within the gastrointestinal system, the small bowel represents the most difficult site to approach with imaging modalities. During the last decades, magnetic resonance enterography has reached an increasing interest, up to be considered an essential part in the diagnostic framework of Crohn's disease patients. Nevertheless, the distention of the intestinal loops provided by the administration of oral contrast medium, the possibility of a dynamic evaluation, and the lack of radiation exposure are huge advantages that can be exploited for the assessment of other clinical conditions affecting the small bowel. Physicians and radiologists should be aware of the possibilities offered by this technique, looking at it as a trustful alternative to the well-worn radiological examinations. In this respect, the purpose of this work is to show some uncommon clinical conditions that can be assessed with magnetic resonance enterography and that fall within the various differential diagnosis of the intestinal disorders.
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Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Bottari
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Francesca Catanzariti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Alfredo Blandino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
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16
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Celiac Artery Vasculitis. Ann Vasc Surg 2018; 56:354.e17-354.e19. [PMID: 30500651 DOI: 10.1016/j.avsg.2018.08.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 11/23/2022]
Abstract
Isolated celiac artery vasculitis is an uncommon disease rarely reported in the Western literature. In this case report, we describe a 52-year-old Chinese male presenting with abdominal pain who was diagnosed with nonspecific celiac artery vasculitis and was successfully treated with a short course of oral corticosteroids.
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17
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Gilyarov MY, Belikova LP, Shchukin IA, Fidler MS, Avakyan GG, Shustrova GE, Martynov MY, Svet AV. [Neurological disorders in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)]. Zh Nevrol Psikhiatr Im S S Korsakova 2018. [PMID: 28635862 DOI: 10.17116/jnevro201611610193-102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis - EGPA (Churg-Strauss syndrome) is a rare autoimmune disorder. The pathogenesis of the disease includes production of anti-neutrophil cytoplasmic antibodies directed against myeloperoxidase with the development of small-vessel necrotizing vasculitis and eosinophilic infiltration of organs. The involvement of peripheral and central nervous system is observed in more than 3/4 of cases. The authors describe three patients with EGPA. In a 53-year-old male patient, EGPA manifested with multiple neuropathies, which regressed after treatment with corticosteroids and cytostatics. In a 34-year-old woman, cerebral sinus thrombosis and cerebral infarction developed in the non-active period of long-term EGPA. The patient was treated with anticoagulants. A 77-year-old woman with a newly diagnosed EGPA, confirmed by bone marrow examination for eosinophilia, developed ischemic stroke and polyneuropathy. The causes and mechanisms of development as well as dynamics and outcomes of neurological disorders, differential diagnosis, treatment and prognosis of eosinophilic granulomatosis with polyangiitis are discussed.
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Affiliation(s)
| | | | - I A Shchukin
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - M S Fidler
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - G G Avakyan
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - M Yu Martynov
- Pirogov City Clinical Hospital, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Svet
- Pirogov City Clinical Hospital, Moscow, Russia
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18
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Cakir M, Yildirim D, Sarac F, Donmez T, Mirapoglu S, Hut A, Erozgen F, Ozer OF, Gecer MO, Tigrel LZ, Tas O. In the Experimental Model of Acute Mesenteric Ischemia, The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment. J INVEST SURG 2018; 32:507-514. [PMID: 29469635 DOI: 10.1080/08941939.2018.1437486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose/Aim: Acute mesenteric ischemia is a syndrome characterized by sudden onset abdominal pain followed by intestinal necrosis. Morbidity and mortality increase with delayed diagnosis. Even with the latest radiological diagnostic methods, early diagnosis and initiation of treatment can be delayed. Using an experimental model, here we aim to determine the relationship between the laboratory parameters used to detect acute mesenteric ischemia and the duration of irreversible ischemia. Materials and Methods: A total of 30 male Wistar albino rats were divided into five groups, all of which underwent general anesthesia: (i) Superior mesenteric artery (SMA) dissection with laparotomy was performed, and blood samples and intestinal segment samples were taken after 2 hr (Sham group); (ii) volvulus of one-third of the small intestines was performed manually by laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (Volvulus group); (iii) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 2 hr (SMA+ligated 2-hr group); (iv) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 4 hr (SMA+ligated 4-hr group); and (v) SMA was ligated with laparotomy, and blood samples and intestinal segment samples were taken after 6 hr (SMA+ligated 6-hr group). Results: The mean lactate dehydrogenase (LDH) activities of the SMA+ligated 2-hr and SMA+ligated 6-hr groups were statistically higher than the control group (p = .004). Compared to the Sham and Volvulus groups, the mean lactate level of the SMA+ligated 6-hr group was significantly higher (p = .004). Compared to the Sham and Volvulus groups, the mean D-dimer levels of the SMA+ligated 4-hr and SMA+ligated 6-hr groups were significantly higher (p = .004 and .003, respectively). By histopathological evaluation, we found that pathological damage increased as the ischemia lengthened. Conclusions: Mesenteric ischemia leads to an irreversible loss of intestinal perfusion and an increase in parameters of ischemia. Irreversible tissue damage occurs after 4 hr of ischemia and peaks after 6 hr, whereas parameters of ischemia (D-dimer, LDH, and L-Lactate levels) are highest at 2 hr after the onset of ischemia.
