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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The esophageal manifestations of diabetic neuropathy result in dysphagia and heartburn, but only in a minority of patients. Gastroparesis causes nausea, vomiting, early satiety, bloating, postprandial fullness, and upper abdominal pain. Delayed gastric emptying is a contributing factor of poor blood glucose control. It may be the first sign of gastroparesis. Intestinal enteropathy can cause constipation, diarrhea, and fecal incontinence. Impaired motility of the small intestine can lead to stasis syndrome, resulting in diarrhea, which can be intensified by hypermotility due to decreased sympathetic inhibition, pancreatic insufficiency, malabsorption of bile salts, and steatorrhea. Fecal incontinence may result from abnormal internal and external anal sphincter function due to neuropathy. Most patients with nonalcoholic fatty liver disease are asymptomatic, but some have malaise or right upper-quadrant fullness. The disease can range from a slight elevation of liver enzymes to severe liver disease with fibrosis and nodular regeneration, but this development is rare.
Gastroenterology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Pathogenesis may be due to disruption of the microvillous membrane. An enteropathy of variable severity may develop. Cryptosporidium may infect small and/or large intestine (Figs 9.44, 9.45). It reproduces both sexually and asexually.
Congenital cardiac anomalies
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Protein-losing enteropathy is a recognised long-term complication of single ventricle patients who have been palliated with the Fontan procedure, whereby systemic venous blood passively drains into the pulmonary arteries, while pulmonary venous return is actively pumped by the systemic single ventricular mass into the systemic circulation. The aetiology of protein-losing enteropathy is unclear and the mortality is high, approaching 50% by 1 year following diagnosis. Various treatment modalities have been tried, all with little long-term success. Definitive treatment is heart transplantation.
Treatment of inflammatory complications in common variable immunodeficiency (CVID): current concepts and future perspectives
Published in Expert Review of Clinical Immunology, 2023
There are a number of good observational studies and case reports on treatment of inflammatory complications in CVID, but randomized controlled trials are scarce. Immune cytopenias can be treated with corticosteroids with IVIG as potential supplement, but rituximab has shown good overall response and is well tolerated. There are few systematic studies on treatment of enteropathy but an IBD-approach with corticosteroids, 5-aminosalicylates and anti-TNF is often used, and there are several case reports on the effect of vedolizumab. Liver disease can present with NRH, granulomas and/or hepatitis and there are reports of effect of corticosteroids and anti-TNF. Corticosteroids is considered first-line treatment of interstitial lung disease, but there is observational support for effect of rituximab either alone or in combination with anti-metabolites. T cells are central in inflammatory complications of CVID and there are reports on the successful use of the mTOR-inhibitor sirolimus in treatment of immune cytopenia and granulomatous disease. There is a wide range of novel immunomodulatory drugs with potential benefit in CVID that should be systematically evaluated in prospective trials.
Strain-level analysis of gut-resident pro-inflammatory viridans group Streptococci suppressed by long-term cotrimoxazole prophylaxis among HIV-positive children in Zimbabwe
Published in Gut Microbes, 2020
Ethan K. Gough, Claire D. Bourke, Chipo Berejena, Annie Shonhai, Mutsa Bwakura-Dangarembizi, Andrew J. Prendergast, Amee R. Manges
We did not have stool samples from HIV-uninfected, ART-naïve or cotrimoxazole-naïve children to determine whether S. salivarius strains differ by HIV or treatment status. However, it is possible that these are useful genetic attributes for bacterial strains residing in an intestinal milieu characterized by enteropathy, inflammation, and increased susceptibility to enteric infection. This finding may also reflect a lack of representative reference genomes for this species of VGS from children in LMICs.50 We also did not have oral samples from the same children to more directly explore the similarities between oral and intestinal strains. However, we have shown that strain-level analysis is crucial to the determination of niche-specific microbe adaptations of potential clinical relevance. Since our stool samples were collected at 84- and 96-weeks post-randomization to stop versus continue cotrimoxazole, we do not know the impact of stopping or continuing cotrimoxazole on S. salivarius strain diversity at earlier time-points. We did not have sufficient coverage of other VGS genomes to determine whether our findings also apply to those species.
Duodenal eosinophils as predictors of symptoms in coeliac disease: a comparison of coeliac disease and non-coeliac dyspeptic patients with controls
Published in Scandinavian Journal of Gastroenterology, 2020
Michael D. Potter, James S. Hunt, Marjorie M. Walker, Mike Jones, Cheng Liu, Martin Weltman, Nicholas J. Talley
We were unable to demonstrate an association between the severity of histological changes, specifically villous atrophy, and symptoms. This is consistent with previous studies. A cohort study of 499 adults examining the mode of presentation and the degree of villous atrophy demonstrated no significant correlation between the degree of atrophy and either a classic (diarrhoea/weight loss) or atypical (anaemia/osteoporosis or dermatitis herpetiformis) presentation (p = .25) [26]. A large cohort study of 1408 adult coeliac patients compared the mode of clinical presentation with the severity of enteropathy, and demonstrated no significant differences in regards to any presenting symptom (including dyspepsia, diarrhoea, abdominal pain, nausea, vomiting and constipation) [16]. A positive association was demonstrated in regards to the severity of enteropathy and the presence of anaemia (p < .0001) and low ferritin (p = .01) [16]. Our results support this observation, with more severe enteropathy associated with iron deficiency at presentation in our cohort.