Search Results (289)

The respiratory consequences of brachycephalic airway obstructive syndrome (BAOS) are well known; however, brachycephalic dogs may also present with alimentary tract signs. The electronic medical records of 176 French bulldogs with BAOS were reviewed to classify the gastrointestinal endoscopic findings, and to evaluate the associations between clinicopathological data, endoscopic respiratory, and digestive findings. Dogs that did not undergo endoscopic examination of both airways and the upper digestive tract were excluded. The type and frequency of respiratory and digestive signs were assessed according to a previously described grading system, in addition to gastrointestinal histopathological findings. Video documentation was reviewed to assign a score to each gastrointestinal endoscopic finding (EGF) and to obtain a total EGF score. All dogs showed at least one EGF. The median total EGF score was 5 (range 1–9). A significant association between the score from digestive signs and the total EGF score was found. In addition, laryngeal granulomas were significantly associated with regurgitation. No associations were found between gastrointestinal histopathological findings and the scores from respiratory or digestive signs. Overall, gastrointestinal endoscopic findings and laryngeal granulomas are common among French bulldogs with BAOS. Therefore, a systematic endoscopic approach to alimentary signs is desirable to determine the most appropriate treatment. Full article

Background/Objectives: Portal hypertension (PH) is a common complication in children with chronic liver diseases. Primary and secondary prophylaxis of variceal bleeding in these patients remains controversial. Our study aims to evaluate the management of gastrointestinal (GI) varices in children with PH in Italy. Methods: A questionnaire was sent to 21 major pediatric hepatology centers. It included 34 questions referring to the medical, endoscopic, radiological, and surgical management of GI varices. Results: Out of 21 centers, 16 returned a completed questionnaire (survey response rate 76%) with a high level of completeness. A total of 1206 children with PH were under follow-up. Splenomegaly associated with hypersplenism was the main indication for endoscopic surveillance in all centers (100%). Primary prophylaxis was performed with endoscopy plus non-selective beta-blockers (NSBBs) in 50%, endoscopy alone in 38%, and NSBBs alone in 12%. All centers managed acute variceal bleeding with endoscopy within 24 h, acid suppression, and octreotide infusion. Secondary prophylaxis of variceal bleeding was conducted using endoscopy (100%) and NSBBs (87%). Transjugular intrahepatic portosystemic shunt (TIPS) was considered a good option when endoscopic treatment failed in 94% of centers. Conclusions: In Italy, there is broad consensus among centers regarding the management of gastrointestinal varices in children with portal hypertension. All participating centers endorsed the use of endoscopic screening for children presenting with clinical signs of portal hypertension. Nonetheless, further research is essential to establish evidence-based guidelines and to improve overall quality of care. Full article

This study introduces a novel reconstruction method (Itihaas’s Anastomosis) for the upper gastrointestinal (UGI) tract following proximal gastrectomy, designed to mitigate the severity of acid reflux syndrome, a frequent postoperative complication. The procedure comprises three side-to-side anastomoses: esophago-gastrostomy, gastro-jejunostomy, and jejuno-jejunostomy. The esophago-gastrostomy anastomosis aims to prevent direct reflux of gastric contents into the esophagus by creating a fundus-like structure, which also facilitates future endoscopic procedures. The gastro-jejunostomy reduces acid reflux by diverting gastric acid to the jejunum for further neutralization, while the jejuno-jejunostomy prevents bile and pancreatic juice reflux into the stomach. A 75-year-old male with adenocarcinoma of the upper stomach underwent this surgical procedure. Postoperative outcomes showed no major complications, with smooth oral contrast passage and no evidence of anastomotic leaks. The patient was discharged after resuming consumption of semi-solid food and experienced no signs of reflux. Itihaas’s Anastomosis represents a novel technical approach that theoretically may reduce acid reflux following proximal gastrectomy. Initial case experience suggests technical feasibility, though all claimed benefits remain theoretical without objective validation. Long-term outcomes, anti-reflux efficacy, and comparative effectiveness require validation through systematic case series with objective assessments. Full article

