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1.
World J Gastroenterol ; 30(24): 3076-3085, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38983956

RESUMO

BACKGROUND: Helicobacter pylori (H. pylori) infection is closely associated with gastrointestinal diseases. Our preliminary studies have indicated that H. pylori infection had a significant impact on the mucosal microbiome structure in patients with gastric ulcer (GU) or duodenal ulcer (DU). AIM: To investigate the contributions of H. pylori infection and the mucosal microbiome to the pathogenesis and progression of ulcerative diseases. METHODS: Patients with H. pylori infection and either GU or DU, and healthy individuals without H. pylori infection were included. Gastric or duodenal mucosal samples was obtained and subjected to metagenomic sequencing. The compositions of the microbial communities and their metabolic functions in the mucosal tissues were analyzed. RESULTS: Compared with that in the healthy individuals, the gastric mucosal microbiota in the H. pylori-positive patients with GU was dominated by H. pylori, with significantly reduced biodiversity. The intergroup differential functions, which were enriched in the H. pylori-positive GU patients, were all derived from H. pylori, particularly those concerning transfer RNA queuosine-modification and the synthesis of demethylmenaquinones or menaquinones. A significant enrichment of the uibE gene was detected in the synthesis pathway. There was no significant difference in microbial diversity between the H. pylori-positive DU patients and healthy controls. CONCLUSION: H. pylori infection significantly alters the gastric microbiota structure, diversity, and biological functions, which may be important contributing factors for GU.


Assuntos
Úlcera Duodenal , Mucosa Gástrica , Microbioma Gastrointestinal , Infecções por Helicobacter , Helicobacter pylori , Úlcera Gástrica , Humanos , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/genética , Úlcera Duodenal/microbiologia , Úlcera Duodenal/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Úlcera Gástrica/microbiologia , Adulto , Estudos de Casos e Controles , Idoso , Metagenômica/métodos , Duodeno/microbiologia , Disbiose/microbiologia
2.
BMC Surg ; 24(1): 204, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982419

RESUMO

BACKGROUND: Single Anastomosis Duodeno-Ileal bypass (SADI) is becoming a key option as a revision procedure after laparoscopic sleeve gastrectomy (LSG). However, its safety as an ambulatory procedure (length of stay < 12 h) has not been widely described. METHODS: A prospective bariatric study of 40 patients undergoing SADI robotic surgery after LSG with same day discharge (SDD), was undertaken in April 2021. Strict inclusion and exclusion criteria were applied and the enhanced recovery after bariatric surgery protocol was followed. Anesthesia and robotic procedures were standardized. Early follow-up (30 days) analyzed postoperative (PO) outcomes. RESULTS: Forty patients (37 F/3 M, mean age: 40.3yo), with a mean pre-operative BMI = 40.5 kg/m2 were operated. Median time after LSG was 54 months (21-146). Preoperative comorbidities included: hypertension (n = 3), obstructive sleep apnea (n = 2) and type 2 diabetes (n = 1). Mean total operative time was 128 min (100-180) (mean robotic time: 66 min (42-85)), including patient setup. All patients were discharged home at least 6 h after surgery. There were four minor complications (10%) and two major complications (5%) in the first 30 days postoperative (one intrabdominal abscess PO day-20 (radiological drainage and antibiotic therapy) and one peritonitis due to duodenal leak PO day-1 (treated surgically)). There were six emergency department visits (15%), readmission rate was 5% (n = 2) and reintervention rate was 2.5% (n = 1) There was no mortality and no unplanned overnight hospitalization. CONCLUSIONS: Robotic SADI can be safe for SDD, with appropriate patient selection, in a high-volume center.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anastomose Cirúrgica , Duodeno , Obesidade Mórbida , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Feminino , Adulto , Procedimentos Cirúrgicos Robóticos/métodos , Estudos Prospectivos , Procedimentos Cirúrgicos Ambulatórios/métodos , Duodeno/cirurgia , Anastomose Cirúrgica/métodos , Obesidade Mórbida/cirurgia , Pessoa de Meia-Idade , Íleo/cirurgia , Cirurgia Bariátrica/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Centros de Atenção Terciária , Laparoscopia/métodos , Gastrectomia/métodos , Resultado do Tratamento
3.
Braz J Med Biol Res ; 57: e13452, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38958368

