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Eosinophilic gastroenteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract. Recently, the authors experienced a case of eosinophilic gastroenteritis presenting as small bowel obstruction. A 51-year old woman was admitted to our hospital complaining of abdominal pain and vomiting. Physical examination revealed a distended abdomen with diffuse tenderness. Complete blood count showed mild leukocytosis without eosinophilia. Computed tomography confirmed a dilatation of the small intestine with ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. Segmental resection of the ileum and end to end anastomosis were performed. Histologically, there was a dense infiltration of eosinophils throughout the entire thickness of ileal wall and eosinophilic enteritis was diagnosed. The patient recovered well, and was free from gastrointestinal symptoms at the time when we reported her disease.
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PMID:Eosinophilic gastroenteritis presenting as small bowel obstruction: a case report and review of the literature. 1746 85

The aim of our study was to evaluate the role of Salmonella spp in children hospitalised for acute gastroenteritis, and to study clinical and microbiological features of paediatric salmonellosis in our geographical area. In all, 540 patients admitted from March to September 2003 with symptoms of acute enteritis to the Infectious Diseases department of the "G. Di Cristina" hospital in Palermo were enrolled. Stool samples were collected within 48 hours of admission and tested for intestinal pathogens (bacterial, viral, parasites). Salmonella spp was detected in 18.5% of samples. The median age of infected children was 4.5 years. Salmonella enteritidis (49%) and Salmonella typhimurium (37%) were the most commonly identified genotypes. S. enteritidis infection was more frequently characterized by vomiting (65.3%) and dehydration (61.2%). Bloody diarrhoea was more common in S. typhimurium infection (40.5%). All strains were susceptible to ceftriaxone, while 40% of strains were resistant to tetracyclines and 37% to ampicillin.
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PMID:[Clinical and microbiological features of Salmonella gastroenteritis in children]. 1751 72

Porcine epidemic diarrhea virus (PEDV) and porcine group A rotavirus (PGAR) are the main causative agents of acute diarrhea in piglets. In South Korea, PGAR is prevalent in piglets naturally infected with PEDV. Piglets naturally co-infected with PEDV and PGAR appeared to have severe and prolonged diarrhea that was distinct from that commonly observed. The aim of this study was to determine the impact of PGAR co-infection on PEDV pathogenicity in piglets. Thirty-six colostrum-deprived, one-day old, Large White-Duroc crossbred pigs were randomly divided into four equal groups: PEDV, PEDV/PGAR, PGAR, and control groups. The piglets were euthanized at 1, 2, or 3 days post-inoculation (DPI) to measure the villous height:crypt depth (VH:CD) ratio and to collect fecal samples for RT-PCR and virus isolation. No significant differences in mean VH:CD ratio and clinical symptoms (diarrhea, vomiting, dehydration, and anorexia) were observed between the PEDV/PGAR-infected and PEDV-infected groups of piglets at 1, 2 and 3 DPI; however, at 2 and 3 DPI, PGAR was detected in all fecal samples by RT-PCR and virus isolation. These findings failed to detect any interaction between PEDV and porcine rotavirus in the small intestines of piglets, suggesting that concurrent infection of PGAR may not synergistically enhance intestinal villous atrophy of piglets with PEDV disease. We propose that the severe diarrhea exhibited in PEDV and PGAR co-infected piglets may be more associated with the immunity level of the host rather than to any synergistic effect of PGAR on PEDV enteritis.
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PMID:Impact of porcine group A rotavirus co-infection on porcine epidemic diarrhea virus pathogenicity in piglets. 1772 5

Norwegian Lundehunds are often affected by gastrointestinal disease, the most common clinical signs of which are intermittent diarrhea, vomiting, weight loss, lethargy, ascites, and subcutaneous edema of the hind legs. The most frequent laboratory changes include hypoalbuminemia (with or without hypoglobulinemia), hypocalcemia, a decrease in the serum cobalamin concentration, and an increase or decrease in the serum folate concentration, reflecting microbial synthesis or malabsorption, respectively. Histopathologic abnormalities can include chronic atrophic gastritis, intestinal lymphangiectasia, and lymphoplasmacytic enteritis. Because the underlying cause of gastroenteropathy in Norwegian Lundehunds has not been identified, treatment is symptomatic.
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PMID:Gastroenteropathy in Norwegian Lundehunds. 1784

