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Background and Aims Biliary tract cancer is a group of highly aggressive malignant disorders, yet risk factors are poorly understood. In this study, we aim to assess whether prolonged use of proton pump inhibitors (PPIs) increases the risk of incident biliary tract carcinoma in a nation-wide population-based cohort in Sweden. Approach and Results Using nation-wide registries, we identified all adults who received maintenance PPIs (>= 180 days) according to the Swedish Prescribed Drug Register from 2005 through 2012. Data on incident biliary tract cancer were retrieved from the Swedish Cancer, Death and Outpatient Registers. Risk of biliary tract cancer in persons who received PPI treatment was compared with the general population of the corresponding age, sex, and calendar year yielding standardized incidence ratios (SIRs) with 95% CIs. Of 738,881 PPI users (median follow-up of 5.3 years), 206 (0.03%) developed gallbladder cancer and 265 (0.04%) extrahepatic and 131 (0.02%) intrahepatic bile duct cancer corresponding to SIRs of 1.58 (95% CI, 1.37-1.81), 1.77 (95% CI, 1.56-2.00), and 1.88 (95% CI, 1.57-2.23), respectively. In sensitivity analyses restricted to persons without a history of gallstones or chronic liver or pancreatic diseases, SIRs were 1.36 (95% CI, 1.17-1.57) and 1.47 (95% CI, 1.19-1.80) for extra- and intrahepatic duct cancer, respectively. The risk remained higher than the corresponding general population with >= 5 years of PPIs use, ruling out confounding by indication. Conclusions In this study, long-term use of PPIs was associated with an increased risk of gallbladder, intrahepatic, and extrahepatic bile duct cancer compared with the general population.

The aim: To define the level of pro- and anti-inflammatory IL-1β, IL-10 in the oral fluid of children with chronic gastroduodenitis, depending on the level of IkBα expression.Materials and methods: Studiing the oral fluid and scraping of the gums of 50 children 6-12 years old was carried out to determine the level of IL-1β, IL-10 and IkBα. The children were divided into 3 groups. Group 1 - 10 children with healthy periodontium and without somatic diseases. 2nd group - 20 somatically healthy children with chronic catarrhal gingivitis. The third group (20 children) of children with gastroduodenitis and chronic catarrhal gingivitis. The determination of the mRNA expression of the IkBα geneand the level of IL-10 and IL-1β in the oral fluid was carried out by real-time PCR.Results: We determined that the level of pro-inflammatory IL-1β in the oral fluid of primary school children had different levels in accordance with the state of dental and somatic health. It was the lowest in somatically healthy children without signs of gingivitis. We revealed that the level of IL-10 has anti-inflammatory properties, and an inverse relationship with the concentration of IL-1β in the oral fluid of examined children. Analysis of IkBα expression made it possible to reveal its suppression in children of the second and third groups compared with healthy children.Conclusions: We found changes in the levels of IkBα in the gums of children with chronic catarrhal gingivitis; attenuated IkBα expression may lead to the deregulation of NF-κB pathways in the pathogenesis of periodontitis. Decreased IkBα expression may affect cytokine production and inflammatory response associated with chronic catarrhal gingivitis and with chronic gastroduodenitis.

Henoch-Schönlein purpura (HSP) is a childhood vasculitis disorder that involves the skin, joints, gastrointestinal (GI) tract, and kidneys. It is related to immunoglobulin A (IgA) antibody deposition in small blood vessels. HSP is a self-limiting disorder, but its morbidity is primarily associated with renal involvement. GI pathologies like intussusception, gastritis, duodenitis, ileitis, or ulcer have been reported to be associated with this disease. However, cardiac and neurological complications are rarely reported. We present the case of a 16-year-old, previously healthy male who was diagnosed with HSP after presenting with a non-blanching purpuric rash in the lower extremities. The patient also had joint and abdominal pain, and swelling in the extremities. There was renal dysfunction at presentation with blood urea nitrogen (BUN) of 67 mg/dL and serum creatinine of 1.9 mg/dL. The serum albumin was low at 2 g/dL, and the patient had nephrotic range proteinuria. Urine microscopy showed red blood cell casts. A renal biopsy was performed, which showed IgA deposition in glomeruli. He was started on intravenous (IV) pulse methylprednisolone and was later prescribed oral steroids. Four weeks after the treatment initiation, he presented with syncope and acute anemia (hemoglobin of 3.5 g/dL). The fecal occult blood was positive. Esophagogastroduodenoscopy (EGD) was not suggestive of gastritis, duodenitis, or ulcer. The pill-cam capsule endoscopy revealed GI bleeding from the terminal ileum near Meckel’s diverticulum. He subsequently required blood transfusions, and the bleeding eventually improved with symptomatic management. Six weeks after treatment initiation, he presented with dizziness and palpitations. The EKG showed the presence of atrial fibrillation, and he had an episode of non-sustained ventricular tachycardia on telemetry. Arrhythmia was diagnosed secondary to HSP cardiac vasculitis, and we initiated treatment with metoprolol and amiodarone. Seven weeks after the initial treatment, he had neurological clinical findings of proximal muscle weakness, tremors, and upper and lower extremity clonus. A second renal biopsy was then performed due to the presence of persistently elevated serum creatinine, which showed 75% of glomeruli with cellular crescents. He was treated with IV cyclophosphamide. Subsequently, the renal function improved. There were no other GI, cardiac, or neurological complications after six months of follow-up. The presentation of HSP can be more severe in adolescents, and they need to be closely monitored for GI, cardiac, renal, and neurological complications after the disease occurrence. Bleeding from Meckel’s diverticulum or an episode of non-sustained ventricular tachycardia with HSP has not been previously reported to our knowledge. Arrhythmia is an exceptionally unusual occurrence in HSP, and it is usually treated with anti-arrhythmic drugs and intensification of the immunosuppressive regimen.

A 66-year-old man with a history of diabetes and dilated cardiomyopathy underwent the implantation of a ventricular assist device (VAD) at the age of 62. He suffered from epigastralgia for a month and then visited our hospital with complaints of severe epigastralgia and hematemesis. A physical examination revealed abdominal distension without rigidity. Laboratory data showed severe systemic inflammation, multiple organ failure, and disseminated intravascular coagulation. Computed tomography showed multifocal thickness of the gastroduodenal wall with surrounding panniculitis, gas in a portal vein and a perigastric vein. Emergency esophago-gastro duodenoscopy (EGD) demonstrated a large erosion in the antrum of the stomach, and penetration surrounded by circumferentially ischemic mucosa in the second and third portions of the duodenum. Based on informed consent, conservative therapy was performed, and his condition improved enabling the start of oral intake on the 37th hospital day. However, 7 days later, there was a relapse of epigastralgia after a meal. Gastrointestinal series and EGD revealed a 10-mm-long pinhole-like stricture at the site. After laparoscopic gastro-jejunal bypass surgery, he has remained in a good condition for 2 years. We demonstrated a rare case of penetration due to severe ischemic duodenitis 4 years after VAD implantation.

