Eosinophilic ascites: A case report

Summary Introduction Eosinophilic gastroenteritis is a heterogeneous disorder affecting both children and adults, and is characterised by the presence of an intense eosinophilic infiltrate on histopathology of one or multiple segments from the oesophagus to the rectum. Involvement of the serosal layer occurs in 10% of cases of eosinophilic gastroenteritis and typically presents as ascites. Case report We report the case of a 25-year-old woman who was admitted to our Hospital complaining of abdominal pain and distension, ascites and diarrhoea of four weeks duration. Laboratory investigations showed a white cell count of 9.2 thousand/mm 3 without eosinophilia, low albumin (3 g/dL) and an increased IgE level (279 U/mL). Abdominal ultrasonography demonstrated peritoneal effusion, and cytological analysis revealed a prevalence of eosinophils in the ascites. Upper and lower multiple endoscopic biopsies revealed an increased amount of mucosal eosinophils. The patient was treated with prednisolone 40 mg/day for two weeks with rapid resolution of her symptoms and the ascites. Discussion Patients with serosal eosinophilic gastroenteritis present with isolated ascites or ascites in combination with symptoms characteristic of mucosal or muscular involvement, such as abdominal pain, nausea, vomiting, diarrhoea, and weight loss. The diagnostic feature is marked eosinophilia in the ascitic fluid. Data on the natural history and therapy are limited to case reports. There have been no prospective, randomized therapeutic clinical trials. Thus, treatment was empiric and based upon the severity of the clinical manifestations. Patients who are symptomatic or have evidence of malabsorption may be treated with systemic glucocorticoids

Chronic pancreatitis: from guidelines to clinical practice

Introduction The paucity of specific standardized criteria leads to uncertainties in clinical practice regarding the management of chronic pancreatitis (CP).Objectives This paper reports some of the systematic guidelines for the diagnosis and treatment of CP recently elaborated by an Italian multicenter study group. We review recommendations on clinical and nutritional aspects of the disease, assessment of pancreatic function, treatment of exocrine pancreatic failure and secondary diabetes, treatment of pain, and prevention of painful relapses. The review also looks at the role of endoscopy in the management of pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications; the appropriate use of various imaging techniques, including endoscopic ultrasound; and the indications for and techniques used in surgical management of CP.</p

Diarrhoea in critical care patients: focus on special issues

BACKGROUND Diarrhoea is common in critically ill patients, especially in elderly subjects during antibiotic therapy and enteral feeding. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrhoeal oral medications, and antibiotic drugs in infections related diarrhoea. AIM OF THE STUDY The purpose of this review is to provide an update on particular types of diarrhoea in critically ill patients. Epidemiological data will be discussed, with special emphasis on Clostridium difficile-associated diarrhoea. The possible therapeutic measures will be presented