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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy-nine gastrointestinal complications in 480 recipients of a renal transplant (RT) (16%) are described. The most frequent complication was high digestive haemorrhage (HDH) (19/480) (2.9%); other complications were: esophagitis, gastroenteritis, diverticulitis, cholecystitis, intestinal tuberculosis, rectal ulcer and colonic polyps. Mortality secondary to gastrointestinal complications was 1.1%. Sixty-seven percent of cases with peptic ulcer developed HDH, an incidence higher than that observed in the general population (20%). Twenty-one percent of transplanted patients with DH had ulcer background. Cholecystitis and diverticulitis were complications with a low incidence (0.2% and 0.6%, respectively) which do not seem to justify aggressive diagnostic and therapeutic manoeuvres prior to the transplant. Prevalence of intestinal tuberculosis in this series (0.4%) was higher to that described in the literature.
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PMID:[Gastrointestinal complications in renal transplantation]. 797 13

A prospective study on the microbes isolated from the alimentary tract in 120 bone marrow transplant (BMT) recipients (1991-1993) was undertaken to define the spectrum of organisms isolated under antimicrobial prophylaxis, their temporal sequence of emergence, and the associated morbidity and mortality. Clostridium difficile (n = 20), isolated in the pre-engraftment and early post-engraftment periods (day 2-45 post-BMT), was the most common microbe recovered from stool of patients with diarrhea. In contrast to previous reports, no significant difference in mortality was observed between patients with and without C. difficile isolated in stool. Two patients had neutropenic ileocecitis with concomitant bacteremia due to Escherichia coli and Klebsiella pneumoniae. One patient was found to have astrovirus gastroenteritis (day 7), and Giardia lamblia was recovered from the stool of another (day -7). Heavy growth of Staphylococcus aureus from direct smear-positive specimens was found from the upper airway of two patients with severe mucositis and complete dysphagia (day 12 and 23). Salmonella spp. of groups B and E were found in the stool of five asymptomatic patients at the time of conditioning. No specific organisms was recovered from the endoscopic brushing of two patients with lower end esophagitis, three patients with upper gastrointestinal bleeding, and three patients with perirectal cellulitis. During the post-engraftment period, five patients had documented cytomegalovirus gastroenterocolitis (days 34-97), one had Mycobacterium chelonae colitis (day 70), and another had nodular gastritis due to Acremonium falciforme (day 270). Overall, only 28% of patients with alimentary tract symptoms/syndrome had specific pathogens isolated from clinical specimens. Differentiation of the causation of alimentary tract symptoms was often difficult because noninfectious complications such as conditioning toxicity, graft-versus-host disease, and its treatment often caused alimentary tract symptoms in addition to predisposed BMT patient to infection. The reluctance of obtaining tissue biopsy for ascertaining the importance of those potential alimentary tract pathogens often dictate the use of empirical treatment.
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PMID:Clinical significance of alimentary tract microbes in bone marrow transplant recipients. 955 72

Infiltration of esophageal epithelium by eosinophils is seen in reflux esophagitis and allergic gastroenteritis. This study was performed to identify differences between patients with acid reflux esophagitis and those with non-acid reflux, possibly allergic, esophagitis. Intraepithelial eosinophils were demonstrated in posttherapy esophageal biopsy specimens in 28 children treated for gastroesophageal reflux disease (GERD). These patients were divided into three groups based on their response to treatment and the results of esophageal pH probe monitoring. Eleven patients (Group A) had incomplete clinical response and normal pH probe monitoring results. Ten patients (Group B) had incomplete response but did not have pH probe monitoring. These two groups formed the index population. Seven patients (Group C) had clinical improvement with GERD therapy and abnormal pH probe monitoring characteristic of GERD; they constituted the control population. Clinical, laboratory, and pathologic features were evaluated to detect differences between index and control populations. Dysphagia, food impaction, failure to thrive, peripheral eosinophilia, and abnormal allergen skin test results were detected only in Group A and B patients. Biopsy specimens of the distal 9 cm of the esophagus, after GERD therapy, contained larger numbers of eosinophils in Groups A and B than in Group C as shown on high-power fields (HPF) (A: 31/HPF +/- 19.5; B: 28/HPF +/-23.7; versus C: 5/HPF +/-6.7; p = 0.009). Eosinophil aggregates were identified only in Groups A and B (p = 0.07). Eosinophils located preferentially in the superficial layers of the squamous epithelium were noted only in Groups A and B (p = 0.02). Group A and B patients demonstrated clinical improvement when given antiallergic therapy. The authors identified a group of pediatric patients characterized by an allergic history, lack of adequate response to GERD therapy, normal esophageal pH probe monitoring results, and large numbers of eosinophils in esophageal biopsy specimens obtained after GERD treatment. On the basis of these features, the authors propose that these patients represent examples of allergic esophagitis.
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PMID:Allergic esophagitis in children: a clinicopathological entity. 1019 68

