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We report a rare case of Good’s Syndrome (GS) or thymoma with immunodeficiency in a 48-year-old male patient. This condition presents in the fourth or fifth decade of life. GS should be suspected in a person presenting with recurrent bacterial infections with encapsulated organisms and opportunistic viral and fungal infections in the setting of thymoma, hypogammaglobulinemia and reduced or absent B cells. Our patient presented with chronic diarrhoea for the past three years, repeated esophageal candidiasis and a superior anterior mediastinal mass. Duodenal biopsy showed CMV duodenitis. Lab investigations revealed low IgM levels [hypogammaglobulinemia] and the biopsy from the mediastinal mass was consistent with thymoma. This case is being written to highlight that unexplained repeated opportunistic microbial infections should prompt the clinician to suspect immunodeficiency in the background of a negative HIV status and to emphasize that GS is one of the causes of adult-onset immunodeficiency where early recognition and treatment can improve and alter the course of the disease as GS carries a worse prognosis compared to XLA [X-linked agammaglobulinemia] and CVID [common variable immunodeficiency].

IMPORTANCE Passive surveillance systems are susceptible to the under-reporting of adverse events (AE) and a lack of information pertaining to vaccinated populations. Conventional active surveillance focuses on predefined AEs. Advanced data mining tools could be used to identify unusual clusters of potential AEs after vaccination. OBJECTIVE To assess the feasibility of a novel tree-based statistical approach to the identification of AE clustering following the implementation of a varicella vaccination program among one-year-olds. SETTING AND PARTICIPANTS This nationwide safety surveillance was based on data from the Taiwan National Health Insurance database and National Immunization Information System for the period 2004 through 2014. The study population was children aged 12-35 months who received the varicella vaccine. EXPOSURE First-dose varicella vaccine. OUTCOMES AND MEASURES All incident ICD-9-CM diagnoses (emergency or inpatient departments) occurring 1-56 days after the varicella vaccination were classified within a hierarchical system of diagnosis categories using Multi-Level Clinical Classifications Software. A self-controlled tree-temporal data mining tool was then used to explore the incidence of AE clustering with a variety of potential risk intervals. The comparison interval consisted of days in the 56-day follow-up period that fell outside the risk interval. RESULTS Among 1,194,189 varicella vaccinees with no other same-day vaccinations, nine diagnoses with clustering features were categorized into four safety signals: fever on days 1-6 (attributable risk [AR] 38.5 per 100,000, p

Aim: to compare physical development in children with celiac disease (CD), depending on adherence to a gluten-free diet (GFD), and in children without CD.Materials and methods: 176 children with gastrointestinal disease were examined. Group 1 consisted of 58 children with newly diagnosed CD and chronic gastritis (CG), before the appointment of a gluten-free diet (GFD), group 2–49 children with CD and CG, adhered of GFD for 1 year, the comparison group consisted of 69 children with CG and duodenitis and excluded CD. The assessment of anthropometric data was carried out using the WHO AnthroPlus software (2009), with the determination of BMI and Z-score values: WAZ, SD; WHZ, SD; HAZ, SD; BAZ, SD.Results: The groups of participants in the study were homogeneous in terms of gender and age. BMI (16,57±3,29; 1,96 ± 3,96; 18,17±,22; t1,2=0,573; t1,3=0,007; t2,3=0,009). Weight deficiency was more often observed in patients in group 1 (56,8%, 4,1%, 23,2%; P1,2=0,00; P1,3=0,00; P2,3=0,02). Obesity was detected in the groups equally (1,7%, 4,1%, 4,3%; P1,2=0,00; P1,3=0,01; P2,3=0,04). Normal body weight was most common in groups 2 (39,7%, 91,8%, 7205%; P1,2=0,00; P1,3=0,01; P2,3=0,04). HAZ, SD statistically differed in all groups (–0,3928±1,13; 0,0133±1,06; 0,4664±1,15; t1,2=0,008, t1,3=0,004, t2,3=0,031).Conclusion: normal body weight was most typical for children on GFD. HAZ, SD in children with CD increased in comparison with children with newly diagnosed CD, but it was less, than in group 3. After a one year of GFD, the improvement of weight has a more pronounced dynamics than growth.

The upper gastrointestinal (UGI) manifestations of inflammatory bowel diseases (IBDs) are frequently obscured by classic ileal and colonic symptoms and are reported to involve only 0.5% to 4% of adult patients. However, because of the improvement of endoscopic techniques and the growing use of esophagogastroduodenososcopy with biopsy, both asymptomatic and clinically significant esophageal, gastric, and duodenal manifestations are increasingly recognized. The UGI involvement in IBD was historically synonymous with Crohn's disease (CD), but the doctrine of ulcerative colitis (UC) being limited to the colon has been challenged, and UC-related gastroduodenal lesions have been reported. The diagnosis of UGI IBD should ideally rely on a combination of the clinical history, endoscopic picture, and histologic features. Although endoscopic changes such as aphthoid or longitudinal ulcers and bamboo-joint-like pattern are suggestive of CD, histologic evaluation increases the sensitivity of the IBD diagnosis since histologic alterations may be present in endoscopically unremarkable mucosa. Conversely, in many cases, the histologic findings are nonspecific, and the knowledge of clinical history is vital for reaching an accurate diagnosis. The presence of epithelioid granuloma is highly suggestive of CD but is present in a minority of CD cases; thus, pathologists should be aware of how to diagnose UGI IBD in the absence of granulomata. This article reviews the most important clinical, endoscopic, and histologic features of IBD-associated esophagitis, gastritis, and duodenitis, as well as the IBD-related manifestations in the biliary tract and the postcolectomy setting.

Aim: The routine use of esophagogastroduodenoscopy (EGD) during the preoperative evaluation of surgical weight loss candidates is controversial. The aim of this study is to evaluate the findings of...

