A case of immune checkpoint inhibitor-associated gastroenteritis detected by ultrasonography.

While immune checkpoint inhibitors (ICIs) have antitumor effects, they also have characteristic side effects, including colitis. However, gastritis has rarely been reported. We report a case of a patient with lung adenocarcinoma who presented with epigastric pain and diarrhea following pembrolizumab administration. Sonography of the abdomen demonstrated diffuse, although mild, gastric wall thickening (mainly in the submucosa), as well as a slight decrease in echogenicity throughout the gastric wall. While the mucosal surface was relatively smooth, color Doppler examination showed increased vascularity. Esophagogastroduodenoscopy and pathological examination confirmed the diagnosis of ICI-related gastroenteritis.

Gastrointestinal ultrasonographic findings in cats with Feline panleukopenia: a case series.

BACKGROUND: Feline panleukopenia virus (FPV) is very resistant and highly contagious and infects domestic cats and other felids. FPV is particularly widespread among sheltered cats, and is associated with high morbidity and mortality, causing severe gastroenteritis characterized by anorexia, lethargy, fever, dehydration, hemorrhagic diarrhea, and vomiting. There is currently no data on the ultrasonographic features of cats affected with FPV. This case series describes abdominal ultrasonographic findings in shelter cats with naturally-occurring FPV, and assesses whether are associated with clinical and laboratory findings. Cats affected by FPV were enrolled in the study if an abdominal ultrasound was performed within 12 hours of diagnosis. Clinical, laboratory and survival data were collected from medical records. Ultrasonographic examinations were reviewed for gastrointestinal abnormalities and their associations with the above data were explored. RESULTS: Twenty-one cats were included. Nine cats (42.9%) died and 12 (57.1%) recovered. Based on ultrasonography, the duodenum and jejunum showed thinning of the mucosal layer in 70.6% and 66.6% of cats, thickening of the muscular layer in 52.9% and 57.1% of cats, and hyperechogenicity of the mucosa in 41.2% and 33.3%. Jejunal hyperechoic mucosal band paralleling the submucosa and irregular luminal surface were both observed in 33.3% of the cats. Survival was positively associated with increased jejunal mucosal echogenicity (P = 0.003) and hyperechoic mucosal band (P = 0.003). Peritoneal free fluid was positively associated with vomiting (P = 0.002). CONCLUSIONS: This study provides ultrasonographic features of naturally-occurring FPV in cats, which, as expected, are compatible with gastroenteropathy. The most frequent findings were diffuse small intestine mucosal layer thinning, muscular layer thickening and mucosal hyperechogenicity, jejunal hyperechoic mucosal band and irregular luminal surface. Ultrasonographic features may be useful to complete the clinical picture and assess the severity of the gastroenteropathy in FPV cats. Prospective studies are needed to confirm ultrasonographic prognostic factors.

Gastroenteritis eosinofílica: aspectos clínicos e imagenológicos de una entidad poco frecuente, reporte de caso / Eosinophilic gastroenteritis: clinical aspects and imagenological features of an infrequent entity, case report

Eosinophil-associated diseases constitute a group of pathologies where eosinophils play an important role. Among them, eosinophilic gastroenteritis is a rare entity. Few demographic data exist in the literature, with an estimated prevalence of 28-30/100,000. The symptoms presented by patients mainly depend on the affected segment of the gastrointestinal tract and the layer infiltrated by eosinophils. We report a 22-year-old male patient with a one-month history of diarrhea, with mucus and occasionally hematic striae. Initial laboratory tests showed leukocytosis with eosinophilia, and imaging studies showed extensive involvement of the gastrointestinal tract characterized by diffuse concentric parietal thickening and submucosal edema associated with ascites. Upper endoscopy and biopsy confirmed the presence of foci of infiltration by eosinophils. The patient was treated with corticosteroids and a lactose and wheat free diet, with a favorable evolution, without relapse after stopping corticosteroid treatment.

