scholarly journals Double Pylorus in Upper Gastrointestinal Bleeding

2021 ◽  
pp. 332-337
Author(s):  
Heasty Oktaricha ◽  
Muhammad Miftahussurur
Keyword(s):  
Duodenal Bulb ◽  
Rare Condition ◽  
High Dose ◽  
Protective Agent ◽  
Gastrointestinal Fistula ◽  
Double Pylorus ◽  
History Of ◽  
Inflammatory Drugs ◽  
H Pylori ◽  
Upper Gastrointestinal

Double pylorus, also known as acquired double pylorus, is a rare condition defined as a gastrointestinal fistula connecting stomach antrum and duodenal bulb. The prevalence of double pylorus ranges from 0.001 to 0.4% by esophagogastroduodenoscopy (EGD). Although the etiology is unknown, the formation of double pylorus is related to Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAID). The development of the occurrence of double pylorus is still unknown, but many systemic diseases play a role. We present the case of a 59-year-old man who was admitted to Dr. Soetomo General Hospital with hematemesis and melena. The patient had a history of diabetes mellitus since 3 years and consumption of medicinal herbs for myalgia, which was suspected of NSAIDs for the past 5 months. The patient had anemia with hemoglobin at 8.3 g/dL, enterogenous azotemia with blood urea nitrogen 28 mg/dL and serum creatinine 1.14 mg/dL. At EGD, double pylorus was found and accompanied by gastric ulcer, a giant white base ulcer, part of it covered by clotting without any sign of active bleeding. Biopsy revealed chronic inactive gastritis, and no H. pylori was found. Treatment mainly depends on gastrointestinal acid suppression through a proton pump inhibitor (PPI). The patient was given a high-dose PPI and a mucosal protective agent. He was treated for 1 week and had improved complaints.

scholarly journals What Do We Do aboutHelicobacter pylori?

1999 ◽  
Vol 13 (2) ◽  
pp. 143-145 ◽  
Author(s):  
CJ Hawkey
Keyword(s):  
Past History ◽  
Ulcer Disease ◽  
History Of ◽  
Inflammatory Drugs ◽  
Heliobacter Pylori ◽  
Anti Inflammatory ◽  
H Pylori

Heliobacter pyloriand nonsteroidal anti-inflammatory drugs (NSAIDs) cause ulcers by different mechanisms. Under some circumstances, patients infected withH pylorimay be less prone to NSAID-associated ulcers than those who areH pylori-negative. Eradication trials have yielded differing results. However, those who have studied patients who have a past history of ulcer disease and are already established on NSAIDs have shown no benefit fromH pylorieradication.

scholarly journals Motion-Cyclo-oxygenase-2 Selective Nonsteroidal Anti-Inflammatory Drugs are as Safe as Placebo for the Stomach: Arguments for the Motion

2003 ◽  
Vol 17 (5) ◽  
pp. 339-341 ◽  
Author(s):  
Richard H Hunt
Keyword(s):  
Small Bowel ◽  
Blood Loss ◽  
Previous History ◽  
High Dose ◽  
Duodenal Ulcers ◽  
Low Dose Aspirin ◽  
History Of ◽  
Important Addition ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause gastritis, gastric and duodenal ulcers, and gastrointestinal (GI) blood loss, as well as alterations in small bowel permeability. Patients at a high risk for these complications include those who are older than 60 years of age, those with a previous history of complicated peptic disease and bleeding, and those who take high dose or multiple NSAIDs, including low dose aspirin, corticosteroids or anticoagulants. The introduction of selective inhibitors of cyclo-oxygenase-2 (COX-2) has provided effective treatment of inflammatory arthritis and musculoskeletal pain, with dramatic reductions in the risk of GI adverse events. The two most widely prescribed coxibs are celecoxib and rofecoxib, and others are being developed. Endoscopic studies have revealed that coxibs are only half as likely to induce upper GI ulceration than are traditional NSAIDs, and are as safe as placebo. Furthermore, the newer drugs do not cause excessive blood loss from the GI tract and do not affect small bowel permeability. The Vioxx Gastrointestinal Outcomes Research Study (VIGOR) revealed that the incidence of myocardial infarction was significantly lower with naproxen than rofecoxib, although this study was not designed to look at this endpoint. Coxibs are an important addition to the pharmacotherapy of inflammatory disease.

