Acta gastro-enterologica Belgica最新文献

Gastric volvulus is a rare entity which lacks evidence in the literature, characterized by the abnormal twisting or rotation of the stomach on itself of at least 180 degrees along its transverse or longitudinal axis. This rotation can lead to the obstruction of the stomach and interfere with its blood supply, causing a variety of symptoms and potentially serious complications. Some patients may be managed temporarily or definitively with conservative or endoscopic treatment, the latest including reduction and percutaneous gastropexy, but most patients benefit from surgery. The authors report three cases of gastric volvulus seen in a six-months period.

Background: Ectopic varices may develop anywhere in the abdomen except in the cardioesophageal junction and cause only 5% of all variceal bleeding. Considering the low prevalence of this disease, management is challenging and low-evidence based. By means of a case report, we reviewed literature on the treatment of ectopic varices using TIPS (Transjugular Intrahepatic Portosystemic Shunt).

Case presentation: A 65-year old patient presented to the emergency department with massive hematochezia and haemorrhagic shock. A CT angiography reported liver cirrhosis, a portal vein thrombosis (PVT) and colonic varices without active bleeding. The patient was transferred to the intensive care unit where colonoscopy confirmed the presence of ascending colonic varices with a red whale sign. He successfully underwent a TIPS placement and was discharged after five days from the hospital.

Conclusion: In this case, TIPS placement proved to be an effective treatment for ectopic variceal bleeding.

Background/aims: Assessment of esophageal emptying is important in the evaluation of patients with dysphagia. As several modalities can evaluate this, we aimed to compare two tests frequently used for assessing esophageal emptying-highresolution impedance manometry (HRiM) and timed barium esophagram (TBE).

Methods: A retrospective study compared the results of HRiM and TBE in patients with dysphagia between 2018 and 2022. Abnormal esophageal clearance was defined as ≥30% swallows with incomplete bolus clearance on HRiM and as residual barium ≥2 cm at 5 minutes on TBE.

Results: 77 patients were included in the study (mean age 51.6; 69% female). The most common HRiM diagnoses were normal motility (37.7%), ineffective esophageal motility (28.6%), and achalasia (19.5%). Effective esophageal clearance was noted on HRiM in only 44 subjects (57.1%), while it was seen on TBE in 57 subjects (74.0%)(P=0.027). There was agreement between the studies in 58 subjects (75.3%). Agreement was significantly affected by the HRiM diagnosis with the highest rate (86.7%) among achalasia patients (P=0.032). The only other factor correlated to agreement between the studies was a lack of alcohol use (P=0.048).

Conclusions: According to the parameters used in this study, TBE is more likely to reveal esophageal emptying than HRiM in patients with dysphagia. While there is fair agreement between the results of the two studies, results are especially concordant in achalasia patients suggesting that either study may be useful in evaluating esophageal emptying in that population.

The authors report the first adolescent (to our knowledge) in Belgium to receive duplimumab for eosinophilic esophagitis (EoE) and eosinophilic duodenitis (EoD). EoE was diagnosed in 2020 in a 13-year-old boy by endoscopy with biopsies following complaints of abdominal pain. Several treatments (omeprazole, topical steroids, and elemental diet) have been tried without adequate and sustained success. In 2023, in addition to the diagnosis of EoE, a diagnosis of mucosal EoD with significant ulceration was established. In January 2023, the EMA approved the use of dupilumab for EoE in children above the age of 12. Weekly subcutaneous dupilumab 300mg was started in November 2023. After three months, a complete endoscopic and histologic normalization of the esophagus and duodenum was achieved. He reported no further clinical signs or adverse events to date.

Background/objectives: Dieulafoy lesion (DL) is a rare yet potentially life-threatening cause of gastrointestinal bleeding. This study retrospectively analyzed all patients diagnosed with DL over the past two decades, focusing on clinical outcomes such as rebleeding and mortality. We aimed to identify factors associated with these outcomes to improve the understanding and management of this condition.

Materials/methods: This study included 39 hospitalized patients who underwent endoscopy for gastrointestinal bleeding and were diagnosed with Dieulafoy lesions. Data were collected retrospectively, and regression analysis was performed to assess factors associated with all-cause mortality and rebleeding rates.

Results: The study included 39 patients, with a mean age of 64 years; 13 (33%) were women. The most common presenting complaint was hematemesis (41%). The most common localization of DLs was the stomach, with 25 (64.1%) DLs detected. Rebleeding rates within one week and mortality within 90 days were 33% and 28%, respectively. In univariate analysis, esophageal localization (HR: 3.398, p = 0.042), low hemoglobin levels (HR: 0.758, p = 0.030), and high Glasgow- Blatchford score (HR: 1.179, p = 0.035) were associated with rebleeding. Duodenal localization was independently associated with higher mortality (HR: 27.276, p < 0.001), after adjusting for age, sex, and comorbidity index.

Conclusion: Dieulafoy lesions are most commonly found in the stomach but can also occur in atypical sites like the jejunum or hernia pouch. Enteroscopy is crucial for diagnosing and treating DLs, especially those in atypical small intestine locations. Lesion localization plays a key role in predicting both rebleeding and mortality rates.

Background and study aim: The gut-liver axis and gut microbiota, with a particular focus on Akkermansia muciniphila, a next-generation probiotic, have been identified as significant factors in preventing the development and progression of liver diseases. This review aims to discuss the potential therapeutic role of A. muciniphila in maintaining liver health, focusing on the latest findings from preclinical and clinical studies.

Methods: To achieve the review's purpose, the most common keywords were searched in three online databases (PubMed, bioRxiv, and Google Scholar).

Results: The search approach identified 49 references. Studies have shown that the gut microbiota, including A. muciniphila, has the potential to be a therapeutic target for many hepatic disorders. Several studies have demonstrated A. muciniphila's beneficial effects on improving metabolic parameters, including insulin resistance, blood cholesterol levels, and overall liver function.

Conclusions: Further research is necessary to determine the optimal dosage, duration, and administration route of A. muciniphila for managing hepatic disorders. While there are promising findings, a more thorough understanding of the underlying mechanisms and the development of effective therapeutic strategies are necessary for successful treatment of liver diseases.

Olmesartan is an angiotensin II receptor blocker (ARB) used for the management of hypertension. We report a case of Olmesartan-associated severe gastritis and enteropathy (OAE) in a 81-year-old female patient who presented with anorexia and weight loss. After discontinuation of the drug, her symptoms improved and follow-up gastroscopy showed endoscopic improvement. Histopathology showed a reduction of eosinophils and intraepithelial lymphocytosis, but a persisting increase in mast cells. Hence, systemic mastocytosis was excluded by further investigations. To our knowledge, this is the first case report of a patient with Olmesartan-associated severe gastritis with histopathological presence of mast cells. We conclude that mast cells, like eosinophils, could be druginduced, although systemic mastocytosis must be ruled out. Future studies should focus on the link between local mast cells and gastro-intestinal diseases.