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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Peptic Ulcer Disease (PUD) is characterized by mucosal excavation in the esophagus, stomach, pylorus, or duodenum. It can manifest as acute or chronic based on the extent and duration of mucosal involvement.
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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Double Pylorus in Upper Gastrointestinal Bleeding.

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Summary

Double pylorus, a rare gastrointestinal fistula, can cause bleeding and anemia. This case highlights its association with NSAID use and the effectiveness of proton pump inhibitors in treatment.

Keywords:
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Area of Science:

  • Gastroenterology
  • Internal Medicine

Background:

  • Double pylorus is a rare gastrointestinal fistula connecting the stomach antrum and duodenal bulb.
  • Its etiology is largely unknown, but associations with Helicobacter pylori infection and NSAID use are suggested.
  • Systemic diseases may also play a role in its development.

Observation:

  • A 59-year-old male presented with hematemesis and melena, indicative of gastrointestinal bleeding.
  • He had a history of diabetes mellitus and recent NSAID-like medicinal herb consumption.
  • Esophagogastroduodenoscopy revealed a double pylorus with a gastric ulcer.

Findings:

  • The patient presented with anemia and azotemia.
  • Biopsy showed chronic inactive gastritis, with no H. pylori detected.
  • The double pylorus was associated with a large gastric ulcer, partially clotted but not actively bleeding.

Implications:

  • Treatment focuses on acid suppression using proton pump inhibitors (PPIs) and mucosal protective agents.
  • High-dose PPI therapy led to symptom improvement within a week.
  • This case underscores the importance of considering double pylorus in patients with unexplained GI bleeding, especially with NSAID exposure.