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Metastases to duodenum in cervical squamous cell carcinoma: A case report and review of the literature.
Chen, Y, Zhang, H, Zhou, Q, Lu, L, Lin, J
Medicine. 2022;(2):e28526
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RATIONALE Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature. PATIENT CONCERNS We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days. DIAGNOSIS Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis. INTERVENTIONS The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient's diet quickly resumed. OUTCOMES The patient refused further intervention and was discharged home to continue palliative care at the local hospital. LESSONS Clinicians should be alert to patients' past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.
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Recent understanding of the pathophysiology of functional dyspepsia: role of the duodenum as the pathogenic center.
Miwa, H, Oshima, T, Tomita, T, Fukui, H, Kondo, T, Yamasaki, T, Watari, J
Journal of gastroenterology. 2019;(4):305-311
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Over almost 30 years since functional dyspepsia (FD) was defined, researchers have endeavored to elucidate the pathophysiology of functional gastrointestinal disorders. Now a consensus is emerging that the gastric symptoms of FD are caused mainly by gastric motility abnormalities and gastric hypersensitivity. The involvement of other causative factors including acid, Helicobacter pylori, psychological factors, and diet has been debated, but how they are involved in the manifestation of dyspeptic symptoms remains unclear. We believe that most of those factors cause FD symptoms by inducing gastric motility abnormalities and gastric hypersensitivity via the duodenum. Here, we discuss 2 possible reasons why patients with FD experience chronic upper abdominal symptoms: (1) the possibility that the contents of the duodenum of patients with FD differ from those of healthy persons and the different contents stimulate the duodenum, and (2) the possibility that the duodenum of patients with FD is more sensitive to noxious stimuli because of low-grade inflammation and increased mucosal permeability.
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Intraepithelial lymphocytes, scores, mimickers and challenges in diagnosing gluten-sensitive enteropathy (celiac disease).
Sergi, C, Shen, F, Bouma, G
World journal of gastroenterology. 2017;(4):573-589
Abstract
The upper digestive tract is routinely scoped for several causes of malabsorption, and the number of duodenal biopsy specimens has increased notably in the last 10 years. Gluten-sensitive enteropathy (GSE) is an autoimmune disease, which shows an increasing prevalence worldwide and requires a joint clinico-pathological approach. The classical histopathology of GSE with partial or total villous blunting is well recognized, but the classification of GSE is not straightforward. Moreover, several mimickers of GSE with intraepithelial lymphocytosis have been identified in the last 20 years, with drug interactions and medical comorbidities adding to the conundrum. In this review, we report on the normal duodenal mucosa, the clinical presentation and laboratory diagnosis of GSE, the duodenal intraepithelial lymphocytes and immunophenotype of GSE-associated lymphocytes, the GSE mimickers, the differences "across oceans" among guidelines in diagnosing GSE, and the use of a synoptic report for reporting duodenal biopsies in both children and adults in the 21st century.
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Hydrothermal Duodenal Mucosal Resurfacing: Role in the Treatment of Metabolic Disease.
Cherrington, AD, Rajagopalan, H, Maggs, D, Devière, J
Gastrointestinal endoscopy clinics of North America. 2017;(2):299-311
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The duodenum has become recognized as a metabolic signaling center that is involved in regulating insulin action and, therefore, insulin resistance states such as type 2 diabetes. Bariatric surgery and other manipulations of the upper intestine, in particular the duodenum, have shown that limiting nutrient exposure or contact in this key region exerts powerful metabolic effects. Early human clinical trial data suggest that endoscopic hydrothermal duodenal mucosal resurfacing is well tolerated in human subjects and has an acceptable safety profile. This article describes the rationale for this endoscopic approach and its early human use, including safety, tolerability, and early efficacy.
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Gastroduodenal mucosal defense mechanisms.
Said, H, Kaji, I, Kaunitz, JD
Current opinion in gastroenterology. 2015;(6):486-91
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PURPOSE OF REVIEW To highlight recent developments in the field of gastroduodenal mucosal defense with emphasis on lumen-gut interactions. RECENT FINDINGS There has been a growing interest in the physiological functions of luminal chemosensors present from tongue to colon that detect organic molecules in the luminal content associated with nutrient ingestion, usually associated with specialized cells, in particular the enteroendocrine cells. These receptors transduce the release of peptide hormones, in particular proglucagon-derived products such as the glucagon-like peptides (GLPs), which have profound effects on gut function and on metabolism. Luminal chemosensors transduce GLP release in response to changes in the cellular environment, as part of the mechanism of nutrient chemosensing. GLP-2 has important trophic effects on the intestinal mucosa, including increasing the proliferation rate of stem cells and reducing transmucosal permeability to ions and small molecules, in addition to increasing the rate of duodenal bicarbonate secretion. GLP-1, although traditionally considered an incretin that enhances the effect of insulin on peripheral tissues, also has trophic effects on the intestinal epithelium. SUMMARY A better understanding of the mechanisms that mediate GLP release can further illuminate the importance of nutrient chemosensing as an important component of the mechanism that mediates the trophic effects of luminal nutrients. GLP-1 and GLP-2 are already in clinical use for the treatment of diabetes and intestinal failure. Improved understanding of the control of their release and their end-organ effects will identify new clinical indications and interventions that enhance their release.
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Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review.
