In the absence of certainty regarding the causes of both inflammatory bowel disease (IBD) and its extraintestinal manifestations (EIMs), there is necessarily ambiguity in both academic and clinical arenas concerning the diagnosis, classifications, and treatments of EIMs. While the “true” EIMs are considered extensions of the IBD gut pathogenesis with an immunologically mediated inflammatory consequence, other EIMs are considered to be complications of IBD itself or its treatment. A third group of IBD EIMs includes those disorders which seem to occur more often in IBD but for which an etiologic or pathophysiologic connection to IBD is highly theoretical. Patients with IBD and EIMs tend to have more severe, long-duration disease, and a reduced quality of life. EIMs presentation may or may not parallel IBD gut inflammatory activity. The clinical decision-making processes necessary for successfully managing simultaneously the gut component of IBD and its EIMs are presented. Based upon clinical experience and review of leading publications, the consensus of best practices, differential diagnoses for EIMs, and current management programs are presented with enumeration of specific decisions and considerations required for successful management of EIMs. EIMs of inflammatory bowel disease reflect the immunopathologic common ground and hence the systemic nature of the IBD. A defined decision-making process is offered which includes consultations and attention to the differential diagnosis to avoid not uncommon mistakes in diagnosis. Management of all EIMs requires assessment of both the clinical and pathologic status of the gut component of IBD combined with judicious selection of general and /or immunosuppression therapy for the EIMs.
{"title":"Decision-Making in Diagnosis and Management of Extraintestinal Manifestations of Inflammatory Bowel Disease","authors":"N. V. Costrini","doi":"10.17140/goj-5-133","DOIUrl":"https://doi.org/10.17140/goj-5-133","url":null,"abstract":"In the absence of certainty regarding the causes of both inflammatory bowel disease (IBD) and its extraintestinal manifestations (EIMs), there is necessarily ambiguity in both academic and clinical arenas concerning the diagnosis, classifications, and treatments of EIMs. While the “true” EIMs are considered extensions of the IBD gut pathogenesis with an immunologically mediated inflammatory consequence, other EIMs are considered to be complications of IBD itself or its treatment. A third group of IBD EIMs includes those disorders which seem to occur more often in IBD but for which an etiologic or pathophysiologic connection to IBD is highly theoretical. Patients with IBD and EIMs tend to have more severe, long-duration disease, and a reduced quality of life. EIMs presentation may or may not parallel IBD gut inflammatory activity. The clinical decision-making processes necessary for successfully managing simultaneously the gut component of IBD and its EIMs are presented. Based upon clinical experience and review of leading publications, the consensus of best practices, differential diagnoses for EIMs, and current management programs are presented with enumeration of specific decisions and considerations required for successful management of EIMs. EIMs of inflammatory bowel disease reflect the immunopathologic common ground and hence the systemic nature of the IBD. A defined decision-making process is offered which includes consultations and attention to the differential diagnosis to avoid not uncommon mistakes in diagnosis. Management of all EIMs requires assessment of both the clinical and pathologic status of the gut component of IBD combined with judicious selection of general and /or immunosuppression therapy for the EIMs.","PeriodicalId":426702,"journal":{"name":"Gastro – Open Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131000488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Wood, A. Fagbemi, L. Jago, D. Belsha, N. Lansdale, A. Kadir
This case report presents the diagnosis of superior mesenteric artery and nutcracker syndromes in a previously fit and well 14-yearold girl. Although these two entities usually occur in isolation, despite their related aetiology, our patient was a rare example of their occurrence together. In this case the duodenal compression of superior mesenteric artery syndrome caused intractable vomiting leading to weight loss, and her nutcracker syndrome caused severe left-sided abdominal pain and microscopic haematuria without renal compromise. Management of the superior mesenteric artery syndrome can be conservative by increasing the weight of the child which leads to improvement of retroperitoneal fat and hence the angle of the artery. The weight can be improved either by enteral feeds or parenteral nutrition. This conservative management initially helped but not in the long-term as the child started losing weight again. The next step in management is surgery (duodenojejunostomy – if the conservative management fails), which the child went through, remarkably improving their symptoms.
