DOCSLIB.ORG

Practical Algorithms in Pediatric Gastroenterology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Practical Algorithms in Pediatric Gastroenterology Editor R. Shaoul Practical Algorithms in Pediatric Gastroenterology Practical Algorithms in Pediatrics Series Editor: Z. Hochberg Practical Algorithms in Pediatric Gastroenterology Editor Ron Shaoul, Haifa 51 graphs and 9 tables, 2014 Basel · Freiburg · Paris · London · New York · Chennai · New Delhi · Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney Contents IV Contributors Gastroesophageal refl ux and vomiting 44 Chronic intestinal II pseudo-obstruction 22 Neonatal vomiting T. Zangen; P.E. Hyman VI Preface R. Shaoul; N.L. Jones Z. Hochberg 46 Irritable bowel syndrome 24 Nausea and vomiting E. Chiou; S. Misra; S. Nurko VII Introduction P.S. Lemos; R. Shaoul R. Shaoul 26 Recurrent vomiting and/or regurgitation Stomach and intestine Y. Vandenplas; R. Shaoul Various gastrointestinal conditions 48 Protein-losing enteropathy 28 Typical and atypical refl ux syndrome B. Zeisler; F.A. Sylvester 2 Abdominal pain Y. Vandenplas; R. Shaoul R. Arnon; S. Misra 50 Celiac disease 30 Recurrent vomiting and/or Y. Bujanover; R. Shaoul 4 Acute gastroenteritis regurgitation and poor weight gain A. Lo Vecchio; D. Turck; A. Guarino 52 Helicobacter pylori Y. Vandenplas; R. Shaoul N.L. Jones; B.D. Gold 6 Food allergy 32 Cyclic vomiting syndrome B. Wershil; F.A. Sylvester 54 Gastrointestinal polyps Y. Vandenplas; B.D. Gold B. Zeisler; F.A. Sylvester 8 Failure to thrive A. Lahad; S. Reif 56 Intestinal malabsorption – Part 1: Other motility disorders Pathogenesis and etiology 10 Chronic diarrhea A. Guarino; E. Ruberto; Y. Finkel Y. Finkel; A. Guarino 34 Achalasia S. Nurko; Y. Vandenplas 58 Intestinal malabsorption – Part 2: 12 Upper gastrointestinal bleeding First diagnostic steps C.G. Sauer; B.D. Gold 36 Constipation A. Guarino; E. Ruberto; Y. Finkel S. Misra; H.M. Van de Vroot 14 Lower gastrointestinal bleeding F.A. Sylvester; D. Turck 38 Dysphagia P.E. Hyman; T. Zangen 16 Malnutrition Infl ammatory bowel disease P.S. Lemos; B. Wershil 40 Fecal incontinence 60 Infl ammatory bowel disease A. Siddiqui; O. Eshach Adiv; S. Nurko 18 Perianal disease D. Turner; A.S. Day A.S. Day; N.L. Jones 42 Hirschsprung’s disease 62 Crohn’s disease P.E. Hyman; T. Zangen 20 Gastrointestinal foreign bodies D. Turner; A.S. Day I. Rosen; R. Shaoul 64 Ulcerative colitis D. Turner; A.S. Day Surgical conditions 80 Hepatitis C Pancreas E. Granot 66 Abdominal mass 100 Acute pancreatitis R. Udassin; A. Vromen; E. Gross 82 Elevated aminotransferases M. Wilschanski; R. Arnon J. Garah; R. Shaoul 68 Right lower quadrant abdominal pain 102 Chronic pancreatitis I. Sukhotnik; P.S. Lemos 84 Elevated alkaline phosphatase M. Wilschanski; R. Shaoul R. Shaoul; J. Garah 70 Peritonitis S. Peleg; R. Shaoul 86 Autoimmune liver disease 104 Index G. Mieli-Vergani; M. Samyn 72 Short bowel syndrome 109 Abbreviations Y. Finkel; I. Sukhotnik 88 Sclerosing cholangitis G. Mieli-Vergani; M. Samyn 90 Acute liver failure Liver G. Mieli-Vergani; M. Samyn 74 Neonatal jaundice 92 Hepatomegaly E. Fitzpatrick; A. Dhawan E. Fitzpatrick; A. Dhawan 76 Acute hepatitis 94 Gallstones Y. Bujanover; S. Reif E. Broide; S. Reif 78 Hepatitis B 96 Portal hypertension E. Granot R. Arnon; A. Dhawan 98 Ascites A. Ben Tov; S. Reif Library of Congress Cataloging-in-Publication Data Disclaimer. The statements, options and data contained in this publi- All rights reserved. No part of this publication may be translated into cation are solely those of the individual authors and contributors and other languages, reproduced or utilized in any form or by any means, Practical