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Clinical Journal of Gastroenterology

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https://www.readbyqxmd.com/read/29340926/gastrointestinal-histoplasmosis-ileal-stricture-successfully-treated-with-through-the-scope-balloon-dilation-in-a-patient-with-hyperimmunoglobulin-m-syndrome
#1
Fredy Nehme, Kyle Rowe, Mohamad El Hawari, Maha Assi, Imad Nassif
Gastrointestinal histoplasmosis is common in patients with disseminated disease affecting both immunocompetent and immunocompromised patients. However, it is often unrecognized due to a lack of specific signs and symptoms. It has only rarely been reported to cause small bowel obstruction, during which surgical treatment was nearly always necessary. Little is known about the usefulness of endoscopic therapy in gastrointestinal histoplasmosis associated strictures. We report the case of a 32-year-old man with a history of hyperimmunoglobulin M syndrome who presented with small bowel obstruction secondary to disseminated gastrointestinal histoplasmosis...
January 16, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29318565/a-case-of-severe-stenosis-of-hepatic-veins-and-inferior-vena-cava-with-stomal-variceal-bleeding-induced-by-oxaliplatin-based-chemotherapy
#2
Hayato Yamaguchi, Yoshihiro Furuichi, Yoshitaka Kasai, Hirohito Takeuchi, Yuu Yoshimasu, Katsutoshi Sugimoto, Ikuo Nakamura, Takao Itoi
A 27-year-old woman with colon cancer and liver metastasis was referred to our hospital. Colectomy and colostomy were performed to improve her ileus. Following 13 sessions of oxaliplatin-based chemotherapy (OC) with mFOLFOX6 + bevacizumab, thrombocytopenia and frequent peristomal bleeding occurred. Computed tomography showed severe ascites, splenomegaly, significant collateral veins around the stoma, and severe stenosis of the hepatic veins (HV) and inferior vena cava (IVC). Ultrasound elastography showed high liver (and spleen) stiffness values...
January 9, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29305822/large-cell-neuroendocrine-carcinoma-arising-from-a-gastritis-cystica-polyposa
#3
Ryusaku Kusunoki, Hirofumi Fujishiro, Yuji Onoda, Shinsuke Suemitsu, Aya Fujiwara, Kousuke Tsukano, Satoshi Kotani, Daisuke Kuroki, Sayaka Ogawa, Satoshi Yamanouchi, Masahito Aimi, Satoko Ito, Youichi Miyaoka, Tatsuya Miyake, Naruaki Kohge, Tomonori Imaoka, Michio Takamura, Hideyuki Ohnuma, Shunji Ishihara, Yoshikazu Kinoshita
Gastritis cystica polyposa is a polypoid lesion that arises from the gastric mucosa at the gastrojejunal anastomotic site and is characterized by cystic dilation of the gastric glands. A 78-year-old man who underwent distal gastrectomy for a gastric ulcer with Billroth II reconstruction approximately 40 years previously, exhibited a gastritis cystica polyposa at the anastomotic site. Ulceration was observed on an annual endoscopic examination. Endoscopic ultrasonography revealed a submucosal hypoechoic mass with multiple cystic lesions...
January 5, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29302921/isolated-breast-metastasis-from-gastric-cancer-in-a-male-patient
#4
Hirokazu Kubo, Tetsuya Shimizu, Hitoshi Sekido, Goro Matsuda, Kazuhisa Takeda, Akira Watanabe, Risa Sakamoto, Yuji Yamamoto, Junya Toyoda, Hitoshi Niino
A 72-year-old man underwent total gastrectomy for gastric cancer (por2, T3, N2, Stage IIIA). Eleven courses of postoperative chemotherapy with TS-1 (tegafur/gimeracil/oteracil) were administered. Five months after surgery, the serum carcinoembryonic antigen value was slightly elevated. However, computed tomography did not reveal any metastatic lesions in other organs. Two years after surgery, the patient felt a mass in the left mammary. A 2-cm tumor was palpable in the central portion of the breast. Ultrasonography revealed a hypoechoic tumor, which was Class 3 on aspiration biopsy cytological examination...
