Hemorrhagic Gastritis Research Articles

삼백초 에탄올 추출물의 위출혈성 스트레스 위염 억제 효과

In this study, gastritis inhibitory substance was ethanol-extracted from Saururus chinensis in order to examine the effect as a part of natural bioactive substance research. In an oral administration experiment, S. chinensis was administered at doses of 0.25 g/kg B.W. to 2 g/kg B.W., resulting in stabilization at 1.5 g/kg B.W. and an LD50 of 1.81 g/kg B.W. In a chronic toxicity experiment, 0.5 g/kg B.W. of S. chinensis was administered for 13 weeks, but toxicity was not observed. S. chinensis ethanol-extracts were administered at a concentration of 250 or 500 mg/kg B.W. before induction of gastritis. Gastrorrhagia, stomach edema, cytokine production, and cell damage were reduced in a concentration-dependent manner. Therefore, S. chinensis ethanol extracts inhibit cell damage by stress-induced hemorrhagic gastritis in a concentration-dependent manner via inhibition of cytokine expression.

Epidemiologia e distribuição de lesões extrarrenais de uremia em 161 cães

Resumo: Com o objetivo de determinar a epidemiologia e as características morfológicas, incluindo a localização anatômica, das lesões extrarrenais de uremia, bem como determinar as principais lesões do sistema urinário associadas à ocorrência de uremia, foram revisados os protocolos de necropsias de cães realizadas no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria de janeiro de 1996 a dezembro de 2012 (17 anos). Nesse período foram necropsiados 4.201 cães, sendo que 161 (3,8%) apresentaram lesões extrarrenais de uremia. Em 134 cães (83,2%) foram descritos sinais clínicos associados à uremia. As lesões extrarrenais mais frequentes, em ordem decrescente, foram: gastrite ulcerativa e hemorrágica (56,5%), mineralização de tecidos moles (55,9%), edema pulmonar (47,2%), estomatite e/ou glossite ulcerativa (30,4%), endocardite/trombose atrial e aórtica (28,6%), hiperplasia das paratireoides (9,3%), osteodistrofia fibrosa (8,1%), anemia (6,2%), laringite ulcerativa (5%), enterite ulcerativa/hemorrágica (3,7%), esofagite fibrinonecrótica (1,9%) e pericardite fibrinosa (1.9%). Na maioria dos casos as lesões extrarrenais de uremia foram decorrentes de azotemia prolongada por lesões renais graves, sendo as mais prevalentes a nefrite intersticial e a glomerulonefrite.

Asymptomatic esophageal varices in a case of pseudoxanthoma elasticum

Asymptomatic esophageal varices in a case of pseudoxanthoma elasticum

A Case of Varicella Zoster Hemorrhagic Gastritis

Introduction: Hemorrhagic gastritis secondary to Varicella zoster virus (VZV) is rarely identified in immunocompromised patients, and we report such a case from our experience. An 82-year-old female with chronic lymphoid leukemia receiving chemotherapy, presented with 1 week of anorexia, abdominal pain, nausea and vomiting. Lab evaluation was significant only for thrombocytopenia, and abdominal CT scan was unrevealing. Her symptoms persisted despite hydration and pain control, and on hospital day 5 she developed worsening thrombocytopenia with transaminemia and leukocytosis. Viral hepatitis panel including HSV, CMV and EBV was negative, as was an abdominal ultrasound with doppler. An upper endoscopy performed to evaluate her symptoms revealed small, hemorrhagic, irregular shallow ulcerations and erosions throughout the stomach (Figure 1A). A diffuse vesicular rash developed on hospital day 10, and acyclovir was initiated empirically. Multi-organ failure rapidly ensued, and care was withdrawn. The endoscopic biopsies later revealed epithelial hemorrhage, ischemia and nuclear viral inclusions with a strongly positive immunohistochemical stain for VZV, consistent with acute hemorrhagic gastritis due to VZV (Figure 1B). Viral swab of a skin lesion was positive for VZV by PCR.Figure 1: (A) Hemorrhagic, ecchymotic shallow ulcerations and erosions with exudate. (B) Immunohistochemical stain for VZV demonstrates diffuse and strong positivity within viral inclusions.Discussion: To our knowledge, this is one of a few cases of VZV hemorrhagic gastritis confirmed by endoscopic biopsy and PCR of cutaneous lesions. Reactivation of VZV is common in immunocompromised patients, usually presenting as a cutaneous eruption of vesicles. Rarely, visceral and gastric involvement can occur, usually concurrent with a hematologic malignancy and disseminated cutaneous involvement. The vesicular eruption can be absent initially and be first observed up to 10 days after abdominal symptoms develop. Presentation of visceral VZV is non-specific and may be characterized by nausea, vomiting, and abdominal pain with possible development of gastrointestinal hemorrhage, pancreatitis and hepatitis. While endoscopic evaluation is often unrevealing, gastrointestinal mucosal involvement can occur in the form of gastric ulcerations or punctate hemorrhages. Treatment is with antivirals. A high clinical suspicion is important to recognize this condition early in the proper clinical setting, as mortality rate can be 40-50%.

A Rare Case of Hemorrhagic Gastritis Caused By Sevelamer-Induced Necrosis

Case Report: A 64 year-old-male with history of ESRD, currently on hemodialysis presented with chief complain of nausea, bloody emesis and diffuse abdominal pain. His home medications were aspirin, hydralazine, gabapentin and sevelamer (4000 mg TID). He denied any history of NSAID use. On presentation, he was febrile, tachycardic and hypotensive. His labs were remarkable for Hb of 7.8, WBC of 10.3 and Cr of 7.7. The patient was resuscitated with normal saline and 1 unit of PRBC. CT abdomen showed pneumatosis with intramural air in the gastric fundus (Figure 1) Upper endoscopy revealed diffuse, severely friable mucosa in the gastric body, biopsy of which revealed pale yellow sevelamer crystals (Figure 2) deposited in the lamina propria of the body of the stomach. Sevelamer was discontinued and he was started on a low phosphate diet and a proton pump inhibitor. He was also advised to obtain a repeat EGD in 1 month.Figure 1: Pneumatosis with intramural air in posterior wall of the fundus of the stomach.Figure 2: Hematoxylin and eosin stain of ulcer bed with sevelamer crystals.Discussion: Sevelamer is anion exchange resin used to treat hyperphosphatemia in patients with ESRD. On hematoxylin and eosin stain, the crystals are 2-toned in appearance with bright pink accentuations on a rusty yellow background. There is very little literature on the mechanism of sevelamer mediated gastric mucosal injury. Sodium polysyterene sulfonate, a cation exchange resin used to treat hyperkalemia, is known to cause mucosal ischemia and ulceration by direct toxicity. Being an exchange resin, it is likely that sevelamer crystals cause mucosal injury by a similar mechanism of direct toxicity. To our knowledge, this is the first reported case of hemorrhagic gastritis due to sevelamer induced necrosis in the literature.

Successful treatment of intractable bleeding caused by radiation-induced hemorrhagic gastritis using oral prednisolone: a case report.

Radiation-induced hemorrhagic gastritis is an intractable and dangerous condition. We describe a 59-year-old female patient with radiation-induced hemorrhagic gastritis. The patient underwent postoperative radiation therapy with a dose of 54 Gy in 30 fractions after a radical operation for a Klatskin tumor. Radiation volume included the gastric antrum. Approximately three months after radiation therapy, she was admitted for melena and anemia. Esophagogastroduodenoscopy showed an area of bleeding in the gastric antrum that was so diffuse that effective laser coagulation was not feasible. After failure of various treatments and transfusion of 7,040 mL of packed red blood cells, we successfully stopped the hemorrhage using oral prednisolone treatment. Based on this case, we think that oral prednisolone treatment can be tried as a first treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.