scholarly journals New Treatment Options for Pituitary Granulomatosis With Polyangiitis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A594-A594
Author(s):  
Hessa Boharoon ◽  
Majid AlAmeri ◽  
Abdulla Mohamed Alnuaimi ◽  
Nigel Mendoza ◽  
Stephen McAdoo ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Treatment Guidelines ◽  
Dynamic Assessment ◽  
Treatment Options ◽  
Case Series ◽  
Rare Condition ◽  
High Dose ◽  
Pituitary Mass ◽  
Remission Maintenance ◽  
History Of

Abstract Background: Granulomatosis with polyangiitis (GPA) rarely involves the pituitary gland and has been reported in 1% of all cases of GPA. Most frequently, it presents with pituitary mass effect and diabetes insipidus (DI). To date, there are no treatment guidelines for this rare condition. Case Presentation: Case 1: A 55 year old female with a history of ANCA-positive pulmonary GPA, previously treated with glucocorticoids and immunosuppressants, presented two years later with cranial DI and bitemporal hemianopia. MRI showed a large sellar mass with suprasellar extension. High dose glucocorticoids resulted in good clinical and radiological response. Further treatment consisted in a combination of Cyclophosphamide and Rituximab (RTX). Further doses of RTX are planned aiming for a period of B-cell depletion. Case 2: A 38 year old female, presented with polyuria, recurrent nosebleeds, headaches and a left visual field defect. Pituitary profile revealed ACTH deficiency and MRI showed a heterogenous cystic lesion with peripheral enhancement and stalk thickening. Steroid replacement led to immediate improvement in her symptoms. Cranial DI was confirmed and raised Proteinase 3 (PR3) antibody suggested GPA. A combination of prednisolone and Methotrexate led to significant improvement of MRI appearances and declining PR3 antibody levels. For remission maintenance, two cycles of RTX were given with further radiological and biochemical improvement, and, following dynamic assessment of her HPA axis, she could be fully weaned off steroids. Case 3 is a 47 year old female with a history of childhood asthma. She was found to have cavitating lung lesions. ANCA positivity confirmed GPA and she was commenced on high-dose steroids. During follow-up, she developed headache, polyuria and polydipsia. MRI pituitary showed a suprasellar lesion and pituitary biopsy revealed inflammatory hypophysitis. Cranial DI was confirmed by water deprivation testing. Previous allergic reactions to both RTX and Ofatumumab precluded anti-CD40 monoclonal antibodies and she was commenced on Azathioprine. A further recurrence of pituitary GPA necessitated escalation of the steroid dose and switch of azathioprine to mycophenolate mofetil. She remains in remission and her steroids reduced to a maintenance dose. Conclusion: GPA pituitary has been observed to occur at variable time after diagnosis often in the absence of any other systemic features. A combination of glucocorticoids and RTX has been approved for severe relapsing pulmonary GPA, however, limited data is available for pituitary GPA. In this case series, the response to high dose steroids and RTX for remission maintenance has been encouraging. Experience with ‘conventional’ immunosuppresants remains limited and therapeutic responses remain variable. Further clinical studies are required to establish effective treatment for pituitary GPA.

scholarly journals Significance of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in patients with bleeding from upper part of the gastrointestinal tract

2007 ◽  
Vol 64 (7) ◽  
pp. 445-448
Author(s):  
Gradimir Golubovic ◽  
Ratko Tomasevic ◽  
Biljana Radojevic ◽  
Aleksandar Pavlovic ◽  
Predrag Dugalic
Keyword(s):  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Ulcer Bleeding ◽  
Significant Difference ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
H Pylori ◽  
Upper Gastrointestinal

Background/Aim. Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs) use are considered to be the most important risk factors having influence on the onset of bleeding gastroduodenal lesions. Whether there is an interaction between H. pylori infection and the use of NSAIDs in the development of peptic ulcer disease is still controversial. The aim of the present study was to evaluate the prevalence of NSAIDs use and H. pylori infection in patients presented with bleeding gastroduodenal lesions. Methods. During the period from January 2003 - December 2003 we prospectively obtained data of all the patients (n=106) presented with signs of upper gastrointestinal bleeding. All the patients were admitted to the intensive care unit, with the endoscopy performed within 12 hours after admission. Histologic analysis was used for the detection of H. pylori infection. The NSAIDs and aspirin use data were obtained by anamnesis. Results. The results of our study revealed that the most common sources of upper gastrointestinal bleeding were duodenal (57 patients, 53.77%) and ventricular (36 patients, 33.96%) ulcers. The majority of the examined cases were associated with both H. pylori infection and NSAIDs use. A statistically significant difference among the studied groups of patients was proven. Conclusion. The majority of bleeding gastroduodenal lesions were associated with the coexistence of H. pylori infection and NSAIDs use, while their independent influences were statistically less important. Eradication of H. pylori infection in patients using NSAIDs might prevent upper gastrointestinal hemorrhage and reduce peptic ulcer bleeding risk. .

