Gastrointestinal Tract Involvement Research Articles

Acute Abdomen in the ERA of COVID 19: Case Series and Literature Review

The COVID-19 pandemic involved the globe and resulted in major mortalities mainly affecting the respiratory system. Initially thought to be respiratory disease it was later postulated and confirmed the involvement of gastro-intestinal tract (GIT) and its contribution to the complications and mortalities. Herein we present five cases of severe COVID-19 infection with GI involvement and their management with literature review.

I've looked at gut from both sides now: Gastrointestinal tract involvement in the pathogenesis of SARS-CoV-2 and HIV/SIV infections.

The lumen of the gastrointestinal (GI) tract contains an incredibly diverse and extensive collection of microorganisms that can directly stimulate the immune system. There are significant data to demonstrate that the spatial localization of the microbiome can impact viral disease pathogenesis. Here we discuss recent studies that have investigated causes and consequences of GI tract pathologies in HIV, SIV, and SARS-CoV-2 infections with HIV and SIV initiating GI pathology from the basal side and SARS-CoV-2 from the luminal side. Both these infections result in alterations of the intestinal barrier, leading to microbial translocation, persistent inflammation, and T-cell immune activation. GI tract damage is one of the major contributors to multisystem inflammatory syndrome in SARS-CoV-2-infected individuals and to the incomplete immune restoration in HIV-infected subjects, even in those with robust viral control with antiretroviral therapy. While the causes of GI tract pathologies differ between these virus families, therapeutic interventions to reduce microbial translocation-induced inflammation and improve the integrity of the GI tract may improve the prognoses of infected individuals.

A Fortunate Twist

Question: A 37-year-old Chinese woman was presented with a 1-day history of colicky central abdominal pain associated with 5 episodes of vomiting and diarrhea. It was the third day of her menstrual cycle. On examination, the abdomen had generalized distension without tenderness. There were no significant constitutional symptoms or family history of bowel malignancy, or personal history of inflammatory bowel disease. Her past medical and surgical history reveals a previous large left endometriotic cyst of 14 cm in 2010 for which she underwent a laparoscopic cystectomy, as well as primary subfertility for which she was undergoing her third cycle of in vitro fertilization (IVF) at the time of presentation. Initial blood investigations revealed elevated white cell count of 17,500/mm3, a normal hemoglobin of 15.4 g/dL, and borderline raised C-reactive protein of 36.2 mg/dL. Computed tomography scan of the abdomen and pelvis revealed small bowel obstruction with transition points at the terminal/distal ileum where enhancing intramural lesions has resulted in luminal narrowing and bulging at the ileocaecal junction (Figure A). There were also several small lesions indeterminate for peritoneal nodules. The patient was offered diagnostic laparoscopy with potential for laparotomy and bowel resection to relieve the obstruction. What do you think the final diagnosis was? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult. During diagnostic laparoscopy, hemorrhagic ascites was noted, which was sent for cytology. A decision was made to convert to a laparotomy in view of limited workspace due to the grossly dilated bowel loops. Intraoperative findings were significant for 2 lesions – 1 in the terminal ileum and the other in the ileocaecal valve (Figures B and C), causing small bowel obstruction. Three peritoneal nodules were noted, biopsied, and sent for histology (Figure D). A limited right hemicolectomy was performed to remove the lesions causing obstruction. The patient made a full recovery 6 days after surgery and was discharged well. Histology reports for both the peritoneal nodules and the right hemicolectomy specimen were consistent with endometriosis. Endometriosis is a common gynecologic condition where endometrium, which usually lines the uterine cavity, is found in other areas of the body. When endometrial tissue starts to grow in the ovaries or fallopian tubes, this may result in blockages in the fallopian tubes, which may form scar tissue and reduce the fertility of a woman. Such patients can be offered IVF. However, there is a potential risk of worsening endometriosis due to ovarian hyperstimulation syndrome.1Seyer-Hansen M. Egekvist A. Forman A. et al.Risk of bowel obstruction during IVF treatment of patients with deep infiltrating endometriosis.Acta Obstet Gynecol Scand. 2018; 97: 47-52Crossref PubMed Scopus (17) Google Scholar Although uncommon, gastrointestinal tract involvement by endometriosis can occur with 90% of lesions localized to the terminal ileum, sigmoid colon, or rectum. However, acute bowel obstruction as a complication of bowel endometriosis is rare and only accounts for <1% of most presentations.2De Ceglie A. Bilardi C. Blanchi S. et al.Acute small bowel obstruction caused by endometriosis: a case report and review of the literature.World J Gastroenterol. 2008; 14: 3430-3434Crossref PubMed Scopus (79) Google Scholar In this case vignette, the initial top differential was that of a neoplastic lesion with peritoneal metastases. In retrospect, endometriosis involving the gastrointestinal tract should have been considered as a differential diagnosis. The patient had a known history of endometriosis with history of colicky abdominal pain during menstruation that could well be related to intermittent subacute bowel obstruction caused by bowel endometriosis. The patient was also undergoing IVF, which could lead to ovarian hyperstimulation syndrome and increase symptoms related to endometriosis. Other rare manifestations of symptomatic endometriosis during IVF treatment include that of thoracic endometriosis as well as urogenital endometriosis, which can cause ureteral obstruction.3Ponticelli C. Graziani G. Montanari E. Ureteral endometriosis: a rare and underdiagnosed cause of kidney dysfunction.Nephron Clin Practice. 2010; 114: c89-c94Crossref PubMed Scopus (0) Google Scholar

