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Clinical Medicine Insights. Gastroenterology

Konstantinos Triantafyllou, Vasilios Papadopoulos, Theodoros Emanouil, Paraskevas Gkolfakis, Vasileia Damaskou, Georgios Tziatzios, Ioannis G Panayiotides, Irene Vafiadis, Spiros D Ladas
INTRODUCTION: We evaluated the effect of Helicobacter pylori (HP) eradication on p53, cyclin D1 expression, and cell proliferation in gastric mucosa. MATERIALS AND METHODS: We assessed p53, cyclin D1, and ki67 immunoexpression in gastric mucosa from 31 HP chronic gastritis patients and 12 controls. Reassessment was performed 6 months after successful HP eradication. RESULTS: Successful eradication resulted in significant decrease of p53 (1...
2016: Clinical Medicine Insights. Gastroenterology
Jonathan Soldera, Silvana Sartori Balbinot, Raul Angelo Balbinot, Andreza Gautério Cavalcanti
Each year, hepatocellular carcinoma is diagnosed in more than half a million people worldwide and it is the fifth most common cancer in men and the seventh most common cancer in women. This article reviews the Barcelona-Clínic Liver Cancer protocol for the diagnosis, staging, and treatment of this disease, and four cases are presented for the discussion of the therapeutic approach. Understanding the diagnostic and therapeutic approaches to this disease is essential, especially if we keep in mind the quintessential basics of prevention and early detection...
2016: Clinical Medicine Insights. Gastroenterology
Nikhil Sonthalia, Samit S Jain, Ravindra G Surude, Vinay B Pawar, Suhas Udgirkar, Pravin M Rathi
Esophageal squamous cell carcinoma (ESCC) is the commonest primary malignant esophageal tumor, which typically presents as endoscopically visible surface mucosal ulcerations, irregularities, or polyploidal masses. We here report a rare case of primary ESCC with completely intramural growth under a normal looking intact nondysplastic surface squamous epithelium disguising as a submucosal tumor. Upper gastrointestinal endoscopy-guided mucosal biopsy was negative for malignancy. Endoscopic ultrasound (EUS) revealed a heteroechoic solid mass originating from the muscularis propria of the distal esophagus...
2016: Clinical Medicine Insights. Gastroenterology
Maria Cappello, Gaetano Cristian Morreale
In the past, laboratory tests were considered of limited value in Crohn's disease (CD). In the era of biologics, laboratory tests have become essential to evaluate the inflammatory burden of the disease (C-reactive protein, fecal calprotectin) since symptoms-based scores are subjective, to predict the response to pharmacological options and the risk of relapse, to discriminate CD from ulcerative colitis, to select candidates to anti-tumor necrosis factors [screening tests looking for hepatitis B virus and hepatitis C virus status and latent tuberculosis], to assess the risk of adverse events (testing for thiopurine metabolites and thiopurine-methyltransferase activity), and to personalize and optimize therapy (therapeutic drug monitoring)...
2016: Clinical Medicine Insights. Gastroenterology
Maria Cappello, Gaetano C Morreale, Anna Licata
Celiac sprue is a chronic disease, which usually occurs in children and young adults. However, it can develop in any age group, and the prevalence is increasing even in the elderly population. The atypical patterns of clinical presentation in this age group sometimes can cause a delay in diagnosis. Given the lower sensitivity and specificity of serological tests in the aged population, clinical suspect often arises in the presence of complications (autoimmune disorders, fractures, and finally, malignancy) and must be supported by endoscopic and imaging tools...
2016: Clinical Medicine Insights. Gastroenterology
Mohammad Taghi Safari, Mohammad Bager Miri, Shahram Ebadi, Shabnam Shahrokh, Amir Houshang Mohammad Alizadeh
Acute recurrent pancreatitis (ARP) is defined as more than two attacks of acute pancreatitis with complete or almost complete resolution of symptoms and signs of pancreatitis between episodes. The initial evaluation fails to detect the cause of ARP in 10%-30% of patients, whose condition is classified as idiopathic ARP. Endoscopic ultrasound (EUS) has gained increasing attention as a useful imaging modality for the pancreas and the extrahepatic biliary tree. The close proximity of the pancreas to the digestive tract allows EUS to obtain detailed images of this organ...
