1/5. Allergic eosinophilic gastroenteritis in a boy with congenital duodenal obstruction.Eosinophilic gastroenteritis (EG) is a rare allergy-related disease, especially in early childhood. We present the case of a 1 year 4 month old boy with congenital duodenal obstruction who developed EG. That diagnosis of EG was made by a series of imaging studies and was confirmed by upper gastrointestinal (UGI) endoscopic biopsy studies which showed significant tissue eosinophilia in both mucosal and submucosal layers. No evidence of parasite segment or ova was found in the stool and biopsy specimen. Specific IgE antibodies to milk were estimated to be 2 (CAP system). Cow's milk allergy was highly suspected but not confirmed by consecutive elimination and challenge tests since the child was too much suffered to be tested. There was partial response to the 2-week treatment with Alfare (semi-elemental formula) and oral prednisolone 1 mg/kg/day. One month after initial examination, perforation of the stomach occurred and exploratory laparotomy disclosed stenosis of the duodenum. Congenital duodenal obstruction was diagnosed based on operative findings and previous sonographic findings. There has been only one report of EG in an infant with congenital duodenal obstruction. The nature of the relationships among cow's milk allergy as a possible etiologic factor, congenital duodenal obstruction as an predisposing factor and EG involvement at both mucosal and submucosal layers remains unclear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/5. Two- to three-fold increase in blood tacrolimus (FK506) levels during diarrhea in liver-transplanted children.BACKGROUND: The diagnosis and treatment of diarrhea in liver transplant recipients often pose a challenge owing to the variety of infectious and non-infectious causes. However, diagnosis is principally focused on ruling out an infectious etiology. tacrolimus, an immunosuppressive agent generally used after liver transplantation, is absorbed mainly from the duodenum through the upper jejunum. It can be assumed that metabolism of the drug will be influenced by diarrhea. methods: Four liver transplant recipients who developed an episode of acute gastroenteritis. Infectious etiology was confirmed; trough tacrolimus levels were measured before, during and after gastroenteritis. RESULTS: All patients presented a two- to three-fold increase in blood tacrolimus levels after the onset of gastroenteritis. CONCLUSIONS: Until the role played by the intestine in the metabolism of tacrolimus is fully understood, it is prudent to recommend early dose reduction of tacrolimus and careful monitoring of trough levels during diarrheal disorders of any nature in pediatric liver-transplanted patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/5. Eosinophilic gastroenteritis and citrus-induced urticaria.The immunological basis of eosinophilic gastroenteritis (EGE) is an interesting contrast between the enigma of urticaria and the increasing usage of molecular technology in clinical allergy. Little is known about the natural history of EGE. It has been known to spontaneously remit, but the typical course, especially in adults, is one of chronic and intermittent disease. Given the often chronic nature of this disease, it is important to use relatively benign treatments initially and limit the use of systemic corticosteroids. Also, given the fact that eosinophilic infiltration of the gastrointestinal tract may also be a manifestation of other potentially dangerous disease processes, such as malignancy or hypereosinophilic syndrome, which may be initially diagnosed as EGE, routine surveillance of the cardiopulmonary and gastrointestinal systems is important. We present a patient who demonstrates the variability of presentation and treatment response in this multifaceted disease. The fact that he has apparently entered remission also makes his an uncommon presentation of EGE.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/5. seizures and encephalopathy as the presenting sign of viral gastroenteritis.OBJECTIVES: To determine the incidence, nature, and outcome of encephalopathy associated with viral gastroenteritis in hospitalized children. methods: Retrospective chart review of all children during a 4-year period with viral gastroenteritis identified by international classification of diseases, Ninth Revision, Clinical Modification/international classification of diseases, Tenth Revision (ICD-9-CM/ICD-10) codes. Children with encephalopathy were defined as cases; the remainder served as controls. RESULTS: Thirteen (7.2%) of 181 children presented with encephalopathy (typical febrile seizures, 4; atypical febrile seizures, 4; afebrile seizures, 3; with alteration in level of consciousness alone, 2). Between cases and controls, the mean age (17.4 vs. 14.9 months, respectively) and temperature (38.4 degrees C vs. 38.5 degrees C, respectively) were not significantly different (mean age, P = 0.52; temperature, P = 0.61). The mean length of hospital stay was longer in children with encephalopathy (7 vs. 4.3 days; P = 0.03). All children recovered without sequelae. CONCLUSIONS: Encephalopathy, including afebrile seizures and nonconvulsive encephalopathy, is a relatively common presenting sign of acute viral gastrointestinal tract infection in hospitalized children, has a good outcome, but is associated with increased diagnostic testing and length of stay.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/5. Giant antral ulcer: a rare presentation of eosinophilic gastroenteritis--case report and review of the literature.A 24-yr-old female presented with a giant gastric ulcer and anemia. She suffered from a transient infantile malabsorption syndrome with eosinophilia. The diagnosis of eosinophilic gastroenteritis associated with the gastric ulcer was made by endoscopic biopsy. ulcer healing was refractory to medical therapy and partial gastrectomy was performed. Histologic examination revealed transmural eosinophilic infiltrates with mast cell infiltrates in the gastric wall. This case illustrates (1) an extremely rare presentation of eosinophilic gastroenteritis--giant, refractory, gastric ulcer; (2) a potential pathogenic role for mast cells in this syndrome; and (3) the chronic and relapsing nature of the syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |