Protein-losing pseudomembranous colitis with cap polyposis-like features

Protein-losing enteropathy(PLE) is characterized by loss of serum proteins into the gastrointestinal tract. It may lead to hypoproteinemia and clinically present as protein deficiency edema, ascites, pleural or pericardial effusion and/or malnutrition. In most cases the site of protein loss is the small intestine. Here we present an unusual case of severe PLE in a 55-year old female with a one-year history of recurrent diarrhea, crampy abdominal pain, and peripheral edema. Endoscopy and MRI showed a diffuse inflammatory thickening of the sigmoid colon and the rectum. Surgical resection of the involved colon was performed and the symptoms were significantly resolved. The final histologic evaluation confirmed a diagnosis of a pseudomembranous colitis with cap polyposis-like features. Such a cause of PLE has never been described before.

A unique case of collagenous colitis presenting as protein-losing enteropathy successfully treated with prednisolone

A 76-year-old woman with a 5-mo history of recurrent diarrhea and generalized edema was admitted to our hospital. Colonoscopy revealed edematous mucosa,and histopathological examination was compatible with collagenous colitis. Protein leakage from the colon,particularly in the ascending portion,was identified on 99mTc-human serum albumin scintigraphy. Collagenous colitis associated with protein-losing enteropathy (PLE) without small bowel disease was diagnosed. Prednisolone treatment ameliorated diarrhea and hypoproteinemia. Collagenous colitis should be included in the differential diagnosis of chronic diarrhea with hypoproteinemia for appropriate management.

Protein-losing enteropathy caused by a jejunal ulcer after an internal hernia in Petersen's space: A case report

BACKGROUND The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery.Of particular concern are internal hernias occurring in Petersen's space,a space that is surgically created after treatment for gastric cancer and obesity.These hernias cause devastating sequelae,such as massive intestinal necrosis,fatal Roux limb necrosis,and superior mesenteric vein thrombus.In addition,protein-losing enteropathy(PLE)is a rare syndrome involving gastrointestinal protein loss,although its relationship with internal Petersen’s hernias remains unknown.CASE SUMMARY A 75-year-old man with a history of laparotomy for early gastric cancer developed Petersen's hernia 1 year and 5 mo after surgery.He was successfully treated by reducing the incarcerated small intestine and closure of Petersen’s defect without resection of the small intestine.Approximately 3 mo after his surgery for Petersen’s hernia,he developed bilateral leg edema and hypoalbuminemia.He was diagnosed with PLE with an alpha-1 antitrypsin clearance of 733 mL/24 h.Double-balloon enteroscopy revealed extensive jejunal ulceration as the etiology,and it facilitated minimum bowel resection.Pathological analysis showed extensive jejunal ulceration and collagen hyperplasia with nonspecific inflammation of all layers without lymphangiectasia,lymphoma,or vascular abnormalities.His postoperative course was unremarkable,and his bilateral leg edema and hypoalbuminemia improved after 1 mo.There was no relapse over the 5-year follow-up period.CONCLUSION PLE and extensive jejunal ulceration may occur after Petersen's hernia.Doubleballoon enteroscopy helps identify and resect these lesions.

Diabetic gastroenteropathy:An underdiagnosed complication

This article is an extensive review that provides an update on the pathophysiology,symptoms,diagnosis,and treatment of diabetic gastroenteropathy.There is no reported prevalence,but it has been described that patients with type 1 diabetes have a cumulative incidence at 10 years of 5.2%,and type 2 patients,1%.Also,in the group of type 1 diabetes,it has been observed that women are more likely to present this condition(5.8%vs 3.5%).Many factors are associate with its development(e.g.,hyperglycemia,vagal dysfunction,loss of expression of neural nitric oxide synthase in the myenteric plexus,alterations in the Cajal interstitial cell network,and oxidative stress).Gastrointestinal discomfort could be perceived 70% higher in diabetic patients,describing that 25%of diabetic patients experience gastrointestinal symptoms.Diabetic enteropathy could affect any portion of the gastrointestinal tract,but esophageal alterations were described in more than 60% of diabetic patients,also 60% of them present constipation,and 20%,diarrhea.Gastric emptying scintigraphy is useful to evaluate gastroparesis,therefore,gastric retention of more than 60%at 2 h has a sensitivity of 100% and specificity of 20% for diagnosis;however,other studies such as breath tests,with a sensitivity of 89% and a specificity of 80%,or the endoscopic capsule contribute to the diagnosis.There is no cure;however,management must be multidisciplinary,focused on slowing the progression of diabetic gastroenteropathy,reducing symptoms,and restoring function;that includes nutritional recommendation,maintain glucose levels kept below 180 mg/dL,use of prokinetics,anti-emetics;nowadays,it has been special interest in surgical treatment,such as pyloroplasty,also gastric electrical stimulation appears to be another alternative.