Perforation and Fistula of the Gastrointestinal Tract in Patients With Necrotizing Pancreatitis: A Nationwide Prospective Cohort.

The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal (GI) tract in a large unselected cohort of patients with necrotizing pancreatitis. Perforation and fistula of the GI tract may occur in necrotizing pancreatitis. Data from large unselected patient populations on the incidence, risk factors, clinical outcomes, and treatment are lacking. We performed a post hoc analysis of a nationwide prospective database of 896 patients with necrotizing pancreatitis. GI tract perforation and fistula were defined as spontaneous or iatrogenic discontinuation of the GI wall. Multivariable logistic regression was used to explore risk factors and to adjust for confounders to explore associations of the GI tract perforation and fistula on the clinical course. A perforation or fistula of the GI tract was identified in 139 (16%) patients, located in the stomach in 23 (14%), duodenum in 56 (35%), jejunum or ileum in 18 (11%), and colon in 64 (40%). Risk factors were high C-reactive protein within 48 hours after admission [odds ratio (OR): 1.19; 95% confidence interval (CI): 1.01-1.39] and early organ failure (OR: 2.76; 95% CI: 1.78-4.29). Prior invasive intervention was a risk factor for developing a perforation or fistula of the lower GI tract (OR: 2.60; 95% CI: 1.04-6.60). While perforation or fistula of the upper GI tract appeared to be protective for persistent intensive care unit-admission (OR: 0.11, 95% CI: 0.02-0.44) and persistent organ failure (OR: 0.15; 95% CI: 0.02-0.58), perforation or fistula of the lower GI tract was associated with a higher rate of new onset organ failure (OR: 2.47; 95% CI: 1.23-4.84). When the stomach or duodenum was affected, treatment was mostly conservative (n=54, 68%). Treatment was mostly surgical when the colon was affected (n=38, 59%). Perforation and fistula of the GI tract occurred in one out of six patients with necrotizing pancreatitis. Risk factors were high C-reactive protein within 48 hours and early organ failure. Prior intervention was identified as a risk factor for perforation or fistula of the lower GI tract. The clinical course was mostly affected by involvement of the lower GI tract.

An Emerging Role for Neutrophil Extracellular Traps in IgA Vasculitis: A Mini-Review

Immunoglobulin A vasculitis (IgAV) is the most common systemic small vessel vasculitis in childhood. Its clinical manifestations are non-thrombocytopenic purpura, accompanied by gastrointestinal tract, joint, kidney and other organ system involvement. The pathogenesis of IgAV has not been fully elucidated. It may be related to many factors including genetics, infection, environmental factors, and drugs. The most commonly accepted view is that galactose-deficient IgA1 and the deposition of IgA and complement C3 in small blood vessel walls are key contributors to the IgAV pathogenesis. Extensive neutrophil extracellular traps (NETs) in the peripheral circulation and skin, kidney, and gastrointestinal tissue of patients with IgAV has been identified in the past two years and is associated with disease activity. This mini-review provides a possible mechanism for NETs involvement in the pathogenesis of IgAV.