Las enfermedades asociadas a eosinófilos constituyen un grupo de patologías en que el aumento de los eosinófilos presenta un rol fundamental, encontrándose entre ellas la gastroenteritis eosinofílica, entidad poco frecuente. En la literatura existen pocos datos demográficos, con una prevalencia estimada entre 28-30 /100.000 habitantes. Los síntomas dependen principalmente del segmento afectado del tracto gastrointestinal y de la capa de la pared infiltrada por eosinófilos. Se presenta el caso clínico de un paciente masculino de 22 años con cuadro de diarrea de un mes de evolución, asociado a mucosidad y ocasionalmente estrías hemáticas. El estudio de laboratorio inicial mostró leucocitosis con eosinofilia, realizándose estudios de imágenes que demuestran extenso compromiso del tubo digestivo caracterizado por engrosamiento parietal difuso concéntrico y edema submucoso del estómago como también de asas de intestino delgado, asociado a ascitis. La endoscopia digestiva alta y biopsia confirmaron la presencia de focos de infiltración por eosinófilos. El paciente fue tratado con corticoides y dieta con restricción de lactosa y trigo, con evolución favorable, sin recaída tras la suspensión del tratamiento corticoidal

Reversible splenial lesion syndrome in children with benign convulsions associated with mild gastroenteritis: A retrospective study of five cases.

OBJECTIVE: To assess the clinical and imaging features of reversible splenial lesion syndrome (RESLES) with benign convulsions associated with mild gastroenteritis (CwG) in children. PATIENTS AND METHODS: We retrospectively reviewed the clinical course, blood and stool examinations, cerebrospinal fluid (CSF) examination, magnetic resonance imaging (MRI), electroencephalography (EEG) findings, therapy and prognosis of five children with RESLES associated with CwG. RESULTS: Five previously healthy patients, four girls and one boy, with mean age 26.4 ±â€¯8.1 months, had clusters of general tonic-clonic or clonic seizures within the first two days of gastroenteritis. Rotavirus antigen was positive in the stool of one case. Interictal EEG was normal except in one case, which showed occipital slow wave. The initial MRI was performed within five days of onset, four patients had an isolated lesion in the splenium of the corpus callosum (SCC), and one patient had lesions extending outside the SCC that involved the genu of the corpus callosum. The follow-up MRI was performed 10-15 days after onset, and all lesions had completely disappeared. All patients were treated with antiviral, rehydration and anticonvulsant therapy in the acute phase. They had good prognosis and normal psychomotor development, with no neurological sequelae after 26-30 months of follow-up. CONCLUSIONS: CwG and RESLES can coexist in young children. The patients present with clusters of general tonic-clonic or clonic seizures in the acute phase. Brain MRI shows focal lesion in the SCC with high signal intensity on T2-weighted and FLAIR sequences. It has good prognosis and excessive treatment is not necessary.

A 17-Year-Old Boy With High-Functioning Autism, Gastrointestinal Illness, and Seizures.

A healthy 17-year-old boy with a high-functioning pervasive developmental disorder presented to the emergency department after having a 4-minute episode of seizure-like activity in the setting of presumed viral gastroenteritis. Within an hour of emergency department arrival, he developed a forehead-sparing facial droop, right-sided ptosis, and expressive aphasia, prompting stroke team assessment and urgent neuroimaging. Laboratory results later revealed a serum sodium of 119 mmol/L. Neurologic deficits self-resolved, and a full physical examination revealed diffuse abdominal tenderness in the lower abdomen with rebound tenderness in the right-lower quadrant. The patient was admitted to the PICU for electrolyte management and monitoring. A computed tomography (CT) scan of the abdomen obtained the following morning revealed the patient's final diagnosis.

[Myocardial Clefts - Incidental Findings in Parainfectious Myocarditis]. / Furchen im Herzen ­ ein Zufallsbefund bei parainfektiöser Myokarditis.

Myocardial Clefts - Incidental Findings in Parainfectious Myocarditis Abstract. We report a 23-year-old woman with parainfectious myocarditis due to gastroenteritis. A transthoracic echocardio-graphy revealed a recess in the left inferobasal ventricle. For further investigation, cardiac magnetic resonance imaging was initiated, which revealed a myocardial cleft, a harmless structural variation of the heart. Cardiac magnetic resonance is a non-invasive imaging technique with a high spatial and temporal resolution that enables a precise depiction of the cardiac anatomy and therefore allows for a differentiation between normal and pathological structural variations of the heart.

Eosinophilic Gastroenteritis in Which Obstructive Jaundice Developed due to Invagination of the Duodenal Wall.