algorithms in pediatric gastroenterology / editor Ron Shaoul. not of the publisher and the editor(s). The appearance of advertise- electronic or mechanical, including photocopying, recording, micro- p. ; cm. -- (Practical algorithms in pediatrics) ments in the book is not a warranty, endorsement, or approval of the copying, or by any information storage and retrieval system, without Includes bibliographical references and index. products or services advertised or of their effectiveness, quality or permission in writing from the publisher. ISBN 978-3-318-02509-5 (alk. paper) -- ISBN 978-3-318-02510-1 safety. The publisher and the editor(s) disclaim responsibility for any (e-ISBN) injury to persons or property resulting from any ideas, methods, in- © Copyright 2014 by S. Karger AG, P.O. Box, CH–4009 Basel I. Shaoul, Ron, editor of compilation. II. Series: Practical algorithms in structions or products referred to in the content or advertisements. (Switzerland) pediatrics. Printed in Switzerland on acid-free and non-aging paper (ISO 9706) [DNLM: 1. Gastrointestinal Diseases--Handbooks. 2. Adolescent. 3. Drug Dosage. The authors and the publisher have exerted every effort by Werner Druck, Basel III Child. 4. Decision Trees--Handbooks. 5. Infant. 6. Liver to ensure that drug selection and dosage set forth in this text are in ISBN 978–3–318–02509–5 Diseases--Handbooks. 7. Pancreatic Diseases--Handbooks. WS 39] accord with current recommendations and practice at the time of pub- e-ISBN 978–3–318–02510–1 RJ446 lication. However, in view of ongoing research, changes in government 618.92’33--dc23 regulations, and the constant fl ow of information relating to drug ther- 2014004252 apy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the rec- ommended agent is a new and/or infrequently employed drug. Contributors Orly Eshach Adiv, MD Emer Fitzpatrick Avishay Lahad, MD IV Pediatric Gastroenterology and Nutrition Unit Consultant Paediatric Hepatologist Pediatric Gastroenerology and Nutrition Unit Rambam Medical Center Paediatric Liver GI and Nutrition Center Pediatric B North Department Haifa, Israel King’s College Hospital Edmond and Lili Safra Children’s Hospital London, UK Sheba Medical Center Ronen Arnon, MD, MHA Tel Hashomer, Israel Associate Professor of Pediatrics and Surgery Jamal Garah, MD Medical Director of Pediatric Hepatology and Pediatric Gastroenterology and Nutrition Unit Piedade Sande Lemos, MD, PhD Liver Transplantation Rambam Medical Center Pediatric Gastroenterology Consultant Recanati-Miller Transplant Institute Haifa, Israel Hospital Fernando Fonseca Mount Sinai School of Medicine Director, Clinica CUF Cascais New York, NY, USA Benjamin D. Gold, MD, FACG Cascais, Portugal Pediatric Gastroenterology, Hepatology and Efrat Broide, MD Nutrition Andrea Lo Vecchio, MD Head of Pediatric Gastroenterology Children’s Center for Digestive Healthcare Section of Pediatrics Institute of Gastroenterology Atlanta, GA, USA Department of Translational Medical Science Assaf Harofeh Medical Center University of Naples Federico II Zerifin, Israel Esther Granot, MD Naples, Italy Kaplan Medical Center Prof. Yoram Bujanover Rehovot and Hebrew University-Hadassah Giorgina Mieli-Vergani Pediatric Gastroenterology Unit Medical School Professor of Paediatric Hepatology Edmond and Lili Safra Children’s Hospital Jerusalem, Israel Consultant Paediatric Hepatologist Sheba Medical Center Paediatric Liver, GI and Nutrition Centre Tel Hashomer, Israel Eitan Gross, MD King’s College London School of Medicine Pediatric Surgery Department King’s College Hospital Eric Chiou, MD The Hebrew University Medical School London, UK Pediatric Gastroenterology, Hepatology and