Sporadic gastrinoma with refractory benign esophageal stricture:A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.

Rebamipide suppresses diclofenac-induced intestinal permeability via mitochondrial protection in mice

AIM: To investigate the protective effect and mechanism of rebamipide on small intestinal permeability induced by diclofenac in mice. METHODS: Diclofenac (2.5 mg/kg) was administered once daily for 3 d orally. A control group received the vehicle by gavage. Rebamipide (100 mg/kg, 200 mg/kg, 400 mg/kg) was administered intragastrically once a day for 3 d 4 h after diclofenac administration. Intestinal permeability was evaluated by Evans blue and the FITC-dextran method. The ultrastructure of the mucosal barrier was evaluated by transmission electron microscopy (TEM). Mitochondrial function including mitochondrial swelling, mitochondrial membrane potential, mitochondrial nicotinamide adenine dinucleotide-reduced (NADH) levels, succinate dehydrogenase (SDH) and ATPase activities were measured. Small intestinal mucosa was collected for assessment of malondialdehyde (MDA) content and myeloperoxidase (MPO) activity. RESULTS: Compared with the control group, intestinal permeability was significantly increased in the diclofenac group, which was accompanied by broken tight junctions, and significant increases in MDA content and MPO activity. Rebamipide significantly reduced intestinal permeability, improved inter-cellular tight junctions, and was associated with decreases in intestinal MDA content and MPO activity. At the mitochondrial level, rebamipide increased SDH and ATPase activities, NADH level and decreased mitochondrial swelling. CONCLUSION: Increased intestinal permeability induced by diclofenac can be attenuated by rebamipide, which partially contributed to the protection of mitochondrial function.

Association of MYO9B gene polymorphisms with inflammatory bowel disease in Chinese Han population

AIM:To explore the association of MYO9B gene polymorphisms with clinical phenotypes and intestinal permeability of individuals with inflammatory bowel disease(IBD)in China.METHODS:A total of 442 IBD patients and 402 healthy volunteers were genotyped for two single nucleotides(rs962917 and rs1545620)using the ligase detection reaction and polymerase chain reaction.Allelic and genotype frequency analyses were performed for the two groups.Intestinal permeability was evaluated using lactulose(L)and mannitol(M)excretion.The association of MYO9B gene polymorphisms with intestinal permeability between the normal and high intestinal permeability groups was analyzed.RESULTS:Overall,there was no significant difference in the genotypic and allelic frequencies of MYO9B between IBD patients and controls.Although no association was found with ulcerative colitis in the comparison between the subgroups,the frequencies of rs962917and rs1545620 were different in the Crohn’s disease(CD)subgroup with ileocolitis(CC vs CT and TT,P=0.014;and AA vs AC and CC,P=0.022,respectively).rs1545620 variants appear to be the genetic susceptibility factor for perianal disease in CD patients(AA vs AC CC,P=0.029).In addition,the L/M ratio was significantly higher in IBD patients than in controls(0.065±0.013 vs 0.020±0.002,P=0.02),but no association was found between the MYO9B gene and the L/M ratio in IBD patients.CONCLUSION:MYO9B gene polymorphisms may influence the sub-phenotypic expression of CD in China.No association between these MYO9B polymorphisms and intestinal permeability in IBD patients was found.

Relationship of distraction rate with inferior alveolar nerve degeneration-regeneration shift

Distraction osteogenesis is an important technique for the treatment of maxillofacial abnormities and defects. However, distraction osteo- genesis may cause the injury of the inferior alveolar nerve. The relationship between distraction rate and nerve degeneration-regeneration shift remains poorly understood. In this study, 24 rabbits were randomly divided into four groups. To establish the rabbit mandibular distraction osteogenesis model, the mandibles of rabbits in distraction osteogenesis groups were subjected to continuous osteogenesis dis- traction at a rate of 1.0, 1.5 and 2.0 mm/d, respectively, by controlling rounds of screwing each day in the distractors. In the sham group, mandible osteotomy was performed without distraction, Pin-prick test with a 10 g blunt pin on the labium, histological and histomorpho- metric analyses with methylene blue staining, Bodian＇s silver staining, transmission electron microscopy and myelinated fiber density of inferior alveolar nerve cross-sections were performed to assess inferior alveolar nerve conditions. At 28 days after model establishment, in the pin-prick test, the inferior alveolar nerve showed no response in the labium to a pin pricks in the 2 mm/d group, indicating a severe dysfunction. Histological and histomorphometric analyses indicated that the inferior alveolar nerve suffered more degeneration and in- juries at a high distraction rate （2 mm/d）. Importantly, the nerve regeneration, indicated by newborn Schwann cells and axons, was more abundant in 1.0 and 1.5 mm/d groups than in 2.0 mm/d group. We concluded that the distraction rate was strongly associated with the inferior alveolar nerve function, and the distraction rates of !.0 and 1.5 mm/d had regenerative effects on the inferior alveolar nerve. This study provides an experimental basis for the relationship between distraction rate and nerve degeneration-regeneration shift during dis- traction osteogenesis, and may facilitate reducing nerve complications during distraction osteogenesis.

Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity

Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption.However,previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever,rashes,colitis exacerbation and acute eosinophilic pneumonia.Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories.In light of symptom exacerbation of ulcerative colitis,increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration,and the Naranjo algorithm score of 10,the possibility of hypersensitivity reaction to mesalamine suppositories should be considered,warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.

Effect of homocysteine on intestinal permeability in rats with experimental colitis,and its mechanism

Objective:To investigate the effect of homocysteine(Hcy)on intestinal permeability in rats with TNBS/ethanol-induced colitis and elucidate its mechanism.Methods:Sprague-Dawley rats were divided into four groups:normal,normal+Hcy injection,TNBS model,and TNBS model+Hcy injection.Experimental colitis was induced by trinitrobenzene sulfonic acid(TNBS)in 50%ethanol;rats were injected subcutaneously with Hcy from the first day after the induction of experimental colitis on 30 consecutive days.To determine the severity of colitis,the disease activity index(DAI)was evaluated;colon tissues were collected for the detection of the activity of myeloperoxidase(MPO)and the contents of MDA,IL-1β,IL-6,TNF-α,MMP-2,and MMP-9.Intestinal epithelial permeability was assessed with Evans blue(EB)dye.The levels of Hcy in plasma and colon mucosa were measured by high-performance liquid chromatography-fluorescence detection(HPLC-FD).Results:Compared with the normal group,the DAI scoring and MPO activity,contents of MDA,IL-1β,IL-6,TNF-α,MMP-2,and MMP-9in the colon and EB in the small intestine were significantly increased in the TNBS group(P<0.01).Compared with the TNBS model group,the DAI scoring,plasma and colonic mucosa Hcy levels,MPO activity and contents of MDA,IL-1β,IL-6,TNF-α,MMP-2,and MMP-9 in colon and EB in small intestine were significantly increased in the TNBS-induced colitis rats with simultaneous Hcy injection(P<0.01).Conclusion:Hcy can increase intestinal permeability and aggravate inflammatory damage in rats with TNBS-induced colitis,the underlying mechanisms of which may be attributed to its effects of promoting the expression of MMP-2 and MMP-9,leading to injury of the intestinal barrier.