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In recent years, there has been an increase in the incidence of morbidity associated with digestive organ pathology in the pediatric population. The oral cavity is the digestive tract opening, sharing a common ectodermal origin with it. The changes in the cytogram of the oral mucous membranes can signal about exacerbation of pathological processes in the gastrointestinal tract. The aim of this work: to identify the features of gingival cellular composition in school-age patients with chronic gastritis and duodenitis in order to improve diagnostic methods at the disease stages. Examinations of the gingival cytogram in children aged 12-17 years with chronic gastritis and duodenitis (27 individuals with the disease in acute stage, 30 – in remission) were carried out. The control group included 28 children who did not have any somatic pathology by the results of the examination. For cytological examination, imprint smears from the gingival vestibular surface of the upper and lower jaws were made. The smears were fixed and stained by the May-Grunwald Pappenheim method, and then examined using a microscope with an im­mersion system. The percentage of epithelial cells and connective tissue cells was calculated per 100 cells. The number of pathologically altered epithelial cells was determined: with vacuolated cytoplasm, with nucleus deformation. In children with chronic gastritis and duodenitis disorders in the gingival cellular composition with a predominance of dystrophic components were found, that was manifested by a decrease in the proportion of epithelial cells at terminal stages of differentiation, an increase in the proportion of cells with cytopathological phenomena, polymorphonuclear leukocytes and lymphocytes. Changes in the cytogram were especially expressed in the phase of disease exacerbation. Knowing the phases of the wound process, based on the timing and sequence of the cellular ensembles seen in the cytogram, it is possible to control the disease periods, and timely apply measures to prevent exacerbations. This diag­nostic method is especially indicated for children who have relative and absolute contraindications for fibroesogastroduodenoscopy.

Key Clinical Message: This case highlights the importance of a definite diagnosis of an IgG4‐related chronic sclerosing duodenitis based on histological and radiological findings to rule out any malignancy in the mass. While dealing with patients having concentric duodenal thickening resulting in stricture formation, one should think of inflammatory etiology as well. IgG4‐related disease is one of these inflammatory disorders where we see soft tissue thickening without a large mass or any associated lymphadenopathy as in our case. Immunoglobulin G4‐related disease (IgG4‐RD) is distinguished as an infiltration of IgG‐4‐positive plasmacytes involving inflammatory lesions across multiple organs which is accompanied by raised IgG4 levels in the serum. Several inflammatory disorders are recognized as part of the IgG4‐RD family based on shared histopathological features, which include Mikulicz's disease, chronic sclerosing sialadenitis, or Riedel's thyroiditis. Our case highlights a distinctive presentation of IgG4‐related diseases; a 58‐year‐old man presenting with duodenal stricture highly suspicious of a duodenal mass/ampullary mass later found to be due to IgG4‐related sclerosing duodenitis with negative malignancy on biopsy. We present the diagnostic challenges faced and relevant findings noted. [ABSTRACT FROM AUTHOR]

In recent years, there has been an increase in the incidence of morbidity associated with digestive organ pathology in the pediatric population. The oral cavity is the digestive tract opening, sharing a common ectodermal origin with it. The changes in the cytogram of the oral mucous membranes can signal about exacerbation of pathological processes in the gastrointestinal tract. The aim of this work: to identify the features of gingival cellular composition in school-age patients with chronic gastritis and duodenitis in order to improve diagnostic methods at the disease stages. Examinations of the gingival cytogram in children aged 12-17 years with chronic gastritis and duodenitis (27 individuals with the disease in acute stage, 30 – in remission) were carried out. The control group included 28 children who did not have any somatic pathology by the results of the examination. For cytological examination, imprint smears from the gingival vestibular surface of the upper and lower jaws were made. The smears were fixed and stained by the May-Grunwald Pappenheim method, and then examined using a microscope with an immersion system. The percentage of epithelial cells and connective tissue cells was calculated per 100 cells. The number of pathologically altered epithelial cells was determined: with vacuolated cytoplasm, with nucleus deformation. In children with chronic gastritis and duodenitis disorders in the gingival cellular composition with a predominance of dystrophic components were found, that was manifested by a decrease in the proportion of epithelial cells at terminal stages of differentiation, an increase in the proportion of cells with cytopathological phenomena, polymorphonuclear leukocytes and lymphocytes. Changes in the cytogram were especially expressed in the phase of disease exacerbation. Knowing the phases of the wound process, based on the timing and sequence of the cellular ensembles seen in the cytogram, it is possible to control the disease periods, and timely apply measures to prevent exacerbations. This diagnostic method is especially indicated for children who have relative and absolute contraindications for fibroesogastroduodenoscopy. [ABSTRACT FROM AUTHOR]

