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Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances. [ABSTRACT FROM AUTHOR]

Duodenal gangliocytic paragangliomas are rare neuroendocrine tumors primarily localized in the periampullary area. Though mostly asymptomatic, they can present with various symptoms, most often jaundice, anemia and abdominal pain. The present paper is a case series report, describing our personal experience with patients presenting to the Emergency Unit with different symptoms due to duodenal gangliocytic paraganglioma. Endoscopic resection is safe and indicated in most of the cases, being also associated with lower medical costs. EUS plays a central role in the pre-resection management and in surveillance, and immunostaining is decisive to ascertain the tumor histologic origin. In addition to reporting our experience, we researched the literature regarding these rare tumors and performed a comprehensive review. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) has become a relatively prevalent disease which associates systemic manifestations mainly conditioned by the dysimmune response triggered by gluten diet. Its oral manifestations have been proven to lead to health disparities and impaired quality of life. Such findings include mainly dental enamel defects (DEDs) and recurrent aphthous stomatitis (RAS). Nevertheless, there are also some potentially severe oral conditions associated with CD, considered to be rare, among which various oral cancers, atrophic glossitis or glossodynia. Thus, the aim of our study was to perform a systematic-review of case presentations reporting rare oral findings associated with CD. The searching protocol was applied to EMBASE, OVID and PubMed. Both pediatric and adult patients were included. The identified conditions include: Plummer-Vinson Syndrome, atrophic glossitis, glossodynia and some oral cancers. Therefore, dental practitioners should be ready to suspect CD also in such rare cases, as prompt management of such conditions could prevent severe and even life threatening complications. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is responsible for digestive and systemic manifestations leading to moderate-to-severe health disparities and impaired quality of life for the affected patients. Several oral manifestations have been described, including mainly dental enamel defects (DEDs) and recurrent aphthous stomatitis (RAS). Nevertheless, publications on the topic reveal visible reporting discrepancies. Therefore, the aim of our study was to perform a systematic-review of case-controlled observational studies on CD oral manifestations. The searching protocol was applied to EMBASE, OVID and PubMed. Both pediatric and adult cohorts were included. The main oral manifestation in children was represented by DEDs, while RAS was rather reported in adults. Despite the relatively constant prevalence reported for such oral manifestations, publications are characterized by high publication and outcome bias. Moreover, oral manifestations are influenced by concurring the oral conditions possibly generated by diet and healthcare disparities. Thus, CD should be searched in patients with DEDs and aphthous ulcers or RAS, yet the concurring conditions should be ruled out, and a thorough CD diagnosis algorithm should be implemented. [ABSTRACT FROM AUTHOR]

Background. Tooth loss and edentulous arcades are health issues emergent all around the world, as absence of teeth characterizes both a poor oral hygiene in developing countries and the old age in the Western world. It has a tremendous impact on mastication and nutrition. Therefore, edentulous patients are frequently exposed to the inability to properly masticate and swallow food. Thus, esophageal food bolus impaction is a frequent and potentially serious condition affecting such patients. The aim of our study is to evaluate the impact of various Kennedy classes of edentulous arcades on esophageal food bolus impaction, leading to disphagia. Materials and methods. 52 partially edentulous patients presenting with acute disphagia secondary to food bolus impaction were included in a cross-sectional study performed in two regional emergency hospitals of Romania between May 2017 and June 2019. Each patient was managed by either oto-rhino-laringology or digestive endoscopy department and tooth loss was established by Kennedy classification. Results and discussion. Patients aged 61 or older were significantly prone to food bolus impaction secondary to partial edentulousness, and Kennedy class 3 of edentulous ridges was significantly more frequently associated to food impaction and disphagia. The need for therapeutic endoscopy performed in emergency settings could help identifying orally disabled patients, as edentulous persons are easily diagnosed by both gastroenterologists and oto-rhino- laringologists performing flexible endoscopy. Hence, the need for dental restorative care should be properly assessed. Conclusions. Edentulous patients presenting with acute disphagia should generally be suspected for esophageal food bolus impaction. On the other hand, besides endoscopic therapy, patients should be referred for restorative dental care. [ABSTRACT FROM AUTHOR]

Background: Hundreds of thousands of routine diagnostic upper digestive tract procedures are performed yearly worldwide either with a screening purpose or to investigate various digestive symptoms in selected groups of patients. Traditionally, digestive endoscopists used to endoscopically explore the digestive tract starting below the upper esophageal sphincter, leaving the oral cavity, hypopharynx and larynx for either oral examination or ear nose and throat (ENT) clinical and endoscopic investigations. As the imagery and technical features of digestive endoscopes progressed, nowadays oropharyngeal lesions may be diagnosed endoscopically, as well. Case series: Our study aims at presenting a small series of cases receiving routine upper digestive tract endoscopy, permitting the detection of asymptomatic oropharyngeal lesions and further proper surgical and oncological management. Discussion: Despite the up-to-date quality indicators of upper digestive tract endoscopy referring to a proper and strict examination of the digestive tract below the upper esophageal sphincter, the new trends in digestive endoscopy lay stress on the fact that the endoscopist should begin endoscopic examination with the oral cavity, uvula, glottis and glottis orifice, hypopharynx and only then to proceed with the examination of the digestive tract. In this way, digestive endoscopy procedures may help detection of incipient pre-malignant or malignant lesions, thus allowing a proper timely therapy. Conclusions: Digestive endoscopists should be trained to properly assess oropharyngeal spaces. Such endoscopic examination requires patience and good technique and skills, patient sedation being mandatory in most of the cases. [ABSTRACT FROM AUTHOR]