Management of ruptured hepatocellular carcinoma invading the gastrointestinal tract: A case report.

Introduction and importanceHepatocellular carcinoma (HCC) constitutes most of primary liver cancers. HCC invading the gastrointestinal tract (GIT) is considered a rare entity with limited reports in the literature. Management can either be palliative or curative such as transarterial chemoembolization (TACE) followed by definitive resection. Here, we present a case of direct HCC invasion of the GIT that was managed by surgical resection.Case presentationA 74-year-old male with a history of a liver mass, found to have HCC. Admitted for medical optimization prior to definitive resection, however his stay was complicated by hemorrhagic shock, with imaging findings of hemoperitoneum suggestive of spontaneous rupture of the mass. TACE was done to stabilize the patient prior to resection. Patient was taken immediately to the operating room for definitive resection.Clinical discussionMost cases of direct HCC invasion into the GI tract present mainly with GI bleed. Some patients, present with abdominal pain without any warning signs of an occult GI bleed. Thus, absence of an occult GI bleeding does not exclude a GIT invasion. Management options are several, but in advanced stages, management is not limited to palliation.ConclusionGIT invasion is a rare complication of HCC reported in scarcity in the literature. Most cases present with GI bleeding but with some rare cases, they present with more generalized symptoms like abdominal pain, weight loss or fatigue. Despite having a poor prognosis, complete surgical resection of the tumor may be a reassuring and life prolonging treatment option for these patients.

Langerhans cell histiocytosis presenting as a submucosal solitary colonic lesion: A case report and review of the literature

AbstractLangerhans cell histiocytosis (LCH) is a rare histiocytic neoplasm. The clinical presentation and the disease extension are variable. LCH may involve a single site, multiple sites within a single system, or multiple systems. Gastrointestinal tract involvement is rare and most often observed in children with multisystem disease. Adult patients with gastrointestinal tract involvement are extremely rare, and only a few cases have been reported. We present a 45‐year‐old man with LCH presenting as a submucosal solitary colonic lesion.

Атипичный гемолитико-уремический синдром: клиническая картина, диагностика и лечение

Atypical hemolytic-uremic syndrome (aHUS) is a rare disease caused by uncontrolled activation of the alternative complement pathway and characterized by acute kidney injury, thrombocytopenia, and microangiopathic hemolytic anemia. Up to one third of aHUS patients present with extrarenal manifestations including central nervous system, lung, liver, and gastrointestinal tract involvement. Identified triggers of aHUS include various complement activating disorfers, e.g. complicated pregnancy. Eculizumab, the terminal complement C5 inhibitor, is targeted treatment approved for patients with aHUS. The authors present two cases of aHUS and review its clinical presentation, diagnosis and treatment.

Behçet's disease with intestinal involvement: case-based review.

Behçet's disease (BD) is a rare (especially in East Europe, Ukraine) systemic vasculitis of blood vessels of varying calibers throughout the body that affects various organs. The variability of the clinical features requires the involvement of doctors of different specialties in the management of such patients. The work was aimed to conduct a literature review of the intestine involvement and skin lesions in BD based on the clinical case with bloody diarrhea at the onset, and to assess the frequency of development of various clinical syndromes in intestinal BD. This is an attempt at describing a manifestation of BD with colitis and to emphasize the necessary revision of BD diagnostic criteria with special attention to early manifestations of BD with gastrointestinal tract involvement.

Increased Demand for Therapeutic Drugs in Pediatric Ulcerative Colitis Patients With Extraintestinal Manifestations.

