Diagnosing Pollen-food Allergy Syndrome Allergologically in a Patient with Suspected Eosinophilic Gastroenteritis.

Pollen-food allergy syndrome (PFAS) consists of type I allergy to pollen and multiple food items that are cross-reactive to the pollen. PFAS typically occurs in the oral cavity and can co-occur with eosinophilic esophagitis. However, it is infrequently reported to present with symptoms of eosinophilic gastroenteritis (EGE), such as abdominal pain and eosinophilic infiltration of the gastrointestinal tract. We herein report a patient with a condition initially suspected of being EGE based on symptoms and pathological findings that was later diagnosed as PFAS associated with birch pollen. PFAS should be considered as a differential diagnosis in patients with EGE-like symptoms.

External treatment of traditional Chinese medicine for radiation enteritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Radiation enteritis (RE) is a common complication that often occurs after radiotherapy for abdominal and pelvic malignancies. RE could influence patients' quality of life seriously and it is difficult to cure by conventional treatments. A lot of studies have revealed that the external treatment of traditional Chinese medicine (TCM) for RE is a safe and economical approach, but there is no relevant systematic review. The present study performed a systematic review and meta-analysis to compare TCM external treatment and conventional treatment for RE to evaluate the effectiveness and safety of external treatment of traditional Chinese medicine in the treatment of RE. METHODS: Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wan-Fang database, VIP Chinese Science and Technique Journals Database, and the Chinese Biomedical Literature Database (CBM) were searched. The time of publication was limited from inception to April, 2021. Two reviewers independently searched for the selected articles and extract the data. The RevMan V.5.3 statistical software (Cochrane Collaboration) and Stata V.16.0 software were used to conduct the meta-analysis. RESULTS: We will show the results of this study in a peer-reviewed journal. CONCLUSION: This meta-analysis will provide reliable evidence for external treatment of TCM in the treatment of RE. INPLASY REGISTRATION NUMBER: INPLASY202140120.

Future therapies for eosinophilic gastrointestinal disorders.

OBJECTIVE: To review novel therapeutics in development for treatment of eosinophilic gastrointestinal disorders (EGIDs). DATA SOURCES: Clinical trial data (clinicaltrials.gov) and literature search on PubMed. STUDY SELECTIONS: Studies on treatment and clinical trials in EGIDs were included in this review. RESULTS: During the past decade, significant progress has been made in understanding disease mechanisms in EGIDs. As a result, a variety of novel therapeutics have been developed for treatment of these disorders. Several monoclonal antibodies against targets, including interleukin (IL) 4, IL-5, IL-13, integrins, and siglec-8, have shown promise in early trials. Novel formulations of corticosteroids are also in development. CONCLUSION: The field of EGID research has advanced rapidly, and disease-modifying therapeutics are closer to clinical application.

Sini San ameliorates duodenal mucosal barrier injury and low­grade inflammation via the CRF pathway in a rat model of functional dyspepsia.

The gut­brain interaction is associated with impaired duodenal mucosal integrity and low­grade inflammation, which have been proven to be important pathological mechanisms of functional dyspepsia (FD). Sini San (SNS) is a classical Chinese medicine used to treat FD, but its underlying mechanisms are poorly understood. The aim of the present study was to evaluate the effects of SNS on duodenal mucosal barrier injury and low­grade inflammation with FD, and to assess its potential molecular mechanisms on the brain­gut axis. FD rats were established using the iodoacetamide and tail­squeezed methods. The expression of corticotropin­releasing factor (CRF), CRF receptor 1 (CRF­R1) and CRF­R2, were determined by western blot analysis and/or immunohistochemistry (IHC). In addition, mast cell (MC) migration was assessed by IHC with an anti­tryptase antibody, and histamine concentration was quantified using ELISA. The mRNA expression levels of tryptase and protease­activated receptor 2 (PAR­2) were quantified using reverse transcription­quantitative PCR, and the protein expression levels of zona occludens protein 1 (ZO­1), junctional adhesion molecule 1 (JAM­1), ß­catenin and E­cadherin were determined via western blot analysis. It was demonstrated that the expression level of CRF was downregulated in the central nervous system and duodenum following SNS treatment, and that SNS modulated the expression of both CRF­R1 and CRF­R2. In addition, SNS suppressed MC infiltration and the activity of the tryptase/PAR­2 pathway in the duodenum. Furthermore, treatment with SNS restored the normal expression levels of ZO­1, JAM­1 and ß­catenin in FD rats. These findings suggested that the therapeutic effects of SNS on FD were achieved by restoring mucosal barrier integrity and suppressing low­grade inflammation in the duodenum, which was at least partially mediated via the CRF signaling pathway.

