Systemic IgG4 disease, a rare cause of severe acute pancreatitis

Rhita Bennis, Tatiana Roy, Yves Nang Atto, Michel Ides Colin Published in the journal : April 2020 Category : Gastroenterology

Autoimmune pancreatitis (AIP) remains little known. It is part of the differential diagnosis of acute non-alcoholic, non-biliary pancreatitis. The clusters of arguments in favor of type 1 AIP diagnosis are the clinical profile (male aged 50-70), the imaging (diffusely enlarged, “sausage-like”, pancreas), the elevation of serum IgG4 beyond the threshold of 135 mg/dl, the histological criteria and the disease corticosensitivity. Type 1 AIP is a component of the systemic IgG4 disease. Lymphadenopathies, pancreatitis and tubulointerstitial nephritis are the most frequent pathologies occurring in IgG4 disease. The evolution is often favorable following treatment with corticosteroids. Given the risk of relapse, a follow-up is necessary. The purpose of this article is to highlight the major elements leading to the diagnosis and treatment of type 1 AIP.

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Severe hypomagnesemia induced by proton pump inhibitors: description of two cases and review of the literature

Matveï Apraxine(1,2), Pierre Levecque†(3), Patrick Druez(1), Karin Dahan(4) Jean-François Cambier(2), Jean-Philippe Lengelé(2) Published in the journal : September 2019 Category : Gastroenterology

Proton pump inhibitors, an essential treatment of gastric acid-related disorders, can cause hypomagnesemia, associated with functional hypoparathyroidism and hypocalcemia. Symptoms may be either minor like cramps or more severe like rhabdomyolysis, cardiac arrhythmias, or epilepsy. We have herein reported on two cases presenting with severe hypomagnesemia, which quickly resolved following drug withdrawal. We have additionally reviewed the underlying mechanism, which is only partially elucidated to date, though possibly linked to a reduced intestinal absorption of magnesium, which as dependent on the channel TRPM6 (transient receptor potential melastatin type 6).

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Stromal tumor (gist) at the angle of Treitz

Jeremy Marchal(1), Zaynab Ouadi(1), Benjamin Alexandre(2), Aude Schillaci(1), Didier Deltour(1) Published in the journal : November 2017 Category : Gastroenterology

GIST are rare mesenchymal tumors, and their pre-operative diagnosis may prove challenging. This can be accounted for by less accessible anatomical localizations, and particularly the duodenum and angle of Treitz, in addition to the fact that the biopsies obtained may turn out to be poorly contributory. Surgical intervention that usually allows for a formal diagnosis remains the cornerstone of treatment. When a GIST is suspected, surgery must be encouraged and this, even in the absence of histologically confirmed disease.

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