Eosinophil infiltration into the esophagus is observed in diverse diseases including gastroesophageal reflux and allergic gastroenteritis, but the processes involved are largely unknown. We now report an original model of experimental esophagitis induced by exposure of mice to respiratory allergen. Allergen-challenged mice develop marked levels of esophageal eosinophils, free eosinophil granules, and epithelial cell hyperplasia, features that mimic the human disorders. Interestingly, exposure of mice to oral or intragastric allergen does not promote eosinophilic esophagitis, indicating that hypersensitivity in the esophagus occurs with simultaneous development of pulmonary inflammation. Furthermore, in the absence of eotaxin, eosinophil recruitment is attenuated, whereas in the absence of IL-5, eosinophil accumulation and epithelial hyperplasia are ablated. These results establish a pathophysiological connection between allergic hypersensitivity responses in the lung and esophagus and demonstrate an etiologic role for inhaled allergens and eosinophils in gastrointestinal inflammation.
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PMID:An etiological role for aeroallergens and eosinophils in experimental esophagitis. 1113 83

The physician is central to deciding whether a patient requires acute inpatient hospital treatment and is also responsible for appropriately documenting the record which permits accurate diagnostic-related grouping (DRG) coding. An area of particular concern both nationally and in New York State has been patients admitted with gastrointestinal (GI) disorders; specifically, DRGs 174 (GI hemorrhage with complication) and 182 (esophagitis, gastroenteritis, and miscellaneous digestive disorders age > 17 with complication comorbidity). A baseline sample of 600 cases from fiscal year (FY) 2006 was selected from 20 hospitals and underwent review for both admission necessity and DRG assignment. The results were disseminated to the hospitals. In addition, hospitals with a >10% error rate were required to implement an improvement plan. A re-measurement sample of 300 cases was taken from FY 2007 for review. The aggregate error rate was 13.3% at baseline and decreased to 8.0% on re-measurement (P < 0.05). Admission denials decreased from 8.0 to 4.7% related primarily to DRG 182. Errors in DRG assignment decreased from 5.7 to 3.3% related primarily to DRG 174. Of note, the greatest improvement in both admission and DRG errors was seen in the hospitals required to implement a formal improvement plan. These data show that a program that includes emphasis on education of physicians on the importance of admission criteria and careful documentation of the record can reduce both inappropriate admissions and improve accuracy of DRG assignment.
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PMID:Room for improvement: gastrointestinal disorders and payment errors. 1818 Oct 13

Eosinophils are important effector cells of the innate immune system. Eosinophilic infiltrative disorders of the gastrointestinal tract, though recognised for decades, have recently witnessed a resurgence of interest, particularly for oesophageal disease. A more comprehensive basis for eosinophilic infiltration and activation has identified interleukin 5 (IL5) as a key cytokine for the differentiation and proliferation of eosinophils, while eotaxins promote the recruitment of mature eosinophils to the gut. When activated, eosinophils release multiple cytotoxic agents and immunomodulatory cytokines, resulting in local inflammation and tissue damage. Although eosinophils normally convey a defence against unwanted interlopers such as parasites, in the absence of such inciting agents, their accumulation and activation can elicit the primary infiltrative disorders of the gut: eosinophilic oesophagitis, gastroenteritis and colitis. Diagnosis of these disorders is dependent on the clinical presentation, endoscopic findings (particularly for eosinophilic oesophagitis), and most importantly, histological confirmation. Dietary modifications and topical corticosteroids are first-line treatments for eosinophilic oesophagitis. Systemic corticosteroids are the mainstay of treatment for eosinophilic gastroenteritis; surgery may be required depending on the layer of mucosa involved. Eosinophilic colitis most often occurs in infants; removal of the causative allergen usually results in a complete response. Steroids may be required for older children/adolescents or adults. This review summarises current knowledge on the trafficking of eosinophils to the gastrointestinal tract and the clinical management of the primary disorders of eosinophilic oesophagitis, eosinophilic gastroenteritis and eosinophilic colitis.
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PMID:Primary eosinophilic disorders of the gastrointestinal tract. 2020 51

This article focuses on the evaluation and management of eosinophilic gastrointestinal diseases other than eosinophilic esophagitis. Those diseases include eosinophilic gastritis, gastroenteritis, enteritis, and colitis. The diagnosis of eosinophilic gastrointestinal disease is primarily dependent on the clinical history and histopathology of multiple biopsy specimens after ruling out other causes of intestinal eosinophilia. The diagnosis of eosinophilic gastrointestinal diseases other than eosinophilic esophagitis is complicated by the lack of uniformly accepted diagnostic criteria. Treatment involves evaluation for food sensitivity, elimination diets, and the use of anti-allergy and anti-inflammatory medications with varying degrees of success. Little is known about the natural history of eosinophilic gastrointestinal diseases, underscoring the need for long-term follow-up studies of patients with these disorders.
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PMID:Evaluation of the patient with suspected eosinophilic gastrointestinal disease. 1914 41

Eosinophils are pro-inflammatory cells that make a major contribution to allergic diseases affecting the upper and lower airways, skin and gastrointestinal tract. IL-5 is central to eosinophil maturation and release from the bone marrow, and to the subsequent accumulation, activation and persistence of eosinophils in the tissues. Reslizumab from Ception Therapeutics Inc is a humanized mAb with potent IL-5-neutralizing effects. The agent inhibited eosinophilia in several animal models; reductions in airway hyperactivity and bronchoconstriction were also observed. Clinical trials for reslizumab have been completed in a small number of patients with asthma, nasal polyposis, hypereosinophilic syndrome (HES) and eosinophil gastroenteritis (EG). Eosinophil depletion was observed in all trials, but clinical responses were often limited, particularly in patients with asthma; furthermore, some patients exhibited rebound of disease to levels greater than baseline. At the time of publication, phase II/III and phase III trials were ongoing in patients with eosinophilic esophagitis (EE), and a phase II trial was ongoing in patients with asthma. Reslizumab is a potentially efficacious and well-tolerated treatment for EG, EE, HES and eosinophilic polyposis, although more trials are required to understand the underlying mechanism of disease rebound. However, the rarity of conditions such as HES, EE and EG makes the conduct of such trials difficult.
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PMID:Reslizumab, a humanized anti-IL-5 mAb for the treatment of eosinophil-mediated inflammatory conditions. 1947 66

The article contains information about severe side effects of long-term acid suppression with non-select proton pump inhibitors (PPI) treatment of gastroesophageal reflux disease (GERD). As far as concern patients with heartborn without esophagitis (non-erosive GERD) using PPI doesn't correspond the pathogenesis and hardly has any advantages. Therapy with gastric acidity inhibitors increases risk of acute gastroenteritis and community-acquired pneumonia. Quality of life is rising and symptoms of gastro-esophageal reflux are getting away thanks to topical harmless treatment GERD without severe esophagitis Pepsan-R.
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PMID:[Gastroesophageal reflux disease: pathogenetic basis of differentiated tactics of treatment]. 1955 28

Eosinophilic esophagitis is an under-recognized inflammatory disorder of the esophagus. It has been frequently diagnosed in pediatric patients; however, over the last few years, there has been an increase in the number of cases recognized in adults as well. Despite this fact, eosinophilic esophagitis (EE) is often a delayed diagnosis in the primary care setting due to the overlapping symptoms it shares with other esophageal and gastrointestinal disorders such as gastroesophageal reflux disease and gastroenteritis, as well as a lack of awareness among physicians who see adult patients. We performed an exhaustive search of the literature, which revealed over 400 articles on EE; however, most were reported in gastroenterology or autoimmune specialty journals. We report a case of eosinophilic esophagitis in a 39-year-old man who presented with persistent epigastric abdominal pain and who was diagnosed via endoscopy and biopsy.
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PMID:The Case of the Infection that Wasn't ! 2030 Apr 4


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