January 4, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29285689/gut-microbiota-in-the-pathogenesis-of-inflammatory-bowel-disease
#5
REVIEW
Atsushi Nishida, Ryo Inoue, Osamu Inatomi, Shigeki Bamba, Yuji Naito, Akira Andoh
Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is a chronic and relapsing inflammatory disorder of the intestine. Although its incidence is increasing globally, the precise etiology remains unclear and a cure for IBD has yet to be discovered. The most accepted hypothesis of IBD pathogenesis is that complex interactions between genetics, environmental factors, and the host immune system lead to aberrant immune responses and chronic intestinal inflammation. The human gut harbors a complex and abundant aggregation of microbes, collectively referred to as the gut microbiota...
December 29, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29285688/pancreatoblastoma-an-unusual-diagnosis-in-an-adult-patient
#6
Gonçalo Nunes, Hélder Coelho, Marta Patita, Rita Barosa, Pedro Pinto Marques, Lídia Roque Ramos, Maria José Brito, Aurora Tomaz, Jorge Fonseca
The authors describe a 31-year-old man admitted due to progressive weight loss, diarrhea and massive hepatomegaly. Laboratory data showed anemia (haemoglobin 11.7 g/dl), abnormal liver tests (total bilirubin 1.4 g/dl, aspartate aminotransferase 70 U/l, alanine aminotransferase 37 U/l and alkaline phosphatase 520 U/l). Abdominal ultrasound (US) displayed a large heterogeneous liver with a segment IV 25 mm nodule. Magnetic resonance revealed a 4 cm pancreatic tail mass and several liver nodules consistent with metastasis...
December 28, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29280097/current-treatment-paradigms-in-pediatric-short-bowel-syndrome
#7
REVIEW
Raghav Chandra, Anil Kesavan
Pediatric short bowel syndrome (SBS) is a serious condition which occurs in children with congenital or acquired reduction in length of the small intestine. SBS results in excessive fluid loss, nutrient malabsorption, electrolyte abnormalities, increased susceptibility to infections, parenteral nutrition associated complications and affects weight gain and growth. In children, SBS is debilitating and uniformly fatal without treatment. The primary goal of treatment is to restore enteral autonomy and reduce long-term dependence on parenteral support by increasing the absorptive potential of the remnant intestine...
December 26, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29270782/a-case-of-pancreatic-neuroendocrine-tumor-with-multiple-cystic-components-of-various-sizes
#8
Makiko Yasumoto, Yoshinobu Okabe, Gen Sugiyama, Yoshiki Naito, Masamichi Nakayama, Toru Hisaka, Hiroto Ishikawa, Hiroyuki Horiuchi, Yukiko Kunou, Tomoyuki Ushijima, Yusuke Ishida, Osamu Tsuruta, Takuji Torimura
The patient was a 51-year-old woman who, while undergoing a thorough health checkup, was found to have a tumor (measuring 60 mm in diameter) in the tail of the pancreas by abdominal ultrasonography. Contrast-enhanced computed tomography revealed delayed contrast enhancement; the tumor also contained numerous low-absorption areas showing poor contrast enhancement. On magnetic resonance imaging, the tumor was visualized as having high signal intensity areas inside the tumor on T2-weighted images. Positron emission tomography revealed an abnormal accumulation in the area corresponding to the tumor...
December 21, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29264833/a-case-of-superficial-esophageal-cancer-invading-into-the-submucosa-following-ductal-involvement-with-microinvasion
#9
Yugo Suzuki, Toshiro Iizuka, Naoko Inoshita, Daisuke Kikuchi, Shu Hoteya, Harushi Udagawa
Microinvasion is considered one reason for diagnostic discrepancies among preoperative diagnostic modalities. Stromal invasion developing from ductal involvement is often observed in such cases. Herein, we present a case of superficial esophageal cancer with ductal involvement and microinvasion around it. The steep concavity with dot-like microvessels in the center of a protruded lesion was presented by endoscopic observation, which was lead to the diagnostic discrepancy between magnified endoscopy and endoscopic ultrasound...
December 20, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29230642/a-case-of-a-protruded-lesion-formed-by-a-poorly-differentiated-intramucosal-adenocarcinoma-of-the-stomach-an-immunohistochemical-analysis
#10
Keiichiro Nakajo, Yasuhiro Oono, Takeshi Kuwata, Tomonori Yano
A 70-year-old woman underwent upper gastrointestinal endoscopy and was found to have a 25-mm protruded lesion in the gastric body. A biopsy revealed malignant cells. Endoscopic submucosal dissection was performed. Histopathologically, the tumor was mainly composed of poorly differentiated adenocarcinoma (PDA), while moderately differentiated adenocarcinoma was observed on its superficial layer. The tumor was located within the mucosal layer. PDAs rarely form a protruded lesion. Here, the presence of a moderately differentiated adenocarcinoma element in the superficial layer of the tumor might have protected the tumor cells from erosion, and solid proliferation of the PDA also contributed to its outward growth...