During the last winter season, there was the hitherto largest norovirus gastroenteritis epidemic in Germany. Noroviruses are genetically highly variable, non-enveloped viruses with a single-stranded, positive sense RNA genome. They are the major cause of epidemic non-bacterial gastroenteritis worldwide, and have been identified as the cause of more than 70% of outbreaks and approximately half of all gastroenteritis outbreaks. Noroviruses also are frequently involved in sporadic cases of gastroenteritis. Typically, norovirus-associated enteritis is characterized by the sudden onset of vomiting and watery diarrhoea, frequently accompanied by several unspecific symptoms, e. g. abdominal pain, anorexia, malaise, headache, and low-grade fever. Diarrhoea without emesis as well as asymptomatic infections is also common. With few exceptions, diseases due to noroviruses are self-limited and the illness duration is restricted to a few days. Noroviruses are transmitted primarily from person-to-person by the faecal-oral route, but airborne transmission also occurs. Contamination of food and water represent important sources for human infection. Treatment ofnorovirus gastroenteritis is usually symptomatic and comprises a sufficient fluid and electrolyte substitution. There is no specific antiviral therapy. For prophylaxis, obeying of common hygienic rules in canteen kitchens and community institutions is regarded to be sufficient. Food with high risk of contamination should be cooked thoroughly. Because of the high stability of noroviruses to several environmental conditions, disinfection should be performed applying disinfectants with proven activity against noroviruses.
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PMID:[Norovirus infections]. 1796 85

The Authors relate clinical-microbiological criteria for a rational diagnosis of acute and prolonged enteritis, distinguishing between home and imported diarrheas. During 2005, 381 subjects (192 children and 189 adults) with acute diarrhea and 110 subjects (16 children and 94 adults) with prolonged diarrhea were examined. In the first group Salmonella prevailed in 11.1% of cases (10.9% among children and 11.1% among adults); Campylobacter in 9.2% (respectively 8.9% and 9.5%); other bacteria were identified in 3.2% of cases (1.0% and 3.8% respectively). Rotavirus were observed in 29.5% of children and Adenovirus in 6.2% of pediatric population. Pathogenic protozoa were observed in 1.6% of people (0.5% in children and 2.7% in adults). Among second group pathogenic protozoa prevailed in 6.4% (6.3% in children and 6.4% in adults); toxin A of C. difficile were detected in 8.5% of total cases. The Authors emphasize the importance to investigate always for Salmonella, Shigella and Campylobacter; in children with vomiting (with acute non invasive enteritis) is necessary to investigate for Rotavirus too; if the diarrhea is prolonged could be important investigate for toxin A/B of C. difficile and for protozoa with specific stains. Based on clinical and epidemiological findings other pathogens could be researched, if possible for own resources.
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PMID:[Acute and prolonged infectious diarrheas, of microbial and viral etiology: methods of clinical and microbiological diagnosis]. 1804 4

We present three cases of late radiation enteritis, all admitted through the accident and emergency unit and managed in the surgical department. All presented with acute symptoms. Two had abdominal pain, nausea, and vomiting and in these two cases, plain radiology and computed tomography scans demonstrated small bowel obstruction. Exploratory laparotomies confirmed chronic radiation damage to the small bowel. The affected areas were resected and anastomoses were performed. The postoperative course was uneventful. The other patient presented with bleeding per rectum and a colonoscopy with biopsy of the rectum confirmed proctitis and radiation enteritis. This patient was treated conservatively and responded well. The key factor needed for successful diagnosis and management of chronic radiation enteritis is a high index of suspicion leading to appropriate use of imaging.
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PMID:Does chronic radiation enteritis pose a diagnostic challenge? A report of three cases. 1868 70

