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1.
Rev Med Chil ; 147(8): 1073-1077, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859974

RESUMO

In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.


Assuntos
Enterite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Diagnóstico Diferencial , Enterite/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
2.
Korean J Gastroenterol ; 74(3): 163-167, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554032

RESUMO

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm3) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Influenza Humana/diagnóstico , Adulto , Antivirais/uso terapêutico , Ascite , Colonoscopia , Ciclopentanos/uso terapêutico , Enterite/tratamento farmacológico , Enterite/etiologia , Eosinofilia/tratamento farmacológico , Eosinofilia/etiologia , Eosinófilos/citologia , Feminino , Gastrite/tratamento farmacológico , Gastrite/etiologia , Guanidinas/uso terapêutico , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/virologia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X
3.
Nihon Shokakibyo Gakkai Zasshi ; 116(8): 668-675, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31406072

RESUMO

Eosinophilic gastroenteritis is a rare disease that causes various abdominal symptoms that result from the infiltration of eosinophils in the digestive tract. However, this condition has been poorly explored, and the treatment criteria and prognosis after treatment are still unclear. A 20-year-old man with a refractory duodenal ulcer had been undergoing treatment since 14 years of age at another hospital. He was admitted to our hospital with abdominal pain and anemia (hemoglobin:6.3g/dL). His blood test showed elevated serum immunoglobulin E levels, considering that he was allergic to many foods. Furthermore, endoscopic biopsy detected the occurrence of eosinophilic gastroenteritis with gastritis, duodenal ulcer, and colitis. We treated him by avoiding allergenic foods and prescribing antihistamine and vonoprazan;however, duodenal ulcer and gastrointestinal tract inflammation did not show improvement. Thus, he was diagnosed with wide-ranging and refractory eosinophilic gastroenteritis and treated with 40mg/day of steroids. After 2 months, he recovered from gastritis and duodenal ulcer, and his eosinophil level decreased, as assessed using endoscopic biopsy. Eosinophilic gastroenteritis is poorly investigated, and its treatment standards have not yet been determined. Nonetheless, steroid treatment is often applied in severe cases.


Assuntos
Colite/diagnóstico , Úlcera Duodenal/diagnóstico , Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Adulto , Humanos , Masculino , Adulto Jovem
4.
BMC Gastroenterol ; 19(1): 154, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455284

RESUMO

BACKGROUND: Systemic lupus erythematosus is an autoimmune disease which can affect multiple organs, resulting in significant mortality and morbidity. Lupus enteritis is one of the rare complications of SLE, defined as vasculitis of the intestinal tract, with supportive biopsy findings and/or image. However, lupus enteritis is seldom confirmed on histology or image and the changes of intestinal mucosa are nonspecific. Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract which affects any part of the gastrointestinal tract. The diagnosis of CD is confirmed by clinical evaluation and a combination of endoscopic, histology, radiology, and/or biochemical investigations. CASE PRESENTATION: Here we report a rare case of a 71-years-old Chinese male has been diagnosed with lupus enteritis which similar to CD in the aspects of endoscopic, histology, and radiology. So far, there are no relevant cases reported. CONCLUSIONS: The endoscopic appearance of lupus enteritis is nonspecific, on the basis of our case, the features of lupus enteritis can be described as spacious, clean and no moss ulcers which discontinuous involved all gastrointestinal tract.


Assuntos
Doença de Crohn/diagnóstico , Endoscopia do Sistema Digestório/métodos , Enterite , Trato Gastrointestinal , Lúpus Eritematoso Sistêmico , Idoso , Anticorpos Antinucleares/sangue , Anticorpos Antifosfolipídeos/sangue , Diagnóstico Diferencial , Enterite/diagnóstico , Enterite/etiologia , Enterite/fisiopatologia , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/patologia , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/terapia , Masculino , Tomografia Computadorizada por Raios X/métodos
5.
Acta Reumatol Port ; 44(2): 145-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31300632