BackgroundUlcerative colitis (UC) is a systemic inflammatory disease with a gut predominance, which may involve other organs. The presence of extraintestinal manifestation (EIM) is an important symptom for clinicians as it alters the treatment decisions. In this study, we aimed to evaluate the initial clinical presentation and disease severity of pediatric UC patients with EIMs.MethodsOne hundred forty-two patients under the age of 18 years who were diagnosed with UC from January 2003 to November 2021 were included in this study. Forty-seven patients with confirmed EIMs and 95 patients without EIMs were divided into two groups and their differences were analyzed.ResultsThe most common EIM was peripheral arthritis. The disease extent at the time of diagnosis shows a higher rate of pancolitis in the EIM-positive group (65.9%) than that of the EIM-negative group (33.7%) (p < 0.001). More than 90% of EIM-positive patients had moderate to severe disease activity on the Mayo endoscopic subscore. In the EIM-positive group, the cumulative use of systemic steroids, immunosuppressants, and biological agents from diagnosis to 1 year follow-up were significantly higher than those of the EIM-negative group (p = 0.009, 0.001, and < 0.001, respectively). About 80% of patients in the EIM-negative group reached remission, but only about 50% of the EIM-positive patients reached remission (p = 0.005). The relapse occurred more frequently in the EIM-positive group than in the EIM-negative group with statistical significance (p < 0.001).ConclusionPediatric UC with EIMs had higher disease severity and often manifested upper gastrointestinal tract involvement. Despite EIMs treatment, the occurrence of new EIMs was observed repeatedly. Cumulative drug demand (steroids, immunosuppressants, and biological agents) for the treatment increased steadily over time, and frequent relapses occurred despite the combinatory use of therapeutic drugs.

Gastrointestinal Manifestations of Immunodeficiency: Imaging Spectrum.

There is a wide spectrum of hereditary and acquired immunodeficiency disorders that are characterized by specific abnormalities involving a plethora of humoral, cellular, and phagocytic immunologic pathways. These include distinctive primary immunodeficiency syndromes due to characteristic genetic defects and secondary immunodeficiency syndromes, such as AIDS from HIV infection and therapy-related immunosuppression in patients with cancers or a solid organ or stem cell transplant. The gut mucosa and gut-associated lymphoid tissue (the largest lymphoid organ in the body), along with diverse commensal microbiota, play complex and critical roles in development and modulation of the immune system. Thus, myriad gastrointestinal (GI) symptoms are common in immunocompromised patients and may be due to inflammatory conditions (graft versus host disease, neutropenic enterocolitis, or HIV-related proctocolitis), opportunistic infections (viral, bacterial, fungal, or protozoal), or malignancies (Kaposi sarcoma, lymphoma, posttransplant lymphoproliferative disorder, or anal cancer). GI tract involvement in immunodeficient patients contributes to significant morbidity and mortality. Along with endoscopy and histopathologic evaluation, imaging plays an integral role in detection, localization, characterization, and distinction of GI tract manifestations of various immunodeficiency syndromes and their complications. Select disorders demonstrate characteristic findings at fluoroscopy, CT, US, and MRI that permit timely and accurate diagnosis. While neutropenic enterocolitis affects the terminal ileum and right colon and occurs in patients receiving chemotherapy for hematologic malignancies, Kaposi sarcoma commonly manifests as bull's-eye lesions in the stomach and duodenum. Imaging is invaluable in treatment follow-up and long-term surveillance as well. Online supplemental material is available for this article. ©RSNA, 2022.

Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview.

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. These complications can cause significant morbidity and negatively impact the quality of life for IBD patients. Although the pathogenesis of EIMs is not clearly elucidated, it is postulated that the diseased GI mucosa similarly stimulates excess immune responses at the extraintestinal sites. Cutaneous EIMs occur in up to 15% of patients with IBD, often predating their IBD diagnosis. They are categorized into (1) specific, (2) reactive, (3) associated, and (4) treatment-induced. Here, we review the epidemiological, clinical, diagnostic, and histologic features of the most commonly described cutaneous EIMs of IBD along with their respective treatment options.