Eosinophilic Gastrointestinal Disorders.

Eosinophilic gastrointestinal disorders (EGID) are a group of disorders characterized by pathologic eosinophilic infiltration of the esophagus, stomach, small intestine, or colon leading to organ dysfunction and clinical symptoms (J Pediatr Gastroenterol Nutr; Spergel et al., 52: 300-306, 2011). These disorders include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), eosinophilic enteritis (EE), and eosinophilic colitis (EC). Symptoms are dependent not only on the location (organ) as well as extent (layer invasion of the bowel wall). Common symptoms of EoE include dysphagia and food impaction in adults and heartburn, abdominal pain, and vomiting in children. Common symptoms of the other EGIDs include abdominal pain, nausea, vomiting, early satiety, diarrhea, and weight loss. These disorders are considered immune-mediated chronic inflammatory disorders with strong links to food allergen triggers. Treatment strategies focus on either medical or dietary therapy. These options include not only controlling symptoms and bowel inflammation but also on identifying potential food triggers. This chapter will focus on the clinical presentation, pathophysiology, and treatment of these increasingly recognized disorders.

Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis.

Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations. We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man. The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital. Then he was misdiagnosed as having Crohn's disease in another university teaching hospital. Finally, the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn's disease by fecal microbiota transplantation. Physical examination revealed a slight distended abdomen with diffuse tenderness. Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%, as well as eosinopenia, monocytopenia and lymphocytopenia. Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon. We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations. The patient was treated by fecal microbiota transplantation combined with oral prednisone, and was free from gastrointestinal symptoms at the time when we reported his disease. This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.

Lethal cardiotoxicity, steatohepatitis, chronic pancreatitis, and acute enteritis induced by capecitabine and oxaliplatin in a 36-year-old woman.

A 36-year-old female was hospitalized with symptoms suggesting intestinal occlusion. She was diagnosed with adenocarcinoma of the ampulla of Vater (pT4N0 stage) and underwent cephalic duodenopancreatectomy 8 months ago. Five cycles of postoperative chemotherapy were administrated using capecitabine and oxaliplatin (CAPOX or XELOX), the last one being completed 1 month ago. During the present hospitalization, because of normal computed tomography and ultrasound abdominal examination, rehydration and antibiotherapy were administrated. However, 4 days after hospital admission, the patient died. At autopsy and histological examination, we found a severe myocardial sclerosis with large scarring areas, severe steatohepatitis, chronic pancreatitis with large fibrotic areas, and acute enteritis. Alcohol consumption was denied. The patient died due to associated heart, liver and pancreatic failure. This multiorgan toxicity and death following CAPOX regimen had not yet been reported in the literature. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6472150549833105.

Eosinophilic gastrointestinal disorders in infants: a Japanese case series.

BACKGROUND: Eosinophilic gastrointestinal disorders (EGIDs) are disorders characterized by primary eosinophil inflammation in the gastrointestinal tract. There are a small number of reports of eosinophil infiltration in gastrointestinal tracts presenting as EGIDs in infants. In this study, we present Japanese cases of EGIDs in infants. METHODS: Five patients diagnosed with or strongly suspected to have EGIDs in our hospital from 2008 to 2010 were reviewed. Radiographic contrast enema examinations and/or endoscopies were performed in 4 and 3 patients, respectively. RESULTS: There were patients with eosinophilic colitis (1 suspected and 2 biopsy-proven), a patient who was suspected of having allergic eosinophilic enterocolitis, and a patient with eosinophilic gastroenteritis associated with pediatric hypereosinophilic syndrome. CONCLUSIONS: The causes and clinical findings of patients with intestinal eosinophil inflammation vary. Therefore, deliberate examination and observation are important for patients with infantile EGID.

Diagnosis of small bowel radiation enteritis by capsule endoscopy.