RESUMO

The misuse of anabolic androgenic steroid associated or not with physical workouts disrupts gastrointestinal (GI) function homeostasis. Our goal was to investigate the effects of nandrolone decanoate (ND) and moderate swimming on the GI transit of solid meals, GI motor contractility, and intestinal histology in rats. Male Wistar rats were allocated to four groups that received intramuscular injections of ND (5.0 mg/kg) or vehicle (60.0 µL) and were submitted or not to swimming sessions (60 min, 5% body weight overload) for 4 weeks. Gastric emptying, intestinal transit, in vitro GI contractility, intestinal morphometry, and duodenal mucosal mast cells were evaluated in all experimental groups. ND treatment accelerated gastric emptying, slowed small intestine transit time, enhanced gastric carbachol-mediated reactivity, decreased crypt depth and villus height, reduced mucosal thickness, and increased the circular and longitudinal muscle layer thickness of the duodenum in sedentary rats. Moderate exercise accelerated intestinal transit time and reduced submucosa thickness. In vehicle-treated animals, a strong negative correlation was found between intestinal transit and mucosal mast cells, which was reversed by ND treatment. Combining ND treatment and swimming accelerated gastric emptying, increased duodenal cholinergic reactivity, inhibited the sodium nitroprusside relaxing response, increased the number of duodenal mast cells, decreased villus height, and increased the thickness of all muscle layers. ND changed the morphological and functional properties of the GI tract over time, with intense dysmotility, especially in sedentary animals, but moderate exercise seemed to have played a compensatory role in these harmful effects in the gut.


Assuntos
Anabolizantes , Duodeno , Motilidade Gastrointestinal , Decanoato de Nandrolona , Nandrolona , Condicionamento Físico Animal , Ratos Wistar , Animais , Masculino , Decanoato de Nandrolona/farmacologia , Duodeno/efeitos dos fármacos , Motilidade Gastrointestinal/efeitos dos fármacos , Anabolizantes/farmacologia , Nandrolona/farmacologia , Nandrolona/análogos & derivados , Mastócitos/efeitos dos fármacos , Ratos , Natação , Esvaziamento Gástrico/efeitos dos fármacos , Mucosa Intestinal/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos
6.
Sci Rep ; 14(1): 12668, 2024 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-38830904

RESUMO

Crohn's disease is an inflammatory condition of the intestine characterized by largely unknown etiology and a relapse remission cycle of disease control. While possible triggers have been identified, research is inconsistent on the precise cause of these relapses, especially in the under-researched pediatric population. We hypothesized that patients in remission would have persistent microbial and inflammatory changes in small intestinal tissue that might trigger relapse. To this end, we analyzed intestinal biopsy samples from six patients with pediatric Crohn's disease in remission and a control group of 16 pediatric patients with no evident pathogenic abnormality. We identified compositional microbiota differences, including decreases in the genera Streptococcus and Actinobacillus as well as increases in Oribacterium and Prevotella in patients with controlled Crohn's disease compared to controls. Further, a histologic analysis found that patients with controlled Crohn's disease had increased epithelial integrity, and decreased intraepithelial lymphocytes compared with controls. Additionally, we observed increased peripheral CD4+ T cells in patients with pediatric Crohn's disease. These results indicate that markers of intestinal inflammation are responsive to Crohn's disease treatment, however the interventions may not resolve the underlying dysbiosis. These findings suggest that persistent dysbiosis may increase vulnerability to relapse of pediatric Crohn's disease. This study used a nested cohort of patients from the Bangladesh Environmental Enteric Dysfunction (BEED) study (ClinicalTrials.gov ID: NCT02812615 Date of first registration: 24/06/2016).


