Editor-in-Chief, Deputy Editor 2017-2019

 

Editor-in-Chief:

Tom MOREELS

 

Deputy Editor:

Nicolas LANTHIER

 

Letters



Cyclic vomiting in a young patient with superior mesenteric artery syndrome


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Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by duodenal compression through aorto-mesenteric clamp, also known as the Wilkie’s syndrome. In SMAS passage is blocked in the lower part of the duodenum by vascular compression. Precipitating factors include increased lordoses, loss of abdominal muscle tone, rapid weight loss (2), abdominal surgery, or intrabdominal inflammatory conditions that may compress the mesenteric vessels. Symptoms are usually non specific and intermittent and include postprandial epigastric fullness, bloating, nausea, vomiting, and abdominal pain that are usually relieved by the prone or knee-to-chest position (3). Diagnosis is based on imaging techniques that include X-ray passage series of the upper gastrointestinal tract and angiographical visualization of the superior mesenteric artery and determination of its angle of branching from the aorta. Retrocolic duodenojejunostomy has proven to be the most satisfactory surgical treatment for this lesion (4). [Product Details...]



Diverticular hemorrhage


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A 54-year-old woman was admitted to our hospital after two episodes of massive rectal bleeding. Her past medical history was significant for insulin-dependent diabetes mellitus, hypertension, diverticular disease, rheumatic arthritis, hypothyroidism, and dyslipidemia. In addition to anti-hypertensive drugs and anti-diabetic drugs, she was taking anti-platelet and non-steroidal anti-inflammatory drugs. There was no previous history of gastrointestinal hemorrhage. Upon arrival at the emergency room, she was awake and alert, but felt weak and dizzy. On physical examination her blood pressure was low 99/65 mmHg, and she was very pale. Her abdomen was soft, non-distended and non-tender. On rectal examination, fresh blood was noticed on the glove. The initial hemoglobin level was 8,5 g/dL, so the patient received a blood transfusion. [Product Details...]



Ischemic proctitis in a diabetic patient


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Ischemic colitis is the most common form of intestinal ischemia, which results from lack of blood flow in the absence of mechanical obstruction. Acute ischemic colitis usually occurs in the descending and sigmoid colon. The rectum is affected very rarely because of its abundant collateral blood supply. Ischemic proctitis is usually related to a derangement in the central circulation from congestive heart failure, arrhythmia, hypotension or vasoconstrictive drugs (1). In this report we present a case of ischemic proctitis in a patient with non-insulin-dependent diabetes mellitus (NIDDM). A 52 year-old non-insulin-dependent diabetic woman was admitted to our outpatient clinic with a 2 week history of abdominal pain and hematochezia. Her past medical history was significant for a ten-year history of NIDDM and hypertension. On physical examination she had lower abdominal tenderness with minimal palpation. Her initial laboratory findings revealed a hemoglobin level of 8.4 mg/dl, leukocyte count of 11600 /dl, and serum glucose level of 183 mg/dl. Multiple stool cultures were negative. Colonoscopy showed necrotic mucosa with subepithelial hemorrhage, fragility and bullous mucosal lesions extending from the dentate line to the 16th cm of the rectum (Fig. 1). [Product Details...]



Oesophageal bezoar induced by black beans successfully removed by associating endoscopy and oral sodium bicarbonate


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Bezoar in the oesophagus is infrequent. There is no report about raw black beans as possible cause. Black beans are the folk prescription for treating chronic constipation in China. We report a case of oesophageal bezoar in a patient with normal oesophagus. A 77-year-old man with hypertension and diabetes presented to our hospital because of abdominal pain with nausea and vomiting since 3 days. He developed also slightly right-sided hemiparesis since 2 days. The preliminary diagnoses were cerebral infarction and intestinal obstruction. The condition of the patient improved, but he still had abdominal pain and moderate fever as soon as he ingested food and an aspiration pneumonia was diagnosed. The upper gastrointestinal tract endoscopy revealed a hard and nodular concretion causing a complete obstruction of the oesophagus at about 25 cm from the incisors (Fig. 1). The patient told that he swallowed raw black beans in the morning since one month, which is a folk prescription to treat chronic constipation in China. [Product Details...]



Proton pump inhibitors and risk of hepatocellular carcinoma : a case-control study in Taiwan


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Proton pump inhibitors (PPIs) are effective drugs that are frequently used for the management of peptic ulcer and gastro-esophageal reflux disease as well as for the elimination of Helicobacter infection. However, the long-term use of PPIs has been shown to cause hypergastrinemia (1,2). Experimental and clinical studies have also shown that hypergastrinemia might correlate with the risk for gastro-intestinal cancers, with the exception of hepatocellular carcinoma (HCC) (3-5). Few studies on the association between PPIs use and HCC risk are available. To clarify this issue, we designed this populationbased, case-control study by using the Taiwan National Health Insurance Program database to explore the association between PPIs use and HCC risk. The details regarding the insurance program have been reported previously (6,7). In order to secure patient privacy, all types of personal identification on files connected with the present study were scrambled using surrogate identification numbers. This study was exempt from full review by the institutional review board. [Product Details...]


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