title: Malabsorption syndrome associated with ulceration of the stomach and small bowel caused by chronic intestinal ischemia in a patient with hyperhomocysteinemia.
abstract: We describe a 39-year-old woman with an 8-month history of abdominal pain, diarrhea, and weight loss. Clinical and laboratory evaluation indicated the presence of a malabsorption syndrome. Endoscopy revealed multiple gastric ulcerations and an abnormal "picture" of the duodenal mucosa. At duodenal biopsy, necrosis confined to the distal parts of the enteric villi and a polymorphonuclear leukocyte response were found. Further evaluation revealed intestinal ischemia as a result of mesenteric atherosclerosis. After a revascularization procedure was performed, the symptoms disappeared. The macroscopic and microscopic picture of the bowel normalized. In our search for risk factors of atherosclerosis, we found a substantially increased basal plasma homocysteine concentration. This case suggests that hyperhomocysteinemia may have a causal role in the development of symptomatic, premature atherosclerosis of the mesenteric circulation.
authors.affiliation: Department of Gastroenterology, Slotervaart Hospital, Amsterdam, The Netherlands.
authors.forename: R C
authors.initials: RC
authors.lastname: Bakker
authors.forename: D P
authors.initials: DP
authors.lastname: Brandjes
authors.forename: P
authors.initials: P
authors.lastname: Snel
authors.forename: J A
authors.initials: JA
authors.lastname: Lawson
authors.forename: J
authors.initials: J
authors.lastname: Lindeman
authors.forename: D
authors.initials: D
authors.lastname: Batchelor
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004381:Duodenal Ulcer / Q000150:complications* / Q000473:pathology; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007422:Intestines / Q000098:blood supply* / Q000473:pathology; D007511:Ischemia / Q000150:complications* / Q000473:pathology; D008286:Malabsorption Syndromes / Q000209:etiology* / Q000473:pathology; D013152:Splanchnic Circulation; D013276:Stomach Ulcer / Q000150:complications* / Q000473:pathology
chemical_list: D006710:Homocysteine