Asunto(s)
Ataxia/etiología , Enfermedad Celíaca/complicaciones , Dieta Sin Gluten , Leucoencefalopatías/etiología , Trastornos Mentales/etiología , Biopsia , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/psicología , Reacciones Cruzadas , Duodeno/patología , Femenino , Deficiencia de Ácido Fólico/complicaciones , Deficiencia de Ácido Fólico/tratamiento farmacológico , Lóbulo Frontal/fisiopatología , Humanos , Deficiencia de IgA/complicaciones , Hierro/uso terapéutico , Deficiencias de Hierro , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/fisiopatología , Leucoencefalopatías/psicología , Imagen por Resonancia Magnética , Trastornos Mentales/fisiopatología , Células de Purkinje/inmunología , Temblor/etiología , Adulto JovenAsunto(s)
Antihipertensivos/efectos adversos , Imidazoles/efectos adversos , Síndromes de Malabsorción/inducido químicamente , Tetrazoles/efectos adversos , Anciano , Antihipertensivos/uso terapéutico , Atrofia , Enfermedad Celíaca/diagnóstico , Enfermedad Crónica , Diagnóstico Diferencial , Diarrea/inducido químicamente , Diarrea/patología , Duodeno/inmunología , Duodeno/patología , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Imidazoles/uso terapéutico , Inmunofenotipificación , Mucosa Intestinal/ultraestructura , Subgrupos Linfocitarios/inmunología , Síndromes de Malabsorción/diagnóstico , Síndromes de Malabsorción/patología , Masculino , Microvellosidades/patología , Tetrazoles/uso terapéuticoAsunto(s)
Mucosa Intestinal/ultraestructura , Síndromes de Malabsorción/clasificación , Microvellosidades/patología , Atrofia , Autoanticuerpos/sangre , Enfermedad Celíaca/diagnóstico , Enfermedad Crónica , Esprue Colágeno/diagnóstico , Esprue Colágeno/patología , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/patología , Diagnóstico Diferencial , Diarrea/etiología , Duodeno/patología , Enteritis/diagnóstico , Enteritis/patología , Enterocitos/inmunología , Eosinofilia/diagnóstico , Eosinofilia/patología , Gastritis/diagnóstico , Gastritis/patología , Humanos , Imidazoles/efectos adversos , Síndromes de Malabsorción/inducido químicamente , Síndromes de Malabsorción/diagnóstico , Síndromes de Malabsorción/patología , Poliendocrinopatías Autoinmunes/diagnóstico , Poliendocrinopatías Autoinmunes/patología , Poliendocrinopatías Autoinmunes/fisiopatología , Tetrazoles/efectos adversosRESUMEN
Collagenous sprue is a rare disease of the small bowel characterized by mucosal atrophy and excessive subepithelial collagen deposition. The etiology remains unclear and the diagnosis is based upon patient´s clinical picture and anatomopathological findings. Clinically, collagenous sprue is characterized by persistent diarrhoea, severe malabsorption, multiple nutrient deficiencies and progressive weight loss. Differential diagnosis includes celiac disease, which is mandatory to rule out because of their frequent association. Glutenfree diet is the first therapeutic step, but it usually is not effective. However, recent studies show high success rates with immunomodulators, mainly corticosteroids. We report the case of a patient presenting with chronic diarrhea and severe malabsorption who was diagnosed with collagenous sprue, with no response to gluten free diet, but with excellent response to budesonida.
Asunto(s)
Esprue Colágeno/diagnóstico , Anciano de 80 o más Años , Enfermedad Crónica , Esprue Colágeno/complicaciones , Tejido Conectivo , Diarrea/etiología , Humanos , MasculinoAsunto(s)
Enfermedades del Colágeno/complicaciones , Diarrea/etiología , Síndromes de Malabsorción/etiología , Corticoesteroides/uso terapéutico , Atrofia , Enfermedad Celíaca/diagnóstico , Enfermedad Crónica , Colágeno/análisis , Enfermedades del Colágeno/diagnóstico , Enfermedades del Colágeno/inmunología , Enfermedades del Colágeno/patología , Neoplasias Colorrectales/complicaciones , Terapia Combinada , Diagnóstico Diferencial , Dieta Sin Gluten , Femenino , Fibrosis , Humanos , Mucosa Intestinal/química , Mucosa Intestinal/patología , Intestino Delgado/química , Intestino Delgado/patología , Síndromes de Malabsorción/diagnóstico , Síndromes de Malabsorción/epidemiología , Síndromes de Malabsorción/inmunología , Síndromes de Malabsorción/patología , Síndromes de Malabsorción/terapia , Masculino , Síndromes Paraneoplásicos/etiología , PrevalenciaRESUMEN
Coeliac disease is a permanent immunological intolerance to gluten proteins in genetically predisposed individuals. The only management is life-long strict adherence to a gluten-free diet. Unfortunately, compliance with gluten-free diet is very difficult in practice due to the widespread presence of gluten in Western diets. For this reason, about 50% of coeliacs following a gluten-free diet continue to suffer from symptoms and present with autoantibodies and/or villous atrophy while on a gluten-free diet. It is therefore important to explore new therapies to improve the management of coeliac disease. To date, five experimental therapies have been tested in randomized and controlled clinical trials. Larazotide acetate reduces the para-cellular passage of gluten to the lamina propria by preventing the opening of intercellular tight junctions. The endopeptidases ALV003 and AN-PEP break down gluten to produce less or non-toxic peptide fragments. A therapeutic vaccine is being tested with the aim of developing gluten tolerance. Finally, infection with the nematode Necator americanus and treatment with the CCR9 antagonist Traficet-EN have also been reported. While substantial progress has been made in the last few years, it is important to remember that all these investigational therapies are in research stage and are generally being considered as "adjunctive" therapies to the gluten-free diet and not as substitutes of the gluten-free diet at this point in time.