Dibra, A, Këlliçi, S, Çeliku, E, Draçini, X, Maturo, A, Çeliku, E
Il Giornale di chirurgia. 2015;(1):29-31
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We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of Na- Cl 0.9% solution. Upper occlusion's signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks.
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Gastroduodenal mucosal defense.
Kemmerly, T, Kaunitz, JD
Current opinion in gastroenterology. 2014;(6):583-8
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PURPOSE OF REVIEW To review recent developments in the field of gastroduodenal mucosal defense. RECENT FINDINGS Research in the field of gastroduodenal mucosal defense has focused on continued elucidation of molecular mechanisms that protect the mucosa and influence healing at the cellular level. Review of literature over the past year reveals that familiar proteins and mediators, such as nitric oxide, toll-like receptors, nucleotide-binding oligomerization domain-containing proteins (NOD2), β-defensins, macrophages, dendritic cells, mucins, autophagy, and the influence of aging and diet, are still subjects of study, but also brings into light new processes and mediators, such as dual oxidases, defense against radiation injuries, and novel proteins such as ZBP-89. SUMMARY These new published findings contribute to our overall understanding of gastroduodenal defense and suggest innovative avenues of future research and possible novel therapeutic targets.
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Risk factors for small bowel bacterial overgrowth and diagnostic yield of duodenal aspirates in children with intestinal failure: a retrospective review.
Gutierrez, IM, Kang, KH, Calvert, CE, Johnson, VM, Zurakowski, D, Kamin, D, Jaksic, T, Duggan, C
Journal of pediatric surgery. 2012;(6):1150-4
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BACKGROUND Children with intestinal failure (IF) are at risk for small bowel bacterial overgrowth (SBBO) because of anatomical and other factors. We sought to identify risk factors for SBBO confirmed by quantitative duodenal culture. METHODS A single-center retrospective record review of children who had undergone endoscopic evaluation for SBBO (defined as bacterial growth in duodenal fluid of >10(5) colony-forming unit per mL) was performed. RESULTS We reviewed 57 children with median (25th-75th percentile) age 5.0 (2.0-9.2) years. Diagnoses included motility disorders (28%), necrotizing enterocolitis (16%), atresias (16%), gastroschisis (14%), and Hirschsprung disease (10.5%). Forty patients (70%) had confirmed SBBO. Univariate analysis showed no significant differences between patients with and without SBBO for the following variables: age, sex, diagnosis, presence of ileocecal valve, and antacid use. Patients receiving parenteral nutrition (PN) were more likely to have SBBO (70% vs 35%, P = .02). Multiple logistic regression analysis confirmed that PN administration was independently associated with SBBO (adjusted odds ratio, 5.1; adjusted 95% confidence interval, 1.4-18.3; P = .01). SBBO was not related to subsequent risk of catheter-related bloodstream infection (CRBSI). CONCLUSION SBBO is strongly and independently associated with PN use. Larger prospective cohorts and more systematic sampling techniques are needed to better determine the relationship between SBBO and gastrointestinal function.
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[Intraduodenal infusion of levodopa].
Valldeoriola, F, Cámara, A
Revista de neurologia. 2010;(1):41-8
Abstract
In the advanced stages of Parkinson's disease (PD), the conventional orally-administered pharmacological treatment can prove to be insufficient to control the motor complications associated with the disease. One of the causes involved in the genesis of the motor fluctuations that are observed in PD is the variable absorption of the medication due to an irregular or erratic emptying of the gastric content. Today, a method of therapy is now available that allows levodopa to be administered directly into the duodenum at a continuous rate by a perfusor. The medication is applied through a duodenal catheter implanted by means of a percutaneous endoscopic gastrostomy. This new form of administration has been marketed under the name of Duodopa, which is a pharmaceutical form of levodopa in a micronised suspension in a thickening gel consisting of sodium carmelose. It is presented in combination with levodopa (20 mg/mL) and a dopa decarboxylase inhibitor, carbidopa (5 mg/mL). Duodopa has proved to be effective in reducing the percentage of off time and in diminishing the periods with disabling dyskinesias. This therapy has also proved to be useful for relieving certain non-motor aspects associated with PD and presents fewer limitations regarding indication for advanced PD patients than those that usually exist for the case of deep brain stimulation. Although the therapy has proved to be effective, it is not free of complications arising from malfunctioning of the infusion system or in relation to the percutaneous endoscopic gastrostomy.
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Intestinal goblet cell autoantibody associated enteropathy.
Hori, K, Fukuda, Y, Tomita, T, Kosaka, T, Tamura, K, Nishigami, T, Kubota, A, Shimoyama, T
Journal of clinical pathology. 2003;(8):629-30
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This report describes a case of refractory enteropathy with circulating intestinal goblet cell autoantibodies (IGA). A 19 year old man with hyperthyroidism had suffered from protracted diarrhoea for nearly 10 years. Histological examination showed evidence of collagenous enterocolitis. The diarrhoea did not improve despite fasting under total parenteral nutrition. An immunofluorescence assay demonstrated IGA without anti-enterocyte autoantibodies, the hallmark of autoimmune enteropathy, although other criteria were fulfilled. None of 109 controls, including 55 cases of inflammatory bowel disease and one of lymphocytic colitis, had IGA. This case is considered to be a variant of autoimmune enteropathy, and might be a distinct entity.