Lesions In Duodenum Research Articles

Effects of dietary sulfur amino acid levels on growth performance and intestinal immunity in broilers vaccinated and subsequently infected with coccidiosis

Coccidia vaccination is a common practice in the poultry industry. However, research is lacking regarding the optimal nutritional support for coccidia vaccinated broilers. In this study, broilers were vaccinated with coccidia oocyst at hatch and were fed with a common starter diet from 1 to 10 d. On d 11, the broilers were randomly assigned to groups in a 4×2 factorial arrangement. Briefly, the broilers were fed one of four diets containing 0.6, 0.8, 0.9, and 1.0% of standardized ileal digestible methionine plus cysteine (SID M+C), respectively, from 11 to 21 d. On d 14, the broilers from each diet group were orally gavaged with either PBS (Mock challenge) or Eimeria oocysts. Compared to PBS-gavaged broilers and regardless of dietary SID M+C levels, the Eimeria-gavaged broilers had 1) decreased gain-to-feed ratio (15-21 d, P=0.002; 11-21 d, P=0.011); 2) increased fecal oocysts (P < 0.001); 3) increased plasma anti-Eimeria IgY (P=0.033); and 4) increased intestinal luminal interleukin-10 (IL-10; duodenum, P=0.039; jejunum, P=0.018) and gamma interferon (IFN-γ; duodenum, P < 0.001; jejunum, P=0.017). Regardless of Eimeria gavage, broilers fed 0.6% SID M+C had decreased (P<0.001) body weight gain (15-21 and 11-21 d) and gain-to-feed ratio (11-14, 15-21, and 11-21 d) when compared to those fed ≥ 0.8% SID M+C. Eimeria challenge increased (P < 0.001) duodenum lesions when the broilers were fed with 0.6, 0.8, and 1.0% SID M+C, and increased (P=0.014) mid-intestine lesions when the broilers were fed with 0.6 and 1.0% SID M+C. An interaction between the two experimental factors was detected on plasma anti-Eimeria IgY titers (P=0.022), as coccidiosis challenge increased plasma anti-Eimeria IgY titers only when the broilers were fed with 0.9% SID M+C. In summary, the dietary SID M+C requirement for grower (11-21 d) broilers vaccinated with coccidiosis was ranged from 0.8 to 1.0% for optimal growth performance and intestinal immunity, regardless of coccidiosis challenge.

Vmist prostahlandynu E2 v syrovattsi krovy patsiientiv iz erozyvno-vyrazkovymy urazhenniamy hastroduodenalnoi zony bez i z komorbidnoiu hipertonichnoiu khvoroboiu

