1/20. Successful treatment with ganciclovir for cytomegalovirus duodenitis following allogenic bone marrow transplantation.cytomegalovirus(CMV) disease is a major cause of morbidity and mortality in immunocompromised patients. CMV enteritis should be considered when nausea and vomiting continue 3 to 4 weeks after bone marrow transplantation(BMT). The treatment of CMV enteritis is not well established. We report a CMV duodenitis patient following allogenic bone marrow transplantation. The patient had prolonged nausea and vomiting for 5 weeks after bone marrow transplantation and CMV duodenitis was diagnosed by the gastroduodenoscopic mucosal biopsy which showed cytomegalic cells. ganciclovir treatment for 3 weeks resulted in the resolution of symptoms and promoted healing of the lesion. The patient was free of CMV infection until 288 days after allogenic BMT without maintenance ganciclovir treatment.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/20. Duodenal colonization by geotrichum candidum in a child with transient low serum levels of IgA and IgM.Fungal colonization was observed in the duodenal biopsy specimens of a nine-year-old girl who complained of anorexia and epigastric pain. endoscopy revealed gastric redness and geotrichum candidum was identified in the duodenum by histopathology and tissue culture. Immunologic work-up showed low serum levels of IgA and IgM. She was treated with ranitidine and antacids for gastritis. At follow-up, the levels of immunoglobulins had normalized, no fungal elements were detected, and clinical symptoms had disappeared. Duodenal invasion by G. candidum has not been described so far. Duodenal colonization by G. candidum may occur when mucosal immunity is disturbed and may be the source of dissemination in severe immunodeficiency states.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
3/20. Inflammatory fibroid polyp of the duodenum.Duodenal inflammatory fibroid polyps (IFP) are extemely rare lesions indistinguishable from submucosal tumors by endoscopic inspection alone. Like gastric inflammatory fibroid polyps, they can be managed by endoscopic polypectomy or mucosectomy. However, preoperative diagnosis of this benign lesion is difficult. Here we present a case of duodenal IFP causing gastrointestinal bleeding that was evaluated by endoscopic ultrasound before surgical removal. On endosonography, the duodenal IFP appeared as a coarsely heterogeneous isoechoic and hypoechoic mass circumscribed by a distinct margin and arising from the third layer of the duodenal wall. The endosonographic appearance of this lesion was in marked contrast to that previously reported for gastric IFPs, which have tended to appear as hypoechoic homogeneous lesions with indistinct margins. Endosonographic evaluation of suspected IFPs before endoscopic or surgical treatment is useful. However, the endosonographic appearances of duodenal and gastric IFPs may be significantly different, possibly because of differences in the makeup of the duodenal and gastric walls.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
4/20. Diffuse duodenitis associated with ulcerative colitis.Backwash ileitis and postcolectomy pouchitis are well-recognized complications of ulcerative colitis (UC), whereas inflammation of the proximal small intestine is not. In contrast, small intestinal disease at any level is common in Crohn's disease (CD). Despite this well-established and accepted dogma, rare cases of histologically proven diffuse duodenitis (DD) associated with UC appear in the literature. In this study, we report our experience with similar cases exhibiting this unusual inflammatory phenomenon. Routine histologic sections from four cases of DD associated with well-documented UC were reviewed and the findings correlated with all available medical records. Multiple endoscopic biopsies showing histologic features of UC and colectomy specimens confirming severe ulcerative pancolitis were available for all cases. Varying degrees of active chronic inflammation and architectural mucosal distortion identical to UC were observed in pre- and postcolectomy duodenal biopsies of one of four and four of four cases, respectively. Similar inflammatory patterns were present postoperatively in the ileum in three of four cases and in the jejunum in one case. Endorectal pull-through (ERPT) procedures were performed in three of four patients and an end-to-end ileorectal anastomosis was done in one patient. Despite extensive upper gastrointestinal tract involvement, none of the patients developed postsurgical Crohn's-like complications during a follow-up period of 12 to 54 months. This suggests that patients with pancolitis and DD do not necessarily have CD, but rather may have UC and, most importantly, that successful ERPT procedures may be performed in these patients.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