Asunto(s)
Enfermedad Celíaca/terapia , Ensayos Clínicos como Asunto , Dieta Sin Gluten , HumanosRESUMEN
Diagnosis of refractory celiac disease (CD) is based on exclusion of other disorders, persistence of malabsorptive symptoms and villous atrophy, despite a strict gluten-free diet for at least 6-12 months. Detection of alterations in the intraepithelial lymphocyte population is crucial for diagnosis. A subgroup of patients with refractory CD may develop severe complications such as enteropathy-associated T cell lymphoma (EATL). We present the case of a patient with longstanding silent CD who developed EALT, highlighting the challenge posed by the diagnosis and treatment of this entity.
Asunto(s)
Linfoma de Células T Asociado a Enteropatía/diagnóstico , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Coagulación con Láser , Síndrome de Plummer-Vinson/cirugía , Anciano de 80 o más Años , Argón , Femenino , HumanosRESUMEN
Anticonvulsant hypersensitivity syndrome is an unpredictable, potentially fatal drug reaction to aromatic anticonvulsants such as carbamazepine, phenytoin and phenobarbital. The hallmark features include fever, eosinophilia, rash and involvement of one or more internal organs. Clearly established diagnostic criteria and treatment guidelines are lacking. A high index of suspicion is required to identify this syndrome, allowing early withdrawal of the drug and avoiding re-exposure. We report an illustrative case of anticonvulsant hypersensitivity syndrome and review the published literature.
Asunto(s)
Anemia Hemolítica/inducido químicamente , Anticonvulsivantes/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Erupciones por Medicamentos/etiología , Epilepsia Parcial Compleja/tratamiento farmacológico , Epilepsia del Lóbulo Temporal/tratamiento farmacológico , Enfermedades Linfáticas/inducido químicamente , Fenitoína/efectos adversos , Adolescente , Aminas/uso terapéutico , Anticonvulsivantes/uso terapéutico , Astrocitoma/complicaciones , Astrocitoma/diagnóstico , Astrocitoma/cirugía , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Carbamazepina/administración & dosificación , Carbamazepina/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Errores Diagnósticos , Quimioterapia Combinada , Epilepsia Parcial Compleja/etiología , Epilepsia del Lóbulo Temporal/etiología , Femenino , Gabapentina , Ganglioneuroma/diagnóstico , Humanos , Giro Parahipocampal/cirugía , Fenitoína/administración & dosificación , Fenitoína/uso terapéutico , Radiocirugia , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
BACKGROUND: Permanent changes have been found in intraepithelial lymphocyte (IEL) subsets in patients with celiac disease. OBJECTIVE: The main aim of this study was to demonstrate the utility of determining CD3()/CD7(+) and T cell receptor (TCR) gamma-delta IEL subsets by flow cytometry as a diagnostic marker of adult celiac disease. PATIENTS AND METHODS: We performed a prospective study in a sample of 128 adult patients (70 with celiac disease and 58 controls). In all patients, distal duodenal biopsy was performed and IEL subsets were determined by flow cytometry. RESULTS: Patients with celiac disease showed an increase in gamma-delta IEL subsets and a decrease in CD3(-)/CD7(+) IEL subsets in comparison with the control group, independently of diet. CONCLUSIONS: The results indicate that IEL subset determination by flow cytometry could be useful to confirm diagnosis of celiac disease. IEL subsets should be investigated in diseases other than celiac disease, as well as in patients with potential or latent celiac disease.
Asunto(s)
Enfermedad Celíaca/patología , Duodeno/patología , Mucosa Intestinal/patología , Receptores de Antígenos de Linfocitos T gamma-delta/análisis , Subgrupos de Linfocitos T/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos CD7/análisis , Complejo CD3/análisis , Enfermedad Celíaca/dietoterapia , Dieta Sin Gluten , Duodenoscopía , Duodeno/inmunología , Femenino , Citometría de Flujo , Enfermedades Gastrointestinales/inmunología , Enfermedades Gastrointestinales/patología , Antígenos HLA-D/análisis , Humanos , Mucosa Intestinal/inmunología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.