Search

Rationale: Gastrointestinal bleeding as the first sign of Brunner's gland adenoma (BGA) is an extremely rare, and its clinical features and treatment methods have not been well described. Patient concerns: We described a 81-year-old female patient with coronary artery disease and chronic atrial fibrillation presenting with presenting with gastrointestinal bleeding requiring blood transfusion. Diagnoses: The diagnosis of our case mainly refered to radiologic imaging and endoscopic examination. Histological result was compatible with BGA. Interventions: This mass lesion (6 × 7 cm diameter) was successfully totally removed by endoscopic submucosal dissection (ESD) for more than three hours. Outcomes: The patient was followed up for 6 months to date without recurrence. Lessons: Endoscopic removal is considered as a safe and low-risk treatment for elderly patients with severe underlying diseases presenting with gastrointestinal bleeding.

Rationale: Fungal infection of gastrointestinal (GI) tract is usually seen in immunocompromised patients, but can rarely occur in immunocompetent people in whom no permissive factor is present. Patient concerns: We describe a 68-year-old male immunocompetent patient presenting with simultaneous fungal esophagitis and giant gastric ulcer. Diagnoses: Repeated endoscopic biopsies were taken from the giant gastric ulcer edge and base and histology demonstrated granulation tissue and pseudohyphal fungal forms. Interventions: The patient was treated with fluconazole and omeprazole for 8 weeks. Outcomes: After antifungal treatment with fluconazole, the patient's clinical symptoms gradually disappeared with the healing of gastric ulcer, which never recurred in this patient until 3 months after follow-up. Lessons: Nonhealing gastroesophageal ulcers highlights the importance of repeated endoscopies and biopsies.

Rationale: Radiation-induced hemorrhagic gastritis is an infrequent cause of upper gastrointestinal bleeding and difficult to manage. The current standard treatment has not been well established. Patient concerns: We described a 32-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for hepatocellular carcinoma recurrence. Diagnoses: The endoscopic examination showed a diffuse area of bleeding in the gastric antrum. Interventions: After failure of conventional hemostasis treatment, we successfully stopped the hemorrhage with repeated endoscopic argon plasma coagulation (APC) combined with low-dose polyglycerol sclerotherapy. Outcomes: The patient was followed up for 6 months to date without recurrence. Lessons: Based on this case, we think that endoscopic APC combined with low-dose polidocanol sclerotherapy can be tried as a treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.

Background: The intestinal microbiota is linked with allergic reaction diseases. However, the difference in the fecal microbiota composition between sensitized wheezy and nonsensitized subjects in Chinese children remains unknown. The aim of this study was to quantitate the amounts of fecal microbiota in wheezy children, and to explore the correlation between fecal microbiota and serum Th1/Th2/Th17-type cytokines and total IgE in these patients. Methods: The amounts of Bifidobacterium and Lactobacillus were determined using a 16S-RNA real-time polymerase chain reaction (PCR) method in wheezy children (cases) and nonwheezy controls. Serum Th1/Th2/Th17-type cytokines levels were measured using flow a cytometric bead array assay. In addition, the concentrations of total serum IgE was also determined. Results: In comparison with that in the healthy control (HC), significantly lower abundance of Bifidobacterium and lower levels of Th1 cytokines (IFN-γ and TNF-α), but higher levels of Th2-type cytokines (IL-4, IL-5) and Th17-type (IL-17A) cytokine were detected in children with bronchiolitis and asthma. But there was no significant difference in the amounts of Lactobacillus. Interestingly, the amounts of fecal Bifidobacterium were correlated positively with serum Th1 cytokines IFN-γ, and correlated negatively with serum Th17 cytokines IL-17A, Th2 cytokines IL-4 and serum total IgE in these patients. Conclusions: Our findings demonstrated that lower quantity of Bifidobacterium, but not Lactobacillus, may be correlated with asthma and bronchiolitis in chinese children. These results also may provide guidance in choosing the proper probiotics for wheezing children.