[Eosinophilic duodenitis associated to food allergy debuting as acute visceral pain in an adult with vitiligo: a case report]. / Duodenitis eosinofílica asociada a alergia alimentaria debutando como dolor visceral agudo en un adulto con vitíligo: reporte de un caso.

BACKGROUND: Eosinophilic duodenitis has a prevalence of 5.1 to 8.2 per 100000 persons. The underlying molecular mechanisms are unknown, but hypersensitivity (seasonal and food allergies, asthma, eczema) response plays a major role in its pathogenesis, allergic predisposition can be found up-to 25-35% of cases. The diagnosis includes clinical manifestation, imaging findings and histological evidence of eosinophilic infiltration >20 eosinophils per high-power field. This is a clinical case report. a 25-years old man with vitiligo consult to emergency department referring dyspepsia symptoms, vomiting and abdominal pain of maximal intensity, in the medical exam upper abdominal pain was found, blood laboratories were unremarkable except a high net eosinophil-count >2000 cells/ul, abdominal ultrasound were normal, upper endoscopy revealed duodenitis with rigid and thickened folds, colonoscopy show hemorrhoids grade I. Coproscopy exam was negative for parasites, total IgE, IgA and IgG were in normal range, a positive IgG to Toxoplasma gondii was reported, autoimmunity panel was negative. In the following 4 days the abdominal pain and eosinophils count increase, a new abdomin-pelvic tomography was done showing thickened duodenum with a new endoscopy showing marked edema in duodenum with severe biliary reflux with biopsies describing an atrophic chronic duodenitis. Allergy tests -skin prick and patch tests- were done resulting positive to cereals (rye, soy, barley), Manihot esculenta, green banana, tomato, cow milk, orange and pineapple. A restrictive diet and protons pump inhibitor was indicated, ambulatory control at 45 days after show symptoms resolution with a normal blood eosinophils count. Here is reported a case of eosinophilic duodenitis related to food allergy in a young man with vitiligo debuting with an unusual clinical presentation of acute visceral pain and biliary reflux which resolved with elimination diet and pantoprazole without use of corticoids, with both, IgE and non-IgE mechanisms playing important roles explaining food sensitization.

[Chronic Duodenitis and Celiac Disease: a path between the nonspecific and the early stages of Marsh]. / Duodenitis crónica y enfermedad celíaca: un camino entre lo inespecífico y los primeros estadíos de marsh.

Given the advances in diagnosis for CD, some patients are detected with symptoms and signs of food intolerance, which have positive antibodies and autoantibodies for coeliac disease, whom present proximal bowel biopsies with chronic nonspecific duodenitis and are not associated with stages 0 and 1 Marsh. On the other hand, patients with bloating, abdominal pain, pondostatural delay, negative antibodies for CD, and chronic nonspecific duodenitis in whom removing cow's milk or gluten, the symptoms remit. There are also celiac patients with biopsies before diagnosis, with chronic nonspecific duodenitis. In this paper, we summarize three brothers with different degrees of chronic duodenitis, one with chronic nonspecific duodenitis, and two with histopathological sings of coeliac disease. It is an invitation to think that chronic nonspecific duodenitis in some patients may be an earlier manifestation of celiac disease.

Con los avances en el diagnóstico para Enfermedad Celíaca (EC), se detectan algunos pacientes con síntomas y signos de intolerancia alimentaria, que presentan anticuerpos y autoanticuerpos positivos para EC, con biopsias de intestino proximal que muestran duodenitis crónica inespecífica y no se relacionan con los estadíos 0 y 1 de Marsh. Por otro lado, hay pacientes con meteorismo, dolor abdominal, retraso pondoestatrural con anticuerpos negativos para EC y duodenitis crónica inespecífica, en los cuales al quitar la leche de vaca o el gluten, remiten los síntomas. También hay pacientes celíacos con biopsias anteriores a la del diagnóstico, que muestran duodenitis crónica inespecífica. En este trabajo, se resumen tres hermanos con diferentes grados de duodenitis crónica, uno con duodenitis crónica inespecífica, y dos con signos histopatológicos de EC. Es una invitación a pensar que la duodenitis crónica inespecífica en algunos pacientes puede ser una manifestación temprana de la EC.

Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding.

Strongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.

Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding / Hiperinfecção por Strongyloides stercoralis: uma causa incomum de hemorragia digestiva

SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.

ResumoHiperinfecção por Strongyloides stercoralis: uma causa incomum de hemorragia digestiva A estrongiloidíase é uma parasitose que pode evoluir para uma forma disseminada, denominada síndrome de hiperinfecção, nos pacientes em estados de imunossupressão. A síndrome de hiperinfecção é ocasionada pela grande multiplicação e migração de larvas infectantes, com envolvimento gastrointestinal e/ou pulmonar característico. Essa doença pode representar um desafio diagnóstico, pois apresenta- se em achados inespecíficos à endoscopia.

Gastrointestinal abnormalities in children with autistic disorder.

OBJECTIVES: Our aim was to evaluate the structure and function of the upper gastrointestinal tract in a group of patients with autism who had gastrointestinal symptoms. STUDY DESIGN: Thirty-six children (age: 5.7 +/- 2 years, mean +/- SD) with autistic disorder underwent upper gastrointestinal endoscopy with biopsies, intestinal and pancreatic enzyme analyses, and bacterial and fungal cultures. The most frequent gastrointestinal complaints were chronic diarrhea, gaseousness, and abdominal discomfort and distension. RESULTS: Histologic examination in these 36 children revealed grade I or II reflux esophagitis in 25 (69.4%), chronic gastritis in 15, and chronic duodenitis in 24. The number of Paneth's cells in the duodenal crypts was significantly elevated in autistic children compared with non-autistic control subjects. Low intestinal carbohydrate digestive enzyme activity was reported in 21 children (58.3%), although there was no abnormality found in pancreatic function. Seventy-five percent of the autistic children (27/36) had an increased pancreatico-biliary fluid output after intravenous secretin administration. Nineteen of the 21 patients with diarrhea had significantly higher fluid output than those without diarrhea. CONCLUSIONS: Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the behavioral problems of the non-verbal autistic patients. The observed increase in pancreatico-biliary secretion after secretin infusion suggests an upregulation of secretin receptors in the pancreas and liver. Further studies are required to determine the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder.

[A case of Brunner's gland hamartoma as a cause of digestive tract hemorrhage]. / Un caso de hamartoma de glándulas de Brunner como causa de hemorragia de tubo digestivo.

A twenty six year old woman was admitted suffering an anemia syndrome, postprandial vomiting and intermittent melena of six months evolution. The hemoglobin was 3.5 g/dL: an endoscopy detected a large tumor in the duodenum with a 90% obstruction of the lumen. A biopsy reported an erosive, acute and chronic duodenitis. Subsequently a surgical exploration with duodenotomy showed a large nodular polyp attached to a stalk that was removed: a hamartomatous polyp of Brunner's glands was reported. It coursed with gastrointestinal bleeding and symptoms of duodenal obstruction, which are two of the most common symptoms of this rare tumor.

L-dopa malabsorption in a parkinsonian patient with Strongyloides stercoralis duodenitis.

We report a parkinsonian patient initially responding to L-dopa who developed a severe loss of drug efficacy due to Strongyloides stercoralis duodenitis. The patient was put on mebendazole and metronidazole, and the parasitosis abated, allowing L-dopa reduction by 33%. Our patient illustrates the advisability of searching for Strongyloides stercoralis when L-dopa malabsorption is suspected in Parkinson's disease.

