Isolated gastric tuberculosis of the cardia

BACKGROUND: Isolated gastric tuberculosis is extremely rare, especially in the subcardiac region, where the low pH, high motility and absence of lymphoid tissue result in an unfavourable environment for the development of tuberculous lesions. METHODS AND RESULTS: Here we present a case of isolated gastric tuberculosis in the gastric cardia with no evidence of pulmonary involvement. Our patient was a young man with vague gastrointestinal symptoms and no previous history of tuberculosis. His condition was first detected on upper endoscopy as a raised subcardiac ulcer similar in appearance to a submucosal tumour. An endoscopic forceps biopsy showed the presence of caseating granulomata and acid-fast bacilli. The lesion resolved completely with 12 months of oral anti-tuberculosis therapy. CONCLUSIONS: This case illustrates the need for a high index of suspicion in order to diagnose this rare condition, as it can present in patients with no particular risk factors or symptoms. Once diagnosed, a complete cure can often be achieved with a course of oral anti-tuberculosis medication, with surgery being reserved for severely symptomatic or refractory lesions.     

Massive gastrointestinal tubercolsis in a young patient without immunosupression

Although the lung is the major site for Mycobacterium tuberculosis infection, gastrointestinal involvement can be present as part of multiorgan disease process or, less commenly, can be seen as primary gastrointestinal tuberculosis. In the cases where the culture is negative, it can be difficult to differantiate tuberculosis from Crohn's disease based on both the clinical and histological features.When side effects of classic antimycobacteria are encountered,we can initially add ciprofloxacin to the treatment of tuberculosis. We reported a case of 19-yr-old patient, who was treated as Crohn's disease and worsen. We began to tuberculosis treatment, and the patient improved clinically and histologically. The main point in this case is that widespread involvement of gastrointestinal tract can be brought about by non resistant strains of Mycobacterium tuberculosis even in immunocompetent patients.     

Massive gastrointestinal tuberculosis in a young patient without immunosuppression

Although the lung is the major site for Mycobacterium tuberculosis infection, gastrointestinal involvement can be present as part of multiorgan disease process or, lesscommenly, can be seen as primary gastrointestinal tuberculosis. In the cases where the culture is negative, it can be difficult to differantiate tuberculosis from Crohn‘‘s disease based on both the clinical and histological features. When side effects of classic antimycobacteria are encountered, we can initially add ciprofloxacin to the treatment of tuberculosis. We reported a case of 19-yr-old patient, who was treated as Crohn‘‘s disease and worsen. We began to tuberculosis treatment, and the patient improved clinically and histologically. The main point in this case is that widespread involvement of gastrointestinal tract can be brought about by non resistant strains of Mycobacterium tuberculosis even in immunocompetent patients.     

Very rare presentation of extrapulmonary tuberculosis: primary gastric tuberculosis

The most common site for gastrointestinal involvement in tuberculosis is the ileocecal region. Tuberculosis of stomach is quite uncommon. It is usually associated with pulmonary tuberculosis or with immunodeficiency. In this case non specific gastrointestinal complaints yielded a diagnosis of primary gastric tuberculosis, which is very rare. Absence of pulmonary focus and endoscopic findings of pangastritis are different features of this case which makes it presentable.     

Antro-duodenal tuberculosis causing gastric outlet obstruction--a rare presentation of a protean disease

Gastroduodenal tuberculosis is a rare location of abdominal tuberculosis. It usually occurs secondary to pulmonary tuberculosis. We report a case of a 63-year-old woman admitted to the referral center for symptoms of upper gastrointestinal obstruction caused by ulcerohypertrophic antroduodenal tuberculosis. The lesion was misdiagnosed as malignancy at endoscopy. Even at surgery, the lesion was considered gastric cancer and imposed an oncologic resection. The diagnosis was established in the presence of giant-cell granulomas with caseating necrosis in the surgical resected specimens. In our case, the rare gastroduodenal location of abdominal tuberculosis occurred as primary tuberculosis, in the absence of other identifiable locations.     

Gastric tuberculosis presenting as non healing ulcer: A case report

Tuberculosis is a major health problem in India. Gastrointestinal tuberculosis is the sixth most common causes of extrapulmonary tuberculosis and it mostly involves the ileocaecal region. Primary gastric tuberculosis in immunocompetent person is very rare. Stomach as its site is rare and is the sixth most common site of gastrointestinal tuberculosis. It mostly presents as a cases of non healing ulcer or gastric outlet obstruction. Yield of endoscopic biopsies for granuloma is low due to submucosal location of these lesions and mostly they are diagnosed after surgical intervention. We report a case of isolated gastric tuberculosis in a middle age immunocompetent female who present as a cases of non healing ulcer and responded well to standard antitubercular treatment. A high index of its suspicion should be kept in mind in any chronic infiltrative lesions of stomach like non healing ulcers and gastric outlet obstruction for its early diagnosis and treatment.     