Assuntos
Doença de Crohn , Disbiose , Microbioma Gastrointestinal , Humanos , Doença de Crohn/microbiologia , Doença de Crohn/patologia , Doença de Crohn/complicações , Disbiose/microbiologia , Feminino , Masculino , Criança , Adolescente , Duodeno/microbiologia , Duodeno/patologia , Inflamação/microbiologia , Inflamação/patologia , Estudos de Casos e Controles
7.
Am J Case Rep ; 25: e943891, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38853402

RESUMO

BACKGROUND The Over-the-Scope-Clip (OTSC) System is a class of endoscopic clips intended to provide improved strength and tissue capture compared to conventional through-the-scope clips. These clips are generally safe and effective in managing many gastrointestinal conditions, with a low overall adverse event rate. Although the OTSC has been used to treat gastrointestinal bleeding and bowel perforations for many years, it often is relegated to second-line therapy and has only recently become a first-line hemostatic therapy for gastrointestinal bleeding. CASE REPORT Here, we present a unique adverse event of the OTSC causing iatrogenic ligation of the gastroduodenal artery (GDA). A 71-year-old man presented with 6 months of epigastric abdominal pain and 2 weeks of hematemesis, and was ultimately diagnosed with a bleeding duodenal ulcer. He underwent multiple endoscopic interventions to attempt to control the duodenal ulcer bleeding, including placement of the OTSC on a visible vessel. Soon after OTSC placement, he became hypotensive with recurrent hematochezia, and Interventional Radiology was consulted for endovascular management of the bleeding. Angiography showed the OTSC had been deployed across the midportion of the GDA from the duodenal lumen, effectively ligating the GDA, causing bleeding due to direct vascular injury. This bleeding was ultimately controlled with coil embolization. However, this iatrogenic ligation of the midportion of the GDA by the OTSC significantly complicated endovascular intervention to control the bleeding. CONCLUSIONS As the OTSC device becomes more commonly used in the endoscopy suite, it is important to share potential pitfalls that may be encountered in the clinical setting that impact not only endoscopists and patients, but other specialties as well.


Assuntos
Duodeno , Doença Iatrogênica , Humanos , Masculino , Idoso , Ligadura , Duodeno/lesões , Duodeno/irrigação sanguínea , Instrumentos Cirúrgicos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Úlcera Duodenal
8.
Front Immunol ; 15: 1397590, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38933260

RESUMO

Chronic inflammatory enteropathy (CIE) is a common condition in dogs causing recurrent or persistent gastrointestinal clinical signs. Pathogenesis is thought to involve intestinal mucosal inflammatory infiltrates, but histopathological evaluation of intestinal biopsies from dogs with CIE fails to guide treatment, inform prognosis, or correlate with clinical remission. We employed single-cell RNA sequencing to catalog and compare the diversity of cells present in duodenal mucosal endoscopic biopsies from 3 healthy dogs and 4 dogs with CIE. Through characterization of 35,668 cells, we identified 31 transcriptomically distinct cell populations, including T cells, epithelial cells, and myeloid cells. Both healthy and CIE samples contributed to each cell population. T cells were broadly subdivided into GZMAhigh (putatively annotated as tissue resident) and IL7Rhigh (putatively annotated as non-resident) T cell categories, with evidence of a skewed proportion favoring an increase in the relative proportion of IL7Rhigh T cells in CIE dogs. Among the myeloid cells, neutrophils from CIE samples exhibited inflammatory (SOD2 and IL1A) gene expression signatures. Numerous differentially expressed genes were identified in epithelial cells, with gene set enrichment analysis suggesting enterocytes from CIE dogs may be undergoing stress responses and have altered metabolic properties. Overall, this work reveals the previously unappreciated cellular heterogeneity in canine duodenal mucosa and provides new insights into molecular mechanisms which may contribute to intestinal dysfunction in CIE. The cell type gene signatures developed through this study may also be used to better understand the subtleties of canine intestinal physiology in health and disease.


