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1

Morphology and histochemistry of the mucosa surrounding small oligotubular adenomas of the large bowel.  

UK PubMed Central (United Kingdom)

The transitional mucosa surrounding adenomas and carcinomas of the large bowel is characterized by a reversion of mucus secretion from sulphomucin to sialomucin and a hyperplasia of crypts and epithelial cells. The specificity of this phenomenon is still a controversial issue. Therefore we studied 72 oligotubular adenomas of the large bowel and the adjacent mucosa by means of histochemistry and morphometry. The peak of sialomucin production is found within the crypts immediately adjacent to the adenoma, whereas the more distant crypts secrete less. The cellular diameter and the depth of the crypts behave in a similar manner, they decrease with increasing distance from the adenoma, still being much higher than in the normal mucosa. The crypt depth correlates well to sialomucin production. The existence of the transitional mucosa around small oligotubular adenomas may indicate, that this mucosal change is not merely secondary to the presence of carcinoma but may be of importance as a precursor lesion of neoplastic changes of the colon and rectum.

Schmidbauer G; Heilmann KL

1985-07-01

2

Morphology and histochemistry of the mucosa surrounding small oligotubular adenomas of the large bowel.  

Science.gov (United States)

The transitional mucosa surrounding adenomas and carcinomas of the large bowel is characterized by a reversion of mucus secretion from sulphomucin to sialomucin and a hyperplasia of crypts and epithelial cells. The specificity of this phenomenon is still a controversial issue. Therefore we studied 72 oligotubular adenomas of the large bowel and the adjacent mucosa by means of histochemistry and morphometry. The peak of sialomucin production is found within the crypts immediately adjacent to the adenoma, whereas the more distant crypts secrete less. The cellular diameter and the depth of the crypts behave in a similar manner, they decrease with increasing distance from the adenoma, still being much higher than in the normal mucosa. The crypt depth correlates well to sialomucin production. The existence of the transitional mucosa around small oligotubular adenomas may indicate, that this mucosal change is not merely secondary to the presence of carcinoma but may be of importance as a precursor lesion of neoplastic changes of the colon and rectum. PMID:4034431

Schmidbauer, G; Heilmann, K L

1985-07-01

3

Pattern of cell kinetics in colorectal mucosa of patients with different types of adenomatous polyps of the large bowel  

International Nuclear Information System (INIS)

It is generally accepted that adenomatous polyps represent the natural precursor of many colorectal malignancies. The sequence, however, which leads from a normally appearing mucosa to cancer is complex and involves many steps, including a hyperproliferative mucosa with an upward expansion of the replicative compartment. The current study evaluates cell replication in normal colorectal mucosa of patients with adenomatous polyps of various types and relates the observed findings to the main clinical and morphologic features of adenomas. Forty-four patients with polyps and 27 controls entered the study. Samples of colorectal mucosa were taken at endoscopy and cell replication was evaluated with a standard autoradiographic procedure. Cell replication was expressed as labeling index (LI), in the whole crypt and in each of the five longitudinal compartments in which the crypts were divided. Total LI and LI per crypt compartment were significantly higher (P less than 0.02 and P less than 0.01, respectively) than in controls. There was no appreciable difference of LI values between patients with single or multiple, tubular or tubulovillous, small or large adenomas, but in all of these subgroups LI was significantly higher than in controls. In conclusion, in normally appearing colorectal mucosa of patients with adenomatous polyps there was a significant increase of cell replication and a marked upward expansion of the proliferative zone; these changes were more evident in the left colon and in the rectum. Finally, cell replication did not seem to be related to the number of polyps, to the most common histotypes, or to the pattern of recurrence.

1991-01-01

4

Pattern of cell kinetics in colorectal mucosa of patients with different types of adenomatous polyps of the large bowel  

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It is generally accepted that adenomatous polyps represent the natural precursor of many colorectal malignancies. The sequence, however, which leads from a normally appearing mucosa to cancer is complex and involves many steps, including a hyperproliferative mucosa with an upward expansion of the replicative compartment. The current study evaluates cell replication in normal colorectal mucosa of patients with adenomatous polyps of various types and relates the observed findings to the main clinical and morphologic features of adenomas. Forty-four patients with polyps and 27 controls entered the study. Samples of colorectal mucosa were taken at endoscopy and cell replication was evaluated with a standard autoradiographic procedure. Cell replication was expressed as labeling index (LI), in the whole crypt and in each of the five longitudinal compartments in which the crypts were divided. Total LI and LI per crypt compartment were significantly higher (P less than 0.02 and P less than 0.01, respectively) than in controls. There was no appreciable difference of LI values between patients with single or multiple, tubular or tubulovillous, small or large adenomas, but in all of these subgroups LI was significantly higher than in controls. In conclusion, in normally appearing colorectal mucosa of patients with adenomatous polyps there was a significant increase of cell replication and a marked upward expansion of the proliferative zone; these changes were more evident in the left colon and in the rectum. Finally, cell replication did not seem to be related to the number of polyps, to the most common histotypes, or to the pattern of recurrence.

Roncucci, L.; Scalmati, A.; Ponz de Leon, M. (Colorectal Cancer Study Group, University of Modena (Italy))

1991-08-15

5

Large bowel resection  

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... large intestine to reconnect, you may have a colostomy . In most cases, the colostomy is short-term. It can be closed with ... large part of your bowel is removed, the colostomy may be permanent. Your surgeon may also look ...

6

Large bowel resection - discharge  

Science.gov (United States)

... large bowel. You may also have had a colostomy. ... with diarrhea. You may have problems with your colostomy. ... protect it if needed. If you have a colostomy, follow care instructions from your doctor or nurse. ...

7

Granular small bowel mucosa: a reflection of villous abnormality  

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Diffuse mucosal granularity was reported recently in small bowel Crohn's disease. The radiographic appearance corresponded on histopathologic examination to villous hypertrophy, fusion, or epithelial bridge formation. We have observed similar granularity in Crohn's disease but also in several other conditions, including radiation enteritis, pancreatic glucagonoma, protein-losing enteropathy, and small bowel ischemia. Histopathologic examination demonstrated various alterations in villous morphology, such as edema, hyperplasia, clubbing, or fusion. In Crohn's disease, this appearance was sometimes an indication of early inflammatory disease but was also seen following extensive small bowel resection, possibly due to villous enlargement resulting from intestinal adaptation. These findings suggest that granular mucosa in the small bowel is a nonspecific finding reflecting an alteration in villous structure.

Jones, B.; Hamilton, S.R.; Rubesin, S.E.; Bayless, T.M.; Ravich, W.J.; Hendrix, T.R.

1987-01-01

8

[The mucin profile in the mucosa of the large intestine in neoplasms].  