A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.

Prevalence and clinical profile of human bocavirus in children with acute gastroenteritis in Chengdu, West China, 2012-2013.

Viral acute gastroenteritis (AGE) is a major cause of mortality in childhood and leads to hospitalization in developing countries. Human bocavirus (HBoV) is a newly described virus associated with gastroenteritis. However, little is known about the clinical and epidemiological profile of human bocavirus (HBoV) in pediatric population in Chengdu, China. Between January 2012 and December 2013, 346 fecal samples from children admitted to hospital with acute gastroenteritis were tested for the presence of HBoV as well as other gastroenteritis viruses. Additionally, laboratory test results, clinical features and epidemiological characters were also collected to assess the correlation between HBoV and acute gastroenteritis in pediatric patients in Chengdu, China. Of the 346 tested fecal samples, 60 (17.34%) were positive for HBoV. The rate of co-detection of HBoV with other gastroenteritis viruses was 43.33% (26/60). HBoV was most detected in the summer/early fall months. Sequence analysis of the VP1/VP2 gene showed that both HBoV1 and HBoV2 circulated in Chengdu, China. No obvious difference was found between the clinical features of the HBoV1 mono-detected patients and HBoV2 mono-detected patients. Besides, in diarrheic children, positive correlation was found between detection of HBoV and diagnose of respiratory disease. Furthermore, blood cells were detected more frequently in fecal samples of patients with HBoV mono-detected. Though HBoV was detected frequently in Children with diarrhea in Chengdu, no statistical association was found between HBoV and disease severity.

Evaluation of benign afebrile convulsions in 16 children with rotavirus gastroenteritis.

In this study, we aimed to investigate the demographic, clinical, and laboratory findings of the patients hospitalized with rotavirus gastroenteritis-related afebrile seizure, retrospectively. The study population consisted of 16 patients (9 girls and 7 boys) with a mean age of 13.81 ± 5.98 months (age range 6-26). The male/female ratio was 0.77. None of the patients had any psychomotor developmental retardation. Neurological examinations of all the patients were normal. There were 7 patients with generalized tonic (43.75%), 8 generalized tonic-clonic (50%), and 1 focal seizure (6.25%). The duration of the seizures varied at a range of 2-7 min (mean 3.68 ± 1.35 min). The period between the onset of the clinical findings of the rotavirus infection and the occurrence of the seizures was ranged from 12 to 48 h (mean 31.5 ± 12.2 h). The prognosis of the rotavirus gastroenteritis-related afebrile convulsions was generally benign. Rotavirus infection should be taken into consideration in infants with gastroenteritis and afebrile convulsions.

Utility of Gastric and Duodenal Biopsies During Follow-up Endoscopy in Children With Eosinophilic Esophagitis.

OBJECTIVES: Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disorder of the esophagus. Consensus guidelines recommend obtaining esophageal, gastric, and duodenal biopsies at diagnostic endoscopy when EoE is suspected. The utility of repeated gastric and duodenal biopsies during follow-up endoscopy in patients previously diagnosed with EoE is not established. The aim of the present study was to explore the role of gastric and duodenal biopsies in children with an established diagnosis of EoE undergoing repeat endoscopy to assess histological response to treatment. METHODS: Retrospective chart review of children diagnosed with EoE at a tertiary care center was conducted. A total of 160 patients with EoE with demographic clinical, endoscopic, and histological data at diagnosis and follow-up endoscopy were included. The frequency of gastric and duodenal biopsies at follow-up endoscopy with abnormal histology and their correlation to endoscopic findings was determined. RESULTS: At follow-up endoscopy, 83% (132/160) of patients had gastric and 74% (118/160) had duodenal biopsies. Histology was normal in 81% of gastric and 92% of duodenal biopsies. The most frequent gastric abnormalities were chemical and inactive chronic gastritis. The most frequent duodenal abnormality was villous blunting with increased intraepithelial lymphocytes. Two patients with normal gastric and duodenal histology progressed to eosinophilic gastroenteritis at follow-up endoscopy. CONCLUSIONS: Gastric and duodenal biopsies obtained in EoE patients during follow-up endoscopy show pathology in a minority of patients, increase costs, and may add potential risk of adverse events. Large multicenter, prospective studies of endoscopic practice during follow-up of EoE are warranted to provide evidence supporting best practices.