{"title":"Superior Mesenteric Artery and Nutcracker Syndromes in a Healthy 14-Year-Old Girl Requiring Surgical Intervention after Failed Conservative Management","authors":"D. Wood, A. Fagbemi, L. Jago, D. Belsha, N. Lansdale, A. Kadir","doi":"10.17140/goj-5-132","DOIUrl":"https://doi.org/10.17140/goj-5-132","url":null,"abstract":"This case report presents the diagnosis of superior mesenteric artery and nutcracker syndromes in a previously fit and well 14-yearold girl. Although these two entities usually occur in isolation, despite their related aetiology, our patient was a rare example of their occurrence together. In this case the duodenal compression of superior mesenteric artery syndrome caused intractable vomiting leading to weight loss, and her nutcracker syndrome caused severe left-sided abdominal pain and microscopic haematuria without renal compromise. Management of the superior mesenteric artery syndrome can be conservative by increasing the weight of the child which leads to improvement of retroperitoneal fat and hence the angle of the artery. The weight can be improved either by enteral feeds or parenteral nutrition. This conservative management initially helped but not in the long-term as the child started losing weight again. The next step in management is surgery (duodenojejunostomy – if the conservative management fails), which the child went through, remarkably improving their symptoms.","PeriodicalId":426702,"journal":{"name":"Gastro – Open Journal","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121295267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Copyright 2018 by Gundamaraju R. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc A close association of microbiota in human health continues to emerge. Microbiota has been implicated in autoimmune disorders such as type I diabetes mellitus, inflammatory bowel disease, rheumatoid arthritis and multiple sclerosis.1 This is pointing out that early-life microbial exposure could be linked to later-life susceptibility to immune-mediated disorders. From the experimental models related to autoimmune disorders, it is known that tissue injury is prevented by alteration in microbiota or in germ-free condition. Therefore, microbial alteration can be beneficial during autoimmune disorders. However, several lines of evidence suggest the role of gender-bias, (regulation of sex-hormones by microbiota) in numerous diseases. This editorial aims to throw light on the novel, emerging triangular relationship between host microbiota, sex hormones (testosterone, progesterone and estrogen) and immune responses cumulatively termed as “Microgenderome”.
这是一篇基于知识共享署名4.0国际许可(CC by 4.0)的开放获取文章，允许以任何媒介或格式复制、再分发、再混合、转换和复制，即使是商业复制，前提是正确引用原始作品。微生物群与人类健康的密切关系不断出现。微生物群与自身免疫性疾病，如I型糖尿病、炎症性肠病、类风湿关节炎和多发性硬化症有关该研究指出，早年接触微生物可能与晚年对免疫介导疾病的易感性有关。从与自身免疫性疾病相关的实验模型中，我们知道组织损伤是通过改变微生物群或在无菌条件下预防的。因此，在自身免疫性疾病中，微生物改变可能是有益的。然而，一些证据表明性别偏见(微生物群对性激素的调节)在许多疾病中的作用。这篇社论的目的是阐明宿主微生物群、性激素(睾酮、孕酮和雌激素)和免疫反应之间新出现的三角关系，这些关系被累积称为“微性别组”。
{"title":"Microgenderome: An Important Variable for Developing Therapeutic Strategies?","authors":"R. Vemuri, R. Gundamaraju","doi":"10.17140/goj-3-e005","DOIUrl":"https://doi.org/10.17140/goj-3-e005","url":null,"abstract":"Copyright 2018 by Gundamaraju R. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc A close association of microbiota in human health continues to emerge. Microbiota has been implicated in autoimmune disorders such as type I diabetes mellitus, inflammatory bowel disease, rheumatoid arthritis and multiple sclerosis.1 This is pointing out that early-life microbial exposure could be linked to later-life susceptibility to immune-mediated disorders. From the experimental models related to autoimmune disorders, it is known that tissue injury is prevented by alteration in microbiota or in germ-free condition. Therefore, microbial alteration can be beneficial during autoimmune disorders. However, several lines of evidence suggest the role of gender-bias, (regulation of sex-hormones by microbiota) in numerous diseases. This editorial aims to throw light on the novel, emerging triangular relationship between host microbiota, sex hormones (testosterone, progesterone and estrogen) and immune responses cumulatively termed as “Microgenderome”.","PeriodicalId":426702,"journal":{"name":"Gastro – Open Journal","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114342380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Sagar, S. Arekapudi, Sachdev Thomas, H. Wong, S. Saligram
A 68-year-old male presented with complaints of heartburn and progressive dysphagia for solid food. His past medical history was remarkable for coronary artery disease with coronary stent placement in 2008 and 2009 and gastroesophageal reflux disease (GERD). His family history was significant for esophageal cancer in brother diagnosed at the age of 53 years. Physical examination was significant for epigastric tenderness but the rest of the examination was otherwise unremarkable. Labs were significant for iron deficiency anemia: hemoglobulin 10.3 gm/dL, hematocrit 31.1%, MCV 87%, iron 24 mcg/dL, transferrin saturation 7 mcg/dL. A computed tomography (CT) scan of abdomen and pelvis with contrast performed to evaluate iron deficiency anemia showed marked circumferential thickening of the visualized portion of the distal esophagus extending to the gastroesophageal GE junction, which was suspicious for esophageal cancer. There was an enlarged lymph node of the gastro-hepatic ligament suspicious for metastasis. Upper endoscopy was performed which showed a large, fungating and ulcerating mass with no bleeding in the mid and distal esophagus. The mass was partially obstructing and circumferential. It extended from mid esophagus to GE junction (Figure 1). Biopsies were taken with cold forceps for histology, which showed poorly differentiated adenocarcinoma with signet-ring cell type with background of Barrett’s esophagus with high-grade dysplasia and positive Her2/neu overexpression by immunohistochemistry stain.
