DOCSLIB.ORG

Masqueraders of GERD

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Masqueraders of GERD CHALLENGES IN PEDIATRIC REFLUX ADVICE TO THE PRACTITIONER Masqueraders of GERD Scope of the Problem Gastroesophageal reflux (GER) and gastro- esophageal reflux disease (GERD) are common in children and may be incompletely responsive to standard medical therapy. When this clinical scenario develops, other diagnoses must be considered. Clinical experience and the advent of endoscopy have identified a number of differ- ent diseases presenting with complaints formerly thought to fall under the umbrella of gastroesopha- geal reflux disease (GERD). These “masqueraders of GERD” include: • eosinophilic esophagitis • food allergic diseases • achalasia • cyclic vomiting syndrome • rumination syndrome The importance of recognizing these conditions lies in the fact that they require therapeutic mea- sures different than those used for GERD. Eosinophilic Esophagitis (EoE) DEFINITION: Eosinophilic esophagitis ( EoE) is characterized by upper gastrointestinal symptoms and dense esophageal eosinophilia, both of which are unre- sponsive to acid blockade. induction and maintenance treatment. Potential problems are related to non-compliance. Clinical features: In the young child, symptoms include feeding Other off label treatment is directed at reducing refusal, vomiting and abdominal pain. Whereas in allergic inflammation with corticosteroids (systemic the teenager, dysphagia and food impaction are or topically – swallowing rather than inhaling the common. A personal or family history of allergic dose delivered by a metered actuation). diseases or peripheral eosinophilia can be absent When food/foreign body impactions are encoun- but is seen in 75% of patients. Upper gastrointesti- tered endoscopic disimpaction with or without nal series may reveal isolated strictures or longitu- esophageal dilation may need to be performed. CHILDREN’S DIGESTIVE dinal narrowing as a manifestation of longstanding HEALTH & NUTRITION FOUNDATION inflammation. Proximal strictures are seen more Prognosis: often than distal strictures. Abnormal features seen The natural history of EoE is unknown. Reports to at upper endoscopy include whitish exudates, date document the presence of esophageal stric- circular rings, longitudinal furrows, and splitting of tures in children and adults with EoE. No cases of NORTH AMERICAN SOCIETY FOR the mucosa. carcinoma have been reported to date. PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION Diagnosis: Food Allergies Mucosal biopsy is required to make the diagnosis www.KidsAcidReflux.org of EoE. The histological hallmark of the disease DEFINITION: www.TeensAcidReflux.org is a markedly increased number of eosinophils Mechanisms of food allergies include both non-IgE www.CDHNF.org (>20/ HPF) found in the squamous epithelium mediated inflammation (gluten intolerance), and www.NASPGHAN.org despite at least two months of proton pump inhibi- IgE mediated reactions (peanut anaphylaxis). In CDHNF National Office tion. The gastric and duodenal mucosa are nor- some instances, mixed reactions take place (eosin- P.O. Box 6, Flourtown, PA 19031 mal. Other causes for esophageal eosinophilia ophilic gastrointestinal diseases). Symptoms are 215-233-0808 YOUR SOURCE FOR PEDIATRIC include GERD, hypereosinophilic syndrome, relieved by the removal of the triggering food and REFLUX AND GERD INFORMATION inflammatory bowel disease, parasitic infection, reappear with the ingestion of the antigen. eosinophilic gastroenteritis,food/drug allergy Educational support for The CDHNF and collagen vascular diseases. Clinical Manifestations: Pediatric GERD Education Campaign Children with food allergies masquerading as was provided by Major Sponsor Treatment: GERD may present with vomiting and abdominal TAP Pharmaceutical Products Inc. Dietary elimination of specific food allergens or pain often associated with other complaints such To order more of this resource or the use of an elemental diet (amino acid based as hives, rash, wheezing, edema, bleeding or diar- other materials from CDHNF e-mail us at formula) is very effective and can be used for both rhea. When esophageal inflammation is present, [email protected] manifestations may be related to esophageal dys- out abdominal pain, interspersed with episodes of been described who exhibit the same clinical pat- motility with dysphagia, food impaction or feeding returning to a normal state of health. tern. This