Immunoglobulin A (IgA) vasculitis mainly affects the joints, skin, kidneys, and gastrointestinal tract; however, purpura is an essential diagnostic criterion. Here, we report an unusual case of IgA vasculitis without purpura in an elderly woman. A 76-year-old woman was admitted to our hospital complaining of diarrhea and abdominal pain. No skin rash, purpura, jaundice, or peripheral lymphadenopathy was observed. Endoscopy of the small intestine revealed severe mucosal sloughing in the duodenum, and a biopsy specimen showed severe erosive duodenitis. A decrease in coagulation factor XIII (FXIII) activity was also observed during laboratory blood tests. IgA immunostaining revealed granular IgA deposition on the walls of the interstitial small blood vessels. Although the patient showed no purpura or renal involvement, a diagnosis of IgA vasculitis was made based on the histopathology findings from biopsies. The administration of purified FXIII concentrate improved her symptoms immediately and facilitated regeneration of the duodenal villi. When gastroenterologists encounter severe erosive duodenitis or inflammation of the small intestine, IgA vasculitis should be listed as part of the differential diagnosis even without purpura and/or renal involvement. For a definitive diagnosis, measurement of FXIII and IgA immunostaining using duodenal biopsy specimens should be performed actively.

Abdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between disaccharidase deficiencies and symptom complexes or inflammation have not been evaluated in this group. The primary aims of the current study were to assess relationships between disaccharidase deficiency and symptoms or symptom complexes and duodenal inflammation, respectively. Patients with abdominal pain who underwent endoscopy with evaluation of disaccharidase activity levels were identified. After excluding all patients with inflammatory bowel disease, celiac disease, H. pylori, or gross endoscopic lesions, patients were evaluated for disaccharidase deficiency frequency. Disaccharidase were compared between patients with and without histologic duodenitis. Lastly, relationships between individual gastrointestinal symptoms or symptom complexes were evaluated. Lactase deficiency was found in 34.3% of patients and disaccharidase pan-deficiency in 7.6%. No individual symptoms or symptom complexes predicted disaccharidase deficiency. While duodenitis was not associated with disaccharidase deficiency, it was only present in 5.9% of patients. Disaccharidase deficiency, particularly lactase deficiency, is common in youth with abdominal pain and multiple deficiencies are not uncommon. Disaccharidase deficiency cannot be predicted by symptoms in this population. Further studies are needed to assess the clinical significance of disaccharidase deficiency.

Sex and gender can affect the prevalence and prognosis of diseases. Our aim was to assess similarities and differences for males and females who underwent an upper endoscopy, with regards to indications and results. We reviewed all upper endoscopy reports from 2012 to 2016. Data regarding demographics, indications, and procedure findings were collected. The upper endoscopy findings were compared regarding the most common indications: gastroesophageal reflux, abdominal pain, gastrointestinal bleeding, and anemia. We investigated 12,213 gastroscopies among males (age, 56.7 ± 17.4) and 15,817 among females (age, 56.0 ± 17.3, p = 0.002). Males who underwent an upper endoscopy for gastroesophageal reflux had higher rates of esophagitis (7.7% vs. 3.4%, p &lt, 0.001) and Barret’s esophagus (4.4% vs. 1.5%, p &lt, 0.001). Females who underwent an upper endoscopy for abdominal pain had a higher rate of hiatal hernia, whereas males had higher rates of esophagitis, helicobacter pylori infection, gastritis, gastric ulcer, duodenitis, and duodenal ulcer (p &lt, 0.001). Gastrointestinal bleeding as an indication for upper endoscopy showed that helicobacter, duodenitis, and duodenal ulcers are more common among males compared to females (p &lt, 0.001). Males with anemia who underwent an upper endoscopy had higher rates of esophagitis (p = 0.021) gastritis (p = 0.002), duodenitis (p &lt, 0.001), and duodenal ulcer (p &lt, 0.001). We found significant differences regarding the pathological gastroscopy findings between males and females in relation to the different indications.

BackgroundRecurrent abdominal pain (RAP) and dyspepsia are common complaints in children. These symptoms are often associated with Helicobacter pylori (Hp)infection. Aim of the present study was to prospectively analyze clinical, endoscopic and histological characteristics of Hp+ and Hp- children with RAP and/or dyspepsia. MethodsPatients aged 2-18 years with RAP and/or dyspepsia, referred for upper endoscopy to Arabkir MC from November 2015 to December 2017, were involved in the study. Histology was assessed according to the updated Sydney system. Gastric and duodenal specimens were stained by modified Giemsa staining for Hp infection. One antral biopsy was cultured in Hp selective media. Results150 patients were included into the study: 70.7% Hp+,29.3% Hp-. Nausea and vomiting were significantly more common in Hp+ patients (pConclusionHp infection prevalence is high in Armenian children with dyspepsia and/or RAP. Clinical symptoms, endoscopic findings and histopathological findings were significantly different in Hp+ patients as compared to Hp- patients.

Limited data are available to support current guidelines recommendations on obtaining gastric and duodenal biopsies of patients with clinical and histologic manifestations consistent with eosinophilic esophagitis (EoE) to rule out eosinophilic gastritis (EG) or duodenitis (EoD). Our study examined the prevalence of concomitant extraesophageal, gastrointestinal pathology to better characterize the diagnostic yield of additional biopsies. This was a single-center, retrospective study which utilized ICD 9 codes (530.13) and search queries of pathology reports (“Eosinophilic esophagitis,” “EoE”) to identify EoE patients. Patient endoscopy reports, pathology reports, and office notes were manually reviewed to characterize cases. The electronic health record search yielded 1,688 EoE adults. In those who had extra-esophageal biopsies obtained, EG was identified in 34 (3.4%), H. pylori in 45 (4.6%), EoD in 27 (3.3%), and histology consistent with celiac disease in 20 (2.5%). Endoscopic abnormalities were found in the stomach of 92% of patients with EoE and EG and in the duodenum of 50% of patients with EoE and EoD. Symptoms of dyspepsia and/or abdominal pain occurred in a significantly greater proportion of patients with extraesophageal disease (64% vs. 19% in EoE group, p