Assuntos
Doenças do Cão , Duodeno , Perfilação da Expressão Gênica , Análise de Célula Única , Transcriptoma , Animais , Cães , Duodeno/patologia , Duodeno/imunologia , Duodeno/metabolismo , Doenças do Cão/genética , Doenças do Cão/imunologia , Doenças do Cão/patologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Doença Crônica , Masculino , Feminino , Linfócitos T/imunologia , Linfócitos T/metabolismo
9.
Food Res Int ; 190: 114624, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38945578

RESUMO

The present work evaluated how a native pea protein isolate (PPI) affects the key roles carried out by bile salts (BS) in lipid digestion by means of the in vitro static INFOGEST protocol. Two gastric residence times were evaluated (10 and 60 min), and then the peptides obtained (GPPP) were mixed with BS at physiological concentration in simulated intestinal fluid to understand how they interact with BS both at the bulk and at the interface. Both GPPP give rise to a film with a predominant viscous character that does not constitute a barrier to the penetration of BS, but interact with BS in the bulk duodenal fluid. When the peptides flushing from the stomach after the different gastric residence times undergo duodenal digestion, it was found that for the longer gastric residence time the percentage of soluble fraction in the duodenal phase, that perform synergistically with BS micelles, was twice that of the lower residence time, leading to an increase in the solubilization of oleic acid. These results finally lead to a greater extent of lipolysis of olive oil emulsions. This work demonstrates the usefulness of in vitro models as a starting point to study the influence of gastric residence time of pea protein on its interaction with BS, affecting lipolysis. Pea proteins were shown to be effective emulsifiers that synergistically perform with BS improving the release and bioaccessibility of bioactive lipids as olive oil.


Assuntos
Ácidos e Sais Biliares , Digestão , Lipólise , Proteínas de Ervilha , Ácidos e Sais Biliares/metabolismo , Ácidos e Sais Biliares/química , Proteínas de Ervilha/química , Proteínas de Ervilha/metabolismo , Pisum sativum/química , Pisum sativum/metabolismo , Peptídeos/metabolismo , Peptídeos/química , Duodeno/metabolismo , Humanos
10.
Gut Microbes ; 16(1): 2361660, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38935764

RESUMO

The microbiota significantly impacts digestive epithelium functionality, especially in nutrient processing. Given the importance of iron for both the host and the microbiota, we hypothesized that host-microbiota interactions fluctuate with dietary iron levels. We compared germ-free (GF) and conventional mice (SPF) fed iron-containing (65 mg/Kg) or iron-depleted (<6 mg/Kg) diets. The efficacy of iron privation was validated by iron blood parameters. Ferritin and Dmt1, which represent cellular iron storage and transport respectively, were studied in tissues where they are abundant: the duodenum, liver and lung. When the mice were fed an iron-rich diet, the microbiota increased blood hemoglobin and hepcidin and the intestinal ferritin levels, suggesting that the microbiota helps iron storage. When iron was limiting, the microbiota inhibited the expression of the intestinal Dmt1 transporter, likely via the pathway triggered by Hif-2α. The microbiota assists the host in storing intestinal iron when it is abundant and competes with the host by inhibiting Dmt1 in conditions of iron scarcity. Comparison between duodenum, liver and lung indicates organ-specific responses to microbiota and iron availability. Iron depletion induced temporal changes in microbiota composition and activity, reduced α-diversity of microbiota, and led to Lactobacillaceae becoming particularly more abundant after 60 days of privation. By inoculating GF mice with a simplified bacterial mixture, we show that the iron-depleted host favors the gut fitness of Bifidobacterium longum.


Assuntos
Proteínas de Transporte de Cátions , Duodeno , Microbioma Gastrointestinal , Hepcidinas , Ferro da Dieta , Fígado , Animais , Camundongos , Microbioma Gastrointestinal/fisiologia , Ferro da Dieta/metabolismo , Ferro da Dieta/administração & dosagem , Proteínas de Transporte de Cátions/metabolismo , Proteínas de Transporte de Cátions/genética , Fígado/metabolismo , Fígado/microbiologia , Duodeno/metabolismo , Duodeno/microbiologia , Hepcidinas/metabolismo , Ferritinas/metabolismo , Vida Livre de Germes , Interações entre Hospedeiro e Microrganismos , Pulmão/microbiologia , Pulmão/metabolismo , Ferro/metabolismo , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Bactérias/classificação , Bactérias/metabolismo , Bactérias/genética , Bactérias/isolamento & purificação , Camundongos Endogâmicos C57BL , Hemoglobinas/metabolismo , Masculino
11.
Medicina (Kaunas) ; 60(6)2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38929559

