Hyponatremia with consciousness disturbance associated with esomeprazole.
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Biomedical subjects
Publications and source records attributed to Didier Mennecier.
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INTRODUCTION: The classical mode of revelation of a coeliac disease is chronic diarrhoea. We report the case of a patient in whom acute diarrhoea revealed the disease. OBSERVATION: In a 40 year-old man with acute diarrhoea with 7 non-bleeding stools per day, upper digestive tract endoscopy showed a villosity atrophy aspect confirmed by the histological examination. The search for specific antibodies of a coeliac disease was positive. A gluten-free diet led to the disappearance of the diarrhoea, followed by the disappearance of the specific antibodies and the regression of the villosity atrophy. COMMENTS: Acute diarrhoea that resists medical treatment must evoke the hypothesis of a coeliac disease and lead to a gastroscopy with duodenal biopsies. The interest of evoking the diagnosis is not only in order to obtain the rapid disappearance of the clinical signs after the introduction of a gluten-free diet but also to avoid an increase in the high risk of malignant lesions of the small intestine.
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P-glycoprotein (P-gp) and MDR1 mRNA expressions were assessed in tumoral and peritumoral specimens from patients with hepatocellular carcinoma (HCC) and in cirrhotic livers without HCC, using immunohistochemistry (C494 monoclonal antibody) and reverse transcription-polymerase chain reaction (RT-PCR) analysis. P-gp overexpression was detected in 24/28 tumoral livers (85%). In the peritumoral liver, staining was strong in cirrhotic nodules, and fainter in non-cirrhotic specimens. P-gp expression was as intense in the cirrhotic specimens free of HCC as in the peritumoral tissue of HCC developing in cirrhotic patients. These results were confirmed by RT-PCR analysis.
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