Introduction The National Endoscopy Database (NED) is populated by data extracted automatically from endoscopy reporting systems (ERSs) of endoscopy services in the UK. 406 out of 520 UK endoscopy sites are currently uploading. We aimed to provide an overview of oesophagogastroduodenoscopies (OGDs) stored on NED. Methods Data from all OGDs uploaded to NED from 2016 to the 28th January 2020 was accessed and analysed using the standard output from the NED website. Results 1,010,741 OGDs have been uploaded to NED. 651,270 of those are from 2019, compared to 281,883 in 2018 and 21,457 in 2017, indicating the ongoing roll-out of NED across the UK. 47% of procedures were performed on male patients, 52% on female and 1% unspecified. 27% of OGDs were performed on patients 13% of procedures were on in-patients, 65% on out-patients, while 22% were unspecified. 51% of procedures were routine, 37% urgent, 3% emergency, and 3% surveillance. 7% were not specified. 49% of procedures were unsedated. The most common indications were: Dyspepsia (17%), Heartburn/Reflux (15%), Anaemia (15%), Dysphagia (14%), Abdominal Pain (12%). Other frequent indications were: Weight Loss (7%), Nausea/Vomiting (6%), Melaena (5%), Haematemesis (3%), Barrett’s Oesophagus (3%), Varices Surveillance (2%). ‘Other’ was included in the indication field in 37% of OGDs. The most common diagnoses were: Normal (31%), Hiatus Hernia (27%), Non-erosive Gastritis (17%), Reflux Oesophagitis (11%). Other frequent diagnoses were: Barrett’s oesophagus (7%), Erosive Gastritis (6%), Gastric Polyp(s) (5%), Non-erosive Duodenitis (5%), Oesophageal Varices (2%), Erosive Duodenitis (2%), Duodenal Ulcer (2%), Gastric Ulcer (2%). ‘Other’ was included in the diagnosis field in 18% of OGDs. (NB: Multiple indications and diagnoses can be entered for a procedure, hence sum of percentages is greater than 100% for these categories) Conclusion The majority of procedures were performed in the ≥ 50 age group, peaking between ages 70 to 79, although a quarter of all procedures were performed in people younger than 50. Close to half of OGDs are performed without sedation. Procedure uploads to the NED continue to increase exponentially year on year. The volume of data and high proportion of sites uploading allows unparalleled insights into OGD practice in the UK.

To study the outcomes of fast-track recovery in patients with perforated duodenal ulcer (PDU).There were 138 patients with PDU who underwent surgical treatment for the period from January 1, 2015 to December 31, 2019. Patients were divided into 3 groups: main group, control group 1 (CG-1) and control group 2 (CG-2). The main group (fast-track group, FT-group) included 51 patients who underwent laparoscopic suturing of PDU followed by enhanced recovery (fast-track). CG-1 comprised 44 patients who underwent open suturing of PDU and conventional perioperative treatment. CG-2 consisted of 43 patients who underwent laparoscopic suturing and conventional perioperative treatment. Complications were assessed using Clavien-Dindo grading system.In the FT group, postoperative complications were observed in 2 patients (3.92%). Anemia of mixed genesis (Clavien-Dindo grade II) was diagnosed in 1 patient and left-sided lower lobe pneumonia in another one (grade II). There were no deaths. Mean length of hospital-stay was 3.86 days. In the 1Treatment outcomes in patients with perforated duodenal ulcer confirmed an effectiveness of laparoscopic suturing and complete abdominal sanitation. These measures create the prerequisites for fast track recovery in urgent surgical practice. FT-protocol of inpatient management is followed by reduced hospital-stay and less incidence of postoperative complications. Moreover, this approach promotes early and safe discharge of patients.Изучить результаты применения метода ускоренного выздоровления (fast-track) у больных перфоративной дуоденальной язвой (ПДЯ).В период с 01.01.15 по 31.12.19 на клинической базе кафедры хирургии и эндоскопии факультета дополнительного профессионального образования РНИМУ им. Н.И. Пирогова проведено хирургическое лечение 138 пациентов с ПДЯ. Пациенты распределены на 3 группы: основную, контрольные 1 (КГ1) и 2 (КГ2). В основную группу (fast-track-группа, FT-группа) вошел 51 пациент, им выполнили лапароскопическое ушивание ПДЯ, применен метод ускоренного выздоровления (fast-track). КГ1 составили 44 больных, которым выполнили открытое ушивание ПДЯ, в периоперационном периоде проводили традиционное лечение. В КГ2 вошли 43 пациента, которым произвели лапароскопическое ушивание ПДЯ, FT-протокол не выполняли, в периоперационном периоде проводили традиционное лечение. Осложнения оценивали по шкале Clavien—Dindo (CDC).В FT-группе послеоперационные осложнения наблюдали у 2 (3,92%) пациентов: в одном случае это анемия средней степени тяжести смешанного генеза (II), в другом — левосторонняя нижнедолевая пневмония (II класс по CDC). Летальных исходов не было. Средняя продолжительность госпитализации составила 3,86 койко-дня. В КГ1 зафиксировано самое большое количество осложнений — 12/27,27%, из них 9 экстраабдоминальных осложнений (легочные (II) у 7 (15,9%) пациентов, сепсис, синдром системной воспалительной реакции (IVB) у 1 (2,27%), делирий (IVA) у 1 (2,27%), раневые осложнения — серома послеоперационной раны (IIIA) у 1 (2,27%)). Интраабдоминальные осложнения: компенсированный пилородуоденальный стеноз (II) у 1 (2,27%), рецидивирующее кровотечение из острых язв желудка и двенадцатиперстной кишки (IIIB) у 1 (2,27%). В КГ1 умерли 2 (4,54%) пациента вследствие прогрессирования синдрома полиорганной недостаточности. Средняя продолжительность госпитализации составила 7,56 койко-дня. В КГ2 были следующие послеоперационные осложнения. Экстраабдоминальные: легочные (II) — пневмония у 4 (9,3%), спонтанный пневмоторакс (IIIA) у 1 (2,32%). Интраабдоминальные: дуоденит (II) у 1 (2,32%), компенсированный пилородуоденальный стеноз (II) у 1 (2,32%). Летальных исходов не было. Средняя продолжительность госпитализации — 6,7 койко-дня.Видеолапароскопические технологии на современном этапе позволяют применять метод ускоренного выздоровления (fast-track) при ПДЯ в условиях ургентной хирургии. Fast-track-программа предусматривает мультидисциплинарный подход к ведению пациента на всех этапах стационарного лечения, создает условия для ранней и безопасной выписки.

