Adult ; Asthma ; diagnosis ; pathology ; Dermatitis, Atopic ; diagnosis ; pathology ; Enteritis ; diagnosis ; pathology ; Eosinophilia ; diagnosis ; pathology ; Gastritis ; diagnosis ; pathology ; Humans ; Male

Diagnosis, Differential ; Enteritis ; diagnosis ; Humans ; Intestinal Mucosa ; pathology ; Intestinal Obstruction ; diagnosis ; Lymphoid Tissue ; Lymphoma ; Ulcer ; diagnosis

Eosinophilic gastroenteritis is defined as a disorder that selectively affects the gastrointestinal tract with eosinophil-rich inflammation in the absence of any known causes for eosinophilia. The clinical manifestations vary according to the site of the eosinophilic infiltrated layer of the bowel wall. Eosinophilic enteritis presenting as intussusception in adult has not been previously reported in the literature. Especially, making the diagnosis of intussusception in adults is often difficult due to the variable clinical findings. In our case, the correct diagnosis of intussusception due to eosinophilic enteritis was arrived at rather easily based on the ultrasonography and endoscopic biopsy. The patient was treated with oral prednisolone at 30 mg/day for 7 days, and then the drug was tapered off for 2 months; we didn't perform surgery. He has been asymptomatic for about 1 year after discharge without disease recurrence.
Middle Aged ; Male ; Intussusception/*diagnosis/pathology ; Humans ; Eosinophilia/complications/*diagnosis/pathology ; Enteritis/complications/*diagnosis/pathology ; Diagnosis, Differential ; Age Factors ; Adult ; Adolescent ; Abdominal Pain

The syndrome of protracted diarrhea (PD) includes several diseases with diverse etiologies. This study was conducted to characterize the spectrum of causes, clinical manifestations, and the outcomes of PD. A retrospective analysis of the clinical and pathological findings was performed on 25 patients with diarrhea starting within the first 2 yr of life and a requirement of parenteral nutrition (PN). According to the intestinal histopathology, patients were classified into four groups: immune enteropathy (12 cases), lymphangiectasia (6 cases), epithelial dysplasia (5 cases), and unclassified (2 cases). All patients with epithelial dysplasia had earlier onset of diarrhea and longer duration of PN than those in the other groups. Three patients (12%) had an evidence of a familial condition. Five patients (three with microvillous inclusion disease and two with immune enteropathy) died. Sixteen patients recovered, and three (two with primary lymphangiectasia and one with microvillous inclusion disease) still had diarrhea. One patient underwent intestinal transplantation for tufting enteropathy. In conclusion, infants with PD should be referred to specialized centers where advanced diagnostic and therapeutic facilities are available, because histological analysis is critical for the diagnosis of PD, and PN or intestinal transplantation is the only therapeutic option in a subset of cases.
Academic Medical Centers ; Age of Onset ; Autoimmune Diseases/pathology ; Child, Hospitalized ; Child, Preschool ; Data Collection ; Diarrhea/*pathology ; Enteritis/immunology/*pathology ; Female ; Human ; Infant ; Infant, Newborn ; Intestinal Mucosa/pathology ; Intestine, Small/immunology/pathology ; Korea ; Lymphangiectasis, Intestinal/pathology ; Male ; Microvilli/pathology ; Retrospective Studies

Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.
Angiography ; Capsule Endoscopy ; Enteritis/complications/*diagnosis/radiography ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestine, Small/pathology ; Male ; Tomography, X-Ray Computed ; Young Adult

Polyarteritis nodosa is a systemic necrotizing vasculitis of the small- and medium-sized arteries with gastrointestinal involvement in more than 50% of cases at some time during the course of the disease. The gastrointestinal manifestations can be diverse and include abdominal pain, nausea and vomiting, ulceration, hemorrhage, occlusion and perforation. Gut involvement is a serious prognostic factor. A 65-year-old man was referred to our department suffering from epigastric pain. A push enteroscopy revealed ischemic enteritis at the proximal small bowel and the CT scan showed a large dilation of the small bowel. His condition deteriorated rapidly and an exploratory laparotomy and total resection of the small bowel was performed. We report a rare case in which the push enteroscopy revealed acute ischemic enteritis of the small bowel and where the pathology specimen showed transmural necrosis of the involved small bowel due to vessel occlusion caused by polyarteritis nodosa.
Abdominal Pain ; Aged ; Arteries ; Endoscopy ; Enteritis* ; Hemorrhage ; Humans ; Laparotomy ; Nausea ; Necrosis ; Pathology ; Polyarteritis Nodosa* ; Tomography, X-Ray Computed ; Ulcer ; Vasculitis ; Vomiting