Extrarenal manifestations of systemic vasculitis in children

The observation data of 22 children with systemic vasculitis (SV) and morphologically verified nephritis is presented. Emphasis was put on extrarenal manifestations of SV in childhood, analysis of clinical, laboratory, immunological, morphological changes and factors influencing on the course and prognosis. It has been established that SV often manifests with general non-specific constitutional symptoms, involvement of the ENT and organs of vision, is characterized by multiple organ and generalized lesions, in 77% of cases in children is associated with anti-neutrophil cytoplasmic antibodies (ANCA). The presence of antibodies to myeloperoxidase (MPO) is noted in most patients with lesions of the skin, joints, lungs, and nervous system and is associated with an unfavorable renal prognosis. ENT and organs of vision, gastrointestinal tract involvement is equally often observed in both MPO and PR3 antibody positive.

International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature

Substantial heterogeneity in terminology used for eosinophilic gastrointestinal diseases (EGIDs), particularly the catchall term "eosinophilic gastroenteritis," limits clinical and research advances. We aimed to achieve an international consensus for standardized EGID nomenclature. This consensus process utilized Delphi methodology. An initial naming framework was proposed and refined in iterative fashion, then assessed in a first round of Delphi voting. Results were discussed in 2 consensus meetings, and the framework was updated and reassessed in a second Delphi vote, with a 70% threshold set for agreement. Of 91 experts participating, 85 (93%) completed the first and 82 (90%) completed the second Delphi surveys. Consensus was reached on all but 2 statements. "EGID" was the preferred umbrella term for disorders of gastrointestinal (GI) tract eosinophilic inflammation in the absence of secondary causes (100% agreement). Involved GI tract segments will be named specifically and use an "Eo" abbreviation convention: eosinophilic gastritis (now abbreviated EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The term "eosinophilic gastroenteritis" is no longer preferred as the overall name (96% agreement). When &gt;2 GI tract areas are involved, the name should reflect all of the involved areas. This international process resulted in consensus for updated EGID nomenclature for both clinical and research use. EGID will be the umbrella term, rather than "eosinophilic gastroenteritis," and specific naming conventions by location of GI tract involvement are recommended. As more data are developed, this framework can be updated to reflect best practices and the underlying science.

Symptoms related to gastrointestinal tract involvement and low muscularity in systemic sclerosis

Introduction/objectivesGastrointestinal tract (GIT) involvement is frequently observed in systemic sclerosis (SSc) and may lead to nutritional impairment. The aim of the study was to assess the prevalence of symptoms related to GIT involvement and to analyze the possible association between gastrointestinal symptoms and low muscularity in SSc patients.MethodsSixty-nine consecutive patients (60 females, median age 53 (IQR 43–63), body mass index (BMI) 23.2 (IQR 20.9–24.6) kg/m2) with diagnosis of SSc admitted to our Scleroderma Unit were enrolled. Clinical status, anthropometric data, and bioelectrical impedance (Inbody 770, USA) analysis-assessed Fat-Free Mass Index (FFMI) were recorded upon enrollment. UCLA questionnaire was used to quantify GIT involvement with seven specific scales.ResultsMean FFMI was 16.2 kg/m2 (IQR 15.2–17.6). The median UCLA total score was 0.53 (IQR 0.19–0.89). FFMI showed a significant negative correlation with UCLA total score (r = −0.29, p = 0.016) and UCLA distention/bloating (r = −0.35, p < 0.01). In 16 patients (23.1%), FFMI was reduced and UCLA distention/bloating was significantly higher (p = 0.039) in SSc patients with lower FFMI [1.75 (IQR 0.75–2.12) vs 0.75 (IQR 0.25–1.75)]. At multiple linear regression model, FFMI showed association with UCLA distention/bloating [beta coefficient − 0.315 (95% CI of beta coefficient: −0.591; −0.039), p = 0.026], BMI [beta coefficient 0.259 (95% CI of beta coefficient: 0.163; 0.355), p = 0.001], and disease duration [beta coefficient − 0.033 (95% CI of beta coefficient: −0.059; −0.007), p = 0.015].ConclusionsIn SSc, low FFMI is associated with symptoms related to GIT involvement, in particular with distension/bloating.Key Points• FFMI is associated with symptoms related to GIT involvement.• Low FFMI is associated with symptoms related to UCLA distention/bloating.• Malnutrition is not associated with symptoms related to GIT involvement.

