RESUMO
Treatment with continuous infusion of intraduodenal (Duodopa®) levodopa / carbidopa is indicated in patients with advanced Parkinson's disease who have not responded to conventional treatment. We present here the case of a patient with this type of probe that debuted jejunitis. A distal phytobezoar was the main causal agent. This rare complication may be favored in cases of intestinal hypomotility. Treatment involves its withdrawal as soon as possible and replacement by a new probe, which results in healing.
Assuntos
Antiparkinsonianos/efeitos adversos , Carbidopa/efeitos adversos , Bombas de Infusão Implantáveis/efeitos adversos , Doenças do Jejuno/induzido quimicamente , Doenças do Jejuno/diagnóstico por imagem , Levodopa/efeitos adversos , Idoso , Antiparkinsonianos/uso terapêutico , Bezoares , Carbidopa/uso terapêutico , Combinação de Medicamentos , Endoscopia Gastrointestinal , Feminino , Humanos , Levodopa/uso terapêutico , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológicoRESUMO
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Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Jejuno/lesões , Levodopa/administração & dosagem , Carbidopa/administração & dosagem , Úlcera Péptica/etiologia , Intubação Gastrointestinal/efeitos adversos , Bezoares/diagnóstico por imagem , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológicoRESUMO
BACKGROUND: Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. AIMS: To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. METHODS: Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as "endoscopy-based management (EBM)" if treatment step-up after endoscopy, or "non EBM (N-EBM)". Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. RESULTS: One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR.
Assuntos
Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Endoscopia Gastrointestinal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colonoscopia , Terapia Combinada , Doença de Crohn/diagnóstico por imagem , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Recidiva , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. AIMS: To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. METHODS: Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as 'endoscopy-based management (EBM)' if treatment step-up after endoscopy, or 'non EBM (N-EBM)'. Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. RESULTS: One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR
No disponible