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Affiliation(s)
- Mikail Cakir
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Dogan Yildirim
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Fatma Sarac
- Department of Pediatric surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Turgut Donmez
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Semih Mirapoglu
- Department of Pediatric Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Adnan Hut
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Fazilet Erozgen
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Omer Faruk Ozer
- Department of Biochemistry, Bezmialem Vakif University, Istanbul, Turkey
| | - Melih Ozgun Gecer
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| | - Leyla Zeynep Tigrel
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Oguzhan Tas
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
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19
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Gong EJ, Kim DH, Chun JH, Ahn JY, Choi KS, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY, Kim JH, Song IH, Kim YG. Endoscopic Findings of Upper Gastrointestinal Involvement in Primary Vasculitis. Gut Liver 2017; 10:542-8. [PMID: 27226428 PMCID: PMC4933413 DOI: 10.5009/gnl15198] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/05/2015] [Accepted: 10/20/2015] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Gastrointestinal involvement in vasculitis may result in life-threatening complications. However, its variable clinical presentations and endoscopic features, and the rarity of the disease, often result in delayed diagnosis. Methods Clinical characteristics, endoscopic features, and histopathological findings were reviewed from medical records. Results Of 6,477 patients with vasculitis, 148 were diagnosed as primary vasculitis with upper gastrointestinal involvement. Of these, 21 cases (14.2%) were classified as large-vessel vasculitis, 17 cases (11.5%) as medium-vessel vasculitis, and 110 cases (74.3%) as small-vessel vasculitis. According to the specific diagnosis, IgA vasculitis (Henoch-Schönlein purpura) was the most common diagnosis (56.8%), followed by Takayasu arteritis (14.1%), microscopic polyangiitis (10.1%), and polyarteritis nodosa (6.8%). Gastrointestinal symptoms were present in 113 subjects (76.4%), with abdominal pain (78.8%) the most common symptom. Erosion and ulcers were striking endoscopic features, and the second portion of the duodenum was the most frequently involved site. Biopsy specimens were obtained from 124 patients, and only eight (5.4%) presented histopathological signs of vasculitis. Conclusions Diagnosis of vasculitis involving the upper gastrointestinal tract is difficult. Because of the widespread use of endoscopy, combining clinical features with endoscopic findings may facilitate making appropriate diagnoses; however, the diagnostic yield of endoscopic biopsy is low.