occurs more often in females, but it it is refusal (see EoE above). In patients with small not considered an eating disorder. Most individu- intestinal and/or colonic inflammation, diarrhea , Clinical Features: als with regurgitation syndrome, regurgitate with bleeding or protein losing enteropathy can occur. CVS can develop in young children, typically every meal. Typically, the regurgitation is effortless around age 5 or 6 years. The vomiting is intense and within 10-20 minutes. The patient may exhibit Diagnosis: and protracted, often 6 times per hour. Vomiting halitosis or complain of a sour taste rather than The diagnosis for food allergies lies in an excel- can be associated with abdominal pain, pre- discomfort or typical peptic symptoms. lent history and physical examination. Radioim- ceding and/or accompanying the episodes of munosorbent testing (RAST) or skin prick can be vomiting. The abdominal pain may also be associ- Diagnosis: abnormal for suspected foods. An elimination trial ated with nausea. However, the abdominal pain A careful history and identification of the recurrent, with or without re-challenge should also be con- and/or nausea are not always associated with the effortless, painless regurgitations is often sufficient sidered. If vomiting is a key symptom on presenta- vomiting episodes in all patients. These “stereo- to make the diagnosis. Observation of preceding tion an upper gastrointestinal series may reveal typical” episodes can last for hours or days. The air swallowing and contraction of the abdominal mucosal thickening. Endoscopic examination can same pattern often repeats with each attack. The wall (while the lower esophagus and glottis relax) detect ulcers, polyps and inflammation. attacks usually stop abruptly and the child quickly can clinch the diagnosis without need for involved and often unnecessary investigations. If avail- Treatment: resumes normal diet and activities. The bouts can occur during intercurrent infections, menstruation able, antro-duodenal manometry will document Food elimination is the treatment of choice for the presence of the diagnostic pressure pattern food allergic diseases. or at times of excitement or stress. The impact on family life and the child’s daily functioning and confirming the creation of a “common cavity” be- Prognosis: quality of life can be significant. While both GER tween the stomach and the mouth. The prognosis of food allergic diseases depends and CVS exhibit vomiting, the vomiting in the for- Treatment: on the allergen. Cow’s milk allergy in infancy is mer is milder and more constant, not as debilitat- Behavioral treatments are usually employed. In usually outgrown by one year of age however, ing and disruptive as in CVS. infants, this involves developmental stimulation. peanut allergy can be lifelong. In adolescents and adults, teaching patients Diagnosis: diaphragmatic breathing and other behavioral Achalasia The causes of CVS are not known. There is often a techniques seems effective in some, while the ru- positive family history for migraines. mination can be stubborn and difficult to dissipate DEFINITION: in others. Determination of any underlying psychi- Achalasia is a motor disease that leads to ab- When doing a differential diagnosis it is crucial atric disorders and directing appropriate medical normal esophageal peristalsis and a functional to exclude raised intracranial pressure from any cause. Chronic sinusitis is sometimes implicated. and psychological therapy is important in achiev- obstruction of the distal esophagus from failure of Rare conditions such as midgut volvulus, ureteral ing successful treatment. the lower sphincter to relax. pelvic obstruction and metabolic causes such as Prognosis: Clinical Manifestations: mitochondrial disease or urea cycle abnormalities The recently reported Mayo Clinic experience Typically, achalasia is a condition seen in adults can present with bouts of intermittent vomiting. suggests a favorable prognosis in most. but can present during childhood (mean age around 9 years). Symptoms include vomiting, Treatment: dysphagia, food impaction, weight loss/failure to The mainstay of CVS management is prevention of thrive, nocturnal regurgitation, chest pain, cough suffering, dehydration, and ketosis once the attack and recurrent pneumonia. begins. Benzodiazepines and ondansetron may be useful adjuncts. Prophylaxis with cyprohepta- Diagnosis: dine, amytriptyline or propanolol may be effective Esophageal