scholarly journals Double pylorus: case report and review of the literature

1999 ◽  
Vol 54 (4) ◽  
pp. 131-134 ◽  
Author(s):  
Adriana Vaz Safatle-Ribeiro ◽  
Ulysses Ribeiro Júnior ◽  
Angelita Habr-Gama ◽  
Joaquim J. Gama-Rodrigues
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Epigastric Pain ◽  
Duodenal Bulb ◽  
Previous History ◽  
Review Of The Literature ◽  
Ulcer Disease ◽  
Double Pylorus ◽  
H Pylori

Double pylorus is an unusual condition in which a double communication between the gastric antrum and the duodenal bulb occurs. It may be congenital, or it may be acquired complication of peptic ulcer disease. We present a case of double pylorus in a gentleman with epigastric pain and previous history of peptic ulcer disease. The relationship between Helicobacter pylori and this disease was assessed. A review of the literature, the role of associated diseases and the role of H. pylori are discussed.

scholarly journals Myocardial dissection complicating left sinus of Valsalva aneurysm in silent takayasu arteritis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Astri Astuti ◽  
Achmad Hafiedz Azis Kartamihardja ◽  
Muhammad Adniel Ilhamy ◽  
Muhammad Dinnar Fahlavi ◽  
Nuraini Yasmin Kusumawardhani ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Rare Condition ◽  
Optimal Dose ◽  
High Dose ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
Clinical Criteria ◽  
Satisfactory Outcome ◽  
History Of ◽  
Left Sinus Of Valsalva

Abstract Background Myocardial dissection (MD) in a left sinus of Valsalva aneurysm (LSVA) is a rare condition that may lead to a fatal complication. Determining the MD etiology is challenging because of various possibilities ranging from congenital to acquired diseases. Here, we discuss an approach for determining the etiology of MD complicating LSVA in Takayasu arteritis (TA) and its treatment. Case presentation A 41-year-old man presented with dyspnea on heavy activities and a history of consciousness loss at the age of 24 years. He was diagnosed with dilated cardiomyopathy and MD complicating LSVA in TA based on combined clinical and pathognomonic diagnostic criteria of TA evaluated using vascular Doppler and computed tomography angiography of the aorta. The patient refused to undergo surgery and received an optimal dose of chronic heart failure therapy, a high-dose steroid, and azathioprine. The patient experienced some improvements in clinical condition, functional outcome, and inflammatory markers at 1-year follow-up. Conclusions Clinical criteria and various imaging modalities may be used to determine the etiology of MD complicating LSVA in silent TA. As an alternative to surgery, the optimal medical treatment might result in a satisfactory outcome.

scholarly journals Protein losing gastroenteropathy due to Helicobacter pylori infection without giant rugal folds, erosion or polyposis

2019 ◽  
Vol 12 (11) ◽  
pp. e230870
Author(s):  
Katsunobu Yoshioka ◽  
Masanori Kishibuchi ◽  
Ko Takada
Keyword(s):  
Gastrointestinal Endoscopy ◽  
Clinical Symptoms ◽  
Duodenal Bulb ◽  
Human Albumin ◽  
Gastric Body ◽  
Upper Gastrointestinal Endoscopy ◽  
Endoscopic Findings ◽  
Urease Test ◽  
H Pylori ◽  
Upper Gastrointestinal

An 85-year-old woman was admitted to our hospital because of progressive hypoproteinemia and generalised oedema. Technetium-99m human albumin scintigraphy revealed protein leakage in the gastrointestinal tract. Upper gastrointestinal endoscopy revealed small whitish nodules from the gastric body up to the duodenal bulb. The urease test for Helicobacter pylori infection was positive. We diagnosed her as having protein-losing gastroenteropathy (PLGE) caused by H. pylori infection. The patient’s hypoproteinemia and clinical symptoms promptly resolved after H. pylori eradication. Our results suggest that a trial of H. pylori eradication is warranted in patients with PLGE, even if endoscopy reveals neither giant rugal folds, erosion of the mucosa, nor polyposis, which are previously reported characteristic endoscopic findings of PLGE.

scholarly journals Higher Proportions of a Healthy Gastric Mucosa in Healthy Japanese Adults with Later Birth Year: Analysis of 41,957 Participants