PURPOSE: To report our clinical experience with 25 patients receiving concurrent capecitabine and irradiation in the treatment of locally advanced or resected pancreatic cancer. METHODS AND MATERIALS: We reviewed the medical records of patients with pancreatic cancer who received treatment with capecitabine and irradiation for pancreatic cancer and received capecitabine 1200 to 1600 mg/m(2) orally twice daily Monday through Friday with concurrent radiation (5040-5400 cGy, 180 cGy, 5 days/week), followed by a 4-week rest, then 6 to 8 cycles of capecitabine alone 2000 to 2500 mg/m(2) twice daily for 14 days every 3 weeks (surgically resected), and capecitabine 2000 to 2500 mg/m(2) BID for 14 days every 3 weeks until progressive disease (unresected). RESULTS: The population consisted of 14 females and 11 males, with a median age of 64 years (range 37-80 years). Histology was adenocarcinoma in 23 patients and neuroendocrine tumor in 2 patients. One patient had resected tumor, 3 patients were resected with positive margins, 1 patient was resectable with poor performance status prohibiting resection, and 20 patients had unresected locally advanced disease. Median dose of capecitabine concurrent with radiation was 1500 mg/m(2)/day (600-1600 mg/m(2)/day) given orally in two divided doses, 5 days per week on days of treatment with radiation therapy. Patients received a median total radiation dose of 5040 cGy (4500-5040 cGy) over 6 weeks. Eleven patients were continued on capecitabine cycles after treatment with concurrent capecitabine and irradiation. The median number of cycles completed was 3, with one patient completing 8 cycles. Median survival was 14 months, with 18 patients surviving through the end of the study period. Median overall primary tumor response over the study period was -2% (-100%-100%). Five patients were taken to laparotomy after treatment based on radiographic response and two patients were successfully resected. By the end of the study period, there were 4 complete remissions, 2 partial remissions, 6 stable disease, and 13 progressive disease. Grade 3 or 4 toxicity was observed mainly with gastrointestinal symptoms including nausea, vomiting, diarrhea, and anorexia. Three patients had G3 hand-foot syndrome, 1 patient had G3 peripheral neuropathy, 1 patient had G4 gastrointestinal bleed, and 1 patient had G3 radiation enteritis. There was one death directly related to treatment secondary to uncontrolled GI bleeding. CONCLUSION: In patients with locally advanced pancreatic cancer, concurrent capecitabine and radiation had good survival response in patients and good tumor response. Toxicity of oral capecitabine was well tolerated.
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PMID:Retrospective Analysis of Capecitabine and Radiation Therapy in the Treatment of Pancreatic Cancer. 1908 4

Background. A 61-year-old woman who had undergone an ileostomy closure 10 days previously presented to a tertiary medical center with abdominal pain, vomiting, diarrhea, dehydration, and oliguria. The patient had undergone a staged total proctocolectomy with ileal-pouch-anal anastomosis and a loop ileostomy 8 months previously to treat her steroid-refractory ulcerative colitis.Investigations. Physical examination, abdominal and pelvic CT scan, blood laboratory tests, pouch endoscopy, and fecal testing for Clostridium difficle toxins A and B.Diagnosis. Fulminant C. difficile-associated pouchitis and enteritis, which led to Psuedomonas aeruginosa septicemia, intravascular coagulopathy, acute renal failure, hemorrhagic ascites and respiratory failure and eventual death.Management. Intravenous hydration, aggressive therapy with oral and intravenous antibiotics, supportive care, hemodialysis, and intubation.
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PMID:Fulminant Clostridium difficile-associated pouchitis with a fatal outcome. 1965 2

Abdominal pain is a frequent complaint in patients with Systemic Lupus Erythematosus (SLE). The authors describe the case of a 33-year-old SLE female patient, followed in their rheumatology clinic, who presented with acute and diffuse abdominal pain, vomiting and diffuse rebound tenderness at abdominal examination. Abdominal ultrasound and CT scans showed small bowel wall thickening, with target sign on the CT scan, which suggested the diagnosis of Lupus Enteritis. The patient was treated with high-dose corticosteroids, with rapid resolution of all abdominal abnormalities. Lupus Enteritis is a rare complication of SLE, due to intestinal small-vessel vasculitis. It is a very serious complication of SLE, but the prognosis can be greatly improved with early diagnosis and adequate treatment, as in the case presented here.
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PMID:[Abdominal pain due to lupus enteritis: a rare cause for a frequent complaint]. 1972 52


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