Search Results (54)

A study was conducted to determine the effects of the level and source of copper (Cu) on Cu concentrations and the mRNA expression of Cu regulatory proteins in the small intestine of pigs. Thirty weanling castrated male pigs, approximately 21 days of age, were stratified by weight and assigned to dietary treatments consisting of control (6.7 mg Cu/kg from feed ingredients; no supplemental Cu) or 225 mg supplemental Cu from either Cu sulfate (CuSO₄) or tribasic Cu chloride (TBCC). Pigs were harvested on days 35 or 36. The soluble Cu and mucosal Cu concentrations in the duodenum, proximal jejunum, and ileum were higher (p < 0.001) in Cu-supplemented pigs versus controls. Duodenal soluble and mucosal Cu concentrations were higher in (p < 0.05) CuSO₄ versus TBCC-supplemented pigs. However, proximal jejunum and ileum mucosal Cu were higher (p < 0.05) in TBCC versus CuSO₄ pigs. The intestinal copper transporter 1 (CTR1) expression was lower (p < 0.05) in Cu-supplemented pigs compared to control pigs but was not affected by the intestinal section or treatment x section. The duodenal mRNA expression of metallothionein1a (MT1a) was greater (p < 0.05) in Cu-supplemented pigs and was greater in CuSO₄ than TBCC-fed pigs. These data demonstrate that both the Cu level and source affect the Cu uptake and mRNA expression of Cu regulatory proteins throughout the small intestine of weanling pigs. Full article

The global rise in metabolic disorders demands novel interventions targeting starch digestion. This study investigated two dietary phenolic acids (caffeic acid (CA) and p-hydroxycinnamic acid (p-HA)) as inhibitors of α-amylase and α-glucosidase through integrated experimental and computational approaches. Molecular docking showed distinct binding modes, and CA formed stable hydrogen bonds with catalytic residues of α-glucosidase, while p-HA interacted mainly with α-amylase via hydrophobic contacts. Enzyme kinetics revealed concentration-dependent mixed-type inhibition, with CA being more potent against α-glucosidase and p-HA against α-amylase. Spectroscopic analysis indicated both acids induced structural changes in the enzymes, with CA causing greater α-helix reduction (Δ7.03% vs. Δ2.10%) by altering the tryptophan microenvironment. Moreover, both compounds significantly suppress glucose absorption in the proximal small intestine in an ex vivo everted gut sac model, with p-HA exhibiting exceptional efficacy in the duodenum. These findings clarify structure–activity relationships and support the potential use of CA and p-HA as local intestinal agents for modulating carbohydrate absorption. Full article

Celiac disease (CeD) is a gluten-induced immune-mediated enteropathy that preferentially involves the proximal duodenum. Consequently, iron deficiency is common in CeD, impacting at least 10% of newly diagnosed individuals. In this narrative review, we aim to investigate the mechanisms, prevalence, treatment, and monitoring of iron deficiency and the impacts of a gluten-free diet (GFD) on iron deficiency in individuals with CeD. We will also review the role of and approach to iron supplementation in this population. Specifically, we will explore whether mucosal healing on a GFD is sufficient for the management of iron deficiency amongst individuals with CeD. Full article

Background and Clinical Significance: Annular pancreas is a rare congenital anomaly in which pancreatic tissue partially or completely encircles the duodenum, potentially causing duodenal obstruction. Clinical presentation varies from asymptomatic cases to persistent vomiting, feeding intolerance, and failure to thrive, often leading to delayed diagnosis. Case Presentation: We report a 2-year and 10-month-old girl with a long-standing history of intermittent, recurrent vomiting since the neonatal period, without growth impairment or other alarming symptoms. Initial imaging suggested proximal duodenal dilation, with suspicion for superior mesenteric artery (SMA) syndrome. Endoscopy revealed mechanical obstruction at the second portion of the duodenum. Contrast-enhanced CT confirmed annular pancreas partially encircling the duodenum. The patient underwent duodeno-duodenostomy with an uneventful postoperative course and complete resolution of symptoms. This case illustrates the diagnostic challenges of annular pancreas in older children with atypical presentations. Multimodal imaging is crucial for accurate diagnosis. Surgical bypass remains the definitive treatment, offering excellent long-term outcomes. Conclusions: Persistent or recurrent vomiting in children, even without classic signs such as bilious vomiting or failure to thrive, should prompt consideration of annular pancreas. Early recognition and timely surgical intervention can prevent prolonged morbidity and ensure normal growth and development. Full article