Acute disseminated encephalomyelitis following Campylobacter jejuni gastroenteritis: Case report and review of the literature.

We describe a case of a 25-year-old male with a diagnosis of acute disseminated encephalomyelitis (ADEM) following infection with Campylobacter jejuni, which is implicated in various human pathologies regarding the central nervous system (CNS) with acute course like Guillain-Barré syndrome (GBS), Miller-Fisher syndrome (MFS), Bickerstaff's brainstem encephalitis (BEE), acute transverse myelitis (ATM) as well as ADEM. These conditions are caused by cross-reactivity between Campylobacter's epitopes and cells of the CNS that causes an immunomediated inflammatory demyelination of the CNS. In the acute phase, magnetic resonance (MR) can detect pathologic signal intensity at the CNS with areas of pathologic contrast enhancement at cortical and spinal white matter that normalize over time or can be stable. These findings can be associated with edema in parts of the CNS. The lesions typically appear at different times during the disease course and also can have a different evolution. Our purpose therefore was to describe the clinical course and MR findings of this case and perform a critical review of the literature.

[The 453rd case: diarrhea, weight loss and diabetes mellitus].

Chronic diarrhea is a common complaint in gastroentology department, which is classified into a variety of types. While as eosinophilic gastroenteritis is a rare cause. A 50-year-old male patient was admitted with a 2-year history of diarrhea worsened for 10 months. Fasting could alleviate the diarrhea. Laboratory findings demonstrated anemia, low vitamins and minerals, fat malabsorption and abnormal D-xylose absorption test, delayed gastric emptying. According to the endoscopic biopsy of gastrointestinal mucosa, the diagnosis of eosinophilic gastroenteritis was made. Diabetic neuropathy may aggravate the symptom. The diarrhea resolved after the administration of steroids.

Use of Dual-Energy CT and Iodine Maps in Evaluation of Bowel Disease.

Dual-energy computed tomography (CT) relies on material-dependent x-ray absorption behavior from concurrently acquired high- and low-kilovolt peak data and has a range of imaging applications. This article focuses on use of dual-energy CT in assessment of bowel disease. After a summary of relevant dual-energy CT image acquisition and postprocessing principles, the authors describe dual-energy techniques of greatest utility in evaluation of benign and malignant pathologic conditions in the bowel, including neoplastic, vascular, infectious, and inflammatory disorders, as well as in assessment of abdominopelvic trauma. The dual-energy postprocessing techniques of iodine-selective imaging and virtual monochromatic imaging have the broadest applicability in bowel imaging. They may be used for improved visualization of subtle differences in bowel wall enhancement or for quantitative assessment of altered enhancement for evaluation of a neoplasm or bowel ischemia. Iodine images and virtual monochromatic low-kiloelectron volt images are particularly helpful for assessment of a neoplasm, ischemia, infection, or inflammation, while iodine maps paired with virtual nonenhanced images are most helpful to differentiate iodine from other dense materials, as in gastrointestinal bleeding or trauma. In most applications, radiation doses at dual-energy CT are comparable to those at traditional CT. However, dual-energy CT may allow reduction in radiation dose by using virtual nonenhanced images that obviate an additional nonenhanced CT acquisition. Limitations of dual-energy CT are discussed, including potential challenges in acquisition, postprocessing, and interpretation.

Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population-based Cohort Study.