manometry remains the gold standard in some patients. Recognizing the pattern of the test for the diagnosis of achalasia. Suggestive vomiting and confirming the diagnosis of CVS is abnormalities include a widened mediastinum and extremely important and provides reassurance, air-fluid level on plain chest radiograph, proximal even though the attacks might not disappear. esophageal dilation and “beaking” on the barium Management can be more focused and measures CHILDREN’S DIGESTIVE swallow study; HEALTH & NUTRITION can be taken to prevent, anticipate, or effectively FOUNDATION Treatment: treat breakthrough attacks. Mechanical dilation is accomplished by esopha- Prognosis: geal
Load more

Recommended publications
  • Childhood Functional Gastrointestinal Disorders: Child/Adolescent
    Gastroenterology 2016;150:1456–1468 Childhood Functional Gastrointestinal Disorders: Child/ Adolescent Jeffrey S. Hyams,1,* Carlo Di Lorenzo,2,* Miguel Saps,2 Robert J. Shulman,3 Annamaria Staiano,4 and Miranda van Tilburg5 1Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’sMedicalCenter,Hartford, Connecticut; 2Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio; 3Baylor College of Medicine, Children’s Nutrition Research Center, Texas Children’s Hospital, Houston, Texas; 4Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Naples, Italy; and 5Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Characterization of childhood and adolescent functional Rome III criteria emphasized that there should be “no evi- gastrointestinal disorders (FGIDs) has evolved during the 2- dence” for organic disease, which may have prompted a decade long Rome process now culminating in Rome IV. The focus on testing.1 In Rome IV, the phrase “no evidence of an era of diagnosing an FGID only when organic disease has inflammatory, anatomic, metabolic, or neoplastic process been excluded is waning, as we now have evidence to sup- that explain the subject’s symptoms” has been removed port symptom-based diagnosis. In child/adolescent Rome from diagnostic criteria. Instead, we include “after appro- IV, we extend this concept by removing the dictum that priate medical evaluation, the symptoms cannot be attrib- “ ” fi there was no evidence for organic disease in all de ni- uted to another medical condition.” This change permits “ tions and replacing it with after appropriate medical selective or no testing to support a positive diagnosis of an evaluation the symptoms cannot be attributed to another FGID.
    [Show full text]
  • Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—A Systematic Review
    J. Med. Toxicol. (2017) 13:71–87 DOI 10.1007/s13181-016-0595-z REVIEW Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review Cecilia J. Sorensen1 & Kristen DeSanto2 & Laura Borgelt3 & Kristina T. Phillips4 & Andrew A. Monte1,5,6 Received: 26 September 2016 /Revised: 25 November 2016 /Accepted: 1 December 2016 /Published online: 20 December 2016 # American College of Medical Toxicology 2016 Abstract Cannabinoid hyperemesis syndrome (CHS) is a removed, 1253 abstracts were reviewed and 183 were in- syndrome of cyclic vomiting associated with cannabis cluded. Fourteen diagnostic characteristics were identi- use. Our objective is to summarize the available evidence fied, and the frequency of major characteristics was as on CHS diagnosis, pathophysiology, and treatment. We follows: history of regular cannabis for any duration of performed a systematic review using MEDLINE, Ovid time (100%), cyclic nausea and vomiting (100%), resolu- MEDLINE, Embase, Web of Science, and the Cochrane tion of symptoms after stopping cannabis (96.8%), com- Library from January 2000 through September 24, 2015. pulsive hot baths with symptom relief (92.3%), male pre- Articles eligible for inclusion were evaluated using the dominance (72.9%), abdominal pain (85.1%), and at least Grading and Recommendations Assessment, weekly cannabis use (97.4%). The pathophysiology of Development, and Evaluation (GRADE) criteria. Data CHS remains unclear with a dearth of research dedicated were abstracted from the articles and case reports and to investigating its underlying mechanism. Supportive were combined in a cumulative synthesis. The frequency care with intravenous fluids, dopamine antagonists, topi- of identified diagnostic characteristics was calculated cal capsaicin cream, and avoidance of narcotic medica- from the cumulative synthesis and evidence for patho- tions has shown some benefit in the acute setting.