Background: Traumatic injuries of the duodenum are generally rare but when they occur, they can result in serious complications. Inaccurate injury classification, delayed diagnosis, or late treatment can significantly raise morbidity and mortality. A multidisciplinary approach is often necessary. Mechanisms of injury: Isolated duodenal injuries are relatively uncommon due to the duodenum’s proximity to pancreas and major vascular structures. Duodenal injuries can result from blunt or penetrating trauma. Classification: The 2019 World Society of Emergency Surgery (WSES)-American Association for the Surgery of Trauma (AAST) guidelines recommend incorporating both the AAST-OIS grading and the patient’s hemodynamic status to stratify duodenal injuries into four categories: Minor injuries WSES class I, Moderate injuries WSES class II, Severe injuries WSES class III, and WSES class IV. Diagnosis: The diagnostic approach involves a combination of clinical assessment, laboratory investigations, radiological imaging and, in particular situations, surgery. Prompt diagnosis is critical because delays exceeding 24 h are associated with a higher incidence of postoperative complications and a significant rise in mortality. Contrast-enhanced abdominal computed tomography (CT) represents the gold standard for diagnosis in patients who are hemodynamically stable. Management: Duodenal trauma requires a multimodal approach that considers hemodynamic stability, the severity of the injury and the presence of associated lesions. Non-operative management (NOM) is reserved for hemodynamically stable patients with minor duodenal injuries without perforation (AAST I/WSES I), as well as all duodenal hematomas (WSES I–II/AAST I–II) in the absence of associated abdominal organ injuries requiring surgical intervention. All hemodynamically unstable patients, those with peritonitis, or with CT findings consistent with duodenal perforations or AAST grade III or higher injuries are candidates for emergency surgery. If intervention is required, primary repair should be the preferred option whenever feasible, while damage control surgery is the best choice in cases of hemodynamic instability, severe associated injuries, or complex duodenal lesions. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated. The role of endoscopic techniques in the treatment of duodenal injuries and their complications is expanding. Conclusions: Duodenal trauma is burdened by potentially high mortality. Among the possible complications, duodenal fistula is the most common, followed by duodenal obstruction, bile duct fistula, abscess, and pancreatitis. The overall mortality rate for duodenal trauma persists to be significant with an average rate of 17%. Future prospective research needed to reduce the risk of complications following duodenal trauma. Full article

Background and Clinical Significance: Superior mesenteric artery syndrome (SMAS) is a rare and often underdiagnosed cause of proximal intestinal obstruction, resulting from compression of the third portion of the duodenum between the SMA and the aorta. It typically occurs in individuals with significant weight loss due to mesenteric fat depletion. CasePresentation: We report the case of a 14.5-year-old female presented with a 6-day history of intractable vomiting and epigastric pain, on a background of intermittent vomiting over the preceding six months associated with a 7 kg unintentional weight loss, culminating in inability to tolerate oral intake. Her clinical course was complicated by a transient episode of blurred vision, numbness, and incoherent speech, initially suspected to be a neurological event. Extensive gastrointestinal and neurological investigations were inconclusive. Elevated fecal calprotectin levels raised suspicion for inflammatory bowel disease, given her family history, though endoscopy and histopathology were unremarkable. Advanced imaging ultimately demonstrated a markedly reduced aortomesenteric angle (6°) and distance (4 mm), confirming the diagnosis of SMAS. The patient was initially managed conservatively with total parenteral nutrition (TPN), achieving partial weight gain of 5 kg after 8 weeks of TPN. Due to persistent duodenal compression, surgical intervention was required. At 7-month follow-up, the patient remained symptom-free with restored nutritional status and a good weight gain. Conclusions: This case highlights the importance of considering SMAS in adolescents with chronic upper gastrointestinal symptoms and significant weight loss. Early recognition and appropriate imaging are essential to diagnosis, and timely surgical management can lead to excellent outcomes when conservative treatment is insufficient. Full article