December 11, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29222736/usefulness-and-limitations-of-dual-layer-spectral-detector-computed-tomography-for-diagnosing-biliary-stones-not-detected-by-conventional-computed-tomography-a-report-of-three-cases
#11
Hirokazu Saito, Kana Noda, Koji Ogasawara, Shutaro Atsuji, Hiroko Takaoka, Hiroo Kajihara, Jiro Nasu, Shoji Morishita, Ikuo Matsushita, Kazuhiro Katahira
Computed tomography (CT) is useful for diagnosing biliary stones. However, the presence of stones not detected by conventional CT, such as iso-dense stones with CT numbers similar to those of bile or small stones, is problematic. Although conventional CT provides only 120-kVp images corresponding to CT numbers at approximately 70 keV, dual-layer spectral detector CT uses one X-ray source and dual-layer detectors to collect low- and high-energy data simultaneously; retrospective spectral analysis, including virtual monochromatic images with photon energy levels of 40-200 keV, material decomposition images, and spectral curves, can be immediately performed on demand...
December 8, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29222735/delayed-perforation-after-endoscopic-submucosal-dissection-treated-successfully-by-temporary-stent-placement
#12
Masami Omae, Magnus Konradsson, Francisco Baldaque-Silva
A 71-year-old male patient with a long-segment (C10M12) Barrett's esophagus harboring multifocal high-grade dysplasia was referred to our clinic. After a multidisciplinary team conference and the patient's informed consent, an endoscopic submucosal dissection (ESD) was performed with resection of 4/5 of the esophageal circumference along 12 cm, without any complications during or immediately after the procedure. In the day after the ESD, the patient presented suddenly with dyspnea and subcutaneous emphysema in the neck and chest...
December 8, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29218566/gastric-neuroendocrine-tumor-arising-from-heterotopic-pancreas
#13
Takehiro Tanaka, Rika Omote, Noriko Okazaki, Hiroyuki Yanai, Tadashi Yoshino
There are few English reports on secondary tumors from heterotopic pancreas. Here, we describe a case of gastric neuroendocrine tumor (NET) arising from heterotopic pancreas. A 72-year-old woman underwent esophagogastroduodenoscopy as part of a general health check-up. An endoscopic examination revealed a submucosal tumor on the greater curvature of the gastric body. Laparoscopic and endoscopic cooperative surgery was performed. Histological diagnosis concluded that it was a Grade 1 NET arising from heterotopic pancreas...
December 7, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29204849/human-intestinal-spirochetosis-mimicking-ulcerative-colitis
#14
Shin Nishii, Masaaki Higashiyama, Sho Ogata, Shunsuke Komoto, Suguru Ito, Akinori Mizoguchi, Hisato Terada, Hirotaka Furuhashi, Takeshi Takajo, Kazuhiko Shirakabe, Chikako Watanabe, Kengo Tomita, Shigeaki Nagao, Soichiro Miura, Ryota Hokari
Human intestinal spirochetosis (HIS) is a colorectal infection caused by the Brachyspira species of intestinal spirochetes, whose pathogenicity in humans remains unclear owing to the lack of or mild symptoms. We monitored the 5-year clinical course of a woman diagnosed with HIS in whom ulcerative colitis (UC) had been suspected. Following a positive fecal occult blood test, she underwent a colonoscopic examination at a local clinic where she was diagnosed with "right-sided" UC concomitant with incidentally detected HIS, and was referred to our hospital...
December 4, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29196972/proximal-total-splenic-artery-embolization-for-refractory-hepatic-encephalopathy
#15
Harufumi Maki, Junichi Kaneko, Junichi Arita, Nobuhisa Akamatsu, Yoshihiro Sakamoto, Kiyoshi Hasegawa, Sumihito Tamura, Hidemasa Takao, Eisuke Shibata, Norihiro Kokudo
A Japanese woman with a history of Kasai operation for biliary atresia had living-donor liver transplantation at the age of 22. The first episode of refractory HE and late cellular rejection was treated by a high dose of methylprednisolone. The second episode of refractory HE was treated by balloon-occluded retrograde transvenous obliteration for a spleno-renal shunt. However, the third episode of refractory HE occurred 11 years after liver transplantation. The liver cirrhosis and hypersplenism were present with a Child-Pugh score of C-10...
