Iron deficiency （ID）, with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Dia...Iron deficiency （ID）, with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by展开更多
The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct in...The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulcer, was admitted to hospital with the diagnosis of cholangitis. Dilatation of the extrahepatic biliary duct was observed by abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography （ERCP） was performed. No area suggesting the presence of the papilla of Vater was found within the second duodenal portion. Finally the major papilla was located in the theoretical pyloric duct. Cholangiography was performed and choledocholithiasis was found in the biliary tree. The patient underwent dilatation of the papilla with a balloon tyre and removal of a 7 mm stone using a Dormia basket, which solved the problem without further complications. This anomaly increased the difficulty of performing therapeutic interventions during ERCR This alteration in anatomy may increase the risk of complications during papillotomy, with a theoretically higher risk of perforation. Dilatation using a balloon was the chosen therapeutic technique both in our case and in the literature, due to its low rate of complications.展开更多
AIM:To determine the incidence and characteristics of intestinal and extra-intestinal cancers among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population...AIM:To determine the incidence and characteristics of intestinal and extra-intestinal cancers among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population.METHODS:This was a prospective,observational,7-year follow-up,cohort study.Cumulative incidence,incidence rates based on person-years of follow-up and relative risk were calculated for patients with inflammatory bowel disease and compared with the background population.The incidence of cancer was determined using a hospital-based data registry from Hospital Universitario de Fuenlabrada.Demographic data and details about time from diagnosis of inflammatory bowel disease to occurrence of cancer,disease extent,inflammatory bowel disease treatment,cancer therapy and cancer evolution were also collected in the inflammatory bowel disease cohort.RESULTS:Eighteen of 590 patients with inflammatory bowel disease developed cancer[cumulative incidence=3%(95%CI:1.58-4.52)vs 2%(95%CI:1.99-2.11)in the background population;RR=1.5;95%CI:0.97-2.29].The cancer incidence among inflammatory bowel disease patients was 0.53%(95%CI:0.32-0.84)per patient-year of follow-up.Patients with inflammatory bowel disease had a significantly increased relative risk of urothelial carcinoma(RR=5.23,95%CI:1.95-13.87),appendiceal mucinous cystadenoma(RR=36.6,95%CI:7.92-138.4),neuroendocrine carcinoma(RR=13.1,95%CI:1.82-29.7)and rectal carcinoid(RR=8.94,95%CI:1.18-59.7).Colorectal cancer cases were not found.CONCLUSION:The overall risk of cancer did not significantly increase in our inflammatory bowel disease patients.However,there was an increased risk of urinary bladder cancer and,with less statistical power,an increased risk of appendiceal mucinous cystadenoma and of neuroendocrine tumors.Colorectal cancer risk was low in our series.展开更多
文摘Iron deficiency （ID）, with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by
文摘The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulcer, was admitted to hospital with the diagnosis of cholangitis. Dilatation of the extrahepatic biliary duct was observed by abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography （ERCP） was performed. No area suggesting the presence of the papilla of Vater was found within the second duodenal portion. Finally the major papilla was located in the theoretical pyloric duct. Cholangiography was performed and choledocholithiasis was found in the biliary tree. The patient underwent dilatation of the papilla with a balloon tyre and removal of a 7 mm stone using a Dormia basket, which solved the problem without further complications. This anomaly increased the difficulty of performing therapeutic interventions during ERCR This alteration in anatomy may increase the risk of complications during papillotomy, with a theoretically higher risk of perforation. Dilatation using a balloon was the chosen therapeutic technique both in our case and in the literature, due to its low rate of complications.
文摘AIM:To determine the incidence and characteristics of intestinal and extra-intestinal cancers among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population.METHODS:This was a prospective,observational,7-year follow-up,cohort study.Cumulative incidence,incidence rates based on person-years of follow-up and relative risk were calculated for patients with inflammatory bowel disease and compared with the background population.The incidence of cancer was determined using a hospital-based data registry from Hospital Universitario de Fuenlabrada.Demographic data and details about time from diagnosis of inflammatory bowel disease to occurrence of cancer,disease extent,inflammatory bowel disease treatment,cancer therapy and cancer evolution were also collected in the inflammatory bowel disease cohort.RESULTS:Eighteen of 590 patients with inflammatory bowel disease developed cancer[cumulative incidence=3%(95%CI:1.58-4.52)vs 2%(95%CI:1.99-2.11)in the background population;RR=1.5;95%CI:0.97-2.29].The cancer incidence among inflammatory bowel disease patients was 0.53%(95%CI:0.32-0.84)per patient-year of follow-up.Patients with inflammatory bowel disease had a significantly increased relative risk of urothelial carcinoma(RR=5.23,95%CI:1.95-13.87),appendiceal mucinous cystadenoma(RR=36.6,95%CI:7.92-138.4),neuroendocrine carcinoma(RR=13.1,95%CI:1.82-29.7)and rectal carcinoid(RR=8.94,95%CI:1.18-59.7).Colorectal cancer cases were not found.CONCLUSION:The overall risk of cancer did not significantly increase in our inflammatory bowel disease patients.However,there was an increased risk of urinary bladder cancer and,with less statistical power,an increased risk of appendiceal mucinous cystadenoma and of neuroendocrine tumors.Colorectal cancer risk was low in our series.