Associaçäo entre lesöes de mucosa gastroduodenal e varizes como causa de hemorragia digestiva alta: estudo retrospectivo em hospital universitário / Association among gastroduodenal mucosa injuries and varices as cause of upper digestive hemorrhage: retospective study in university hospital

Com o objetivo de analisar endoscopicamente a associaçäo entre lesöes de mucosa gastroduodenal e varizes como causa de hemorragia digestiva alta em portadores de síndrome de hipertensäo portal, foram avaliados no Gastrocentro da Universidade Estadual de C - UNICAMP, 11 pacientes com hemorragia digestiva no período de 1§ de agosto de 1990 a 15 de julho de 1992, submetidos à endoscopia até 24 horas após admissäo no Pronto-Socorro. Considerando a faixa etária, o sexo e clínica foi encontrada prevalência de 83,7//da terceiras e sextas décadas, sendo 70,08 por cento do sexo masculino e 29,92 por cento do feminino. A hematêmese esteve presente em 94,02 por cento dos casos. Foram causas de hemorragia digestiva alta: varizes esofágicas (47,87 por cento), varizes gástricas (9,40 por cento), lesöes agudas da mucosa gastroduodenal (34,19 por cento) úlcera gástrica (5,98 por cento) e úlcera duodenal (2,56 por cento). Concluíram os autores existir associaçäo importante entre lesöes de mucosa gastroduodenal e varizes como causa da hemorragia digestiva alta na hipertensäo portal, e que é imprescindível a avaliaçäo endoscópica precoce rotineira e detalhada naqueles pacientes com sangramento digestivo alto. É aconselhável um exame endoscópico semestral quando os sintomas dispépticos forem constantes, com antecedentes de tratamento de lesöes de mucosa gastroduodenal ou úlcera péptica, e anual nos demais

[Association of gastroduodenal mucosa lesions and varices as a cause of upper digestive hemorrhage. Retrospective study at a university hospital]. / Associação entre lesões de mucosa gastroduodenal e varizes como causa de hemorragia digestiva alta. Estudo retrospectivo em hospital universitário.

During the period from August 1st, 1990 to June 15, 1992, 117 patients with portal hypertension and upper gastrointestinal bleeding were examined at the "GASTROCENTRO"--State University of Campinas--UNICAMP, Campinas, SP, Brazil few hours after hospital admission. The objectives were to study the association of gastroduodenal acute lesions and esophageal varices. The predominant ages were thirties and sixties years (83.76%), being 70.08% of males. The hematemesis occurred in 94.02% of the cases. The etiologies of the bleeding were: esophageal varices, 47.87%; gastroduodenal acute mucosal lesions, 34.19%; gastric varices, 9.4%; gastric ulcers, 5.98% and duodenal ulcers, 2.56%. The authors concluded that exists a significant association of acute gastroduodenal lesions and esophageal varices causing upper gastrointestinal bleeding. It is essential to examine early and in detail the gastroduodenal mucosa during upper digestive endoscopy in the patient with portal hypertension and esophageal varices to diagnose the etiology of the bleeding. It is advisable to perform endoscopic examination twice a year when the dyspeptic symptoms are constant, with previous treatment for gastroduodenal acute mucosal lesions or peptic ulcers, and annual in the others.

Asma brônquica e úlcera duodenal e bulboduodenite erosiva em crianças: relato de seis casos / Bronchial asthma and duodenal ulcer and erosive bulboduodenitis in children: report of 6 cases

A coexistência de asma brônquica moderada e severa e úlcera duodenal ou duodenite erosiva, näo está estabelecida ou descrita na literatura. A partir de um protocolo de pesquisas em que se procurava estabelecer a presença de esofagite de refluxo em crianças com asma moderada ou grave, 32 crianças foram submetidas à endoscopia digestiva alta e supreendentemente foram encontradas seis crianças (18,7%) com os seguintes achados: úlcera duodenal em quatro delas e bulboduodenite erosiva em dois. Estes casos säo relatados e discutidos alguns aspectos etiopatogênicos desta possível associaçäo, além de realçar ao clínico pediatra a valorizaçäo da dor epigástrica em asmáticos, geralmente considerada de origem funcional

[Bronchial asthma and duodenal ulcer and erosive bulbo-duodenitis in children: report of 6 cases]. / Asma brônquica e úlcera duodenal e bulboduodenite erosiva em crianças: relato de seis casos.

