Menetrier’s disease exacerbating ulcerative colitis and relieved by gastrectomy

Ménétrier’s disease (MD) is a rare gastropathy characterised by giant rugal folds which can present with nausea, vomiting, abdominal pain and protein losing gastropathy. We report a 21-year-old woman with comorbid MD and ulcerative colitis (UC). Management was complicated by limited treatment options for MD, significant symptom burden, worsening nutrition and difficulty determining which disease was the predominant cause of symptoms. Since age 18 the patient experienced recurrent UC flares characterised by diarrhoea, persistent vomiting and corticosteroid dependence. Endoscopic assessment demonstrated concurrent MD and active UC. Octreotide and cetuximab were trialled given persistent hypoalbuminaemia and suspicion for MD associated protein-losing gastropathy. UC management comprised dose-optimised infliximab and methotrexate. Repeat endoscopic assessment demonstrated improvement in UC without corresponding improvement in symptoms or hypoalbuminaemia. Nasojejunal feeding and parenteral nutrition failed to significantly improve nutritional status and accordingly the patient proceeded to radical total gastrectomy. Postoperatively, MD-associated symptoms and hypoalbuminemia resolved completely.

A Rare Metastatic Site of Invasive Lobular Breast Carcinoma: A Case Report

Here, we report a case of a 42-year-old female patient with left lobular breast cancer-gastric metastasis (initially misdiagnosed five years ago as an invasive ductal carcinoma) presenting with dyspepsia, weight loss, and persistent vomiting lasting for four weeks. Upper GI endoscopy revealed evidence of linitis plastica, and histological and immunocytochemical analyses of the biopsy confirmed gastric metastasis secondary to invasive lobular breast carcinoma.

Value of age and alarm features for predicting upper gastrointestinal malignancy in patients with dyspepsia: an endoscopic database review of 4664 patients in Thailand

ObjectiveAge and alarm features are commonly used as indicators for endoscopy in dyspeptic patients; however, the age cut-off and the predictive value of these parameters for identifying upper gastrointestinal (UGI) malignancies are uncertain.DesignCross-sectional study.SettingData were extracted from the Gastrointestinal Endoscopy Centre of Siriraj Hospital, Thailand, during 2005–2011.ParticipantsConsecutive patients underwent a first-time upper endoscopy for dyspepsia. Patients with previous surgery, suspected UGI malignancy by imaging, or indefinite biopsy results on prior examination were excluded.Main outcome measuresAlarm features included dysphagia, unintentional weight loss, GI bleeding/anaemia, and persistent vomiting. The diagnostic performance of each alarm feature and different age cut-off values were evaluated.ResultsA total of 4664 patients (mean age: 52.0±14.4 years, 66% female) were included. Alarm symptoms were presented in 21.6%. The prevalence of active Helicobacter pylori infection was 26.3%. Fifty-eight (1.2%) patients had UGI malignancy. The prevalence of malignancy significantly increased with increasing age (0.6% in patients aged <50 years, and 1.8% in patients aged >60 years (p<0.001)). Cancer was found in two patients aged <50 years who did not have alarm features. Patients with alarm features had a higher prevalence of malignancy (OR 22.3, 95% CI 10.5 to 47.4; p<0.001) than those without. The pooled sensitivity, specificity, positive predictive value and negative predictive value of alarm features for UGI malignancy were 87.0%, 79.1%, 4.7% and 99.8%, respectively. Among all age groups, persistent vomiting had a positive likelihood ratio (PLR) >10, while dysphagia and GI bleeding/anaemia had a PLR >10 in patients <50 years old.ConclusionDespite the overall limited value of age and alarm features, persistent vomiting, dysphagia, and GI bleeding/anaemia are strong predictors for malignancy in patients aged <50 years. Without these symptoms, cancer prevalence is negligible; thus, they are worthy guidance for endoscopic evaluation in this age group.

Tra reflussi e torcicolli

The paper descibes the cases of a 10-year-old girl and a 3-year-old boy with CNS neoplasia. The girl presented with acute vomiting and cervicalgia while in the boy vomiting persisted for three months as the only symptom and was iniatially misinterpreted as due to gastroesophageal reflux. The authors stress that in very young children (< 4 y) persistent vomiting may be the only symptom of a CNS neoplasia.

Dysphagia due to spontaneous hyperinflation of a swallowable intragastric balloon

A 49-year-old woman presented as an acute admission with persistent vomiting and an inability to tolerate both solids and liquids. Five weeks prior to the admission she had an Elipse swallowable intragastric balloon placed into her stomach as an aid to weight loss. This type of balloon stays inflated inside the stomach for 16 weeks before disintegrating and passing through the gastrointestinal tract. Observations and blood parameters were unremarkable but abdominal radiograph indicated that the balloon had undergone spontaneous hyperinflation—a rare complication. At gastroscopy, the balloon was found to fill the entire stomach volume causing dysphagia. The balloon was punctured endoscopically, contents suctioned and remnants retrieved through the gastroscope. The patient commenced oral intake the following day and was discharged home with no further symptoms at 12-week follow-up.

Boerhaave syndrome, a rare oesophageal rupture: a case report

<sec id="s1"> <title/> Boerhaave syndrome is a disorder mainly unknown among ambulance staff. However, the high mortality and morbidity rates associated with this rare disorder, and the fact that other conditions present with similar symptoms, suggest that this is one disorder to add to the differential diagnosis list. This case study describes a 17-year-old male complaining of left-sided ‘pressure’-type chest pain and persistent vomiting who on examination was found to have subcutaneous emphysema present. Deceived by a differential diagnosis, the patient was transferred under the belief that he had suffered a spontaneous pneumothorax as he was tall, young and thin. This case report reviews the literature surrounding Boerhaave syndrome and how it can present. </sec>

Pattern of Presentation and Organ Involvement in Dengue Fever at Dhaka Medical College Hospital

Dengue fever first identified as ‘Dhaka Fever’ in 1964 & became endemic around 2000. The most recent spreading of dengue in 2019 was also notable for change in the presenting features of the patients attributed by some to the fact that causative virus might be of different serotype. Our study aims to assess the current pattern of presentation of dengue virus infection, done in inpatient of Department of Medicine of Dhaka Medical College Hospital Dhaka. This was a crosssectional, observational, descriptive study conducted between 1st August and 30th September 2019. A total 70 subjects, age >12 years were included in this study. Among them 55 were male & 15 were female, with a mean age of 28.33(±12.15) years. Comorbidities noticed in few cases such as DM (2, 2.90%), HTN (3, 4.35%), IHD (1,1.45%), CKD & COPD (1,1.45%). The most common presentation were fever (64, 91.43%), headache (62, 88.57%) anorexia (59, 85.51%), generalised pain (51, 73.91%), nausea (49, 71.01%). Examination findings at admission were temperature was high but not very high, pulse were normal, both systolic & diastolic pressure were somewhat normal, among the warning signs, severe abdominal pain (27.54%), persistent vomiting (21.74%), lethargy /restlessness /sudden behavioural change (21.74%) were most common. The common haematological parameters & routine investigation values were not deviated from expected range. As dengue is likely to continue to constitute a serious public health problem in Bangladesh, this study may help the practitioners to understand the changing pattern & to manage patients accordingly. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 199-207