Eosinophilic gastroenteritis: Clinical characteristics and management.

There is paucity of published data related to eosinophilic gastroenteritis (EGE). We aimed to study the clinical characteristics, management, and follow-up of EGE. From March 2014 to December 2018, patients with gastrointestinal (GI) symptoms suspected to have EGE were investigated. This is a retrospective study. Complete blood count, upper GI endoscopy (UGIE), and biopsy were done. Contrast-enhanced computed tomography (CECT) abdomen was done when intestinal obstruction was suspected. Laparoscopic small bowel resection or stricturoplasty and full-thickness biopsy were obtained. EGE was diagnosed if the biopsies showed eosinophilic infiltration of one or more regions of the GI tract (> 30 eosinophils per high power field [HPF]). Patients were treated with immunosuppressive therapy and if indicated surgery. Clinical response to therapy was assessed and patients were followed up for 1 year. Forty-one patients (mean age 34.8 years, median age 32, range 25-70 years, 29 males) had EGE. Upper abdominal pain was the most common symptom. Peripheral eosinophilia was present in 82.9% patients. On UGIE, duodenal lesions were observed in 75% patients. EGE was confirmed in 37 patients by endoscopic duodenal biopsies, in 2 patients by jejunal mucosal biopsies using enteroscopy, and in 2 patients by full thickness surgical biopsies. Forty-one patients were treated with oral corticosteroids inclusive of 4 patients who underwent surgery. Of the 37 patients, 6 were lost to follow-up; 31 patients were followed up for a period of 1 year. All the patients who were treated with corticosteroids responded to initial therapy. Over a follow-up period one case had frequent relapses. EGE should be suspected in patients with upper abdominal pain. Peripheral eosinophilia occurs in the majority. Tissue diagnosis showing eosinophilic infiltration is diagnostic. Oral corticosteroid therapy is highly effective and relapse is rare.

Ampullary carcinosarcoma with osteosarcomatous, small cell neuroendocrine carcinoma and conventional adenocarcinoma components; First report.

Caracinosarcomas are tumours with diverse epithelial and mesenchymal differentiation. They most commonly occur in the female reproductive organs and upper aero digestive tract. They are relatively rare in the gastrointestinal tract and affect the oesophagus most commonly. Ampullary carcinosarcomas are exceptionally rare. We report a case of ampullary carcinosarcoma in a 67-year-old male, with osteosarcomatous, small cell carcinoma and conventional adenocarcinoma components. To the best of our knowledge, this is the first reported case of its kind.

Gastrointestinal ALκ amyloidosis presenting as protein-losing enteropathy correctly diagnosed by immunohistochemistry using amyloid-type-specific antibodies.

A 54-year-old man presented with protein-losing enteropathy. Biopsies from the stomach, duodenum, ileum and colon showed deposits of amyloid. The bone marrow showed plasmacytosis. After an initial misdiagnosis of AA amyloid, a revised diagnosis of ALκ amyloidosis was made at an expert referral laboratory. Care must be taken in the use of antibodies and proper controls in the performance and interpretation of immunohistochemistry for amyloidosis. A wide panel of amyloid-type-specific antibodies must be used and interpreted in comparative mode to avoid misdiagnosis.

A 51-week, open-label clinical trial in India to assess the efficacy and safety of pancreatin 40000 enteric-coated minimicrospheres in patients with pancreatic exocrine insufficiency due to chronic pancreatitis.

BACKGROUND/OBJECTIVES: To assess the efficacy and safety of pancreatin (pancrelipase) enteric-coated minimicrospheres (MMS) over a one-year period in patients with pancreatic exocrine insufficiency (PEI) due to chronic pancreatitis (CP). METHODS: This was a 51-week, open-label extension (OLE) of a one-week, multicenter, double-blind, randomized, placebo-controlled trial in India that enrolled patients ≥18 years of age with confirmed PEI due to CP. Patients received pancreatin (Creon(®) 40000 MMS™) at a dose of 80,000 Ph. Eur. lipase units with each of three main meals/day and 40,000 with each of up to three snacks/day. RESULTS: Of 61 patients entering the OLE, 48 completed treatment (nine were lost to follow up, two withdrew consent, one discontinued due to adverse event [acute exacerbation of CP], one protocol violation). There were significant improvements from baseline to end of OLE in mean ± SD coefficient of fat absorption (CFA: 22.7 ± 12.2%), coefficient of nitrogen absorption (CNA: 6.5 ± 7.9%), body weight (4.9 ± 4.9 kg), BMI (1.9 ± 1.9 kg/m(2)), and most nutritional laboratory parameters tested (p ≤ 0.001). Mean daily stool frequency was reduced from 2.8 to 1.6 (p < 0.001). Improvements in clinical symptoms, clinical global impression of disease symptoms, and quality of life were also observed. Treatment-emergent adverse events (TEAEs) were observed in 64% of patients overall. Only 13% of patients experienced TEAEs judged treatment related. CONCLUSIONS: In patients with PEI due to CP, treatment with pancreatin for one year was associated with significant improvements in fat absorption, nitrogen absorption, and nutritional parameters, improvements in clinical symptoms, and a favorable safety and tolerability profile.

Occult hepatitis B virus infection as a cause of cirrhosis of liver in a region with intermediate endemicity.

BACKGROUND: Serological tests may fail to identify hepatitis B virus (HBV) infection as a cause of liver cirrhosis in a proportion of patients. The frequency of such occult infection in regions with intermediate HBV endemicity is not known. Such cases may be diagnosed by incremental testing for IgG anti-HBc, serum HBV DNA, and HBV DNA in liver tissue. METHODS: We tested sera of 111 patients with cirrhosis, including 39 with history of significant alcohol ingestion, for HBsAg, anti-HBc and serum HBV DNA. In addition, in a subset of 14 patients, HBV DNA was looked for in liver tissue. RESULTS: On HBsAg and anti-HBc testing, 66 patients had HBV infection. Serum HBV DNA testing identified HBV infection in 13 additional cases. Of 18 patients labeled as 'cryptogenic' on serological testing, HBV DNA was detected in the serum in 7 patients. Of 14 patients in whom paired liver tissue and serum specimens were tested, 4 additional patients with HBV infection were detected after liver biopsy analysis. CONCLUSIONS: Serological tests for HBsAg and anti-HBc antibody are insensitive in identifying HBV infection in patients with liver cirrhosis. HBV DNA testing in serum and liver can help in establishing HBV infection as etiology, either alone or in addition to another cause.