Background: Non‐Helicobacter pylori Helicobacter (NHPH) is rarely detected in duodenal mucosa due to its preference for slightly acidic environments. Here, we report four cases of NHPH‐infected gastritis with duodenal spiral bacilli, potentially NHPH, indicating the possibility of duodenal mucosal infection. Case Presentation: In every case, gastric mucosa showed endoscopic findings characteristic of NHPH‐infected gastritis, and a mucosal biopsy was taken from the duodenal bulb; spiral bacilli were identified under microscopy using Giemsa staining. Case 1, a 46‐year‐old man, had diffuse spotty redness, mucosal edema, and multiple tiny erosions in the duodenal bulb, along with larger erosions in the second portion of the duodenum upon endoscopic examination. Histopathologically, moderate infiltration of mononuclear cells and neutrophils in the lamina propria and gastric epithelial metaplasia were observed. Case 2, a 54‐year‐old man, showed an elevated lesion, 1 cm in diameter, with multiple red spots and a few tiny erosions in the duodenal bulb. Histopathologically, mild inflammatory cell infiltration and gastric epithelial metaplasia were observed. In Case 3, a 52‐year‐old man, endoscopy revealed a flat elevated lesion, 7 mm in diameter, with multiple red spots and a few tiny erosions in the anterior wall of the duodenal bulb. Histopathologically, we observed moderate inflammatory cell infiltration in the gastric antrum and gastric epithelial metaplasia in the duodenal bulb. Case 4, a 40‐year‐old man, showed mild spotty redness in the duodenal bulb. Histopathologically, mild mononucleocyte infiltration and gastric epithelial metaplasia were observed. A single spiral bacillus was observed in Case 4 by microscopy. In all but Case 2, Helicobacter suis was identified in the gastric juice by polymerase chain reaction analysis. Conclusions: Spiral bacilli resembling NHPH may infect the duodenal mucosa, particularly the bulb, causing inflammation. Gastric contents entering the duodenum may reduce the intraduodenal pH, promoting NHPH survival and proliferation. [ABSTRACT FROM AUTHOR]

Introduction. Recently, an increased risk of celiac disease or eosinophilic esophagitis has been postulated among patients with either of these disorders, prompting some to suggest a common underlying mechanism, whereas others maintain that their co-existence is coincidental. Methods. We compared clinical and pathological features of 29 patients meeting criteria for both celiac disease and eosinophilic esophagitis to 26 celiac disease and 26 eosinophilic esophagitis controls to determine whether any distinguished study patients from controls. Results. Eight (28%) study patients presented with symptoms of both celiac disease and eosinophilic esophagitis, whereas 14 (48%) had celiac disease symptoms only and 5 had (17%) esophageal symptoms only. Study patients had similar autoimmune and atopic conditions seen in both control groups. Histological severity of disease, including Marsh II-III duodenal histology (study specimens: 87%; controls: 89%), mean peak esophageal eosinophil counts (study specimens: 55/400x field; controls: 80/400X field, P =.1), and presence of eosinophil microabscesses, scale crust, and subepithelial fibrosis were also similar to controls. Gluten-free diet resolved celiac disease-related symptoms (19 of 20, 95%) and histology (10 of 12, 83%), but not esophageal symptoms or eosinophilia in most study patients. Conclusion. Patients with concomitant celiac disease and eosinophilic esophagitis lack distinguishing features compared to controls with celiac disease or eosinophilic esophagitis alone. The occurrence of both disorders is likely coincidental in most cases. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors (ICI) improve the prognosis of many cancers but cause immune‐related adverse events (IrAEs). Limited data are available on upper gastrointestinal (UGI) IrAEs. We describe the clinical characteristics, prognosis, and efficacy of medical therapy in patients with UGI IrAEs. Methods: This is a retrospective, multicenter cohort study of patients with UGI symptoms and moderate to severe endoscopic UGI lesions, occurring after ICI. Efficacy of induction medical therapy and at the most recent follow‐up was assessed. Results: Forty patients were included; of these, 34 (85%) received anti‐PD(L)1, either alone (n = 24) or combined with anti CTLA‐4 (n = 10). Eighteen patients (45%) had concomitant enterocolitis. All patients had severe endoscopic lesions (erosions, ulcerations, hemorrhage, or necrotic lesions). Three patients who received an inefficient initial medical treatment had a complicated course: One patient died of enterocolitis, one had a pneumomediastinum, and one developed an ulcerated stricture of the pylorus. Thirty‐five patients (88%) were treated with corticosteroids; 28 patients (80%) responded, and 20 (57%) reached clinical remission. Eight patients were treated with infliximab, and six responded (75%). After a median follow‐up of 11 months, 36 patients (90%) were in corticosteroid‐free clinical remission for their UGI symptoms. Endoscopic lesions persisted in 68% of patients. Conclusions: ICI cause severe UGI IrAEs, which are associated with enterocolitis in approximately half of the patients. Most patients with UGI IrAEs respond to corticosteroids or infliximab. These data support the recommendation to treat these patients without delay and in the same way as those with enterocolitis. [ABSTRACT FROM AUTHOR]

Resumen: Introducción y objetivo: La mucosa gástrica ha sido estudiada desde la época anterior al Helicobacter pylori, pero son anecdóticas las descripciones completas del estómago y duodeno, y excepcionales las del duodeno distal. El objetivo fue evaluar diversas características epidemiológicas y el estado inflamatorio gastroduodenal en pacientes con síntomas gastrointestinales altos. Material y métodos: Estudiamos a 138 pacientes divididos en: grupo no ulceroso (dispepsia funcional, n = 77 y ERGE, n = 27) y grupo ulceroso (úlcera gástrica, n = 13 y úlcera duodenal, n = 21). En cada paciente se tomaron 10 biopsias (2 en el cuerpo; 3 en el antro, 3 en el duodeno proximal y 2 en el duodeno distal) para estudio histológico o microbiológico. Resultados: La prevalencia de dispepsia, dispepsia funcional y H. pylori fue del 80.4%, 69.4% y 82.6%, respectivamente. En el cuerpo se apreció una significativa mayor frecuencia de gastritis crónica superficial en el grupo ulceroso que en el no ulceroso; sin embargo, en el antro, el grupo ulceroso mostró más gastritis crónica atrófica (p