December 1, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29188552/intrahepatic-subcapsular-biloma-after-endoscopic-retrograde-cholangiopancreatography-treated-by-endoscopic-biliary-drainage
#16
Hiroaki Igarashi, Hiroko Yamashita, Kiyoshi Tsuchiya, Dai Sugimoto, Itsuro Ogata
Several major complications from endoscopic retrograde cholangiopancreatography (ERCP), including pancreatitis, cholangitis, and hemorrhage have been discussed in detail; however, a few uncommon but severe complications have been reported. We encountered an unusual case of post-ERCP intrahepatic subcapsular biloma. An 89-year-old woman with a 25-mm mass located at the hepatic hilum, suggestive of cholangiocarcinoma, underwent ERCP which demonstrated complete stricture of the common hepatic duct. Subsequently, two plastic stents were placed from the common bile duct to the right and left intrahepatic branches...
November 29, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29181738/long-term-survival-after-multidisciplinary-therapy-for-brain-metastases-from-asymptomatic-esophageal-adenocarcinoma
#17
Takeshi Matsutani, Nobutoshi Hagiwara, Tsutomu Nomura, Itsuo Fujita, Yoshikazu Kanazawa, Daisuke Kakinuma, Akihisa Matsuda, Eiji Uchida
Asymptomatic T1 (invaded submucosa) esophageal carcinoma rarely metastasizes to the brain. A 53-year-old Japanese man complaining of right hemiparesis and convulsion was admitted to our hospital. Brain imaging demonstrated a ring-like, enhanced brain tumor in the left parietal lobe. The pathological findings of the resected tumor were consistent with a metastatic adenocarcinoma from the gastrointestinal tract. Additional examinations revealed an elevated-type tumor in the lower third of the thoracic esophagus...
November 27, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29168104/safe-use-of-infliximab-for-the-treatment-of-severe-perianal-crohn-s-disease-after-diagnosis-and-treatment-of-lymphoma
#18
Carlos Bernardes, Pedro Russo, Diana Carvalho, Joana Saiote, Jaime Ramos
Inflammatory bowel disease is associated with an increased likelihood of developing lymphoma. However, it is still controversial if this risk may be attributed to the disease itself or rather represents an effect of immunosuppressive treatment. Although tumor necrosis factor alpha (TNFα) is a key cytokine for cancer immunosurveillance, the potential relationship between anti-TNFα agents and the pathogenesis of lymphoproliferative disorders remains unclear. Here, we describe the case of a patient with severe perianal Crohn's disease, treated with infliximab monotherapy, whose unusual presentation with acute groin pain required surgical intervention and led to the diagnosis of diffuse large B-cell lymphoma...
November 22, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29164476/diverticular-colitis-with-progression-to-ulcerative-colitis-after-sigmoidectomy
#19
Atsuyo Ikeda, Tsunekazu Mizushima, Yutaro Egashira, Hidekazu Takahashi, Norikatsu Miyoshi, Naotsugu Haraguchi, Taishi Hata, Chu Matsuda, Yuichiro Doki, Masaki Mori
Diverticular colitis is chronic inflammation of the colon where diverticula are present. The endoscopic and histopathological findings of this disease are sometimes similar to those of ulcerative colitis, and several reports describe cases of diverticular colitis that progressed to typical ulcerative colitis. A 77-year-old woman with intramesenteric penetration of the sigmoid diverticulum underwent low anterior resection. One month later, the patient experienced anastomotic leakage, and transverse colostomy was performed...
November 21, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29159718/genetics-and-epigenetics-in-the-pathogenesis-of-primary-biliary-cholangitis
#20
REVIEW
Satoru Joshita, Takeji Umemura, Eiji Tanaka, Masao Ota
Primary biliary cholangitis (PBC) is a chronic, slowly progressive cholestatic autoimmune liver disease predominantly afflicting women. PBC is characterized by the presence of disease-specific antimitochondrial antibodies and the histological destruction of intrahepatic bile ducts, which eventually lead to cirrhosis and hepatic failure. Fortunately, ursodeoxycholic acid therapy has improved the outcome of the vast majority of PBC cases. Although the etiology of PBC has not yet been elucidated, human leukocyte antigen (HLA) class II alleles have been consistently associated with disease onset for decades...
November 20, 2017: Clinical Journal of Gastroenterology
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