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Duodenal Crohn’s Disease Complicated by Pancreatitis and Common Bile Duct Obstruction

INTRODUCTION: Crohn’s disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless – its diagnosis requires a high level of clinical suspicion.

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Introduction: Crohn’s disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless – its diagnosis requires a high level of clinical suspicion.

Case presentation: We present the case of a 29-year-old male patient with a 2-month history of weight loss, epigastric pain and postprandial vomiting. He underwent upper endoscopy, which revealed a circumferential duodenal ulcer causing non-transposable luminal stenosis and was medicated with proton pump inhibitors. While awaiting gastroenterology consultation, he presented at the emergency department for sudden onset of abdominal pain with dorsal irradiation, nausea and vomiting. Laboratory tests showed anaemia and increased liver enzymes, amylase and lipase. Abdominal computed tomography showed ectasia of the common bile duct (CBD) and intrahepatic biliary tract and a small amount of gas in the main pancreatic duct associated with duodenal thickening. The case was interpreted as probable CD complicated by pancreatitis and obstruction of the CBD, and he was hospitalized under antibiotic therapy and hydrocortisone with improvement of the condition. After discharge, he underwent colonoscopy that revealed several ulcers in the ileum and magnetic resonance imaging that showed distension of the stomach with reduction of the calibre of the transition from the duodenal bulb to the second portion of the duodenum in a 10- to 15-mm extension, as well as associated dilatation of the intrahepatic bile ducts and CBD and diffuse and regular ectasia of the main pancreatic duct. Combination therapy with azathioprine and infliximab was initiated; the patient presented clinical response at 12 weeks and endoscopic/imaging remission at 9 months.

Discussion/conclusion: Hepatobiliary and pancreatic manifestations are common in CD patients involving multiple mechanisms. In this case report, we pre-sent a patient with duodenal CD complicated with pancreatitis and CBD obstruction due to distortion phenomena by duodenal stenosis, a condition that is rarely described.

Introdução: A Doença de Crohn (DC) é caracterizada pelo envolvimento segmentar e transmural de qualquer porção do trato gastrointestinal desde a boca até ao ânus. A DC duodenal é uma entidade clínica rara, sendo que a maioria dos doentes são assintomáticos − o seu diagnóstico requer um alto grau de suspeição clínica.

Apresentação do caso: Doente do sexo masculino com 29 anos, apresentou quadro com 2 meses de evolução de perda de peso, dor epigástrica e vómitos pós-prandiais. Realizou endoscopia digestiva alta, que revelou úlcera duodenal circunferencial causando estenose luminal não transponível, tendo sido medicado com inibidor da bomba de protões. Enquanto aguardava pela consulta de Gastroenterologia, recorreu ao serviço de urgência por dor abdominal com irradiação dorsal com início súbito, náuseas e vómitos. Os exames laboratoriais revelaram anemia, aumento dos testes hepáticos e aumento da lípase e amílase. A tomografia computadorizada abdominal mostrou ectasia da via biliar principal (VBP) e dos ductos biliares intra-hepáticos e pequena quantidade de gás no ducto pancreático principal associado a marcado espessamento duodenal. Interpretado como provável DC complicada por pancreatite e obstrução da VBP, foi internado sob antibioterapia e hidrocortisona com melhoria clínica. Após a alta, realizou colonoscopia que revelou várias úlceras no íleo terminal e ressonância magnética que mostrou marcada distensão do estômago com redução do calibre da transição do bulbo duodenal para a segunda porção do duodeno em 10–15 mm extensão; associadamente, dilatação dos ductos biliares intra-hepáticos e da VBP e ectasia difusa e regular do ducto pancreático principal. O doente iniciou terapêutica combinada com azatioprina e infliximab apresentando resposta clínica às 12 semanas e remissão endoscópica/imagiológica aos 9 meses.

Discussão/con-clusão: Manifestações hepatobiliares e pancreáticas são comuns em doentes com DC tendo por base múltiplos mecanismos. Neste caso, mostramos um doente com DC duodenal complicada com pancreatite e obstrução da VBP por distorção causada por estenose duodenal, condição raramente descrita.