There is paucity of knowledge on the histological features of the intestinal mucosa in malnourished adults of Bangladesh. The purpose of the study was to explore the histological features of the intestinal mucosa in malnourished adults of Bangladesh and to compare the findings with their well-nourished counterparts. 64 adults (37 malnourished with body mass index, BMI2 and 27 controls with BMI>18.5 kg/m2) from the Bangladesh Environmental Enteric Dysfunction (BEED) study, who underwent upper-gastrointestinal endoscopy, were selected for this study. With a view to address the association of environmental enteric dysfunction (EED) with malnutrition, upper-gastrointestinal endoscopy was performed and mucosal biopsies from the distal duodenum were studied for histopathology. Villous height, crypt depth, and presence of inflammatory infiltrates in lamina propria were investigated. Bivariate analysis was performed to quantify the relation between malnutrition and the histological features. About 95% adults, irrespective of nutritional status, were diagnosed to have chronic non-specific duodenitis on histopathology. Malnourished adults suffered significantly more from chronic active duodenitis compared to their well-nourished counterparts (p=0.003). Malnourished adults also had significantly higher frequency of subtotal villous atrophy, crypt hyperplasia and marked cellular infiltration in the lamina propria than the healthy controls (p

Introduction Upper gastrointestinal bleeding (UGIB) is defined as any blood loss originating from the esophagus, stomach or the proximal duodenum above the ligament of Treitz. Ethnic trends regarding the causes of UGIB have been reported. The aim of this study was to identify the most common causes of UGIB among patients residing in Tabuk city, Saudi Arabia. Methods We have conducted a retrospective descriptive cohort study at King Fahad Specialist Hospital (KFSH), Tabuk, Saudi Arabia. All adult patients above the age of 18 years who were suspected of UGIB and referred for esophagogastroduodenoscopy (EGD) were included. The collected data included age, sex, nationality, complaint, EGD, and histopathologic findings. Results Between January 1, 2017 and December 31, 2019, 73 patients were included. 83.6% were Saudi, and 64.4% were males. Hematemesis was the main complaint (65.8%). Esophagogastroduodenoscopy was normal in 6.84% of cases; however, it showed UGIB due to esophageal and gastric varices (9.57%) as well as non-variceal causes (83.56%). The most frequent non-variceal findings which represent about two-thirds of the cases were duodenal ulcer (20.53%), antral gastropathy (13.68%), gastric ulcer (12.32%), antral gastritis (10.94%), and duodenal/gastric mass (9.57%), whereas much less frequent findings representing a total of 16.39% of cases included Cameron gastropathy, gastropathy/duodenopathy, esophagitis/gastritis, gastritis/duodenitis, gastroesophageal reflux disease (GERD), and Mallory-Weiss tear. Conclusion Non-variceal causes showed higher prevalence as causes of UGIB than variceal causes in the Tabuk area. Furthermore, chronic duodenal and gastric ulcers were the most common culprits of bleeding, whereas duodenitis, gastritis, esophagitis, and Mallory-Weiss syndrome were the least common non-variceal causes.

Background The association of upper gastrointestinal endoscopic findings with sex, age, and Helicobacter pylori infection in asymptomatic healthy people is unclear. The aim of this study was to retrospectively determine the associations of upper gastrointestinal endoscopic findings in asymptomatic healthy people with sex, age, and H. pylori infection. Methods A retrospective study was conducted on 2923 patients from a health examination center in Xiangya Hospital between September 2015 and September 2019. Data on sex, age, H. pylori infection, and gastroscopy results were collected. Results Among 2923 asymptomatic patients who underwent gastroscopy, 2911 (99.59%) had abnormal results. The top three results were chronic gastritis (95.11%), peptic ulcer (17.45%), and duodenitis (9.17%). Inflammation of the gastric mucosa in chronic gastritis was more severe in the H. pylori-positive group. The incidence of peptic ulcer decreased with increasing age and was higher in men, patients aged H. pylori-positive patients. The incidence of polyps was higher in women (9.54%) than in men (5.94%), and the incidence in individuals aged ≥60 years (11.63%) was higher than that in those aged Conclusion The incidence of abnormal upper gastrointestinal endoscopic results is high in asymptomatic healthy people undergoing a check-up and is associated with sex, age, and H. pylori infection. Gastroscopy should be considered part of a routine health check.

Gastrointestinal toxicity is a leading adverse event from the use of cancer immunotherapy. Prompt recognition and treatment are integral to improving clinical outcomes in patients with these complications. While upper gastrointestinal involvement such as gastritis and duodenitis has been increasingly recognized with the use of immune checkpoint inhibitors (ICIs), there have been few reported cases of esophageal involvement and none to our knowledge that have resolved with anti-tumor necrosis factor alpha therapy. Here, we discuss the management of a 75 year-old woman with metastatic melanoma who was treated with nivolumab and developed ICI induced esophageal toxicity 5 weeks after her first treatment. She was initially unsuccessfully treated with steroids followed by three doses of infliximab which resulted in resolution of the esophagitis.

Aim There is insufficient knowledge on the * duodenal histology and Helicobacter pylori infection in malnourished Bangladeshi children. Therefore, we attempted to explore the prevalence of H. pylori infection and duodenal histopathology in 2-year-old chronic malnourished Bangladeshi slum-dwelling children and investigate their association with dyspeptic symptoms. Methods This cross-sectional study was conducted using the data of the Bangladesh Environmental Enteric Dysfunction study in an urban slum of Dhaka, Bangladesh. With a view to address the association of environmental enteric dysfunction (EED) with stunting, upper gastrointestinal endoscopy was performed on 54 chronic malnourished children {31 stunted [length-for-age Z-scores (LAZ) Results In all, 83.3% (45/54) of the children had histopathological evidence of duodenitis. Chronic mild duodenitis was found to be the most prevalent form of duodenitis (53.7%) in the children. Only 8.9% (4/45) of the children with duodenitis had dyspepsia (p Conclusions The number of chronic malnourished children suffering from duodenitis was found to be very high. Majority of these children was asymptomatic. Children positive for HpSA had significant association with dyspeptic symptoms.