Introduction and aim: The gastric mucosa has been studied since the pre-Helicobacter pylori (H. pylori) era, but the complete descriptions of the stomach and duodenum have been anecdotal, and those of the distal duodenum, exceptional. Our aim was to evaluate the different epidemiologic characteristics and the gastroduodenal inflammatory status in patients with upper gastrointestinal symptoms. Materials and methods: We studied 138 patients divided into: the non-ulcer group (functional dyspepsia [n = 77] and GERD [n = 27]) and the ulcer group (peptic ulcer [n = 13] and duodenal ulcer [n = 21]). Ten biopsy samples (2 from the corpus, 3 from the antrum, 3 from the proximal duodenum, and 2 from the distal duodenum) were taken in each patient for histologic and/or microbiologic study. Results: The prevalence of dyspepsia, functional dyspepsia, and H. pylori was 80.4%, 69.4%, and 82.6%, respectively. The frequency of superficial chronic gastritis in the corpus was significantly higher in the ulcer group vs. the non-ulcer group, whereas there was more chronic atrophic gastritis in the antrum in the ulcer group (P < 0.05). Duodenitis was significantly more frequent in the ulcer group vs. the non-ulcer group, in both the proximal and distal duodenum. Pangastroduodenitis was a significant finding in the ulcer group. In both groups, chronic gastritis (corpus and antrum) and duodenitis (proximal and distal) were significantly related to the presence of H. pylori. Proximal duodenitis is not an uncommon finding in functional dyspepsia (37.7%) and is twice as frequent as distal duodenitis (16.9%). Conclusions: The ulcer group presented with a gastroduodenal inflammatory map different from that of the non-ulcer group and was characterized by a higher frequency of superficial chronic gastritis in the corpus, chronic atrophic gastritis in the antrum, and a very high frequency of proximal duodenitis. Resumen: Introducción y objetivo: La mucosa gástrica ha sido estudiada desde la época anterior al Helicobacter pylori, pero son anecdóticas las descripciones completas del estómago y duodeno, y excepcionales las del duodeno distal. El objetivo fue evaluar diversas características epidemiológicas y el estado inflamatorio gastroduodenal en pacientes con síntomas gastrointestinales altos. Material y métodos: Estudiamos a 138 pacientes divididos en: grupo no ulceroso (dispepsia funcional, n = 77 y ERGE, n = 27) y grupo ulceroso (úlcera gástrica, n = 13 y úlcera duodenal, n = 21). En cada paciente se tomaron 10 biopsias (2 en el cuerpo; 3 en el antro, 3 en el duodeno proximal y 2 en el duodeno distal) para estudio histológico o microbiológico. Resultados: La prevalencia de dispepsia, dispepsia funcional y H. pylori fue del 80.4%, 69.4% y 82.6%, respectivamente. En el cuerpo se apreció una significativa mayor frecuencia de gastritis crónica superficial en el grupo ulceroso que en el no ulceroso; sin embargo, en el antro, el grupo ulceroso mostró más gastritis crónica atrófica (p < 0.05). La duodenitis fue significativamente más frecuente en el grupo ulceroso, tanto en el duodeno proximal como en el distal. La pangastroduodenitis fue un hallazgo significativo en el grupo ulceroso. Todos los grupos mostraron gastritis crónica (cuerpo y antro) y duodenitis (proximal y distal) relacionadas significativamente con la presencia de H. pylori. La duodenitis proximal no es un fenómeno extraño en la dispepsia funcional (37.7%), con una frecuencia que duplica a la de duodenitis distal (16.9%). Conclusiones: El grupo ulceroso presentó un mapa inflamatorio gastroduodenal diferente al del grupo no ulceroso, caracterizado por una mayor frecuencia de gastritis crónica superficial en cuerpo, atrófica en antro y muy frecuente duodenitis proximal.

Abstract Background The coinfection between cytomegalovirus (CMV) and either human herpesvirus‐6 (HHV‐6) or HHV-7 in renal transplant recipients is well known; however, there have been few reports of coinfection of CMV associated with HHV-8. This paper presents a first case of acute gastric ulcer and duodenitis associated with CMV and HHV‐8 coinfection after renal transplantation. Case presentation A 33-year-old male with a history of kidney transplantation was admitted to hospital because of postural epigastric pain. The recipient was CMV seropositive prior to transplantation and received trimethoprim-sulfamethoxazole without universal prophylaxis. Approximately 5 months after renal transplant, the recipient complained postural epigastric pain. An endoscopy revealed diffuse ulcerative lesions in the lower body and in the antrum of the stomach, as well as several erythematous mucosal lesions in the duodenum. Histopathologic examination identified CMV inclusions consistent with invasive CMV disease and immunohistochemical staining showed positive results for HHV-8 and CMV. No tumorous diseases such as Kaposi’s sarcoma were detected. After 3 weeks of intravenous ganciclovir treatment, we observed that serum CMV PCR remained within the normal range and clinical symptoms improved. A follow-up endoscopy performed 3 weeks later showed that the severity of the above mentioned lesions had improved. Conclusions We report the first case of a renal transplant recipient diagnosed with acute gastric ulcer and duodenitis associated with coinfection of CMV and HHV-8. Ganciclovir appears to be effective in diseases associated with coinfection of CMV and HHV-8.

Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms. Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS. 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms. Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low. [ABSTRACT FROM AUTHOR]

Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention. [ABSTRACT FROM AUTHOR]

Background: Diseases of gastrointestinal (GI) tract present wit myriad signs and symptoms. Appropriate management of these diseases involves proper evaluation. Upper GI endoscopies are becoming increasingly popular because it helps in first localizing the lesion and then biopsy specimens can be obtained from affected area. Duodenal biopsy followed by histopathological examination may clinch the diagnosis in majority of the cases. Aims and Objectives: The aim of the study was to find out diagnostic utility of endoscopic duodenal biopsies and histopathological finding in the upper GI diseases. (1) To analyze duodenal endoscopic biopsy samples obtained from patients presenting with the upper GI symptoms. (2) To correlate endoscopic and histopathological findings in studied cases. Materials and Methods: A retrospective and prospective observational study was carried out at the private histopathology center over a period of 2 years. All the patients underwent upper GI endoscopy with duodenal biopsies using flexible endoscope. Histopathology of the samples obtained from endoscopic duodenal biopsies in patients presenting with the upper GI symptoms were analyzed. The endoscopic findings such as mass lesion or ulcerative lesion were correlated with histopathological findings. Results: Out of these 704 biopsies, 303 (43.04%) were esophageal biopsies, 220 [31.25%] were gastric, and 181 [25.71%] were duodenal biopsies. There were 129 (71.27%) males and 52 (28.73%) females with a M: F ratio of 2.5: 1. The mean age of the cases was found to be 54.7±12.32 years. Out of 181 biopsies which were performed in this study, 100 (55.25%) lesions were found to be having neoplastic etiology whereas 81 (44.75%) lesions were found to have non-neoplastic etiology. Among patients who were found to have duodenal growth on endoscopy well differentiated adenocarcinoma (15.47%) followed by moderately differentiated adenocarcinoma (6.63%) were the common pathologies. In cases of non-neoplastic etiology, non-specific duodenitis was most common pathology (17.13%). Conclusion: Endoscopic biopsy followed by histopathological examination is cornerstone of the management of patients presenting with intractable upper GI symptomatology.

Eosinophilic duodenitis (EoD), characterized by nonspecific gastrointestinal symptoms and increased numbers of duodenal eosinophils, may be in the eosinophilic gastrointestinal disease spectrum. However, diagnostic thresholds and pathogenic processes of duodenal tissue eosinophilia are inadequately characterized. We aimed to define an EoD transcriptome and pathologic pathways. RNA sequencing and histologic features of human duodenal biopsy samples were analyzed as a function of duodenal eosinophils levels. For analyses, we defined EoD as more than 52 peak eosinophils/hpf (n = 8), duodenal eosinophilia as 30 to 52 eosinophils/hpf (n = 11), and normal controls as fewer than 30 eosinophils/hpf (n = 8). Associations between gene expression and histologic features were analyzed with Spearman correlation. We identified 382 differentially expressed genes (EoD transcriptome) between EoD and normal controls (>2-fold change [adjusted P <.05]). The EoD transcriptome distinguished EoD from controls (duodenal eosinophilia and normal controls). The duodenal eosinophil count was correlated with a distinct EoD transcriptome when 50 to 60 peak eosinophils/hpf were present. The EoD transcriptome was enriched in genes involved in IL-4/IL-13 signaling, mast cells, and myeloid progenitor cells. Among duodenal histologic features, lamina propria eosinophil sheets was the most associated with transcriptomic changes (r = 0.66; P <.01). EoD gene signatures were shared with eosinophilic esophagitis and eosinophilic gastritis but not with eosinophilic colitis or celiac disease. We have identified an EoD transcriptomic signature that emerges at 50 to 60 peak eosinophils/hpf and established EoD as part of a spectrum of upper eosinophilic gastrointestinal disorder associated with type 2 immunity and distinct from eosinophilic colitis and celiac disease. These findings provide a basis for improving diagnosis and treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The coinfection between cytomegalovirus (CMV) and either human herpesvirus‐6 (HHV‐6) or HHV-7 in renal transplant recipients is well known; however, there have been few reports of coinfection of CMV associated with HHV-8. This paper presents a first case of acute gastric ulcer and duodenitis associated with CMV and HHV‐8 coinfection after renal transplantation. Case presentation: A 33-year-old male with a history of kidney transplantation was admitted to hospital because of postural epigastric pain. The recipient was CMV seropositive prior to transplantation and received trimethoprim-sulfamethoxazole without universal prophylaxis. Approximately 5 months after renal transplant, the recipient complained postural epigastric pain. An endoscopy revealed diffuse ulcerative lesions in the lower body and in the antrum of the stomach, as well as several erythematous mucosal lesions in the duodenum. Histopathologic examination identified CMV inclusions consistent with invasive CMV disease and immunohistochemical staining showed positive results for HHV-8 and CMV. No tumorous diseases such as Kaposi's sarcoma were detected. After 3 weeks of intravenous ganciclovir treatment, we observed that serum CMV PCR remained within the normal range and clinical symptoms improved. A follow-up endoscopy performed 3 weeks later showed that the severity of the above mentioned lesions had improved. Conclusions: We report the first case of a renal transplant recipient diagnosed with acute gastric ulcer and duodenitis associated with coinfection of CMV and HHV-8. Ganciclovir appears to be effective in diseases associated with coinfection of CMV and HHV-8. [ABSTRACT FROM AUTHOR]

Abstract Phlegmonous duodenitis is an extremely rare condition, and only a few cases have been previously reported. Here, we report a case of phlegmonous duodenitis caused by Streptococcus parasanguinis and Escherichia coli in a 78‐year‐old immunocompromised patient with diabetes mellitus and immunosuppressive drugs. Abdominal computed tomography showed diffuse thickening of the duodenum and gastric antrum, and esophagogastroduodenoscopy revealed some erosions with purulent discharge and reddish and edematous mucosa in the duodenal bulb. A bacteriological culture test detected the two abovementioned bacteria and established the diagnosis of phlegmonous duodenitis. Following the initiation of antibiotic treatment, his condition rapidly improved. Endoscopists should be aware of this rare entity and pay attention to the endoscopic duodenal findings similar to those of phlegmonous gastritis, particularly in immunocompromised patients who develop abdominal symptoms with severe inflammation.