The coexistence of moderate and severe asthma and duodenal ulcer is not very well established as yet. We started a protocol trying to establish the presence of reflux esophagitis in children with moderate or severe asthma. Thirty two patients underwent upper digestive endoscopy and, surprisingly, we found six children (18.7%) with the following digestive aspects: four children had duodenal ulcer, and two had erosive duodenitis. We report these cases and discuss some etiopathogenic aspects about these possible association, and beware the clinician to pay attention to abdominal pain in children with bronchial asthma.

Tropical peptic ulcer disease: an endoscopic study from rural Haiti.

We performed upper gastrointestinal endoscopy in 60 rural Haitian patients who complained of chronic upper abdominal pain. Twenty-five of 37 men (68%) and 5 of 23 women (22%) had abnormal findings. In men the predominant abnormalities were severe duodenal ulcer, duodenitis, and pyloroduodenal obstruction; duodenal ulcer or duodenitis appeared to precede obstructive disease by about 20 years. In women the abnormal findings invariably were milder than in men and consisted of duodenal ulcer, duodenitis, and gastritis. These observations as well as the observations of others indicate that peptic ulcer disease is common in developing countries, particularly among men. We hypothesize that this familiar abnormality reported from unfamiliar places represents the ordinary spectrum of peptic ulcer disease, but that inadequate treatment of recurrent episodes over time leads to obstruction. Physicians need to learn more about the epidemiology of peptic disease in developing countries and to devise better methods of effective treatment to prevent the late complication of gastric outlet obstruction.

[Crohn's disease of the duodenum associated with acute acalculous cholecystopathy]. / Doenca de Crohn do duodeno associada à colecistopatia aguda alitiásica.

Since the initial description of Crohn's disease (CD) located in the distal ileum, great number of cases has been observed, and we know that this disease can occur in any part of the digestive tube, from mouth to anus. The duodenal involvement is rare and no more than two hundred cases have been observed. A case of Crohn's disease located in the duodenum, with a severe acalculus cholecystitis, without intestinal involvement is presented. Radiological study showed a stenotic process in the first, second and third duodenal portion, later on confirmed by endoscopy. This was confirmed at surgery, when a gastrojejunostomy with truncal vagotomy, cholecystectomy, besides duodenum and liver biopsies were performed. The patient is asymptomatic four years after surgery. It is considered that bile reflux, resulting from involvement of Vater papilla by CD, is responsible factor of the biliary pathology.

[Emergency endoscopy in upper digestive tract hemorrhage]. / Endoscopía de urgencia en hemorragia digestiva alta (H.D.A.).

The experience in upper G.I. tract hemorrhage accumulated during the first 30 months in the Emergency Hemorrhage Unit at the Hospital Posadas is here reported over a total of 428 endoscopies, we found 518 lesions. Ninety one (21%) presented with active bleeding, and 317 (76%) were considered as the probable cause of the bleeding. In 37 cases (8.6%) the site of bleeding was detected, but the diagnosis wasn't done. The most frequent lesions were erosive gastritis (21.2%), gastric ulcer (20%), erosive duodenitis (12.6%), duodenal ulcer (12.15%) and esophageal varices (12.12%) the diagnosis was normal 14.7% of the cases. One hundred and sixty one patients were admitted to the hospital; on 143 (88.82%) patients the original diagnosis was confirmed but it was modified in 18 patients (11.18%) by surgery or repeated endoscopy. During the last 20 months of the period the accuracy diagnostic of the endoscopy increased 95%. When compared with the first 10 months (76%) this fact shows, the importance of the experience acquired by the endoscopist. Most of the patients received medical treatment with a mortality of 9.02% and 25 patients received surgical treatment with a mortality of 28%.