Objective: To investigate the characteristics of duodenal bulbar microbiota in children with duodenal ulcer and Helicobacter pylori (Hp) infection. Methods: This prospective cohort study enrolled 23 children with duodenal ulcers diagnosed by gastroscopy who were admitted to the Children's Hospital of Zhejiang University School of Medicine due to abdominal pain, abdominal distension, and vomiting from January 2018 to August 2018. They were divided into Hp-positive and Hp-negative groups according to the presence or absence of Hp infection. Duodenal bulbar mucosa was sampled to detect the bacterial DNA by high-throughput sequencing. The statistical difference in α diversity and β diversity, and the relative abundance in taxonomic level between the two groups were compared. Microbial functions were predicted using the software PICRUSt. T-test, Rank sum test or χ² test were used for comparison between the two groups. Results: A total of 23 children diagnosed with duodenal ulcer were enrolled in this study, including 15 cases with Hp infection ((11.2±3.3) years of age, 11 males and 4 females) and 8 cases without Hp infection ((10.1±4.4) years of age, 6 males and 2 females). Compared with Hp-negative group, the Hp-positive group had higher Helicobacter abundance (0.551% (0.258%, 5.368%) vs. 0.143% (0.039%, 0.762%), Z=2.00, P=0.045) and lower abundance of Fusobacterium, Streptococcus and unclassified- Comamonadaceae (0.010% (0.001%, 0.031%) vs. 0.049% (0.011%, 0.310%), Z=-2.24, P=0.025; 0.031% (0.015%, 0.092%) vs. 0.118% (0.046%, 0.410%), Z=-2.10, P=0.036; 0.046% (0.036%, 0.062%) vs. 0.110% (0.045%, 0.176%), Z=-2.01, P=0.045). Linear discriminant analysis (LDA) effect sized showed that at the genus level, only Helicobacter was significantly enriched in Hp-positive group (LDA=4.89, P=0.045), while Streptococcus and Fusobacterium significantly enriched in Hp-negative group (LDA=3.28, 3.11;P=0.036,0.025, respectively). PICRUSt microbial function prediction showed that the expression of oxidative phosphorylation and disease-related pathways (pathways in cancer, renal cell carcinoma, amoebiasis, type 1 diabetes mellitus) in Hp-positive group were significantly higher than that in Hp-negative group (all P<0.05), while the expression of pathways such as energy metabolism and phosphotransferase system pathways were significantly lower than that in Hp-negative group (all P<0.05). Conclusion: In children with Hp-infected duodenal ulcers, the mucosal microbiota of the duodenal bulb is altered, characterized by an increased abundance of Helicobacter and a decreased abundance of Clostridium and Streptococcus, and possibly alters the biological function of the commensal microbiota through specific metabolic pathways.
Male ; Female ; Humans ; Child ; Duodenal Ulcer/diagnosis* ; Helicobacter Infections/complications* ; Helicobacter pylori/genetics* ; Prospective Studies ; Microbiota

Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.
Alanine Transaminase/analysis ; Aspartate Aminotransferases/analysis ; Bilirubin/blood ; Chemical and Drug Induced Liver Injury/complications/*diagnosis/pathology ; Duodenal Ulcer/pathology ; Endoscopy, Digestive System ; Female ; Focal Nodular Hyperplasia/complications/*diagnosis/pathology ; Humans ; Liver/enzymology/pathology ; Magnetic Resonance Imaging ; Middle Aged ; Tomography, X-Ray Computed

INTRODUCTIONLaparoscopic simple closure (LSC) coupled with Helicobacter pylori eradication is a well-recognised treatment for perforated duodenal ulcers. This study aimed to evaluate its safety and efficacy.

METHODSThis was a retrospective cohort study conducted on patients who underwent LSC of perforated duodenal ulcers from January 2002 to December 2009. Patients were stratified according to the American Society of Anesthesiologist classification and Boey's risk score.