Introduction. The combination of erosive-ulcerative lesions (EUI) of the gastroduodenal zone with hypertension (HT) is a common phenomenon and is a modern medicine’s pressing issue. Taking nonsteroidal anti-inflammatory drugs (NSAIDs), including by patients with HT, is accompanied by prostaglandin synthesis suppression due to cyclooxygenase inhibition and results in an arterial pressure increase. Moreover, it should be mentioned that patients with HT have a higher risk of gastroduodenal lesions. The aim of the study. To explore the prostaglandin E2 content in the blood serum of patients with gastroduodenal erosive-ulcerative lesions without and with comorbid hypertension. Materials and methods. The research involved 20 patients with gastroduodenal EUI without comorbid HT and 30 patients with gastroduodenal EUI suffering comorbid HT. All patients went through general clinical examinations, esophagogastroduodenofibroscopy (EGDFS), and stool tests to verify H.pylori infection, with prostaglandin E2 (PGE2) content in blood serum being determined. Results. EGDFS showed that among patients with gastroduodenal EUI without comorbid HT, 25.00 % were diagnosed with gastric EUI; half of the cases (50.00 %) revealed duodenum lesions, and another 25.00 % – combined stomach and duodenum lesions. At the same time, patients with EUI combined with comorbid HT manifested more frequent (p-value less than 0.05) gastric localization of mucosal EUI (50.00 %); 16.67 % of patients had the duodenum lesions, while combined stomach and duodenum defects were observed in 33.33 %. H. pylori infection was confirmed in 13 patients (65.00 %) with EUI without comorbid HT and in 22 examined individuals (73.33 %) with the gastroduodenal zone EUI and comorbid HT. The endogenous PGE2 was significantly higher in patients who had only gastric mucosa and duodenum EUI without comorbid HT and amounted to 2135.79 ± 80.94 pg/ml (p-value less than 0.05), while patients with EUI and comorbid HT were tested a significantly lower PGE2 level in blood serum – 1513.55 ± 92.48 pg/ml. At the same time, the significantly lower PGE2 level in patients with EUI and comorbid HT compared to the similar indicator in patients without it explains the differences in the EUI distribution in both groups of patients revealed during endoscopic examination. Since a significantly weakened PGE2 synthesis leads to lower bicarbonate and mucus secretion and more intensive acid production, the balance between the aggression and protection factors is upset, which contributes to the EUI emergence mainly in the stomach’s antral part. The research has exposed no significant difference in PGE2 content in patients with duodenum mucosa EUI and those with a combination of gastric and duodenum mucosa lesions (p-value more than 0.05). Besides, the PGE2 content was tested significantly lower in patients with EUI gastric localization, than in those with combined ulcers (p-value less than 0.05). The presence or absence of H. pylori infection also did not affect the endogenous PGE2 level (p-value more than 0.05). Conclusions. The prostaglandin E2 content in the blood serum of patients with gastroduodenal erosive-ulcerative lesions with comorbid hypertension was notably lower than in patients with erosive-ulcerative lesions of the gastroduodenal zone without comorbid hypertension. Moreover, a significant prostaglandin E2 decrease in the blood serum of patients with gastroduodenal erosive-ulcerative lesions with comorbid hypertension upsets the balance between aggression and protection factors, which contributes to the emergence of erosive-ulcerative defects, mostly in the stomach.

Recurrent bleeding duodenal and colonic ulcers due to post-transplant lymphoproliferative disorder.

Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation as the result of immunosuppressant medications. Epstein-Barr virus (EBV) has been implicated in most of these cases, specifically with B-cell predominant lymphoma. This case report describes a 24-year-old female who presented with recurrent GI bleed within 6months post-orthostatic heart transplant. Endoscopic evaluations including video capsule study, push enteroscopy, and colonoscopy revealed multiple ulcerated lesions in duodenum, jejunum, and colon secondary to Epstein-Barr Virus-associated monomorphic PTLD. Despite continuation of rituximab after discharge, she returned to the hospital for recurrent GI bleed requiring additional endoscopic intervention. PTLD is a devastating disease of the post-transplant population. Due to a high risk of recurrent GI bleeding, patients with PTLD may benefit from careful monitoring by gastroenterology as an outpatient with a low threshold for repeat endoscopic evaluation despite being on immunotherapy or chemotherapy.

Differential diagnosis of superficial duodenal epithelial tumor and non-neoplastic lesion in duodenum by magnified endoscopic examination with image-enhanced endoscopy.

Differential diagnosis of superficial duodenal epithelial tumors (SDETs) and non-neoplastic lesions (NNLs) in duodenum by endoscopy is difficult. Here, we attempted to distinguish them by magnified endoscopic examination with image-enhanced endoscopy (IEE-ME). Various IEE-ME findings of 95 SDETs who underwent endoscopic resection and 58 NNLs who underwent biopsy were retrospectively reviewed. When we compared the IEE-ME findings of SDETs and NNLs, the presence of demarcation line (DL) (97.9% vs. 79.3%, P = 0.0002), white opaque substance (WOS) (84.2% vs. 1.7%, P < 0.0001) and light blue crest (LBC) (93.7% vs. 32.8%, P < 0.0001) and the absence of enlarged marginal epithelium (EME) (98.9% vs. 62.1%, P < 0.0001) were significantly more frequent in SDETs than NNLs. When divided into each superficial structure, it was the most effective to evaluate the combination of WOS and LBC as SDET with open-loop structure (OLS), and the combination of DL and EME as SDET with closed-loop structure (CLS). However, LBC was excluded because of low inter- and intra-observer agreements. Finally, the sensitivity, specificity and accuracy for the diagnosis of SDETs were 88.4%, 98.3% and 92.2%, respectively, and we developed an algorithm for the differential diagnosis of duodenal lesions. We could distinguish SDET from NNL, diagnosed SDET as presence of WOS indicated OLS of superficial structure, and presence of DL and absence of EME indicated CLS of superficial structure.