Rare cause of upper gastrointestinal bleeding owing to hepatic cancer invasion: A case report

Upper gastrointestinal bleeding refers to bleeding that arises from the gastrointestinal tract proximal to the ligament of Treitz. The primary reason for gastrointestinal bleeding associated with hepatocellular carcinoma is rupture of a varicose vein owing to pericardial hypotension. We report a rare case of gastrointestinal bleeding with hepatocellular carcinoma in a patient who presented with recurrent gastrointestinal bleeding. The initial diagnosis was gastric cancer with metastasis to the multiple lymph nodes of the lesser curvature. The patient underwent exploratory laparotomy, which identified two lesions in the gastric wall. Total gastrectomy and hepatic local excision was then performed. Pathological results indicated that the hepatocellular carcinoma had invaded the stomach directly, which was confirmed immunohistochemically. The patient is alive with a disease-free survival of 1 year since the surgery. Hepatocellular carcinoma with gastric invasion should be considered as a rare cause of upper gastrointestinal bleeding in hepatocellular carcinoma patients, especially with lesions located in the left lateral hepatic lobe. Surgery is the best solution.     

Duodenal tuberculosis with a choledocho-duodenal fistula

A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and Mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. Biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.     

Both massive upper and lower gastrointestinal hemorrhage secondary to tuberculosis

We report a case of gastrointestinal tuberculosis, presenting with both massive upper and lower gastrointestinal bleeding that required two emergency operations. Massive bleeding is rare in gastrointestinal tuberculosis because of associated obliterative endarteritis. Tuberculosis should be considered in the differential diagnosis of massive gastrointestinal bleeding in the appropriate clinical setting even in an immunocompetent patient.     

Asymptomatic gastric tuberculosis in the gastric body mimicking an isolated microscopic erosion: A rare case report

Introduction:Gastric tuberculosis is rarely seen in clinical practice, which occurs mostly secondary to lung tuberculosis, intestinal tuberculosis, and other common tuberculosis. Gastric tuberculosis rarely presents as a single microscopic superficial erosion. We recently diagnosed such a case, hence reporting it herein.Patient concerns:A 40-year-old female patient was admitted with a chief complaint of painful enlarged cervical lymph nodes. She had no other symptoms or any previous history of remarkable diseases.Diagnosis:Physical examination found multiple enlarged cervical lymph nodes. Computer tomography revealed multiple circular well-defined soft tissue masses in the bilateral carotid sheath spaces. A cervical lymph node biopsy showed caseous necrosis with infiltration of neutrophils and lymphocytes, and most importantly, mycobacteria through staining for acid fast bacilli. Routine gastroscopy showed a 0.5 cm × 0.5 cm well-defined erosion on the large curvature of the gastric body. Gastric biopsy revealed chronic granulomatous inflammation with mycobacteria through staining for acid fast bacilli. The patient was diagnosed as having cervical lymph node tuberculosis and gastric tuberculosis.Interventions and outcomes:She received 6 months of standard anti-tuberculosis therapy. The enlarged cervical lymph nodes shrank in size and the pain was relieved.Conclusions:Gastroscopy should be performed to look for gastric tuberculosis if the patient presents primary tuberculosis in other organs/tissues such as cervical lymph nodes. If any small erosion is found, a biopsy is justified for checking the possibility of gastric tuberculosis.     

Management of Severe Gastrointestinal Tuberculosis with Injectable Antituberculous Drugs

Abdominal tuberculosis (TB) is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. However, intravenous therapy is needed for severe forms of tuberculosis with extensive gastrointestinal involvement. The authors report an immunocompetent patient with gastrointestinal TB who was successfully managed with a combination of surgical intervention and anti-TB medications, and discuss the importance of injectable anti-TB medications in the management of severe gastrointestinal TB. The present case report provides a model for assessment and intervention in severe forms of gastrointestinal TB.     

Consecutive regression of concurrent laryngeal and gastric MALT lymphoma after anti-Helicobacter pylori therapy

The most common primary lymphoma of the gastrointestinal tract is B-cell lymphoma arising from mucosa-associated lymphoid tissue known as MALT lymphoma. Although the majority of these lesions affect the stomach and are associated with Helicobacter pylori organisms, sites other than the gastrointestinal tract may be affected. This case report describes a patient with concomitant laryngeal MALT lymphoma and Helicobacter pylori-related gastric MALT lymphoma derived from the same clone as confirmed by PCR. Treatment of Helicobacter pylori infection in this patient using antibiotics led to regression of both lesions. This patient remains in remission at 46-month follow-up. This is the first case report on the regression of a laryngeal MALT lymphoma after Helicobacter pylori eradication. We suggest that all patients presenting with extragastric MALT lymphoma should undergo upper gastrointestinal endoscopy with gastric biopsies for the determination of Helicobacter pylori status and presence of concomitant gastric MALT lymphoma, followed by a course of anti-Helicobacter pylori antibiotic therapy. Nonresponders may subsequently be considered for surgery and/or chemo/radiation therapy.     