RESULTSOf the 213 patients, 22 (10.3%) were excluded as they required conversion to open surgery. 191 (89.7%) patients who underwent successful laparoscopic repair were included in the study. The median age of the patients was 39 (range 19-73) years, and the majority were male (n = 180, 94%). Median duration of pre-hospital symptoms was eight hours and median time from admission to surgery was six hours. Median operative time was 65 minutes and median hospital stay was five days. Ten patients (median age 53.5 years) required intensive care unit admission. Two patients developed leakage from the suture line - one required re-exploration and the other was managed conservatively. Four patients had intra-abdominal abscesses - one required re-exploration, while three were managed by percutaneous radiological drainage. One patient developed pneumonia and one had pulmonary embolism. There were no surgical site infections. All patients were followed up as surgical outpatients (median duration 36 days). None of the patients required definitive surgery. There was one death in the cohort.

CONCLUSIONLSC of perforated duodenal ulcers is a reliable, safe and minimally invasive procedure that has low morbidity.

Adult ; Aged ; Duodenal Ulcer ; diagnosis ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Peptic Ulcer Perforation ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

Superior mesenteric artery (SMA) syndrome is an uncommon cause of duodenal outlet obstruction. Symptoms and signs suggestive of this condition are nonspecific, and a high index of suspicion coupled with appropriate imaging studies are necessary for diagnosis. We present the case of a 70-year-old man who developed SMA syndrome following prolonged hospitalisation for a surgically treated bleeding duodenal ulcer. His SMA syndrome resolved after successful nonoperative management based on accepted guidelines for nutritional therapy, thus avoiding the need for reoperation and its attendant risks in a malnourished patient.
Aged ; Duodenal Obstruction ; drug therapy ; Duodenal Ulcer ; complications ; surgery ; Endoscopy ; Hospitalization ; Humans ; Male ; Malnutrition ; Nutrition Therapy ; methods ; Refeeding Syndrome ; diagnosis ; Superior Mesenteric Artery Syndrome ; diet therapy ; Treatment Outcome

Mesenteric venous thrombosis is a clinically very rare disease, and may cause bowel infarction and gangrene. Difficulty in the dignosis the disease due to its non-specific symptoms and low prevalence can cause a clinically fatal situation. Mesenteric venous thrombosis may be caused by both congenital and acquired factors, and protein C deficiency, which is a very rare genetic disorder, is one of many causes of mesenteric thrombosis. The authors experienced a case of mesenteric venous thrombosis caused by protein C deficiency in a patient with duodenal ulcer bleeding, so here we report a case together with literature review.
Duodenal Ulcer/*complications/diagnosis ; Endoscopy, Gastrointestinal ; Humans ; Male ; *Mesenteric Veins ; Middle Aged ; Peptic Ulcer Hemorrhage/*complications ; Protein C Deficiency/*complications/diagnosis ; Tomography, X-Ray Computed ; Venous Thrombosis/*diagnosis/etiology/ultrasonography

Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with 'black esophagus'. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.
Acute Disease ; Duodenal Ulcer/drug therapy/etiology ; Endoscopy, Gastrointestinal ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Esophagus/*pathology ; Gastric Outlet Obstruction/*complications/pathology ; Humans ; Ischemia/pathology ; Male ; Middle Aged ; Necrosis ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
Acute Disease ; Adult ; Diagnosis, Differential ; Duodenal Diseases/*diagnosis/pathology/surgery ; Duodenal Ulcer/*complications ; Hematoma/*diagnosis/pathology/surgery ; *Hemostasis, Endoscopic ; Humans ; Male ; Pancreatitis/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*therapy ; Postoperative Complications ; Tomography, X-Ray Computed