RESUMO

Background and Objectives: Hyperprolactinemia, as a potential side-effect of some antipsychotic medications, is associated with decreased bone density and an increased risk of fractures. This study investigates whether calcium and vitamin D supplementation affects prolactin receptor (Prlr) gene expression in the duodenum, vertebrae, and kidneys of female rats with sulpiride-induced hyperprolactinemia. Materials and Methods: Twenty-one-week-old female Wistar rats were assigned to three groups: Group S consisted of ten rats who received sulpiride injections (10 mg/kg) twice daily for 6 weeks; Group D (10 rats) received daily supplementation of 50 mg calcium and 500 IU vitamin D along with sulpiride for the last 3 weeks; and Group C consisting of seven age-matched nulliparous rats serving as a control group. Real-time PCR was used to assess Prlr gene expression in the duodenum, vertebrae, and kidneys. Results: In Group S, Prlr gene expression was notably decreased in the duodenum (p < 0.01) but elevated in the vertebrae and kidneys compared to Group C. Conversely, Group D exhibited significantly increased Prlr expression in the duodenum (p < 0.01) alongside elevated expression in the vertebrae and kidneys. Conclusions: In sulpiride-induced hyperprolactinemia, decreased Prlr gene expression in the duodenum may lead to reduced intestinal calcium absorption. Consequently, prolactin may draw calcium from the skeletal system to maintain calcium balance, facilitated by increased Prlr gene expression in the vertebrae. However, vitamin D supplementation in sulpiride-induced hyperprolactinemia notably enhances Prlr gene expression in the duodenum, potentially ameliorating intestinal calcium absorption and mitigating adverse effects on bone health.


Assuntos
Cálcio , Duodeno , Hiperprolactinemia , Ratos Wistar , Receptores da Prolactina , Sulpirida , Vitamina D , Animais , Hiperprolactinemia/tratamento farmacológico , Hiperprolactinemia/induzido quimicamente , Sulpirida/farmacologia , Feminino , Vitamina D/farmacologia , Vitamina D/uso terapêutico , Ratos , Cálcio/metabolismo , Duodeno/efeitos dos fármacos , Duodeno/metabolismo , Receptores da Prolactina/metabolismo , Expressão Gênica/efeitos dos fármacos
13.
Nutrients ; 16(11)2024 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-38892566

RESUMO

BACKGROUND: The diagnosis of coeliac disease (CD) in adults is based on clinical, serological and histological criteria. The inappropriate performance of intestinal biopsies, non-specificity of mild histological lesions and initiation of a gluten-free diet (GFD) before biopsy may hamper the diagnosis. In these situations, determining the intraepithelial lymphogram of the duodenum by flow cytometry (IEL-FC) can be helpful. OBJECTIVES: To describe the clinical scenarios in which the IEL-FC is used and its impact on the diagnosis of CD. METHODS: All adult patients with suspected CD at three tertiary centres for whom the duodenal histology and IEL-FC were available were identified. Catassi and Fasano's diagnostic criteria and changes to a CD diagnosis after the IEL-FCs were collected. RESULTS: A total of 348 patients were included. The following indications for an IEL-FC formed part of the initial study for CD (38%): negative conventional work-up (32%), already on a GFD before duodenal biopsies (29%) and refractoriness to a GFD (2%). The IEL-FC facilitated a definitive diagnosis in 93% of patients with an uncertain diagnosis who had had a conventional work-up for CD or who were on a GFD before histology. CONCLUSIONS: The IEL-FC facilitates the confirmation or rejection of a diagnosis of CD in clinical scenarios in which a conventional work-up may be insufficient.