Rare Case of Gangliocytic Paraganglioma

Gangliocytic paragangliomas (GP) are very rare tumors, almost exclusively found in duodenum. These are considered benign tumors but rarely may recur or metastasize. The common clinical presentation includes gastrointestinal bleeding, abdominal pain, and in rare cases as obstruction. Definitive treatment is complete resection of tumor, endoscopically or surgically. We present a case of 44-year-old female, who presented with persistent nausea, vomiting, abdominal pain along with on and off melena. She had benign physical exam. Extensive workup done was negative, except CT Enterography showed filling defect. Endoscopy biopsy done showed possible ganglionueroma. She underwent surgery and final pathology results came back as Gangliocytic paraganglioma. Discussion GP is a rare tumor that is located in the duodenum in 90% of cases with a particular predilection to the region of the ampulla of Vater although can be rarely seen in 3rdand 4thportion. Outside duodenum, its occurrence is extremely rare. Due to submucosal nature, exact origin of GP is unknown. The age of presentation is very vast ranging from 15-84 years, with slight male predominance. Clinical presentation is variable, with almost 50% of cases presenting with bleed, followed by anemia and abdominal pain. Rare presentation with duodenal obstruction and biliary obstruction is also seen in some case reports Differentials are related to any mass lesion in duodenum with typical examples of duodenal cancer (benign and malignant) or polyps<./p> Diagnosis is usually made by recognizing the mass according to diagnostic guidelines of presenting case, as in our case of melena and abdominal pain and is confirmed by histopathology. Its main histologic features are epithelioid cells, spindle-shaped cells and ganglion-like cells. Treatment of GPs is resection, endoscopically or surgery, usually depending on size, local invasion and LNs involvement. As most of the GPs are benign, the treatment of choice for gangliocytic paragangliomas is endoscopic resection4. An aggressive behavior may also be suggested by the presence of nuclear pleomorphism, mitotic activity and infiltrative margin. In the case of ampullary paragangliomas, these findings favor radical surgical resection. Reoccurrence rate is very rare but can be seen.2501_A Figure 1. CT abdomen/pelvis with PO/IV Enterography Contrast protocol showing filling defect in periampullary region2501_B Figure 2. high power showing focal aggregates of ganglion cells amidst numerous nerve sheath Schwann cells2501_C Figure 3. low power showing spindle cell tumor underlying the duodenal mucosa

Unusual Cause of Gastric Outlet Obstruction

A 23 year old female was presented with post prandial epigastric fullness and vomiting since 4 months. Her barium meal showed sack-like filling lesion in duodenum surrounded by radiolucent band (Figure A). CECT abdomen revealed contrast material–filled diverticulum (Figure B). She underwent duodenotomy and diverticulum excision.

Duodenal Lipomatosis as a Curious Cause of Upper Gastrointestinal Bleed: A Report with Review of Literature.

Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules.

Dieulafoy lesion in duodenum of child successfully treated by transcatheter embolization: A case report

Abstract A 15-year-old boy had massive bleeding from Dieulafoy lesion of the duodenum. An emergency GI endoscopy revealed clot in duodenum while angiography showed extravasation of contrast medium from the right gastric artery. Transcatheter superselective embolization was performed and stopped the bleeding completely.

Pancreatic metastasis from renal cell carcinoma: A different cause for recurrent duodenal bleeding

A 64-year-old man with a renal cell carcinoma (RCC) underwent right nephrectomy. There was no identifiable recurrence during follow-up. Six years after surgery he presented with melena and ferropenic anaemia. Endoscopic evaluation demonstrated a vascular lesion in duodenum and haemostasis was performed. However, the bleeding recurred and further endoscopies revealed an enlarged multilobulated infiltrative and ulcerative lesion over the duodenum bulb. Histological and imagiological investigations were, even so, suggestive of a vascular lesion adjacent to the duodenal wall. Given the uncertain diagnosis and recurrent bleeding a surgical resection was deemed unavoidable. A cephalic duodenopancreatectomy was performed and histologic evaluation revealed an intrapancreatic RCC metastasis with duodenal infiltration. No evidence of recurrence after 12 months was observed.In conclusion, RCC metastasis should be considered in patients with a pancreatic mass as it gives the past history of RCC. Awareness of this entity and a high index of suspicion would help in proper diagnosis and treatment.