OBJECTIVE: Acute gastroenteritis (AGE) is a leading cause of pediatric emergency department (ED) visits. Despite evidence-based guidelines, variation in adherence exists. Clinical decision tools can enhance evidence-based care, but little is known about their use and effectiveness in pediatric AGE. This study sought to determine if the following tools-1) pathways/order sets, 2) medical directives for oral rehydration therapy (ORT) or ondansetron, and 3) printed discharge instructions-are associated with AGE admission and ED revisits. METHODS: This was a retrospective population-based cohort study of all children 3 months-18 years with an AGE ED visit in Ontario, Canada, from 2008 to 2010, using linked survey and health administrative databases. Logistic regression models associating clinical decision tools (CDTs) with hospitalizations and revisits controlling for hospital and patient characteristics were employed. RESULTS: Of the 57,921 patient visits during the study period, there were 2,401 hospitalizations (4.2%). A total of 55,520 patients were discharged from the ED, with 2,378 (4.3%) experiencing a 72-hour return visit. In adjusted models, none of the tools were significantly associated with admission. Medical directive for ORT was associated with lower return visit rates (adjusted odds ratio [aOR] = 0.86, 95% confidence interval [CI] = 0.79-0.94] and printed discharge instructions with higher return visits (aOR = 1.33, 95% CI = 1.08-1.65); pathways/order sets and medical directives for ondansetron had no association. CONCLUSIONS: Admissions in children with AGE are not associated with the presence of CDTs. While ORT medical directives are associated with lower ED revisits, printed discharge instructions have the opposite effect. The simple presence/absence of decision support tools does not guarantee improved clinical outcomes.

Thickened gastrointestinal wall findings on computed tomography in children: a reason for endoscopy?

OBJECTIVES: Bowel wall thickening on computed tomography (CT) scans in children may raise concern for inflammatory bowel disease (IBD). The significance of this radiological finding is unclear. Our purpose was to evaluate the clinical outcomes with regard to IBD in children with no known underlying disease, presenting with abdominal pain and thickened bowel wall on CT scan. METHODS: A retrospective analysis of pediatric patients with abdominal pain and CT findings of thickened bowel wall was performed between 2006 and 2010. Endoscopic findings, clinical variables, and follow-up assessments were evaluated. RESULTS: Fifty-six patients presenting with abdominal pain and thickened bowel wall findings on CT scan were identified. Overall, 30 (54%) had terminal ileum wall thickening, 17 (30%) had isolated colonic wall thickening, and 9 (16%) had other small bowel wall thickening. Of the 56 patients, 21 (38%) underwent endoscopy, of which 14 (67%) had positive findings-11 (79%) had histologic evidence of chronic colitis, and 5 (36%) had duodenitis/ileitis. Ultimately, 11/56 (20%) were diagnosed as having IBD, 8/56 (14%) with functional abdominal pain/constipation, 9/56 (16%) appendicitis, 10/56 (18%) infectious gastroenteritis, and 18/56 (32%) with miscellaneous diagnoses. Median levels of erythrocyte sedimentation rate, C-reactive protein, albumin, and platelet count were significantly abnormal in the IBD group compared to the non-IBD group. Additional follow-up of those who did not undergo endoscopic evaluation revealed no new diagnoses of IBD. CONCLUSIONS: The presence of thickened bowel wall on CT scans is a nonspecific finding in children. Laboratory evaluation may help distinguish which patients require additional evaluation and endoscopy.

Imaging features of bowel toxicities in the setting of molecular targeted therapies in cancer patients.

Molecular targeted therapies are becoming ubiquitous in cancer treatment. These drugs may cause gastrointestinal toxicities including perforation, pneumatosis, enteritis, colitis and fistula formation. Knowledge of these complications and their management enables early radiological identification and appropriate intervention, reducing patient morbidity and mortality.

Imaging of complications of oncological therapy in the gastrointestinal system.

Treatment of cancer involves a multidisciplinary approach consisting of surgery, chemotherapy, molecular targeted therapy and radiation therapy. These therapies work on the tumor cells to result in cell stasis or cell death. The same mechanism can result in toxicity to the normal gastrointestinal tract. Radiation therapy can cause acute and chronic injury. The chronic injury results from involvement of the vascular supply of the gastrointestinal tract and by causing fibrosis. The purpose of this article is to describe the imaging of complications resulting from oncologic treatment in the gastrointestinal system.

Contrast-enhanced ultrasonography (CEUS) for the evaluation of the inflammation of the digestive tract wall.

The evaluation of digestive wall lesions has benefited in latter years from advanced, noninvasive techniques such as contrast enhanced ultrasound (CEUS). This method appreciates the microcirculation in inflamed bowel segments in terms of qualitative and quantitative parameters. Based on precise and reproducible criteria it evaluates the extension and the activity of disease, as well as the presence of complications. Monitoring studies using quantitative measurements of inflammation could lead to the development of prognostic factors regarding the treatment efficacy. The performance of this method can be improved by the use of intraluminal contrast media.