Assuntos
Doença Celíaca , Duodeno , Citometria de Fluxo , Imunofenotipagem , Linfócitos Intraepiteliais , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Doença Celíaca/imunologia , Humanos , Feminino , Masculino , Adulto , Imunofenotipagem/métodos , Pessoa de Meia-Idade , Duodeno/patologia , Citometria de Fluxo/métodos , Linfócitos Intraepiteliais/imunologia , Biópsia , Idoso , Adulto Jovem , Dieta Livre de Glúten
14.
Nutrients ; 16(11)2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38892582

RESUMO

There is increasing evidence indicating that changes in both the composition and functionality of the intestinal microbiome are closely associated with the development of several chronic inflammatory diseases, with celiac disease (CeD) being particularly noteworthy. Thanks to the advent of culture-independent methodologies, the ability to identify and quantify the diverse microbial communities residing within the human body has been significantly improved. However, in the context of CeD, a notable challenge lies in characterizing the specific microbiota present on the mucosal surfaces of the intestine, rather than relying solely on fecal samples, which may not fully represent the relevant microbial populations. Currently, our comprehension of the composition and functional importance of mucosa-associated microbiota (MAM) in CeD remains an ongoing field of research because the limited number of available studies have reported few and sometimes contradictory results. MAM plays a crucial role in the development and progression of CeD, potentially acting as both a trigger and modulator of the immune response within the intestinal mucosa, given its proximity to the epithelial cells and direct interaction. According to this background, this review aims to consolidate the existing literature specifically focused on MAM in CeD. By elucidating the complex interplay between the host immune system and the gut microbiota, we aim to pave the way for new interventions based on novel therapeutic targets and diagnostic biomarkers for MAM in CeD.


Assuntos
Doença Celíaca , Duodeno , Microbioma Gastrointestinal , Mucosa Intestinal , Doença Celíaca/microbiologia , Humanos , Microbioma Gastrointestinal/fisiologia , Mucosa Intestinal/microbiologia , Duodeno/microbiologia
15.
Am J Case Rep ; 25: e943879, 2024 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-38932438

RESUMO

BACKGROUND When people in their 60s experiences abdominal pain, vomiting, and unexplained weight loss without a history of abdominal surgery, the usual diagnosis is obstruction caused by a neoplastic mass. Nevertheless, in exceptionally rare cases, these symptoms arise from complications linked to a visceral artery aneurysm. CASE REPORT We present a case of a 60-year-old man with immunodeficiency and Sneddon-Wilkinson disease (a rare subcorneal pustular dermatosis), who developed a pancreaticoduodenal aneurysm of uncertain origin, associated with pancreatic mass, retroperitoneal hematoma, and duodenal obstruction. The treatment approach included transcatheter arterial coil embolization with supportive measures such as parenteral nutrition, a nasogastric tube, octreotide administration, and antiemetics. Despite these interventions, persistence gastrointestinal symptoms prompted an endoscopic ultrasound fine-needle aspiration to rule out malignancy. The biopsy confirmed localized fibro-inflammation. Although he was initially considered for a gastro-jejunal bypass, conservative management effectively improved the pancreatic lesion and duodenal obstruction, leading to discontinuation of parenteral nutrition. The patient was able to resume a regular diet 4 weeks after embolization. CONCLUSIONS Pancreaticoduodenal artery aneurysm is a rare visceral aneurysm with multiple etiologies and potentially fatal consequences. We report an unusual case of a pancreaticoduodenal artery aneurysm associated with pancreatic mass and duodenal obstruction. This diagnosis warrants consideration when an immunodeficient patient presents symptoms of abdominal pain and vomiting. Early endovascular embolization, combined with conservative approaches, effectively alleviated the symptoms in our patient.