Background and Clinical Significanc: Congenital duodenal diaphragm (CDD) is a rare congenital condition causing partial or complete obstruction of the duodenum, most frequently located in the second part of the duodenum. It is a rare but important cause of intestinal obstruction in infants and young children. Clinically, it often presents with persistent vomiting and failure to thrive. Diagnosis can be made through abdominal X-ray showing the characteristic “double bubble” sign, upper gastrointestinal (GI) series, or gastroscopy. Case Presentation: A 17-month-old female infant with known psychomotor retardation was admitted for evaluation of inadequate weight gain and intermittent postprandial vomiting, both present since birth. Laboratory investigations, including metabolic and electrolyte panels, were within normal limits. Given the persistent clinical symptoms, an upper gastrointestinal series was performed to assess for possible anatomical abnormalities. Imaging revealed a significant delay in the passage of contrast into the second portion of the duodenum, with marked prestenotic dilatation. Subsequent gastroscopy identified a duodenal diaphragm nearly occluding the duodenal lumen at the same site, impeding the passage of the endoscope. Associated findings included gastritis and the presence of food debris in the stomach and proximal duodenum, indicating impaired gastric emptying. The patient underwent successful surgical management via duodenotomy with resection of the septum. Postoperative recovery was uneventful. Conclusions: In infants or young children with persistent postprandial vomiting and inadequate weight gain, anatomical causes such as duodenal diaphragm/web should be considered in the differential diagnosis. Once identified, treatment should be initiated promptly, either endoscopically or surgically, depending on the severity and anatomical characteristics of the obstruction. Full article

Background/Objectives: Upper gastrointestinal Crohn’s disease (UGI-CD) is inconsistently defined and often underrecognized, obscuring epidemiology, complicating diagnosis, and delaying tailored care. The absence of a unified, operational definition with segment-specific criteria hinders reproducibility and comparability across studies. Methods: We performed a narrative synthesis of adult and pediatric studies and major guidelines, examining definitions, prevalence, diagnosis, and management. Where possible, findings were mapped to upper GI segments (esophagus, stomach, duodenum, proximal small bowel). Results: Definitions of UGI-CD are heterogeneous. Prevalence varies widely and rises with systematic foregut assessment; isolated upper GI disease without ileocolonic involvement is rare. Diagnosis relies on esophagogastroduodenoscopy with biopsies, complemented by cross-sectional imaging and enteroscopy. Management should extend beyond standard ileocolonoscopy, with segment-tailored monitoring. Anti-TNF agents show the most consistent efficacy in esophagogastroduodenal disease, whereas benefits are attenuated in proximal small bowel involvement. For stricturing disease, endoscopic balloon dilation is suitable for short, non-penetrating strictures but often requires repetition; surgery is preferred for complex anatomy or failed dilation. A short summary of the article’s main findings is provided. Conclusions: UGI-CD remains poorly standardized across definition, epidemiology, and management. We propose a pragmatic diagnostic and monitoring pathway and highlight priorities for research: segment-based reporting, inclusion of upper GI-only cohorts, and validation of treatment targets aligned with treat-to-target care—steps essential to improve early recognition and patient outcomes. Full article