Letter to editor‘Gastroenteropathy in gastric cancer patients concurrent with diabetes mellitus’

The present letter to the editor is related to the study titled“Diabetic gastroenteropathy:An underdiagnosed complication”.Diabetic gastroenteropathy contributes to a decline in quality of life.In addition,gastroenteropathy is generally observed in patients with concurrent gastric cancer and diabetes mellitus before surgery,and the occurrence of the symptoms might be due not only to cancer but also to the complications of diabetes mellitus.

Experience of primary intestinal lymphangiectasia in adults: Twelve case series from a tertiary referral hospital

BACKGROUND While primary intestinal lymphangiectasia(PIL)is considered a rare condition,there have been several reported cases in adults.Nevertheless,the absence of clear guidance from diagnosis to treatment and prognosis poses challenges for both physicians and patients.AIM To enhance understanding by investigating clinical presentation,diagnosis,treatment,complications,and prognoses in adult PIL cases.METHODS We enrolled adult patients diagnosed with PIL between March 2016 and September 2021.The primary outcome involved examining the diagnosis and treatment process of these patients.The secondary outcomes included identifying complications(infections,thromboembolism)and assessing prognoses(frequency of hospitalization and mortality)during the follow-up period.RESULTS Among the 12 included patients,peripheral edema(100%)and diarrhea(75%)were the main presenting complaints.Laboratory tests showed that all the pati-ents exhibited symptoms of hypoalbuminemia and hypogammaglobulinemia.Radiologically,the predominant findings were edema of the small intestine(67%)and ascites(58%).The typical endoscopic finding with a snowflake appearance was observed in 75%of patients.Among the 12 patients,two responded positive-ly to octreotide and sirolimus,and eight who could undergo maintenance therapy discontinued subsequently.Complications due to PIL led to infection in half of the patients,thromboembolism in three patients,and one death.CONCLUSION PIL can be diagnosed in adults across various age groups,with different severity and treatment responses among patients,leading to diverse complications and prognoses.Consequently,tailored treatments will be necessary.We anticipate that our findings will contribute to the management of PIL,an etiology of protein-losing enteropathy.

Role of cyclic guanosine monophosphate-adenosine monophosphate synthase-stimulator of interferon genes pathway in diabetes and its complications

Diabetes mellitus(DM)is one of the major causes of mortality worldwide,with inflammation being an important factor in its onset and development.This review summarizes the specific mechanisms of the cyclic guanosine monophosphate-adenosine monophosphate synthase(cGAS)-stimulator of interferon genes(STING)pathway in mediating inflammatory responses.Furthermore,it compre-hensively presents related research progress and the subsequent involvement of this pathway in the pathogenesis of early-stage DM,diabetic gastroenteropathy,diabetic cardiomyopathy,non-alcoholic fatty liver disease,and other complic-ations.Additionally,the role of cGAS-STING in autonomic dysfunction and intes-tinal dysregulation,which can lead to digestive complications,has been discuss-ed.Altogether,this study provides a comprehensive analysis of the research advances regarding the cGAS-STING pathway-targeted therapeutic agents and the prospects for their application in the precision treatment of DM.

Eosinophilic gastroenteritis with cytomegalovirus infection in an immunocompetent child

A 3-year-old boy developed transient protein-losing gastroenteropathy associated with cytomegalovirus (CMV) infection. Both IgG and IgM antibodies to CMV were positive in a serologic blood test. Upper gastrointestinal endoscopy showed multiple erosions throughout the body of the stomach, without enlarged gastric folds. Histological examination of the biopsy specimens indicated eosinophilic gastroenteritis and CMV infection. The patient had complete resolution without specific therapy for CMV in four weeks. An allergic reaction as well as CMV infection played important roles in the pathogenesis of this case.