Systemic lupus erythematosus(SLE) is a systemic disease of unknown etiology. Its main pathology is vasculitis and serositis, due to deposition of the immune complex or antibodies. Most findings are nonspecific ; abdominal manifestations include enteritis, hepatomegaly, pancreatic enlargement, serositis, lymphadenopathy, splenomegaly,nephritis, interstitial cystitis, and thrombophlebitis. We described radiologic findings of various organinvolvement of SLE; digestive system, serosa, reticuloendothelial system, urinary system, and venous system.Diagnosis of SLE was done according to the criteria of American Rheumatism Association. Understanding of thevariable imaging findings in SLE may be helpful for the early detection of abdominal involvement andcomplications.
Antibodies ; Antigen-Antibody Complex ; Cystitis, Interstitial ; Digestive System ; Enteritis ; Hepatomegaly ; Lupus Erythematosus, Systemic* ; Lymphatic Diseases ; Mononuclear Phagocyte System ; Pathology ; Rheumatic Diseases ; Serositis ; Serous Membrane ; Thrombophlebitis ; Vasculitis

Eosinophilic gastroenteritis (EGE) is a disorder characterized by eosinophilic infiltration of the bowel wall and various gastrointestinal (GI) manifestations. This study aimed to evaluate the characteristics of EGE in infants and children. A total of 22 patients were diagnosed with histologic EGE (hEGE) or possible EGE (pEGE). Serum specific IgE levels, peripheral eosinophil counts, and endoscopic biopsies were carried out. In the hEGE group (n = 13), initial symptoms included hematemesis, abdominal pain, and vomiting. Three of the subjects had normal endoscopic findings. Eight patients were categorized into the infant group and 5 into the child group. All patients in the infant group showed clinical improvement after switching from cow's milk feeding to special formula or breast feeding. The infant group showed a higher eosinophil count in the gastric mucosal biopsy than the child group. In the pEGE group (n = 9) initial symptoms included hematemesis, abdominal pain, and vomiting. Seven patients in this group showed a good response to treatment with restriction of the suspected foods and/or the administration of ketotifen. Both hEGE and pEGE groups showed clinical improvement after restriction of suspected foods in the majority of cases and also showed a similar clinical course. EGE should be considered in the differential diagnosis of patients with chronic abdominal pain, vomiting, and hematemesis of unknown cause. The infant group may have a better prognosis than the child group if treated properly.
Child ; Child, Preschool ; Diagnosis, Differential ; Disease Progression ; Endoscopy, Gastrointestinal/*methods ; Enteritis/*pathology/*therapy ; Eosinophilia/*pathology/*therapy ; Female ; Gastritis/*pathology/*therapy ; Humans ; Infant ; Infant, Newborn ; Intestinal Mucosa/*pathology ; Male ; Republic of Korea ; Treatment Outcome

Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with abdominal pain, diarrhea, ascites, and peripheral eosinophilia. Steroids remain the mainstay of treatment for EGE, but symptoms often recur when the dose is reduced. Macrolides have immunomodulatory effects as well as antibacterial effects. The immunomodulatory effect results in inhibition of T-lymphocyte proliferation and triggering of T-lymphocyte and eosinophil apoptosis. Macrolides also have a steroid-sparing effect through their influence on steroid metabolism. We report a rare case of EGE, which relapsed on steroid reduction but improved following clarithromycin treatment.
Anti-Bacterial Agents/therapeutic use ; Clarithromycin/*therapeutic use ; Enteritis/*drug therapy/immunology/pathology ; Eosinophilia/*drug therapy/immunology/pathology ; Gastritis/*drug therapy/immunology/pathology ; Humans ; Immunologic Factors/therapeutic use ; Male ; Middle Aged ; Prednisolone/administration & dosage

There are various etiologies of duodenojejunitis such as Henoch-Schonlein purpura (H-S purpura), vasculitis, Crohn's disease, celiac sprue, ischemia, lymphoma, Zollinger-Ellison syndrome, bacteria or parasite infection, radiation, drug induced jejunitis, eosinophilic jejunitis, and toxins. A 31-year-old man presented with left upper quadrant pain. He did not have febrile sense, hematochezia, melena, diarrhea, arthralgia and hematuria. He had neither drug history nor traveling history. Esophagogastroduodenoscopy showed diffuse mucosal erythema and segmental hemorrhagic erosions on the distal area to the descending portion of the duodenum and proximal jejunum, which were commonly observed in the gastrointestinal involvement of H-S purpura. However, he showed no skin lesions, joint and urologic problems until the discharge. Autoimmune markers such as antinuclear antibody and antineutrophil cytoplasmic antibody were negative. Celiac and mesenteric angiogram showed no vascular abnormality. After the administration of oral prednisolone 40 mg daily for therapeutic trial, abdominal pain and endoscopic lesions were improved. He experienced relapses of same episode without skin lesions 16 times during follow-up of 8 years, which were also treated with prednisolone. The abdominal computed tomography during the follow-up also showed no significant finding. We report a case of primary recurrent duodenojejunitis similar to the gastrointestinal involvement of H-S purpura without purpura.
Adult ; Angiography ; Anti-Inflammatory Agents/therapeutic use ; Duodenitis/*diagnosis/drug therapy/pathology ; Endoscopy, Gastrointestinal ; Enteritis/*diagnosis/drug therapy/pathology ; Humans ; Jejunal Diseases/*diagnosis/drug therapy/pathology ; Male ; Prednisolone/therapeutic use ; Purpura, Schoenlein-Henoch/diagnosis ; Recurrence