The close anatomical and physiological connection of the digestive organs leads to a significant spread of functional disorders in various diseases. Purpose — to investigate the frequency and features of the clinical course of biliary dysfunction (BD) in children. Materials and methods. 66 children aged 10–18 years with BD were examined. The study included a complete clinical examination of children, laboratory and instrumental methods. To assess the severity of clinical symptoms in the examined patients was used traditional score scale of symptoms (0–3 points) and the frequency index (FI). Results. In most children, the database was combined with other functional and organic lesions of the digestive tract (n=56, 84.8%). The database was most often combined with chronic gastritis and duodenitis, as well as with functional motor disorders. FI in children with BD involved in the pathological process of the stomach and duodenum was the highest (0.59), and IR in children with BD and intestinal involvement was the lowest (0.23). The relationship between the frequency of combined pathology and the frequency of cases of increase in the size of the gallbladder (χ2=22.87 at a critical value of χ2=9.33 for the significance level p

OBJECTIVE To identify risk factors and generate hypotheses for pediatric persistent postconcussion symptoms (PPCS). SETTING A regional healthcare system in the Southeastern United States. PARTICIPANTS An electronic health record-based algorithm was developed and validated to identify PPCS cases and controls from an institutional database of more than 2.8 million patients. PPCS cases (n = 274) were patients aged 5 to 18 years with PPCS-related diagnostic codes or with PPCS key words identified by natural language processing of clinical notes. Age, sex, and year of index event-matched controls (n = 1096) were patients with mild traumatic brain injury codes only. Patients with moderate or severe traumatic brain injury were excluded. All patients used our healthcare system at least 3 times 180 days before their injury. DESIGN Case-control study. MAIN MEASURES The outcome was algorithmic classification of PPCS. Exposures were all preinjury medical diagnoses assigned at least 180 days before the injury. RESULTS Cases and controls both had a mean of more than 9 years of healthcare system use preinjury. Of 221 preinjury medical diagnoses, headache disorder was associated with PPCS after accounting for multiple testing (odds ratio [OR] = 2.9; 95% confidence interval [CI]: 1.6-5.0; P = 2.1e-4). Six diagnoses were associated with PPCS at a suggestive threshold for statistical significance (false discovery rate P < .10): gastritis/duodenitis (OR = 2.8; 95% CI: 1.6-5.1; P = 5.0e-4), sleep disorders (OR = 2.3; 95% CI: 1.4-3.7; P = 7.4e-4), abdominal pain (OR = 1.6; 95% CI: 1.2-2.2; P = 9.2e-4), chronic sinusitis (OR = 2.8; 95% CI: 1.5-5.2; P = 1.3e-3), congenital anomalies of the skin (OR = 2.9; 95% CI: 1.5-5.5; P = 1.9e-3), and chronic pharyngitis/nasopharyngitis (OR = 2.4; 95% CI: 1.4-4.3; P = 2.5e-3). CONCLUSIONS These results support the strong association of preinjury headache disorders with PPCS. An association of PPCS with prior gastritis/duodenitis, sinusitis, and pharyngitis/nasopharyngitis suggests a role for chronic inflammation in PPCS pathophysiology and risk, although results could equally be attributable to a higher likelihood of somatization among PPCS cases. Identified risk factors should be investigated further and potentially considered during the management of pediatric mild traumatic brain injury cases.

Background Functional variants of the cytotoxic T-lymphocyte antigen-4 (CTLA4) could contribute to the pathogenesis of disorders characterized by abnormal T-cell responses. Case presentation We report a case of a 13-year-old girl who first presented with polyarticular juvenile idiopathic arthritis poorly responsive to treatment. During the following years the patient developed cytopenias, chronic lymphoproliferation, high values of T-cell receptor αβ+ CD4- CD8- double-negative T cells and defective Fas-mediated T cells apoptosis. Autoimmune lymphoproliferative syndrome was diagnosed and therapy with mycophenolate mofetil was started, with good hematological control. Due to the persistence of active polyarthritis, mycophenolate mofetil was replaced with sirolimus. In the following months the patient developed hypogammaglobulinemia and started having severe diarrhea. Histologically, duodenitis and chronic gastritis were present. Using the next generation sequencing-based gene panel screening, a CTLA4 mutation was detected (p.Cys58Serfs*13). At the age of 21 the patient developed acute autoimmune hemolytic anemia; steroid treatment in combination with abatacept were started with clinical remission of all symptoms, even arthritis. Conclusions Targeted immunologic screening and appropriate genetic tests could help in the diagnosis of a specific genetically mediated immune dysregulation syndrome, allowing to select those patients who can take advantage of target therapy, as in the case of abatacept in CTLA4 deficiency.

Background and aims Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural history therefore, we aimed to evaluate the epidemiology of annular pancreas and identify underlying associations using a large database. Methods A multi-institutional database (Explorys) was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms diagnosis of "MRI, CT, EUS and/or ERCP" between April 2015 and April 2020 was identified. Subsequently a cohort of patients with history of "annular pancreas" was identified. Results There were a total of 40,075,980 individuals in the database with 6,162,600 (15.38%) who had an magnetic resonance imaging, computed tomography, endoscopic retrograde cholangiopancreatography, and/or endoscopic ultrasound. There were 210 (3.4/100,000) had a diagnosis of annular pancreas. When compared with the control group, patients with annular pancreas were more likely to have a history of alcohol use, smoking, acute pancreatitis, chronic pancreatitis, gastritis, duodenitis, jaundice, and gastrointestinal outlet obstruction. Conclusions This is the largest study evaluating the epidemiology of annular pancreas. We found the estimated prevalence rate of annular pancreas to be 3.4/100,000 in those who had abdominal imaging. Annular pancreas was more likely to be diagnosed in patients with symptoms pertaining to acute or chronic pancreatitis, biliary, and gastric outlet obstruction.