Science.gov (United States)

Qualitative and quantitative changes in secretion of goblet cells of large bowel mucosa in adenomatous polyps (60), adenocarcinoma (30) and bioptates of adjacent transitional mucosa (30) were studied. As neoplasia progressed, mucin profile appeared to follow a certain pattern: it reached its peak in moderate dysplasia in polyps containing predominantly sulphomucins; subsequently both sulphomucin and sialomucin levels decreased. Adenocarcinomas showed a sharp drop in glycoprotein level, and an insignificant build-up of sialomucins was registered in some cases only. Enhanced abnormal secretion was observed in mucinous carcinoma and adenocarcinoma characterized by the presence of large mucinous areas. Also, qualitative changes were identified in transitional mucosa adjacent to tumor. PMID:1343158

Bagdasarian, A A; Manukian, E V; Oganesian, L A

1992-01-01

9

[The mucin profile in the mucosa of the large intestine in neoplasms  

UK PubMed Central (United Kingdom)

Qualitative and quantitative changes in secretion of goblet cells of large bowel mucosa in adenomatous polyps (60), adenocarcinoma (30) and bioptates of adjacent transitional mucosa (30) were studied. As neoplasia progressed, mucin profile appeared to follow a certain pattern: it reached its peak in moderate dysplasia in polyps containing predominantly sulphomucins; subsequently both sulphomucin and sialomucin levels decreased. Adenocarcinomas showed a sharp drop in glycoprotein level, and an insignificant build-up of sialomucins was registered in some cases only. Enhanced abnormal secretion was observed in mucinous carcinoma and adenocarcinoma characterized by the presence of large mucinous areas. Also, qualitative changes were identified in transitional mucosa adjacent to tumor.

Bagdasarian AA; Manukian EV; Oganesian LA

1992-01-01

10

[False acute large bowel obstruction  

UK PubMed Central (United Kingdom)

Acute pseudobstruction of the large intestine is also termed the "Ogilvie" syndrome. The life- threatening condition without obvious mecha nical obstruction of the intestine, results from a major enlargement of the large intestine, which, if no therapy is initiated on time, may result in perforation of the right- sided colon, most commonly of the caecum. In this case study, the patient underwent urgent surgery for incipient caecal perforation. Nor the preoperative plain abdominal x- ray examination, abdominal CT, nor the laparotomy procedure detected any mechanical bowel obstruction. The condition was diagnosed as the Ogilvie syndrome in a chronic renal disorder of the patient. The procedure included transversostomy, drainage of the peritoneal cavity and complex management, and the patient was discharged to homecare on the ninth postoperative day. However, two weeks later, the patient was rehospitalized for bleeding from the stoma site. Colonoscopy detected a small stenosing tumor in the lienal flexure of the large intestine. The case study highlights failure of both the CT and x-ray abdominal examinations (air up to the sigmoid), as well as of the surgical exploration. Therefore, it may be concluded that not all pseudoobstructions are truely "pseudo".

Pelikán A; Jain G; Rajagopal AS; Shinkfield M

2007-11-01

11

[False acute large bowel obstruction].  

Science.gov (United States)

Acute pseudobstruction of the large intestine is also termed the "Ogilvie" syndrome. The life- threatening condition without obvious mecha nical obstruction of the intestine, results from a major enlargement of the large intestine, which, if no therapy is initiated on time, may result in perforation of the right- sided colon, most commonly of the caecum. In this case study, the patient underwent urgent surgery for incipient caecal perforation. Nor the preoperative plain abdominal x- ray examination, abdominal CT, nor the laparotomy procedure detected any mechanical bowel obstruction. The condition was diagnosed as the Ogilvie syndrome in a chronic renal disorder of the patient. The procedure included transversostomy, drainage of the peritoneal cavity and complex management, and the patient was discharged to homecare on the ninth postoperative day. However, two weeks later, the patient was rehospitalized for bleeding from the stoma site. Colonoscopy detected a small stenosing tumor in the lienal flexure of the large intestine. The case study highlights failure of both the CT and x-ray abdominal examinations (air up to the sigmoid), as well as of the surgical exploration. Therefore, it may be concluded that not all pseudoobstructions are truely "pseudo". PMID:18214147

Pelikán, A; Jain, G; Rajagopal, A S; Shinkfield, M

2007-11-01

12

Diverticulitis of the right large bowel  

International Nuclear Information System (INIS)

Perforation in the course of diverticulitis of the right side of the large bowel is a rare disease, which is mostly misinterpreted as appendicitis and generally disregarded in the differentialdiagnosis of pathological processes of the lower right abdomen. The results of radiological investigations (plane film, barium enema, CT) are demonstrated in two cases and diagnostic findings are discussed. Plane film of the abdomen allows only unspecific diagnosis of an inflammatory process in the rigth lower quadrant, barium enema reveales changes in the wall of the colon due to abscess formation. CT is also suitable to show those peridiverticular inflammatory changes, which lead to the right diagnosis. (orig.)

1981-01-01

13

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension  

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Full Text Available AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria.METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence.RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension.CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.

Jamilé Wakim-Fleming, Nizar N Zein, Ana Bennett, Rocio Lopez, Janice Santisi, William D Carey

2008-01-01

14

Effects of Lactobacillus GG on genes expression pattern in small bowel mucosa.  

UK PubMed Central (United Kingdom)

BACKGROUND AND AIMS: Probiotics have been used for cure and prevention of several clinical conditions. However, further insights into the mechanism of action are needed to understand the rationale of their use. The aim of this study was to investigate the influence of Lactobacillus GG on the genetic expression patterns in the small bowel mucosa. METHODS: Six male patients (38+/-5 years) with endoscopically proven oesophagitis were enrolled. All patients were treated for 1 month with esomeprazole and randomised to receive Lactobacillus GG or placebo. After 1 month of treatment, upper endoscopy was repeated. Biopsies of the duodenal mucosa were taken prior to and after the treatment, and the genes expression patterns were assessed using GeneChip Human U133A array. Genes with significant expression changes were selected and analysed to identify specific cellular pathways modified by Lactobacillus GG. To support the array data, 10 target genes were studied using Syber-Green PCR. RESULTS: Microarray analysis showed that Lactobacillus GG administration determined the up- and down-regulation of 334 and 92 genes, respectively. Real-time PCR confirmed the reliability of the analysis. Lactobacillus GG mainly affected the expression of genes involved in immune response and inflammation (TGF-beta and TNF family members, cytokines, nitric oxide synthase 1, defensin alpha 1), apoptosis, cell growth and cell differentiation (cyclins and caspases, oncogenes), cell-cell signalling (ICAMs and integrins), cell adhesion (cadherins), signal transcription and transduction. CONCLUSIONS: These data indicate that administration of Lactobacillus GG is associated with a complex genetic response of the duodenal mucosa, reflected by the up- and down-regulation of several genes involved in specific cellular pathways.

Di Caro S; Tao H; Grillo A; Elia C; Gasbarrini G; Sepulveda AR; Gasbarrini A

2005-05-01

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Qualitative and quantitative analyses of the bifidobacterial microbiota in the colonic mucosa of patients with colorectal cancer, diverticulitis and infl ammatory bowel disease  

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AIM: To characterize the bifidobacterial microbiota of the colonic mucosa in patients with colon cancer, inflammatory bowel disease or diverticulitis. METHODS: A sample of the distal colonic mucosa was taken during surgery from a total of 34 patients, twenty-one with diagnosed colorectal cancer, ni...

Gueimonde Fernández, Miguel; Ouwehand, Arthur; Huhtinen, Heikki; Salminen, Eeva; Salminen, Seppo

16

Synchronous Adenocarcinomas of the small (Jejunum) and large (Transverse and Sigmoid Colon) bowel. A Case Study  

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Full Text Available SUMMARY A case of synchronous primary adenocarcinomas of the small and large bowel in a patient, thoroughly investigated for abdominal discomfort, is presented. Primary tumors of the small bowel are rare, and the diagnosis of primary adenocarcinoma of the small bowel in the presence of primary adenocarcinomas of the large bowel requires a high degree of suspicion and may well modify the prognostic outcome if detected early. Key Words: synchronous, adenocarcinoma, large bowel , small bowel, diagnosis, treatment.