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Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hyun Chun
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwi-Sook Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Yıldırım D, Hut A, Tatar C, Dönmez T, Akıncı M, Toptaş M. Prognostic factors in patients with acute mesenteric ischemia. Turk J Surg 2017; 33:104-109. [PMID: 28740960 PMCID: PMC5508232 DOI: 10.5152/ucd.2016.3534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/26/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Acute mesenteric ischemia, one of the causes of acute abdominal pain due to occlusion of the superior mesenteric artery, has a fatal course as a result of intestinal necrosis. There is no specific laboratory test to diagnose acute mesenteric ischemia. The basis of treatment in cases of acute mesenteric ischemia is composed of early diagnosis, resection of intestinal sections with infarction, regulation of intestinal blood flow, second look laparotomy when required, and intensive care support. The aim of this study is to investigate the factors affecting mortality in patients treated and followed-up with a diagnosis of acute mesenteric ischemia. MATERIAL AND METHODS Forty-six patients treated and followed-up with a diagnosis of acute mesenteric ischemia between January 1st, 2008 and December 31st, 2014 at the General Surgery Clinic of our hospitalwere retrospectively evaluated. The patients were grouped as survivor (Group 1) and dead (Group 2). Age, gender, accompanying disorders, clinical, laboratory and radiologic findings, duration until laparotomy, evaluation according to the Mannheim Peritonitis Index postoperative complications, surgical treatment applied, and type of ischemia and outcome following surgery were recorded. RESULTS A total of 46 patients composed of 22 males and 24 females with a mean age of 67.5±17.9 and with a diagnosis of mesenteric ischemia were included in the study. Twenty-seven patients died (58.7%) while 19 survived (41.3%). The mean MPI score was 16.8±4.7 and 25.0±6 in Group 1 and Group 2, respectively, and the difference between the two groups was statistically significant (p<0,001). Fourteen of the 16 (51.9%) patients who had a Mannheim Peritonitis Index score of 26 or higher died while two of them survived (10.5%). Thirteen out of the 30 (48.1%) patients with a Mannheim Peritonitis Index score of 25 or lower died while 17 (89.5%) patients survived. The increased MPI score was significantly correlated withmortality (p=0.004). CONCLUSION Suspicion of disease and early use of imaging in addition to clinical and laboratory evaluations are essential in order to decrease mortality rates in acute mesenteric ischemia. Prevention of complications with critical intensive care during the postoperative period aids in decreasingthe mortality rate. In addition, using the Mannheim Peritonitis Index can be helpful.
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Affiliation(s)
- Doğan Yıldırım
- Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Adnan Hut
- Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Cihad Tatar
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Turgut Dönmez
- Clinic of General Surgery, Lütfiye Nuri Burat State Hospital, İstanbul, Turkey
| | - Muzaffer Akıncı
- Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Toptaş
- Clinic of Anesthesiology and Reanimation, Haseki Training and Research Hospital, İstanbul, Turkey
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Müller-Ladner U. Gut and Liver in Vasculitic Disorders. Dig Dis 2016; 34:546-51. [PMID: 27333193 DOI: 10.1159/000445260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although the gastrointestinal (GI) tract including its related organs is not generally regarded as one of the primary organ systems of primary and secondary vasculitic disorders, there are numerous mechanisms of these diseases operative in or around the different structures and compartments of the GI tract. KEY MESSAGES A majority of the respective clinical symptoms and problems are linked to an alteration of (peri)vascular homeostasis. Alteration of perivascular matrix metabolism can also affect the functional integrity and motility of the GI tract. Apart from the specific GI phenomena of the individual diseases as outlined in detail in this review, the epidemiology of GI involvement follows in general the characteristics of the respective underlying systemic disease. In addition, gender and age do neither influence the occurrence nor the severity of the GI manifestations significantly. With respect to clinical symptoms, vasculitides may result in abdominal pain, bleeding, ileus, intestinal necrosis and hematochezia because of reduced blood flow and hyper-acute occlusion in the antiphospholipid syndrome. Small-bowel involvement in vasculitic entities can cause pseudoobstruction, obstruction, malabsorption and bacterial overgrowth. Laboratory parameters can point to specific diseases but are frequently nonspecific. Thus, if biopsy fails or in unclear endoscopic situations, a variety of imaging techniques including Doppler ultrasound, abdominal CT, MRI and angiography are used and required for identification and localization of the underlying disease. Therapeutic strategies in vasculitides usually include corticosteroids and immunosuppressants, for example, cyclophosphamide in granulomatosis with polyangiitis and in panarteriitis nodosa but also biologics such as rituximab in ANCA-associated vasculitides. Virostatic drugs including interferon-α and ribavirin can be used in hepatitis B- and C-triggered vasculitides such as panarteriitis nodosa and hepatitis C-associated cryoglobulinemia. CONCLUSIONS Immediate diagnostic and therapeutic steps of action need to be performed if vasculitis of the GI tract is suspected in order to avoid irreversible damage to organs and to improve the well-being and life of the affected patient.
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Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik, Justus-Liebig University Giessen, Bad Nauheim, Germany
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A Rare Case of Adult Acute Ileocecal Ischemia Related to Henoch-Schönlein Purpura: MDCT Findings. J Belg Soc Radiol 2016; 100:37. [PMID: 30151449 PMCID: PMC6100678 DOI: 10.5334/jbr-btr.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is a form of immune complex-mediated leukocytoclastic vasculitis involving the skin and other organs. It primarily affects children. The occurrence of HSP in adults is rare, and gastrointestinal (GI) involvement is one of its most common clinical manifestations. The GI symptoms are caused by hemorrhage and edema within the bowel and wall mesentery. Complete recovery usually occurs, and life-threatening complications are rare. We report a typical case of GI involvement of the ileocecal area diagnosed with multidetector computed tomography (MDCT) and confirmed by skin biopsy.