Assuntos
Falso Aneurisma , Obstrução Duodenal , Duodeno , Pâncreas , Humanos , Masculino , Pessoa de Meia-Idade , Falso Aneurisma/terapia , Falso Aneurisma/etiologia , Falso Aneurisma/diagnóstico , Pâncreas/irrigação sanguínea , Obstrução Duodenal/etiologia , Duodeno/irrigação sanguínea , Embolização Terapêutica
16.
Obes Surg ; 34(7): 2627-2633, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38837020

RESUMO

INTRODUCTION: Revisional bariatric surgery is associated with higher perioperative complications over primary procedures. Adjustable gastric bands (AGB) continue to be the most frequently converted bariatric configuration. This study examines trends in current clinical indication and safety profile of the most frequently pursued AGB conversions. MATERIALS AND METHODS: MBSAQIP data from 2020 to 2022 was retrospectively analyzed in a cohort study examining 30-day postoperative outcomes after AGB conversion to sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or single anastomosis duodenoileostomy (SADI). Descriptive statistics were used, including multivariable and 2:1 nearest neighbor matching analysis. RESULTS: This study included 19,335 AGB conversions, of which most were to SG (n = 11,736) followed by RYGB (n = 7442) and SADI (n = 157). While a majority were completed for weight loss, there were differences in distribution of primary indication for each conversion cohort, such as higher proportion of RYGB conversion for gastroesophageal reflux disease (18.7%) compared to SG (7.92%) and SADI (5.10%). Multivariable analysis demonstrates conversion to RYGB has significantly higher odds of 30-day major complications (OR 1.75, p < 0.001), reoperation (OR 2.08; p = 0.001), readmission (OR 1.69; p = 0.001), and emergency department visits (OR 1.50; p = 0.001) over SG. These risks and odds of reintervention (OR 1.75; p < 0.001) remained significantly higher after conversion to RYGB versus SG on matched analysis. None of these risks is significantly different between conversions to SADI versus SG in either multivariable or matched analysis. CONCLUSIONS: Compared to AGB conversion to SG, single-stage conversion to RYGB had increased odds of perioperative complications while risks of conversion to SADI were not significantly different.


Assuntos
Gastrectomia , Derivação Gástrica , Obesidade Mórbida , Complicações Pós-Operatórias , Reoperação , Humanos , Derivação Gástrica/métodos , Derivação Gástrica/efeitos adversos , Feminino , Masculino , Estudos Retrospectivos , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Reoperação/estatística & dados numéricos , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Gastroplastia/métodos , Gastroplastia/efeitos adversos , Redução de Peso , Anastomose Cirúrgica/métodos , Duodeno/cirurgia , Resultado do Tratamento
17.
Nat Immunol ; 25(7): 1218-1230, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38914866

RESUMO

Transglutaminase 2 (TG2) plays a pivotal role in the pathogenesis of celiac disease (CeD) by deamidating dietary gluten peptides, which facilitates antigenic presentation and a strong anti-gluten T cell response. Here, we elucidate the molecular mechanisms underlying the efficacy of the TG2 inhibitor ZED1227 by performing transcriptional analysis of duodenal biopsies from individuals with CeD on a long-term gluten-free diet before and after a 6-week gluten challenge combined with 100 mg per day ZED1227 or placebo. At the transcriptome level, orally administered ZED1227 effectively prevented gluten-induced intestinal damage and inflammation, providing molecular-level evidence that TG2 inhibition is an effective strategy for treating CeD. ZED1227 treatment preserved transcriptome signatures associated with mucosal morphology, inflammation, cell differentiation and nutrient absorption to the level of the gluten-free diet group. Nearly half of the gluten-induced gene expression changes in CeD were associated with the epithelial interferon-γ response. Moreover, data suggest that deamidated gluten-induced adaptive immunity is a sufficient step to set the stage for CeD pathogenesis. Our results, with the limited sample size, also suggest that individuals with CeD might benefit from an HLA-DQ2/HLA-DQ8 stratification based on gene doses to maximally eliminate the interferon-γ-induced mucosal damage triggered by gluten.