推拿敷贴治疗小儿乳食积滞型便秘的疗效观察

目的:评价中医推拿敷贴疗法对小儿乳食积滞型便秘的临床疗效。方法:将60名便秘患儿按随机数字表法分为2组,治疗组采用推拿手法联合中药穴位敷贴进行治疗,对照组给予小儿化食丸口服治疗,期间观察经治10 d中医证候积分和临床症状改善情况。结果:经治10 d,治疗组总有效率96.7%,对照组90%,治疗组在总疗效方面优于对照组,差异有统计学意义。结论:推拿敷贴治疗小儿乳食积滞型便秘的临床疗效确切,适于推广应用。

从“滞”探析功能性胃肠病的发病观

《罗马Ⅳ:功能性胃肠病肠-脑互动异常》中,功能性胃肠病(functional gastrointestinal disorders,FGIDs)又被称之为肠-脑互动异常。针对现代FGIDs疾病谱的变化及FGIDs致病因素的多元化,在"现代""三因"致病因素的反复作用下,脾胃虚弱,升降失常,气机"凝滞",产生了FGIDs胃肠道症状,同时,FGIDs患者常具有慢性头痛、呼吸困难、心慌、肌肉疼痛等胃肠道以外症状。FGIDs属于中医脾胃系统疾病,其临床症状与中医脾胃功能失常密切相关,"脾胃虚滞"是FGIDs基本病机,临床可从"滞"论治FGIDs。FGIDs患者症状重叠现象极为常见,FGIDs临床常见八滞:虚滞、气滞、血滞、火滞、湿滞、痰滞、食滞、寒滞。FGIDs临床常用祛滞八法:健补脾胃祛滞法、疏肝理气祛滞法、活血化瘀祛滞法、泻肝行湿祛滞法、燥湿运脾祛滞法、理气化痰祛滞法、消食化痰祛滞法、温胃散寒祛滞法。进一步探析"脾胃虚滞"理论及从"滞"论治FGIDs理论,对现代FGIDs及脾胃相关病的防治具有重要的临床指导意义。

以低蛋白血症为主要表现的蛋白丢失性胃肠病病因和误诊分析

目的分析以低蛋白血症为主要表现的蛋白丢失性胃肠病的病因及其误诊原因,旨在加深对其病因的认识,提高其诊断率,减少误诊。方法收集2002年1月～2007年12月湘雅医院住院患者作为研究对象,选择以低蛋白血症为主要表现的蛋白丢失性胃肠病16例。结果①16例病例中蛋白丢失性胃肠病病因为不典型克罗恩氏病、小肠淋巴管扩张症、免疫增殖性小肠病、Menetrier’s病、多发性硬化及嗜酸性胃肠炎,其中以克罗恩氏病多见,占50.00%(8/16);②以低蛋白血症为主要表现的罕少见病误诊率高达62.50%(10/16)。③双气囊小肠镜对以低蛋白血症为主要表现的小肠罕少见病检出率100%(9/9)。结论①以低蛋白血症为主要表现的蛋白丢失性胃肠病误诊率高;其病因以不典型克罗恩氏病最常见且容易误诊;②双气囊小肠镜检查对该病的诊断有重要诊断价值。

针灸治疗糖尿病胃肠病的临床研究进展

总结针灸治疗糖尿病胃肠病的临床研究进展,从针灸疗法、选穴研究方面进一步分析指出现阶段临床研究存在的问题及未来发展的方向。针灸治疗糖尿病胃肠病疗效确切、疗法多样、选穴灵活,但存在评价标准不统一、科研设计欠合理、样本范围及数量偏小、数据处理可信度差等问题亟待解决。目前关于针灸治疗糖尿病胃轻瘫的临床研究较深入,未来应加强针灸治疗食管综合征及糖尿病性腹泻、糖尿病性便秘的临床研究。

CT对胃肠道疾病的诊断价值

目的：比较X线、CT、MRI及DSA在胃肠病变检诊中的应用价值。方法2012年1月～2012年12月间在我科进行影像学检查的胃肠病变患者纳入研究对象，共94例，其中男52例，年龄2～81岁，中位年龄52岁；女42例，年龄8～87岁，中位年龄59岁。检查方法包括 X 线消化道气钡双重造影，CT 平扫，CT 增强（CT-CE），CT 血管造影（CTA），MRI平扫，MRI增强，数字血管减影血管成像（DSA）。在随访中，以消化内镜检查和（或）手术病理诊断为参考标准，评价影像方法的诊断正确率。结果94例患者中，X线消化道气钡双重造影检查14例，明确诊断12例，另2例通过C T检查明确诊断。C T检查68例，平扫明确诊断7例，进一步增强扫描明确诊断57例，再进一步结合消化道气钡双重造影明确者1例、MRI明确者1例、DSA明确者1例，还有1例通过手术探查明确。CTA检查11例，直接明确诊断者8例，进一步DSA明确者3例。MRI检查1例，未能直接明确诊断，进一步CT检查明确。结论 CT在胃肠病检诊中较X线、M RI和DSA具有更高的诊断价值，但是合理联合多种方法能够弥补单一影像学方法显示病变的局限，可以明显提高对胃肠病变的诊断正确率。

驻疆边防官兵功能性胃肠疾病流行病学调查分析

目的探讨驻疆边防官兵功能性胃肠疾病(functional gastrointestinal disorders,FGIDs)的发病情况及其相关影响因素。方法按照FGIDs罗马Ⅲ分类及诊断标准,对驻疆边防官兵进行问卷调查。按国际统一评判方法(SA forRomeⅢ-DQ)对各种功能性胃肠疾病进行诊断。结果①抽样调查官兵1062人,FGIDs总发病人数333例,总发病率为31.34%。其中肠易激综合征(irritable bowel syndrome,IBS)发病率最高,为21.06%,其次为功能性烧心9.79%、功能性腹痛综合征4.94%、功能性便秘4.57%和功能性腹泻4.10%。而上腹痛综合征、胆囊及SO功能紊乱以及慢性肛痛发病率较低,均不到1%。②各类FGIDs发病率依次为功能性肠病30.75%,功能性食管疾病11.65%,功能性胃十二指肠疾病9.23%,功能性腹痛综合征4.94%,功能性肛门直肠疾病1.17%,功能性胆囊及SO功能紊乱0.09%。③主要症状中咽部疼痛或不适发生率最高(10.62%),其次为腹泻和恶心,分别为9.97%和8.95%。④FGIDs发病集中在26岁-35岁之间;AB型血发病率最低,最高为A型血;汉族和少数民族发病率无显著差异;随着军龄、军衔的增长,发病率有升高趋势。结论驻疆边防官兵FGIDs总体发病率高于普通人群,可能与边防官兵任务重,驻地天气条件恶劣,训练紧张,生活单调有关。

气滞胃痛颗粒治疗肝胃不和型胆汁反流性胃炎临床观察

目的观察气滞胃痛颗粒治疗肝胃不和型胆汁反流性胃炎临床疗效。方法胆汁反流性胃炎患者136例随机分为2组,治疗组70例予气滞胃痛颗粒5 g,每日3次餐前30 min开水冲服,对照组予铝碳酸镁片1.5 g,每日3次饭后1 h嚼服,多潘立酮片10 mg,每日3次饭前30 min口服。2组均以8周为1个疗程。治疗后2组均做胃镜检查,比较治疗前后各项临床症状积分变化情况以及镜下各项指标积分变化情况。结果2组治疗后各项症状积分较治疗前显著降低,胃镜下所见各项指标积分亦明显降低,总有效率分别为91.4%、74.2%。治疗组总有效率高于对照组(P<0.05),改善腹痛、嗳气、纳差症状方面优于对照组(P<0.05),显效患者复发率低于对照组(P<0.05)。结论气滞胃痛颗粒治疗肝胃不和型胆汁反流性胃炎疗效满意,复发率低。