5/20. Symptomatic CMV duodenitis. An important clinical problem in AIDS.Duodenal disease resulting from cytomegalovirus (CMV) infection is unusual in the absence of other gastrointestinal disease. We report two cases of CMV infection symptomatically isolated to the duodenum. One patient presented with ulcer-type dyspepsia, and the other with severe gastrointestinal bleeding. ganciclovir therapy resulted in both a clinical and endoscopic remission. The importance of endoscopic evaluation is discussed given the necessity of mucosal biopsy for diagnosis and the availability of specific and effective therapy.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
6/20. Successful treatment of Good syndrome with cytomegalovirus duodenoenteritis using a combination of ganciclovir and immunoglobulin with high anti-cytomegalovirus antibody titer.We describe the case of a 64-year-old woman with Good syndrome who presented with watery diarrhea and abdominal distention caused by cytomegalovirus (CMV) duodenoenteritis. thymoma and hypogammaglobulinemia were first identified when the patient was 58 years old. She had repeatedly complained of symptoms even after thymectomy. Abdominal radiography revealed multiple air-fluid levels, and computed tomography revealed ascites and dilation of the small intestine. Immunofluorescent staining of specimens obtained by duodenal mucosal biopsy revealed intracellular inclusion bodies of CMV, although serum CMV pp65 antigenemia assays yielded negative results. CMV infection of the small intestine caused mucosal edema resulting in malabsorption. The patient was treated using ganciclovir and an immunoglobulin preparation with a high titer of antibodies against CMV (CMV-Ig), and subsequently made a rapid recovery from abdominal symptoms. When patients with Good syndrome complain of abdominal symptoms, particularly chronic diarrhea, a diagnosis of CMV gastroenteritis should not be excluded, even if negative results are obtained for CMV pp65 antigenemia assays. Combination therapy of ganciclovir and CMV-Ig seems useful for patients with CMV gastroenteritis.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
7/20. Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy.We report coexistent collagenous colitis and collagenous sprue in a 62-year-old woman with diarrhea. Investigations suggested malabsorption, and small intestinal biopsies demonstrated a flattened mucosa with subepithelial collagen deposition. Colonic biopsies also showed a thickened subepithelial collagen band as well as a striking lamina propria inflammatory cell infiltrate. Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. Repeat biopsies after 2 months demonstrated restoration of normal small intestinal and colonic collagen bands; only a chronic inflammatory cell infiltrate (consistent with microscopic/lymphocytic colitis) persisted in colonic biopsies. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity.- - - - - - - - - - ranking = 20.849854461809keywords = lamina propria, propria, mucosa, lamina (Clic here for more details about this article) |
8/20. Chronic ischaemic gastritis: an unusual form of splanchnic vascular insufficiency.Three cases of erosive gastroduodenitis secondary to chronic splanchnic vascular insufficiency are reported. In all cases, pain failed to respond to conventional therapeutic measures for peptic ulcer disease. A patchy discolouration and erythematous mottling of the gastric mucosa, with scattered shallow aphthous ulcers, was seen on endoscopic examination. angiography showed coeliac axis involvement in all patients, with insufficient mesenteric collateral pathways. Chronic gastritis resolved clinically and endoscopically after revascularization.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
9/20. Collagenous gastroduodenitis on collagenous colitis.We report on a case of collagenous gastroduodenitis with concomitant collagenous colitis in a 75-year-old woman with watery diarrhea of approximately six months' standing. The step biopsy material obtained from the colon revealed continuous collagenous colitis with thickening of the basal membrane to 30 microns. The biopsies taken from the stomach and duodenum also revealed a band-like deposition of collagen in the duodenum (bulb and proximal portion of the descending portion) along the basal membrane of the lining epithelium, associated with partial atrophy of the villi. In the stomach, this band of collagen was located, parallel to the mucosal surface, at the level of the floor of the foveolae.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
10/20. Necrotizing duodenitis--a stress-associated lesion?We report three cases of stress ulceration exhibiting primarily mucosal abnormalities of the duodenum with duodenal ulceration and linear ulcerations on the duodenal folds which is unique in our experience. We hypothesize that vascular insufficiency during low flow states decreases the ability of mucosa to buffer back-diffused hydrogen ion, leading to mucosal injury and ulceration. The duodenal folds receive an end-arteriole supply and are thus affected before other areas of the duodenum. Given the degree of necrosis associated with these lesions on pathological examination, we have chosen the term necrotizing duodenitis to describe the lesions observed.- - - - - - - - - - ranking = 3keywords = mucosa (Clic here for more details about this article) |
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