We report a case of radiation-induced enteritis of the small bowel diagnosed by capsule endoscopy. A 67-year-old woman, who had received radiotherapy for a carcinoma of cervix 10 years ago, presented with passage of tarry stool and anaemia. The gastroscopy results were normal and the small bowel enema showed no abnormalities, but colonoscopy revealed altered blood clots in the right-sided colon and in the terminal ileum. M2A capsule endoscopy was subsequently performed that showed an ulcer and stricture at the distal ileum. The capsule, however, became lodged at this stricture site caused by the stenosis. A small bowel resection was performed to remove both the diseased section and the capsule, and the patient made an uneventful recovery.

Pelvic silicone prosthesis for prevention of radiation enteritis: US and CT features.

A patient with a pelvic silicone prosthesis is presented. The sonographic and computed tomographic features in such patients can be confusing and incorrectly interpreted unless the radiologist knows that the prosthesis had been inserted as a radioprotective device.

[The value of imaging techniques in the diagnosis of non-specific abdominal pain in young patients]. / Wertigkeit bildgebender Verfahren bei der Diagnostik unspezifischer abdomineller Beschwerden junger Patienten.

In a retrospective study the use of imaging modalities in the diagnosis of non-specific abdominal pain in patients under 31 years was evaluated. 253 patients with primarily non-specific abdominal complaints were analysed. For further investigation one of the following methods had to be applied: abdominal sonography and/or upper gastrointestinal tract roentgenograms and/or enteroclysis and/or barium enema. In 66% (167/253) of all cases abdominal pain remained non-specific. Clinical history and physical examination led to the final diagnosis in 66/86 (76.7%) of patients with pathologic findings. 21/561 (3.7%) radiographic examinations revealed abnormalities of clinical importance. In 10/253 (4%) patients the final diagnosis could be established only with the help of radiologic and/or endoscopic examinations. The low efficacy of conventional radiology justifies the demand for a stricter indication in the young patient suffering from non-specific abdominal pain.

Experimental cryptosporidiosis in calves: clinical manifestations and pathological findings.

Twenty-two calves between one and 20 days old were infected orally or by contact with cryptosporidia. Calves were maintained as either specific pathogen free, colostrum fed or sucking and were inoculated with either a bacteria free or a contaminated cryptosporidium preparation. Enteritis was characterised by depression, anorexia and diarrhoea and cryptosporidium oocysts were excreted during the clinical course of the illness. In the initial stages of the disease, cryptosporidium infestation was found throughout the small intestine; in the later stage the large intestine was also affected. Villous atrophy and fusion was present at small intestinal sites infected with cryptosporidia and lactase levels were depressed. No lesions were seen in infected large intestinal mucosa. Although the incubation period was longest (five to seven days) in calves infected by contact, there were few differences in the clinical course of disease or the pathological findings between any of the infected calves.

[Experimental demonstration of occult blood in the stool after sole abdominal irradiation or chemotherapy or a combination of both (author's transl)]. / Nachweis okkulter Stuhlblutung nach abdominaler Bestrahlung, Chemo- wie Radiochemotherapie im Experiment.

Using Heglostix-Ames test strips, it was possible with normally fed animals, to furnish evidence of occult blood in spontaneous droppings of mice. The mice were exposed either to partial irradiation encompassing the abdomen and using different exit doses between 100 R and 1100 R, or were injected intramuscularly with doses between 120 and 900 mg/kg Endoxan or, instead, 110 and 840 mg/kg Proreside. The moment of the beginning and also the duration of positive reactions could be proved to depend on the dose. In simultaneous as well as alternating radiation- and chemotherapy evidence was given of cumulation effects. Reactions were always negative in nontreated controls.

Fiberoptic pansigmoidoscopy. An evaluation and comparison with rigid sigmoidoscopy.

A flexible 60-cm fiberoptic sigmoidoscope was evaluated in 139 patients. In 120 patients flexible sigmoidoscopy was compared with routine rigid sigmoidoscopy with respect to patient tolerance, distance of inspection, procedure time, and diagnostic yield. All patients were prepared with a single cleansing enema, and given no analgesia. Despite the fact that the flexible instrument was inserted nearly 3 times as far into the colon (55 cm versus 20 cm), more patients preferred the flexible examination. Significant pathological lesions were discovered by the flexible examination in 39% of patients, whereas rigid sigmoidoscopy discovered lesions in only 13%. Fluoroscopy performed during flexible sigmoidoscopy in 19 additional patients revealed that the instrument tip had reached the descending colon or beyond in 84% of patients. There were no complications. The flexible fiberoptic pansigmoidoscope offers promise as a practical diagnostic tool for a rapid and complete examination in patients with suspected colorectal diseases.