DUODENITIS SINTOMAS PDFJuly 7, 2020
duodenitis sintomas pdf file. Quote. Postby Just» Tue Aug 28, am. Looking for duodenitis sintomas pdf file. Will be grateful for any help! Top. Chronic gastritis involves longterm inflammation that can last for. Dettori and others published 36 p patients with ibslike symptoms and duodenitis could be cured. Gastritis is inflammation of the lining of the stomach. It may occur as a short episode or may be It, along with a similar condition in the first part of the intestines known as duodenitis, resulted in 50, deaths in H. pylori was first.
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Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy. Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis.
To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. One thousand ten duodenal biopsy reports were found.
dudenitis Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected.
Eleven biopsies showed parasites, including cases of Cryptosporidium sp. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed.
Villus atrophy and reactive epithelium were usual in Strongyloides cases. No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.
Mil e dez laudos de biopsia duodenal foram revistos. Todos os blocos de biopsia selecionados como casos foram recuperados e revisados por experiente patologista. Onze biopsias mostraram parasitas, incluindo casos de Cryptosporidium sp. Anemia e hipoalbuminemia foram importantes dados laboratoriais. Parasitic duodenitis is a relevant cause of morbidity, especially in developing countries. Moreover, parasitic diseases have acquired highlights in the context of immunosuppressive diseases, especially after the emergence of HIV pandemic and propagation of immunomodulation therapies.
In such cases, intestinal parasitosis can promote severe disease and lead to death. Few papers study duodenum specifically parasitic infections.
Epidemiological data are poor and, in most cases, all gastroenteritis are displayed together. Thereby, the relevance of works outlining the parasitic duodenitis profile is clear. The main clinical manifestations are diarrhea, vomiting, nausea, abdominal pain and weight loss. Some studies mention the appearance of intestinal blockage, fever and evolution to sepsis 2, 4, 5, 8, 9.
The most common endoscopic findings are mucosal edema, erythema, friability, white villi, erosion and pseudopolyps. Histopathological findings showed edema and infiltration of the lamina propria by lymphocites and plasmocites, shortened or absent villus, cryptitis and crypt hyperplasia, epithelial layer infiltration by numerous intra-epithelial lymphocites and antigen-presenting cells and the presence of lymphagectasia 2, 4, 5, 8.
This paper aims to set a profile of the parasitic duodenitis diagnosed by upper digestive endoscopy among patients of “Complexo Hospitalar Professor Edgar Santos” HUPESa general teaching Hospital in the state of Bahia, Northeast Brazil, establishing the characteristics of affected patients, the main signs and symptoms and histological findings.
It is a retrospective and descriptive study of a group of cases, allowing a preliminary approach to this subject. A total of biopsy reports from duodenum were reviewed in search of positivity for parasites. Then the positive cases were selected according to the description of the presence of parasites, either as eggs or larvae in any portion of the duodenum and others etiologies were excluded.
Two cases of mycobacteria and a case of Whipple’s disease were found and excluded, limiting the cases to protozoa and helminths. After reviewing the biopsy records, clinical and laboratory data were collected from medical records of selected patients.
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Clinical, laboratorial and endoscopic data were extracted from reports closer to duodenal biopsy made before the beginning of antiparasitic therapy. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist, to better characterize the histopathological findings. In this review, 1 of the 12 cases was excluded because the parasite quoted in the report could not be found on a new microscopy. All specimens were stained with hematoxylin-eosin H-E. A database was created with the standardized collected data, from which the distributions, means and medians were calculated.
A total of biopsy records were reviewed, representing the total number of individuals attended in HUPES from January to January Among these, 11 patients had a parasite found on their biopsies and their medical records were reviewed.
Table 1 summarizes the clinical and epidemiological features of cases. Gender distribution showed there were six Table 1 also shows the requested and realized protoparasitological stool examinations Eight patients presented an endoscopy records attached to the medical records.
No case had the description of ulceration. Distribution of HIV positive patients and systemic corticosteroid use is also presented in Table 1. Considering each parasite as a distinct group, all four patients with Cryptosporidium were HIV positive, while only one had both S. However, two of the patients known to be infected by S.
