Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Espru Colágeno/induzido quimicamente , Olmesartana Medoxomila/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Espru Colágeno/diagnóstico por imagem , Espru Colágeno/patologia , Endoscopia do Sistema Digestório , Feminino , Humanos , Olmesartana Medoxomila/administração & dosagemRESUMO
PURPOSE: Collagenous sprue (CS) is a rare enteropathy characterized by villous atrophy and a thickened subepithelial collagen band. The aim of this study is to describe the cross-sectional imaging findings of CS. METHODS: A case-control, retrospective study with cases of all CS patients from January 2000 to 2015 was performed. Inclusion criteria were (1) Histopathologic diagnosis and (2) Imaging with computed tomography abdomen/pelvis (CT A/P), CT enterography (CTE), or magnetic resonance enterography within 6 months of small bowel (SB) biopsy. Control subjects were irritable bowel syndrome (IBS) patients who underwent CTE. Imaging studies were examined by two GI radiologists, blinded to patient data. RESULTS: 108 patients (54 CS; 54 IBS) were included. Mean age was 56.7 ± 16.5 years, and 68% were female (72% in CS group vs. 63% in IBS group; p = 0.3). CS patients were significantly older (67 ± 12 vs. 47 ± 15 year; p < 0.001) and more likely to be on angiotensin receptor blockers (41% vs. 6%; p < 0.001) as compared to the IBS group. Compared to IBS, CS patients were more likely to have mesenteric lymph node (LN) prominence (56% vs. 15%; p < 0.001), jejunoileal fold pattern reversal (46% vs. 6%; p < 0.001), SB dilation (28% vs. 0%; p < 0.001), SB conformational change (28% vs. 6%; p = 0.002), SB wall thickening (13% vs. 2%; p = 0.03), and ulcerative jejunoileitis (4% vs. 0%; p = 0.01). Radiologists suspected malabsorption in 72% in the CS group and 2% in the IBS group (p < 0.001). CONCLUSION: Imaging findings suggestive of mucosal malabsorption are commonly demonstrated in CS.
Assuntos
Espru Colágeno/diagnóstico por imagem , Estudos de Casos e Controles , Espru Colágeno/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Olmesartana Medoxomila/efeitos adversos , Anticorpos Antinucleares/análise , Doença Celíaca/induzido quimicamente , Atrofia/induzido quimicamente , Diarreia/induzido quimicamente , Duodenopatias/induzido quimicamente , Metilprednisolona/uso terapêutico , Diagnóstico Diferencial , Espru Colágeno/complicações , Espru Colágeno/patologia , Endoscopia do Sistema Digestório/instrumentação , Endoscopia do Sistema Digestório/métodos , Redução de Peso , Antígenos HLA-DQ/análise , Imuno-Histoquímica/métodos , Antígenos CD4/análiseRESUMO
Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient's diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.
Assuntos
Anti-Hipertensivos/efeitos adversos , Espru Colágeno/patologia , Diarreia/patologia , Duodeno/patologia , Imidazóis/efeitos adversos , Tetrazóis/efeitos adversos , Idoso , Atrofia , Biópsia , Espru Colágeno/induzido quimicamente , Diarreia/induzido quimicamente , Humanos , Hipertensão/tratamento farmacológico , Masculino , Vômito/induzido quimicamente , Vômito/patologia , Redução de PesoRESUMO
A 56-year-old Caucasian woman presented with epigastric pain, watery diarrhoea, bloating and flatulence following treatment with duloxetine and venlafaxine for anxiety and depression. Abdominal examination was benign. Blood work revealed haemoglobin of 96â g/L (115-160â g/L), iron 6â µmol/L (10-33â µmol/L), transferrin saturation 0.08 (0.20-0.55), ferritin 26â µg/L (15-180â µg/L), albumin 46â g/L (35-50â g/L), pre-albumin 293â mg/L (170-370â mg/L), total IgA 2.64â g/L (0.78-3.58â g/L) and anti-tTG IgA 5â units (<20â units). Faecal occult blood tests were 3/3 positive and stool cultures were negative. CT enterography was normal. Colonic biopsy revealed collagenous colitis, while duodenal biopsy showed collagenous sprue with blunted to completely flattened villi and markedly thickened subepithelial collagen table entrapping capillaries and lymphocytes. The patient started a gluten-free diet, loperamide and ferrous gluconate. Her symptoms resolved and a faecal immunochemical test performed 6â months later was negative.