Introduction: The acid peptic disorder is a disorder in which due to hyperacidity, there is the damageof inner lining(mucosa) of the stomach and duodenum causing various manifestations like inflammation,ulcer, etc. The acid peptic disorder is a disorder in which due to hyperacidity, there is the damage of innerlining(mucosa) of the stomach and duodenum causing various manifestations like inflammation, ulcer, etc.A major symptom of the acid peptic disorder is a pain in the abdomen typically non radiating, burning, andlocated at in epigastrium, Other include nausea, vomiting, dyspepsia, haemtemesis, and melena, etc. Uppergastrointestinal tract disorders are common in surgical practice. Helicobacter pylori is a common cause ofacid peptic disorders. Still in literature there is a controversy still exist to question about role of Helicobacterin causing acid peptic disorders. So This study was undertaken to evaluate the correlation of H. Pyloriinfection with acid peptic disorders. Method: This study was a prospective observational. The durationof this study was from September 2017 to September 2019. The numbers of patients were 150. After theestablishment of a clinical diagnosis of an acid peptic disorder, the patient was posted for endoscopy. H.pylori status was determined by the rapid urease test. The data collected included the presenting complaints,clinical signs, endoscopic findings, results of rapid urease test, and histopathological examination. Thepresence of H pylori infection was correlated with symptoms, and endoscopy findings. Results: In the presentstudy, 150 patients with upper gastrointestinal symptoms were studied It was found that the maximumnumber of subjects belonged to the age group 31-40 yrs. It was found that of subjects male 112 and female.It was found that maximum number of subjects had pain in epigastric region 120 cases i. e. 80% followedby symptoms nausea 75 cases ie. 50%. about endoscopic findings 70 patients were having gastritis, 15 hada duodenal ulcer,9 patients had Duodenitis, the gastric ulcer was found in 08 patients, gastric malignancyin 02 patients and 46 patients had endoscopic normal mucosa. The highest positivity of RUT was seen inpatients of duodenal ulcers (86.66%), followed by gastritis (82.85%) and gastric ulcer (75%). Conclusions:Present study, we have found that there is an association of H. Pylori infection in an acid peptic disorder likeduodenal ulcer, gastric ulcer, and gastritis.

BACKGROUND: Eosinophilic gastritis and duodenitis are characterized by gastrointestinal mucosal eosinophilia, chronic symptoms, impaired quality of life, and a lack of adequate treatments. Mast-cell activity may contribute to the pathogenesis of the conditions. AK002 (lirentelimab) is an anti–Siglec-8 antibody that depletes eosinophils and inhibits mast cells and that has shown potential in animal models as a treatment for eosinophilic gastritis and duodenitis. METHODS: In this phase 2 trial, we randomly assigned adults who had symptomatic eosinophilic gastritis, eosinophilic duodenitis, or both conditions in a 1:1:1 ratio to receive four monthly infusions of low-dose AK002, high-dose AK002, or placebo. The primary end point was the change in gastrointestinal eosinophil count from baseline to 2 weeks after the final dose; to maximize statistical power, we evaluated this end point in the placebo group as compared with the combined AK002 group. Secondary end points were treatment response (>30% reduction in total symptom score and >75% reduction in gastrointestinal eosinophil count) and the change in total symptom score. RESULTS: Of the 65 patients who underwent randomization, 43 were assigned to receive AK002 and 22 were assigned to receive placebo. The mean percentage change in gastrointestinal eosinophil count was −86% in the combined AK002 group, as compared with 9% in the placebo group (least-squares mean difference, −98 percentage points; 95% confidence interval [CI], −121 to −76; P

A 21-year-old male southern rockhopper penguin (Eudyptes chrysocome) was presented with a chronic history of intermittently decreased appetite, lethargy, and regurgitation. On the external physical examination, the bird was determined to be in fair-to-thin body condition with the complete blood count and plasma chemistry panel being largely unremarkable. Full-body radiographic images were considered normal, and gastroscopy showed only mild gastritis and duodenitis. The penguin was euthanatized shortly thereafter due to acute onset of respiratory distress. During the gross necropsy examination, the bird had severe airsacculitis with thick, yellow-to-tan, moist granular plaques adhering to the surface of many air sacs, as well as regional contiguous pneumonia. Intralesional acid-fast bacilli were observed in histologic sections of air sac tissue, and polymerase chain reaction of the affected air sacs was positive for Mycobacterium fortuitum. This clinical case study describes mycobacteriosis in a sub-Antarctic penguin and to the best of the authors' knowledge, the first reported isolation of M fortuitum from a penguin.

To evaluate the effects of somatostatin analogs and disease activity status on the upper gastrointestinal system in patients with acromegaly. One hundred eighty-one patients with acromegaly were retrospectively assessed. The demographic, biochemical, pathologic, and radiologic data of the patients were evaluated. The upper gastrointestinal endoscopies and endoscopic biopsies were investigated. We divided patients into four groups according to the use of somatostatin analogs, and into two groups according to disease activity. We compared the data of patients between groups A, B, C, and D, and controlled/uncontrolled groups separately. Before and in the peri-endoscopic period, 67 and 27 patients were being treated with octreotide long-acting release (LAR) (group A) and lanreotide autogel (group B), respectively. Twenty-one patients used somatostatin analogs, but they were stopped for various reasons before upper gastrointestinal endoscopy (group C), and 66 patients did not use a somatostatin analog (group D). In the peri-endoscopic period, 103 (60%) patients were responsive to medical and/or surgical treatment and 67 (40%) patients were non-responsive. The rate of gastritis was higher in group A than in groups B and D. The incidence of duodenitis and gastric ulcer was much higher in group D. The rate of gastritis was higher in the controlled group compared to the uncontrolled group. The study showed that octreotide LAR treatment could be a risk factor in addition to known factors for the development of gastritis in patients with acromegaly.

Background Pyoderma gangrenosum (PG) is an uncommon, idiopathic, ulcerative neutrophilic dermatosis. In many cases, PG is associated with a wide variety of different disorders but SLE in association with PG is relatively uncommon. In this article we present the case of a middle aged patient with PG as the initial clinical presentation of SLE. We also provide a brief review of cobalamin deficiency which occurred in our patient and evidence-based management options. Case presentation A 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud’s phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements. Conclusions We report a case of PG as the first manifestation of SLE which was treated successfully with immunosuppressants and vitamin supplements. Our report highlighted the need to consider connective tissue diseases such as SLE in a patient presenting with PG in order for appropriate treatment to be instituted thereby achieving a good outcome.