The Helicobacter pylori infection features a series of particular aspects, depending on patients' age. In children, some particular aspects should be mentioned - for instance, the prevalence of the infection, the low complication rate and the risk of malignization, the diagnostic and therapeutic schemes that must be adjusted based on age. For these reasons, some of the recommendations for adults cannot be applied in children. Concurrently, management difficulties also occur in elderly patients in terms of risk of complications, higher rate of antibiotic resistance, presence of comorbidities and often concomitant medication. The article overviews the clinical, diagnostic and therapeutic aspects of H. pylori infection management in children and elderly patients, respectively. [ABSTRACT FROM AUTHOR]

Background: Biliary reflux secondary to cholecystectomy or endoscopic sphincterotomy (ES) is a late condition commonly encountered among patients referred for gastroenterological management. It has been recognized as part of the post-cholecystectomy syndrome, but it also occurs long time after endoscopic biliary clearance through endoscopic retrograde cholangiopancreatography (ERCP). Dysgeusia may be a leading symptom in patients with biliary reflux. Materials and methods: Our study aimed at assessing the presence of dysgeusia among patients with biliary reflux secondary to either cholecystectomy or ERCP and ES, comparatively with a group of control patients diagnosed with non-alcoholic fatty liver disease (NAFLD). 47 patients were included in the study over 6 months: 14 patients diagnosed with post-cholecystectomy syndrome, 16 patients evaluated 1 year after ERCP and ES and 17 controls diagnosed with NAFLD. Presence of dysgeusia was determined by an open questionnaire. Results and discussion: Statistically significant differences were observed among the study groups and controls. Dysgeusia was a condition more frequently encountered in both study groups, compared to NAFLD patients. Nevertheless, there are no significant differences between the two study groups as to the presence of such symptom. Conclusions: Dysgeusia may be regarded as a common symptom associated with biliary reflux, so that it may be considered a potential late complication of ERCP and cholecystectomy. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is an autoimmune disorder occurring in genetically susceptible individuals, being characterized by inflammatory injury of the small intestine mucosa after ingestion of wheat gluten or related barley or rye products. The condition can develop at any age, although symptoms are most likely to appear during early childhood, between 9 and 18 months. Clinical presentation includes a family history and a range of symptoms such as recurrent abdominal pains, diarrhea, vomiting, bloating and flatulence, iron-deficiency anemia, weight loss, asthenia, and failure to thrive. The standard diagnostic criteria of CD require a clinical context, together with new serologic tests for antibodies against tissue transglutaminase and deamidated gliadin peptide, and especially characteristic histologic findings in small bowel biopsies (the gold standard for diagnosis). Gluten-free diet is the cornerstone therapy of CD. Although safe and effective, this method is not ideal: it is of limited nutritional value, expensive, and compliance or life quality problems are described in many countries. Consequently, alternative therapeutic strategies were developed to decrease the immunogenicity and to prevent the absorption of glutencontaining grains, together with strategies to limit T-cell migration or re-establish mucosal homeostasis. Celiac disease can appear in various associations, with atypical clinical presentation, requiring careful and early diagnosis for introducing the gluten-free diet as soon as possible, and for reducing the rate of subsequent complications. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has always been recognized as the digestive endoscopy procedure most frequently associated with adverse events and complications. Acute pancreatitis, bleeding, perforations and infections are the usual cited procedural adverse events. The aim of our study was to evaluate whether ERCP is prone to post-procedural oro-pharyngeal symptoms compared to usual gastroscopy. Materials and methods: The prospective study enrolled 155 patients of whom 90 underwent ERCP for choledocholithiasis and 65 were examined by conventional front view gastroscopy in a tertiary unit of gastroenterology and hepatology, between January and July 2017. The presence of immediate postprocedural and of 48 hour oro-pharyngeal pain and/or discomfort was assessed. Results and discussion: No significant differences were recorded as to the presence of oro-pharyngeal symptoms in the two groups. Nevertheless, over 38% of the patients did experience such symptoms immediately after endoscopy, while in up to more than 14% of them the symptoms did not disappear in the first 48 hours. Conclusions: Oro-pharyngeal symptoms, a reality of the digestive endoscopy procedures, should be considered as precocious adverse events associated with upper digestive tract endoscopy. Even if complete resolution of symptoms is expected to occur in most patients after 24 hours, there are cases when prolonged discomfort could happen. [ABSTRACT FROM AUTHOR]

Background and aims: Munchausen syndrome by proxy is a condition traditionally comprising physical and mental abuse and medical neglect as a form of psychogenic maltreatment of the child, secondary to fabrication of a pediatric illness by the parent or guardian. The aim of our paper is to assess whether such condition occurs in current pediatric dental practice and to evidence certain situations in which the pediatric dentist should suspect this form of child abuse. Problem statement: Munchausen syndrome by proxy in pediatric dentistry may lead to serious chronic disabilities of the abused or neglected child, being one of the causes of treatment failure. Discussion: Prompt detection of such condition should be regarded as one of the duties of the practitioner who should be trained to report the suspected cases to the governmental child protective agencies. This should be regarded as a form of child abuse and neglect, and the responsible caregiver could be held liable when such wrongful actions cause harm or endanger child's welfare. Conclusion: Munchausen syndrome by proxy should be regarded as a reality in current pediatric dental practice and dental teams should be trained to properly recognize, assess and manage such complex situations. [ABSTRACT FROM AUTHOR]