Introduction: The study of short stature of digestive origin in children shows no pre-established laboratory patterns. However, endoscopy of the digestive tract may be a useful tool for this purpose. Objective: To report a series of cases of children with a diagnosis of short stature who underwent upper digestive tract endoscopy as part of their study. Case report: 15 children between the ages of 2 and 16 years were included; 53.3 % were girls. 26.7 % presented with malnutrition according to their body mass index and height-for-age, 66.7 % had short stature, and 33.3 % moderate short stature. Abdominal pain was reported in 53.3 % of the cases, and no weight gain in 46.7 %. Other symptoms were lack of appetite in 26.7 %, vomiting in 13.3 %, among others. Between 40 % and 93.4 % of the children presented macro and/or microscopic esophagitis, gastritis, and duodenitis. The most important microscopic findings were chronic duodenitis with giardiasis, duodenal ulcers, duodenal nodular lymphoid hyperplasia, Helicobacter pylori, and chronic eosinophilic duodenitis. Conclusions: Although endoscopy of the digestive tract is a method barely used and not well described in the study of children with short stature, this case report describes organicity in 80 % of the children analyzed.

Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active “lobulitis” and “ductitis” is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.

Objectives Severe obesity in the pediatric population has lifelong consequences. Bariatric surgery has been suggested for selected adolescents with severe obesity after careful evaluation. The indications for preoperative esophagoenteroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD prior to bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities. Methods We conducted a retrospective chart review in a single tertiary pediatric medical center of adolescents treated during 2011-2018. Data collected from electronic medical records included patient demographics, endoscopic findings, and laboratory parameters. Results A total of 80 patients (40 males) underwent evaluation. Macroscopic abnormalities were detected in 54% of the endoscopies, including gastritis, esophagitis, and duodenitis in 46%, 16%, and 13%, respectively. Forty-nine percent of the biopsies showed histological abnormalities; in 35 (44%) patients, Helicobacter pylori (H. pylori) was detected. Thirty-three patients (41%) received medical treatment and two (2.5%) required a second EGD. Metabolic comorbidities included hypertriglyceridemia (38% of the patients), low HDL (23%), and pre-diabetic (16%) or diabetic levels of HbA1C (4%). Fifty-five percent of the cohort had elevated alanine aminotransferase (ALT), suggestive of nonalcoholic fatty liver disease. Conclusions Endoscopies performed prior to bariatric surgeries suggest a higher prevalence of clinically significant findings, many of which required treatment. These findings support incorporating an EGD into the preoperative evaluation of this patient population.

While coronavirus disease 2019 (COVID-19) is well known to cause significant lower respiratory symptoms, recent literature has documented numerous cases of multi-systemic involvement that can present with atypical symptoms. We report a case of an 83-year-old man, recovering from abdominal aortic aneurysm repair complicated by colonic injury requiring colostomy rendering him dependent on gastrostomy tube feedings for 3 years, who was transferred from a nursing care facility to the emergency department with altered mental status, fever and jaundice. Abdominal imaging and biopsy studies eventually identified duodenitis and ampullitis complicated by a suspected Klatskin tumor leading to biliary obstruction, sepsis and hepatoencephalopathy. Polymerase chain reaction (PCR) for COVID-19 was positive. Despite the severity of the initial presentation, the patient had no respiratory symptoms or abnormal chest X-ray findings on admission and developed hypoxia late into the disease course. Thus, this case is a report of an abnormal initial COVID-19 presentation with gastrointestinal and hepatobiliary involvement leading to hepatoencephalopathy but no lung findings, highlighting the importance of investigating extrapulmonary processes in COVID-19-positive patients regardless of pulmonary symptoms.

Objective:To describe the prevalence ofHelicobacter pylori(HP) in children and adolescents, and to assess its association with lesions in the esophagus, stomach, and duodenum according to the patient’s life cycle.MethodsːA cross-sectional analytical study with children and adolescents referred to a gastroenterology service and underwent esophagogastroduodenoscopy at a hospital in Vitória, Espírito Santo, Brazil, from 2001 to 2013. Variablesanalyzed were the following:sex, age,macro andmicroscopic alterations and severity of infestation.The Chi-square and Fisher's exact tests and adjustedresidueanalysis were used (α = 5%).Resultsːthe prevalence of infection was 24.4%.Esophagitis (29.4%) and gastritis (34.1%) were associated with HP. The life cycle was associated with esophagitis and duodenitis. Infection was associated with life cycle: infants (0.8%), preschool children (10.5%), school-aged children (16.5%), and adolescents (72.2%).The residues showed a strong association between HP and gastritis, and no association between the school-aged and esophagitis.Adolescents were the major contributors to the association between life cycle and infection, and life cycle and lesion.ConclusionsːInfectionwith HP was associated with esophagitis and gastritis and was higher among adolescents, who had a marked tendency to develop gastritis and a milder tendency to develop esophagitis.The tendency of developing infection and gastritis was not present in the other life cycles.Public policies focusing on promotion and protecting health, especially in vulnerable population groups, are needed. Objetivo: Descrever a prevalência de Helicobacter pylori (HP) em crianças e adolescentes, e avaliar a sua associação com lesões no esôfago, estômago, e duodeno de acordo com o ciclo de vida (CV). Métodosː Estudo analítico transversal com crianças e adolescentes encaminhados para um serviço de gastroenterologia e submetidos a esofagogastroduodenoscopia num hospital em Vitória, Espirito Santo, Brasil de 2001 a 2013. Variáveis analisadas: sexo, idade, alterações macro e microscópicas e gravidade da infestação. Foram utilizados os teste do Qui-quadrado e exato de Fisher, e a análise de resíduos ajustados (α = 5%). Resultadosː A prevalência da infecção foi de 24,4%. Esofagite (29,4%) e gastrite (34,1%) foram associadas à HP. O CV foi associado à esofagite e à duodenite. A infecção estava associada ao CV: bebês (0,8%), crianças em idade pré-escolar (10,5%), crianças em idade escolar (16,5%), e adolescentes (72,2%). A análise de resíduos mostrou forte associação entre a HP e a gastrite, e nenhuma associação entre a idade escolar e a esofagite. Os adolescentes foram os que mais contribuíram para a associação entre CV e infecção, e entre CV e lesão.Conclusõesː A infecção por HP esteve associada à esofagite e à gastrite e foi mais elevada entre os adolescentes, que tinham uma marcada tendência para o desenvolvimento da gastrite e uma tendência mais branda para o desenvolvimento da esofagite. A tendência de desenvolvimento de infecção e gastrite não estava presente nos outros CV. São necessárias políticas públicas centradas na promoção e protecção da saúde, especialmente em grupos populacionais vulneráveis.