Common variable immunodeficiency (CVID), the most common symptomatic primary antibody deficiency, is accompanied in some patients by a duodenal inflammation and malabsorption syndrome known as CVID enteropathy (E-CVID).The goal of this study was to investigate the immunological abnormalities in CVID patients that lead to enteropathy as well as the contribution of intestinal microbiota to this process.We found that, in contrast to noE-CVID patients (without enteropathy), E-CVID patients have exceedingly low levels of IgA in duodenal tissues. In addition, using transkingdom network analysis of the duodenal microbiome, we identified Acinetobacter baumannii as a candidate pathobiont in E-CVID. Finally, we found that E-CVID patients exhibit a pronounced activation of immune genes and down-regulation of epithelial lipid metabolism genes. We conclude that in the virtual absence of mucosal IgA, pathobionts such as A. baumannii, may induce inflammation that re-directs intestinal molecular pathways from lipid metabolism to immune processes responsible for enteropathy.

Isolation of Cokeromyces recurvatus, a dimorphic mucormycete fungus, from clinical specimens poses a diagnostic challenge to physicians and laboratorians as this organism may represent a rare colonizer or true pathogen. Here, we report a case of Cokeromyces recurvatus present in a circumferential duodenal lesion. The patient is a 64-year-old with no past medical history, admitted with a three-week history of left upper quadrant abdominal pain. Computerized tomography scan identified duodenitis with significant gastric outlet obstruction, confirmed by the presence of a partially obstructing non-bleeding duodenal ulcer on upper endoscopy. Histology showed variably sized spherical structures without nuclei, reproductive tracts, or alimentary tracts. Small, clustered spherules representing putative endospores were observed within the larger structures and in the exudate. Based on the histology, the differential included Coccidioides spp, Emmonsia spp, or Chrysosporium spp. Additionally, gastric biopsies revealed concurrent Helicobacter pylori gastritis. The fungus was identified as C. recurvatus by broad-range fungal polymerase chain reaction performed on formalin-fixed paraffin-embedded biopsy tissue, as well as morphology and DNA sequencing of the cultured isolate. The fungus had low MICs to all major antifungal classes; however, in the context of the Helicobacter pylori infection, the patient was only treated with amoxicillin and clarithromycin with improvement in his symptoms before hospital discharge. Only three cases of Cokeromyces recurvatus isolated from the GI tract have been reported; this case highlights a unique clinical presentation in the small bowel in a patient without underlying medical conditions. [ABSTRACT FROM AUTHOR]

Aim. The clinical guidelines are intended to supplement specialty decision-making for improved aid quality in patients with gastritis and duodenitis though acknowledging the latest clinical evidence and principles of evidencebased medicine.Key points. Gastritis is an inflammatory disease of stomach mucosa, with a separate definition of acute and chronic gastritis. Chronic gastritis is a cohort of chronic diseases uniting a typical morphology of persistent inflammatory infiltration, impaired cellular renewal with emergent intestinal metaplasia, atrophy and epithelial dysplasia of gastric mucosa. Oesophagogastroduodenoscopy (OGDS) or high-resolution OGDS with magnified or non-magnified virtual chromoendoscopy, including targeted biopsy for atrophy and intestinal metaplasia grading and neoplasia detection, are recommended to verify gastritis and duodenitis, precancer states and/or gastric mucosal changes. All chronic gastritis patients positive for H. рylori should undergo eradication therapy as aetiological and subsidiary for gastric cancer prevention. Chronic gastritis patients with symptoms of dyspepsia (epigastric pain, burning and congestion, early satiety), also combined with functional dyspepsia, are recommended proton pump inhibitors, prokinetics, rebamipide and bismuth tripotassium dicitrate in symptomatic treatment. With focal restricted intestinal metaplasia, follow-up is not required in most cases, mainly when advanced atrophic gastritis is ruled out in high-quality endoscopy with biopsy. However, a familial history of gastric cancer, incomplete intestinal metaplasia and persistent H. pylori infection render endoscopy monitoring with chromoendoscopy and targeted biopsy desirable once in three years. Patients with advanced atrophic gastritis should have high-quality endoscopy every 3 years, and once in 1–2 years if complicated with a familial history of gastric cancer.Conclusion. The recommendations condense current knowledge on the aetiology and pathogenesis of gastritis and duodenitis, as well as laboratory and instrumental diagnostic techniques, main approaches to aetiological H. pylori eradication and treatment of dyspeptic states.

Background: Diseases of gastrointestinal (GI) tract present wit myriad signs and symptoms. Appropriate management of these diseases involves proper evaluation. Upper GI endoscopies are becoming increasingly popular because it helps in first localizing the lesion and then biopsy specimens can be obtained from affected area. Duodenal biopsy followed by histopathological examination may clinch the diagnosis in majority of the cases. Aims and Objectives: The aim of the study was to find out diagnostic utility of endoscopic duodenal biopsies and histopathological finding in the upper GI diseases. (1) To analyze duodenal endoscopic biopsy samples obtained from patients presenting with the upper GI symptoms. (2) To correlate endoscopic and histopathological findings in studied cases. Materials and Methods: A retrospective and prospective observational study was carried out at the private histopathology center over a period of 2 years. All the patients underwent upper GI endoscopy with duodenal biopsies using flexible endoscope. Histopathology of the samples obtained from endoscopic duodenal biopsies in patients presenting with the upper GI symptoms were analyzed. The endoscopic findings such as mass lesion or ulcerative lesion were correlated with histopathological findings. Results: Out of these 704 biopsies, 303 (43.04%) were esophageal biopsies, 220 [31.25%] were gastric, and 181 [25.71%] were duodenal biopsies. There were 129 (71.27%) males and 52 (28.73%) females with a M: F ratio of 2.5: 1. The mean age of the cases was found to be 54.7±12.32 years. Out of 181 biopsies which were performed in this study, 100 (55.25%) lesions were found to be having neoplastic etiology whereas 81 (44.75%) lesions were found to have non-neoplastic etiology. Among patients who were found to have duodenal growth on endoscopy well differentiated adenocarcinoma (15.47%) followed by moderately differentiated adenocarcinoma (6.63%) were the common pathologies. In cases of non-neoplastic etiology, non-specific duodenitis was most common pathology (17.13%). Conclusion: Endoscopic biopsy followed by histopathological examination is cornerstone of the management of patients presenting with intractable upper GI symptomatology. [ABSTRACT FROM AUTHOR]

