RESUMO
BACKGROUND: Eosinophilic duodenitis has a prevalence of 5.1 to 8.2 per 100000 persons. The underlying molecular mechanisms are unknown, but hypersensitivity (seasonal and food allergies, asthma, eczema) response plays a major role in its pathogenesis, allergic predisposition can be found up-to 25-35% of cases. The diagnosis includes clinical manifestation, imaging findings and histological evidence of eosinophilic infiltration >20 eosinophils per high-power field. This is a clinical case report. a 25-years old man with vitiligo consult to emergency department referring dyspepsia symptoms, vomiting and abdominal pain of maximal intensity, in the medical exam upper abdominal pain was found, blood laboratories were unremarkable except a high net eosinophil-count >2000 cells/ul, abdominal ultrasound were normal, upper endoscopy revealed duodenitis with rigid and thickened folds, colonoscopy show hemorrhoids grade I. Coproscopy exam was negative for parasites, total IgE, IgA and IgG were in normal range, a positive IgG to Toxoplasma gondii was reported, autoimmunity panel was negative. In the following 4 days the abdominal pain and eosinophils count increase, a new abdomin-pelvic tomography was done showing thickened duodenum with a new endoscopy showing marked edema in duodenum with severe biliary reflux with biopsies describing an atrophic chronic duodenitis. Allergy tests -skin prick and patch tests- were done resulting positive to cereals (rye, soy, barley), Manihot esculenta, green banana, tomato, cow milk, orange and pineapple. A restrictive diet and protons pump inhibitor was indicated, ambulatory control at 45 days after show symptoms resolution with a normal blood eosinophils count. Here is reported a case of eosinophilic duodenitis related to food allergy in a young man with vitiligo debuting with an unusual clinical presentation of acute visceral pain and biliary reflux which resolved with elimination diet and pantoprazole without use of corticoids, with both, IgE and non-IgE mechanisms playing important roles explaining food sensitization.
Assuntos
Duodenite , Hipersensibilidade Alimentar , Dor Visceral , Vitiligo , Feminino , Animais , Bovinos , Humanos , Duodenite/complicações , Duodenite/diagnóstico , Vitiligo/complicações , Dor Visceral/complicações , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Alérgenos , Dor Abdominal/etiologia , Imunoglobulina GRESUMO
Given the advances in diagnosis for CD, some patients are detected with symptoms and signs of food intolerance, which have positive antibodies and autoantibodies for coeliac disease, whom present proximal bowel biopsies with chronic nonspecific duodenitis and are not associated with stages 0 and 1 Marsh. On the other hand, patients with bloating, abdominal pain, pondostatural delay, negative antibodies for CD, and chronic nonspecific duodenitis in whom removing cow's milk or gluten, the symptoms remit. There are also celiac patients with biopsies before diagnosis, with chronic nonspecific duodenitis. In this paper, we summarize three brothers with different degrees of chronic duodenitis, one with chronic nonspecific duodenitis, and two with histopathological sings of coeliac disease. It is an invitation to think that chronic nonspecific duodenitis in some patients may be an earlier manifestation of celiac disease.
Con los avances en el diagnóstico para Enfermedad Celíaca (EC), se detectan algunos pacientes con síntomas y signos de intolerancia alimentaria, que presentan anticuerpos y autoanticuerpos positivos para EC, con biopsias de intestino proximal que muestran duodenitis crónica inespecífica y no se relacionan con los estadíos 0 y 1 de Marsh. Por otro lado, hay pacientes con meteorismo, dolor abdominal, retraso pondoestatrural con anticuerpos negativos para EC y duodenitis crónica inespecífica, en los cuales al quitar la leche de vaca o el gluten, remiten los síntomas. También hay pacientes celíacos con biopsias anteriores a la del diagnóstico, que muestran duodenitis crónica inespecífica. En este trabajo, se resumen tres hermanos con diferentes grados de duodenitis crónica, uno con duodenitis crónica inespecífica, y dos con signos histopatológicos de EC. Es una invitación a pensar que la duodenitis crónica inespecífica en algunos pacientes puede ser una manifestación temprana de la EC.
Assuntos
Autoanticorpos/sangue , Doença Celíaca/complicações , Duodenite/complicações , Biomarcadores/sangue , Biópsia , Doença Celíaca/diagnóstico , Criança , Pré-Escolar , Doença Crônica , Duodenite/diagnóstico , Antígenos HLA-DQ/sangue , Humanos , Masculino , Transglutaminases/imunologiaRESUMO
Strongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.
Assuntos
Duodenite/patologia , Strongyloides stercoralis , Estrongiloidíase/patologia , Idoso , Animais , Duodenite/complicações , Evolução Fatal , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Estrongiloidíase/complicaçõesRESUMO
SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.
ResumoHiperinfecção por Strongyloides stercoralis: uma causa incomum de hemorragia digestiva A estrongiloidíase é uma parasitose que pode evoluir para uma forma disseminada, denominada síndrome de hiperinfecção, nos pacientes em estados de imunossupressão. A síndrome de hiperinfecção é ocasionada pela grande multiplicação e migração de larvas infectantes, com envolvimento gastrointestinal e/ou pulmonar característico. Essa doença pode representar um desafio diagnóstico, pois apresenta- se em achados inespecíficos à endoscopia.