Assuntos
Doença Celíaca , Dieta Livre de Glúten , Proteínas de Ligação ao GTP , Perfilação da Expressão Gênica , Glutens , Mucosa Intestinal , Proteína 2 Glutamina gama-Glutamiltransferase , Transglutaminases , Doença Celíaca/imunologia , Humanos , Glutens/imunologia , Transglutaminases/metabolismo , Transglutaminases/antagonistas & inibidores , Proteínas de Ligação ao GTP/metabolismo , Proteínas de Ligação ao GTP/antagonistas & inibidores , Proteínas de Ligação ao GTP/genética , Mucosa Intestinal/patologia , Mucosa Intestinal/metabolismo , Mucosa Intestinal/imunologia , Mucosa Intestinal/efeitos dos fármacos , Feminino , Masculino , Adulto , Transcriptoma , Duodeno/patologia , Duodeno/imunologia , Duodeno/metabolismo , Interferon gama/metabolismo , Pessoa de Meia-Idade , Antígenos HLA-DQ/genética , Antígenos HLA-DQ/imunologia , Adulto Jovem , Imunidade Adaptativa/efeitos dos fármacos
18.
Obes Res Clin Pract ; 18(3): 232-234, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38944551

RESUMO

Transit bipartition (TB) emerges as a bariatric surgery alternative to Duodenal Switch (DS), emphasizing complete intestinal access and reduced malabsorption. By directly stimulating the distal ileum, TB promotes weight loss while preserving endoscopic duodenal access. This technique enhances anorexigenic hormones, aiding in satiety and weight loss, with lower malnutrition risks than DS. TB shows favorable short-term outcomes in weight management and comorbidity reduction, serving as a simpler, less malabsorptive option than DS. Nonetheless, long-term studies are essential for comprehensive efficacy assessment.


Assuntos
Cirurgia Bariátrica , Duodeno , Redução de Peso , Humanos , Cirurgia Bariátrica/métodos , Duodeno/cirurgia , Obesidade Mórbida/cirurgia , Íleo/cirurgia , Resultado do Tratamento
19.
JAMA Netw Open ; 7(6): e2414340, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38829616

RESUMO

Importance: Results from long-term follow-up after biliopancreatic diversion with duodenal switch (DS) are scarce. Objective: To compare weight loss, health outcomes, and quality of life 10 years or more after Roux-en-Y-gastric bypass (RYGB) and DS surgery in patients with severe obesity-that is, a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 50 to 60. Design, Setting, and Participants: This open-label randomized clinical trial was conducted at 2 academic bariatric centers in Sweden and Norway. Sixty patients with a BMI of 50 to 60 were included from March 1, 2006, to August 31, 2007. Data were analyzed from August 12, 2022, to January 25, 2023. Interventions: Laparoscopic RYGB or laparoscopic DS. Main Outcomes and Measures: The main outcome was change in BMI after 10 or more years. Secondary outcomes included anthropometric measures, lipid and glycemic profiles, bone mass density, adverse events, gastrointestinal tract symptoms, and health-related quality of life. Results: Forty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years (mean [SD] age, 48.0 [6.0] years; 35 women [73%]). At follow-up, the mean BMI reductions were 11.0 (95% CI, 8.3-13.7) for RYGB and 20.3 (95% CI, 17.6-23.0) for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; P < .001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (P = .001). Mean serum lipid levels, except high-density lipoprotein cholesterol and hemoglobin A1c, improved more in the DS group during follow-up. Bone mass was reduced for both groups from 5 to 10 years, with lower bone mass after DS at 10 years. Quality-of-life scores (Obesity-Related Problem Scale and the 36-Item Short Form Health Survey) were comparable across groups at 10 years. The total number of adverse events was higher after DS (135 vs 97 for RYGB; P = .02). More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; P = .008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; P = .005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, of whom 3 (10%) underwent revisional surgery. Conclusions and Relevance: In this randomized clinical trial, BMI reduction was greater after DS, but RYGB had a better risk profile over 10 years. Biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50 to 60. Trial Registration: ClinicalTrials.gov Identifier: NCT00327912.


Assuntos
Índice de Massa Corporal , Derivação Gástrica , Obesidade Mórbida , Qualidade de Vida , Redução de Peso , Humanos , Derivação Gástrica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Suécia , Noruega , Duodeno/cirurgia , Laparoscopia/métodos , Desvio Biliopancreático/métodos
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