Nonspecific Granulomatous Inflammation of the Stomach and Duodenum

Comfort, Mandred W.; Weber, Harry M.; Baggenstoss, Archie H.; Kiely, William F.

doi:10.1097/00000441-195022060-00004

Cited by 66 publications

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“…Two out of five patients reported by Comfort et al (1950) and four out of 17 of those noted by Richman, Zeifer, Winkelstein, Kirschner, and Stenhardt (1955) died within a short time of diagnosis. Little has been written on the outcome of this involvement.…”

Section: Discussionmentioning

confidence: 78%

“…Typically, this took place late at night or in the early hours of the morning and led to relief of symptoms. Episodic diarrhoea stressed by Comfort et al (1950) occurred in seven of the 12 patients. It was not a prominent symptom but it was not possible to determine whether it was due to involvement of the duodenum or of other areas of affected gut.…”

Section: Symptomsmentioning

confidence: 98%

“…The patients have been followed for a mean of 9.7 years (range 1-20); two have died of other causes but the remaining 10 are well. In 1950, Comfort, Weber, Baggenstoss, and Kiely in a report on five patients established that nonspecific granulomatous inflammation of the stomach and the duodenum was the same condition as regional enteritis affecting other parts of the small intestine. Roberts and Hamilton (1966) found that only 34 patients had been reported by 1962.…”

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confidence: 97%

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Crohn's disease of the stomach and duodenum

Fielding¹,

Toye²,

Beton³

et al. 1970

Gut

121

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SUMMARY Clinical and radiological abnormalities in 12 patients with gastroduodenal involvement were encountered amongst 300 patients followed by one of us between 1944 and 1969. Symptoms of dyspepsia were relatively mild and obstructive symptoms when present were readily relieved by bypass surgery. The patients have been followed for a mean of 9.7 years (range 1-20); two have died of other causes but the remaining 10 are well.In 1950, Comfort, Weber, Baggenstoss, and Kiely in a report on five patients established that nonspecific granulomatous inflammation of the stomach and the duodenum was the same condition as regional enteritis affecting other parts of the small intestine. Roberts and Hamilton (1966) found that only 34 patients had been reported by 1962. By 1967, approximately 62 patients had been recorded but little information is available from the reports as to the prognosis and clinical course. This paper considers the significance of involvement of stomach and duodenum in Crohn's disease from the experience of 12 patients encountered amongst 300 followed by one of us between 1944 and 1969. Clinical MaterialThere were six men and six women, including a brother and sister.

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Section: Discussionmentioning

confidence: 78%

Section: Symptomsmentioning

confidence: 98%

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confidence: 97%

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Crohn's disease of the stomach and duodenum

Fielding¹,

Toye²,

Beton³

et al. 1970

Gut

121

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“…A 9~YEAR~OLD child was seen with peripheral 9-YEAR.-C~LD child was seen with peripheral eosinophilia and the insidious onset of chronic, severe abdominal pain accompanied by features of malabsorption and marked weight loss. His evaluation demonstrates the difficulty in distinguishing strongyloidiasis from inflammatory bowel disease and eosinophilic gastroenteritis.…”

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confidence: 99%

Chronic Abdominal Pain and Eosinophilia

Kerr¹

1983

Clin Pediatr (Phila)