RESUMO

INTRODUCTION: Lupus enteritis (LE) is a rare, potentially life-threatening manifestation of systemic lupus erythematosus (SLE). Early diagnosis is crucial for early treatment and prevention of serious complications such as ischemic enteritis, bowel infarction with bleeding and/or perforation and peritonitis. The objective of this case review is to identify strategies for early diagnosis of LE. METHODS: Retrospective analysis of patients with SLE (fulfilling ACR 1997 and/or SLICC classification criteria) and presenting LE from three tertiary SLE centers was conducted. The diagnosis was based on clinical and imaging features consistent with LE and exclusion of other causes of GI disorders. RESULTS: We report seven cases of LE (female: 100%; age range: 16-55 years). All presented with acute onset abdominal pain, nausea and vomiting at the emergency room. Two patients had lupus enteritis as inaugural manifestation of SLE. Of the remaining five, one presented at the previous visit to the lupus clinic with clinically active disease and two had serologically active/ clinically inactive SLE. High anti-dsDNA antibodies and low serum complement were universally present at time of the LE event. Abdominal ultrasound was the first imaging exam to be performed in the emergency room. In all cases it showed bowel wall thickening, dilatation of intestinal segments, increased reflectivity of mesenteric fat and mild ascites, raising the suspicion of LE and immediate start of treatment. These features were later confirmed by CT scan in five patients. DISCUSSION: Despite being rare, LE must always be considered in any SLE patient presenting with GI symptoms. Abdominal ultrasound can be a reliable first line diagnostic tool for LE.


Assuntos
Enterite/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Dor Abdominal/etiologia , Adolescente , Adulto , Diagnóstico Precoce , Enterite/diagnóstico por imagem , Enterite/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
J Vet Diagn Invest ; 31(5): 783-787, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31347467

RESUMO

Rhodococcus equi infection in horses is common and is characterized by pyogranulomatous pneumonia and ulcerative enterocolitis. R. equi clinical disease in cattle, however, is rare and typically manifests as granulomatous lymphadenitis discovered in the abattoir. A 19-mo-old female Santa Gertrudis had a history of intermittent inappetence and weight loss for a 3-mo period before euthanasia. Gross and histologic examination revealed severe, chronic, ulcerative, and granulomatous inflammation in the tongue, pharynx, and small intestine. Also, the heifer had severe, granulomatous pharyngeal and mesenteric lymphadenitis. Bacterial cultures from the ileum, tongue, and liver yielded numerous-to-moderate numbers of R. equi. PCR analysis of the isolate detected the linear virulence plasmid vapN, which is often identified in bovine isolates (traA- and vapN-positive). The bacteria also lack the circular plasmids vapA and vapB that are associated with virulence in horses and swine, respectively. We report herein an atypical and unusual clinical presentation of R. equi infection in cattle, which has zoonotic potential.


Assuntos
Infecções por Actinomycetales/veterinária , Doenças dos Bovinos/diagnóstico , Enterite/veterinária , Glossite/veterinária , Rhodococcus equi/isolamento & purificação , Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/microbiologia , Animais , Bovinos , Doenças dos Bovinos/microbiologia , Enterite/diagnóstico , Enterite/microbiologia , Evolução Fatal , Feminino , Glossite/diagnóstico , Glossite/microbiologia , Granuloma/diagnóstico , Granuloma/microbiologia , Granuloma/veterinária , Úlcera/diagnóstico , Úlcera/microbiologia , Úlcera/veterinária
7.
Dtsch Med Wochenschr ; 144(13): 893-896, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31252443

RESUMO

Eosinophilic Gastrointestinal Disease (EGID) is a rare disease of largely unknown etiology. We describe a case of a 79-year-old patient with the initial diagnosis of eosinophilic gastritis with a haemorrhagic-ulcerous course and a rapid recurrence of the disease after discontinuing drug therapy. ANAMNESIS AND CLINICAL FINDINGS: The patient stated that he had melena for several days. He was completely asymptomatic. The existing medication has not been changed lately. EXAMINATIONS AND DIAGNOSIS: Gastroscopy, endosonography and CT scan revealed a tumor suspicious for malignancy in the corpus ventriculi. Histopathological examination revealed the correct diagnosis. THERAPY AND COURSE: The patient was treated with prednisolone and PPI. This led to a regression of the findings and a complete clinical remission. A treatment-free interval led to a fulminant recurrence with again upper GI bleeding. After resumption of drug therapy, the detected gastric ulcer rapidly declined. CONCLUSION: EGID is hardly distinguishable from classic gastroenteritis in its clinical appearance. Diagnosis requires a histopathological examination of the affected tissue. Oral glucocorticoids play a role in the treatment of acute EGID. Both single episodes and chronic recurrent courses have been observed. The drugs used for therapy should therefore be discontinued carefully.


Assuntos
Enterite , Eosinofilia , Gastrite , Hemorragia Gastrointestinal , Úlcera Gástrica , Idoso , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Enterite/complicações , Enterite/diagnóstico , Eosinofilia/complicações , Eosinofilia/diagnóstico , Gastrite/complicações , Gastrite/diagnóstico , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Melena , Prednisolona/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Recidiva , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/etiologia
8.
Ital J Pediatr ; 45(1): 69, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171002

RESUMO

BACKGROUND: Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow's milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical. CASE PRESENTATION: A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration. CONCLUSIONS: A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk.


