Double-balloon endoscopy WAS effective in diagnosing small intestinal duplication: a case report.

INTRODUCTION: Ileal duplications are encountered infrequently in adults, because symptoms including abdominal pain, intussusception, hemorrhage, and perforation usually present in early childhood. In this report, we present an adult case of ileal duplication that was revealed by double-balloon endoscopy (DBE). CASE DESCRIPTION: A 73-year-old Japanese man presented with anemia and melena. Anal DBE detected the narrow opening of an extra lumen in the ileum about 100 cm proximal to the ileocecal valve. Enteroclysis via DBE showed a 5-cm-long ileal diverticulum-like structure at the mesenteric side of the ileum. No ectopic gastric mucosa was detected by technetium-99m pertechnetate scintigraphy. The final diagnosis was ileal duplication. DISCUSSION AND EVALUATION: This is the first report of tubular ileal duplication diagnosed by using DBE. The small intestinal duplication opening was not detected by using VCE and plane CT in this case, but was found by using DBE. CONCLUSIONS: The present case demonstrates that DBE was useful in the diagnosis of an adult small intestinal duplication that was not visualized by other modalities.

A multicenter study on the prevalence of eosinophilic esophagitis and PPI-responsive esophageal eosinophilic infiltration.

OBJECTIVE: Eosinophilic esophagitis (EoE) is diagnosed by the presence of dysphagia and intraepithelial eosinophilic infiltration of ≥15 per high-power field (HPF). EoE should be distinguished from proton pump inhibitor-responsive esophageal eosinophilic infiltration (PPI-R EEI) in patients that are responsive to PPI treatment. The aim of this study was to determine the prevalence of EoE and PPI-R EEI in Japanese patients in a multicenter study. METHODS: Ten hospitals participated in this study. Esophageal biopsy was performed when the patients had typical EoE symptoms or when endoscopic findings revealed a typical EoE appearance. EEI was defined as the intraepithelial eosinophilic infiltration of ≥15 per HPF. Patients with EEI received rabeprazole for 8 weeks to distinguish EoE from PPI-R EEI. RESULTS: A total of 13,634 subjects that underwent upper gastrointestinal endoscopy because of further examination or as a routine checkup were enrolled. Seventy-one (0.5%) patients suspected with EoE were examined by biopsy. A histological examination of 7 (9.9%) cases revealed EEI. Two of these 7 patients showed no symptoms and the other 5 were treated with PPI. Two (0.01%) patients were diagnosed with EoE and 3 (0.02%) with PPI-R EEI. CONCLUSION: EoE and PPI-R EEI were rare in Japanese patients that underwent upper gastrointestinal endoscopy.

[Prevalence, diagnosis and treatment of extraesophageal manifestations of GERD].

Gastroesophageal reflux disease (GERD) is associated with a variety of extraesophageal symptoms including asthma, chronic cough, laryngeal disorders, and various ENT symptoms. Recent studies suggest that GERD underlies or contributes to chronic sinusitis, chronic otitis media, dental erosion, and obstructive sleep apnea syndrome (OSAS). In this article, we review the prevalence, diagnosis, and treatment of extraesophageal symptoms and including Montreal definition, a new definition and classification of GERD by an International Consensus Group.

[Rumination syndrome in an adult with normal intelligence].

A 32-year-old woman visited our department because of repeated regurgitation of food, and was diagnosed with rumination syndrome based on possession of symptoms typical for it. Although rumination syndrome is classified as a functional esophageal disorder according to the Rome II criteria, it is not well known in Japan, and there have been no previous reports of it in an adult with normal intelligence. Since patients with rumination syndrome are often misdiagnosed and receive unnecessary treatment, awareness of it by physicians is important.