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Purpose: Duodenal involvement in COVID-19 is poorly studied. Aim was to describe clinical and histopathological characteristics of critically ill COVID-19 patients suffering from severe duodenitis that causes a significant bleeding and/or gastrointestinal dysmotility. Methods: In 51 critically ill patients suffering from SARS-CoV-2 pneumonia, severe upper intestinal bleeding and/or gastric feeding intolerance were indications for upper gastrointestinal endoscopy. Duodenitis was diagnosed according to macroscopic signs and mucosal biopsies. Immunohistochemistry was performed to detect viral specific protein and ACE2. In situ hybridization was applied to confirm viral replication. Results: Nine of 51 critically ill patients (18%) suffering from SARS-CoV-2 pneumonia had developed upper GI bleeding complications and/or high gastric reflux. Five of them presented with minor and four (44%) with severe duodenitis. In two patients, erosions had caused severe gastrointestinal bleeding requiring PRBC transfusions. Immunohistochemical staining for SARS-CoV-2 spike protein was positive inside duodenal enterocytes in three of four patients suffering from severe duodenitis. Viral replication could be confirmed by in situ hybridization. Conclusion: Our data suggest that about 8% of critically ill COVID-19 patients may develop a severe duodenitis presumably associated with a direct infection of the duodenal enterocytes by SARS-CoV-2. Clinical consequences from severe bleeding and/or upper gastrointestinal dysmotility seem to be underestimated. [ABSTRACT FROM AUTHOR]

Assessment of the upper gastrointestinal tract (UGI) may enable more personalized treatment strategies in pediatric inflammatory bowel disease (IBD). However, data on the frequency and significance of these findings remain limited. Data on 132 pediatric IBD patients with systematic UGI sampling were collected and the baseline characteristics and presence of complications compared between those with and without histological UGI findings. The control group comprised 162 children who received no diagnoses. Seventy-six children had ulcerative colitis (UC), 47 Crohn's disease (CD) and nine IBD unclassified. UGI findings were more common in IBD patients than controls (69.7% vs. 30.9%, respectively, p <.001), particularly in the stomach (62.1% vs. 16.8%; p <.001). Among IBD patients, findings were more common in CD than in UC (80.9% vs. 63.2%; p =.038), particularly in the duodenum (21.3% vs. 2.6%, p =.001). Four patients had UGI granulomas consistent with CD. Hypoalbuminemia (OR 3.22; 95% CI 1.18–8.79) and failure to thrive (2.82; 1.17–6.78) increased the likelihood of UGI findings in IBD. In CD, perianal morbidity was less common in those with than in those without UGI findings (13.2% vs. 44.4%; p =.032) whereas in UC, UGI findings increased the risk for co-morbidities (18.8% vs. 3.6%; p =.059). The long-term outcomes did not differ between patients with or without UGI findings. Histologic UGI findings were more common in children with IBD than in children with no gastrointestinal diagnoses. In CD, UGI findings were more frequent than in UC, especially in the duodenum. In UC, UGI findings were associated with more complex disease. [ABSTRACT FROM AUTHOR]

Aim:Findings compatible with duodenitis are not rare in patients who have undergone endoscopy. Although the final histopathological diagnoses in most of these cases are chronic primary non-specific duodenitis, less commonly, there are also diseases that cause secondary duodenitis, too. We aimed to examine the causes of secondary duodenitis in our patients in detail.Methods:Upper gastrointestinal endoscopic procedures of 3.776 adult patients performed for various reasons in our endoscopy unit (Istanbul Yeni Yuzyıl University, Medical Faculty, Gaziosmanpasa Hospital, Department of Gastroenterology) between 2017 and 2021 were reviewed retrospectively by scanning the hospital automation system. The demographic, clinical, endoscopic, and histopathological features of the patients who underwent endoscopic biopsies with a prediagnosis of duodenitis were examined.Results:Biopsies with a pre-diagnosis of duodenitis were performed on 231 (6.12%) of 3776 adult patients during the endoscopic procedures. The mean age of the patients was 42.03 years (18-89 years); 42.4% were males and 57.6% were female. The most common symptoms/signs of the patients were dyspepsia (45%), chronic diarrhea (38%), and iron deficiency anemia (34%), respectively. The two main histological diagnoses were primary non-specific duodenitis (58.44%) and celiac disease (29.87%). In the remaining cases, various causes of secondary duodenitis such as graft versus host disease, eosinophilic duodenitis, Brunner’s gland adenoma, polyps, giardiasis, Crohn’s disease, cytomegalovirus duodenitis, and amyloidosis were detected.Conclusion:Although the most common etiology of duodenitis we encountered in our study was primary non-specific duodenitis, a considerable number, and variety of other etiologies of secondary duodenitis were also detected. Among many causes of secondary duodenitis, celiac disease should be kept in mind especially in female patients with younger age, presenting with dyspepsia.