Diagnostic delay in a multi-organ tuberculosis immunocompetent patient: a case report

A 67-year-old immunocompetent male presented with intermittent fever for 3 months associated with urinary incontinence, altered bowel habits and history of loss of appetite and weight. He was treated as having enteric fever at various clinics in the city by different physicians. On evaluation the patient was found to have disseminated tuberculosis with involvement of the lungs, eyes, testes, brain, bone, kidneys, liver, spleen and possibly the gastrointestinal tract. This paper reports a case of disseminated tuberculosis to many organs with significant diagnostic delay more than twelve decades after the discovery of the tuberculosis bacillus by Robert Koch.     

Primary Gastric Tuberculosis: A Case Report and Literature Review

Gastric tuberculosis is a rare entity; it usually occurs secondary to another lesion(s), mainly in the lungs. Only a few cases of primary gastric tuberculosis have been reported in the literature. Most commonly, gastric tuberculosis lesion(s) is located in the lesser curvature of the antrum and prepylorus, so the clinical picture is similar to that of peptic ulcer, in addition to the constitutional symptoms seen in tuberculosis in general. We report a case of a young man presented with abdominal pain acute gastric outlet obstruction due to a large mass in the lesser curvature of the antrum and the pylorus. The histological examination revealed caseating granuloma with the presence of acid-fast bacilli. Partial gastrectomy with Bilroth II reconstruction was performed and the patient was put on antituberculosis medications. There was no evidence of the tuberculous lesion anywhere else. Patient's follow-up observation in the clinic was uneventful.     

Prostaglandin E1 analogue therapy in the treatment of refractory gastric ulcer in an elderly patient

An active 80-year-old woman without a history of peptic ulcer disease, recent nonsteroidal anti-inflammatory drug use, or smoking developed severe, symptomatic epigastric pain initially diagnosed as nonulcer dyspepsia secondary to esophagitis. Initial treatment consisted of 12 weeks of full-dose H2-receptor antagonist therapy. During this therapy the patient developed multiple gastric ulcers confirmed by endoscopy, and continued to have significant dyspeptic symptoms. An additional 16 weeks of combination therapy with ranitidine and sucralfate failed to ameliorate upper gastrointestinal symptoms, and there was significant increase in gastric ulcer size. Repeated ulcer biopsies showed no malignancy. Prior to scheduling elective gastric ulcer surgery, a trial of oral prostaglandin E1 analogue therapy was initiated with an investigational agent. Within the first three weeks of therapy, there was significant symptomatic improvement. Endoscopy of the upper gastrointestinal tract at 12 weeks revealed complete ulcer healing. This case report suggests that prostaglandin E1 analogue therapy should be considered as an alternative to elective gastric ulcer surgery for patients with refractory gastric ulcer.     

Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma.     

Endoscopic ultrasound-guided cutting of holes and deep biopsy for diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors using a novel vertical diathermic loop

AIM To report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy(EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors.METHODS Ten consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up. RESULTS EUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors(GISTs), and only one case of chronic non-atrophic gastritis. That is, nine(90%) of the cases treated by EUS-CHDB showed positive findings.CONCLUSION EUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.     

Hepatic tuberculosis; a rare case of bleeding gastric varices

A laparotomy was performed on a 68-year-old female who, in spite of medical treatment, suffered from uncontrolled upper gastrointestinal bleeding due to ruptured gastric varices. Histological examination of the liver tissue taken during operation revealed tuberculosis. Hepatic tuberculosis, although rare, should be kept in mind as one of the differential diagnosis when there is unexplained, noncirrhotic bleeding gastric varices.     

Pill-induced gastric injury

Pill-induced esophageal injury is a well described clinical entity. In contrast, pill-induced gastric injury has not been well characterized. In this report, we describe two patients with acute gastric ulcers due to pill ingestion and review the available literature on pill-induced gastric injury. The first patient presented with upper gastrointestinal hemorrhage and was found to have a large gastric ulcer with multiple potassium chloride pills in the ulcer crater. The second patient presented with odynophagia and endoscopy revealed doxycycline-induced esophageal and gastric injury. To our knowledge, this is the first case report of doxycycline-induced gastric ulcer.     

Esophageal adenocarcinoma with white opaque substance observed by magnifying endoscopy with narrow band imaging

White opaque substance (WOS) is observed in the gastric neoplasia of 0‐IIa type using magnifying endoscopy with narrow band imaging (NBI‐ME). Colonic and duodenal neoplasms with WOS have also been reported. Immunohistochemical examination with adipophilin reveals WOS in gastric neoplasms as lipid droplets, and WOS is specific for neoplasm with intestinal or gastrointestinal phenotype. We herein report a case of adenocarcinoma of the esophagogastric junction with WOS. A male patient in his sixties was found by esophagogastroduodenoscopy to have an esophageal elevated lesion. NBI‐ME showed whitish deposits that looked similar to WOS in gastric neoplasms. The patient underwent endoscopic submucosal dissection and the lesion was resected in a single piece. This tumor had diffuse positivity for adipophilin and gastrointestinal phenotype.