V. Penopoulos, N.Gougoulias, J. Walonga, G. Christianopoulos,; K. Pistevou-Gobaki, G. Kokozidis, G. Kitis

2007-01-01

17

Large bowel leiomyosarcoma - a case report  

International Nuclear Information System (INIS)

The authors report a case of a 49-year-old male patient with leiomyosarcoma of the ascending colon. The patient presented with anemia and an abdominal mass, and the symptoms progressed until a final diagnosis was made nine months later. A plain abdominal x-ray showed the presence of gas outside the bowel, in the right hypochondrium. The double contrast barium enema showed a sublevel displacement of the hepatic flexure and diverticula. An abdominal ultrasound revealed a heterogeneous expansive lesion below the liver containing gas, and a computed tomography of the abdomen revealed an excavated mass below the liver containing liquid, that was not filled by contrast medium. The patient was submitted to a right hemicolectomy with ileocoloanastomosis and the histopathological analysis of the excised material revealed a leiomyosarcoma of the ascending colon. (author)

2001-01-01

18

Multiple primary malignant tumors involving the large bowel.  

Science.gov (United States)

We reviewed 5680 autopsy protocols in order to determine the frequency of Multiple Primary Malignant Tumors (MPMT) in different organs. The large bowel was the organ most frequently involved, making up to 32 per cent of all MPMT cases. Of 26 patients with colorectal MPMT, six were multicentric in the large bowel, and 20 were associated with extracolonic malignancies. The tissues harboring primary malignancies were, in order of decreasing frequency, liver, lung, and female and male reproductive organs. We compared the exact location of large bowel cancers in patients with and without a prior cholecystectomy; there was no statistically significant difference between the two groups, especially for right-sided colonic carcinoma in women. PMID:6499619

Shah, I A; Alfsen, G C

1984-12-01

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Distinct microbial populations exist in the mucosa-associated microbiota of sub-groups of irritable bowel syndrome.  

UK PubMed Central (United Kingdom)

BACKGROUND: There is increasing evidence to support a role for the gastrointestinal microbiota in the etiology of irritable bowel syndrome (IBS). Given the evidence of an inflammatory component to IBS, the mucosa-associated microbiota potentially play a key role in its pathogenesis. The objectives were to compare the mucosa-associated microbiota between patients with diarrhea predominant IBS (IBS-D), constipation predominant IBS (IBS-C) and controls using fluorescent in situ hybridization and to correlate specific bacteria groups with individual IBS symptoms. METHODS: Forty-seven patients with IBS (27 IBS-D and 20 IBS-C) and 26 healthy controls were recruited to the study. Snap-frozen rectal biopsies were taken at colonoscopy and bacterial quantification performed by hybridizing frozen sections with bacterial-group specific oligonucleotide probes. KEY RESULTS: Patients with IBS had significantly greater numbers of total mucosa-associated bacteria per mm of rectal epithelium than controls [median 218 (IQR - 209) vs 128 (121) P = 0.007], and this was chiefly comprised of bacteroides IBS [69 (67) vs 14 (41) P = 0.001] and Eubacterium rectale-Clostridium coccoides [52 (58) vs 25 (35) P = 0.03]. Analysis of IBS sub-groups demonstrated that bifidobacteria were lower in the IBS-D group than in the IBS-C group and controls [24 (32) vs 54 (88) vs 32 (35) P = 0.011]. Finally, amongst patients with IBS, the maximum number of stools per day negatively correlated with the number of mucosa-associated bifidobacteria (P < 0.001) and lactobacilli (P = 0.002). CONCLUSIONS & INFERENCES: The mucosa-associated microbiota in patients with IBS is significantly different from healthy controls with increases in bacteroides and clostridia and a reduction in bifidobacteria in patients with IBS-D.

Parkes GC; Rayment NB; Hudspith BN; Petrovska L; Lomer MC; Brostoff J; Whelan K; Sanderson JD

2012-01-01

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Dyspnea and large bowel obstruction: a misleading Chilaiditi syndrome.  

UK PubMed Central (United Kingdom)

Chilaiditi sign is named after the Greek radiologist Demetrius Chilaiditi who first described it when he was working in Vienna In (1910), and it is an incidental radiographic finding. This sign can be more frequently mistaken for pneumoperitoneum which is usually an indication of bowel perforation and can lead to needless surgical intervention. There are several case report reported in literature that describe the association between colonic volvulus and Chilaiditi syndrome that underline the frequent association between these anatomical condition instead no previous report described the association between Chilaiditi syndrome and large bowel obstruction secondary to a malignant sigmoid stenosis in a man presenting with symptoms and signs of upper respiratory distress combined with subacute bowel obstruction.

Antonacci N; Di Saverio S; Biscardi A; Giorgini E; Villani S; Tugnoli G

2011-11-01

 
 
 
 
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Dyspnea and large bowel obstruction: a misleading Chilaiditi syndrome.  

Science.gov (United States)

Chilaiditi sign is named after the Greek radiologist Demetrius Chilaiditi who first described it when he was working in Vienna In (1910), and it is an incidental radiographic finding. This sign can be more frequently mistaken for pneumoperitoneum which is usually an indication of bowel perforation and can lead to needless surgical intervention. There are several case report reported in literature that describe the association between colonic volvulus and Chilaiditi syndrome that underline the frequent association between these anatomical condition instead no previous report described the association between Chilaiditi syndrome and large bowel obstruction secondary to a malignant sigmoid stenosis in a man presenting with symptoms and signs of upper respiratory distress combined with subacute bowel obstruction. PMID:21861981

Antonacci, Nicola; Di Saverio, Salomone; Biscardi, Andrea; Giorgini, Eleonora; Villani, Silvia; Tugnoli, Gregorio

2011-08-20

22

Adult large bowel obstruction: A review of clinical experience  

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Full Text Available Background : Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. Materials and Methods : This is a prospective study of adult patients with acute large bowel obstruction over a 6-year period. The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. If the obstruction involved the right colon resection and primary ileo-colic anastomosis was performed, while for a lesion in the left colon a resection and primary colocolic anastomosis was performed after intraoperative antegrade colonic irrigation. If the obstructing lesions were thought to be malignant and too advanced to merit any excisional or the patient?s general condition was too poor to withstand resection, a biopsy was taken and a decompressive bypass procedure given pending the confirmation of the diagnosis. The clinical course and postoperative outcome were carefully documented. Results : A total of 50 patients aged 20-80 years, with a median age of 49 years, presented with features consistent with large bowel obstruction. Of these, 32 had simple sigmoid volvulus and were offered sigmoid colectomy and primary colorectal anastomosis, while 3 further patients with compound sigmoid volvulus had double resection with primary ileo-ileal and colorectal anastomosis. A patient with sigmoid volvulus had a Hartmann?s procedure. Twelve patients had colon cancer, four had left hemicolectomy and primary colocolic anastomosis; three, sigmoid colectomy and primary colorectal anastomosis; three, low anterior resection and primary colorectal anastomosis; one decompressive colostomy and one, a right hemicolectomy and primary ileocolic anastomosis. The two patients with functional obstruction (Ogilvie syndrome) had tube caecostomy. All resections and primary anastomosis involving the right colon were preceded by antegrade on-table colonic lavage. One clinical anastomotic leak occurred in a low rectal anastomosis and minor wound infection in 10 patients. Operative mortality occurred in three patients with sigmoid volvulus. Conclusion : Adult large bowel obstruction is infrequent in our community and is caused commonly by sigmoid volvulus. Resection and primary anastomosis of the acute left-sided large bowel obstruction seems safe after antegrade on-table colonic lavage, provided bowel gangrene with peritonitis or any additional risk factor for anastomotic breakdown is not present.