Assuntos
Anemia/etiologia , Biópsia/efeitos adversos , Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente
11.
Am J Gastroenterol ; 114(6): 984-994, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31008735

RESUMO

OBJECTIVES: The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments for patients with EG, EGE, and EC. METHODS: In this retrospective study, data were collected from 6 centers in the Consortium of Eosinophilic Gastrointestinal Researchers from 2005 to 2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. RESULTS: Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis of all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/vomiting and abdominal pain, the most common. One hundred fifty-four subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the second most common gastrointestinal (GI) segment involved. Multisite inflammation was more common in children than in adults (68% vs 37%; P < 0.001). Initial treatment patterns varied highly between centers. One hundred-nine subjects (29%) had follow-up within 6 months, and the majority had clinical, endoscopic, and histologic improvements. CONCLUSIONS: In this cohort, EG, EGE, and EC were diagnosed more frequently over time, and inflammation of GI segments outside the primary disease site co-occurrence of atopy was common with a lack of male predominance. Symptoms were similar between diseases, and initial treatment strategies were highly variable. Future investigation should assess the cause of the increased prevalence of eosinophilic GI disorders and prospectively assess outcomes to establish treatment algorithms.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colite/epidemiologia , Enterite/epidemiologia , Eosinofilia/epidemiologia , Eosinófilos/patologia , Gastrite/epidemiologia , Gastroenterite/epidemiologia , Fármacos Gastrointestinais/uso terapêutico , Mucosa Intestinal/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Colite/diagnóstico , Colite/tratamento farmacológico , Comorbidade/tendências , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Feminino , Seguimentos , Previsões , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
12.
Intern Med ; 58(15): 2167-2171, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996166

RESUMO

No specific endoscopic features for eosinophilic gastroenteritis (EGE) have been reported previously. This study therefore evaluated the endoscopic findings of six patients with EGE. The diagnosis was confirmed based on gastrointestinal symptoms, pathological findings on biopsy, and the absence of other diseases. The site of the lesion was identified based on eosinophilic infiltration with ≥20 cells per high-power field during a pathological specimen analysis. Flattening of the small intestinal villi was observed in four patients; we speculate that this may be a specific feature in the diagnosis of EGE.


Assuntos
Duodeno/fisiopatologia , Endoscopia/métodos , Enterite/diagnóstico , Enterite/fisiopatologia , Eosinofilia/diagnóstico , Eosinofilia/fisiopatologia , Gastrite/diagnóstico , Gastrite/fisiopatologia , Mucosa Intestinal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Dig Dis Sci ; 64(8): 2231-2241, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30982212

RESUMO

BACKGROUND: Eosinophilic gastroenteritis (EGE) is a rare, chronic inflammatory condition of the gastrointestinal tract. Little is known about its natural history and treatment outcomes. The aims of our analysis were to describe clinical presentation, response to current medical treatments, and to evaluate the response of refractory EGE to anti-integrin therapy. METHODS: Patients with confirmed diagnosis of EGE fulfilling the diagnostic criteria: (1) the presence of gastrointestinal symptoms, (2) dense eosinophilic infiltration of the gastrointestinal mucosa, and (3) exclusion of other conditions leading to gastrointestinal eosinophilia were included in this analysis. In patients non-responding to corticosteroids and/or anti-TNF treatment the integrin blocker vedolizumab was used. RESULTS: EGE patients (n = 22) were predominantly female (63%) with a median age at diagnosis of 41.5 years. The most frequent symptoms were abdominal pain (100%), diarrhea (59%), nausea/vomiting (36%), and bloating (27%). No pathognomonic endoscopic alterations were found. Eosinophilic infiltration was observed in the majority of patients in more than one segment. Patients were treated with systemic steroids, topical, and enteral release steroids in 21/22 (95%) patients, proton pump inhibitors in 7/22 (32%), TNFα inhibitors in 3/22 (14%), and vedolizumab in 4/22 (18%) patients. In 3/4 of steroid-refractory patients vedolizumab induced a clinical and histological improvement. CONCLUSIONS: The combination of highly variable clinical presentation, subtle endoscopic abnormalities, and involvement of several GI segments undermines the difficulty to diagnose EGE and the need for structured biopsy sampling. Corticosteroids were efficient in the majority of patients to induce remission. Response to the integrin blocker vedolizumab suggests further assessment in refractory cases.