Objective To compare and analyze the disease burden of gastro-intestinal diseases in China between 1990 and 2017. Methods The Global Burden of Disease Study 2017 was searched for the following indicators: morbidity, mortality, disability adjusted life years (DALY), year of life lost (YLL), and years lived with disability (YLD) which were then analyzed. The gastrointestinal disease burden characteristics of people of different genders and ages were explored. Results Between 1990 and 2017, the incidence of 8 gastrointestinal diseases increased. The top three standardized DALY were malignant gastrointestinal tumors: comprising gastric cancer (391.66 per 100,000), esophageal cancer (222.58 per 100,000) and colorectal cancer (216.19 per 100,000). The only increase in standardized mortality was for colorectal cancer which increased by 8.20%, from 9.33 per 100,000 to 10.10 per 100,000. The burden of disease increases with age. Compared with females, males have lower incidence of gastrointestinal diseases, but mortality and DALY rates are higher. Conclusion The burden of disease caused by malignant gastrointestinal tumors accounts for the main burden of gastrointestinal diseases in China, and men are higher than women. Malignant tumors such as colorectal cancer are the focus of prevention and control measures for gastrointestinal diseases.

Background: Fecal calprotectin (FC) is suggested as a novel biomarker for the diagnosis of gastrointestinal (GI) diseases; however, few studies have investigated its diagnostic value for Helicobacter pylori (H. pylori). Therefore, the current study evaluated the level of FC and its diagnostic value in patients with H. Pylori and its related conditions including gastritis and duodenitis. Methods: In this case-control study, 120 children with upper GI symptoms, who were indicated to undergo upper GI endoscopic examination, were consecutively included. Patients were categorized into different groups based on their endoscopic findings including H. pylori, gastritis, duodenitis or normal. Results: Patients with gastritis (P = 0.014) and those with duodenitis (P < 001) had significantly higher FC. The level of FC was higher in patients with H. pylori but this difference was marginally significant (P = 0.054). The level of FC had poor ability to diagnose the presence of H. pylori (P = 0.054) and gastritis (area under the curve, AUC = 0.639, P = 0.014). However, it had acceptable power to diagnose patients with or duodenitis (AUC = 0.718, P < 0.001). The sensitivity and specificity of FC for diagnosis of gastritis were 64 and 65 percent (cut-off = 45.2 µg/g), and for duodenitis were 77 and 61 percent (cut-off = 46.2 µg/g), respectively. Conclusions: FC can be considered as an objective and diagnostic tool for duodenitis. However, due to the low sensitivity and specificity, it is suggested to consider it as an objective supplementary test beside other established diagnostic modalities. [ABSTRACT FROM AUTHOR]

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.

Cutaneous T-cell lymphomas (CTCL) are the most frequently encountered form of primary cutaneous lymphoma (PCL). Although this group of diseases primarily affects the skin, extracutaneous manifestations are reported. Primary cutaneous aggressive epidermotropic cytotoxic T-cell lymphoma (pcAECTCL) is a rare form of CTCL that usually presents with an aggressive course and poor prognosis. Given the scarcity of cases, the disease is poorly understood. There have been reports of cases of extracutaneous manifestations of the disease, with more aggressive courses associated with an increased propensity for systemic spread. The most common extracutaneous manifestations of pcAECTCL include those affecting the lungs, central nervous system, testis, and oral mucosa, which can cause progressive dysphagia. We describe a patient with a chronic relapsing/remitting rash diagnosed as pcAECTCL. A positron emission tomography (PET) scan revealed diffuse uptake within the gastric region. Initial esophagogastroduodenoscopy (EGD) showed multiple ulcerations and erosions in the stomach with concern for extracutaneous spread of the patient's pcAECTCL. However, no definitive histopathological or flow immunophenotypic evidence of metastasis was found on the initial or subsequent repeat EGD., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Edeson et al.)

Eosinophilic gastrointestinal disorders (EGIDs) are representative of eosinophilic invasion of various sections of the gastrointestinal tract and do not pertain to any secondary causes. To affirm the diagnosis of eosinophilic infiltration of the gastrointestinal tract, tissue biopsy evidence must be demonstrated. Both iron deficiency anemia and gastritis symptoms may be brought on by mucosal eosinophilic infiltration. One of the most common dietary deficiencies globally is iron deficiency anemia which affects most developing populations. Reduced dietary iron and poor iron absorption are significant reasons for iron deficiency anemia (IDA), although the most common causes are menstruation and GI bleeding in women. Here, we describe a case of an 18-year-old female, with iron deficiency anemia, who was diagnosed with eosinophilic duodenitis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bal et al.)

