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PubMed1990

Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies.

Gastrointestinal tract involvement with hepatocellular carcinoma was observed in 8 out of 396 patients (2%) during the course of the disease. Histological involvement was confirmed in 6 cases. All 8 patients were men. The most common clinical presentation was frank gastrointestinal bleeding, which became evident in all cases. Esophageal varices were not seen in any patient. The sites of involvement were the stomach (3), duodenum (4), and jejunum (1). The median time between the diagnosis of primary tumors and gastrointestinal tract involvement was 4.5 months (range: 0 to 12 months). Hematogenous spread was presumed to have occurred in two patients with diffuse-type hepatocellular carcinoma, one of whom had main portal vein thrombosis. Direct invasion by contiguous neoplasm was the major mode of gastrointestinal tract involvement. This complication is more likely to develop in patients with large, subcapsular, massive type hepatocellular carcinoma treated by transcatheter arterial embolization and/or intra-arterial chemotherapy. The median survival after the diagnosis of gastrointestinal involvement was 1 month (2 weeks-4 months).

Adult↗

PubMed2005

Utility of immunohistochemistry in distinguishing primary adenocarcinomas from metastatic breast carcinomas in the gastrointestinal tract.

CONTEXT: Breast carcinoma often metastasizes to the gastrointestinal tract, especially the stomach, where it is frequently difficult to distinguish from a primary gastric carcinoma. OBJECTIVE: To evaluate the utility of immunohistochemical stains in differentiating primary gastric carcinomas from metastatic breast carcinomas. DESIGN: Mucosal biopsy specimens from 47 adenocarcinomas involving the gastrointestinal tract (28 primary gastric carcinomas and 19 metastatic breast carcinomas) and 16 control cases of primary breast carcinomas without metastasis were immunohistochemically stained for estrogen receptor protein (ER), progesterone receptor protein (PR), gross cystic disease fluid protein (GCDFP), human epidermal growth factor receptor 2 protein, cytokeratin (CK) 5/6, CK/7, CK/20, a panel of mucin glycoprotein antigens (MUC2, MUC3, MUC5AC, and MUC6), monoclonal antibody DAS-1, and caudal-type homeobox transcription factor CDX2 and compared between primary and metastatic adenocarcinomas. RESULTS: Highly significant proportions of metastatic breast carcinomas were positive for ER (72%), PR (33%), GCDFP (78%), and CK5/6 (61%) compared with primary gastric carcinomas (ER, 0%; PR, 0%; GCDFP, 0%; and CK5/6, 14%) (P < .001, P = .002, P < .001, and P = .004, respectively). Of these immunostains, ER, PR, and GCDFP were 100% specific. Primary breast tumors and their metastases showed a similar phenotypic profile. In contrast, primary gastric carcinomas showed significantly higher proportions of cases that stained with CK20 (50%), MUC2 (54%), MUC5AC (71%), MUC6 (39%), DAS-1 (43%), and CDX2 (67%) compared with metastatic breast carcinomas (CK20, 0%; MUC2, 24%; MUC5AC, 6%; MUC6, 0%; DAS-1, 0%; and CDX2, 0%) (P = .001, P = .01, P < .001, P = .02, P = .009, and P < .001, respectively). No significant differences were observed with regard to any of the other immunostains (human epidermal growth factor receptor 2 protein, CK7, and MUC3) between the patient groups. CONCLUSIONS: Estrogen receptor protein, PR, GCDFP, CK5/6, CK20, MUC5AC, MUC6, DAS-1, and CDX2 are helpful in distinguishing primary gastric carcinomas from metastatic breast carcinomas. Of these, ER, PR, and GCDFP are highly specific for metastatic breast carcinomas, whereas CK20, DAS-1, MUC2, MUC5AC, MUC6, and CDX2 are highly specific for primary gastric carcinomas.

Adenocarcinoma↗

PubMed2003

CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract.