Hadassah Nutrition Jerusalem, Israel Sudipta Misra, MBBS, MD, DM Texas Children’s Clinical Care Center Clinical Professor of Pediatrics and Chief Houston, TX, USA Alfredo Guarino, MD Division of Pediatric Gastroenterology, Section of Pediatrics Hepatology and Nutrition Prof. Andrew S. Day Department of Translational Medical Science Brody School of Medicine, East Carolina University Paediatric Gastroenterologist University of Naples Federico II Vidant Medical Center Department of Paediatrics Naples, Italy Greenville, NC, USA University of Otago Christchurch, New Zealand Paul E. Hyman, MD Samuel Nurko, MD Professor of Pediatrics, Louisiana State University Director Anil Dhawan Chief, Gastroenterology Center for Motility and Professor of Paediatric Hepatology Children’s Hospital Functional Gastrointestinal Disorders Director Paediatric Liver GI and Nutrition Centre New Orleans, LA, USA Boston Children’s’ Hospital King’s College Hospital Boston, MA, USA London, UK Nicola L. Jones, ND, FRCPC, PhD Departments of Paediatrics and Physiology Sarit Peleg, MD Prof. Yigael Finkel University of Toronto Pediatric Gastroenterology Service Department of Clinical Science and Education Cell Biology Program, Hospital for Sick Children Ha’emek Medical Center Karolinska Institutet Toronto, ON, Canada Afula, Israel Stockholm, Sweden Shimon Reif, MD Anees Siddiqui, MD Prof. Dr. Yvan Vandenplas Director Pediatric Gastroenterology Pediatric Gastroenterology Department of Pediatrics Specially for Children/Dell Children’s UZ Brussel, Vrije Universiteit Brussel Hadassah Medical Center Medical Center Brussels, Belgium Jerusalem, Israel Austin, TX, USA Holly M. Van de Voort, MD Irit Rosen, MD Igor Sukhotnik, MD Centennial Pediatrics Murfreesboro Pediatric Gastroenterology and Nutrition Unit Pediatric Surgery Unit Murfreesboro, TN, USA Rambam Medical Center Bnai Zion Medical Center Haifa, Israel Haifa, Israel Amos Vromen, MD Pediatric Surgery Department Eliana Ruberto, MD Francisco A. Sylvester, MD The Hebrew University Medical School Section of Pediatrics Professor of Pediatrics and Immunology Hadassah Department of Translational Medical Science University of Connecticut School of Medicine
Load more

Recommended publications
  • Clinical Cases of Crohn's Disease in Pediatric Hirschprung's Patients
    Open Access Austin Journal of Gastroenterology Case Report Clinical Cases of Crohn‘s Disease in Pediatric Hirschprung‘s Patients Cerniauskaite R1, Statkuviene J2, Labanauskas L2, Urbonas V3, Bagdzevicius S4, Adamonis K5, Abstract Rokaite R2, Janciauskas D6 and Kucinskiene R2* Crohn’s and Hirschsprung’s diseases are two different conditions of 1Department of Radiology, Vilnius University Hospital intestinal tract though both of them are genetically predisposed. Each disease Santariskiu Clinics, Lithuania have genetic mutations in some genes, however there are no evidence that 2Department of Pediatric gastroenterology, Hospital of there are mutations common to both conditions. Lithuanian University of Health Sciences, Lithuania 3Department of Pediatric gastroenterology, Vilnius We present 3 clinical cases of patients who underwent surgery in infancy University Hospital Santariskiu Clinics, Lithuania for Hirschsprung’s disease. Later in early childhood all the patients developed 4Department of Pediatric surgery, Hospital of Lithuanian clinical symptoms of inflammatory bowel disease and Crohn’s disease was University of Health Sciences, Lithuania diagnosed. Both conditions were confirmed histologically. After introducing the 5Department of Gastroenterology, Hospital of Lithuanian treatment for Crohn’s disease positive effect was shown. These cases raise University of Health Sciences, Lithuania the hypothesis that the two conditions may have similarities in etiology and 6Department of Pathology, Hospital of Lithuanian pathogenesis and may