Assuntos
Corticosteroides/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Enterite/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Gastrite/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Adolescente , Corticosteroides/efeitos adversos , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Criança , Enterite/diagnóstico , Enterite/imunologia , Eosinofilia/diagnóstico , Eosinofilia/imunologia , Feminino , Gastrite/diagnóstico , Gastrite/imunologia , Fármacos Gastrointestinais/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
BMC Gastroenterol ; 19(1): 49, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943900

RESUMO

BACKGROUND: CMUSE is a rare disease whose diagnosis remains difficult because the lesion is confined to the small bowel. CASE PRESENTATION: Here, we present a case of 43-year-old female patient suffered chronic abdominal pain for 20 years, and finally diagnosed with CMUSE. Capsule endoscopy was performed when general endoscopic investigation failed to find the lesion, but the capsule was stranded in the small intestine. Moreover, capsule retention results in acute intestinal obstruction. Thus, surgery was performed and CMUSE was confirmed. The patient was recovered after partial small intestine resection. CONCLUSIONS: Capsule retention occurred in nearly 60% of patients with CMUSE. Capsule endoscopy should be avoided when the patient is suspected of CMUSE, especially with severe anemia and radiologic finding in the ileum.


Assuntos
Endoscopia por Cápsula/efeitos adversos , Enterite/patologia , Corpos Estranhos/etiologia , Obstrução Intestinal/etiologia , Intestino Delgado/patologia , Úlcera/patologia , Dor Abdominal/etiologia , Adulto , Endoscopia por Cápsula/instrumentação , Dor Crônica/etiologia , Constrição Patológica/diagnóstico , Enterite/diagnóstico , Feminino , Humanos , Úlcera/diagnóstico
15.
Acta Gastroenterol Belg ; 82(1): 5-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30888747

RESUMO

BACKGROUND: Eosinophilic gastroenteritis (EG) is uncommon disease, and the pathogenesis of this disease have yet to be fully clarified. AIM: This study was to describe the clinical manifestations, endoscopic features and treatment outcomes of a cohort of patients with EG. METHOD: This retrospective study was included 28 consecutive patients who were diagnosed EG between January 2011 and December 2015 in Taizhou Hospital. The patients' clinical manifestations, endoscopic features and treatment outcomes were reviewed from a prospectively maintained database. RESULTS: Twenty-eight patients with EG were enrolled in the study (median age 54 years). The main symptoms were abdominal pain (78.6%), abdominal distension (50.0%), nausea and vomiting (28.6%) and diarrhea (25.0%). Laboratory examinations showed the elevation of blood eosinophil count (85.7%), serum IgE (71.4%). Endoscopic findings included small patchy mucosal erythema or erosions (75.0%), mucosal fold thickening (17.9%), submucosal nodules (21.4%), small gastroduodenal ulcers (14.3%). Twenty patients were treated and responded to prednisolone but five patients (25.0%) relapsed during the follow-up. The other 8 patients were treated with loratadine, proton pump inhibitors and dietary modification, 5 patients had clinical resolution during the follow-up. The other 3 patients did not achieve clinical remission, and then were given prednisone treatment. CONCLUSION: For some patients with gastrointestinal symptoms and peripheral eosinophilia, a high suspicion of EG is necessary and multiple endoscopic examinations might be helpful in diagnosis of EG. Most patients with EG could achieve remission after with the treatment of steroid or dietary elimination therapy.


Assuntos
Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Dor Abdominal/etiologia , Adulto , Idoso , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologia
16.
Clin Rev Allergy Immunol ; 57(2): 272-285, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30903439

RESUMO

Eosinophilic gastrointestinal disorders (EGID) are a group of disorders characterized by pathologic eosinophilic infiltration of the esophagus, stomach, small intestine, or colon leading to organ dysfunction and clinical symptoms (J Pediatr Gastroenterol Nutr; Spergel et al., 52: 300-306, 2011). These disorders include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), eosinophilic enteritis (EE), and eosinophilic colitis (EC). Symptoms are dependent not only on the location (organ) as well as extent (layer invasion of the bowel wall). Common symptoms of EoE include dysphagia and food impaction in adults and heartburn, abdominal pain, and vomiting in children. Common symptoms of the other EGIDs include abdominal pain, nausea, vomiting, early satiety, diarrhea, and weight loss. These disorders are considered immune-mediated chronic inflammatory disorders with strong links to food allergen triggers. Treatment strategies focus on either medical or dietary therapy. These options include not only controlling symptoms and bowel inflammation but also on identifying potential food triggers. This chapter will focus on the clinical presentation, pathophysiology, and treatment of these increasingly recognized disorders.