PURPOSE: To evaluate whether computed tomography (CT) accurately depicted gastrointestinal tract involvement in peripheral T-cell lymphoma (PTCL). MATERIALS AND METHODS: CT scans were retrospectively reviewed in 14 patients with pathologically proved PTCLs of the gastrointestinal tract for the following considerations: sites, patterns of involvement (ie, morphologic features, bowel wall thickness or mass size, and contrast enhancement pattern), and ancillary findings at other sites (ie, lymphadenopathy, bowel perforation, and involvement of other organs). RESULTS: PTCL involved the stomach in three patients, the small intestine in eight, both the stomach and the small intestine in one, and the sigmoid colon in two; multifocal involvement was seen in three (21%) patients. CT failed to demonstrate the bowel lesions in three of 14 patients. At CT, 11 patients had gastric or bowel wall thickening (n = 10) and a polypoid mass (n = 1). In 10 patients, the gastric or bowel wall thickening was mild (<1 cm) in six, moderate (1-2 cm) in three, and severe (>2 cm) in one. Lymphadenopathy was noted in nine (64%) patients, with the nonbulky type in eight and the bulky type in one. Bowel perforation occurred in four (29%) patients. Other organs were involved in eight (57%) patients. CONCLUSION: CT can depict PTCL involving the gastrointestinal tract if it is not confined to the mucosa. There is a tendency toward preferential jejunal or duodenal involvement, as well as bowel perforation.

Adult↗

PubMed1994

Impact of intrauterine growth retardation on the gastrointestinal tract and the pancreas in newborn pigs.

Effects of intrauterine growth retardation (IUGR) on the gastrointestinal tract and the pancreas were examined using a model of piglets with naturally occurring IUGR. IUGR was associated with significant reductions in gastrointestinal and pancreatic tissue weights. The reduction in tissue weight in the gastrointestinal tract was due to lowered cell numbers and was proportionate to the body as a whole. In contrast to the gastrointestinal tract, the reduction in the pancreas was due to both lowered cell numbers and smaller cell size and was disproportionately greater than the body as a whole. IUGR was associated with precocious occurrence of maltase and sucrase activities in the small-intestinal mucosa. The exocrine cells of the pancreas in the animals with IUGR appeared immature when compared with those in normal piglets. Further studies are required to examine the postnatal effects of IUGR on the gastrointestinal tract, the pancreas, and somatic development.

Animals↗

PubMed1994

Sonography of the fetal gastrointestinal tract: anatomic variants, diagnostic pitfalls, and abnormalities.

Prenatal sonography has the potential to show a wide range of abnormalities in a fetus's gastrointestinal tract. Suspected fetal gastrointestinal abnormalities should be interpreted with caution, however, as the sonographic appearance of a healthy fetus's gastrointestinal tract is variable and there is considerable overlap in the appearances of normal and abnormal fetal bowel. Similarly, pathologic processes originating from organ systems other than the gastrointestinal tract can at times exhibit sonographic patterns remarkably similar to those of dilated bowel. This review examines the sonographic findings of gastrointestinal disorders seen in utero, emphasizing potential diagnostic pitfalls arising from confusion with normal anatomy, anatomic variants, and pathologic processes elsewhere in the fetus.

Congenital Abnormalities↗

PubMed1999

Upper gastrointestinal tract bleeding in critically ill pediatric patients.

Similar to adults, children under physiologic stress can develop an imbalance in defensive (mucosal layer, motility) and aggressive (gastric acid, bile salts, enzymes) factors responsible for maintaining a healthy gastrointestinal tract. Hypoxia in the gastrointestinal tract likely disrupts the defensive factors, thereby permitting damage by aggressive factors to upper gastrointestinal epithelium that may progress to stress ulceration and acute upper gastrointestinal tract bleeding (UGIB). The basic pathophysiology may be similar in children and adults; however, differences in the time to developing ulceration, ulcer location, and number of ulcers have been reported. Functional development of the gastrointestinal tract is influenced by disease, gestational and postnatal age, and exposure to and type of enteral feedings, thereby confounding the development and prophylaxis of UGIB in neonates and infants. In addition, pharmacotherapy decisions are often complicated by drug administration issues and adverse effects.

Adolescent↗

PubMed1999

Non-gastrointestinal tract associations of Helicobacter pylori infection.

Helicobacter pylori infection is linked to conditions of the upper gastrointestinal tract, including peptic ulcer and gastric adenocarcinoma. It has also been associated with a wide variety of non-gastrointestinal tract conditions. However, the evidence in support of H. pylori infection as a cause of the non-gastrointestinal tract conditions is not widely understood. We reviewed the medical literature for publications and abstracts dealing with putative non-gastrointestinal tract associations of H. pylori infection. We appraised the level of evidence and applied it to an established set of 9 criteria for determining causation. We found that many studies examining a possible causal relationship have been uncontrolled or inadequately controlled. Studies have often failed to control for socioeconomic status. Studies of treating H. pylori infection in patients with these disorders have been poorly designed and inappropriately controlled, and therefore add little to the evidence base. Attention should be focused on appropriate testing for and treatment of H. pylori infection in patients with conditions that are of proven association, notably peptic ulcer disease.