    [Show full text]
  • Nutritional Approaches to Chronic Nausea and Vomiting
    NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #168 NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #168 Carol Rees Parrish, M.S., R.D., Series Editor Nutritional Approaches to Chronic Nausea and Vomiting Nitin K. Ahuja In addition to a relative lack of definitive diagnostics and effective therapies, maintenance of adequate nutritional intake can represent a significant challenge for patients with chronic nausea and vomiting. The strength and specificity of available dietary recommendations vary by underlying diagnosis, each of which has a tendency to overlap with others. The relevance of particular clinical distinctions (e.g. gastric emptying delay) is not yet certain, in light of which it may be the case that dietary recommendations for one patient category can be selectively applied to others with similar benefits. This brief review will consider the existing evidence basis for nutritional approaches to a variety of non-structural causes of chronic nausea and/or vomiting, including gastroparesis, chronic nausea and vomiting syndrome, functional dyspepsia, cyclic vomiting syndrome, and rumination syndrome. INTRODUCTION or a variety of reasons, chronic nausea and there is keen interest in potentially mitigating dietary vomiting can be difficult complaints to manage strategies. Chronic nausea and vomiting also may Fclinically. In cases of severe or refractory limit the adequacy of nutritional intake, which can symptoms, quality of life can be markedly diminished, necessitate consideration of enteral or parenteral which often corresponds with significant healthcare feeding alternatives. While several options exist for resource utilization.1 Objective testing modalities pharmacologic and mechanical intervention among beyond endoscopy and scintigraphy are also limited, patients with chronic nausea and vomiting, this review leading to a sometimes frustrating lack of etiologic will focus on nutrition-based approaches to their specificity and often empiric patterns of therapeutic longitudinal support.
    [Show full text]
  • Progress Report Intestinal Malabsorption and the Skin
    Gut: first published as 10.1136/gut.12.11.938 on 1 November 1971. Downloaded from Gut, 1971, 12, 938-947 Progress report Intestinal malabsorption and the skin The interrelationship between the gut and the skin is complex. It is certainly not a one-way system, and just as the gut can affect the skin so can the skin affect the gut: in fact there are four ways in which diseases of the skin and gut can be interrelated1' 2, namely, (1) malabsorption can cause a rash; (2) a rash can cause malabsorption; (3) skin abnormalities and malabsorption can have a common cause; and (4) skin disease and malabsorption can be related indirectly. Group I In this instance the rash arises as the result of malabsorption and disappears when the malabsorption is corrected. The concept was first formulated by William Hillary in 17593 and the idea was kept alive by Whitfield and his 'dermatitis colonica'.4 The early literature on the subject has been reviewed by Wells.5 Two groups ofphysicians6" 7 have looked at the incidence of rashes in adults with malabsorption and have quoted figures of 20%6 and 10%7 respectively. Conversely, in our dermatology department we have screened http://gut.bmj.com/ over 200 patients with the appropriate rashes (see below) and have not found clinical coeliac disease to be responsible for any of them. We have in the last seven years seen two patients with rashes secondary to coeliac disease but these had bowel symptoms as well as a rash at the time they presented to us.
    [Show full text]
  • Cyclical Vomiting Syndrome (CVS) Is a Rare Condition Affecting ~3 in 100,000 Children, with Caucasian but No Sex Predominance
    orphananesthesia Anaesthesia recommendations for patients suffering from Cyclical (or cyclic) vomiting syndrome Disease name: Cyclical (or cyclic) vomiting syndrome ICD 10: G43.A0 Synonyms: Cyclical vomiting, not intractable; persistent vomiting, cyclical; cyclic vomiting, psychogenic Cyclical vomiting syndrome (CVS) is a rare condition affecting ~3 in 100,000 children, with Caucasian but no sex predominance. It is generally a disorder of childhood with symptom onset in pre or early school age. Adult cases (onset in 3rd to 4th decade) are also reported. As patients are well in between episodes, there is usually a delay in diagnosis (2-3 years in children, longer in adults), with frequent emergency department presentations. It is a diagnosis of exclusion. Diagnostic criteria have been published by various bodies including the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, the Rome Foundation (Rome IV 2016 under functional gastrointestinal disorders) and also the International Classification of Headache Disorders (3rd edition beta version). This reflects the uncertainty about the pathophysiology of the syndrome, described variously as functional, psychiatric, neurological either epileptogenic or autonomic dysfunction, association with or triggered by cannabis use versus a migraine variant or as episodic symptoms associated with migraine. Medicine in progress Perhaps new knowledge Every patient is unique Perhaps the diagnostic is wrong Find more information on the disease, its centres of reference and patient organisations on Orphanet: www.orpha.net 1 Disease summary The pattern experienced by an individual is stereotypical: a prodrome including nausea, a hyperemesis/vomiting phase (typically 6-8 episodes per hour for a few days; associated with continuing nausea, headache and abdominal pain), recovery phase and an asymptomatic phase of a few to several weeks.