Abstract 209: The Safety of Emergent Bedside Gastrointestinal Endoscopy in Patients with Moderate and Severe Aortic Stenosis in the Cardiac Intensive Care Unit

Purpose: Recent advances in the management of aortic stenosis (AS) including the availability of percutaneous valve therapies have resulted in the evaluation of patients with increased co-morbidities. AS is associated with an increased risk of Gastrointestinal (GI) bleeding which is further increased by antithrombotic and antiplatelet treatment that often accompany hospitalization. The aim of our study was to determine the safety of emergent bedside endoscopies in patients with moderate to severe AS in the Cardiac Intensive Care Unit (CICU) setting presenting with acute GI bleeding. Objective and Methods: We identified all patients with moderate to severe AS who were admitted to the CICU at the Cleveland Clinic and experienced GI bleeding requiring emergent bedside endoscopies between Jan 2011 and Jan 2013. Data collection included demographics, indication for admission to the CICU, indication for bedside endoscopy, etiologies of GI bleeding, and intra procedural as well as post procedural hemodynamic instability and respiratory distress. AS was defined as moderate for aortic valve area (AVA) in the range 1.5-1.00 cm square and severe for AVA < 1.00 cm square. Result: 17 patients (10 males) with a mean age 78.4 ± 10.6 years were identified. Overall 4 patients had moderate AS while 13 had severe AS. The peak gradient across the aortic valve was 53.8 ± 24.8 with a mean AVA 0.74 ± 0.25 cm square. Indication for urgent bedside endoscopies included episodes of acute melena, hematemesis, acute anemia of an undetermined etiology, in addition to evaluation of acute anemia in the perioperative period. 88% of patients were on either antiplatelet or anticoagulation or both. The patients underwent a total of 20 bedside endoscopies: 16 upper endoscopies and 4 colonoscopies. IV fentanyl and midazolam were used for sedation in patients not previously intubated. The etiologies of GI bleeding were peptic ulcer disease (n=5), hemorrhagic gastritis (n=5), esophagitis with esophageal ulcer (n=3), GI angiodysplasias (n=3), and diverticulitis (n=1). None of the patients developed acute hemodynamic instability or acute respiratory distress during or after the endoscopy. Conclusion: The etiologies of acute bleeding in patients with AS are diverse. Emergent bedside GI endoscopies done in the CICU for the diagnosis and management of acute GI bleeding is a safe procedure in patients with moderate to severe AS.

Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations.

Gastrointestinal problems are common, especially in endurance athletes, and often impair performance or subsequent recovery. Generally, studies suggest that 30–50 % of athletes experience such complaints. Most gastrointestinal symptoms during exercise are mild and of no risk to health, but hemorrhagic gastritis, hematochezia, and ischemic bowel can present serious medical challenges. Three main causes of gastrointestinal symptoms have been identified, and these are either physiological, mechanical, or nutritional in nature. During intense exercise, and especially when hypohydrated, mesenteric blood flow is reduced; this is believed to be one of the main contributors to the development of gastrointestinal symptoms. Reduced splanchnic perfusion could result in compromised gut permeability in athletes. However, although evidence exists that this might occur, this has not yet been definitively linked to the prevalence of gastrointestinal symptoms. Nutritional training and appropriate nutrition choices can reduce the risk of gastrointestinal discomfort during exercise by ensuring rapid gastric emptying and the absorption of water and nutrients, and by maintaining adequate perfusion of the splanchnic vasculature. A number of nutritional manipulations have been proposed to minimize gastrointestinal symptoms, including the use of multiple transportable carbohydrates, and potentially the use of nutrients that stimulate the production of nitric oxide in the intestine and thereby improve splanchnic perfusion. However, at this stage, evidence for beneficial effects of such interventions is lacking, and more research needs to be conducted to obtain a better understanding of the etiology of the problems and to improve the recommendations to athletes.