2016: Clinical Medicine Insights. Gastroenterology
Edmund Leung, Simon Bramhall, Prajeesh Kumar, Moustafa Mourad, Amdad Ahmed
INTRODUCTION: Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality. METHOD: We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on "PubMed" as a search platform using the keywords "foramen of Winslow" and "hernia". CASE SUMMARY: A 66-year-old man presented acutely with severe epigastric pain and vomiting...
2016: Clinical Medicine Insights. Gastroenterology
Aditi Kumar, Daniel Wheatley, Amar Puttanna
Primary sclerosing cholangitis is a chronic immune-mediated liver disease. Though rare, it poses several clinical concerns for the managing physician. There are currently limited therapeutic options in the management of the condition and weak evidence base behind them. Endoscopic intervention is limited to those patients with obstructing stricture-related disease, and even liver transplantation has a risk of disease recurrence. Surveillance for inflammatory bowel disorders, metabolic bone disease, and malignancy is paramount when managing such patients...
2016: Clinical Medicine Insights. Gastroenterology
Vishnu Prasad Nelamangala Ramakrishnaiah, Somanath Malage, G S Sreenath, Sudhakar Kotlapati, Sunu Cyriac
Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient...
2016: Clinical Medicine Insights. Gastroenterology
Monika Vyas, Xiu Yang, Xuchen Zhang
Gastric polyps are frequently encountered on endoscopic examinations. While many of these represent true epithelial lesions, some of the polyps may result from underlying stromal or lymphoid proliferations or even heterotopic tissue. Histologic examination is essential for accurate typing of the polyps to predict malignant potential and underlying possible genetic abnormalities. The focus of this review is on gastric hamartomatous polyps, which are relatively rare and diagnostically challenging. Though most of the gastric hamartomatous polyps are benign, certain types are associated with increased malignant potential...
2016: Clinical Medicine Insights. Gastroenterology
Atsushi Imagawa, Keiko Takeuchi, Kozue Suto
Endoscopic image of achalasia usually shows dilated esophageal cavity with retained liquids and foods. Recently, "pinstripe pattern" (PSP) in the case of achalasia patient was reported as an endoscopic image of the indicator for early detection of achalasia. The typical endoscopic image of PSP can be recognized in this case.
2016: Clinical Medicine Insights. Gastroenterology
Yasumasa Matuso, Hiroshi Yasuda, Midori Suzuki, Shinya Ishigooka, Shun-Ichiro Ozawa, Masaki Yamashita, Hiroyuki Yamamoto, Fumio Itoh
Diverticulum of the horizontal portion of the duodenum is a rare cause of upper gastrointestinal (GI) bleeding. Since it is difficult to access the horizontal portion of the duodenum by standard upper GI endoscopy, only a very few cases of endoscopic hemostasis have been reported. Herein, we report a case of diverticular bleeding from the horizontal portion of the duodenum for which hemostasis was achieved using a small-caliber colonoscope, which has an insertion part designed with a passive-bending function/high-force transmission and a transparent tip hood...
2015: Clinical Medicine Insights. Gastroenterology
Ryan Marshall, Ian Taylor, Christopher Lahr, Thomas L Abell, Ingrid Espinoza, Nitin K Gupta, Christian R Gomez
Crohn's disease and ulcerative colitis are the primary inflammatory bowel diseases (IBDs) affecting the gastrointestinal tract. The current therapy aims at decreasing inflammation and reducing symptoms. This typically requires immune suppression by steroids, thiopurines, methotrexate, or tumor necrosis factor inhibitors. Patients may be unreceptive to medical therapy, and some may discontinue the treatment due to adverse effects. Noninvasive, transcutaneous vagus nerve stimulation (VNS) is currently used as a treatment for depression and epilepsy, and it is being investigated for the treatment of conditions such as multiple sclerosis, migraines, and Alzheimer's disease...
2015: Clinical Medicine Insights. Gastroenterology
Sunmin Lee, Shumenghui Zhai, Guo Yolanda Zhang, Xiang S Ma, Xiaoxiao Lu, Yin Tan, Philip Siu, Brenda Seals, Grace X Ma
BACKGROUND: Hepatitis C virus (HCV) is a major cause of chronic liver disease and cancer. Vietnamese Americans are at high risk of HCV infection, with men having the highest US incidence of liver cancer. This study examines an intervention to improve HCV knowledge among Vietnamese Americans. STUDY: Seven Vietnamese community-based organizations in Pennsylvania and New Jersey recruited a total of 306 Vietnamese participants from 2010 to 2011. RESULTS: Average knowledge scores for pretest and posttest were 3...