Sule A; Ajibade A

2011-01-01

23

Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients  

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Full Text Available AIM: To determine the composition of both fecal and duodenal mucosa-associated microbiota in irritable bowel syndrome (IBS) patients and healthy subjects using molecular-based techniques.METHODS: Fecal and duodenal mucosa brush samples were obtained from 41 IBS patients and 26 healthy subjects. Fecal samples were analyzed for the composition of the total microbiota using fluorescent in situ hybridization (FISH) and both fecal and duodenal brush samples were analyzed for the composition of bifidobacteria using real-time polymerase chain reaction.RESULTS: The FISH analysis of fecal samples revealed a 2-fold decrease in the level of bifidobacteria (4.2 ± 1.3 vs 8.3 ± 1.9, P < 0.01) in IBS patients compared to healthy subjects, whereas no major differences in other bacterial groups were observed. At the species level, Bifidobacterium catenulatum levels were significantly lower (6 ± 0.6 vs 19 ± 2.5, P < 0.001) in the IBS patients in both fecal and duodenal brush samples than in healthy subjects.CONCLUSION: Decreased bifidobacteria levels in both fecal and duodenal brush samples of IBS patients compared to healthy subjects indicate a role for microbiotic composition in IBS pathophysiology.

Angèle PM Kerckhoffs, Melvin Samsom, Michel E van der Rest, Joris de Vogel, Jan Knol, Kaouther Ben-Amor, Louis MA Akkermans

2009-01-01

24

[Clinical aspects of inflammatory diseases of the large bowel with reference to coloscopy (author's transl)].  

Science.gov (United States)

Ulcerative colitis and regional colitis Crohn are the most frequent inflammatory diseases of the large bowel in Europe. Clinical differentiation of these disorders are difficult. Diarrhoe with bloody stools are predominant. In cases with Morbus Crohn anorectal fistulas and involvement of the terminal ileum are frequently found. In cases with ulcerative colitis anorectal fistulas are more rare but in this disease a carcinoma of the colon often develops, especially when the course is severe and the involvement of the colon is extended. Clinical symptoms, courses and complications of both diseases are described. In differential diagnoses endoscopic procedures especially coloscopy play an important role. In cases of ulcerative colitis about 90% the rectum is involved. Spontaneous haemorrhage of the colonic mucosa with edema and pseudopolyps are typical endoscopic findings. Most cases with Crohn's disease show flat and irregular ulcers within a normal mucosa. In later stage a "cobble stone" relief is demonstrable. Endoscopy and guided biopsy are not only important for differential diagnosis but also for treatment and prognosis. PMID:1005713

Seifert, E

1976-11-01

25

Double contrast examination in inflammatory large bowel disease  

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In a prospective clinical series of 2371 consecutive patients referred for double contrast examination (DCE) of the large bowel, 154 had clinical and/or radiographic signs of inflammatory disease. The patients were followed up from May 1976 until May 1981. At the time of interpretation of the roentgenograms, the radiologist was unaware of clinical and laboratory findings. In 31 patients, organ specimens were studied histologically and in 101 other multiple endoscopic biopsies were available. Basing on the clinical observations and the pathology reports, the accuracy of the DCE was calculated at 99%; the predictive value of a positive DCE at 92, and that of a negative DCE at 99%.

Fork, F.T.; Lindstroem, C.; Ekelund, G.

1982-12-01

26

Small bowel adenocarcinoma mimicking a large adrenal tumor  

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Full Text Available Introduction. Adenocarcinoma of the small bowel is a rare gastrointestinal neoplasm usually affecting the distal duodenum and proximal jejunum. Because of their rarity and poorly defined abdominal symptoms, a correct diagnosis is often delayed. Case Outline. We present a 43-year-old woman admitted at the Clinic for Endocrinology due to a large tumor (over 7 cm) of the left adrenal gland. The tumor was detected by ultrasound and confirmed by CT scan. The patient complained of abdominal pain in the left upper quadrant, fatigue and septic fever. Normal urinary catecholamines excluded pheochromocytoma. The endocrine evaluations revealed laboratory signs of subclinical hypercorticism: midnight cortisol 235 nmol/L, post 1 mg - overnight Dexamethasone suppression test for cortisol 95.5 nmol/L and basal ACTH 4.2 pg/mL. Plasma rennin activity and aldosterone were within the normal range. Surgery was performed. Intraoperative findings showed signs of acute peritonitis and a small ulceration of the jejunum below at 70 cm on the anal side from the Treitz’s ligament. Adrenal glands were not enlarged. Patohistology and immunochemistry identified adenocarcinoma of the jejunum without infiltration of the lymphatic nodules. The extensive jejunal resection and lavage of the peritoneum were performed. Due to complications of massive peritonitis, the patient died seven days after surgery. Conclusion. Poorly defined symptoms and a low incidence make the diagnosis of small bowel carcinoma, particularly of the jejunal region, very difficult in spite of the new endoscopic techniques.

Ivovi? Miomira; Živaljevi? Vladan; Vujovi? Svetlana; Marina Ljiljana; Tan?i?-Gaji? Milina; Dun?erovi? Dušan; Bara? Marija; Mici? Dragan

2013-01-01

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Small bowel adenocarcinoma mimicking a large adrenal tumor.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Adenocarcinoma of the small bowel is a rare gastrointestinal neoplasm usually affecting the distal duodenum and proximal jejunum. Because of their rarity and poorly defined abdominal symptoms, a correct diagnosis is often delayed. CASE OUTLINE: We present a 43-year-old woman admitted at the Clinic for Endocrinology due to a large tumor (over 7 cm) of the left adrenal gland.The tumor was detected by ultrasound and confirmed by CT scan.The patient complained of abdominal pain in the left upper quadrant, fatigue and septic fever. Normal urinary catecholamines excluded pheochromocytoma. The endocrine evaluations revealed laboratory signs of subclinical hypercorticism: midnight cortisol 235 nmol/L, post 1 mg - overnight Dexamethasone suppression test for cortisol 95.5 nmol/L and basal ACTH 4.2 pg/mL. Plasma rennin activity and aldosterone were within the normal range. Surgery was performed. Intraoperative findings showed signs of acute peritonitis and a small ulceration of the jejunum below at 70 cm on the anal side from the Treitz's ligament. Adrenal glands were not enlarged. Patohistology and immunochemistry identified adenocarcinoma of the jejunum without infiltration of the lymphatic nodules. The extensive jejunal resection and lavage of the peritoneum were performed. Due to complications of massive peritonitis, the patient died seven days after surgery. CONCLUSION: Poorly defined symptoms and a low incidence make the diagnosis of small bowel carcinoma, particularly of the jejunal region, very difficult in spite of the new endoscopic techniques.

Ivovi? M; Zivaljevi? V; Vujovi? S; Marina L; Gaji? MT; Dundjerovi? D; Bara? M; Mici? D

2013-03-01

28

Left paraduodenal hernia: a rare cause of large bowel obstruction and gangrene.  

UK PubMed Central (United Kingdom)

Internal hernias are a rare cause of intestinal obstruction. Paraduodenal hernias are the most common type of internal hernias. Although small bowel obstruction is associated with internal hernias, large bowel obstruction is unique. The authors here report a case of left para duodenal hernia with simultaneous small and large bowel obstruction and gangrene. The patient underwent emergency laparotomy and generous resection of gangrenous small and large bowel was carried out and stoma was created. Postoperatively, the patient had a smooth recovery and was discharged after a few days.Reversal of stoma was carried out after 2 months.