Assuntos
Enterite/epidemiologia , Enterite/terapia , Eosinofilia/epidemiologia , Eosinofilia/terapia , Esofagite Eosinofílica/epidemiologia , Esofagite Eosinofílica/terapia , Gastrite/epidemiologia , Gastrite/terapia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Biológica , Criança , Pré-Escolar , Dietoterapia , Enterite/diagnóstico , Enterite/fisiopatologia , Eosinofilia/diagnóstico , Eosinofilia/fisiopatologia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/fisiopatologia , Feminino , Gastrite/diagnóstico , Gastrite/fisiopatologia , Predisposição Genética para Doença , Humanos , Fatores Imunológicos/uso terapêutico , Lactente , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Fatores Sexuais , Adulto Jovem
17.
J Gastrointestin Liver Dis ; 28(1): 47-51, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851172

RESUMO

BACKGROUND AND AIMS: Eosinophilic gastrointestinal disorders (EGIDs) have been linked with atopic conditions, connective tissue disorders, and autoimmunity, but the association between EGIDs and autonomic dysfunction has not been extensively described. We aimed to assess this association and determine the prevalence of autonomic dysfunction in our EGID population. METHODS: In this retrospective cohort study, we analyzed adult patients in the University of North Carolina Eosinophilic Esophagitis (EoE)/EGID database who also had a diagnosis of comorbid autonomic dysfunction (postural orthostatic tachycardia syndrome [POTS] or gastroparesis). The electronic medical record was abstracted and disease characteristics summarized. RESULTS: We identified seven patients who had EGID and autonomic dysfunction. All had POTS and were Caucasian, and five (71%) were female; 2 also had gastroparesis. Onset of autonomic symptoms coincided with onset of EGID symptoms in 3 patients (43%) or with an acute EGID flare in 3. In no cases did successful control of EGID lead to improvement of autonomic symptoms. Two subjects (29%) had comorbid Ehlers-Danlos syndrome and mast cell activation syndrome. The prevalence of POTS in EGID patients was 7/560 (1.25%), compared to an estimated 0.17% prevalence of POTS in the general population. CONCLUSIONS: The prevalence of autonomic dysfunction was 5-10-fold higher in EGID than expected in the general population, suggesting an association between the two conditions, though the underlying mechanism is unclear. Providers should consider comorbid autonomic dysfunction in patients with EGID, particularly when symptoms persist despite treatment.


Assuntos
Doenças do Sistema Nervoso Autônomo/epidemiologia , Enterite/epidemiologia , Eosinofilia/epidemiologia , Esofagite Eosinofílica/epidemiologia , Gastrite/epidemiologia , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Adolescente , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico , Comorbidade , Registros Eletrônicos de Saúde , Enterite/diagnóstico , Eosinofilia/diagnóstico , Esofagite Eosinofílica/diagnóstico , Feminino , Gastrite/diagnóstico , Gastroparesia/diagnóstico , Gastroparesia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Dtsch Med Wochenschr ; 144(1): 46-53, 2019 01.
Artigo em Alemão | MEDLINE | ID: mdl-30602187

RESUMO

The global incidence and prevalence of eosinophilic gastrointestinal diseases is rising. Clinically, acute eosinophilic esophagitis cannot be distinguished from other causes of esophagitis. Endoscopic findings like rings, webs or furrows have a lower sensitivity than previously assumed. An improvement of symptoms by proton-pump inhibitors also doesn't rule out the diagnosis - it has to be confirmed histologically. Early therapy will prevent later complications like strictures and motility disorders. The presentation of eosinophilic gastroenteritris/colitis is even less specific. Common cause seems to be a Th2-mediated food allergy. Successful therapies include allergen-free diets and topic steroids. Additionally, in the case of proton-pump inhibitor-responsive eosinophilic esophagitis, proton pump inhibitors do not only block gastral acid production, but may also have a direct inhibitory effect on Th2-immunity. Therefore, Th2-specific biologicals have theoretical advantages, but they could not really convince in first clinical studies.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Diagnóstico Diferencial , Enterite/diagnóstico , Enterite/patologia , Enterite/fisiopatologia , Eosinofilia/diagnóstico , Eosinofilia/patologia , Eosinofilia/fisiopatologia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/patologia , Esofagite Eosinofílica/fisiopatologia , Gastrite/diagnóstico , Gastrite/patologia , Gastrite/fisiopatologia , Humanos
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