STZ-糖尿病大鼠小肠动力与肠神经胆碱能和氮能神经元关系的研究

目的:探讨链脲佐菌素(STZ)诱导的糖尿病大鼠小肠动力改变与小肠肌间神经丛胆碱能和氮能神经元之间的关系。方法:45只SD大鼠随机分为STZ-糖尿病组、胰岛素组和正常对照组,造模后16周处死。测定大鼠肠动力,采用组织化学染色法观察大鼠小肠肌间神经丛胆碱能和氮能神经元的形态改变。结果:与对照组相比较,糖尿病组和胰岛素组大鼠肠动力均明显减弱(P均<0.05);肌间神经丛胆碱能神经元数目均显著减少(P均<0.01),氮能神经元数量均有减少的趋势(P均>0.05)。胰岛素组肠动力显著高于糖尿病组(P<0.05),但肠神经元计数两组无显著性差异(P>0.05)。结论:STZ-糖尿病大鼠肠动力减弱与肠道肌间神经丛胆碱能和氮能神经损伤有关,胰岛素强化治疗可延缓糖尿病胃肠动力障碍的进展。

肝性胃肠病108例临床分析

目的 探讨肝性胃肠病的诊断及消化道出血的病因。 方法 肝性胃肠病 10 8例临床分析。 结果 肝脏活组织检查对诊断肝硬化较B超更为可靠 ;慢性肝病患者同时存在两种以上胃肠道病变者较多 ;慢性肝病引起的消化道出血 ,以胃粘膜糜烂和食道静脉破裂出血为主。 结论 临床医师对慢性肝病患者应尽量完善各项检查 ,及时治疗 。

辛开苦降法治疗消化系统疾病研究

辛开苦降法是中医方剂重要的组方原则之一,体现了中医治疗八法中的"和法"。因其独特的配伍方式,广泛应用于气机升降失常、寒热错杂、虚实夹杂等病证的治疗中。目前,辛开苦降法已成为中医治疗消化系统疾病的一种常用方法,对于单纯西药治疗效果一般的消化系统疾病,如功能性胃肠病、慢性萎缩性胃炎、胃食管反流性疾病、结肠癌等治疗效果优势显著。近几年对其治疗机制的研究也已取得较大进展。继续深入探索辛开苦降法的临床应用及其作用机制,对提高临床疗效、减轻医疗负担、弘扬中医文化具有深远意义。

蛋白丢失性胃肠病诊治进展

蛋白丢失性胃肠病(PLG)不是一个独立的原发疾病,而是继发于其他多种基础疾病的临床综合征,以水肿、腹泻、发热为主要临床表现。诊断是治疗的基础,因此不仅要确定存在蛋白质从胃肠道丢失的情况,还要明确其病因。利用放射性核素标记蛋白或其他特殊物质来检测胃肠道中的放射性,推算蛋白从胃肠道丢失的比率是PLG的特异性诊断方法之一。PLG的预后与原发病控制与否相关,因此最根本的治疗是对基础疾病的治疗,即在给予支持治疗的同时有针对性地治疗原发病,只有彻底消除引起蛋白丢失的病因,PLG才有可能得到彻底的治愈。

患者胃肠引流液中幽门螺杆菌的检出及VitC含量测定

目的探讨胃肠引流液中幽门螺杆菌(Helicobacterpylori,Hp)的检出率及患者VitC水平。方法用PCR技术、细菌培养、快速尿素酶试验检测胃肠引流液中的Hp,用反相液相色谱法检测患者胃肠引流液及血浆中VitC含量。结果282例患者胃肠引流液中Hp检出率为411%(116/282),PCR、细菌培养及快速尿素酶试验阳性率分别为429%(121/282)、113%(32/282)、411%(116/282)。胃溃疡、十二指肠溃疡、复合溃疡、胃癌、急性肠梗阻、急性胆囊炎及门静脉高压合并食管胃底静脉曲张患者Hp检出率分别为546%(30/55)、522%(24/46)、583%(7/12)、482%(27/56)、222%(8/36)、276%(16/58)、211%(4/19),差异具显著性(P<001)。胃溃疡、十二指肠溃疡、复合溃疡、胃癌Hp阳性患者与Hp阴性患者血浆及胃肠引流液VitC浓度相比,差异均具有显著性(P<001)。结论胃肠引流液中可检出Hp,且能分离培养出活菌;PCR技术是一种敏感、有效的检测胃引流液中Hp的方法。Hp感染人体后引起胃肠引流液及血浆中VitC含量的减少,可能与胃十二指肠疾病的发生有关。