Hafeez Bhatti AB; Khan MA

2012-04-01

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Intestinal schistosomiasis presenting as large bowel perforation in an HIV-positive individual  

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Full Text Available RA Cadwallader, N Shabalala, I ThirskNgwelezana Hospital, Empangeni, South AfricaAbstract: Endemic to over 70 countries and resulting in 200 million infected individuals and 500,000 deaths each year, the Schistosoma trematode worm can result in multisystem morbidity. Bowel obstruction secondary to this parasite has previously been described, but we report the first case of schistosomiasis affecting the sigmoid colon and resulting in perforation in a male positive for human immunodeficiency virus.Keywords: large bowel obstruction, large bowel perforation, schistosomiasis, bowel resection

Cadwallader RA; Shabalala N; Thirsk I

2011-01-01

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Multiple large bowel resections: potential risk factor for anastomotic leak.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Identify risk factors of anastomotic leak (AL) after large bowel resection (LBR) for ovarian cancer (OC) and compare outcomes between AL and no AL. METHODS: All cases of AL after LBR for OC between 01/01/1994 and 05/20/2011 were identified and matched 1:2 with controls for age (±5 years), sub-stage (IIIA/IIIB; IIIC; IV), and date of surgery (±4 years). Patient-specific and intraoperative risk factors, use of protective stomas, and outcomes were abstracted. A stratified conditional logistic regression model was fit to determine the association between each factor and AL. RESULTS: 42 AL cases were evaluable and matched with 84 controls. Two-thirds of the AL had stage IIIC disease and >90% of both cases and controls were cytoreduced to <1cm residual disease. No patient-specific risk factors were associated with AL (pre-operative albumin was not available for most patients). Rectosigmoid resection coupled with additional LBR was associated with AL (OR=2.73, 95% CI 1.13-6.59, P=0.025), and protective stomas were associated with decreased risk of AL (0% vs. 10.7%, P=0.024). AL patients had longer length of stay (P<0.001), were less likely to start chemotherapy (P=0.020), and had longer time to chemotherapy (P=0.007). Cases tended to have higher 90-day mortality (P=0.061) and were more likely to have poorer overall survival (HR=2.05, 95% CI 1.18-3.57, P=0.011). CONCLUSIONS: Multiple LBRs appear to be associated with increased risk of AL and protective stomas with decreased risk. Since AL after OC cytoreduction significantly delays chemotherapy and negatively impacts survival, surgeons should strongly consider temporary diversion in selected patients (poor nutritional status, multiple LBRs, previous pelvic radiation, very low anterior resection, steroid use).

Kalogera E; Dowdy SC; Mariani A; Weaver AL; Aletti G; Bakkum-Gamez JN; Cliby WA

2013-07-01

31

Small bowel adenocarcinoma mimicking a large adrenal tumor  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction. Adenocarcinoma of the small bowel is a rare gastrointestinal neoplasm usually affecting the distal duodenum and proximal jejunum. Because of their rarity and poorly defined abdominal symptoms, a correct diagnosis is often delayed. Case Outline. We present a 43-year-old woman admitte...

Ivovi? Miomira; Živaljevi? Vladan; Vujovi? Svetlana; Marina Ljiljana; Tan?i?-Gaji? Milina; Dun?erovi? Dušan; Bara? Marija

32

Epstein Barr Virus replication linked to B cell proliferation in inflamed areas of colonic mucosa of patients with inflammatory bowel disease  

Science.gov (United States)

Background Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract. Epstein-Barr virus (EBV) infection is associated with increased disease severity in therapeutically immunosuppressed IBD patients. The role of EBV infection in patients with IBD who are unresponsive to medical therapy is unclear. Anti-viral strategies may be a viable treatment option if severity of EBV infection, reflected in peripheral blood, contributes to IBD progression. Objectives We investigated the role of EBV in IBD patients unresponsive to medical therapy by examining EBV reactivation and B-cell proliferation in colonic mucosa. Study Design EBV DNA copy numbers were measured by real-time PCR in peripheral blood mononuclear cells (PBMC) of 84 patients with IBD and 115 non-IBD controls in a retrospective cross-sectional study. EBV-infected cells in colonic mucosa were identified by immunohistochemistry. Results EBV load in PBMC was higher in patients with IBD than in non-IBD controls, especially in patients not responding to medication. Inflamed colonic mucosa of these patients had high levels of expression of lytic and latent EBV genes that localized to proliferating B-lymphocytes, which was not seen in patients responding to therapy. Conclusions EBV replication was associated with severe IBD and mucosal inflammation. Increased proliferation and EBV infection of B-lymphocytes in inflamed colonic mucosa highlight the potential role of EBV in mucosal inflammation. The immunomodulatory effects of EBV could delay the resolution of the IBD associated inflammation, thus contributing to disease progression. These results indicate that anti-viral therapeutic strategies for the resolution of IBD may be useful.

Sankaran-Walters, Sumathi; Ransibrahmanakul, Kanat; Grishina, Irina; Hung, Jason; Martinez, Enrique; Prindiville, Thomas; Dandekar, Satya

2010-01-01

33

The impact of helical computed tomography on the diagnosis of unsuspected inflammatory bowel disease in the large bowel  

Energy Technology Data Exchange (ETDEWEB)

Inflammatory bowel diseases (IBD) are diagnoses that can be easily overlooked clinically. The aim of this study was to investigate if CT is able to make a contribution to the identification of previously unsuspected cases of IBD. We retrospectively identified cases in which the possibility of an IBD was raised in CT reports (over a 4-year period), by utilising a keyword search of the radiology database. Cases with a previously known or suspected IBD were rigorously excluded by review of case notes, and endoscopic, radiological, histological and microbiological findings. The CT images of the identified cases were reviewed by a blinded observer to document the extent of bowel wall thickening, the location of lesion(s), and presence of peri-colic fat abnormality, ascites and/or collections. The observer also attempted to corroborate the presence, and to identify the type, of IBD based on the CT appearances alone. Thirty-five cases (out of approximately 19,000 body CTs performed) of clinically unsuspected IBD were identified, of which 27 underwent further investigation. An IBD was confirmed in 48% (13 of 27): Crohn's disease (n=6), ulcerative colitis (n=2), pseudomembranous colitis (n=3) and other (n=2), of which 70% (9 of 13) were correctly typed by the reviewer. Inflammatory bowel disease was not substantiated in the remainder (14 of 27), although 7 of these had other bowel pathologies: diverticular disease (n=4); and carcinoma (n=3). Prospectively determining the presence, and furthermore type, of IBD on CT is challenging largely because of the considerable overlap in the appearances of the individual IBDs and indeed of normality. Nevertheless, CT is able to identify clinically unsuspected cases and radiologists should be alert to this treatable and not infrequently elusive diagnosis. (orig.)