    [Show full text]
  • 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]
  • Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms
    nutrients Review Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms Annamaria Altomare 1,2 , Claudia Di Rosa 2,*, Elena Imperia 2, Sara Emerenziani 1, Michele Cicala 1 and Michele Pier Luca Guarino 1 1 Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; [email protected] (A.A.); [email protected] (S.E.); [email protected] (M.C.); [email protected] (M.P.L.G.) 2 Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; [email protected] * Correspondence: [email protected] Abstract: Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder charac- terized by abdominal pain associated with defecation or a change in bowel habits. Gut microbiota, which acts as a real organ with well-defined functions, is in a mutualistic relationship with the host, harvesting additional energy and nutrients from the diet and protecting the host from pathogens; specific alterations in its composition seem to play a crucial role in IBS pathophysiology. It is well known that diet can significantly modulate the intestinal microbiota profile but it is less known how different nutritional approach effective in IBS patients, such as the low-FODMAP diet, could be Citation: Altomare, A.; Di Rosa, C.; responsible of intestinal microbiota changes, thus influencing the presence of gastrointestinal (GI) Imperia, E.; Emerenziani, S.; Cicala, symptoms. The aim of this review was to explore the effects of different nutritional protocols (e.g., M.; Guarino, M.P.L.
    [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]
  • Mastocytic Enterocolitis
    Patient Counseling Report MASTOCYTIC ENTEROCOLITIS WHAT IS MASTOCYTIC ENTEROCOLITIS? Mastocytic enterocolitis is a disease of the colon, or large intestine that is caused by an increased number of mast cells in the lining of the colon. It is believed that this increased number of mast cells is caused by a form of immune response by the gastrointestinal tract. This allergic response then causes a physical response by the body which results in diarrhea and abdominal pain. Previously, Mastocytic Enterocolitis was classifed as diarrhea-predominant irritable bowel syndrome (IBS) due to the fact that there was not a more specific diagnosis. With this diagnosis, a more specific treatment regimen can be offered with the hope of relieving symptoms. Mastocytic Enterocolitis affects patients as young as 16 and has been documented in patients as old as 85. Mastocytic Enterocolitis is not associated with an increased risk for cancer and patients diagnosed with this disease usually have a normal endoscopy and normal endoscopic findings. HOW IS MASTOCYTIC ENTEROCOLITIS DIAGNOSED? The goal of treatment is to try and reduce the number of mast cells During your endoscopy procedure, tissue biopsies were taken and sent to in the colon and relieve symptoms like abdominal pain, diarrhea, a specialized gastrointestinal pathology laboratory. At the laboratory, and weight loss. Most individuals respond well to treatment and see a special stain was utilized to highlight the mast cells in your tissue. a relatively dramatic reduction in their symptoms. Unfortunately, The special stain revealed that the number of mast cells in your tissue was treatment may not always work for patients and you and your doctor abnormally high and therefore you were diagnosed with Mastocytic may need to find another treatment regimen that can be successful for Enterocolitis.