{"title":"Endoscopic Suturing of Esophageal Stent","authors":"D. Sagar, S. Arekapudi, Sachdev Thomas, H. Wong, S. Saligram","doi":"10.17140/goj-3-127","DOIUrl":"https://doi.org/10.17140/goj-3-127","url":null,"abstract":"A 68-year-old male presented with complaints of heartburn and progressive dysphagia for solid food. His past medical history was remarkable for coronary artery disease with coronary stent placement in 2008 and 2009 and gastroesophageal reflux disease (GERD). His family history was significant for esophageal cancer in brother diagnosed at the age of 53 years. Physical examination was significant for epigastric tenderness but the rest of the examination was otherwise unremarkable. Labs were significant for iron deficiency anemia: hemoglobulin 10.3 gm/dL, hematocrit 31.1%, MCV 87%, iron 24 mcg/dL, transferrin saturation 7 mcg/dL. A computed tomography (CT) scan of abdomen and pelvis with contrast performed to evaluate iron deficiency anemia showed marked circumferential thickening of the visualized portion of the distal esophagus extending to the gastroesophageal GE junction, which was suspicious for esophageal cancer. There was an enlarged lymph node of the gastro-hepatic ligament suspicious for metastasis. Upper endoscopy was performed which showed a large, fungating and ulcerating mass with no bleeding in the mid and distal esophagus. The mass was partially obstructing and circumferential. It extended from mid esophagus to GE junction (Figure 1). Biopsies were taken with cold forceps for histology, which showed poorly differentiated adenocarcinoma with signet-ring cell type with background of Barrett’s esophagus with high-grade dysplasia and positive Her2/neu overexpression by immunohistochemistry stain.","PeriodicalId":426702,"journal":{"name":"Gastro – Open Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121088085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N figures for oesophagectomy mortality in the United Kingdom have been steadily dropping (12% to 9%) since the late 1990’s.1 More recently, these figures have improved significantly as shown in the 2016 annual report of the UK National Oesophago-Gastric Cancer Audit (NOGCA), revealing a post-oesophagectomy 90-day mortality rate of 3.2%.2 Despite this, surgical treatment for oesophageal cancer still carries significant morbidity, often quoted up to 64%.3 While centres of excellence maintain high standards of surgery and improved surgical techniques, with minimally invasive techniques potentially reducing physiological stresses on patients, we are perhaps being less conservative in our selection of patients for surgery; all having varying influences on the overall risks.
{"title":"The Role of Pre-Assessment in Oesophageal Cancer Surgery","authors":"N. Akotia, A. Charalabopoulos","doi":"10.17140/GOJ-3-E004","DOIUrl":"https://doi.org/10.17140/GOJ-3-E004","url":null,"abstract":"N figures for oesophagectomy mortality in the United Kingdom have been steadily dropping (12% to 9%) since the late 1990’s.1 More recently, these figures have improved significantly as shown in the 2016 annual report of the UK National Oesophago-Gastric Cancer Audit (NOGCA), revealing a post-oesophagectomy 90-day mortality rate of 3.2%.2 Despite this, surgical treatment for oesophageal cancer still carries significant morbidity, often quoted up to 64%.3 While centres of excellence maintain high standards of surgery and improved surgical techniques, with minimally invasive techniques potentially reducing physiological stresses on patients, we are perhaps being less conservative in our selection of patients for surgery; all having varying influences on the overall risks.","PeriodicalId":426702,"journal":{"name":"Gastro – Open Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124623721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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