Markose, G.; Freeman, A.H. [Department of Radiology, Addenbrooke' s NHS Trust, Cambridge (United Kingdom); Ng, C.S. [Department of Radiology, Addenbrooke' s NHS Trust and the University of Cambridge, Cambridge (United Kingdom)

2003-01-01

34

The impact of helical computed tomography on the diagnosis of unsuspected inflammatory bowel disease in the large bowel  

International Nuclear Information System (INIS)

Inflammatory bowel diseases (IBD) are diagnoses that can be easily overlooked clinically. The aim of this study was to investigate if CT is able to make a contribution to the identification of previously unsuspected cases of IBD. We retrospectively identified cases in which the possibility of an IBD was raised in CT reports (over a 4-year period), by utilising a keyword search of the radiology database. Cases with a previously known or suspected IBD were rigorously excluded by review of case notes, and endoscopic, radiological, histological and microbiological findings. The CT images of the identified cases were reviewed by a blinded observer to document the extent of bowel wall thickening, the location of lesion(s), and presence of peri-colic fat abnormality, ascites and/or collections. The observer also attempted to corroborate the presence, and to identify the type, of IBD based on the CT appearances alone. Thirty-five cases (out of approximately 19,000 body CTs performed) of clinically unsuspected IBD were identified, of which 27 underwent further investigation. An IBD was confirmed in 48% (13 of 27): Crohn's disease (n=6), ulcerative colitis (n=2), pseudomembranous colitis (n=3) and other (n=2), of which 70% (9 of 13) were correctly typed by the reviewer. Inflammatory bowel disease was not substantiated in the remainder (14 of 27), although 7 of these had other bowel pathologies: diverticular disease (n=4); and carcinoma (n=3). Prospectively determining the presence, and furthermore type, of IBD on CT is challenging largely because of the considerable overlap in the appearances of the individual IBDs and indeed of normality. Nevertheless, CT is able to identify clinically unsuspected cases and radiologists should be alert to this treatable and not infrequently elusive diagnosis. (orig.)

2003-01-01

35

GPR15-mediated homing controls immune homeostasis in the large intestine mucosa.  

UK PubMed Central (United Kingdom)

Lymphocyte homing, which contributes to inflammation, has been studied extensively in the small intestine, but there is little known about homing to the large intestine, the site most commonly affected in inflammatory bowel disease. GPR15, an orphan heterotrimeric guanine nucleotide-binding protein (G protein)-coupled receptor, controlled the specific homing of T cells, particularly FOXP3(+) regulatory T cells (Tregs), to the large intestine lamina propria (LILP). GPR15 expression was modulated by gut microbiota and transforming growth factor-?1, but not by retinoic acid. GPR15-deficient mice were prone to develop more severe large intestine inflammation, which was rescued by the transfer of GPR15-sufficient Tregs. Our findings thus describe a T cell-homing receptor for LILP and indicate that GPR15 plays a role in mucosal immune tolerance largely by regulating the influx of Tregs.

Kim SV; Xiang WV; Kwak C; Yang Y; Lin XW; Ota M; Sarpel U; Rifkin DB; Xu R; Littman DR

2013-06-01

36

GPR15-mediated homing controls immune homeostasis in the large intestine mucosa.  

Science.gov (United States)

Lymphocyte homing, which contributes to inflammation, has been studied extensively in the small intestine, but there is little known about homing to the large intestine, the site most commonly affected in inflammatory bowel disease. GPR15, an orphan heterotrimeric guanine nucleotide-binding protein (G protein)-coupled receptor, controlled the specific homing of T cells, particularly FOXP3(+) regulatory T cells (Tregs), to the large intestine lamina propria (LILP). GPR15 expression was modulated by gut microbiota and transforming growth factor-?1, but not by retinoic acid. GPR15-deficient mice were prone to develop more severe large intestine inflammation, which was rescued by the transfer of GPR15-sufficient Tregs. Our findings thus describe a T cell-homing receptor for LILP and indicate that GPR15 plays a role in mucosal immune tolerance largely by regulating the influx of Tregs. PMID:23661644

Kim, Sangwon V; Xiang, Wenkai V; Kwak, Changsoo; Yang, Yi; Lin, Xiyao W; Ota, Mitsuhiko; Sarpel, Umut; Rifkin, Daniel B; Xu, Ruliang; Littman, Dan R

2013-05-09

37

Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?  

UK PubMed Central (United Kingdom)

BACKGROUND: In large-bowel intussusceptions, several US signs are known to indicate a lower likelihood of reducibility by enema. US can demonstrate echogenic dots or lines (foci) in the bowel wall, which might indicate an ischemic bowel. OBJECTIVE: To determine the presence of echogenic intramural and subserosal foci in large-bowel intussusceptions and to evaluate the degree of correlation with reducibility. MATERIALS AND METHODS: Between 2001 and 2008, 74 consecutive US examinations were retrospectively evaluated by two pediatric radiologists for intramural and subserosal echogenic foci, or trapped gas, in the intussusception. The degree of correlation between the sonographic findings and reducibility was evaluated. RESULTS: Of 73 intussusceptions examined by US, 56 (76%) were reducible and 17 (23%) were not reducible. Out of 10 intussusceptions with intramural gas, 11 with subserosal gas, and 14 with intramural and subserosal gas, 8 (80%), 6 (56%), 9 (64%), respectively, were not reducible. The presence of intramural gas or subserosal gas or both predicted a lower chance of reduction, but with regard to the effect of these findings together, intramural gas was the only significant predictor. CONCLUSION: Having intramural gas in large-bowel intussusception significantly decreases the chance of reduction.

Stranzinger E; Dipietro MA; Yarram S; Khalatbari S; Strouse PJ

2009-01-01

38

Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?  

Energy Technology Data Exchange (ETDEWEB)

In large-bowel intussusceptions, several US signs are known to indicate a lower likelihood of reducibility by enema. US can demonstrate echogenic dots or lines (foci) in the bowel wall, which might indicate an ischemic bowel. To determine the presence of echogenic intramural and subserosal foci in large-bowel intussusceptions and to evaluate the degree of correlation with reducibility. Between 2001 and 2008, 74 consecutive US examinations were retrospectively evaluated by two pediatric radiologists for intramural and subserosal echogenic foci, or trapped gas, in the intussusception. The degree of correlation between the sonographic findings and reducibility was evaluated. Of 73 intussusceptions examined by US, 56 (76%) were reducible and 17 (23%) were not reducible. Out of 10 intussusceptions with intramural gas, 11 with subserosal gas, and 14 with intramural and subserosal gas, 8 (80%), 6 (56%), 9 (64%), respectively, were not reducible. The presence of intramural gas or subserosal gas or both predicted a lower chance of reduction, but with regard to the effect of these findings together, intramural gas was the only significant predictor. Having intramural gas in large-bowel intussusception significantly decreases the chance of reduction. (orig.)

Stranzinger, Enno [Inselspital Berne (University Hospital of Berne), Department of Diagnostic Radiology, Berne (Switzerland); University of Michigan Health System, Section of Pediatric Radiology, Ann Arbor, MI (United States); DiPietro, Michael A.; Yarram, Sai; Strouse, Peter J. [University of Michigan Health System, Section of Pediatric Radiology, Ann Arbor, MI (United States); Khalatbari, Shokoufeh [Michigan Institute for Clinical and Health Research (MIHR), Ann Arbor, MI (United States)

2009-01-15

39

Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?  

International Nuclear Information System (INIS)

[en] In large-bowel intussusceptions, several US signs are known to indicate a lower likelihood of reducibility by enema. US can demonstrate echogenic dots or lines (foci) in the bowel wall, which might indicate an ischemic bowel. To determine the presence of echogenic intramural and subserosal foci in large-bowel intussusceptions and to evaluate the degree of correlation with reducibility. Between 2001 and 2008, 74 consecutive US examinations were retrospectively evaluated by two pediatric radiologists for intramural and subserosal echogenic foci, or trapped gas, in the intussusception. The degree of correlation between the sonographic findings and reducibility was evaluated. Of 73 intussusceptions examined by US, 56 (76%) were reducible and 17 (23%) were not reducible. Out of 10 intussusceptions with intramural gas, 11 with subserosal gas, and 14 with intramural and subserosal gas, 8 (80%), 6 (56%), 9 (64%), respectively, were not reducible. The presence of intramural gas or subserosal gas or both predicted a lower chance of reduction, but with regard to the effect of these findings together, intramural gas was the only significant predictor. Having intramural gas in large-bowel intussusception significantly decreases the chance of reduction. (orig.)