Background Dyspepsia is a common disorder in kidney transplant recipients, and the risk of post-transplant complications is increased in candidates with upper gastrointestinal disease. We evaluated gastrointestinal lesions of kidney transplant candidates on dialysis. Methods In this study, endoscopic and pathological findings in hemodialysis (HD) and peritoneal dialysis (PD) patients with gastrointestinal symptoms on the waiting list were compared. Results The most common non-ulcerous lesions in the endoscopic examination were gastritis (62.3%), erosive gastritis (38.7%), duodenal erosion or duodenitis (18.9%) and esophagitis (13.2%). The ulcerous lesion was present in only 3 patients. Gastroesophageal reflux disease, ulcerated lesion and non-ulcerated lesion rates were similar in both dialysis groups. Histopathological examination revealed Helicobacter pylori (HP) positivity in 28.3% of patients. HP positivity rate was significantly higher in PD patients than in HD patients (38.7% vs. 13.6%, p = 0.046). Chronic gastritis (75.5%) was the most common pathological finding. HP positivity rate was 37.5% in patients with chronic gastritis, but HP was negative in patients without chronic gastritis. In multivariate analysis, male gender, urea and albumin levels were associated with the presence of pathological chronic gastritis. The presence of gastritis, total cholesterol and ferritin levels were found significant for HP positivity. A total cholesterol > 243 mg/dL was significantly related to an increased risk of the presence of HP positivity. Conclusions Gastrointestinal lesions and HP infection are common in dialysis patients. Dialysis modality may affect the frequency of some lesions. It may be useful to have an endoscopic examination before entering the transplant waiting list for all candidates.

Background Eosinophilic gastritis and/or eosinophilic duodenitis (EG/EoD) is characterized by persistent symptoms and elevated eosinophils in the gastrointestinal tract. Limited disease awareness and lack of diagnostic guidelines suggest that patients may remain undiagnosed or endure diagnostic delay. Objective To characterize the path to diagnosis for patients with EG/EoD in a representative population. Methods In this observational cohort study, 4108 eligible patients diagnosed with EG/EoD between 2008 and 2018 were identified in an administrative claims database in the United States. Patient medical claim history was analyzed to describe events related to diagnosis. Results Mean year from symptom presentation to diagnosis of EG/EoD was 3.6; factors contributing to diagnostic delay included delayed gastroenterologist referral, delayed esophagogastroduodenoscopy (EGD), and lack of biopsy collection and/or histopathologic evaluation. Missed diagnosis on index EGD occurred in 38.2% of patients, resulting in a mean increase of 1.6 years in time to diagnosis versus patients diagnosed on index EGD. Patients presented with nonspecific symptoms and 44.3% were diagnosed with another gastrointestinal condition before EG/EoD diagnosis. Independent predictors of >2-year diagnostic delay included adult age; prior diagnosis of irritable bowel syndrome, functional dyspepsia, or gastric/peptic ulcer; use of other procedures such as colonoscopy; presence of edema; and history of certain allergic diseases. Conclusions This study found that patients with EG/EoD experienced an average of 3.6 years between initial symptom presentation and diagnosis and revealed several factors contributing to diagnostic delay. We hope that these findings, together with heightened awareness and standardization of diagnostic guidelines, will improve the diagnostic journey of patients with EG/EoD.

Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0&ndash, 17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.

ObjectiveTo identify risk factors and generate hypotheses for pediatric post-concussion syndrome (PCS) using a phenome-wide association study (PheWAS).MethodsA PheWAS (case-control) was conducted following the development and validation of a novel electronic health record-based algorithm that identified PCS cases and controls from an institutional database of >2.8 million patients. Cases were patients ages 5-18 with PCS codes or keywords identified by natural language processing of clinical notes. Controls were patients with mild traumatic brain injury (mTBI) codes only. Patients with moderate or severe brain injury were excluded. All patients used our healthcare system at least three times 180 days before their injury. Exposures included all pre-injury medical diagnoses assigned at least 180 days prior.ResultsThe algorithm identified 274 pediatric PCS cases (156 females) and 1,096 controls that were age and sex matched to cases. Cases and controls both had a mean of >8 years of healthcare system use pre-injury. Of 202 pre-injury medical, four were associated with PCS after controlling for multiple testing: headache disorders (OR=5.3; 95%CI 2.8-10.1;P=3.8e-7), sleep disorders (OR=3.1; 95%CI 1.8-5.2;P=2.6e-5), gastritis/duodenitis (OR=3.6, 95%CI 1.8-7.0;P=2.1e-4), and chronic pharyngitis (OR=3.3; 95%CI 1.8-6.3;P=2.2e-4).ConclusionsThese results confirm the strong association of pre-injury headache disorders with PCS and provides evidence for the association of pre-injury sleep disorders with PCS. An association of PCS with prior chronic gastritis/duodenitis and pharyngitis was seen that suggests a role for chronic inflammation in PCS pathophysiology and risk. These factors should be considered during the management of pediatric mTBI cases.

Objective: Gastrointestinal bleeding can be seen in children of all ages, and it is one of the most frequent reasons for referral to a paediatric gastroenterologist. The aim of this study was to determine the demographic and aetiological factors of the paediatric patients admitted to our clinic with upper or lower gastrointestinal bleeding. Methods: This study included 150 patients who were admitted with upper and/or lower gastrointestinal bleeding between January 2010 and April 2014. Results: This research included 63 (42%) girls and 87 (58%) boys. The mean age of the patients was 11.0 +/- 4.6 years old. With regard to the aetiology of these upper gastrointestinal bleeding cases, Helicobacter pylori was detected in 25.3%, and 80% of the H. pylori positive patients were older than 10 years old. Fourteen (70%) of the 20 patients with peptic ulcer disease were older than 10 years old. Oesophageal varices were detected in 8 (5.3%) of these gastrointestinal bleeding patients, while 23 (15.3%) patients had drug use histories prior to bleeding. Twenty (25%) of the patients were diagnosed with ulcerative colitis, 4 (5%) were diagnosed with Crohn's disease, and 10 (12.5%) had colon polyps. Ninety percent of the polyps were localised in the rectosigmoid colon. Conclusion: Peptic ulcer disease was the most common aetiology of the paediatric patients with upper gastrointestinal bleeding. The majority of the cases with lower gastrointestinal bleeding were diagnosed with inflammatory bowel disease; therefore, ulcerative colitis plays an important role in paediatric lower gastrointestinal bleeding cases.

An 82‐year‐old man was presented to our hospital due to epigastric and right hypochondrial pain 17 weeks after the initiation of intravenous treatment with nivolumab for recurrent lung adenocarcinoma as multiple lung and sternal metastases. Urgent gastroscopy revealed macroscopic duodenitis such as severe erythema, oedema, black‐coloured erosions, and ulcers located throughout the second portion of the duodenum, which was confirmed by abdominal computed tomography as circumferential thickening of the duodenal wall. Those lesions were pathologically considered as non‐specific inflammation and spontaneously disappeared within a month, suggesting nivolumab‐induced immune‐related adverse events., Immune‐related adverse events usually occur in the colon; however, the duodenum could be affected by the immune checkpoint inhibitors. This is an extremely rare phenomenon that is characterized by pathologically non‐specific inflammation.

