Adult autoimmune enteropathy in autoimmune hepatitis patient. Case report and literature review

Iaquinto, Gaetano; Panico, Luigi; Luongo, Gelsomina; Tenneriello, Valentina; Iaquinto, Salvatore; Giardullo, Nicola; Aufiero, Vera Rotondi; Mazzarella, Giuseppe; Rispoli, Raffaella; Lucariello, Angela; Perna, Angelica; Luca, Antonio De

doi:10.1016/j.clinre.2021.101673

Cited by 8 publications

(6 citation statements)

References 53 publications

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“…We shall investigate only CRLMs resections because if we compared data to other indications to liver surgery, like HCC, we found in literature that the robotic approach requires longer operative time probably as consequence of the underlining liver injury and the less incidence of parenchymal sparing indications 57‐63 …”

Section: Discussionmentioning

confidence: 99%

“…56 We shall investigate only CRLMs resections because if we compared data to other indications to liver surgery, like HCC, we found in literature that the robotic approach requires longer operative time probably as consequence of the underlining liver injury and the less incidence of parenchymal sparing indications. [57][58][59][60][61][62][63] After the introducing of da Vinci System at beginning of the last century, Ho et al in 2012 reported a systematic review of 217 patients underwent RLRs for benign and malignant liver disease (HCC, Cholangiocarcinoma, metastases). The mean operative time reported at that time was longer than the average reported in the present review, but it should be considered that we analyzed data after 10 years of technological development in MIS and we selected only CRCLM.…”

Section: Operative Timementioning

confidence: 99%

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Robotic surgery for colorectal liver metastases resection: A systematic review

Rocca

Scacchi

Cappuccio

et al. 2021

Robotics Computer Surgery

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Background:The role of robotic surgery for colorectal cancer liver metastases (CRCLMs) has never been investigated in large series.Methods: A systematic literature review was carried out on PubMed and Cochrane libraries. Results:We selected nine studies between 2008 and 2021. Two hundred sixty-two patients were included. One hundred thirty-one patients underwent simultaneous resections. The mean blood loss was 309.4 ml (range, 200-450 ml), the mean operative time was 250.5 min (range, 198.5-449.0 min). The mean length of hospital stay was 7.98 days (range, 4.5 to 12 days). The overall postoperative mortality was 0.4%. The overall morbidity rate was 37.0%, Clavien-Dindo grade III-IV complications were 8.4%. The mean 3-year overall survival was 55.25% (range, 44.4-66.1%), the mean 3-year disease free survival was 37% (range, 33.3-41.9%) Conclusion:We can conclude that robotic-assisted surgery might be considered as a technical upgrade option for minimally invasive approach to CRCLM resections even for simultaneous operations and challenging cases.

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Section: Discussionmentioning

confidence: 99%

Section: Operative Timementioning

confidence: 99%

Robotic surgery for colorectal liver metastases resection: A systematic review

Rocca

Scacchi

Cappuccio

et al. 2021

Robotics Computer Surgery

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“…These data support the suggestion that AIE is in fact a feature of a generalized hyperactive immune state (33). Reports of adult-onset AIE developing in patients with ulcerative colitis, autoimmune hepatitis, and rheumatoid arthritis further strengthen this hypothesis (34–36). The association with other immune-mediated enteropathies such as (refractory) CD is considered a clinical conundrum because differentiation among them is challenging (6).…”

Section: Discussionmentioning

confidence: 84%

Adult-Onset Autoimmune Enteropathy in an European Tertiary Referral Center

Wanrooij

Neefjes-Borst

Bontkes

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: Adult-onset autoimmune enteropathy (AIE) is a rare cause of severe chronic diarrhea because of small intestinal villous atrophy. We report on patients with adult-onset AIE in an European referral center. METHODS: Retrospective study including patients diagnosed with AIE in the Amsterdam UMC, location VUmc, between January 2003 and December 2019. Clinical, serological, and histological features and response to treatment were reported. The specificity of antienterocyte antibodies (AEA) was evaluated by examining the prevalence of AEA in (i) controls (n = 30) and in patients with (ii) AIE (n = 13), (iii) celiac disease (CD, n = 52), (iv) refractory celiac disease type 2 (n = 18), and (v) enteropathy-associated T-cell lymphoma (EATL, n = 10). RESULTS: Thirteen AIE patients were included, 8 women (62%), median age of 52 years (range 23–73), and 6 (46%) with an autoimmune disease. AEA were observed in 11 cases (85%), but were also found in CD (7.7%), refractory celiac disease type 2 (16.7%), and EATL (20%). Ten patients (77%) were human leukocyte antigen DQ2.5 heterozygous. Total parenteral nutrition was required in 8 cases (62%). Steroids induced clinical remission in 8 cases (62%). Step-up therapy with rituximab, cyclosporine, infliximab, and cladribine in steroid-refractory patients was only moderately effective. Four patients died (31%), but 4 (31%) others are in long-term drug-free remission after receiving immunosuppressive treatment, including 1 patient who underwent autologous stem cell transplantation. DISCUSSION: Adult-onset AIE is a rare but severe enteropathy that occurs in patients susceptible for autoimmune disease. Four patients (31%) died secondary to therapy-refractory malabsorption, while immunosuppressive therapy leads to a long-lasting drug-free remission in one-third of patients.

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“…The differential diagnosis of chronic diarrhea in adults with autoimmune enteropathy includes celiac disease, inflammatory bowel disease, lymphoma, eosinophilic enteritis, microscopic colitis, drug-associated enteropathy, common variable immunodeficiency, infections, and Whipple disease [7].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Autoimmune Enteropathy Associated with Autoimmune Hepatitis

Correia

Garrido

Chaves

et al. 2023

JGLD

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A 74-year-old woman was admitted for weight loss, abdominal pain and diarrhea for a year. Blood tests showed elevated transaminases, cholestasis and hyperbilirubinemia. Capsule endoscopy revealed extensively scattered lymphangiectasias, shortened villi and erosions in the jejunum and ileum. The histological examination of the small bowel mucosa biopsies evidenced severe mucosal atrophy and crypt hyperplasia, without significant intraepithelial lymphocytosis. The clinical picture, lack of response to a gluten-free diet and endoscopic and histopathologic findings were compatible with autoimmune enteropathy. Simultaneously, autoimmune hepatitis was also diagnosed. The patient showed significant improvement after starting treatment with prednisolone and azathioprine. To our knowledge, this is the first case of autoimmune enteropathy diagnosed simultaneously with autoimmune hepatitis.

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Adult autoimmune enteropathy in autoimmune hepatitis patient. Case report and literature review

Cited by 8 publications

References 53 publications

Robotic surgery for colorectal liver metastases resection: A systematic review

Robotic surgery for colorectal liver metastases resection: A systematic review

Adult-Onset Autoimmune Enteropathy in an European Tertiary Referral Center

A Rare Case of Autoimmune Enteropathy Associated with Autoimmune Hepatitis

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