A Caucasian American patient with celiac disease diagnosed in Japan and successfully treated with a gluten-free diet.

We report the case of a 33-year-old Caucasian American man diagnosed with celiac disease in Japan. He presented to a community hospital because of chronic watery diarrhea and weight loss for 6 months. The laboratory data showed low serum albumin and serum cholesterol. A colonoscopy was normal. He was referred to our hospital for further work-up. Serum tissue transglutaminase immunoglobulin A (IgA) and endomysial antibody were positive. The HLA type was DQ2. Esophagogastroduodenoscopy (EGD) revealed nodular and mosaic-patterned mucosa from the bulb to the second part of the duodenum. The histopathological findings were consistent with Marsh type 3c of the modified Marsh classification for celiac disease. The patient was instructed to follow a gluten-free diet (GFD). Six months after the initiation of the GFD, his symptom and the levels of serum albumin and cholesterol were improved, and the serum tissue transglutaminase IgA and endomysial antibody became negative. However, EGD showed little improvement. Capsule endoscopy also revealed mosaic-patterned mucosa, nodular mucosa, and scalloping of the folds of the duodenum and proximal small intestine. There was no definite improvement in histopathological findings. Collectively, the GFD was effective in this patient with celiac disease, but it should be maintained to achieve endoscopic and histopathologic healing.

[A case of adenosquamous carcinoma at the esophagogastric junction, initially diagnosed as collision carcinoma].

A 47-year-old man was found to have a type 2 tumor of the esophagogastric junction on upper gastrointestinal endoscopy. Biopsy specimens revealed squamous cell carcinoma of the esophagus and adenocarcinoma of the stomach. The preoperative diagnosis was a collision carcinoma. No distant metastases were identified on computed tomography; therefore, partial esophagectomy and gastrectomy were performed. Pathological examination of the resected specimen revealed adenosquamous carcinoma at the esophagogastric junction (TNM classification: stage IIA, T3N0M0). Adenosquamous cell carcinoma of the esophagus and stomach is rare, but that at the esophagogastric junction even rarer.

Successful treatment of ileocolic intussusception with air enema reduction in an adult patient.

Intussusception is a rare condition in adults, representing only 1% of all bowel obstructions. In adult cases, operative explorations are recommended to treat the bowel obstruction and to diagnose underlying diseases. The objective of the current case report was to describe the successful treatment of ileocolic intussusception with air enema reduction in an adult patient. A previously healthy 21-year-old woman had a 20-hour history of colicky abdominal pain and vomiting and was diagnosed as having idiopathic ileocolic intussusception by abdominal computed tomography. We treated the patient with air enema reduction under fluoroscopic guidance instead of an operative procedure. She received oxygen and intravenous midazolam to provide some degree of pain relief. Air was carefully pumped manually into the rectum, and the air pressure was monitored with a manometer. Because of air leakage from the rectum through the void to the outside the body, we continued to provide air to maintain the air pressure between 40 and 60 mm Hg. Three minutes after initiation of the air enema, when the patient experienced increasing abdominal pain and vomiting, the pressure was temporarily increased to greater than 100 mm Hg, and the air reached the terminal ileum. We considered the reduction successful and confirmed it with an abdominal ultrasound examination. We believe that air enema reduction is effective for treating idiopathic intussusception within 24 hours of symptom onset in young, previously healthy adult patients.

[Arteriosclerosis and gastoduodenal ulcer].

Recent reports suggested an increase in the occurrence of gastroduodenal ulcers in old age people. And it was reported that gastroduodenal ulcers in old age generation has the characteristics which was different from that in young generation. Namiki et al reported that gastric ulcer in old age generation occurs often at the gastric corpus and is larger and deeper and more often with bleeding comparing with that in young people. Furthermore NSAID ulcer is known to occur more often in old age than in young. Although the pathogenesis of the gastroduodenal ulcer in old age is not clear, a decrease in gastric mucosal blood flow with aging might be related that is possibly due to narrowing of arteries based on arteriosclerosis. Since the report by Virchow that suggested the importance of vessels as a cause for gastric ulcer, many studies indicated the involvement of vessels in the pathogenesis of gastroduodenal ulcer. Until recently, however, there were no methods except autopsy to evaluate the severity of arteriosclerosis, therefore the involvement of arteriosclerosis in the pathogenesis was not clarified. Recently a new device that case evaluate the arteriosclerosis by the measuring pulse wave velocity was developed and is now widely used. We undertook to clarify the relation between arteriosclerosis and gastroduodenal ulcer. The result suggested the involvement of arteriosclerosis in the pathogenesis of gastroduodenal ulcer, especially of NSAID ulcer with bleeding. In this manuscript, we refer to the previous reports that suggest the relation between arteriosclerosis and gastroduodenal ulcer.

Neutrophil-derived hydroxyl radicals mediate interleukin-8-induced increases in tetragastrin-stimulated acid secretion in rats.

Until recently, the secretion of gastric acid, which plays an important role in the pathogenesis of peptic ulcer, was thought to be controlled by diet, the autonomic nerves and gut hormones. However, peptic ulcer is now known to be caused by the infection with Helicobacter pylori (H. pylori), so it is possible that inflammation modifies the secretion of gastric acid. We used gastric-lumen-perfused rats to first examine the effect of interleukin-8 (IL-8) on acid secretion and then the involvement of free radicals and neutrophils in the action of IL-8. IL-8 enhanced tetragastrin-stimulated acid secretion and free radical scavengers or inhibitors and the pretreatment with anti-rat neutrophil serum inhibited this effect, which indicates that IL-8 enhances gastrin-stimulated acid secretion and that neutrophil-derived hydroxyl radicals mediate the IL-8-induced increase in acid secretion.