Assuntos
Anemia Ferropriva/diagnóstico , Colite Colagenosa/diagnóstico , Colágeno/metabolismo , Espru Colágeno/diagnóstico , Diarreia/diagnóstico , Enterocolite/diagnóstico , Mucosa Intestinal/patologia , Anemia Ferropriva/etiologia , Biópsia , Colite Colagenosa/complicações , Colite Colagenosa/dietoterapia , Colite Colagenosa/patologia , Espru Colágeno/complicações , Espru Colágeno/dietoterapia , Espru Colágeno/patologia , Colo/patologia , Diarreia/etiologia , Dieta Livre de Glúten , Duodeno/patologia , Enterocolite/complicações , Enterocolite/dietoterapia , Enterocolite/patologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We present a rare case of collagenous sprue in an elderly woman with significant weight loss and malnutrition. Collagenous sprue is a rare, female-predominant and immune-mediated gastrointestinal disease that can affect any part of the gut, and shares a strong association with Coeliac disease. The diagnosis is confirmed by gut histopathology demonstrating a subepithelial collagenous band and inflammatory infiltrate in the lamina propria. The pathogenesis and natural history is poorly elucidated, and treatment involves a gluten-free diet and/or immunomodulatory therapy.
Assuntos
Doença Celíaca/diagnóstico , Espru Colágeno/dietoterapia , Espru Colágeno/patologia , Redução de Peso , Idoso , Biópsia por Agulha , Doença Celíaca/patologia , Espru Colágeno/diagnóstico , Diagnóstico Diferencial , Dieta Livre de Glúten , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Mucosa Intestinal/patologia , Medição de Risco , Resultado do TratamentoAssuntos
Mucosa Intestinal/ultraestrutura , Síndromes de Malabsorção/classificação , Microvilosidades/patologia , Atrofia , Autoanticorpos/sangue , Doença Celíaca/diagnóstico , Doença Crônica , Espru Colágeno/diagnóstico , Espru Colágeno/patologia , Imunodeficiência de Variável Comum/diagnóstico , Imunodeficiência de Variável Comum/patologia , Diagnóstico Diferencial , Diarreia/etiologia , Duodeno/patologia , Enterite/diagnóstico , Enterite/patologia , Enterócitos/imunologia , Eosinofilia/diagnóstico , Eosinofilia/patologia , Gastrite/diagnóstico , Gastrite/patologia , Humanos , Imidazóis/efeitos adversos , Síndromes de Malabsorção/induzido quimicamente , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/patologia , Poliendocrinopatias Autoimunes/diagnóstico , Poliendocrinopatias Autoimunes/patologia , Poliendocrinopatias Autoimunes/fisiopatologia , Tetrazóis/efeitos adversosRESUMO
Collagenous sprue is a clinicopathological entity with an unknown etiology. Its clinical features include progressive malabsorption, diarrhea, weight loss, unresponsiveness to treatment, and high mortality rates. The age interval of collagenous sprue is quite broad and ranges between 2 and 85 years. As far as to our knowledge, the presented case is the first reported case in infancy.
Assuntos
Doença Celíaca/patologia , Espru Colágeno/patologia , Intestino Delgado/patologia , Enteropatias Perdedoras de Proteínas/patologia , Doença Celíaca/diagnóstico , Colágeno/metabolismo , Espru Colágeno/diagnóstico , Humanos , Lactente , Masculino , Enteropatias Perdedoras de Proteínas/diagnósticoAssuntos
Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Espru Colágeno/diagnóstico , Espru Colágeno/patologia , Ceco/patologia , Colo/patologia , Endoscopia do Sistema Digestório , Feminino , Mucosa Gástrica/patologia , Histocitoquímica , Humanos , Mucosa Intestinal/patologia , Microscopia , Pessoa de Meia-IdadeRESUMO
Collagenous sprue is a rare small bowel enteropathy that has overlapping clinical features with coeliac disease; it is commonly associated with arthritic autoimmune conditions, which often require non-steroidal anti-inflammatory drugs (NSAIDs). In the limited published literature available, there are putative suggestions of a link between NSAID use and collagen deposition in intestinal subepithelia in such patients. The authors present a case of a 43-year-old woman with long-standing NSAID use for autoimmune polyarthropathy and positive coeliac antibodies. However, distal duodenal biopsies revealed a thickened band of subepithelial collagen with villous atrophic appearances consistent with collagenous sprue. The patient was treated with a gluten-free diet and her NSAIDs were discontinued. After 6 months, her gastrointestinal symptoms had resolved with complete histological resolution of the collagenous subepithelial bands and villous atrophy on duodenal biopsy.