Keywords: Common bile duct obstruction; Duodenal Crohn’s disease; Pancreatitis.

Source: https://pubmed.ncbi.nlm.nih.gov/31970238/?utm_source=no_user_agent&utm_medium=rss&utm_campaign=pubmed-2&utm_content=14S2P3JOHoFcMo3M7TFdHK-QVNqlBZlxBx1Kmm5Bxn5762lgWa&fc=20200804222140&ff=20200813015519&v=2.11.5

Heartland

The Role of Cannabinoids as Anticancer Agents in Pediatric Oncology

Cannabinoids are a group of chemicals that bind to receptors in the human body and, in turn, modulate the endocannabinoid system (ECS). They can be endogenously produced, synthetic, or derived from the plant Cannabis sativa L. Research over the past several decades has shown that the ECS is a cellular communication network essential to maintain multiple biological functions and the homeostasis of the body. Indeed, cannabinoids have been shown to influence a wide variety of biological effects,…

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Cannabinoids are a group of chemicals that bind to receptors in the human body and, in turn, modulate the endocannabinoid system (ECS). They can be endogenously produced, synthetic, or derived from the plant Cannabis sativa L. Research over the past several decades has shown that the ECS is a cellular communication network essential to maintain multiple biological functions and the homeostasis of the body. Indeed, cannabinoids have been shown to influence a wide variety of biological effects, including memory, pain, reproduction, bone remodeling or immunity, to name a few. Unsurprisingly, given these broad physiological effects, alterations of the ECS have been found in different diseases, including cancer. In recent years, the medical use of cannabis has been approved in different countries for a variety of human conditions. However, the use of these compounds, specifically as anticancer agents, remains controversial. Studies have shown that cannabinoids do have anticancer activity in different tumor types such as breast cancer, melanoma, lymphoma and adult brain cancer. Specifically, phytocannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) has been shown to induce apoptosis and inhibit proliferation of adult cancer cells, as well as modulate angiogenesis and metastasis. Despite increasing evidence that cannabinoids elicit antitumor effects in adult cancers, there is minimal data available on their effects in children or in pediatric cancers despite public and clinical demand for information. Here we describe a comprehensive and critical review of what is known about the effects of cannabinoids on pediatric cancers, highlight current gaps in knowledge and identify the critical issues that need addressing before considering these promising but controversial drugs for use in pediatric oncology.

Keywords: CBD; THC; cannabidiol; cannabinoid; childhood cancer; medical cannabis; pediatric oncology; Δ9-tetrahydrocannabinol.

Source: https://pubmed.ncbi.nlm.nih.gov/33466435/?utm_source=no_user_agent&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1zmroqAMnEquTZFTfdGx1V1gPEavo-Be3-FKTecJpOlB7LykCL&fc=20200804213506&ff=20210120135252&v=2.14.2

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Heartland

Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment

Cannabis sativa L. turned out to be a valuable source of chemical compounds of various structures, showing pharmacological activity. The most important groups of compounds include phytocannabinoids and terpenes. The pharmacological activity of Cannabis (in epilepsy, sclerosis multiplex (SM), vomiting and nausea, pain, appetite loss, inflammatory bowel diseases (IBDs), Parkinson’s disease, Tourette’s syndrome, schizophrenia, glaucoma, and coronavirus disease 2019 (COVID-19)), which has been…