Background: Karwinskia humboldtiana (Kh) is a toxic plant that produces a fruit that, when ingested in large quantities, causes damage to the lungs, liver, kidneys, pancreas, and duodenum. Pancreatic damage was measured using a semiquantitative score, revealing that it is progressive and characterized by selective apoptosis and necrosis of the exocrine portion. However, renal injury has not been evaluated using injury scales and has only been reported descriptively. Pancreatic adenocarcinoma is one of the top five causes of cancer death in the United States, and options for its treatment are limited. One of the toxins extracted from the fruit (T-514) has been tested as a possible antineoplastic agent in various cancer cell lines. In order to preliminarily assess its possible usefulness against pancreatic cancer, we decided to re-evaluate kidney damage using a semi-quantitative scale, hoping to obtain a lesser injury intensity than that reported in the pancreas. Methods: We analyzed kidney samples from the same model of acute pancreatitis by Kh by semiquantitative scoring to compare the results with those previously reported in the pancreas, and performed a TUNEL assay to analyze cell death in the kidney. Results: The renal injury that occurs in this model of Kh poisoning consists mainly of hydropic degeneration and loss of microvilli in proximal tubules. According to the scale used in this work, the following percentages of kidney injury were obtained: 8.26 ± 0.93% for the control group, 9.65 ± 1.60%, 11.04 ± 1.36%, 12.78 ± 2.46%, 14.03 ± 1.83% and 15.76 ± 3.73% for the groups 24 h, 48 h, 72 h, 96 h and 120 h after Kh administration. In contrast, the following were reported for the pancreas: 0.28 ± 0.83% for the control group, 14.81 ± 7.64%, 35.63 ± 12.05%, 67.13 ± 5.27%, 85.28 ± 13.14% and 87.13 ± 11.17% for the groups 24 h, 48 h, 72 h, 96 h and 120 h after Kh administration. These results indicate that pancreatic injury is 71.37% more intense than renal injury at 120 h after Kh. No evidence of nuclear chromatin fragmentation was found in the kidney. Conclusions: The renal damage in this model of acute pancreatitis is of lower intensity than the pancreatic damage, suggesting that Kh and its toxins may be useful in the treatment of pancreatic cancer and their study in an in vitro or in vivo cancer model is justified. Full article

This study evaluated the effects of dietary potassium diformate supplementation on growth performance, nutrient digestibility, gastrointestinal pH, jejunal morphology, digestive enzyme activity, and antioxidant status of weaned piglets in a 28-day trial. Twenty-four weaned piglets were selected and, after a 4-day adaptation period, randomly assigned to 4 treatment groups (n = 6). The dietary treatments included a control diet (basal diet) and 3 diets supplemented with 0.6%, 1.2%, or 1.8% potassium diformate in the basal diet. The results indicated that the feed conversion ratio (FCR) of piglets was reduced by all three potassium diformate supplementation levels compared to the control group (p < 0.05). Additionally, the FCR was decreased in piglets fed the 1.8% potassium diformate-supplemented diet compared to those fed the 1.2% potassium diformate-supplemented diet (p < 0.05). Piglets fed the three potassium diformate-supplemented diets exhibited higher apparent total tract digestibility (ATTD) of dry matter and crude protein than the control group (p < 0.05). The 1.8% potassium diformate groups also showed increased ATTD of calcium and phosphorus compared to the control group (p < 0.05). Supplementation with 1.2% or 1.8% potassium diformate reduced the digesta pH in the proximal stomach, distal stomach, and duodenum, while increased jejunal villus height (VH), VH/crypt depth (VH/CD) ratio, and catalase and total superoxide dismutase activities in the jejunal mucosa compared to the control group (p < 0.05). The 1.2% potassium diformate group showed higher α-amylase activity than the control group (p < 0.05). Correlation analysis revealed that FCR negatively correlated with ATTD of dry matter, crude protein, calcium, phosphorus, and jejunal VH, while positively correlating with digesta pH in the proximal stomach (p < 0.05). The ATTD of dry matter negatively correlated with digesta pH in the proximal stomach, distal stomach, and duodenum, and positively correlated with jejunal VH/CD ratio and catalase activity (p < 0.05). The ATTD of crude protein negatively correlated with digesta pH in the proximal stomach, distal stomach, and duodenum (p < 0.05). Collectively, dietary supplementation with 1.8% potassium diformate reduced FCR of weaned piglets, which was associated with enhanced nutrient digestibility, reduced pH in the anterior gastrointestinal tract, and improved jejunal morphology. Full article

