A rare cause of abdominal pain with fever

An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia. The imaging findings allowed us to diagnose a Lemmel’s syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.

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Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2009/791627 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Salvatore Maria Antonio Campo ◽

Roberto Lorenzetti ◽

Marina de Matthaeis ◽

Cesare Hassan ◽

Angelo Zullo ◽

...

Keyword(s):

Old Age ◽

Iron Deficiency Anaemia ◽

Gastrointestinal Endoscopy ◽

Barium Swallow ◽

Upper Gastrointestinal Endoscopy ◽

Metal Stent ◽

History Of ◽

Upper Gastrointestinal ◽

Progressive Dysphagia

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

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Repeat Upper Gastrointestinal Endoscopy in Patients with Functional Dyspepsia: Yield, Findings, and Predictors of Positive Findings

Gastroenterology Research and Practice ◽

10.1155/2015/904683 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Supot Pongprasobchai ◽

Natta Asanaleykha ◽

Pongchirat Tantayakom

Keyword(s):

Peptic Ulcer ◽

Functional Dyspepsia ◽

Reflux Esophagitis ◽

Gastrointestinal Endoscopy ◽

Multivariate Analyses ◽

Upper Gastrointestinal Endoscopy ◽

Erosive Gastritis ◽

History Of ◽

Alarm Features ◽

Upper Gastrointestinal

Background. No guideline on repeat esophagogastroduodenoscopy (EGD) in functional dyspepsia (FD) exists. This study aimed to define yield, findings, and predictors of positive findings on repeat EGD in FD.Methods. FD patients who underwent at least 2 EGDs during October 2005 to November 2011 were enrolled and reviewed. Yield and findings were analyzed and univariate and multivariate analyses were performed to identify predictors of positive repeat EGD.Results. The median time to repeat EGD was 34 months. Among 146 patients, 115 patients (79%) had negative and 31 (21%) had positive repeat EGD, including erosive gastritis (13.0%), peptic ulcer (7.5%), reflux esophagitis (1.4%), and Barrett’s esophagus (0.7%). Four independent predictors of positive repeat EGD were smoking (HR 3.88, 95% CI 1.31–11.51,P=0.015), hypertension (HR 2.96, 95% CI 1.38–6.36,P=0.050), history of malignancies (HR 3.65, 95% CI 1.16–11.46,P=0.027), and antiplatelets or NSAIDs used within 4 weeks (HR 4.10, 95% CI 1.13–14.90,P=0.032), while alarm features or failure to treatment did not predict positive repeat EGD. Conclusion. Yield of repeat EGD in FD was substantially low, all findings were acid-related disorders, and there was no malignancy. Smoking, hypertension, history of malignancies, and antiplatelets/NSAIDs use associated with positive repeat EGD.

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Severe Chest Pain due to N-Acetylcysteine-Induced Esophagitis

Case Reports in Medicine ◽

10.1155/2019/8057259 ◽

2019 ◽

Vol 2019 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Weihong Wang ◽

Yu Zhang ◽

Yi Liu ◽

Lei Xu ◽

Dingmei Shi

Keyword(s):

Chest Pain ◽

Gastrointestinal Endoscopy ◽

Unusual Case ◽

Upper Gastrointestinal Endoscopy ◽

Shortness Of Breath ◽

Severe Chest Pain ◽

History Of ◽

Upper Gastrointestinal ◽

Powdered Form

We report an unusual case of severe chest pain caused by N-acetylcysteine-induced esophagitis. An 81-year-old Chinese man with a history of interstitial lung disease was admitted to our hospital with intermittent arrhythmia that began 5 days ago. The patient presented with complaints of cough, sputum, and shortness of breath. Cefminox injections and N-acetylcysteine tablets were prescribed to improve respiratory symptoms. The patient developed severe chest pain and odynophagia 4 hours after swallowing the N-acetylcysteine tablet while in the decubitus position. Upper gastrointestinal endoscopy revealed four discrete areas of ulcerations measuring approximately 1 cm at the midesophageal level. The distance between the foci and the incisors was approximately 24 cm. The patient continued the N-acetylcysteine orally, which was administered in powdered form with more water while in the upright position. Pantoprazole and hydrotalcite were also administered to the patient. The symptoms subsided, and a follow-up endoscopy after 20 days showed that the ulcers healed. This case highlights that seemingly safe drugs such as N-acetylcysteine can lead to severe chest pain if ingested inappropriately.

