[Three cases of severe chronic diarrhea with a rare cause and a simple therapy]. / Drei Fälle von schwerer chronischer Diarrhö mit seltener Ursache und einfacher Therapie.

We report three cases of severe olmesartan-associated chronic diarrhea with weight loss and malassimilation syndrome. Histologically, a sprue-like enteropathy was diagnosed in each case, while serological tests for celiac disease were negative. After stopping the medication, symptoms improved within a few days. Histologically, remission was documented after 3 months. Olmesartan-associated enteropathy is an underestimated entity and an important differential diagnosis in patients with chronic diarrhea.

Esophageal intramural pseudodiverticulosis: endoscopic diagnosis and therapy.

Esophageal intramural pseudodiverticulosis is a rare disease that may lead to esophageal stenosis and dysphagia. The aim of the study was to evaluate the endoscopic diagnosis, treatment and clinical course of intramural pseudodiverticulosis. We retrospectively studied endoscopic criteria of intramural pseudodiverticulitis, associated diseases, and the clinical course, particularly in patients with dysphagia because of esophageal stenosis in a period from 2002 to 2012. In 23 patients, the diagnosis was made according to endoscopic criteria. As risk factors, alcohol and tobacco consumption were present in all patients. Concomitant candida infection was present in six (26%) patients. In 12 (52%) patients esophageal stenosis was present, which was localized in the upper half of the esophagus. In 11 patients bougienage has been performed with excellent improvement of the dysphagia score from 3.7 to 1.3 (P = 0.002). However, dysphagia was recurrent in four patients with need for repeated bougienage. About half of the patients with intramural pseudodiverticulosis present with stenosis of the esophagus at the time of diagnosis. In patients with proximal esophageal stenosis and a typical risk constellation, intramural pseudodiverticulosis should be suspected. Treatment of stenosis with bougienage is effective to resolve dysphagia, but repeated bougienage may be necessary.

[Multilocular hepatic masses due to Enterobius vermicularis]. / Multilokuläre hepatische Raumforderungen durch Enterobius vermicularis.

Infestation with Enterobius vermicularis involving extraintestinal manifestation is rare. In a 50-year-old man with lower abdominal pain, computed tomography led to a suspected diagnosis of sigmoid carcinoma with liver metastasis. After ruling out colon cancer by endoscopy, laparoscopic resection of one suspected tumor nodule in the liver was performed. Histopathological examination revealed parasitic granulomas containing pinworms. Hematogenous migration was postulated in the setting of phlebitis with thrombosis of the inferior mesenteric vein.

Nodular pulmonary amyloidosis with spontaneous fatal blood aspiration.

Amyloidosis is a multisystem disease, which is characterized by the extracellular deposition of insoluble abnormal fibrils. Histological and subsequent immunohistochemical examinations are necessary for the determination of the diagnosis and the classification of the amyloid type. The most common systemic variant is immunoglobulin-derived light chain (AL) amyloidosis. However, local or organ-limited AL amyloidosis can occur. Isolated pulmonary amyloidosis is a rare condition and frequently an incidental finding at chest scans or during autopsy. Generally, it is associated with a benign prognosis. Here, we present two fatal cases, in which the cause of death was asphyxiation due to severe blood aspiration. During autopsy, several nodules were found in the lungs. Based on histological and immunohistochemical analysis, the diagnosis of an isolated nodular pulmonary AL amyloidosis lambda light chain was made. Amyloid was also present in pulmonary blood vessels, which lead to fragility and finally fatal hemorrhage.

Incidental and ablation-induced findings during upper gastrointestinal endoscopy in patients after ablation of atrial fibrillation: a retrospective study of 425 patients.

BACKGROUND: Although rare, atrioesophageal fistula is a serious and often lethal complication of radiofrequency catheter ablation in patients with atrial fibrillation (AF). Consequently, esophagogastroduodenoscopy after AF catheter ablation has been suggested to detect thermal esophageal lesions. OBJECTIVE: To report the incidence of thermal lesions and other incidental gastrointestinal (GI) abnormalities in patients with AF after radiofrequency catheter ablation. METHODS: Four hundred twenty-five (mean age 59 ± 10 years; 64% men) consecutive patients with symptomatic AF who underwent left atrial radiofrequency catheter ablation were scheduled for upper GI endoscopy 1-3 days after the procedure. Patients were asymptomatic for GI diseases, that is, exhibiting no dysphagia, heart burn, or abdominal pain. RESULTS: Pathological GI findings were observed in 328 (77%) patients and included gastral erosions (22%), esophageal erythema (21%), gastroparesis (17%), hiatal hernia (16%), reflux esophagitis (12%), thermal esophageal lesion (11%), and suspected Barrett's esophagus (5%). Biopsies were performed in 70 (17%) patients, showing gastritis (84%), Helicobacter pylori colonization (17%) and mucosa-associated lymphoid tissue (17%), esophagitis (9%), and Barrett's esophagus (4%). Further diagnostic workup or treatment was initiated in 105 (25%) patients. CONCLUSIONS: Upper GI pathologies are observed frequently in asymptomatic patients. Half of all patients have a requirement for treatment. Among the findings, thermal esophageal lesions and gastroparesis can be attributed to AF catheter ablation. The high incidence of gastroparesis is a novel finding that deserves further investigation.