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Raman SP, Fishman EK. Computed Tomography Angiography of the Small Bowel and Mesentery. Radiol Clin North Am 2016; 54:87-100. [DOI: 10.1016/j.rcl.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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24
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Tsurikisawa N, Oshikata C, Tsuburai T, Sugano S, Nakamura Y, Shimoda T, Tamama S, Adachi K, Horita A, Saito I, Saito H. Th17 cells reflect colon submucosal pathologic changes in active eosinophilic granulomatosis with polyangiitis. BMC Immunol 2015; 16:75. [PMID: 26714881 PMCID: PMC4696253 DOI: 10.1186/s12865-015-0138-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/22/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic eosinophilic pneumonia (CEP) or eosinophilic gastroenteritis (EG), or both, with asthma precede the onset of eosinophilic granulomatosis with polyangiitis (EGPA) in half of all EGPA patients. It is not known what determines whether patients with CEP or with EG following asthma will develop EGPA. METHODS We studied 17 EGPA patients and 12 patients with CEP but without EGPA. We assayed serum ICAM-1, VCAM-1, and VEGF, and the percentage of peripheral blood CD4(+) T cells producing IL-17 (Th17 cells), at both onset and remission. We also examined the numbers of submucosal eosinophils and the basement membrane-to-crypt and crypt-to-crypt distance to evaluate edema in the colon submucosa at onset and remission in EGPA and at onset in CEP. RESULTS Nine of 12 (75.0%) CEP patients had symptoms or endoscopic findings. Colonic submucosal eosinophil counts and edema in EGPA at onset were greater than at remission or in CEP at onset. Th17 cells (%) and serum ICAM-1 levels at onset were greater in EGPA than in CEP. In EGPA, peripheral blood Th17 cells (%) were significantly correlated with serum ICAM-1 level, colonic submucosal eosinophil count, and degree of edematous change; inversely correlated with serum VEGF level; but not correlated with VCAM-1 level. CONCLUSIONS Eosinophilia and colonic submucosal edematous change were greater in EGPA than in CEP. The mechanism of vasculitis in EGPA appears related to increases in serum Th17 cell numbers and ICAM-1 levels and decreases in VEGF levels.
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Affiliation(s)
- Naomi Tsurikisawa
- Departments of Allergy and Respirology, Sagamihara, Kanagawa, Japan.
| | - Chiyako Oshikata
- Departments of Allergy and Respirology, Sagamihara, Kanagawa, Japan.
| | - Takahiro Tsuburai
- Departments of Allergy and Respirology, Sagamihara, Kanagawa, Japan.
| | - Satoshi Sugano
- Department of Medical Gastroenterology, Sagamihara, Kanagawa, Japan.
| | - Yoko Nakamura
- Department of Medical Gastroenterology, Sagamihara, Kanagawa, Japan.
| | - Takuya Shimoda
- Department of Medical Gastroenterology, Sagamihara, Kanagawa, Japan.
| | - Shunpei Tamama
- Department of Medical Gastroenterology, Sagamihara, Kanagawa, Japan.
| | - Ken Adachi
- Department of Medical Gastroenterology, Sagamihara, Kanagawa, Japan.
| | - Ayako Horita
- Department of Diagnostic Pathology, Sagamihara, Kanagawa, Japan.
| | - Ikuo Saito
- Department of Diagnostic Pathology, Sagamihara, Kanagawa, Japan.
| | - Hiroshi Saito
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan.
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Kim M, Kim YU, Boo SJ, Kim SM, Kim HW. Antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding. Kidney Res Clin Pract 2015; 34:180-4. [PMID: 26484044 PMCID: PMC4608877 DOI: 10.1016/j.krcp.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/25/2014] [Accepted: 11/05/2014] [Indexed: 11/16/2022] Open
Abstract
A 61-year-old woman was admitted to hospital because of generalized edema and proteinuria. Her renal function deteriorated rapidly. Serum immunoglobulin and complement levels were within normal ranges. An autoantibody examination showed negative for antinuclear antibody and antineutrophil cytoplasmic antibody. Histologic examination of a renal biopsy specimen revealed that all of the glomeruli had severe crescent formations with no immune deposits. The patient was treated with steroid pulse therapy with cyclophosphamide followed by oral prednisolone. Fifteen days later, she experienced massive recurrent hematochezia. Angiography revealed an active contrast extravasation in a branch of the distal ileal artery. We selectively embolized with a permanent embolic agent. On the 45(th) hospital day, the patient suddenly lost consciousness. Brain computed tomography showed intracerebral hemorrhage. We report a case of antineutrophil cytoplasmic antibody-negative pauci-immune glomerulonephritis with massive intestinal bleeding and cerebral hemorrhage.
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Affiliation(s)
- Miyeon Kim
- Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Young Uck Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Jin Boo
- Division of Gastroenterology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - So Mi Kim
- Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Woo Kim
- Division of Nephrology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Corresponding author. Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, 1753-3, Ara-1-dong, Jeju-si, Jeju Special Self-Governing Province 690-716, Korea.
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Yoshinaga K, Morikawa D, Deshpande GA, Hiraoka E. A case of lower leg skin rash and severe arthralgia. BMJ Case Rep 2015; 2015:bcr-2015-210714. [PMID: 26109626 DOI: 10.1136/bcr-2015-210714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kazutaka Yoshinaga
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Daiki Morikawa
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | | | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
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Nozari N, Divsalar P. Systemic lupus erythematosus presenting with a fatal intestinal vasculitis: a case report. Middle East J Dig Dis 2014; 6:162-4. [PMID: 25093065 PMCID: PMC4119674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/25/2014] [Indexed: 11/21/2022] Open
Abstract
This case report demonstrates fatal gastrointestinal vasculitis as a rare presentation of systemic lupus erythematosus. A 34-year-old woman presented with abdominal pain and diarrhea. Anti nuclear antibody was positive and high titre of anti-ds DNA antibody was also reported. Treatment with corticosteroid and supportive cares were started; however, her condition worsened. Eventually, she was considered as a candidate for diagnostic laparoscopy. Immediately after laparoscopy, she developed respiratory distress along with upper gastrointestinal bleeding. Soon after, the patient died because of disseminated intravascular coagulation .
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Affiliation(s)
- Neda Nozari
- 1 Fellow of Gastroenterology, Digestive Disease Research Center, Shariatie Hospital, Tehran University of Medical Science, Tehran, Iran
,Corresponding Author: Neda Nozari, MD Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran Tel: +98 21 82415000 Fax:+98 21 82415400
| | - Parisa Divsalar
- 2 Pasteur Hospital, Bam University of Medical Sciences, Bam, Iran
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Intestinal disorders caused by scurvy. Clin Res Hepatol Gastroenterol 2014; 38:e39-40. [PMID: 24239317 DOI: 10.1016/j.clinre.2013.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/27/2013] [Indexed: 02/04/2023]
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Liu LX, Zhu FQ, Lin H, Wen P, Wen JB. Clinical manifestations and endoscopic characteristics of adult abdominal type allergic purpura: An analysis of 26 cases. Shijie Huaren Xiaohua Zazhi 2013; 21:2364-2366. [DOI: 10.11569/wcjd.v21.i23.2364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To summarize the clinical and endoscopic features of abdominal type allergic purpura in adult patients.
METHODS: Clinical and endoscopic data for 26 adult patients with abdominal type allergic purpura were analyzed retrospectively.
RESULTS: All patients had abdominal pain, and 13 patients had digestive tract hemorrhage. Endoscopy revealed hyperaemia, edema, bleeding spots, erosion and ulcer in the gastrointestinal mucosa. Severe mucosal lesions were often found in the duodenum, ileum and caecum.
CONCLUSION: Gastrointestinal endoscopy is helpful for early diagnosis of adult abdominal type allergic purpura.
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van den Heijkant TC, Aerts BAC, Teijink JA, Buurman WA, Luyer MDP. Challenges in diagnosing mesenteric ischemia. World J Gastroenterol 2013; 19:1338-41. [PMID: 23538325 PMCID: PMC3602491 DOI: 10.3748/wjg.v19.i9.1338] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 09/30/2012] [Accepted: 10/16/2012] [Indexed: 02/06/2023] Open
Abstract
Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.
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