Assuntos
Idoso , Animais , Humanos , Masculino , Duodenite/patologia , Strongyloides stercoralis , Estrongiloidíase/patologia , Duodenite/complicações , Evolução Fatal , Hemorragia Gastrointestinal/etiologia , Estrongiloidíase/complicaçõesRESUMO
OBJECTIVES: Our aim was to evaluate the structure and function of the upper gastrointestinal tract in a group of patients with autism who had gastrointestinal symptoms. STUDY DESIGN: Thirty-six children (age: 5.7 +/- 2 years, mean +/- SD) with autistic disorder underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal cultures. The most frequent gastrointestinal complaints were chronic diarrhea, gaseousness, and abdominal discomfort and distension. RESULTS: Histologic examination in these 36 children revealed grade I or II reflux esophagitis in 25 (69.4%), chronic gastritis in 15, and chronic duodenitis in 24. The number of Paneth's cells in the duodenal crypts was significantly elevated in autistic children compared with non-autistic control subjects. Low intestinal carbohydrate digestive enzyme activity was reported in 21 children (58.3%), although there was no abnormality found in pancreatic function. Seventy-five percent of the autistic children (27/36) had an increased pancreatico-biliary fluid output after intravenous secretin administration. Nineteen of the 21 patients with diarrhea had significantly higher fluid output than those without diarrhea. CONCLUSIONS: Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients. The observed increase in pancreatico-biliary secretion after secretin infusion suggests an upregulation of secretin receptors in the pancreas and liver. Further studies are required to determine the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder.
Assuntos
Transtorno Autístico/complicações , Gastroenteropatias/epidemiologia , Transtorno Autístico/epidemiologia , Pré-Escolar , Diarreia/complicações , Diarreia/epidemiologia , Sistema Digestório/metabolismo , Dissacarídeos/metabolismo , Duodenite/complicações , Duodenite/epidemiologia , Duodeno/patologia , Esofagite Péptica/complicações , Esofagite Péptica/epidemiologia , Feminino , Gastroenteropatias/complicações , Humanos , Síndromes de Malabsorção/complicações , Síndromes de Malabsorção/epidemiologia , Masculino , Celulas de Paneth/patologia , Prevalência , Receptores Acoplados a Proteínas G , Receptores dos Hormônios Gastrointestinais/metabolismo , Secretina/metabolismo , Regulação para CimaRESUMO
A twenty six year old woman was admitted suffering an anemia syndrome, postprandial vomiting and intermittent melena of six months evolution. The hemoglobin was 3.5 g/dL: an endoscopy detected a large tumor in the duodenum with a 90% obstruction of the lumen. A biopsy reported an erosive, acute and chronic duodenitis. Subsequently a surgical exploration with duodenotomy showed a large nodular polyp attached to a stalk that was removed: a hamartomatous polyp of Brunner's glands was reported. It coursed with gastrointestinal bleeding and symptoms of duodenal obstruction, which are two of the most common symptoms of this rare tumor.
Assuntos
Glândulas Duodenais , Duodenopatias/complicações , Hemorragia Gastrointestinal/etiologia , Hamartoma/complicações , Pólipos Intestinais/complicações , Adulto , Anemia/etiologia , Glândulas Duodenais/patologia , Diagnóstico Diferencial , Duodenopatias/diagnóstico , Neoplasias Duodenais/diagnóstico , Duodenite/complicações , Feminino , Hamartoma/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Pólipos Intestinais/diagnóstico , Leiomioma/diagnóstico , Melena/etiologiaRESUMO
We report a parkinsonian patient initially responding to L-dopa who developed a severe loss of drug efficacy due to Strongyloides stercoralis duodenitis. The patient was put on mebendazole and metronidazole, and the parasitosis abated, allowing L-dopa reduction by 33%. Our patient illustrates the advisability of searching for Strongyloides stercoralis when L-dopa malabsorption is suspected in Parkinson's disease.
Assuntos
Duodenite/metabolismo , Enteropatias Parasitárias/metabolismo , Levodopa/farmacocinética , Doença de Parkinson/complicações , Strongyloides stercoralis , Estrongiloidíase/metabolismo , Idoso , Animais , Duodenite/complicações , Duodenite/parasitologia , Humanos , Levodopa/uso terapêutico , Masculino , Mebendazol/uso terapêutico , Metronidazol/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/metabolismo , Estrongiloidíase/complicaçõesRESUMO
Com o objetivo de analisar endoscopicamente a associaçäo entre lesöes de mucosa gastroduodenal e varizes como causa de hemorragia digestiva alta em portadores de síndrome de hipertensäo portal, foram avaliados no Gastrocentro da Universidade Estadual de C - UNICAMP, 11 pacientes com hemorragia digestiva no período de 1§ de agosto de 1990 a 15 de julho de 1992, submetidos à endoscopia até 24 horas após admissäo no Pronto-Socorro. Considerando a faixa etária, o sexo e clínica foi encontrada prevalência de 83,7//da terceiras e sextas décadas, sendo 70,08 por cento do sexo masculino e 29,92 por cento do feminino. A hematêmese esteve presente em 94,02 por cento dos casos. Foram causas de hemorragia digestiva alta: varizes esofágicas (47,87 por cento), varizes gástricas (9,40 por cento), lesöes agudas da mucosa gastroduodenal (34,19 por cento) úlcera gástrica (5,98 por cento) e úlcera duodenal (2,56 por cento). Concluíram os autores existir associaçäo importante entre lesöes de mucosa gastroduodenal e varizes como causa da hemorragia digestiva alta na hipertensäo portal, e que é imprescindível a avaliaçäo endoscópica precoce rotineira e detalhada naqueles pacientes com sangramento digestivo alto. É aconselhável um exame endoscópico semestral quando os sintomas dispépticos forem constantes, com antecedentes de tratamento de lesöes de mucosa gastroduodenal ou úlcera péptica, e anual nos demais