Introduction: Malabsorption occurs due to different causes and the clinical presentation varies with the underling etiology. Very few studies have been done to determine the etiological spectrum of malabsorption in northern India. Aim: To assess the etiology in patients presenting with malabsorption and to study clinical, haematological, biochemical, serological, endoscopic and histological features of these patients. Materials and Methods: Clinical assessment of 91 cases presenting with malabsorption complains in the gastro OPD was done along with vitamin B12 and fecal fat estimation. Relevant haematological, serological investigations, endoscopy was done. Duodenal biopsy was taken. Data was obtained and analysed. All patients clinically presenting with malabsorption were included in the study. The patients excluded were those, who refused for endoscopy or participation in the study. Results: The most common causes of malabsorption were non-specific duodenitis(42.8%), celiac disease (CD)(18.7%), tropical sprue (TS) (8.8%), giardiasis(3.3%), eosinophilic enteritis (2.2%), lymphangiectasia(1.1%), abetalipoproteinemia(1.1%) and 22% cases were normal histologically. The principal features differentiating celiac disease and tropical sprue were also noted. Patients with CD more often had anemia, scalloping of folds on endoscopy, moderate or severe villous atrophy and increased intraepithelial lymphocytes, in comparison to patients with TS. Conclusion: CD is commoner than TS. Though histology is gold standard for the diagnosis of CD, TS and other intestinal mucosal diseases, correlation of histological findings with clinical, hematological, endoscopic and serological findings is important as subtle histological changes may be missed depriving the patient of proper treatment. Keywords: Celiac disease, Diarrhea, Malabsorption, Tropical sprue, Villous atrophy, IELs.

Background Ulcerative colitis (UC) is defined as a chronic inflammatory bowel disease that can occur in any part of the large bowel. In addition, UC affects only the large bowel except for backwash ileitis and pouchitis, whereas Crohn's disease (CD) affects the entire digestive tract. Inflammatory bowel disease (IBD) patients tend to be diagnosed with CD or indeterminate colitis when combined with gastric lesion. However, in recent years, some UC patients are reported to have various degrees of lesions in gastroduodenum. Here, we report a case of gastroduodenitis associated with UC (GDUC). Case summary A 25-year-old man with a history of Klippel-Trenaunay syndrome presented to the hospital with mucopurulent bloody stool and epigastric persistent colic pain for 2 wk. Continuous superficial ulcers and spontaneous bleeding were observed under colonoscopy. Subsequent gastroscopy revealed mucosa with diffuse edema, ulcers, errhysis, and granular and friable changes in the stomach and duodenal bulb, which were similar to the appearance of the rectum. After ruling out other possibilities according to a series of examinations, a diagnosis of GDUC was considered. The patient hesitated about intravenous corticosteroids, so he received a standardized treatment with pentasa of 3.2 g/d. After 0.5 mo of treatment, the patient's symptoms achieved complete remission. Follow-up endoscopy and imaging findings showed no evidence of recurrence for 26 mo. Conclusion The occurrence of gastrointestinal involvement in UC is rare, which may open a new window for studying the etiology and pathogenesis of UC. Physicians should consider broad differential diagnosis by endoscopic biopsy and laboratory examinations.

Although the features of lower gastrointestinal tract inflammation associated with ulcerative colitis and Crohn disease are generally familiar to pathologists, there is less awareness of and familiarity with the manifestations of inflammatory bowel disease in the esophagus, stomach, and duodenum. Nonetheless, their diagnosis has therapeutic and possibly prognostic implications, potentially foretelling severe complications. The recognition that ulcerative colitis can affect gastrointestinal organs proximal to the large intestine and terminal ileum represents a revision of concepts ingrained among generations of physicians. This article reviews the pathologic features and clinical significance of esophagitis, gastritis, and duodenitis associated with inflammatory bowel disease.

Summary Celiac disease is a multi-factorial chronic inflammatory intestinal disease, characterized by malabsorption resulting from mucosal injury after ingestion of wheat gluten or related rye and barley proteins. Inappropriate T-cell-mediated immune response against ingested gluten in genetically predisposed people, leads to characteristic histological lesions, as villous atrophy and intraepithelial lymphocytosis. Nevertheless, celiac disease is a comprehensive diagnosis with clinical, serological and genetic characteristics integrated with histological features. Biopsy of duodenal mucosa remains the gold standard in the diagnosis of celiac disease with the recognition of the spectrum of histological changes and classification of mucosa damage based on updated Corazza-Villanacci system. Appropriate differential diagnosis evaluation and clinical context also for the diagnosis of complications is, moreover, needed for correct histological features interpretation and clinical management.

Stevens-Johnson syndrome and toxic epidermal necrolysis form a rare but severe disease spectrum characterized by widespread epidermal detachment. Gastrointestinal manifestations of the disease, however, are rarely described in the pediatric literature and have a high mortality among adults. There are limited data on the treatment of these cases, with conflicting evidence regarding the benefit of steroids, IVIG, or other immunosuppressive agents. We review previous instances of gastrointestinal involvement in children and report the case of a previously healthy 13-year-old who presented with the typical ocular and skin findings of Stevens-Johnson syndrome, subsequently developed severe life-threatening diarrhea, and was found to have severe esophagitis, duodenitis, and colitis on endoscopic evaluation. Treatment was initiated with an immediate, short course of steroids along with early introduction of an enteral diet via nasogastric tube, and resulted in full gastrointestinal recovery. This case highlights successful medical treatment of the first reported pediatric case of SJS/TEN with both upper and lower gastrointestinal tract involvement.