    [Show full text]
  • Recurrent Abdominal Pain and Vomiting
    A SELF-TEST IM BOARD REVIEW ON A CME EDUCATIONAL OBJECTIVE: Readers will be aware of narcotic bowel syndrome as a consequence CLINICAL CREDIT of prolonged narcotic use. CASE MARKUS AGITO, MD MAGED RIZK, MD Department of Internal Medicine, Quality Improvement Officer, Digestive Akron General Medical Center, Disease Institute, Cleveland Clinic; Assistant Akron, OH Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH Recurrent abdominal pain and vomiting 32-year-old man presents to the emer- Based on the information available, which A gency department with excruciating is the least likely cause of his symptoms? abdominal pain associated with multiple epi- 1 sodes of vomiting for the past 2 days. He re- □ Acute pancreatitis ports no fevers, headaches, diarrhea, constipa- □ Cyclic vomiting syndrome tion, hematochezia, melena, musculoskeletal □ Acute intermittent porphyria symptoms, or weight loss. His abdominal pain □ Gastroparesis is generalized and crampy. It does not radiate Acute pancreatitis and has no precipitating factors. The pain is Acute pancreatitis is the least likely cause of relieved only with intravenous narcotics. his symptoms. It is commonly caused by gall- stones, alcohol, hypertriglyceridemia, and cer- See related editorial, page 441 tain drugs.1 The associated abdominal pain is usually epigastric, radiates to the back, and is He does not smoke, drink alcohol, or use accompanied by nausea or vomiting, or both. illicit drugs. He has no known drug or food The onset of pain is sudden and rapidly increas- allergies. He says that his current condition es in severity within 30 minutes. CT shows en- causes him emotional stress that affects his largement of the pancreas with diffuse edema, A year ago, performance at work.
    [Show full text]
  • Status of Brain Imaging in Gastroparesis
    Review Status of Brain Imaging in Gastroparesis Zorisadday Gonzalez * and Richard W. McCallum Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Ave., El Paso, TX 79905, USA; [email protected] * Correspondence: [email protected] Received: 6 March 2020; Accepted: 7 April 2020; Published: 9 April 2020 Abstract: The pathophysiology of nausea and vomiting in gastroparesis is complicated and multifaceted involving the collaboration of both the peripheral and central nervous systems. Most treatment strategies and studies performed in gastroparesis have focused largely on the peripheral effects of this disease, while our understanding of the central nervous system mechanisms of nausea in this entity is still evolving. The ability to view the brain with different neuroimaging techniques has enabled significant advances in our understanding of the central emetic reflex response. However, not enough studies have been performed to further explore the brain–gut mechanisms involved in nausea and vomiting in patients with gastroparesis. The purpose of this review article is to assess the current status of brain imaging and summarize the theories about our present understanding on the central mechanisms involved in nausea and vomiting (N/V) in patients with gastroparesis. Gaining a better understanding of the complex brain circuits involved in the pathogenesis of gastroparesis will allow for the development of better antiemetic prophylactic and treatment strategies. Keywords: gastroparesis; brain imaging; functional magnetic resonance imaging (fMRI); positron emission tomography (PET) scan; central nervous system (CNS) 1. Introduction Gastroparesis is a chronic heterogeneous motor disorder with variable clinical manifestations including episodic nausea, vomiting, retching, post-prandial fullness, early satiety, and/or upper abdominal pain in the absence of mechanical obstruction [1].