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Cannabis sativa L. turned out to be a valuable source of chemical compounds of various structures, showing pharmacological activity. The most important groups of compounds include phytocannabinoids and terpenes. The pharmacological activity of Cannabis (in epilepsy, sclerosis multiplex (SM), vomiting and nausea, pain, appetite loss, inflammatory bowel diseases (IBDs), Parkinson’s disease, Tourette’s syndrome, schizophrenia, glaucoma, and coronavirus disease 2019 (COVID-19)), which has been proven so far, results from the affinity of these compounds predominantly for the receptors of the endocannabinoid system (the cannabinoid receptor type 1 (CB1), type two (CB2), and the G protein-coupled receptor 55 (GPR55)) but, also, for peroxisome proliferator-activated receptor (PPAR), glycine receptors, serotonin receptors (5-HT), transient receptor potential channels (TRP), and GPR, opioid receptors. The synergism of action of phytochemicals present in Cannabis sp. raw material is also expressed in their increased bioavailability and penetration through the blood-brain barrier. This review provides an overview of phytochemistry and pharmacology of compounds present in Cannabis extracts in the context of the current knowledge about their synergistic actions and the implications of clinical use in the treatment of selected diseases.

Keywords: Cannabis; multitarget; phytocannabinoids (THC and CBD); receptors; terpenes.

Source: https://pubmed.ncbi.nlm.nih.gov/33466734/?utm_source=no_user_agent&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1zmroqAMnEquTZFTfdGx1V1gPEavo-Be3-FKTecJpOlB7LykCL&fc=20200804213506&ff=20210120135252&v=2.14.2

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Heartland

Pervasive cropland in protected areas highlight trade-offs between conservation and food security

Global cropland expansion over the last century caused widespread habitat loss and degradation. Establishment of protected areas aims to counteract the loss of habitats and to slow species extinctions. However, many protected areas also include high levels of habitat disturbance and conversion for uses such as cropland. Understanding where and why this occurs may realign conservation priorities and inform protected area policy in light of competing priorities such as food security. Here, we use…

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. 2021 Jan 26;118(4):e2010121118.

doi: 10.1073/pnas.2010121118.

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Varsha Vijay et al. Proc Natl Acad Sci U S A. .

Abstract

Global cropland expansion over the last century caused widespread habitat loss and degradation. Establishment of protected areas aims to counteract the loss of habitats and to slow species extinctions. However, many protected areas also include high levels of habitat disturbance and conversion for uses such as cropland. Understanding where and why this occurs may realign conservation priorities and inform protected area policy in light of competing priorities such as food security. Here, we use our global synthesis cropland dataset to quantify cropland in protected areas globally and assess their relationship to conservation aims and socio-environmental context. We estimate that cropland occupies 1.4 million km2 or 6% of global protected area. Cropland occurs across all protected area management types, with 22% occurring in strictly protected areas. Cropland inside protected areas is more prevalent in countries with higher population density, lower income inequality, and with higher agricultural suitability of protected lands. While this phenomenon is dominant in midnorthern latitudes, areas of cropland in protected areas of the tropics and subtropics may present greater trade-offs due to higher levels of both biodiversity and food insecurity. Although area-based targets are prominent in biodiversity goal-setting, our results show that they can mask persistent anthropogenic land uses detrimental to native ecosystem conservation. To ensure the long-term efficacy of protected areas, post-2020 goal setting must link aims for biodiversity and human health and improve monitoring of conservation outcomes in cropland-impacted protected areas.

Keywords: CBD; area-based targets; conservation; food security; protected areas.

Conflict of interest statement

The authors declare no competing interest.

References

    1. Klein Goldewijk K., Beusen A., Doelman J., Stehfest E.. New anthropogenic land use estimates for the holocene: HYDE 3.2. Earth Syst. Sci. Data. 2017;9:927–953.
    1. Barrett C. B.. Measuring food insecurity. Science. 2010;327:825–828.
    1. Fogel R. W.. The Escape from Hunger and Premature Death, 1700-2100: Europe, America, and the Third World. 2004.
    1. Crist E., Mora C., Engelman R.. The interaction of human population, food production, and biodiversity protection. Science. 2017;356:260–264.
    1. Pimm S. L., Vijay V.. Population, Agriculture, and Biodiversity: Problems and Prospects. 2020;365.

Source: https://pubmed.ncbi.nlm.nih.gov/33468666/?utm_source=no_user_agent&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1zmroqAMnEquTZFTfdGx1V1gPEavo-Be3-FKTecJpOlB7LykCL&fc=20200804213506&ff=20210120135252&v=2.14.2

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