Background: Upper gastrointestinal (UGI) endoscopy reveals abnormal pathological findings in 55% patients of iron deficiency anemia therefore gastrointestinal pathology should be ruled out iron deficiency anemia not responding to the treatment. Aim: To determine the role of upper gastrointestinal endoscopy and find out the pathological changes which occur in children with iron deficiency anemia (IDA) Materials and Methods: This cross-sectional study included 95 pediatric patients with iron deficiency anemia in the age group between 3 to 17 years who underwent routine upper gastrointestinal endoscopy. All potential bleeding lesions were identified and biopsy samples were taken from 2nd part of duodenum for histopathological examinations. Results: The mean age of cases was 7.33.3 years. Endoscopy revealed abnormal finding in 63.1% patients. The gastrointestinal pathologies identified were celiac disease in 22 patients, nonspecific duodenitis in 11 patients, H.Pylori duodenitis in 8 patients, erosive duodenitis in 7 patients and giardiasis in 3 patients. Conclusion: Upper gastrointestinal endoscopy has a definitive role in identifying the underlying cause of iron deficiency anemia in patients not responding to conventional therapy. Keywords: Upper gastrointestinal endoscopy, Duodenal biopsy, Iron deficiency anemia.

Context.— Immune checkpoint inhibitor (CPI) therapies are associated with multi-organ immune-related adverse events. Although colonic mucosal changes have been described, inflammatory changes incited by CPIs in the upper gastrointestinal tract have not been well characterized. Objective.— To investigate morphologic and immunologic changes incited by CPI therapy in the upper gastrointestinal tract. Design.— We compared the morphology and immune cell phenotype of gastric and duodenal biopsies from patients treated with anti–cytotoxic T-lymphocyte associated protein 4 (CTLA-4) or anti–programmed death receptor-1/programmed death ligand-1 (PD-1/PD-L1) antibodies with biopsies from patients with Helicobacter pylori gastritis, patients with celiac disease, and normal controls. Results.— Gastric biopsies from patients on CPIs showed chronic gastritis mimicking H pylori gastritis. However, CPI gastritis demonstrated greater numbers of CD8+ intraepithelial lymphocytes, less lamina propria inflammation, fewer plasma cells and CD20+ B cells, fewer lymphoid aggregates, and reduced CD4:CD8 ratio in both the lamina propria and the epithelial layer. There were no differences between anti–CTLA-4 and anti–PD-1/PD-L1 gastritis, except for more lymphoid aggregates in anti–PD-1/PD-L1 gastritis. Duodenal biopsies from patients on CPIs revealed chronic duodenitis with villous blunting, mimicking celiac disease. Compared with celiac disease, CPI duodenitis demonstrated higher prevalence of neutrophilic infiltrates and erosions, increased lamina propria CD3 and CD8 T cells, and reduced CD4:CD8 ratio. Upper gastrointestinal biopsies were more inflamed than concomitant colonic biopsies in the majority of patients. Conclusions.— The morphologic and immunophenotypic distinctions between CPI-associated upper gastrointestinal injuries and common infectious and autoimmune diseases may provide useful discriminators when clinicians are confronted with gastric and duodenal inflammatory changes in patients receiving CPI therapy.

Purpose of the study. To study the epidemiological pathology of the upper gastrointestinal tract among the population of St. Petersburg for the period 2015 to 2018.Materials and methods.We calculated and analyzed the incidence, prevalence, dynamics and structure of the pathology of the upper gastrointestinal tract in various age groups. The reporting forms of Federal Statistical Observation № 1 for 2015–2018 were the source of the information.Results.The gastritis and duodenitis has a high incidence among chronic diseases of the upper gastrointestinal tract. The high incidence is can be seen among adolescents aged 15–17–20.3 per 1000. Peptic ulcer can be seen among people aged 18–55–1.2 per. Nowadays there is a problem of registration and accounting of gastroenterological hernias and gastroesophageal refl ux disease. This issue has to be solved and requires search for resolutions in the face of its prevalence and social signifi cance.

The aim : to provide clinical and instrumental characteristics and to evaluate the morphological changes of the stomach and duodenum mucous membrane in children with comorbidity of chronic gastroduodenitis (HGD) and primary hypertension (PH). Materials and methods . 102 children aged 9–17 years with HGD and PH were examined. The first group consisted of 47 children with a combination of HGD and PН, the second group – 55 children with HGD and normal arterial pressure. Morphological study of biopsy specimens of the stomach and duodenum mucous membrane (MM) was performed in 33 children. Results. Gastroduodenoscopy showed an erythematous gastroduodenopathy in 57.4 % of children in group І and 60.0 % of children in group ІІ (P = 0.79), hypertrophic changes in the stomach and duodenal ММ – in 6.4 % of children in group І and 12.7 % of children in group II (P = 0.28), subatrophy – in 10.6 % of children in group І and 14.5 % of children in group II (P = 0.56), erosion – in 25.5 % of children in group І and 12.7 % of children in group ІІ (P = 0.1), motor-evacuation disorders – in 63.8 % of children in group І and 41.8 % of children in group ІІ (Р = 0.03). Unlike this data, the morphological study of the MM biopsy revealed a statistically significant difference in microcirculatory disturbances in the MM, namely plethora was detected in 81.3 % of children in group I and 52.9 % of children in group II (P = 0.02), severe edema was observed in 75.0 % of children in group I and 41.2 % of children in group II (P = 0.049), hemorrhages in the lamina propria – in 62.5 % of children in group I and 23.5 % of children in group II (P = 0.02), microtrombosis – in 37.5 % of children in group I and 5.9 % of children in group II (P = 0.03), as well as concerning destructive changes in the MM: micro-erosion were found in 56.3 % of children in group I and 17.6 % of children in group II (Р = 0.02), erosion – in 43.8 % of children in group І and 11.8 % of children in group II (P = 0.04). Conclusions. The combined course of HGD and PH in children is characterized by more frequent motor-evacuation and microcirculatory disorders (plethora, severe edema, hemorrhages in the lamina propria, microtrombosis), as well as more pronounced erosive changes in the MM as compared to an isolated course of HGD.

Clinical interest into the function of tuft cells in human intestine has increased in recent years. However, no quantitative study has examined intestinal tuft cells in pathological specimens from patients. This study quantified tuft cell density by using a recently identified marker, specific for tyrosine phosphorylation (pY1798) of girdin (also known as CCDC88A or GIV) in the duodenum of pediatric patients. Deidentified sections with pathological diagnosis of acute duodenitis, ulcer, or celiac disease, and age-matched normal control were analyzed under double-blind conditions. Immunostaining for pY1798-girdin demonstrated the distinct shape of tuft cells with and filopodia-like basolateral membrane structure and a small apical area, which densely expressed gamma-actin. As compared to normal tissues, the specimens diagnosed as celiac disease and duodenal ulcer had significantly fewer tuft cell numbers. In contrast, acute duodenitis showed varied population of tuft cells. The mucosa with severe inflammation showed lower tuft cell numbers than the specimens with none to mild inflammation. These results suggest that loss of tuft cells may be involved in prolonged inflammation in the duodenal mucosa and disrupted mucosal integrity. pY1798-girdin and gamma-actin are useful markers for investigating the distribution and morphologies of human intestinal tuft cells under healthy and pathological conditions.

Purpose of the study. To evaluate the effectiveness of interactive teaching technologies and rebamipids in the complex therapy of erosive lesions of the gastroduodenal zone in young men.Material and research methods. Two groups of patients were examined. The observation group included 36 recruits with HP-associated gastritis with erosion (HSE) and duodenitis with erosion (DSE). Comprehensive treatment was used as a treatment: standard first-line triple therapy with the inclusion of rebamipide 100 mg 3 times a day for 14 days and interactive therapeutic training. The comparison group consisted of 18 patients with HP-associated GSE and DsE who received standard triple eradication therapy also for 14 days. The average age of the examined patients in the observation group was 21.0 ± 0.7 years, the comparison group was 20.1 ± 0.7 years.Results. The inclusion of Helicobacter pylori-associated gastritis and duodenitis with erosion of rebamipide and interactive learning technologies into the treatment regimen resulted in more effective relief of pain syndrome and dyspeptic manifestations in conscripts, restoration of mucus-forming and acid-producing functions of the stomach; to lower blood cortisol levels; reduce the degree of morphological activity of inflammation. There is a more effective eradication of Helicobacter pylori (91.7%) and epithelization of erosion (97.2%) in comparison with the standard scheme (88.9% and 94.4%, respectively). The use of interactive teaching technologies allowed to increase the level of medical activity and hygienic literacy (96.0% of recruits changed their diet, the nature of nutrition — 88.0%). The level of psycho-emotional status significantly improved after the treatment.Conclusion Combined therapy using rebamipide and interactive therapeutic training is effective in erosive lesions of the gastroduodenal zone in young men and increases patient adherence to treatment and leads to stabilization of psycho- emotional status.

Background: Diverticula are commonly observed in the duodenum. Duodenal diverticulum (DD) usually does not give symptoms throughout life and is diagnosed by coincidence. However, it may present with different symptoms in patients. Objective: This study aims to evaluate the prevalence of DD and juxtapapillary duodenal diverticulum (JDD) and its association with other possible pathologies and to determine its clinical impact by using Computed Tomography (CT). Methods: This retrospective observational study, which was taken consecutively between the years of 2013-2020, was evaluated in the Radiology Department. The total number of cases was 4850 (male-2440; female-2410). CT images were evaluated by two experienced radiologists at the workstation. DD and JDD prevalence and clinical findings in the hospital registry system were examined. Results: The age of the patients included in the study ranged from 17 to 92 years (mean age 46.94±16.42). In patients with DD (female-130; male-101), mean age was 62.24 ± 12.69 (21-92). The prevalence of DD was 4.76% (n=231). The prevalence of JDD was 4.02% (n=195) and increased with age (p Conclusion: Our study shows that cholelithiasis, choledocholithiasis, cholecystitis, diverticulitis, duodenitis, pancreatitis may be associated with JDD. Therefore, in contrast-enhanced abdominal CT scans taken for various reasons, investigation of the presence and characteristics of JDD and detection of pathologies that may be associated with JDD are important for patients to benefit from early diagnosis and treatment opportunities and to take precautions against possible complications.

Coeliac disease is the most well-known cause of villous atrophy in duodenal biopsies. Other well recognised causes of villous atrophy include infection with Giardia duodenalis and HIV, peptic duodenitis, drug-induced enteropathy, common variable immunodeficiency, Crohn’s disease, Whipple’s disease, small intestinal bacterial overgrowth, eosinophilic gastroenteritis, tropical or collagenous sprue and autoimmune enteropathy. While mucosal adaptation due to malnutrition, leading to villous atrophy, has been reported in paediatric populations in Africa and South America, in hibernating animals and animal models of experimental starvation, there is very little literature on adult human subjects. We report a case of a 76-year-old gentleman, presenting with chronic metabolic acidosis and anorexia who was found to have villous atrophy on duodenal biopsy, in the absence of any evidence of coeliac disease or other non-coeliac enteropathy. The nutritional state improved with correction of the underlying metabolic abnormality, and serial endoscopic assessment showed improvement in the villous atrophy. We discuss the relationship between malnutrition and villous atrophy, and suggest a potential workup for non-coeliac villous atrophy.

A 60-year-old gentleman presented with chronic diarrhoea and weight loss. Following an array of investigations, primarily targeting a possible malignancy, gastritis and duodenitis were observed on endoscopy. Gastric and duodenal biopsies showed aggregates of PAS positive macrophages in the lamina propria. Polymerase chain reaction confirmed the presence of Whipple's disease (WD). WD is a rare multisystemic granulomatous infectious disorder, affecting many organ systems but predominantly the gastrointestinal system. WD has a two stage process. The prodromal stage is dominated by arthralgia and arthritis, followed by a latency period, from one to ten years and then by a later steady-state stage which is characterized by the involved organ systems. WD can be fatal if left untreated, however a strict antibiotic regime may eradicate the causative organism, Tropheryma whipplei. We report a rare case of WD diagnosed on a gastric biopsy with an agglomeration of misleading signs and symptoms which demonstrate the mimicry of this potential infectious disease.