Roux-en-Y gastric bypass (RYGB) surgery induces profound gut microbiota alterations that may impact metabolic outcomes. This study investigated site-specific effects of a multicomponent bovine colostrum-honey-serviceberry (CHJ) complex on post-RYGB microbiome changes in obese rats. Twenty-nine Wistar rats underwent RYGB surgery with CHJ supplementation, followed by mucosal-associated microbiota analysis from five gastrointestinal segments using 16S rRNA sequencing and serum metabolite profiling. RYGB caused regional-specific changes: decreased alpha diversity, systematic Proteobacteria increases (31.2 ± 5.1% in duodenum), and reductions in SCFA-producing bacteria (Romboutsia, Roseburia). CHJ supplementation exhibited dual effects on the microbiome: restoration of beneficial bacteria (Lactobacillus, Bifidobacterium) in distal segments while concurrently promoting Enterobacteriaceae growth in proximal regions. CHJ also maintained alpha diversity levels of the mucosa-associated microbiota comparable to those observed in the control group. Disconnects emerged between predicted microbial functions and systemic metabolites: thiamine pathway activation accompanied 78.5% serum vitamin B1 reduction, indicating severe absorption deficits. Three distinct patterns emerged: pro-inflammatory (proximal), decolonization (widespread Helicobacteraceae loss), and restorative (selective CHJ-mediated recovery). Results demonstrate that post-RYGB dysbiosis exhibits profound regional heterogeneity requiring segment-specific interventions and highlight complex interactions between nutritional supplementation and surgically altered gut ecology in determining metabolic outcomes. Full article

Background/Objectives: Duodenum-preserving pancreatic head resection (DPPHR) preserves digestive and absorptive functions better than pancreaticoduodenectomy (PD). Zinc is primarily absorbed in the duodenum and proximal jejunum and plays a critical role in nutritional maintenance and pancreatic regeneration. However, no studies have compared the postoperative pancreatic volume and serum zinc levels between DPPHR and PD. Methods: We retrospectively analyzed 41 patients who underwent DPPHR (n = 23) or subtotal stomach-preserving PD (n = 18) for low-grade pancreatic malignancies at our institution. The remnant pancreatic volumes on postoperative day 7 and 1 year were measured via computed tomography. Nutritional parameters, including serum albumin, prognostic nutritional index (PNI), and serum zinc levels, were compared between the groups. Serum zinc levels were evaluated in patients with DPPHR (n = 11) or PD (n = 7). Results: The DPPHR group demonstrated significantly better preservation of remnant pancreatic volume on postoperative day 7 and 1 year compared to the PD group (p = 0.045 and p = 0.041, respectively). Volume maintenance ratios were also significantly higher in the DPPHR group. Serum albumin levels at 1 year postoperatively were significantly better in the DPPHR group, although no significant difference was found in the PNI. Among patients evaluated for serum zinc, the DPPHR group showed significantly higher zinc levels compared to the PD group (80.3 vs. 65.8 μg/dL, p = 0.017). Conclusions: DPPHR preserves remnant pancreatic volume and maintains serum zinc levels better than PD, potentially contributing to improved postoperative nutritional status and quality of life. Further prospective studies with larger cohorts are warranted to validate these findings. 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: Bouveret syndrome is a complication of cholelithiasis, characterized by the migration of a large gallstone from the gallbladder to a part of the stomach or intestine through a bilio-enteric fistula. This condition results in a rare form of gallstone ileus, presenting signs and symptoms of gastric outlet obstruction. Methods: This case report aims to present a rare instance of Bouveret syndrome in a 64-year-old woman who presented to our emergency department with recurrent epigastric pain and vomiting for over 2 months. After a CT scan, an esophagogastroscopy was performed following a multidisciplinary discussion. An endoscopic evaluation revealed a large (4 cm) gallstone found in the proximal duodenum using an endoscope. We then inserted the holmium laser fiber system through a standard ERCP catheter, passing it through the endoscope’s working channel. By positioning the holmium laser fiber within the catheter, we stabilized the energy on the gallstone, which was then fragmented into smaller pieces after administering pulse energy. Results: In this case report, we successfully treated Bouveret syndrome using endoscopic laser lithotripsy combined with mechanical lithotripsy, avoiding traditional surgery. Conclusions: The endoscopic approach that combines laser and mechanical lithotripsy appears effective in fragmenting large gallstones into smaller pieces, facilitating their passage through the digestive tract and resolving the obstruction. Full article

Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. Case 1: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm × 4.0 cm × 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. Case 2: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret’s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. Conclusions: Bouveret’s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes. Full article