    [Show full text]
  • Canine Chronic Enteropathy
    Vet Times The website for the veterinary profession https://www.vettimes.co.uk Canine chronic enteropathy Author : Andrew Kent Categories : Companion animal, Vets Date : March 20, 2017 ABSTRACT Chronic enteropathy is a common presenting complaint in practice and can be subdivided based on the response to treatment. The aetiology is complex, but the loss of immunologic tolerance to luminal antigens is likely to be a key component that results from altered immunity, abnormal mucosal barrier and the impact of the intestinal environment (such as food or bacteria). A logical approach to investigation and treatment, prioritised based on clinical severity, allows good control of clinical signs in most cases. However, this disease can be challenging and a small percentage of cases will be unresponsive to treatment. Dietary manipulation, and modulation of the intestinal microbiota and the immune system are all key components of therapy and different approaches exist to each of these areas. A number of new options for therapy are under investigation and it is hoped these will offer treatments that can improve quality of life for patients and reduce the adverse effects that can be experienced with existing approaches. Chronic gastrointestinal disease (defined as greater than three weeks’ duration) is a common presenting complaint in practice, with typical signs including diarrhoea, vomiting, weight loss and change of appetite. 1 / 10 Figure 1. An ultrasonographic image of the canine small intestine showing hyperechoic mucosal striations. This finding may be associated with lacteal dilation. A logical approach to investigations allows an accurate diagnosis in most cases; however, some confusion exists over the most appropriate terms to use for this spectrum of diseases.
    [Show full text]
  • ORIGINAL ARTICLE Non-Caucasian Race, Chronic Opioid Use and Lack
    AJHM Volume 5 Issue 1 (Jan-March 2021) ORIGINAL ARTICLE ORIGINAL ARTICLE Non-Caucasian Race, Chronic Opioid Use and Lack of Insurance or Public Insurance were Predictors of Hospitalizations in Cyclic Vomiting Syndrome Vikram Kanagala, MD1; Sanjay Bhandari, MD2; Tatyana Taranukha, MD1; Lisa Rein, PhD3; Ruta Brazauskas, PhD3; Thangam Venkatesan, MD1 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 2Division of General Internal Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 3Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI. Corresponding author: Thangam Venkatesan, MD. 8701 Watertown Plank Rd. Medical Education Building. ([email protected]) Received: April 24, 2020. Revised: January 2, 2021. Accepted: March 3, 2021. Published: March 31, 2021. Am j Hosp Med 2021 Jan;5(1):2021. DOI: https://doi.org/10.24150/ajhm/2021.001 Introduction: Cyclic vomiting syndrome (CVS) is associated with frequent hospitalizations; risk factors for this are unknown. We sought to determine predictors of increased hospitalizations and length of hospital stay (LOS). Methods: We performed a retrospective review of patients with CVS at a tertiary referral center. Clinical characteristics and details about yearly hospitalizations and LOS were assessed; follow- up was divided into two one-year periods before and after the initial clinic visit. Negative binomial regression was used to assess predictors of hospital admission and total length of stay for each time period; the regression results are presented as ratio ratios (RRs). Results: Of 118 patients (70% female, 73% Caucasian), mean follow up was 3.4 2 years. During the first year of follow up, chronic opioid use (Rate Ratio [RR] 2.22) and being uninsured or having public health insurance (RR, 2.39) were associated with higher rates of hospitalization.