Tables 2 and 3 show the laboratory profile of cases with S. Mean rates and medians are presented for the most interesting laboratorial findings referring to valid data of 11 cases.
These patients had a general profile composed by low hemoglobin levels, depletion of serum albumin and loss of electrolytes. Eosinophilia was not a common finding. Lymphopenia was clearer in Cryptosporidium cases. Eight patients had assessable transaminases values and seven showed normal levels, while only one showed border values.
Table 4 describes the main histological findings observed during biopsy specimens review. With regard to eosinophilic infiltrate in biopsies with S. Remaining patients had no significant infiltration. Figure 1 shows histopathological changes in S. The usual pattern of acute inflammation and reactive epithelium deserves attention, besides ulcerations, in S. These changes were not observed in cases of Cryptosporidium sp. In analyzed material, this infection has not determined significant inflammation or architectural changes in duodenal mucosa.
The mean and median ages were 42 and 45 years, respectively. Villous atrophy was described in all cases.
This study did not use the moderate degree classification of infiltration moderate duodenitis. In the study performed by Macfarlane et al.
duodenitis sintomas pdf file
One proposed explanation for this difference is the profile of patients in the care services where data were collected. It was found that most patients affected by this disease are in the age group of young adults, like data found in the study sintomxs HUPES.
However, there are studies that show a greater affection in elderly The endoscopic examination was not more effective than the stool parasitological detection of pathogens, except in cases of cytomegalovirus and Leishmania 13which favors the idea of requesting a stool sample examination before performing an endoscopy in patients with abdominal complaints.
These data may show that the prevalence of enteric pathogens is underestimated in literature. From a group of clinically healthy individuals a sample of 85 patients7. A possible explanation for the higher prevalence of S. Five of these cases had an intense eosinophilic infiltrate, two had moderate and two others had insignificant infiltrate.
There is even the possibility of a false-negative histopathological exam if only the stomach is biopsied. In our study, the degree of infection was not correlated with inflammatory infiltrates, and duodenitia eosinophilic infiltrates were less common. Men also appeared as the main victims. This study also demonstrated that the most affected site by S.
Four of these patients were diagnosed by duodenal histopathology. The presence of S.
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Most biopsies had an increased number of lymphocytes, showing collection of lymphocytes around the base of crypts, lymphocytic expansion in the lamina propria and numerous intraepithelial lymphocytes. It was not proved the relationship between degree of infection and inflammation. Aspects such as villous atrophy 21 of 41 patientsreactive epithelium 22 of 41 patients and apoptosis were also displayed.
No aspect was pathognomonic. Unlike the study in HUPES, an inflammatory reaction with mucosa injury was more evident, which could be explained by the coexisting cytomegalovirus infection in some cases of the serie.
In HUPES sample, the presence of these parasites adhered to the duodenal mucosa did not cause significant changes in the histopathological aspect of biopsies. According to Genta et al. These patients had a normal or moderately increased inflammatory component, consisting mainly of lymphocytes and plasma cells.
Five patients had villous atrophy, which was related to more severe infections. These findings are more compatible with those found in HUPES study, showing a trend toward preservation of duodenal epithelium without an important inflammatory infiltrate in lamina propria, consistent with surface characteristic of infection by Cryptosporidium sp.
A Brazilian study conducted by Coutinho et al. Regarding clinical symptoms, both studies showed a predominance of abdominal pain, vomiting and diarrhea. Among these, the predominant were mucosal edema, white villi, bleeding, exanthema and erosion of mucosa.
More severe disease would be responsible for exuberant clinical findings. This finding again reinforces the need of stool examination for early investigations.
Due to the small sample of our study, it is not possible to make statistical inferences pointing to a possible strength of association between parasitic infections and duodenal symptoms, laboratory findings, endoscopic and histopathological findings.
The work was underlied to some biases, which may have affected the final results.
Some biases could not be minimized, as biopsies reports that may have issued false-negative results, reducing the final sample. Measurement biases like questionnaire mismatch and preparing the researchers were minimized whereas the data collection questionnaire was applied twice to suit duidenitis language presented in medical records and all researchers were trained together.