Background/Objectives: Heart failure (HF) poses a major challenge in managing adults with congenital heart defects (ACHD). Emerging evidence suggests that HF in ACHD increases the risk of underweight due to heightened metabolic demands, gastrointestinal complications, and psychological factors such as anxiety and depression. Despite its critical implications, few studies have examined this association. This study evaluates the relationship between HF and underweight—defined as a body mass index (BMI) < 18.5—in ACHD. Methods: The Pathfinder-CHD Registry is a prospective, observational, web-based HF registry including ACHD with manifest HF, history of HF, or significant risk for HF. It documents congenital diagnoses, HF type, comorbidities, and treatments. Patients were categorized by BMI into mild (17.00–18.49), moderate (16.00–16.99), and severe (<16.00) underweight. Results: As of September 2024, the registry enrolled 1420 adults (mean age 31.8±11.3 years; 49.2% female). Underweight was present in 59 patients (4.2%): 62.7% mild, 18.6% moderate, and 18.6% severe. Among the remaining 1361 patients, 52.8% had normal weight, 32.8% were overweight, and 14.2% were obese. Women had significantly lower metabolic body weight than men (p = 0.002). Underweight correlated with younger age (p < 0.001) and CHD type (p = 0.02). Notably, 42.9% of underweight patients had cyanotic CHD. Conclusions: Underweight is an underrecognized problem in ACHD with HF. Adults with complex CHD or connective tissue disorders are disproportionately affected. Underweight should be seen as an alarm sign requiring personalized, multidisciplinary management, including nutritional support, tailored therapy, and close monitoring to improve outcomes. Full article

Combretum micranthum G. Don (kinkeliba) is a medicinal plant traditionally employed in West Africa for its diuretic and gastrointestinal therapeutic properties. Despite its extensive ethnomedicinal use, comprehensive toxicological assessments are still lacking. This study aimed to characterize the phenolic composition of C. micranthum ethanolic leaf extract using HPLC-DAD-ESI-MS and evaluate its acute and subacute oral toxicity in BALB/c mice, per OECD Guideline 420. Female mice received oral doses of 50, 300, and 2000 mg/kg of extract for acute toxicity assessment for 14 days. In the subacute study, both sexes were administered daily doses at the same concentrations over 28 days. Clinical signs, body weight, and food and water consumption were regularly monitored throughout both protocols. At the end of each study, hematological, biochemical, and histopathological parameters were analyzed. Phenolic profiling revealed nine major compounds with a total of 293.54 mg/g extract. No mortality or significant clinical manifestations were observed at any dose. However, significant variations in platelet counts and amylase activity were noted in the acute phase. In the subacute model, slight, non-critical alterations in hepatic and renal biomarkers were observed, without signs of systemic toxicity. Histopathological examination revealed similar lesions in both acute and subacute phases, including multifocal inflammatory infiltrates (lymphocytes and neutrophils) in the periportal area of the liver, minimal bacterial overgrowth in the superficial layer of the gastric mucosa, minimal medullary mineralization and inflammatory infiltrates with lymphocytes in the kidneys, and minimal to moderate vacuolization in the pancreatic acini. These results indicate that C. micranthum ethanolic extract is relatively safe at the tested doses, reinforcing its traditional use and supporting further research into its pharmacological potential. Full article