The range of lesions in the small intestine of children with celiac disease determined by capsule endoscopy.

Celiac disease is achronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution. The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease. Atotal of nine patients aged from 15 to 18years (average age: 16years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following abowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan). The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in ashort section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients asignificant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients amosaic mucosal pattern was noted. The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment.

PATHOLOGICALSTUDY ON COLIBACILLOSIS IN CHICKENS AND DETECTION OF ESCHERICHIA COLI BY PCR

The aim of the present study was to detect the pathogenic Escherichia coli (E. coli) through pathological study of the colibacillosis affected birds. These isolated E. coli were further confirmed by PCR using specific primer. For this purpose, a total of 20 swabs (10 from lung and 10 from intestine of 10 dead birds) were collected in sterile nutrient broth. The histopathological samples were collected in 10% buffered neutral formalin. The used methods were histopathology, isolation and identification of E. coli by conventional methods and as well as by PCR method. A total of 10 isolates of E. coli from 20 swabs of lung and intestine was characterized by conventional routine methods of bacteriology. Gross pathological lesions of all lungs in the present investigation were congested and consolidated. Duodenum showed congestion and hemorrhages with excess mucus in the luminal surface of it. Microscopically, all the lungs showed severe congestion, infiltration of heterophils, macrophages and lymphocytes in the wall of bronchus as well as in the peribronchial alveoli. E. coli infected all the duodenum showed severe infiltration of leukocytes mainly heterophils, lymphocytes and macrophages in the submucosa of the duodenal wall. In this study, DNA of 8 isolates out of 10 isolated E. coli organisms was amplified by PCR using ECO-f and ECO-r primer targeting 16S ribosomal DNA and found 585 bp amplicon which is specific for E. coli with enteroinvasive type confirmed by histopathological lesions in duodenum. Further investigation should be focused on serotyping and detection of genes of E. coli which are responsible for pathogenicity of the organism.DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11205Bangl. J. Vet. Med. (2011). 9(1): 17-25

A New Model of Duodenal Ulcers Induced in Rats by Indomethacln Plus Histamine

We standardized a new method for producing duodenal ulcers in rats by administering indomethacin plus histamine, and investigated the pathogenesis. Indomethacin (5 mg/kg) was first given subcutaneously to rats fasted for 24 h, and subsequently histamine dihydrochloride (40 mg/kg) was given subcutaneously three times, at 2.5-h intervals, beginning 30 min after injection of indomethacin. This combined treatment induced one or two round lesions (9.8 +/- 1.4 mm2) in the proximal duodenum at an incidence of 100%, and a few lesions in the corpus and antrum of the stomach as well. Indomethacin or histamine alone had no effect on either the duodenum or the stomach. The lesions in the duodenum and antrum were inhibited by oral cimetidine (3-100 mg/kg) and 16,16-dimethyl prostaglandin E2 (dmPGE2) (3-30 micrograms/kg) in a dose-related manner, whereas those in the corpus were inhibited only by cimetidine. Indomethacin alone had no effect on gastric acid secretion, but did potentiate the increase of acid secretion caused by histamine. Histamine did not affect duodenal HCO3-secretion, whereas indomethacin slightly inhibited the basal HCO3-secretion and completely blocked the acid-stimulated HCO3-secretion. Intraduodenally administered cimetidine (30 mg/kg) or dmPGE2 (30 micrograms/kg) significantly inhibited acid secretion or increased HCO3-secretion, respectively, and both reduced the amount of acid emptied into the duodenum after treatment with indomethacin plus histamine. These results indicate that the development of duodenal lesions induced by indomethacin plus histamine in rats is due to both an increase in gastric acid secretion and an impairment of acid-induced duodenal HCO3-secretion. This newly established model will be useful for studying the pathogenesis of duodenal ulcers and for screening antiulcer agents.