Cardiovascular Diseases↗

PubMed2003

Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer.

BACKGROUND: Outcomes in patients with brain metastases from gastrointestinal tract cancers are not well defined. In this study we used precise, single-session, focal tumor irradiation (radiosurgery) in patients with brain metastases and evaluated the results. METHODS: Thirty-nine patients had brain metastases from gastrointestinal tract cancer and were treated with radiosurgery. Thirty-two also had whole brain radiotherapy. Primary lesions included colorectal cancer (n = 25), esophageal cancer (n = 11), cholangiocarcinoma (n = 1), duodenal cancer (n = 1), and jejunal cancer (n = 1). Seventy-two tumors were treated. RESULTS: The overall median survival was 9 months after diagnosis of metastatic brain disease and 5 months after radiosurgery. The 1-year survival rate after radiosurgery was 19%. The last imaging study of 49 tumors showed complete remission (CR) in 3 tumors (6.1%), partial remission (PR) in 27 tumors (55.1%), no change (NC) in 11 tumors (22.4%), and progression in 8 tumors (16.3%). The local tumor control rate (CR, PR, NC) was 84%. Two patients (5.1%) had a new or worsening neurologic deficit after radiosurgery. CONCLUSIONS: Stereotactic radiosurgery provides reasonable local control of brain metastases from gastrointestinal tract cancer with few side effects. However, it should be used judiciously in patients with active extracranial cancers since the expected survival may be limited.

Adult↗

PubMed2004

[Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal].

BACKGROUND/AIMS: Most of ingested foreign bodies pass through the gastrointestinal tract spontaneously, but some of them (about 20%) need endoscopic or surgical removal. The aims of this study were to characterize the clinical features associated with foreign bodies in the upper gastrointestinal tract and to determine the clinical factors for their successful removal by endoscopic techniques. METHODS: We analyzed retrospectively 209 cases of foreign bodies in the upper gastrointestinal tract at Chonnam National University Hospital between May 1998 and May 2003. RESULTS: Foreign bodies were found in 97.1% (203/209) of the cases during endoscopic procedure. The types were chiefly fish bones (21.2%), coins (14.8%), meats (11.3%), and bezoars (8.9%). The locations were upper esophagus (49.8%), stomach (26.6%), lower esophagus (11.3%), and mid-esophagus (7.4%). Endoscopic removal was successful in 93.1% (189/203) of the cases, and surgical removal was successful in 8/203 (3.9%) of the cases. Age (p=0.015) and short duration of impaction (p=0.015) were the independent factors to predict the successful removal of the foreign bodies by endoscopic techniques. CONCLUSIONS: Endoscopic removal of foreign bodies in the upper gastrointestinal tract is an effective and safe procedure. Foreign bodies are more successfully removed by endoscopic techniques in children or in cases of short duration of impaction.

Adult↗

PubMed1990

Endoscopic polypectomies in upper gastrointestinal tract.

Nine polyps retrieved from the upper gastrointestinal tract by endoscopic polypectomy in nine patients are reported. Polyps were removed from the distal esophagus (1), stomach (7) and duodenum (1). Dysphagia, obstructive jaundice and upper gastrointestinal bleeding were the presenting features in four patients. In five patients gastric polyps were detected incidentally at endoscopy. Of the nine polyps, six were adenomas, two were hyperplastic polyps and one in the esophagus was inflammatory. All the polyps could be retrieved completely and there were no complications. Thus polyps do occur in the upper gastrointestinal tract in India; their electrosurgical removal is easy and safe and allows histopathological examination of the entire polyp.

Adult↗

PubMed1998

Roentgenographic study of ethosuximide-induced functional changes in rat gastrointestinal tract and their modulation by Nivalin in a chronic experiment.

Ethosuximide, a typical antiabsence drug, causes gastrointestinal complaints in the drug-treated patients. In the present study we investigated in an experimental model the functional disturbances occurring in rat gastrointestinal tract (GIT) after a 100-day chronic administration of ethosuximide. Contrast radiographic study of rat gastrointestinal tract was used. The mechanical activity of GIT smooth muscle (SM) preparations was measured using an in vitro isometric technique. The 100-day ethosuximide treatment induced atonia, disturbed peristalsis, and lead to a delay of the contrast material evacuation from the gastrointestinal tract combined with a reduction of the acetylcholine effect on the contractions of GIT smooth muscles in ethosuximide-treated rats. Nivalin cannot eliminate the ethosuximide-induced disturbances in the gastrointestinal tract after a 100-day administration of ethosuximide to the rats. It is thus assumed that Nivalin is not capable of compensating the inhibiting effect of ethosuximide. The authors assume that desensitization of acetylcholine receptors may occur and this reduces the effect of Nivalin action.