Background/Objectives: Potassium-competitive acid blockers (P-CABs) offer rapid gastric acid inhibition and lower toxicity compared to proton pump inhibitors (PPIs). This study investigates the drug–drug interaction between P-CABs and immunosuppressants tacrolimus and mycophenolate in kidney transplant recipients (KTRs). Methods: Sixty-two KTRs were randomized to receive either 50 mg of tegoprazan or 20 mg of pantoprazole. Patients were monitored using a smart clinical trial platform incorporating remote monitoring and safety management systems, which tracked drug adherence and vital signs. General and gastrointestinal (GI) symptoms were surveyed via a self-developed app on patients’ phones. Trough levels of tacrolimus and mycophenolate were measured every 4 weeks over 12 weeks. Results: Medication adherence was 100% in both groups. A total of 13,726 biometric data points and 5031 questionnaire responses were collected, with 5704 feedback messages and 56 video visits conducted. At 12 weeks, the mean trough levels of tacrolimus and mycophenolate were similar between the tegoprazan and pantoprazole groups (5.5 ± 1.6 vs. 5.8 ± 2.0 ng/mL, p = 0.50 and 2.7 ± 1.4 vs. 2.6 ± 1.4 µg/mL, p = 0.57, respectively). The intragroup difference in trough levels from baseline to week 12 was not significant in either group. GI symptoms scores, vital signs, and allograft function remained stable and comparable between groups. Conclusions: Tegoprazan does not alter the blood trough levels of tacrolimus and mycophenolate during the 12-week follow-up in KTRs and has a similar impact on GI symptoms as pantoprazole. This study confirms the feasibility and safety of using a smart clinical trial system with remote monitoring for randomized trials. Full article

Background: Idiopathic duodenal hematoma is a rare clinical condition, typically associated with trauma, anticoagulation therapy, gastrointestinal procedures, or coagulopathies. We present a unique case of spontaneous duodenal hematoma in a patient without identifiable risk factors. Case presentation: We present the case of a 60-year-old Asian woman who presented to the emergency room (ER) with a 10-day history of progressive abdominal pain, early satiety, nausea, and vomiting. She had no history of trauma, anticoagulant use, or underlying predisposing conditions. On clinical evaluation, she was hemodynamically stable, and the initial laboratory results were unremarkable except for signs of dehydration and inflammation. A computed tomography (CT) scan revealed a heterogeneous lesion in the second portion of the duodenum, initially raising suspicion of a duodenal tumor. Further evaluation with magnetic resonance imaging (MRI) confirmed a duodenal hematoma with compression of the adjacent pancreas. Management and Outcome: The patient was managed conservatively with bowel rest, nasogastric decompression, intravenous (IV) fluid, and a proton pump inhibitor (PPI). Serial imaging demonstrated gradual hematoma resolution, with progressive improvement in her symptoms. She was discharged in stable condition and returned to normal activity after three weeks with complete hematoma resolution as seen on follow-up imaging. Conclusions: This case highlights the importance of considering spontaneous hematoma in the differential diagnosis of abdominal pain, even without risk factors. Early diagnosis and conservative treatment remain the mainstay of management and can lead to full recovery in uncomplicated cases. Full article

Malaria remains a major public health threat in Cameroon, with an estimated 3 million new cases of Plasmodium spp. infections reported each year. The aim of this study was to assess the occurrence of Plasmodium infections in Cameroon in a group of symptomatic and asymptomatic individuals, residents of the town of Mbalmayo, located in the Central Region of Cameroon. Screening was conducted in December 2024 at the Mbalayo District Hospital. This study involved a total of 93 people aged between 1 and 70 years old, who voluntarily agreed to have their blood samples taken and tested for malaria. As part of this study, the demographic variables of the participants were taken, malaria rapid diagnostic tests (mRDTs) were performed, and blood samples were applied to the Whatman FTA cards for further real-time PCR diagnostics. The occurrence of Plasmodium infections in the residents of Mbalmayo differed depending on the diagnostic method used (30.1% with mRDT vs. 60.2% when RT-PCR assays were performed). A total of 55 malaria cases were found to be caused by P. falciparum, while one case was found to be caused by P. vivax. Nearly half of the study participants exhibited no signs or symptoms of malaria, whereas 35.7% reported fever, 17.9% respiratory symptoms, and 10.7% gastrointestinal symptoms. The prevalence of malaria remains high in populations inhabiting the Central Region in Cameroon. P. falciparum is the dominant species in the region. A considerable proportion of infected individuals are asymptomatic, which supports the finding that asymptomatic carriers play a critical role in disease transmission. The differences between the results depending on the diagnostic method used (mRDT vs. RT-PCR) suggest that there is a need to use a combination of different methods for the identification of malaria, especially in cases of low parasitemia. Full article

