Gastroenterol. Insights, Volume 1, Issue 1 (September 2009) – 8 articles

A rare case of Brunner’s gland hyperplasia mimicking duodenal cancer is reported. A 68-year old woman had an elevated lesion in the second portion of the duodenum. Endoscopy after spraying with indigo carmine dye showed a granular appearance and fold convergence. The biopsy specimen suggested hyperplasia without malignancy. However, since the endoscopic features strongly suggested malignancy, endoscopic mucosal resection (EMR) was performed to establish the correct diagnosis. The final pathology diagnosis was Brunner's hyperplasia. Full article

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure and can produce moderate to severe abdominal pain. Limited information is available regarding pain assessment after the procedure. This study aims to compare the pain scores between diagnostic and therapeutic procedures within 24 hours post-ERCP in adult patients. We prospectively analyzed the patients who underwent ERCP from February to November 2007. Pain scores and pain medications used at 2, 6, 12, 18, and 24 hours post-procedure were studied. One hundred and seventy-seven patients, 29 with a diagnostic ERCP (group D) and 148 with a therapeutic ERCP (group T), were enrolled. The mean pain scores at baseline were not significantly different between the two groups. The mean pain scores at two and six hours post-ERCP in group T were significantly higher than in group D (P=0.035 and 0.020, respectively). The scores at the other periods of time in both groups were not significantly different. The total dose of pethidine used for pain control after ERCP in both groups was not significantly different. In conclusion, ERCP-induced abdominal pain mainly occurs within six hours after the procedure. Therapeutic ERCP has a higher pain score than that of diagnostic ERCP only at two and six hours post-ERCP. Full article

Obstructive jaundice secondary to common bile duct stricture is attributed most commonly to pancreatic cancer and cholangiocarcinoma. Benign tumors of the extrahepatic biliary duct such as papilloma or adenoma are rare, accounting for 6% of biliary tumors.1,2 Among them, neurofibromas of the extrahepatic biliary tract are extremely rare and clinically non-specific. Their preoperative diagnosis is most difficult, especially when there is no history of cholecystectomy or biliary tract trauma.3,4 We report a case of such a lesion in a young female patient. Full article

A 69-year-old female with recurrent esophageal cancer and multiple lymph node metastases and vomiting was admitted to our hospital. A computed tomography (CT) scan showed a lymph node metastasis that had become cystic and enlarged, and was suggested to be the cause of the vomiting. Endoscopic ultrasound-guided fine-needle aspiration showed squamous cell carcinoma and elevated amylase in the cystic tumor. Although a rare cause of pancreatic pseudocyst, lymph node metastasis from an advanced cancer should be considered. Full article

A 28-year old man had congenital dysphagia due to intracerebral neurofibroma. He visited our hospital complaining of heartburn and occasional coffee residue-like vomiting for half a year. Esophagoscopy revealed a mucosal bridge in the middle part of the esophagus (Figure 1). This lesion was destroyed spontaneously by deeper insertion of the endoscope. Moreover, esophagoscopy showed linear mucosal breaks between the middle and lower body of the esophagus (Figure 2). Therefore, he was diagnosed as having a mucosal bridge due to reflux esophagitis. Full article

The gastrointestinal tract and its associated mucosal immune system have been extensively studied in the context of their involvement in disease processes, both within the tract itself and in its associated organs. However, historically a number of aspects of both gastrointestinal physiology and pathophysiology have been to some extent overlooked. In particular, the relationship of the gastrointestinal tract with its indigenous microbiota, and also the influence of the tract on behavior and neural systems and vice versa. Here, we describe recent advances in our knowledge and understanding of these areas, and attempt to put these advances in perspective with regard to potential therapeutic strategies. Full article

Gastrostomy operations are performed on children referred to the pediatric surgical clinic without being influenced by the patient’s state of nutrition. This has been motivated by the idea that a gastrostomy would enable a fast and secure improvement in this regard. The question arises whether an improvement in the preoperative nutritional status would reduce the number of postoperative complications. The aim of the study was to test the hypothesis that the frequency of postoperative complications after a video-assisted gastrostomy is correlated to the child’s preoperative state of nutrition. Fifty consecutive children with severe nutritional problems underwent a video-assisted gastrostomy operation where gastrostomy buttons were placed as the initial surgical feeding tube. At the time of the operation, the children’s nutritional parameters were registered routinely. After the operation, the children were followed up prospectively for six months and all complications were documented according to a protocol. The children were ranked according to the severity and frequency of postoperative complications and problems. Correlation to nutritional parameters was calculated. The children did not present with any serious postoperative intra-abdominal complications. There was a significant correlation between the frequency of minor complications and the child’s state of nutrition, measured as the number of standard deviations from normal length and weight as well as phosphate, magnesium, and iron levels in the blood. This study revealed a significant correlation between the patients’ state of nutrition and the postoperative complications during the first postoperative six months. Thus, the findings support a routine of nutritional evaluation prior to performing a gastrostomy operation. Full article

A seven-year old girl with a gastrostomy feeding tube presented with aspecific symptoms such as discomfort and a foul smell. No cause could be found but a culture revealed Group A Streptococcus. These were eradicated by antibiotic treatment and the symptoms resolved immediately. In patients with a gastrostomy feeding tube presenting with aspecific complaints for which a cause can not be found, a culture for Group A Streptococcus should be obtained. Full article