Intussusception is a rare but potentially serious complication of gastric surgery, and 6 cases have been reported in Korea. Diagnosis can be made by endoscopy, upper gastrointestinal series or computed tomography, but it needs a high index of suspicion for diagnosis. Early diagnosis and prompt surgical intervention is mandatory to avoid mortality. We report two cases of intussusception occurring through the stoma after gastric surgery. A 58-year-old woman presented with epigastric pain and vomiting followed by hematemesis, 30 years after gastrojejunostomy for pyloric obstruction caused by duodenal ulcer. Endoscopy showed jejunogastric intussusception and CT scan was compatible with the diagnosis. She was managed by segmental resection and anastomosis of the jejunum. Another 60-year-old man presented with epigastric pain and hematemesis, 7 years after total gastrectomy with a Roux-en-Y anastomosis for advanced gastric cancer. He was diagnosed as having chronic type jejunal intussusception by endoscopy and CT scan, and intussusception was resolved spontaneously.
Anastomosis, Roux-en-Y ; Diagnosis ; Duodenal Ulcer ; Early Diagnosis ; Endoscopy ; Female ; Gastrectomy ; Gastric Bypass ; Gastroenterostomy ; Hematemesis ; Humans ; Intussusception* ; Jejunum ; Korea ; Middle Aged ; Mortality ; Postoperative Complications ; Stomach Neoplasms ; Tomography, X-Ray Computed ; Vomiting

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.
Cerebral Infarction ; Diagnosis ; Diverticulum ; Duodenal Diseases* ; Gastrectomy ; Gastric Bypass ; Gastrointestinal Stromal Tumors ; Hand ; Hemorrhage ; Humans ; Hyperplasia ; Jejunostomy ; Laparoscopy* ; Length of Stay ; Peptic Ulcer ; Polyps ; Postoperative Complications ; Pulmonary Edema ; Reoperation ; Stomach Neoplasms ; Surgical Procedures, Minimally Invasive ; Wound Infection

PURPOSE: The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic surgery in the treatment of gastric and duodenal diseases. METHODS: 27 patients who suffered from various gastroduodenal diseases were operated on between Feb. 1996 and July 1997. Operating times, procedures associated with pathologic diagnosis, bleeding during operation, mean starting times of oral intake, postoperative hospital stays, and complications were examined using the operating records and the medical charts. RESULTS: The procedures and the associated pathologic conditions were a feeding jejunostomy (gastric cancer peritonei), 12 wedge resections (1 duodenal diverticulum, 1 Brunner's gland hyperplasia, 2 gastric polyps, 6 gastrointestinal stromal tumors, and 2 early gastric carcinomas, 3 gastrojejunostomies (unresectable gastric cancers), 10 subtotal gastrectomies (9 complicated peptic ulcers and early gastric cancer), and a radical (D1 alpha) subtotal gastrectomy. The average operating times were 85 minutes in the feeding jejunostomy, 132 minutes in the wedge resections, 95 minutes in the gastro jejunostomies, 208 minutes in the subtotal gastrectomies (Billroth-I: 160 min; Billroth-II: 262 min.), and 300 minutes in the radical operation. The mean intraoperative bleeding was 80-800 cc. The mean start ing time of solid oral intake and postopeative hospital stay were shorter than in open surgery (oral intake: 1-5 day; hospital stay: 6-9 days). There were six postoperative complications. One patient died due to a cerebral infarction during the operation. one wound infection, one stump leakage, one pulmonary edema, and two cases of postoperative bleeding occurred, but they were treated conventionally without reoperation. CONCLUSION: Minimally invasive surgery appears to be an invaluable tool for treating gastroduodenal diseases. Furthermore, it is a valid option in experienced hands and in selected cases of gastric cancer, allowing patients to benefit from a less cumbersome hospital stay and from more satisfaction.
Cerebral Infarction ; Diagnosis ; Diverticulum ; Duodenal Diseases* ; Gastrectomy ; Gastric Bypass ; Gastrointestinal Stromal Tumors ; Hand ; Hemorrhage ; Humans ; Hyperplasia ; Jejunostomy ; Laparoscopy* ; Length of Stay ; Peptic Ulcer ; Polyps ; Postoperative Complications ; Pulmonary Edema ; Reoperation ; Stomach Neoplasms ; Surgical Procedures, Minimally Invasive ; Wound Infection