2021 ◽  
Author(s):  
Yoko SAITO ◽  
Shogo KIKUCHI
Keyword(s):  
Gastric Mucosa ◽  
Individual Risk ◽  
Negative Results ◽  
Healthy Mucosa ◽  
Japanese Adults ◽  
History Of ◽  
H Pylori ◽  
The Individual ◽  
Antibody Levels ◽  
Upper Gastrointestinal

Abstract Purpose: In Japan, most gastric cancers are associated with gastric mucosal atrophy caused by chronic infection with Helicobacter pylori (H. pylori). To recognize the condition of the gastric mucosa and to determe the infection status of H. pylori are important for predicting the individual risk of gastric cancer. The present study aimed to determine the proportion of Japanese adults with a healthy gastric mucosa (without H. pylori infection) among 12 birth-year groups encompassing 1935 to 1990.Methods: The gastric mucosa was classified as healthy or having gastritis based on routine double-contrast upper gastrointestinal barium X-ray radiopgraphy examination (UGI-XR). The participants were 41,957 healthy Japanese adults. Serum or urine H. pylori antibody levels were also assessed.Results: In total, 25,424 participants had a healthy mucosa without a history of H. pylori eradication. The proportions of participants with a healthy mucosa by birth year were 19.8% (57/288), 27.1% (306/1,128), 32.4% (569/1,756), 37.6% (1,808/4,811), 49.2% (3,207/6,522), 60.1% (3,966/6,550), 71.2% (5,224/7,342), 77.2% (5,114/6,624), 80.6% (3,342/4,149), 85.0% (1,404/1,652), 85.3% (302/354), and 94.7% (125/132) in 1935, 1940, 1945, 1950, 1955, 1960, 1965, 1970, 1975, 1980, 1985, and after 1990, respectively (p for trend < 0.01). All participants with a healthy mucosa showed negative results in H. pylori antibody tests.Conclusion: The proportion of participants with a normal gastric mucosa increased linearly with birth years. Prevalence of a morphologically healthy gastric mucosa may have been increasing, in parallel with prevalence of H. pylori infection has been decreasing.

scholarly journals Idiopathic small bowel diaphragm disease: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Omar Marghich ◽  
Alexandre Maubert ◽  
Efoé-Ga Yawod Olivier Amouzou ◽  
Louis Denimal ◽  
Emmanuel Benizri ◽  
...  
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Rare Condition ◽  
Diaphragm Disease ◽  
History Of ◽  
Inflammatory Drugs ◽  
Nsaid Usage ◽  
Anti Inflammatory

Abstract Small bowel diaphragm disease is a rare condition usually associated with the prolonged use of non-steroidal anti-inflammatory drugs (NSAID) and that can be mistaken and treated as other pathologies. We describe a case of a 64-year-old man with a prolonged course of pain and subacute bowel obstructions, without any history of NSAID usage, found to have a multiple diaphragmatic stricture in the small bowel.

scholarly journals Efficacy of Cyclosporine in the Induction and Maintenance of Remission in a Systemic Lupus Erythematosus Patient Presenting with Macrophage-Activating Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Franchesca Cruz-Pérez ◽  
Salvador Vilá ◽  
Grissel Ríos ◽  
Luis M. Vilá
Keyword(s):  
Lupus Erythematosus ◽  
Macrophage Activation ◽  
Liver Enzymes ◽  
Rare Condition ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Prednisone Dose ◽  
History Of ◽  
Severe Pancytopenia ◽  
Maintenance Of Remission

Macrophage-activating syndrome (MAS) is a rare condition characterized by dysfunctional macrophage activation leading to overproduction of cytokines and phagocytosis of erythrocytes, leukocytes, and platelets. MAS is associated with infectious diseases, malignancies, and autoimmune rheumatic disorders. Herein, we present a 22-year-old Hispanic woman with SLE who was hospitalized because of a three-week history of fever, fatigue, polyarthralgia, nausea, and abdominal pain. Initial laboratories showed severe pancytopenia with marked elevation of liver enzymes and ferritin levels. Bone marrow biopsy revealed macrophages with engulfed erythrocytes consistent with MAS. The patient was treated with high-dose corticosteroids, intravenous immunoglobulins, and cyclosporine 3 mg/kg/day. She had a remarkable clinical response to this therapy. She was continued on cyclosporine, and prednisone dose was gradually decreased to 7.5 mg daily without experiencing recurrent disease. She remained in full clinical remission for 12 months. Our case, together with other reports, suggests that combination therapy with corticosteroids, immunoglobulins, and cyclosporine appears to be effective for patients with SLE-associated MAS. Furthermore, cyclosporine seems to be a good drug for maintenance of remission.

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