2015: Clinical Medicine Insights. Gastroenterology
Olga Y Korolkova, Jeremy N Myers, Samuel T Pellom, Li Wang, Amosy E M'Koma
BACKGROUND: As accessible diagnostic approaches fail to differentiate between ulcerative colitis (UC) and Crohn's colitis (CC) in one-third of patients with predominantly colonic inflammatory bowel disease (IBD), leading to inappropriate therapy, we aim to investigate the serum cytokine levels in these patients in search of molecular biometric markers delineating UC from CC. METHODS: We measured 38 cytokines, chemokines, and growth factors using magnetic-bead-based multiplex immunoassay in 25 UC patients, 28 CC patients, and 30 controls...
2015: Clinical Medicine Insights. Gastroenterology
Amir Houshang Mohammad Alizadeh, Esmaeil Shamsi Afzali, Catherine Behzad, Mirhadi Mousavi, Dariush Mirsattari, Siavash Zafar Doagoo, Mohammad Reza Zali
BACKGROUND: Pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), resulting in substantial morbidity and occasional mortality. There are notable controversies and conflicting reports about risk factors of post-ERCP pancreatitis (PEP). AIM: To evaluate the potential risk factors for PEP at a referral tertiary center, as a sample of the Iranian population. MATERIALS AND METHODS: Baseline characteristics and clinical as well as paraclinical information of 780 patients undergoing diagnostic and therapeutic ERCP at Taleghani hospital in Tehran between 2008 and 2012 were reviewed...
2015: Clinical Medicine Insights. Gastroenterology
Vinaya Gaduputi, Rakhee Ippili, Sailaja Sakam, Hassan Tariq, Masooma Niazi, Amir A Rahnemai-Azar, Sridhar Chilimuri
We report this case of a 63-year-old woman who presented with progressive illness characterized by abdominal pain, weight loss, anorexia, generalized weakness, and fatigue. The patient was found to have obstructive jaundice with multiple mass lesions in the liver, spleen, and kidney on computed tomography scan of abdomen. She developed cholangitis, necessitating an emergent endoscopic retrograde cholangiopancreatography with biliary stenting and decompression. Later, she was found to have hepatic sarcoidosis on wedge biopsy of the liver...
2015: Clinical Medicine Insights. Gastroenterology
Sotirios N Anastasiadis, Olga I Giouleme, Georgios S Germanidis, Themistoklis G Vasiliadis
Relative adrenal insufficiency (RAI) was demonstrated in patients with cirrhosis and liver failure. A relationship appears to exist between the severity of the liver disease and the presence of RAI. Neither the mechanism nor the exact prevalence of RAI is fully understood. There is though a hypothesis that low high-density lipoprotein (HDL) levels in this group of patients may be responsible for the insufficiency of cortisol. Several questions also arise about the way and the kind of cortisol (total cortisol, free cortisol, or even salivary cortisol) that should be measured...
2015: Clinical Medicine Insights. Gastroenterology
Larry Good, Bruce P Burnett
AIM: Chronic diarrhea with fecal incontinence (FI) is a severe, underreported, and intractable problem in many patients for which limited pharmaceutical options exist. METHODS: A retrospective case history was collected after the administration of a prescription medical food composed of serum-derived bovine immunoglobulin/protein isolate (SBI) at 5 g once daily in a patient with chronic mesenteric ischemia (CMI) for chronic loose, frequent, and urgent stools. The patient was an 84-year-old white male with a 20-year history of progressively worsening chronic diarrhea with six to eight watery stools per day (Bristol Stool Form Scale, Type 7), urgency, nocturnal diarrhea, FI, and postprandial abdominal discomfort before administration of SBI...
2015: Clinical Medicine Insights. Gastroenterology
Sameh Roshdy, Osama Hussein, Ahmed Abdallah, Khaled Abdel-Wahab, Ahmed Senbel
INTRODUCTION: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin. METHODS: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated. RESULTS: The study population included 13 male and 6 female patients with a mean age of 55 years...
2015: Clinical Medicine Insights. Gastroenterology
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