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A 9~YEAR~OLD child was seen with peripheral 9-YEAR.-C~LD child was seen with peripheral eosinophilia and the insidious onset of chronic, severe abdominal pain accompanied by features of malabsorption and marked weight loss. His evaluation demonstrates the difficulty in distinguishing strongyloidiasis from inflammatory bowel disease and eosinophilic gastroenteritis. Case Report A 9-year-old Caucasian male was seen in November of 1979 with intense, cramping abdominal pain of 24 hours' duration. His physical examination was essentially normal except for some mild voluntary abdominal guarding in the right upper quadrant. Weight was 92 pounds (90%) and height 54.5 inches (50%). Past medical history was significant only for hayfever and atopic disease. Laboratory findings: WBC 7,400/cu mm with 50% polymorphonudeocytes, 38% lymphocytes, 5% monocytes, 6% eosinophils, and I Elo basophils; hemoglobin 14.0 g/dl; hematocrit 39.9Elo;' sedimentation rate (Wintrobe) 8 mm/hr; heterophile negative; and SGOT 21 UJL. This episode spontaneously resolved over the next . few days without a specific diagnosis.About a year later, the patient returned to the office for recurrent episodes of intense, gnawing, mid-epigastric pain accompanied by occasional vomiting over a period of nine weeks; the episodes would occur at any time of the day, without relation to meals, and might last up to two or three hours. Physical examination at this time was remarkable for a 12-pound weight loss. He had guiac-positive stools and also passed some grossly bloody stools.Laboratory: WBC 9,400/cu mm with 36% neutrophils, 29% lymphocytes, 3% monocytes, and 32% eosinophils; hemoglobin 15.3 g/dl; hematocrit 43%; peripheral smear within normal limits; absolute eosinophils count 2834/cu mm; sedimentation rate 7 mm/hr; CRP negative; total protein 6.6 g/d1; albumin 4.3 g/dl; serum immunoelectrophoresis, nor-_ mal; IgE 280 U f ml; rheumatoid factor negative; bilirubin 0.4 mg/dl; SGPT I 1U/!; SGOT 9 IU/l; amylase 127 dye units/dl; serum folate 4.6 ng/ml; carotene 42 mcg/dI. Serum samples sent to the Center for Disease Control (CDC) for ascaris, toxocara (ELISA), and cysticercosis titers (IHA) were negative. Stool samples for ova and parasites were negative on three separate occasions. Meckel's scan was negative. Barium enema showed minimal changes in the distal colon consistent with early nonspecific colitis.The patient was referred to the University of California, Davis, Medical Center, Department of Pediatric Gastroenterology for further evaluation. A physical examination was again recorded as normal except for the declining growth parameters. Upper gastrointestinal series with small-bowel follow-through was normal. Esophagogastroduodenoscopy was unrevealing; biopsy of the gastric mucosa was normal, but no tissue of duodenal origin was obtained. On colonoscopy, the sigmoid area and the first 3 cm of the descending colon appeared normal. Multiple biopsies were obtained. The lamina propria was edematous and, in some areas, showed an increase in fibrous tissue, which ...

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“…Such evidence that is available has been based on histo logical examination of the liver which has often been provided at autopsy. It is thought that the commonest lesion is fatty change but chronic inflamma tion may be present and granulomata are occasionally found [5,8,9,11,22,24,32]. Rarely focal necrosis, cirrhosis, metastatic abscesses, amyloidosis and sclerosing cholangitis have been reported [1,29,33], Biochemical evidence of hepatic dysfunction is even harder to find in the literature and it is thought to be uncommon even in the presence of histolog ical lesions [15,22], However, Monto (20) and Dordal et al [9] showed that abnormal liver function tests were present in cases of Crohn's disease in whom there was a clinical impression of liver disturbance.…”

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The Incidence and Significance of Liver Dysfunction in Crohn’s Disease

Dyer¹,

Dawson²

1972

Digestion

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26% of 62 patients with Crohn’s disease had elevated serum levels of alkaline phosphatase and 58% of 38 patients showed impaired excretion of BSP; all the patients with hyperphosphatasaemia also showed increased BSP retention. There was no correlation of these tests with other indices of liver function which tended to be normal and no correlation with activity of the disease, duration of symptoms, age of the patient or the serum levels of albumin and cholesterol. Biochemical abnormalities due to liver dysfunction are common and should not be attributed to malabsorption.

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Nonspecific Granulomatous Inflammation of the Stomach and Duodenum

Cited by 66 publications

References 0 publications

Crohn's disease of the stomach and duodenum

Crohn's disease of the stomach and duodenum

Chronic Abdominal Pain and Eosinophilia

The Incidence and Significance of Liver Dysfunction in Crohn’s Disease

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