2009-01-01

40

Broad MICA/B Expression in the Small Bowel Mucosa: A Link between Cellular Stress and Celiac Disease.  

UK PubMed Central (United Kingdom)

The MICA/B genes (MHC class I chain related genes A and B) encode for non conventional class I HLA molecules which have no role in antigen presentation. MICA/B are up-regulated by different stress conditions such as heat-shock, oxidative stress, neoplasic transformation and viral infection. Particularly, MICA/B are expressed in enterocytes where they can mediate enterocyte apoptosis when recognised by the activating NKG2D receptor present on intraepithelial lymphocytes. This mechanism was suggested to play a major pathogenic role in active celiac disease (CD). Due to the importance of MICA/B in CD pathogenesis we studied their expression in duodenal tissue from CD patients. By immunofluorescence confocal microscopy and flow cytometry we established that MICA/B was mainly intracellularly located in enterocytes. In addition, we identified MICA/B(+) T cells in both the intraepithelial and lamina propria compartments. We also found MICA/B(+) B cells, plasma cells and some macrophages in the lamina propria. The pattern of MICA/B staining in mucosal tissue in severe enteropathy was similar to that found in in vitro models of cellular stress. In such models, MICA/B were located in stress granules that are associated to the oxidative and ER stress response observed in active CD enteropathy. Our results suggest that expression of MICA/B in the intestinal mucosa of CD patients is linked to disregulation of mucosa homeostasis in which the stress response plays an active role.

Allegretti YL; Bondar C; Guzman L; Cueto Rua E; Chopita N; Fuertes M; Zwirner NW; Chirdo FG

2013-01-01

 
 
 
 
41

Broad MICA/B Expression in the Small Bowel Mucosa: A Link between Cellular Stress and Celiac Disease.  

Science.gov (United States)

The MICA/B genes (MHC class I chain related genes A and B) encode for non conventional class I HLA molecules which have no role in antigen presentation. MICA/B are up-regulated by different stress conditions such as heat-shock, oxidative stress, neoplasic transformation and viral infection. Particularly, MICA/B are expressed in enterocytes where they can mediate enterocyte apoptosis when recognised by the activating NKG2D receptor present on intraepithelial lymphocytes. This mechanism was suggested to play a major pathogenic role in active celiac disease (CD). Due to the importance of MICA/B in CD pathogenesis we studied their expression in duodenal tissue from CD patients. By immunofluorescence confocal microscopy and flow cytometry we established that MICA/B was mainly intracellularly located in enterocytes. In addition, we identified MICA/B(+) T cells in both the intraepithelial and lamina propria compartments. We also found MICA/B(+) B cells, plasma cells and some macrophages in the lamina propria. The pattern of MICA/B staining in mucosal tissue in severe enteropathy was similar to that found in in vitro models of cellular stress. In such models, MICA/B were located in stress granules that are associated to the oxidative and ER stress response observed in active CD enteropathy. Our results suggest that expression of MICA/B in the intestinal mucosa of CD patients is linked to disregulation of mucosa homeostasis in which the stress response plays an active role. PMID:24058482

Allegretti, Yessica L; Bondar, Constanza; Guzman, Luciana; Cueto Rua, Eduardo; Chopita, Nestor; Fuertes, Mercedes; Zwirner, Norberto W; Chirdo, Fernando G

2013-09-13

42

[Changes in tight junction protein expression and permeability of colon mucosa in rats with dextran sulfate sodium-induced inflammatory bowel disease].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To develop an experimental rat model of inflammatory bowel disease (IBD) by administration of dextran sulfate sodium (DSS), and to observe changes in the tight junction protein expression and permeability of colon mucosa. METHODS: Male Sprague-Dawley (SD) rats were randomly divided into control (n=27) and IBD model groups (n=27). In the IBD model group, IBD was induced by 6-day administration of 3% DSS in water followed by 14-day administration of water only. The control group was fed with water only. Pathological changes in colon mucosae were observed on days 7, 14 and 21 after DSS administration. Colon tissue specimens were collected on day 21 for measuring myeloperoxidase (MPO) activity. The transepithelial electric resistance (TEER), transepithelial potential difference (TEPD) and short circuit current (Isc) of the specimens were measured by Ussing chamber. Real-time PCR and Western blot were used to measure the mRNA and protein expression of tight junction proteins in colon epithelia. RESULTS: In the IBD model group, diarrhea, hemafecia and weight loss were seen. Inflammation occurred mainly in the distal colon and was characterized by crypt abscess and inflammatory cell infiltration. The IBD model group showed significantly increased MPO activity (P<0.01), significantly decreased TEER (P<0.01) and TEPD (P<0.01), and significantly increased Isc (P<0.01) compared with the control group. No claudin 2 expression of mRNA and protein was detected in the control group, and they were expressed in the IBD model group. The expression levels of claudin 3, occludin and ZO-1 in the IBD model group were significantly decreased compared with in the control group (P<0.01). CONCLUSIONS: IBD rats show colonic barrier dysfunction and changes in the expression of tight junction proteins. The changes in the expression of tight junction proteins may contribute to colonic barrier dysfunction in cases of IBD in the chronic recovery stage.

Rao YX; Chen J; Chen LL; Gu WZ; Shu XL

2012-12-01

43

A comparison of cell proliferation at different sites within the large bowel of the mouse.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This study was undertaken in order to compare cell proliferation at different sites along the length of the large bowel of the mouse. Simple morphometry has been used along with 3HTdR labelling studies and metaphase arrest with vincristine. Differences have been described in the shape and size of cr...

Sunter, J P; Appleton, D R; Dé Rodriguez, M S; Wright, N A; Watson, A J

44

The Wnt antagonist sFRP1 is downregulated in premalignant large bowel adenomas  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Our previous studies have implicated the Wnt antagonist, sFRP1, as a tumour suppressor gene in advanced colorectal cancer. In this study, we set out to investigate the relationship between sFRP1 expression and large bowel adenomas, a precursor of colorectal cancer. The induction of ?-catenin/TCF med...

Caldwell, G M; Jones, C E; Taniere, P; Warrack, R; Soon, Y; Matthews, G M; Morton, D G

45

Streptococcus bovis bacteraemia associated with candidal lesions of the large bowel in a leukaemic child. A case report.  

UK PubMed Central (United Kingdom)

A 5-year-old boy with acute myeloblastic leukaemia had large-bowel masses, demonstrated at autopsy, 5 weeks after an episode of Streptococcus bovis bacteraemia. The association of Strept. bovis bacteraemia with large-bowel disease, well documented in adults, should be considered in children.

Berkowitz FE; MacDougall LG; Patidar JV; Grieve TP

1987-08-01

46

Jumbo forceps are superior to standard large-capacity forceps in obtaining diagnostically adequate inflammatory bowel disease surveillance biopsy specimens.  