Immune checkpoint inhibitors improve patient survival in multiple cancers, but immune-related adverse events, including new immunologic conditions arising during therapy, pose a significant challenge. Gastrointestinal immune-related adverse events, although common, exhibit diverse presentations. We present a case of duodenitis resembling celiac disease because of the anti-programmed cell death protein-1 antibody, pembrolizumab. Despite diagnostic uncertainty and therapeutic interventions, including gluten-free diet, symptoms stabilized even with resuming gluten. In addition, endoscopic abnormalities after pembrolizumab therapy have neither progressed nor completely resolved. This case underscores the need for investigation into the pathogenesis of immune checkpoint inhibitor-induced duodenitis, with implications for care of patients on immunotherapies., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Introduction Gastrointestinal tract (GIT) endoscopy with biopsy is essential for diagnosing and managing various GIT diseases, including malignancies and inflammatory conditions. This study aimed to analyze the spectrum of histopathological lesions in the GIT and their correlation with the endoscopic findings. Methodology This retrospective observational study was conducted at a tertiary medical college involving 114 patients who underwent GIT endoscopy between June 2023 and June 2024. This study focused on lesion types across different GIT sites (esophagus, stomach, and duodenum) and the agreement between endoscopic and histological diagnoses. Results Lesions were most prevalent in the stomach (52.6% of cases, n=60), followed by the duodenum (35.1%, n=40) and esophagus (12.3%, n=14). Significant correlations were found between endoscopic and histological diagnoses in the esophagus (concordance for esophagitis was 100%) and stomach (concordance for gastritis was 95%). In the duodenum, the concordance was high for duodenitis (100%) but lower for other lesions such as neuroendocrine tumors (71.43%). However, Cohen's kappa values indicated poor overall agreement across all sites (κ=0.49), reflecting variability in diagnostic accuracy. Conclusion This study highlights the reliability of endoscopic procedures for diagnosing upper GIT lesions, particularly in the esophagus and stomach, while emphasizing the challenges in diagnosing duodenal lesions. These findings support the need for targeted screening and further research to enhance diagnostic accuracy and patient outcomes in GIT diseases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee of the Institute of Medical Sciences and SUM Hospital issued approval IMS/IEC/107/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rauta et al.)

Strongyloidiasis is endemic in tropical and sub-tropical regions however cases of strongyloidiasis have been reported in temperate climates. Corticosteroid use, immunosuppression, infection with human T-lymphotropic virus type 1 (HTLV1), and chronic alcohol use are the most common and well-established risk factors for strongyloidiasis. Due to Strongyloides stercoralis characteristic features of hyperinfection and dissemination, it can potentially cause a lethal infection in an immunocompromised individual. Strongyloidiasis is predominantly asymptomatic, however some unusual manifestations of strongyloidiasis include duodenal obstruction, ileus, reactive arthritis, ascites, hepatic lesions, and pancreatitis. Here we present a case of a 47-year-old-St. Lucian female who was found to have duodenitis and pancreatitis secondary to Strongyloides stercoralis in the setting of underlying HTLV-1 infection and chronic alcohol use.

Aim: Findings compatible with duodenitis are not rare in patients who have undergone endoscopy. Although the final histopathological diagnoses in most of these cases are chronic primary non-specific duodenitis, less commonly, there are also diseases that cause secondary duodenitis, too. We aimed to examine the causes of secondary duodenitis in our patients in detail. Methods: Upper gastrointestinal endoscopic procedures of 3.776 adult patients performed for various reasons in our endoscopy unit (Istanbul Yeni Yuzyıl University, Medical Faculty, Gaziosmanpasa Hospital, Department of Gastroenterology) between 2017 and 2021 were reviewed retrospectively by scanning the hospital automation system. The demographic, clinical, endoscopic, and histopathological features of the patients who underwent endoscopic biopsies with a prediagnosis of duodenitis were examined. Results: Biopsies with a pre-diagnosis of duodenitis were performed on 231 (6.12%) of 3776 adult patients during the endoscopic procedures. The mean age of the patients was 42.03 years (18-89 years); 42.4% were males and 57.6% were female. The most common symptoms/signs of the patients were dyspepsia (45%), chronic diarrhea (38%), and iron deficiency anemia (34%), respectively. The two main histological diagnoses were primary non-specific duodenitis (58.44%) and celiac disease (29.87%). In the remaining cases, various causes of secondary duodenitis such as graft versus host disease, eosinophilic duodenitis, Brunner's gland adenoma, polyps, giardiasis, Crohn's disease, cytomegalovirus duodenitis, and amyloidosis were detected. Conclusion: Although the most common etiology of duodenitis we encountered in our study was primary non-specific duodenitis, a considerable number, and variety of other etiologies of secondary duodenitis were also detected. Among many causes of secondary duodenitis, celiac disease should be kept in mind especially in female patients with younger age, presenting with dyspepsia. [ABSTRACT FROM AUTHOR]

Helicobacter pylori represents a pathogen causing chronic infection in around a half of the global human population, which manifestations vary from asymptomatic infection to developing gastritis and peptic ulcer. The data accumulated suggest that overt clinical types of this infection are associated with lost immunoregulation and increased pro-inflammatory cell-mediated immune response triggered by H. pylori-specific T helper cells. Here, we examined the degree of peripheral blood CD4+ T cell maturity and related expression of chemokine receptors involved in migration to gastrointestinal tract (CCR9 and CCR6), as well as Тand B-cell zones of lymphoid organs (CCR7 and CXCR5). It was shown that overt H. pylori-infection was coupled to changes in expression pattern of chemokine receptors on T helper cells. In particular, percentage of mature CD4+CD45RO+ T cells bearing CCR9 and immature CD4+CD45RO– Т cells expressing CXCR5 was increased in peripheral blood of patients with chronic gastroduodenitis. However, increased amount of activated mature CD4+CD45RO+ICOS+ T cells was observed in patients with chronic gastroduodenitis comorbid with peptic ulcer that was also associated with elevated amount of mature CCR6+ T helpers (mainly CD4+CD45RO+CCR7– CCR6+ cells) and follicular T helper cells as well as emerging minor CD4+CD45RO+CXCR5+CCR6+.T cell subset, not affecting CD4+CCR9+ Т cells. Thus, the data obtained evidence that tissue-specific T-helper cell migration is controlled separately in of H. pylori-associated diseases.

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.

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. [ABSTRACT FROM AUTHOR]