Animals↗

PubMed2002

Congenital malformation of the gastrointestinal tract in Aseer region, Saudi Arabia.

OBJECTIVE: The aim of this prospective study was to evaluate the prevalence and pattern of congenital malformations of the gastrointestinal tract among the Saudi newborn population in Aseer region, Kingdom of Saudi Arabia. METHODS: Every consecutive newborn admitted to the neonatal intensive care unit of Aseer Central Hospital, Kingdom of Saudi Arabia with features of gastrointestinal tract anomaly during the period January 1995 to December 2000 had relevant data obtained and entered into a program form. RESULTS: During the 6 year period, a total of 1386 Saudi infants were admitted into the neonatal intensive care unit of Aseer Central Hospital. Of these, 12.4% were confirmed to have congenital malformation of the gastrointestinal tract; male/female ratio of 1.7:1. The total number of live births by Saudi mothers in Aseer region during the period was 128,093, giving an incidence rate of 1.3 per 1000 live births. The 172 newborns presented with 174 anomalies of the gastrointestinal tract. The leading malformations were imperforate anus (78 cases or 44.8%), tracheosophageal fistula/atresia (42 cases or 24.1%) and intestinal atresia (37 cases or 21.3%). Other lesions included Hirschsprung's disease (14 cases or 8%) and stenosis (2 pyloric and one duodenal) (1.7%). Some patients had more than one defect within the tract (1%) and multisystemic defects (23%). The overall fatality rate was (12%), due largely to post-operative infection (75% of cases) and multiple anomalies (25% of cases). CONCLUSION: The prevalence of congenital defect of the gastrointestinal tract in Aseer region appears to be high. The incidence of associated multisystemic anomalies is also high. Fatality incidence is influenced by post-operative sepsis and associated multiple defects. A high incidence of consanguineous marriage in the region may be the underlying etiological factor hence genetic counseling may be helpful.

Digestive System Abnormalities↗

PubMed1984

[Nodular lymphoid hyperplasia of the duodenum in cancers of the gastrointestinal tract].

In an autoptic study the coincidence of carcinomas of the gastrointestinal tract and nodular lymphoid hyperplasia (NLH) of the duodenum was studied histologically. Out of sixty cases of carcinomas in the gastrointestinal tract not one case of concomitant NLH in the duodenum could be demonstrated, nor in the first section of the jejunum, which was examined for comparison's sake. A connection between NLH and carcinomas of the gastrointestinal tract, as pointed out in the literature, could not be confirmed through this study.

Adult↗

PubMed2006

Immunohistochemical analysis of ZnT1, 4, 5, 6, and 7 in the mouse gastrointestinal tract.

Expression of five zinc transporters (ZnT1, 4, 5, 6, and 7) of the Slc30 family in the mouse gastrointestinal tract was studied by immunohistochemical analysis. Results demonstrated unique expression patterns, levels, and cellular localization among ZnT proteins in the mouse gastrointestinal tract with some overlapping. ZnT1 was abundantly expressed in the epithelium of the esophagus, duodenum of the small intestine, and cecum of the large intestine. ZnT4 was predominantly detected in the large intestine. ZnT5 was mainly expressed in the parietal cell of the stomach and in the absorptive epithelium of the duodenum and jejunum. ZnT6 was predominantly detected in the chief cell of the stomach, columnar epithelial cells of the jejunum, cecum, colon, and rectum. Lastly, ZnT7 was observed in all epithelia of the mouse gastrointestinal tract with the highest expression in the small intestine. Expression of ZnT proteins in the absorptive epithelial cell of the gastrointestinal tract suggests that ZnT proteins may play important roles in zinc absorption and endogenous zinc secretion.

Animals↗

PubMed2002

Expression of synaptic vesicle protein 2 (SV2) in neuroendocrine tumours of the gastrointestinal tract and pancreas.