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., Цель работы – дать клинико-инструментальную характеристику и оценить морфологические изменения слизистой оболочки (СО) желудка и двенадцатиперстной кишки (ДПК) у детей с коморбидным течением хронического гастродуоденита (ХГД) и первичной артериальной гипертензии (ПАГ).Материалы и методы. Обследовали 102 ребенка в возрасте 9–17 лет с ХГД и ПАГ. Первую группу составили 47 детей с сочетанием ХГД и стабильной ПАГ, вторую группу – 55 детей с ХГД и нормальным артериальным давлением. Морфологическое исследование биоптатов СО желудка и ДПК проведено у 33 детей.Результаты. Во время ФЭГДС эритематозная гастродуоденопатия диагностирована у 57,4 % детей I группы и 60,0 % детей II группы (р = 0,79), гипертрофические изменения СО желудка и ДПК – у 6,4 % детей I группы и 12,7 % детей II группы (р = 0,28), субатрофия – у 10,6 % детей I группы и 14,5 % детей II группы (р = 0,56), эрозии – у 25,5 % детей I группы и 12,7 % детей II группы (р = 0,1), моторно-эвакуаторные нарушения – у 63,8 % детей I группы и 41,8 % детей II группы (р = 0,03). Морфологическое исследование биоптатов СО показало статистически значимую разницу в нарушении микроциркуляции СО: полнокровие СО отмечено у 81,3 % детей I группы и 52,9 % детей II группы (р = 0,02), значительный отек – у 75,0 % детей I группы и 41,2 % детей II группы (р = 0,049), кровоизлияния в собственной пластинке – у 62,5 % детей I группы и 23,5 % детей II группы (р = 0,02), микротромбозы – у 37,5 % детей I группы и 5,9 % детей II группы (р = 0,03). Разница отмечена также относительно деструктивных изменений СО: микроэрозии обнаружены у 56,3 % детей I группы и 17,6 % детей II группы (р = 0,02), эрозии – у 43,8 % детей I группы и 11,8 % детей II группы (р = 0,04).Выводы. Сочетанное течение ХГД и ПАГ у детей характеризуется частыми моторно-эвакуаторными и микроциркуляторными нарушениями (полнокровием, выраженным отеком, кровоизлияниями в собственной пластинке, микротромбозами), а также более выраженными эрозивными изменениями СО по сравнению с изолированным течением ХГД., Мета роботи – надати клініко-інструментальну характеристику та оцінити морфологічні зміни слизової оболонки (СО) шлунка та дванадцятипалої кишки (ДПК) у дітей із коморбідним перебігом хронічного гастродуоденіту (ХГД) і первинної артеріальної гіпертензії (ПАГ).Матеріали та методи. Обстежили 102 дитини віком 9–17 років із ХГД і ПАГ. Перша група – 47 дітей із поєднанням ХГД і стабільної ПАГ, друга група – 55 дітей із ХГД і нормальним артеріальним тиском. Морфологічне дослідження біоптатів СО шлунка та ДПК виконали у 33 дітей.Результати. Під час ФЕГДС еритематозну гастродуоденопатію виявили у 57,4 % дітей І групи та 60,0 % дітей ІІ групи (р = 0,79), гіпертрофічні зміни СО шлунка та ДПК – у 6,4 % дітей І групи та 12,7 % дітей ІІ групи (р = 0,28), субатрофію – в 10,6 % дітей І групи та 14,5 % дітей ІІ групи (р = 0,56), ерозії – у 25,5 % дітей І групи та 12,7 % дітей ІІ групи (р = 0,1), моторно-евакуаторні порушення – у 63,8 % дітей І групи і 41,8 % дітей ІІ групи (р = 0,03). Морфологічне дослідження біоптатів СО показало статистично значущу різницю щодо порушення мікроциркуляції СО: повнокров’я СО виявили у 81,3 % дітей І групи і 52,9 % дітей ІІ групи (р = 0,02), виразний набряк – у 75,0 % дітей І групи і 41,2 % дітей ІІ групи (р = 0,049), крововиливи у власній пластинці – у 62,5 % дітей І групи і 23,5 % дітей ІІ групи (р = 0,02), мікротромбози – у 37,5 % дітей І групи і 5,9 % дітей ІІ групи (р = 0,03). Різниця встановлена також щодо деструктивних змін СО: мікроерозії виявили у 56,3 % дітей І групи і 17,6 % дітей ІІ групи (р = 0,02), ерозії – у 43,8 % дітей І групи та 11,8 % дітей ІІ групи (р = 0,04).Висновки. Поєднаний перебіг ХГД і ПАГ у дітей характеризується частішими моторно-евакуаторними й мікроциркуляторними порушеннями (повнокров’ям, вираженим набряком, крововиливами у власній пластинці, мікротромбозами), а також виразнішими ерозивними змінами СО порівняно з ізольованим перебігом ХГД.

Background Post-transplant lymphoproliferative disease is a recognized complication following solid organ transplantation. This is usually a B cell disease and frequently associated with Epstein Barr virus infection, although T cell PTLD can occur. T cell PTLD is usually a monomorphic, lymphomatous disease associated with an adverse prognosis. Case report We report a 52 year old male pre-emptive renal transplant recipient who developed severe diarrhea with weight loss following intensification of his immunosuppression due to antibody mediated rejection 3 years after transplantation. Duodenal biopsy demonstrated monoclonal CD8+ T cell duodenitis leading to increased intraepithlieal lymphocytes and sub-total villous atrophy mimicking coeliac disease. Coeliac disease was excluded by negative anti-tissue transglutaminase antibody, HLA-DQ2 and HLA-DQ8 testing. There was no evidence of lymphoma either on biopsy or CT enterography and no FDG avid disease on PET. Symptoms did not improve with reduction of immunosuppression, but resolved fully on complete withdrawal of treatment. The transplant failed and he was established on dialysis. The diagnosis was early PTLD. Conclusions Oesophagogastroduodenoscopy with small bowel biopsies is a useful investigation for determining the cause of diarrhoea in renal transplant patients when more common causes have been excluded. This is the first report that we are aware of clonal T cell PTLD mimicking coeliac disease which only resolved after complete withdrawal of immunosuppression. As treatments for lymphoma are aggressive they are only initiated in the malignant phase and management of early stage PTLD is to minimise risk of progression by reducing immunosuppression. Any plans to retransplant will have to take into consideration the possibility that PTLD will recur.