This study presents a comparative analysis of the computed tomographic (CT), radiographic, and ultrasonographic (US) characteristics of gastrointestinal foreign bodies, including bezoars, in dogs and cats, and evaluates their association with complications and clinical outcomes. A total of 33 cases (26 dogs, 7 cats) with surgically or endoscopically confirmed foreign bodies were reviewed, classified as bezoars (n = 15) or distinct foreign bodies (n = 18). CT features such as attenuation values, transition zones, and proximal-to-distal small intestinal diameter ratios were compared. Bezoars typically appeared as intraluminal masses with mottled gas patterns and indistinct boundaries (33.3% vs. 94.4%, p < 0.001) and were associated with longer clinical signs (median 14 vs. 5.5 days, p = 0.013), more frequent transition zones (92.3% vs. 41.7%, p = 0.011), and a greater diameter ratio (2.9 vs. 1.25, p = 0.012) across the transition zone. Radiographic and US evaluations were available in six bezoar cases; only one radiograph (17%) detected the bezoar, while US showed acoustic shadowing in four cases (67%). Six patients (18%) experienced adverse outcomes, with bowel wall ruptures significantly associated with poor prognosis (p < 0.001). These findings highlight the superior diagnostic performance of CT, particularly for bezoars, and emphasize the importance of identifying transition zones and bowel diameter ratios in assessing gastrointestinal foreign bodies and their associated risks. Early CT evaluation may thus facilitate timely intervention and improve clinical outcomes. Full article

Introduction: Congenital duodenal atresia (DA) (Type I) with a fenestrated web can be characterized by a late presentation with a delayed diagnosis. It is even rarer and usually associated with proximal duodenomegaly. Conventional management involves web resection and duodeno–duodeno anastomosis with or without duodenoplasty. We describe our mininvasive surgical strategy and management, detailing the aspects of laparoscopic techniques. Material and Methods: We retrospectively reviewed the medical records of five patients affected by fenestrated duodenal web (DA) with a delayed onset of symptoms and diagnosis who were managed in our Department over a period of 10 years (2013–2023). We analyzed the age of patients at diagnosis, clinical signs and symptoms, associated congenital anomalies, radiological and intraoperative findings, surgical treatment, and outcomes. Diagnostic examinations included ultrasound (US), Upper-Gastrointestinal Study (UGI), and Esophagogastroduodenoscopy (EGDS). Results: Three boys and two girls, median age of 5.5 months (range 3–11 months), were included in this study. Three underwent previous surgery for long-gap esophageal atresia (EA), two of Type A, and one of Type C, requiring a gastrostomy immediately after birth (delayed esophageal repair for prematurity in Type C) and subsequent delayed primary anastomosis. Major associated anomalies were EA (3), anterior ectopic anus (1), cloaca (1), and Type IV laryngeal web (1). An antenatal diagnostic suspicion of duodenal atresia (obstruction) on ultrasound was described in two patients. UGI suggested a fenestrated duodenal web, visualized at ultrasound in two patients. Duodenal dilation was associated in two cases. The symptoms were feeding difficulties, nonbilious vomiting, upper abdominal distension, and poor growth. All presented with a pre-ampullary obstruction. Endoscopic confirmation was only possible in one patient. The older patient underwent an endoscopic resection of a duodenal web. In the other four, we performed a laparoscopic longitudinal antimesenteric duodenal incision, web resection (excision), and transverse suture (closure was performed) without duodenoplasty. Intraduodenal Indocyanine Green (ICG) visualization (under near-infrared light) was used in the last two cases. No postoperative complications were recorded, with a mean hospital stay of 8 days. A contrast study performed at 4 weeks demonstrated an improved proximal duodenal profile; patients tolerated a full diet and remained symptom-free. Conclusions: According to our experience with minimally invasive techniques, laparoscopy and endoscopy are effective and safe, supporting web resection for the management of a duodenal web without tapering of the proximal duodenum. They require advanced technical skills. Intraduodenal-ICG injection during laparoscopic treatment of Type 1 DA allows localization of the duodenal web, confirmation of bowel patency (bowel canalization) and the tightness of suture. Full article

Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. In this study, we investigated the prevalence and severity of insufflation and discussed the potential impact on the outcome of resuscitation. Methods: This study was based on computed tomography (CT) images from two university hospitals in Munich, Germany, which were taken as part of the trauma room care of out-of-hospital cardiac arrest (OHCA) patients. According to local resuscitation protocol, CT performed during ongoing cardiopulmonary resuscitation or after the return of spontaneous circulation (ROSC) was archived to determine the potentially reversible cause of cardiac arrest. CT images from 2014 to 2018 were analyzed in this study. Using an advanced visualization and analysis platform for medical image data, the gas volume within the gastrointestinal tract was determined and compared between resuscitations with lethal and secondary survival outcomes. Results: A total of 92.44% of included OHCA patients (n = 172) showed signs of increased gastrointestinal gas volume in comparison to the physiologically prevalent gas volume. In OHCA patients with a lethal outcome, significantly more gas was detected in the gastrointestinal tract with a median of 757.40 mL compared to 380.65 mL in resuscitations with secondary survival (p ≤ 0.05; W = 4278). Furthermore, Cohen’s r was used to calculate the effect size, indicating a weak association with the outcome of resuscitation (r = 0.24). In addition, a logistic regression analysis was performed to examine the influence of age, gender (female), and the gas volume of the intestines and stomach on the dependent variable “death”. The analysis shows that the model, as a whole, is significant (Chi² = 17.67; p 0.02; n = 172) and supports the hypothesis that intestinal insufflation correlates with a lethal outcome from resuscitation (b = 0.001; OR 1.001 (95% CI [1.000–1.002]; p = 0.021). Conclusions: Insufflation in resuscitation patients is a common phenomenon with potential consequences for the outcome. Even if the effect we have shown appears small, the outcome of resuscitation patients can possibly be improved by preventing or correcting insufflation. To understand its potential impact on resuscitation outcomes fully, further work must be performed to investigate causality. Full article

Background: The coronavirus–caused disease (COVID-19), first identified in China in December 2019, has spread worldwide becoming a global pandemic. Although people infected with the SARS-CoV-2 virus presented mainly respiratory and gastrointestinal symptoms, an increase in cardiovascular incidents was observed in several scientific studies. SARS-CoV-2 virus has been shown to disrupt the normal immune response leading to a dysregulation of immune system function and massive production of inflammatory cytokines commonly known as “cytokine storm”. Methods: 57 patients eventually participated in the study, assigned to non–COVID (24 patients) and COVID (33 patients) groups. After signing consent to participate in the study, each patient was given a self–administered questionnaire to fill out prior to specimen collection, anthropometric measurements were taken and venous blood was collected for the following determinations: pro- and anti–inflammatory cytokines using a Bio–Plex 200 system, oxidative stress markers and basic hematological blood parameters. Results: showed statistically significant higher values of IL–1Ra and IL–1β in the COVID-19 group. Of the oxidative stress markers, only MDA levels were higher in the COVID-19 group. Conclusions: the results of our study provide evidence and support the occurrence of elevated levels of IL–1Ra, IL–1β and MDA in the COVID-19 group of patients, which are associated with a worse course and prognosis of COVID-19. A better understanding of the pathophysiology and dysregulation of the immune system associated with the cytokine storm is essential to select patients at risk and develop effective drugs and vaccines. Full article