    [Show full text]
  • The Entire Intestinal Tract Surveillance Using Capsule Endoscopy After Immune Checkpoint Inhibitor Administration: a Prospective Observational Study
    diagnostics Article The Entire Intestinal Tract Surveillance Using Capsule Endoscopy after Immune Checkpoint Inhibitor Administration: A Prospective Observational Study Keitaro Shimozaki 1 , Kenro Hirata 1,* , Sara Horie 1, Akihiko Chida 1, Kai Tsugaru 1, Yukie Hayashi 1, Kenta Kawasaki 1, Ryoichi Miyanaga 1, Hideyuki Hayashi 2 , Ryuichi Mizuno 3, Takeru Funakoshi 4, Naoki Hosoe 5, Yasuo Hamamoto 2 and Takanori Kanai 1 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] (K.S.); [email protected] (S.H.); [email protected] (A.C.); [email protected] (K.T.); [email protected] (Y.H.); [email protected] (K.K.); [email protected] (R.M.); [email protected] (T.K.) 2 Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] (H.H.); [email protected] (Y.H.) 3 Department of Urology, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] 4 Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] 5 Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] * Correspondence: [email protected]; Tel.: +81-3-3353-1211 Citation: Shimozaki, K.; Hirata, K.; Abstract: Background: Despite the proven efficacy of immune checkpoint inhibitors (ICIs) against Horie, S.; Chida, A.; Tsugaru, K.; various types of malignancies, they have been found to induce immune-related adverse events, such Hayashi, Y.; Kawasaki, K.; Miyanaga, as enterocolitis; however, the clinical features of ICI-induced enterocolitis remain to be sufficiently R.; Hayashi, H.; Mizuno, R.; et al.
    [Show full text]
  • Resveratrol Alleviates Acute Campylobacter Jejuni Induced Enterocolitis in a Preclinical Murine Intervention Study
    microorganisms Article Resveratrol Alleviates Acute Campylobacter jejuni Induced Enterocolitis in a Preclinical Murine Intervention Study Markus M. Heimesaat 1,* , Soraya Mousavi 1, Ulrike Escher 1,Fábia Daniela Lobo de Sá 2 , Elisa Peh 3 , Jörg-Dieter Schulzke 2 , Sophie Kittler 3, Roland Bücker 2 and Stefan Bereswill 1 1 Institute of Microbiology, Infectious Diseases and Immunology, Charité—University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; [email protected] (S.M.); [email protected] (U.E.); [email protected] (S.B.) 2 Institute of Clinical Physiology, Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; [email protected] (F.D.L.d.S.); [email protected] (J.-D.S.); [email protected] (R.B.) 3 Institute for Food Quality and Food Safety, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany; [email protected] (E.P.); [email protected] (S.K.) * Correspondence: [email protected]; Tel.: +49-30-450524318 Received: 7 October 2020; Accepted: 23 November 2020; Published: 25 November 2020 Abstract: The polyphenolic compound resveratrol has been shown to exert health-beneficial properties. Given globally emerging Campylobacter infections in humans, we addressed potential anti-pathogenic, immuno-modulatory and intestinal epithelial barrier preserving properties of synthetic resveratrol in the present preclinical intervention study applying a murine acute campylobacteriosis model. / Two days following peroral C. jejuni infection, secondary abiotic IL-10− − mice were either subjected to resveratrol or placebo via the drinking water.
    [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]
  • Pdf (30 November 2019, Date Last Accessed)
    Gastroenterology Report, 8(1), 2020, 25–30 doi: 10.1093/gastro/goz065 Advance Access Publication Date: 17 December 2019 Review REVIEW Gastrointestinal adverse events associated with immune checkpoint inhibitor therapy Eva Rajha1, Patrick Chaftari1,*, Mona Kamal1, Julian Maamari2, Christopher Chaftari3, Sai-Ching Jim Yeung1 1Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Schoool of Medicine, Lebanese American University, Byblos, Lebanon; 3Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA *Corresponding author. Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: þ1-832-833-1702; Email: [email protected] Abstract Immunotherapy with checkpoint inhibitors has revolutionized cancer therapy and is now the standard treatment for several different types of cancer, supported by favorable outcomes and good tolerance. However, it is linked to multiple immune manifestations, referred to as immune-related adverse events (irAEs). These adverse events frequently affect the skin, colon, endocrine glands, lungs, and liver. The gastrointestinal system is one of the most commonly affected organ sys- tems and is responsible for the most frequent emergency visits resulting from irAEs. However, because immune checkpoint inhibitors are a recent addition to our arsenal of cancer drugs, many health-care providers remain unfamiliar with the management of irAEs. Gastroenterologists involved in the treatment of oncology patients who have received checkpoint inhibitors are currently encountering cases of abdominal pain, diarrhea, and other nonspecific symptoms that may be challenging to manage. This article reviews the gastrointestinal, hepatic, and pancreatic toxicities of checkpoint inhibitors and provides an approach to their diagnosis and recommended workup.
    [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]