Comparison of Fecal Occult Blood Tests for Colorectal Cancer Screening in an Alaska Native Population With High Prevalence ofHelicobacter pyloriInfection, 2008–2012

IntroductionAlaska Native colorectal cancer (CRC) incidence and mortality rates are the highest of any ethnic/racial group in the United States. CRC screening using guaiac-based fecal occult blood tests (gFOBT) are not recommended for Alaska Native people because of false-positive results associated with a high prevalence of Helicobacter pylori-associated hemorrhagic gastritis. This study evaluated whether the newer immunochemical FOBT (iFOBT) resulted in a lower false-positive rate and higher specificity for detecting advanced colorectal neoplasia than gFOBT in a population with elevated prevalence of H. pylori infection.MethodsWe used a population-based sample of 304 asymptomatic Alaska Native adults aged 40 years or older undergoing screening or surveillance colonoscopy (April 2008–January 2012).ResultsSpecificity differed significantly (P < .001) between gFOBT (76%; 95% CI, 71%–81%) and iFOBT (92%; 95% CI, 89%–96%). Among H. pylori-positive participants (54%), specificity of iFOBT was even higher (93% vs 69%). Overall, sensitivity did not differ significantly (P = .73) between gFOBT (29%) and iFOBT (36%). Positive predictive value was 11% for gFOBT and 32% for iFOBT.ConclusionThe iFOBT had a significantly higher specificity than gFOBT, especially in participants with current H. pylori infection. The iFOBT represents a potential strategy for expanding CRC screening among Alaska Native and other populations with elevated prevalence of H. pylori, especially where access to screening endoscopy is limited.

Upper Digestive Endoscopic Lesions in Chronic Kidney Disease (CKD): Experience of a Senegalese Center; About 50 Cases

Objectives: This study was conducted to evaluate upper digestive endoscopic lesions among patients with chronic kidney disease. Methodology: We conducted a retrospective cross-sectional study in Nephrology and Gastroenterology services at Hospital Center University Aristide Le Dantec from January 2008 to December 2009. All patients with chronic kidney disease who underwent an upper gastrointestinal endoscopy were included. Results: Fifty patients were included, with a mean age of 44.2 years and a sex ratio (male/female) of 1.27. Upper digestive endoscopy was abnormal in 76%. Peptic esophagitis was noted in 7 patients, hiatal hernia in 10 and cardial incontinence in 2. Congestive gastritis was observed in 6 cases, followed by erosive and hemorrhagic gastritis in 5 cases each one and a gastric ulcer in 2. Six patients presented a bulbitis, which was erosive in 3, congestive in 2 and 1 of the large folds. Bulbar ulcer was noted in 3 patients and post bulbar ulcer was also noted in 3 patients. One patient presented a congestive duodenitis. Conclusion: Upper digestive endoscopy lesions are frequent and diverse among patients with chronic kidney disease. These finding justify the systematization of upper digestive endoscopy in digestive complaining uremic patients.

Gastroduodenal pathology in patients with asymptomatic gallbladder stones.

Gallbladder stones are still a common pathology worldwide, and the number of patients diagnosed without any symptoms is increasing due to the use of ultrasound and imaging tools such as CT and MRI. The aim of this study was to identify gastroduodenal pathologies in patients with diagnosed asymptomatic gallbladder stones, since some cases of epigastric pain may have led to unnecessary cholecystectomies. Gastroscopic investigations were performed in 33 patients diagnosed with asymptomatic gallbladder stones during a gallstone screening program in Chiang Mai, Thailand, and followed-up with yearly ultrasound examinations. The mean age of the patients was 56.6 years, and mean follow-up time was 2.3 years. Our results showed that inflammatory-based gastroduodenal lesions in this group were common (15/33 patients, 45.4%). Lesions included gastric ulcers (1 patient, 3%), duodenal ulcers (5 patients, 15.1%), and gastroduodenal ulcers (2 patients, 6.1%). Almost all of the ulcers were in the healing or scarring stage. Inflammatory-based mucosal changes were also detected in these patients as follows: erosive gastritis (6 patients, 18.2%) and hemorrhagic gastritis (1 patient, 3%). Inflammatory-based gastroduodenal pathologies such as peptic ulcers and gastritis are common in patients with asymptomatic gallstones. If such patients become symptomatic, meticulous examinations are needed to avoid unnecessary cholecystectomies and resulting complications such as postcholecystectomy syndrome. The theory that gastroduodenal lesions occur after gallbladder removal needs to be re-evaluated given that lesions can be detected before surgery and even before the occurrence of symptoms.

