Volume 80 - 2017 - Fasc.3 - Case series
Ectopic variceal bleeding due to portosystemic shunt via dilated mesenteric veins and a varicous left ovarian vein : case report and literature review of ectopic varices
Ectopic varices are dilated portosystemic venous collaterals located outside of the gastro-esophageal region. Whereas they are common endoscopic findings in patients with portal hypertension, ectopic variceal bleeding is rather rare and accounts for only 1 to 5 % of all variceal bleedings. The rectum and the duodenum are the most common sites for ectopic varices, but they can be present along the whole intestinal tract and neighborhood. At present, there is no consensus well established on diagnostic workup for ectopic variceal bleeding and their therapeutic strategies. Further investigation of large series or randomized-controlled trials is needed because nowadays most of the data available are based on case reports. We report here an unusual case of an ectopic variceal bleeding, presented as an acute small intestine bleeding, due to a portosystemic shunt via dilated mesenteric veins and a varicous left ovarian vein in a patient with alcoholic cirrhosis. The involvement of an ovarian vein in ectopic variceal bleeding is rarely described. (Acta gastroenterol. belg, 2017, 80, 388-395).
Current status of gastroesophageal reflux disease : diagnosis and treatment
Aims : The aim of this study was to explore the recent advances in diagnosis and treatment of gastroesophageal reflux disease (GERD).
Methods : Previous studies were searched using the terms "gastroesophageal reflux disease" and "diagnosis" or "treatment" in Medline and Pubmed. Articles that were not published in the English language, manuscripts without an abstract, reviews, meta- analysis, and opinion articles were excluded from the review. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the contemporary approaches to GERD.
Results : GERD has a variety of symptomatic manifestations, which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of other alarming symptoms, these symptoms allow one to make a presumptive diagnosis of GERD and initiate empiric therapy. GERD-associated complications include erosive esophagitis, peptic stricture, Barrett's esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modifications, medical and surgical therapy. Medical therapy involves acid suppression, which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti- reflux surgery after undergoing a proper pre-operative evaluation.
Conclusion : The management of this disease requires a complex approach. Maintenance therapy of GERD after using anti-secretory drugs should be continuously monitored. (Acta gastroenterol. belg., 2017, 80, 396-404).
Nodular Lymphoid Hyperplasia of the Gastrointestinal Tract : a comprehensive review
Nodular lymphoid hyperplasia (NLH) is a rare benign condition that is characterized by diffuse hyperplasia of the lymphoid follicles of the gastrointestinal tract (GIT). During endoscopy, NLH appears as multiple or occasionally innumerable nodules measuring a few millimeters in diameter. NLH occurs mainly in the small intestine, less commonly in the large intestine and rarely involves the stomach. There are multiple associated diseases such as immunoglobulin deficiency syndromes, giardiasis, Helicobacter pylori (H. pylori) infection, HIV and celiac disease. NLH elicits a wide range of symptoms that can range from asymptomatic to chronic diarrhea, weight loss, bleeding from the rectum and, very infrequently, intestinal obstruction. The clinical significance of NLH relies not only on the associated conditions but also on the possible complications. The most important of which are malignant transformation, particularly to gastric carcinoma, and intestinal or extra-intestinal lymphoma. There is no consensus regarding the management and surveillance of NLH. However, surveillance is recommended by most authors, but the intervals and duration have not yet been identified. (Acta gastroenterol. belg., 2017, 80, 405-410).
Hippocratic views in the treatment of rectal prolapse
Known since antiquity, rectal prolapse was first studied systematically by Hippocrates (460-377 BC) who recognized the predisposing factors and proposed several therapeutic approaches such as defecation positions, manual retraction and specific herbal or mineral based anti-haemorrhagic and pain-killing poultices. Hippocratic medicine avoided invasive surgical procedures probably due to a lack of knowledge in human anatomy. However, Hippocrates' views astonishingly lasted in time, presenting similarities to current medical theories on rectal prolapse. (Acta gastroenterol. belg., 2017, 80, 411-415).