Currently, biliary sludge (BS) is considered as a pathological process associated with an increase in the lithogenicity of bile and according to the modern classification of gallstone disease referred to the prestone stage of the disease. In the mechanism of BS formation, the main role belongs to four factors: glut of bile with cholesterol, formation of crystallization nucleus, dysfunction of the gallbladder (contraction, absorption, secretion), violation of the enterohepatic circulation of bile acids. Clinical manifestations in BS are most often associated with concomitant functional disorders of the biliary tract and chronic bacterial duodenitis with duodenal hypertension. The main directions in the treatment of BS are reduced to the restoration of the normal rheological properties of bile, the normalization of the motor function of the biliary system and the duodenum, the correction of the intestinal microbiome. The article discusses effective treatment regimens for BS depending on its morphological features and clinical course with the use of ursodeoxycholic acid or hofitol. The mechanism of Chophytol action (Mayoly Spindler, France) at BS is presented. The additional use of Meteospasmyl in the presence of intestinal antiseptic indications contributes to the rapid resolution of clinical manifestations in this pathology.

The significant prevalence of chronic gastritis and/or duodenitis among children and adolescents, the ability of H. pylori to induce serious complications lead to the importance of effective anti-helicobacter therapy. The aim of the work was to determine the rationality of prescribed drugs and the expediency of financial expenses for pharmacotherapy of chronic gastritis and/or duodenitis associated with H. pylori and gastro-esophageal reflux disease based on the results of a retrospective clinical and economic analysis of medical prescriptions in Dnipro. The material for the study were the 92 prescription sheets (form No. 003-4/y) of stationary patients aged 5–17 years with a diagnosis of chronic gastritis and/or duodenitis associated with H. pylori and gastro-esophageal reflux disease undergoing treatment at the Dnipropetrovsk Children's City Clinical Hospital № 6 for the period 2012–2017. Analysis of the prescriptions frequency, their ranking for cost and importance for the treatment were carried out using pharmacoeconomic methods: ABC-, VEN-, frequency analysis and integrated frequency/ABC/VEN analysis. Frequency analysis of treatment regimens showed that only 47.8% of patients were prescribed a «gold standard» of treatment, while 52.2% of patients had medical prescriptions that did not comply with the national treatment protocols adopted by the Ministry of Health of Ukraine. It was found that in the structure of medical prescriptions for the treatment of chronic gastritis and/or duodenitis associated with H. pylori and GERD, there was excessive use of non-essential drugs «N» (43.9%), which were prescribed almost in the same volume as vital drugs «V» (56.1%). According to the ABC-analysis, it was established, that the main financial resources were spent on the medicines of six groups: dietary supplements for normalization and maintenance of normal intestinal microflora, omeprazole, mozapride, clarithromycin, domperidone and amoxicillin. It was found, that on average one patient was prescribed 6.6 preparations worth 722.42 UAH. It can be concluded that the main funds was not spent on the necessary and important medicines for the treatment of the studied nosologies.

Background. Helicobacter pylori infection is most prevalent in developing countries. It is an etiological agent of peptic ulcer, gastric adenocarcinoma, and mucosal-associated lymphoid tissue (MALT) lymphoma. Despite the development of different assays to confirm H. pylori infection, the diagnosis of infection is challenged by precision of the applied assay. Hence, the aim of this study was to understand the diagnostic accuracy of PCR and microscopy to detect the H. pylori in the gastric antrum biopsy specimen from gastric disorder patients. Methods. A total of 52 patients with gastric disorders underwent upper gastrointestinal endoscopy with biopsy. The H. pylori infection in gastric biopsies was identified after examination by microscopy and 23S rRNA specific PCR. The agreement between two test results were analysed by McNemar’s test and Kappa coefficient. Result. H. pylori infection was confirmed in 9 (17.30%) patients by both assays, 6.25% in antral gastritis, 22.22% in gastric ulcer, 100% in gastric ulcer with duodenitis, 50% in gastric ulcer with duodenal ulcer, and 33.33% in severe erosive duodenitis with antral gastritis. Out of nine H. pylori infection confirmed patients, 3 patients were confirmed by microscopy and 8 patients by PCR. In case of two patients, both microscopy and PCR assay confirmed the H. pylori infection. The agreement between two test results was 86.54% and disagreed by 13.46% (p value > 0.05). Conclusion. We found that PCR assay to detect H. pylori is more sensitive than microscopy. However, we advocate for the combination of both assays to increase the strength of diagnostic accuracy due to the absence of the gold standard assay for H. pylori infection.

BackgroundRare cases of immune checkpoint inhibitor (ICI)-associated celiac disease (ICI-CeD) have been reported, suggesting that disruption of tolerance mechanisms by ICIs can unmask celiac disease (CeD). This study aims to characterize the clinicopathological and immunophenotypic features of ICI-CeD in comparison to ICI-associated duodenitis (ICI-Duo) and usual CeD.MethodsA medical and pathological records search between 2015 and 2019 identified eight cases of ICI-CeD, confirmed by tTG-IgA. Nine cases of ICI-Duo, 28 cases of moderate CeD, as well as 5 normal controls were used as comparison groups. Clinical information was collected from the electronic medical records. Immunohistochemistry for CD3, CD8, T-cell receptor gamma/delta (γδ), programmed death ligand 1 (PD-L1), and programmed death 1 (PD-1) were performed, with quantification of intraepithelial lymphocyte (IEL) subsets in three well-oriented villi. CD68, PD-L1, and PD-1 were assessed as a percentage of lamina propria surface area infiltrated by positive cells. Statistical significance was calculated by the Student’s t-test and Fisher’s exact test.ResultsThe eight patients with ICI-CeD (F:M=1:3) and nine patients with ICI-Duo (F:M=5:4) presented similarly with diarrhea (13/17) and abdominal pain (11/17) after a median of 1.6 months on ICI therapy. In patients with ICI-CeD, tTG-IgA ranged from 104 to >300 IU/mL. Histological findings in ICI-CeD and ICI-Duo were similar and included expansion of the lamina propria, active neutrophilic duodenitis, variably increased IELs, and villous blunting. Immunohistochemistry showed that the average number of IELs per 100 enterocytes is comparable between ICI-CeD and ICI-Duo, with increased CD3+CD8+T cells compared with normal duodenum but decreased γδ T cells compared with CeD. Average PD-L1 percentage was 9% in ICI-CeD and 18% in ICI-Duo, in comparison to ConclusionsICI-CeD resembles ICI-Duo clinically and histologically but shares the serological features and response to gluten withdrawal with classic CeD. Immunophenotyping of IELs in ICI-CeD and ICI-Duo also shows similar CD3, CD8, γδ T cell subsets, and PD-L1 populations, all of which differed quantitatively from usual CeD. We conclude that ICI-CeD is biologically similar to ICI-Duo and is likely a variant of ICI-Duo, but treatment strategies differ, with ICI-CeD often improving with GFD alone, whereas ICI-Duo requires systemic immunosuppression.