    [Show full text]
  • NSAID Enteropathy: a Review of the Disease Entity and Its Distinction from Crohn’S Enteropathy
    Published online: 2019-07-17 THIEME 78 Review Article NSAID Enteropathy: A Review of the Disease Entity and Its Distinction from Crohn’s Enteropathy Smita Esther Raju1 Rajvinder Singh2 Mahima Raju3 1Department of Radiology, Royal Adelaide Hospital, Adelaide, Address for correspondence Smita Esther Raju, MBBS, DMRD, MD, Australia FRANZCR, Department of Radiology, Royal Adelaide Hospital, Port 2Department of Gastroenterology, Lyell McEwin Hospital, South Road, Adelaide 5000, Australia (e-mail: [email protected]; Australia [email protected]). 3School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia J Gastrointestinal Abdominal Radiol ISGAR 2019;2:78–86 Abstract Nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy is an increasingly recognized entity. Patients of older age and those suffering from conditions such as Keywords arthritis requiring long term NSAIDs are thought to be at greater risk. Introduction of ► computed tomogra- enteroscopic techniques has greatly improved understanding of NSAID-related small phy enterography intestinal injury. Complementary high-resolution cross-sectional imaging techniques ► Crohn's disease aid in initial evaluation and for exclusion of alternative etiology. Erosions, superficial ► diaphragm disease ulcerations, and short segment strictures are the most commonly described findings. ► enteropathy The diagnosis of the condition lies in obtaining relevant history in addition to a high ► enteroscopy degree of suspicion during investigation of anemia, obscure gastrointestinal bleeding, ► magnetic resonance small bowel obstruction, and protein losing enteropathy. Herein, the authors present enterography a review of pathogenesis and imaging findings of NSAID enteropathy with particular ► nonsteroidal anti-in- emphasis on distinction from Crohn’s enteropathy. flammatory drugs ► small intestine ► stricture Introduction 0.6% of nonusers.
    [Show full text]
  • Cyclic Vomiting Syndrome
    Cyclic Vomiting Syndrome National Digestive Diseases Information Clearinghouse What is cyclic vomiting What is the gastrointestinal syndrome? (GI) tract? Cyclic vomiting syndrome, sometimes The GI tract is a series of hollow organs referred to as CVS, is an increasingly joined in a long, twisting tube from the recognized disorder with sudden, repeated mouth to the anus—the opening through attacks—also called episodes—of severe which stool leaves the body. The body nausea, vomiting, and physical exhaustion that occur with no apparent cause. The episodes can last from a few hours to several days. Episodes can be so severe that a person has to stay in bed for days, unable to go to school or work. A person may need treatment at an emergency room or a Esophagus hospital during episodes. After an episode, Mouth a person usually experiences symptom- Stomach free periods lasting a few weeks to several months. To people who have the disorder, as well as their family members and friends, cyclic vomiting syndrome can be disruptive and frightening. Duodenum The disorder can affect a person for months, years, or decades. Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day, last the same Small length of time, and occur with the same intestine symptoms and level of intensity. Anus Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum. digests food using the movement of muscles • in children, an abnormal inherited gene in the GI tract, along with the release of may also contribute to the condition hormones and enzymes.
    [Show full text]
  • Diagnosis, Pathophysiology, and Treatment—A Systematic Review
    J. Med. Toxicol. DOI 10.1007/s13181-016-0595-z REVIEW Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review Cecilia J. Sorensen1 & Kristen DeSanto2 & Laura Borgelt3 & Kristina T. Phillips4 & Andrew A. Monte1,5,6 Received: 26 September 2016 /Revised: 25 November 2016 /Accepted: 1 December 2016 # American College of Medical Toxicology 2016 Abstract Cannabinoid hyperemesis syndrome (CHS) is a removed, 1253 abstracts were reviewed and 183 were in- syndrome of cyclic vomiting associated with cannabis cluded. Fourteen diagnostic characteristics were identi- use. Our objective is to summarize the available evidence fied, and the frequency of major characteristics was as on CHS diagnosis, pathophysiology, and treatment. We follows: history of regular cannabis for any duration of performed a systematic review using MEDLINE, Ovid time (100%), cyclic nausea and vomiting (100%), resolu- MEDLINE, Embase, Web of Science, and the Cochrane tion of symptoms after stopping cannabis (96.8%), com- Library from January 2000 through September 24, 2015. pulsive hot baths with symptom relief (92.3%), male pre- Articles eligible for inclusion were evaluated using the dominance (72.9%), abdominal pain (85.1%), and at least Grading and Recommendations Assessment, weekly cannabis use (97.4%). The pathophysiology of Development, and Evaluation (GRADE) criteria. Data CHS remains unclear with a dearth of research dedicated were abstracted from the articles and case reports and to investigating its underlying mechanism. Supportive were combined in a cumulative synthesis. The frequency care with intravenous fluids, dopamine antagonists, topi- of identified diagnostic characteristics was calculated cal capsaicin cream, and avoidance of narcotic medica- from the cumulative synthesis and evidence for patho- tions has shown some benefit in the acute setting.
    [Show full text]