Asian Journal of Research and Reports in Gastroenterology

IgG4 Disease Revealed by a Type 1 Autoimmune Pancreatitis: A Case Report

2023-03-14T12:32:15+00:00

Aim: To describe clinical, paraclinical and evolutive features of an IgG4 disease.

Presentation of Case: The patient was a male, 51 years old, seen in consultation in the gastro-enterology and hepatology department of University teaching hospital “Campus” of Lome for epigastric pain of sudden onset six days before admission, with transfixing irradiation, evolving intermittently in a febrile context. On admission, the patient has a subicterus. The evolution during hospitalization was marked by the sudden onset three days later of bilateral inflammatory polyarthritis of the knees and ankles. Biological examination revealed diabetes mellitus; lipasemia was elevated to 122U/l. There was a disturbance of the renal balance; and a significant increase of plasma IgG4 at 2.380 g/l. The abdominal ultrasound showed a globally hypertrophic pancreatic gland, of heterogeneous structure, without focal lesions or necrosis; without biliary lithiasis. An abdominal CT scan showed, after injection of contrast medium, a global hypertrophy of the pancreas with a corporal-caudal predominance, giving a classic "sausage" appearance; associated with a lack of enhancement of the pancreatic parenchyma.

Conclusion: Type 1 autoimmune pancreatitis is the pancreatic manifestation of IgG4 disease. It is a rare pathology of recent discovery, with a predominance in elderly and male subjects. The diagnosis must be evoked in front of a pancreatic pain associated with articular manifestations, or in case of absence of obvious etiology of a pancreatitis. This diagnosis is defined by recommandations of International Association of Pancreatology. The treatment is based on the use of corticosteroids unlike autoimmune pancreatitis type 2 which is self-limiting with a low risk of relapse and complications.

Leaky Gut Syndrome and Oral Lesions - A Hypothesis

2023-03-22T10:20:49+00:00

There are many oral lesions which run a chronic course and always recur despite being treated multiple times by experts. They cause tremendous damage to multiple tissues. Many oral diseases have orofacial manifestations only, while others are associated with multiple serious systemic manifestations. Various researchers across the globe have been struggling to find out permanent solutions through various therapeutic approaches like, ayurveda and holistic etc but internal root causes should be found out which might give us breakthrough quick therapies in near future.

We need to explore evidence based various hidden internal /systemic causes to achieve permanent cure of such chronic long-standing diseases.

All systems of the body are interconnected and always works in harmony. Oral diseases can never be restricted to orofacial tissues. They are strongly connected to gastro intestinal, ectodermal tissues and all the systems. This article is an attempt to find out same through few hypotheses and connecting oral lesions with other disorders.

A Rare Bisalbuminemia Etiology: Cholestatic Hepatitis Case Report

2023-02-13T09:34:48+00:00

Bisalbuminemias consist in a qualitative modification of the albumin pattern aspects, characterized by a duplication of the albumin fraction on the electrophoretic trace of the serum proteins. The prevalence of bisalbuminemia is about 0,03 to 1/1000. They can be inherited or acquired. We report a case of bialbuminemia admitted at the hepato-gastroenterology Department of HMIMV RABAT.

This is 52 years old patient, operated for cerebral glioblastoma treated by radio-chemotherapy who consist in Temozolomide, presented cholestatic jaundice two weeks after oral chemotherapy. Electrophoresis serum protein use a capillary electrophoresis system (Capillaries, Sebia) reveals a hypoproteinemia and duplication of the albumin fraction.

Bisalbuminemias is a qualitative abnormality of the albumin pattern, diagnosed by electrophoretic trace of the serum proteins. It can be inherited or acquired but globally without pathological effects. The acquired etiology are several whose cholestatic hepatitis induced by drug can be evoked pending a more thorough study.

Duodenal Dieulafoy’s Lesion-arising Awareness of this Rare Cause of Gastrointestinal Bleed

2023-03-14T12:24:37+00:00

Aim: The aim of this report is to raise awareness about the risk of bleeding associated with duodenal Dieulafoy lesions (DLs) and to emphasize the importance of utilizing imaging modalities when DLs are suspected as the cause of bleeding.

Presentation: This case study reports a 68-year-old male who presented with non-bloody vomiting and multiple episodes of hematochezia. An angiogram revealed active bleeding in the duodenum, which was subsequently identified and treated on the first attempt during endoscopy as a bleeding duodenal DL.

Discussion: DLs are a rare cause of gastrointestinal bleeding, characterized by dilated submucosal vessels that have a tortuous path, making them susceptible to erosion. They are most commonly found in the stomach, and are extremely rare in the duodenum, often requiring multiple endoscopic attempts to identify and treat. However, we were able to successfully treat our patient upon the first attempt with the help of angiogram prior to endoscopy. Use of multiple methods to achieve hemostasis (epinephrine injection, heat probe, and hemoclips) is effective in treating DLs.

Conclusion: It is important to recognize DLs as a potential cause of gastrointestinal bleeding, given their high mortality rate. The use of imaging prior to endoscopy can potentially prevent the need for multiple attempts at identifying and treating the lesion.