Evaluation and Management Strategies for GI Involvement with Amyloidosis

Amyloidosis is a heterogeneous disease that can cause a wide array of nonspecific symptoms when the gastrointestinal (GI) tract is involved, including weight loss, early satiety, change in bowel habits with diarrhea, constipation, or alternating bowel pattern. Endoscopy with biopsy for Congo red staining establishes the diagnosis and fibril subtyping helps to guide targeted treatment options. Light chain amyloidosis is the most frequent subtype found throughout the GI tract. Transthyretin amyloidosis is most likely to be found on rectal biopsy. Management of the symptoms of GI tract involvement with amyloidosis relate to addressing the underlying symptom complex that is produced and generally abstracted from the management of severe forms of functional GI disorders. Attention to improving symptom management and nutrition status can improve quality of life in these patients.

Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement.

Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5pg/ml; p = 0.076). Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.

Diagnosis of metastatic angiosarcoma of the aorta in colonic lesion biopsies.

Angiosarcomas are rare tumors that usually entail a poor prognosis because of extensive invasiveness and high rates of distant metastasis. Gastrointestinal tract involvement is uncommon but may cause digestive bleeding. A definitive diagnosis requires histological and immunohistochemical testing. Metastatic lesions to the gut usually have a typical morphology, which must be identified in order to avoid delay in the diagnosis and potential treatment of this malignant condition.

Sarcoidosis diagnosed by a tiny esophageal lesion:a case report

A woman in her 60s was referred to the Department of Gastroenterology with anemia. She had a recurrent transient loss of consciousness 11 years ago, and she was examinated at the cardiology and neurology departments, but the cause was not identified. Epileptic seizures were suspected. Sodium valproate medication was started, and the patient's condition progressed with no recurrence. Esophagogastroduodenoscopy showed a tiny submucosal tumor-like lesion with mild depression in a 21cm thoracic esophagus. Biopsy revealed epithelioid granulomas with multinucleated giant cells in the subepithelial stroma. Computed tomography (CT), positron emission tomography-computed tomography (PET-CT), and magnetic resonance imaging (MRI) showed multiple lesions in the hilar lymph nodes, spleen, and heart that are typical of sarcoidosis. These findings led to the diagnosis of esophageal lesion associated with sarcoidosis. The patient had no subjective symptoms;however, treatment with prednisolone 30mg was started because cardiac sarcoidosis is a risk of death. Gastrointestinal tract involvement in sarcoidosis is rare;esophageal sarcoidosis is particularly rare, and there are few reports on superficial lesions. Here, we report a case of sarcoidosis that was diagnosed from a tiny esophageal lesion.

Minireview: Peripheral Nesfatin-1 in Regulation of the Gut Activity-15 Years since the Discovery.

Simple SummaryNesfatin-1 is a newly identified molecule derived from the precursor protein NEFA/nucleobindin2. In this minireview we analyzed the research on the nesfatin-1 localization in the gastrointestinal tract of the mammals. We also referred to the effects of the protein on disorders in the gastrointestinal tract.Nesfatin-1, discovered in 2006, is an anorexigenic molecule derived from the precursor protein NEFA/nucleobindin2. It is generally postulated that this molecule acts through a specific G protein-coupled receptor, as yet unidentified. Research conducted over the last 15 years has revealed both central and peripheral actions of nesfatin-1. Given its major central role, studies determining its inhibitory effect on food intake seem to be of major scientific interest. However, in recent years a number of experiments have found that peripheral organs, including those of the gastrointestinal tract (GIT), may also be a source (possibly even the predominant source) of nesfatin-1. This mini-review aimed to summarize the current state of knowledge regarding the expression and immunoreactivity of nesfatin-1 and its possible involvement (both physiological and pathological) in the mammalian GIT. Research thus far has shown very promising abilities of nesfatin-1 to restore the balance between pro-oxidants and antioxidants, to interplay with the gut microbiota, and to alter the structure of the intestinal barrier. This necessitates more extensive research on the peripheral actions of this molecule. More in-depth knowledge of such mechanisms (especially those leading to anti-inflammatory and anti-apoptotic effects) is important for a better understanding of the involvement of nefatin-1 in GIT pathophysiological conditions and/or for future therapeutic approaches.