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MISSING RATE OF GASTRIC CANCER DURING UPPER GASTROINTESTINAL ENDOSCOPY AND INFLUENCE ON THE NATURAL HISTORY OF THE DISEASE

10.26226/morressier.59a6b345d462b80290b5466f ◽

2017 ◽

Author(s):

Rosario Salmoral

Keyword(s):

Gastric Cancer ◽

Natural History ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

History Of ◽

Upper Gastrointestinal

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CIRRHOTIC PATIENTS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.09.1705 ◽

2016 ◽

Vol 23 (09) ◽

pp. 1099-1103

Author(s):

Abdul Aziz Sahto ◽

Amir Shahzad ◽

Mahnaz Faiz Sahito

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Endoscopy ◽

Lateral Position ◽

Outcome Variable ◽

Upper Gastrointestinal Endoscopy ◽

Care Hospital ◽

Left Lateral Position ◽

History Of ◽

Cirrhotic Patients ◽

Upper Gastrointestinal

Objectives: The aim behind this study was to determine the prevalence of portalhypertensive gastropathy in cirrhotic patients undergoing upper gastrointestinal endoscopy at atertiary care hospital in Shaheed Benazeerabad. Study Design: Hospital based cross sectionalstudy. Setting: Medicine Department of People’s Medical University, Shaheed Benazeerabad.Period: Six months from 20th August 2014 to 21st February 2015. Material and Methods: Atotal of 115 patients presenting with variceal bleeding (having history of liver cirrhosis since>2 years) and who further was undergoing diagnostic Endoscopic gastrodudenoscopy wereenrolled in the study. All endoscopies were performed by the endoscopists using a GIFQ 160Gastroscope (Olympus, Tokyo, Japan) in the left lateral position. The presence or absenceof PH gastropathy (outcome variable) was noted at each endoscopy. SPSS version 17.0 wasused to analyze the collected data. Results: The average age of the patients was 39.98±11.02years and mean duration of liver cirrhosis was 4.62±1.5 years. There were 70 (60.87%) maleand 45 (39.13%) were female. Regarding socioeconomic status, most of the cases were inlower and middle class. Frequency of portal hypertensive gastropathy (PHG) in patients of livercirrhosis undergoing upper gastrointestinal endoscopy was observed in 60% (69/115) cases.Conclusion: The frequency of PHG was 60% in the studied group of cirrhotic patients. Thisconcludes that if in the liver cirrhosis patients early identification and appropriate therapeuticmeasures of PHG is taken the morbidity in these patients can be decreased.

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Mixed adenoneuroendocrine carcinoma of proximal stomach; a rare but sinister pathology

Journal of Pathology of Nepal ◽

10.3126/jpn.v10i2.29050 ◽

2020 ◽

Vol 10 (2) ◽

pp. 1772-1775

Author(s):

Deepshikha Gaire ◽

Daisy Maharjan ◽

Nisha Sharma

Keyword(s):