AimsEvaluate the rate and significance of Helicobacter pylori (H. pylori) involving duodenal foveolar metaplasia of chronic peptic duodenitis (CPD).MethodsWe identified 100 biopsy cases of CPD with synchronous stomach biopsies. All 200 were reviewed for histological changes (eg, chronic gastritis, acute inflammation) and underwent immunohistochemical staining for H. pylori. Results were correlated with patient age, sex, endoscopy indication and findings on stomach biopsy.ResultsCases included 49 men and 51 women, with a median age of 56 years. Reflux or dysphagia was the most common symptom. Chronic gastritis was present in 46 stomach biopsies, with 54 within normal limits. Twelve stomach biopsies showed H. pylori, all of which showed gastritis. Two duodenal biopsies (2%) demonstrated H. pylori organisms on immunohistochemistry, both from patients with H. pylori gastritis.ConclusionsRoutine examination of CPD samples for H. pylori appears unnecessary if a stomach biopsy is available for review.

OBJECTIVE To determine incidences and underlying causes of fatal intestinal inflammatory lesions (FIILs) and demographic characteristics of affected equids necropsied at any of the California Animal Health and Food Safety Laboratory facilities between January 1, 1990, and April 16, 2013. ANIMALS 710 equids with FIILs, including colitis, duodenitis, enteritis, enterocolitis, enteropathy, enterotyphlitis, gastritis, gastroenteritis, ileitis, jejunitis, typhlitis, or typhlocolitis, alone or in combination. PROCEDURES The medical records were reviewed, and data collected included animal age, sex, geographic origin, necropsy submission date, and breed, purpose, or characteristic of use. Descriptive statistics were compiled and reported as numbers and percentages. RESULTS Colitis (323/710 [45.5%]), enteritis (146/710 [20.6%]), and typhlocolitis (138/710 [19.4%]) were the most common FIILs, and the underlying cause of most FIILs was categorized as either undetermined (465/710 [65.5%]) or bacterial (167/710 [23.5%]). The most common bacteria responsible for FIILs were Clostridium spp and Salmonella spp. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the underlying cause for most FIILs could not be identified; however, when it was identified, it was most commonly bacterial and typically Clostridium spp or Salmonella spp, which could be useful information for practitioners when evaluating and managing horses and other equids with intestinal distress. In addition, results underscored the need for improved diagnostic procedures and strategies to determine underlying causes of FIILs in equids. Knowledge of the most common FIILs and their underlying causes may help in diagnosing and mitigating intestinal disease in equids.

Focal duodenal necrosis (FDN) is an intestinal disease of egg-layer chickens characterized by multifocal necrosis of the duodenal loop and proximal jejunum. Affected flocks usually have decreased egg weights and drops in egg production. Previous studies have associated this condition with Clostridium perfringens infection. We tried to reproduce FDN by experimental infection of egg-laying chickens using different netB-positive and netB-negative C. perfringens strains, and duodenal homogenate obtained from FDN lesions. Chickens challenged with C. perfringens and/or duodenal homogenate developed duodenitis after challenge. Gross lesions included mucosal erosions, hyperemia, mucosal hemorrhages, and watery intestinal content. Microscopic lesions included mild enterocyte degeneration and necrosis, and mild-to-moderate hemorrhage and lymphoplasmacytic and heterophilic infiltration of the lamina propria. Two netB-positive C. perfringens strains closely related to necrotic enteritis pathogenic strains, by genomic composition, were re-isolated from lesions. Necrosis of intestinal crypts was observed in chickens challenged with duodenal homogenate with or without C. perfringens coinfection. Characteristic microscopic FDN lesions with significant necrosis and loss of villus enterocytes were not reproduced.

Arterial dissection is a well-recognized pathology often seen in Vascular Surgery offices and Emergency Departments alike; however, visceral arterial dissection is an extremely rare, small subset of this entity. With that, an isolated celiac artery dissection as presented within this report is an exceptionally unique pathology that has scarcely been reported, and due to this, management guidelines are undefined. Given the viscera supplied by the celiac artery, many intra-abdominal structures are at risk for ischemia when damage to the celiac artery occurs, potentially witnessed by this report. Due to the exclusivity of this pathology, we are compelled to report the case of a 71-year-old male who presented with complaints of abdominal pain and was found to have an acute celiac artery dissection, which likely resulted in severe ischemic duodenitis, as well as possibly acute pancreatitis, and questionable influence on cholecystitis.

Background and Aims: The Helicobacter pylori (H. pylori) prevalence in Asian countries is highly variable. We aimed to determine the current H. pylori prevalence, correlate with gastroduodenal diseases and study gastric cancer incidence in western Odisha.Methods: Out of 3289 patients referred for endoscopy, 2820 eligible patients underwent upper gastrointestinal endoscopy with biopsy and included in the study; H. pylori was considered positive when either of Rapid Urease Test (RUT) or histopathology showed positive result.Results: The H. pylori prevalence was 29.2% in overall distribution, 41.1% in gastritis and or duodenitis, 65.1% in gastric ulcer, 83.3% in duodenal ulcer, 19.2% in gastric polyp and 11.1% in gastric cancer. The H. pylori in fection was significantly associated with gastritis and or duodenitis [P

Back Ground: Helicobacter pylori are the most common chronic bacterial infection, and a significant etiological factor in acid peptic diseases and gastric cancer. Dyspepsia is a common gastrointestinal disorder, and the most common indication for gastroscopy. Detection of H. pylori during endoscopy has become standard clinical practice. Objective: To detect the different underling OGD causes of dyspeptic symptoms in patients presented to the outpatients clinic of the gastroenterology unit in Al-Ramadi General Hospital, and to evaluate the role of H. pylori in relation to the different OGD results.Methods: One hundred patients with various upper gastrointestinal complaints were investigated for evidence of H. pylori infection and its possible relation to the upper gastrointestinal disease. Multiple biopsies from the antrum of the stomach were taken through fiber optic endoscope from these patients. Diagnosis of H. pylori infection was done by the urease test.Results: One hundred patients, (62 males, 38 females), with age range between (9-63) year old and a mean age of 36 year old, were included in this study. Urease test was positive in (48%) of all patients (46% in male, 50% in female). Urease test was positive in 82% of patients with duodenal ulcer, 75% with Gastric carcinoma, 60% with gastric ulcer, 50% with gastritis, 50% with duodenitis, 41% with esophagitis, 37% with normal looking mucosa.Conclusion: H. pylori were more likely associated with DU than GU. There is a high association between H. pylori and CA stomach. H. pylori was found in about 1/3 of patients with normal OGD and its difficult to tell about its role in this group of people. Most patients with positive OGD and negative urease test were found to have other predisposing factors such as NSAID or cigarette smoking. CA stomach was the least likely cause of upper GI symptoms. About half of the patients with upper GI symptoms have normal OGD which could either indicates functional dyspepsia or other causes of dyspepsia like liver, gall bladder or pancreatic diseases.

Aim: The aim of this research was to determine the association of recurrent abdominal pain and Helicobacter pylori (H. pylori) infection in childhood, in correlation with the finding of an upper endoscopy. Introduction: Recurrent abdominal pain (RAP) was defined according to Apley and Naish's criteria from the year 1959 as at least three or more episodes of abdominal pain lasting longer than three months in children older than 3 years, and severe enough to prevent normal activities in child. The association of RAP and H. pylori has been analyzed in several different researches, and there are conflicting results about their interconnection. However, the etiological association of the presence of H. pylori with the onset and development of acute and chronic active gastritis and duodenal ulcer is known. Material and method: The research protocol included a total of 77/183 (42.07%) children divided by age into three subgroups: preschool age (3 to 6.9 years), school-age (7 to 10.9 years) and adolescent age (11 to 15 years) in whom the diagnosis of RAB was determined by meeting the criteria according to Apley and Naish (1959), and the American Academy of Pediatrics (2005). H. pylori infection was confirmed by enzyme-linked immunosorbent assay (ELISA), while esophagogastroduodenoscopy was performed by the device for upper endoscopy type Olimpus GIF Type Q156, in the endoscopic cabinet of the Clinic for Internal Medicine, University Clinical Center Tuzla. Results: Of the total number of examined children (77), the analyse of Helicobacter pylori infection presence showed the biggest number of positive findings in school age 91.3%, in adolescent age 78.0%, while the smallest number was in preschool age (25.0%). The most common findings of upper endoscopy and microscopic findings were described as: antritis acuta in 16%, gastritis chronica activa et erosiva in 32%, and duodenitis acuta (12%). Conclusion: A significant association of H. pylori infection and RAP are confirmed by positive finding of esophagogastroduodenoscopy, leading to conclusion that immunological testing for the presence of this bacteria is justified. After obtaining a positive finding with confirmed infecion, it is necessary to start with the treatment.

Objective: Endoscopic duodenal biopsies constitute a significant load of specimens in the histopathological section of a tertiary care hospital. Most of these diseases comprise non-neoplastic lesions causing significant morbidity. The purpose of this study was to see the frequency of these diseases in our patient population and to compare and analyze our results with similar other studies. Methods: In this retrospective study records of all duodenal biopsies reported from Feb 2017- Jan 2018 were retrieved. Both non neoplastic and neoplastic conditions along with biopsies with unremarkable findings were included. Various histological parameters like villous blunting, IEL count per 100 enterocytes, crypt hyperplasia, inflammation in lamina propria, and presence of microorganisms, any dysplasia or malignancy were studied. Data was statistically analyzed using SPSS v.23. Results: A total of 159 duodenal biopsies were included in the study. Normal duodenal morphology was noted in 85 (53.45%) cases while 74 (46.83%) cases revealed abnormal duodenal pathology. There were 46 (28.93%) cases consistent with celiac disease. Twenty eight (17.61%) cases were of other duodenal pathologies of which non-specific duodenitis was most common. There were 22 (13.83%) cases of duodenitis and 2 (1.26%) cases were of duodenal ulcer. One case (0.62%) each was seen of Brunner gland hyperplasia, adenocarcinoma, signet ring carcinoma and one case was of metastatic adenocarcinoma. Conclusion: In our study we found a significant percentage of 46.83% exhibiting abnormal duodenal pathology. Cases consistent with celiac disease were 28.93% while 13.83% of the cases had duodenitis. The percentage of malignant cases was minimal (1.88%).

Purpose Recently, fecal microbiota transplantation (FMT) has been tested in veterinary medicine as a treatment option for multiple gastrointestinal (GI) diseases, such as inflammatory bowel disease (IBD). However, there are no reports of changes in the microbial diversity of fecal microbiome after treatment with FMT in canine IBD cases. Moreover, little is known about the long-term efficacy and safety of FMT treatment for dogs. Herein, we present a case of canine intractable IBD treated with repeated, long-term FMT. Patients and methods The patient was a 10-year-old, neutered, male, 4-kg Toy Poodle with a prolonged history of vomiting and diarrhea. Fecal examination for pathogens was negative. Despite treatment with multiple antibacterial and antidiarrheal agents, the patient showed no improvement. Endoscopic mucus sampling diagnosed a case of lymphocytic-plasmacytic duodenitis, ie, idiopathic IBD. Eventually, we performed periodic, long-term fecal microbiota transplantation of fresh donor feces collected from a 4-year-old, 32.8-kg, neutered male Golden Retriever by rectal enema. Additionally, we performed 16S rRNA sequence analysis, before and after FMT, to evaluate the microbiome diversity. Results Fecal microbiome diversity after FMT resembled that of the healthy donor dog’s fecal microbiome, before FMT, which led us to conclude that the fecal microbiome in our patient normalized with FMT. Moreover, the clinical symptoms improved remarkably with regard to the changes in the fecal microbiome. Additionally, we noted no observable side effects during FMT treatment. Conclusion This report indicates the efficacy and safety of long-term, periodic FMT for a case of canine IBD based on attenuation of clinical symptoms and changes in fecal microbiome diversity. Therefore, FMT could be chosen as a treatment option for IBD in canines in the future.