Multiple Organ Damage Due to Boric Acid Toxicity

Background: Boric acid (BA) is commonly used as pesticide, disinfectant and wood preservative. Its ingestion can cause serious organ damages resulting in death. Case report: A 19 year old man was found dead with two empty packs of BA tablets in vicinity of his body. On autopsy examination, brownish stains along with right angle of mouth and right nostril were found. Stomach was damaged with hemorrhagic gastritis. All internal organs including liver, kidney, spleen and brain were congested. The toxicological analysis of viscera confirmed boron ion toxicity. Discussion: Boric acid is a moderately toxic compound that is a mucosal corrosive agent affecting upper respiratory and gastrointestinal tracts. It can also act as a generalized cellular poison, and thus all end organs including liver, kidneys, brain and gastrointestinal tract are prone to its toxicity. Massive BA poisoning mostly occurs in adults as a result of suicide attempt. Early aggressive hydration and hemodialysis can prevent its mortality. Conclusion: A dead body with erythematous rash, redness of skin, bluish green color of vomitus and fecal matter, corrosive changes in oral and nasal cavity and multiple organ damages can be highly suggestive of BA poisoning. How to cite this article: Rani M, Meena MC. Multiple Organ Damage Due to Boric Acid Toxicity. Asia Pac J Med Toxicol 2013;2:157-9.

Healing of Recalcitrant Radiation-Induced Hemorrhagic Gastritis Achieved after Bone Marrow Recovery

Healing of Recalcitrant Radiation-Induced Hemorrhagic Gastritis Achieved after Bone Marrow Recovery

Infection disséminée au virus varicelle-zona avec gastrite hémorragique compliquant une leucémie lymphoïde chronique : une observation et revue de la littérature

IntroductionThe reactivation of varicella-zoster virus occurs in immunocompromised patients, especially in cases of hematological malignancy. Disseminated reactivation could involve digestive tract with life-threatening condition. Case reportA 76-year-old woman, with a history of chronic lymphocytic leukemia, presented with left hypochondrium pain, and a vesicular rash with hemorrhagic shock that revealed an hemorrhagic gastritis due to varicella-zoster virus. The literature review identified 28 additional cases of gastrointestinal mucosal damage during reactivation of varicella-zoster virus. Mortality is 40%. We report here the first case in the course of low-grade lymphoid malignancy. ConclusionAcute gastrointestinal symptoms in immunocompromised patients should evoke a varicella-zoster virus reactivation with gastrointestinal involvement. This clinical manifestation, although rare, should not be ignored because of its severity.

6. Overview of GI indications and cryo technology via flexible endoscopy

Since the mid-1960s, Cryotherapy was a technique in search of an indication for gastrointestinal diseases. In those early days, Cryotherapy although hampered by technical challenges was advocated for treating duodenal ulcers, gastric erosions, and hemorrhagic gastritis. By this time, Cryotherapy was showing great promise in other clinical areas such as dermatologic and prostatic conditions. Despite this initial enthusiasm, the results of clinical trials for these conditions were disappointing and when added to challenges of technically delivering freezing therapy to the gastrointestinal tract, Cryotherapy was soon forgotten as a modality to treat gastrointestinal disease. However the groundbreaking work by Pasricha and colleagues from Johns Hopkins in 1999 described for the first time an endoscopic device that was capable of delivering freezing therapy to the gastrointestinal mucosa. These initial experiments performed in an animal model demonstrated the feasibility of Cryotherapy with a compressed gas. This was soon followed by experiments demonstrating the feasibility of using low pressure liquid nitrogen by an endoscopic catheter. The initial clinical trials focused on diseases that would respond to ablating the superficial mucosa such bleeding arteriovenous malformations, radiation gastritis and proctitis and Barrett’s esophagus. Using Cryotherapy for palliation of advanced gastrointestinal tumors has shown success in case reports but has been less well studied. Two different techniques have evolved for delivering Cryotherapy. The initially described technique used compressed gas such as nitrous oxide and CO 2 . Rapid expansion of the gases results in a significant drop in local temperature enabling cryogenic damage to the mucosa. The second technique involves direct application of low pressure liquid nitrogen to the mucosa. The techniques appear to have similar efficacy. Although lacking in prospective randomized trials, endoscopic Cryotherapy is a promising modality for the treatment of gastrointestinal mucosal disease.

