Severe anaemia after gastric biopsy in an infant with eosinophilic gastritis

Background: Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow's milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical. Case presentation: A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration. Conclusions: A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk

Non Celiac Gluten Sensitivity and Diagnostic Challenges

Non-celiac gluten sensitivity (NCGS), also referred to as non-celiac wheat sensitivity (NCWS), is a clinical syndrome characterized by both intestinal and extra-intestinal symptoms responsive to the withdrawal of gluten-containing food from the diet. The aim of this review is to summarize recent advances in research and provide a brief overview of the history of the condition for the benefit of professionals working in gastroenterology. Academic databases such as PubMed and Google Scholar were searched using key words such as ”non-celiac gluten sensitivity”, “gluten related disorders”, and the studies outlined in reference page were selected and analysed. Most of the analysed studiers agree that NCGS would need to be diagnosed only after exclusion of celiac disease and wheat allergy, and that a reliable serological marker is not available presently. The mechanisms causing symptoms in NCGS after gluten ingestion are largely unknown, but recent advances have begun to offer novel insights. The estimated prevalence of NCGS, at present, varies between 0.6 and 6%. There is an overlap between irritable bowel syndrome and NCGS with regard to the similarity of gastrointestinal symptoms. The histologic characteristics of NCGS are still under investigation, ranging from normal histology to slight increase in the number of T lymphocytes in the superficial epithelium of villi. Positive response to gluten free diet for a limited period (e.g., 6 weeks), followed by the reappearance of symptoms after gluten challenge appears, at this moment, to be the best approach for confirming diagnosis. The Salerno expert criteria may help to diagnose NCGS accurately in particular for research purposes but it has limited applicability in clinical practice

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Dysplasia in perforated intestinal pneumatosis complicating a previous jejuno-ileal bypass: a cautionary note.

We present the case of an elderly woman who devel- oped a bowel perforation related to pneumatosis intes- tinalis, 33 years after a jejuno-ileal bypass for severe obesity. Final histological examination revealed the presence of dysplasia in the resected specimen. On the basis of our case and a review of the literature, we discuss the etiopathogenesis, the clinical aspects and the treatment of this rare condition

Painful constipation: a neglected entity?

Functional chronic constipation is a common symptom in daily clinical practice. Although the definition of constipation may be variable, there is usually agreement that (at least for research purposes) the definition given by the Rome Committee are useful. However, some blind spots or hidden angles remain, even in the more thorough classifications; among these, there is painful constipation, a poorly defined yet clinically encountered entity. The present article reviews the current knowledge about painful constipation, trying to put together the scarce data available, and to frame it in the more general context of chronic constipation

The significance of duodenal mucosal atrophy in patients with common variable immunodeficiency: a clinical and histopathological study

Gastrointestinal manifestations and villous atrophy can be seen in patients with common variable immunodeficiency (CVID). In some patients, infectious agents may be responsible, whereas in Others, celiac diseases (CD) may be the cause. In this study, we investigate the causes and th ehistopathologic festures seen in patients with CVID. Eleven patients with CVID and villous atrophy underwent duodenal biopsies, human leukocyte antien (HLA) typing, and testing for all celiac antibodies. Fifteen patients with CVID and normal villi and 6 patients with CD but without CVID served as controls. Histologic response to a gluten-free diet (GFD) allowed a diagnosis of CD in 3 of 11 patients. In the remaining 8, the lack of a histologic response to a GFD or HLA typing excluded CD. Celiac antibodies gave conflicting results and were of no help. Polymorphonuclear infiltrates and lesions like graft-versus-host disease are seen more ofter in flat mucos aunresponsive to a GFD. However, the specificity of these findings remains to be determined and response to a GFD remains the only diagnostic criteria for CD in these patients. Villous atrophy was gluten-sensitive in 3 of 11 patients with CVID. It was not related to gluten-responsive CD in most patients

Colonoscopic findings in coeliac disease on a gluten-free diet

Background: to date, there are few data on colonoscopic findings in patients with celiac disease, and most of these obtained in patients with iron deficiency anaemia. Aims: we assessed colonoscopic findings in unselected pa tients with coeliac disease, since there are no studies available also considering morphological aspects, and there is literature sugges tion of increased prevalence of colorectal tumours. Material and methods: colonoscopies with multiple biopsies were retrospectively analyzed in 42 coeliac disease patients on gluten-free diet above age 40; 16 had clinical or laboratory fea tures of iron deficiency anaemia. Mucosal biopsies were evaluated for the presence of intraepithelial lymphocytes and of mucosal eosinophils, in addition to conventional histologic assessment, and compared with those obtained in 15 controls. Results: macroscopic abnormalities (polyps, diverticula, in flammatory changes) were found in 26% of patients. Microscopic abnormalities (lymphocytic colitis, melanosis coli, rectal histiocyto sis) were found in 36% of patients. None of these findings was found in controls. Coeliac disease patients had significantly higher eosinophil score than controls in the right colon, whereas this was not significantly different between groups in the left colon. Conclusions: colonoscopic findings in coeliac disease on gluten-free diet may reveal significant findings, even in patients without iron deficiency anaemia. There is the need of further stud ies in larger cohorts of patients to establish whether colonoscopy in these patients may be clinically useful

Pneumococcal vaccination in celiac disease

Introduction: Celiac disease (CD) is an immune-mediated disorder associated with gluten exposure in genetically predisposed subjects. Areas covered: Infectious disease is one of the causes of morbidity and mortality in CD patients. Invasive streptococcus pneumoniae (pneumococcus) is a particularly dangerous morbid condition in both the general population and celiac patients. Pneumococcal vaccination is the most effective means for its prevention. Expert opinion: In CD, evaluation of spleen function should be useful to select patients who may benefit from vaccination to reduce the risk of pneumococcal disease. Different strategies could be employed: physicians could search for signs of hyposplenism on peripheral blood smear or abdominal ultrasound. However, the best strategy to identify which patients will benefit from pneumococcal vaccination has not yet been defined

Microscopic Enteritis; Clinical Features and Correlations with Symptoms

Aim: To assess the clinical characteristic of CD as well as correlation of symptoms and the degrees of intestinal mucosal lesions in Iranian children. Background: Microscopic Enteritis (Marsh 0-II) is associated with malabsorption. Patients and methods: From August 2005 to September 2009, 111 cases with malabsorption and classical gastrointestinal symptoms were evaluated. Results: The mean (±SD) age of children with CD was 4.9±3.5 years (range, 6 month - 16 years) and the mean duration of symptoms was 8 ± 20.5 months. 50 cases (45%) were female and 61 cases (55%) were male. The most common clinical presentation was failure to thrive in 72%, chronic diarrhea in 65.8% and Iron deficiency anemia in 59.5%. Sensitivity of EMA was 100% in patients with Marsh IIIb and Marsh IIIc. EMA was also positive in 77% of cases with Marsh 0, 18% in Marsh I, 44% in Marsh II and 81.8% in patients with Marsh IIIa. Conclusion: Histopathology did not reflect the severity of gluten sensitivity. This would suggest that the degree of intestinal mucosal damage might not be a reliable prognostic factor. Significant symptoms can be present with minor histological change on biopsy