Gastrointestinal Endoscopy ◽

Histopathological Examination ◽

Gastroesophageal Junction ◽

Upper Gastrointestinal Endoscopy ◽

Radiological Findings ◽

Proximal Stomach ◽

History Of ◽

Adenocarcinoma Component ◽

Physical Findings ◽

Upper Gastrointestinal

Mixed adeno-neuroendocrine carcinoma is a rare tumor of the gastrointestinal tract comprising of both epithelial and neuroendocrine components, each representing at least 30% of the tumor. Diagnosis is based on clinical evaluation, radiological findings, histopathological features in conjunction with immunostaining with specific neuroendocrine markers such as chromogranin, synaptophysin, CD56, and markers of epithelial differentiation such as cytokeratin, CDX2, and carcinoembryonic antigen. A 50-year-old female presented with a history of dysphagia, chest pain, anorexia, and significant weight loss with normal physical findings and baseline investigations. Upper Gastrointestinal endoscopy showed growth at the gastroesophageal junction involving cardia of the stomach. Histopathological examination of the resected mass showed both adenocarcinoma and neuroendocrine carcinomatous components each involving more than 30% of total mass examined. Identifying adenocarcinoma component admixed with a high-grade neuroendocrine component is significant as the prognosis and survival of patients differ from pure adenocarcinoma.

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Gastric predominant hereditary hemorrhagic telangiectasia

VASA ◽

10.1024/0301-1526.35.4.258 ◽

2006 ◽

Vol 35 (4) ◽

pp. 258-261

Author(s):

Katsinelos ◽

Chatzimavroudis ◽

Zavos ◽

Kamperis ◽

Triantafillidis ◽

...

Keyword(s):

Hereditary Hemorrhagic Telangiectasia ◽

Gastrointestinal Endoscopy ◽

Autosomal Dominant ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Upper Gastrointestinal Endoscopy ◽

Autosomal Dominant Disorder ◽

Plasma Coagulation ◽

History Of ◽

Upper Gastrointestinal

Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomal-dominant disorder that frequently presents with epistaxis and gastrointestinal bleeding which may be a diagnostic and therapeutic challenge. We describe a 48-year-old monk with familiar history of HHT, who presented with frequent epistaxes and symptoms of ferropenic anemia. Upper gastrointestinal endoscopy revealed innumerable telangiectasias in the stomach. The patient underwent three sessions with argon plasma coagulation treatment but the results were poor. We also review the literature on the pathophysiology of the disease and discuss the suggested treatment.

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Clinical correlation between Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v4i4.18255 ◽

2017 ◽

Vol 4 (4) ◽

pp. 135-139 ◽

Cited By ~ 1

Author(s):

Prabin Bikram Thapa ◽

Dhiresh Kumar Maharjan ◽

Tseten Yonjon Tamang ◽

Suman Kumar Shrestha

Keyword(s):

Cirrhotic Patient ◽

Gastrointestinal Endoscopy ◽

Major Complication ◽

Oesophageal Varices ◽

Upper Gastrointestinal Endoscopy ◽

History Of ◽

Grade Ii ◽

Cirrhotic Patients ◽

One Year ◽

Upper Gastrointestinal

Background: Bleeding oesophageal varices are a major complication of portal hypertension following liver cirrhosis. Child Pugh’s score has been used as a prognostic tool while managing a patient with liver cirrhosis.Objective: To clinically correlate Child Pugh’s score and oesophageal varices in upper gastrointestinal endoscopy in cirrhotic patient.Methods: This is a prospective descriptive study done from January 2014 to January 2015. Cirrhotic patients who were referred for upper gastrointestinal endoscopy with or without history of upper GI bleeding were included. Patients were categorized according to Child Pugh’s score into A, B, C and correlated with their endoscopic finding of grading of varices.Results: A total of 50 cirrhotic patients underwent upper gastrointestinal endoscopy during one year. Out of which 60% were in Child Pugh’s category A, 30 % in category B and 10 % in category C. Among them 62% had grade I varices, 20% had grade II varices and 18 % had grade III varices. Those who presented with history of hematemesis had higher grades of oesophageal varices in comparison to those without hematemesis.Conclusion: Cirrhotic patients with higher Child Pugh’s score had higher grades of oesophageal varices leading presentation with hematemesis. Hence, routine screening of cirrhotic patient is necessary before the development of varices.

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