Treatment of patients with metastatic renal cell carcinoma undergoing hemodialysis: case report of two patients and short literature review

BackgroundRenal cell carcinoma (RCC) may involve both kidneys. When bilateral nephrectomy is necessary renal replacement therapy is mandatory. Treating such patients with sequential therapy based on cytokines, antiangiogenic factors and mammalian target of rapamycin (mTOR) inhibitors is challenging.Case presentationThe first case, a 50-year-old Caucasian female, underwent a radical right nephrectomy for RCC. Twelve years later she underwent a radical left nephrectomy along with total hysterectomy including bilateral salpingo-oophorectomy for RCC involving the right kidney and ovary. Hemodialysis was necessary because of bilateral nephrectomy. She relapsed with pulmonary metastases and enlarged mediastinal lymph nodes and received cytokine based therapy along with bevacizumab. Therapy was discontinued despite the partial response because of hemorrhagic gastritis. Therapy was switched to an antiangiogenic factor but the patient manifested a parietal brain hematoma and stopped therapy. Subsequently disease relapsed with malignant pleural effusion and pulmonary nodules and a mammalian target of rapamycin inhibitor was administered which was withdrawn only at patient’s deteriorating performance status. The patient died of the disease 13 years after the initial diagnosis of RCC.The second case, a 51-year-old, Caucasian male, underwent a radical right nephrectomy for a chromophobe RCC. Six months later he underwent a radical left nephrectomy for RCC that proved to be a clear cell RCC. Due to bilateral nephrectomy hemodialysis was obligatory. Following disease recurrence at the anatomical bed of the right kidney therapy with antiangiogenic factor was administered which led to disease regression. However the patient experienced a left temporal-occipital brain hematoma. A radical excision of the recurrence which histologically proved to be a chromophobe RCC was not achieved and the patient received mTOR inhibitor which led to disease complete response. Nine years after the initial diagnosis of RCC he is disease free and leads an active life.ConclusionPatients with RCC are in significant risk to manifest bilateral disease. Renal insufficiency requiring hemodialysis poses therapeutic challenges. Clinicians must be aware of the antiangiogenic factors’ adverse effects, especially bleeding, that may manifest in higher frequency and more severe in this setting.

Long-term Outcomes of Endoscopic Variceal Ligation to Prevent Rebleeding in Children with Esophageal Varices

After an episode of acute bleeding from esophageal varices, patients are at a high risk for recurrent bleeding and death. However, there are few reports regarding the long-term results of secondary prophylaxis using endoscopic variceal ligation (EVL) against variceal rebleeding in pediatrics. Thirty-seven, who were followed for over 3 yr post-eradication, were included in the study. The mean duration of follow up after esophageal variceal eradication was 6.4±1.9 yr. The mean time required to achieve the eradication of varices was 3.25 months. The mean number of sessions and O-bands needed to eradicate varices was 1.9±1.2 and 3.8±1.5, respectively. During the period before the first EVL treatment, 145 episodes of bleedings developed in 37 children. Over the 3 yr of follow-up after variceal eradication, only 4 episodes of rebleeding developed in 4 of 37 patients. The four rebleeding episodes consisted of an esophageal variceal bleed, a gastric variceal bleed, a duodenal ulcer bleed, and a bleed caused by hemorrhagic gastritis. There was no mortality during long-term follow up after variceal eradication. During long-term follow up after esophageal variceal eradication using solely EVL in children with esophageal variceal bleeds, rebleeding episodes and recurrence of esophageal varices were rare. EVL is a safe and highly effective method for the long-term prophylaxis of variceal rebleeding in children with portal hypertension.

Isolated Gastric Crohn's Disease:

Crohn's disease is usually associated with intestinal disease when it affects the stomach. It is the most common cause of granulomatous gastritis; however, isolated gastric Crohn's disease is an uncommon finding. This is a case report of a 26-year-old woman who presented with intermittent epigastric pain for 2 years and severe weight loss during the course of her illness. Paraclinical investigations ruled out the possibility of malignancy; further investigations revealed a short segment of focal thickening in the gastric antrum. However, small and large bowels were normal on abdominal computed tomography and severe form of hemorrhagic gastritis on upper gastrointestinal endoscopy. Multiple gastric biopsies obtained from the stomach were consistent with the diagnosis of Crohn's disease. Treatment with prednisolone and azathioprine was effective in controlling the patient's symptoms; however, these recurred 3 weeks after she interrupted therapy. Treatment was resumed with the same drugs, and she was symptom-free over the18 months during which she was followed up. This case demonstrates the role of gastric biopsy as an important investigation in establishing the diagnosis of this rare presentation. It also reflects the dramatic response of gastric Crohn's disease to the treatment with prednisolone and azathioprine.

Isolated Gastric Crohn's Disease:

Crohn's disease is usually associated with intestinal disease when it affects the stomach. It is the most common cause of granulomatous gastritis; however, isolated gastric Crohn's disease is an uncommon finding. This is a case report of a 26-year-old woman who presented with intermittent epigastric pain for 2 years and severe weight loss during the course of her illness. Paraclinical investigations ruled out the possibility of malignancy; further investigations revealed a short segment of focal thickening in the gastric antrum. However, small and large bowels were normal on abdominal computed tomography and severe form of hemorrhagic gastritis on upper gastrointestinal endoscopy. Multiple gastric biopsies obtained from the stomach were consistent with the diagnosis of Crohn's disease. Treatment with prednisolone and azathioprine was effective in controlling the patient's symptoms; however, these recurred 3 weeks after she interrupted therapy. Treatment was resumed with the same drugs, and she was symptom-free over the18 months during which she was followed up. This case demonstrates the role of gastric biopsy as an important investigation in establishing the diagnosis of this rare presentation. It also reflects the dramatic response of gastric Crohn's disease to the treatment with prednisolone and azathioprine.

Atypical clinical course of pneumonia in a patient with ummunodeficiency, iron-deficient anemia and dietary supplement intake

A clinical case pneumonia and multiple organ dysfunction syndrome in a patient with iron-deficiency anemia and previous intake of a dietary supplement for weight loss is presented, including results of examinations, observation and treatment. A 22 years old female was admitted with complaints on dyspnea, dry cough, malaise, «pulsing» head ache at the back of the head, vertigo while walking, fever up to 39 °С during the previous 3 days. Basing on the results of chest X-ray and laboratory examination the diagnosis of «Community-acquired subtotal right-sided pneumonia of mixed origin, severe clinical course, respiratory failure grade III, complicated by toxic shock syndrome, toxic pulmonary edema, disseminated intravascular coagulopathy stage I. Acute cardiac failure, acute respiratory distress syndrome. Acute iron-deficiency anemia. Acute erosive hemorrhagic gastritis. Obesity, II degree» was set up. In spite of active treatment patient’s condition deteriorated due to intoxication, cardiac failure and respiratory distress progress. Autopsy revealed that the patient has died of severe viral pneumonia, although such an extensive pneumonia is not typical for a 22-year old patient. Severe pneumonia development may be explained by immunodeficiency intensified by acute iron-deficiency anemia, which can be a possible side effect of previous intake of a dietary supplement for weight loss and alimentary factors.