Introduction: Hereditary transthyretin amyloidosis (ATTRv) is a severe, multisystemic, autosomal dominant disease with variable penetrance caused by mutations in the TTR gene generating protein misfolding and accumulation of amyloid fibrils. The diagnosis is usually challenging because ATTRv may initially manifest with nonspecific multisystemic symptoms. Conversely, an early diagnosis is needed to start timely appropriate therapy. Hence, screening models have been proposed to improve ATTRv diagnosis. In this study, we propose a genetic screening model based on predefined “red flags” followed by “cascading screening” on first-degree relatives of patients who tested positive. Materials and methods: After obtaining written informed consent, genetic testing on salivary swabs was performed in individuals who met at least two major red flags for ATTRv (age > 65 years old, progressive sensory or sensorimotor neuropathy not responsive to steroids or immunomodulant therapies, recent and unexplained weight loss associated with gastrointestinal signs and symptoms, diagnosis of cardiac amyloidosis, bilateral or relapsing carpal tunnel syndrome, unexplained autonomic dysfunction) or one major flag and two minor flags (family history of neuropathy, ambulation disorders or cardiopathy, sudden cardiac death, a bedridden, wheelchaired patient without specific diagnosis excluding upper motor neuron diseases, infections, juvenile cardiac disease, ocular disorders, lumbar spine stenosis, biceps tendon rupture). Results: In the first screening phase, 29 suspected cases (individuals meeting at least two major red flags or one major red flag and two minor red flags) underwent genetic testing. One patient (3.5%) was diagnosed with hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN), carrying the Phe64Leu mutation. Then, cascade screening allowed for early recognition of two additional individuals (two pre-symptomatic carriers) among two first-degree relatives (100%). The identified patient was a 72-year-old man who had a family history of both cardiopathy, neuropathy, and a diagnosis of juvenile cardiac disease and progressive sensorimotor neuropathy unresponsive to steroids or immunomodulant therapies. Conclusions: ATTRv is a progressive and often fatal disease that should be promptly diagnosed and treated to stop progression and reduce mortality. Systematic screening for ATTRv yielded increased recognition of the disease in our neurological clinic. A focused approach for the screening of ATTRv-PN could lead to an earlier diagnosis and identification of asymptomatic carriers, enabling timely intervention through close clinical monitoring and early treatment initiation at symptom onset. Full article

We report in this clinical case Mallory–Weiss syndrome suspected on computed tomography (CT) and confirmed on endoscopy. Mallory–Weiss syndrome is a rare cause of upper gastrointestinal bleeding from vomiting-induced mucosal laceration(s) at the gastroesophageal junction. The description of Mallory–Weiss Syndrome is rare on imaging and this observation provides CT semiological elements useful in detecting signs of Mallory-Weiss syndrome. Full article

One of the primary challenges encountered in managing captive callitrichids is a group of gastrointestinal disorders that are collectively known as Marmoset Wasting Syndrome (MWS). Unfortunately, MWS is still not well understood. It is suggested that MWS has a multifactorial etiology; stress, infection, malnutrition, malabsorption, and enteritis or colitis may be associated with MWS. Usually, animals demonstrate more than one of the following clinical signs: progressive weight loss, alopecia, chronic diarrhea, muscle atrophy, hypoproteinemia, and anemia. Recent advances in diagnostics, mostly noninvasive fecal and urine tests, yielded promising results. Good treatment results have been achieved with the administration of glucocorticoids and tranexamic acid, although no cure has been found yet. Probiotics and gel diets also demonstrated to be potentially useful. However, once animals are affected by MWS, treatments eventually become ineffective, and animals will inevitably require euthanasia to prevent further suffering. Preventative measures should be aimed at reducing stress and optimizing housing, husbandry, and diets. More research is warranted to elucidate the pathogenesis of MWS in captive callitrichids and to refine diagnostic and treatment methods. Full article