Identification of neuroendocrine differentiation in tumours has important implications for prognosis and therapy. The aim of the present study was to evaluate monoclonal antibodies against synaptic vesicle protein 2 (SV2) as histopathological markers for neuroendocrine differentiation in tumours of the gastrointestinal tract and pancreas. Paraffin blocks from 211 gastrointestinal tumours were examined by immunocytochemistry, using a monoclonal antibody against SV2. Virtually all endocrine tumours of the gastrointestinal tract (11/11 gastric, 53/53 ileal, 16/21 appendiceal, and 22/22 rectal) and pancreas (24/24) were positively labelled. SV2 labelling was also demonstrated in gastrointestinal pacemaker cell tumours (8/8), while adenocarcinomas of the gastrointestinal tract and pancreas were negative, with the exception of occasional adenocarcinomas demonstrating weak SV2 labelling (stomach 1/22, rectum 1/29, and pancreas 0/21). Western blotting of tumour biopsies confirmed expression of SV2 in endocrine tumours of the gastrointestinal tract and pancreas. No relationship was observed between SV2 expression in tumours and hormone production or malignant potential. In conclusion, SV2 is expressed in neuroendocrine tumours of the gastrointestinal tract and pancreas, but not in non-endocrine tumours. The SV2 monoclonal antibody can therefore be used as a general marker for neuroendocrine differentiation in gastrointestinal and pancreatic tumours.

Antibodies, Monoclonal↗

PubMed2002

[Extra-gastrointestinal tract diseases and Helicobacter pylori infection].

Helicobacter pylori infection is linked to conditions of the upper gastrointestinal tract, including peptic ulcer and gastric adenocarcinoma na MALT lymphoma. It has also been associated with wide variety of extragastric and non-gastrointestinal conditions. However, the evidence in support of Helicobacter pylori infection as a cause of the non-gastrointestinal tract diseases is not widely understood. We reviewed the medical literature in regard to putative association of Helicobacter pylori infection and non-gastrointestinal tract condition, notably cardiovascular, autoimmune and dermatological diseases. The majority of published papers examining the potential causal relationship were case-control studies, cross-sectional and cohort studies while only a few recent articles that did not confirm the evidence of causal relationship represent well designed population-based prospective studies. The lack of clear evidence for etiopathogenetic associations of Helicobacter pylori infection and non-gastrointestinal tract conditions should focus our attention on appropriate testing and treatment of Helicobacter pylori infection in patients with conditions that are of proven association such as peptic ulcer disease.

Autoimmune Diseases↗

PubMed1985

Immune disorders of the gastrointestinal tract and liver.

Immune disorders of the gastrointestinal tract and hepatobiliary systems comprise a diverse group of illnesses which share in common certain overlapping and yet distinctive expressions of cellular and humoral immunity. As is evident from material contained in this article, controversy and disparate results frequently characterize the study of immune mechanisms in a given disease process. Nonetheless, advances in quantitation of specific immunocyte function and phenotypic expression have greatly facilitated the depth of understanding of the immune process related to these disorders. Challenges for future clinical investigation of these disorders are to characterize cell-specific target antigens to which immunologic attack is directed and to unravel the immunogenetic mechanisms that trigger and direct immune-mediated injury to host tissues. It is anticipated that continued investigation of immune disorders of the gastrointestinal tract and liver will clarify pathogenetic mechanisms and thus permit formulation of rational and effective therapies.

Anemia, Pernicious↗

PubMed2004

Considerations concerning a tailored, individualized therapeutic management of patients with (neuro)endocrine tumours of the gastrointestinal tract and pancreas.

Endocrine tumours of the gastrointestinal tract and pancreas may present at different disease stages with either hormonal or hormone-related symptoms/syndromes, or without hormonal symptoms. They may occur either sporadically or as part of hereditary syndromes. In the therapeutic approach to a patient with these tumours, excessive hormonal secretion and/or its effects should always be controlled first. Tumour-related deficiencies or disorders should also be corrected. Subsequently, control should be aimed at the tumour growth. Surgery is generally considered as first-line therapy for patients with localized disease, as it can be curative. However, in patients with metastatic disease the role of first-line surgery is not clearly established and other therapies should be considered, such as non-surgical cytoreductive therapies, biotherapy (with somatostatin analogues or interferon-alpha), embolization and chemoembolization of liver metastases, chemotherapy (with single or multiple dose regimens) and peptide receptor-targeted radiotherapy. The delicate balance of the use of the different therapeutical options in patients with endocrine tumours of the gastrointestinal tract and pancreas emphasizes the importance of team approach and team expertise.

Gastrinoma↗