UK PubMed Central (United Kingdom)

BACKGROUND: In inflammatory bowel disease (IBD) surveillance colonoscopy, an increased number of biopsy specimens correlates with a higher dysplasia detection rate. Larger biopsy specimens may also increase the diagnostic yield. OBJECTIVE: To compare a new jumbo forceps with a standard large-capacity forceps in obtaining diagnostically adequate IBD surveillance biopsy specimens. DESIGN: Prospective single-center study. PATIENTS AND METHODS: Twenty-four patients who were undergoing an IBD surveillance colonoscopy were enrolled. As part of standard IBD surveillance, 8 paired biopsy specimens were obtained from the rectosigmoid by using the jumbo forceps and a standard large-capacity forceps. OUTCOME MEASUREMENTS: Biopsy specimens were deemed adequate if they met all 3 of the following criteria: (1) length > or =3 mm, (2) penetration into the muscularis mucosa, and (3) < 20% crush artifact. RESULTS: The proportion of adequate biopsy specimens obtained with the jumbo forceps was significantly higher than that obtained with the large-capacity control forceps (67% vs 48%, P < .0001). The average length of the biopsy specimen obtained with the jumbo forceps was 4.00 mm (95% CI, 3.81-4.20 mm) compared with 3.19 mm (95% CI, 2.99-3.38 mm) with the large-capacity (control) forceps. LIMITATIONS: (1) No validated outcome measurement for the quality of GI biopsy specimens exists and (2) in this study, interobserver variability between pathologists was high. CONCLUSIONS: The jumbo forceps was superior to a standard large-capacity forceps in obtaining diagnostically adequate IBD surveillance biopsy specimens. Because biopsy specimens obtained with the jumbo forceps were larger, the use of this forceps for IBD surveillance will allow the endoscopist to sample a larger colonic mucosal surface area, potentially resulting in an increased dysplasia detection rate.

Elmunzer BJ; Higgins PD; Kwon YM; Golembeski C; Greenson JK; Korsnes SJ; Elta GH

2008-08-01

47

Whole genome gene expression meta-analysis of inflammatory bowel disease colon mucosa demonstrates lack of major differences between Crohn's disease and ulcerative colitis.  

UK PubMed Central (United Kingdom)

BACKGROUND: In inflammatory bowel disease (IBD), genetic susceptibility together with environmental factors disturbs gut homeostasis producing chronic inflammation. The two main IBD subtypes are Ulcerative colitis (UC) and Crohn's disease (CD). We present the to-date largest microarray gene expression study on IBD encompassing both inflamed and un-inflamed colonic tissue. A meta-analysis including all available, comparable data was used to explore important aspects of IBD inflammation, thereby validating consistent gene expression patterns. METHODS: Colon pinch biopsies from IBD patients were analysed using Illumina whole genome gene expression technology. Differential expression (DE) was identified using LIMMA linear model in the R statistical computing environment. Results were enriched for gene ontology (GO) categories. Sets of genes encoding antimicrobial proteins (AMP) and proteins involved in T helper (Th) cell differentiation were used in the interpretation of the results. All available data sets were analysed using the same methods, and results were compared on a global and focused level as t-scores. RESULTS: Gene expression in inflamed mucosa from UC and CD are remarkably similar. The meta-analysis confirmed this. The patterns of AMP and Th cell-related gene expression were also very similar, except for IL23A which was consistently higher expressed in UC than in CD. Un-inflamed tissue from patients demonstrated minimal differences from healthy controls. CONCLUSIONS: There is no difference in the Th subgroup involvement between UC and CD. Th1/Th17 related expression, with little Th2 differentiation, dominated both diseases. The different IL23A expression between UC and CD suggests an IBD subtype specific role. AMPs, previously little studied, are strongly overexpressed in IBD. The presented meta-analysis provides a sound background for further research on IBD pathobiology.

Granlund Av; Flatberg A; Østvik AE; Drozdov I; Gustafsson BI; Kidd M; Beisvag V; Torp SH; Waldum HL; Martinsen TC; Damås JK; Espevik T; Sandvik AK

2013-01-01

48

Proximal large bowel volvulus in children: 6 new cases and review of the literature.  

UK PubMed Central (United Kingdom)

BACKGROUND: Proximal large bowel volvulus is considered as an extremely rare surgical emergency in children. Approximately 40 cases have been reported, and because of its rarity, the diagnosis is often missed or delayed. The purpose of this study was to review the presentation, treatment, and clinical outcome of proximal large bowel volvulus. METHODS: A systematic review and analysis of the data relating to 6 patients from the author's practice and cases published in the English literature from 1965 to 2010 was performed. Detailed information regarding demographics, clinical presentation and methods of diagnosis, surgical procedure, complications, and outcome were recorded. RESULTS: Thirty-six cases of proximal large bowel volvulus were retrieved from the English literature, and 6 cases, from the author's practice. The male-female ratio was 1:1, with a median age of 10 years. There were 29 (69%) cases with neurodevelopmental delay. Clinical presentation included 29 (69%) cases with constipation, 41 (98%) with colicky abdominal pain, 42 (100%) with abdominal distension, and 35 (83%) with vomiting. Plain radiography was specific in 64% (27/42) of cases, barium enema in 100% (15/15), and computed tomography in 100% (2/2). All patients underwent surgery, with resection and primary anastomosis in 24 (57%) cases, stoma formation in 11 (26%), and detorsion of volvulus without resection in 7 (17%) cases. Six patients (14%) died postoperatively. CONCLUSION: A child with neurodevelopmental delay and a history of constipation presenting with an acute onset of colicky abdominal pain and progressive abdominal distension with vomiting should be suspected of having a cecal and proximal large bowel volvulus.

Folaranmi SE; Cho A; Tareen F; Morabito A; Rakoczy G; Cserni T

2012-08-01

49

Non-Hodgkin’s lymphomas of the large bowel - clinical characteristics, prognostic factors and survival  

Directory of Open Access Journals (Sweden)

Full Text Available The aims of this study were to review the clinical presentation of non-Hodgkin’s lymphomas of the large bowel, to analyze the prognostic factors using univariate and multivariate methods, as well as the overall survival. We identified 24 cases at our clinic between 1991 and 2005, based on pathohistological analysis and standard diagnostic criteria established by Dawson et al. They accounted for 1,2% of all cases of the large bowel malignancies (24/2021) during this period. The following clinical information such as age, gender, symptoms, tumor localization, operation performed, histology grade, stage of disease, and adjuvant chemotherapy was obtained. Survival function was expressed by Kaplan-Meier curve and Log-rank test was performed for the difference in survival between two patient groups. Multivariate analysis was carried out using the Cox proportional hazard model. Overall mean survival time was 41,91months. According to the univariete analysis, the factors influencing overall survival rate was operation type (elective and emergent). Tumor stage and operation type were independent prognostic factors for survival, as determined by multivariate analysis. Our results showed that tumor stage and operation type should be considered as the most important prognostic factors in patients with primary non-Hodgkin’s lymphomas of the large bowel.

Stanojevi? G.Z.; Stojanovi? M.P.; Stojanovi? M.M.; Krivokapi? Z.; Jovanovi? M.M.; Kati? V.V.; Jeremi? M.M.; Brankovi? B.R.

2008-01-01

50

New Large Bowel Segmentation on Plain Abdominal Radiography in Comparison with the Conventional Method  

Directory of Open Access Journals (Sweden)

Full Text Available Plain abdominal radiography is a very basic examination and plays an important role in primary care. The objectives of this study were to clarify colon distributions on plain abdominal radiographs. Forty-three healthy volunteers underwent gastric fluoroscopy, and 2 hours later, plain abdominal radiography in the supine position. A region of interest (ROI) was defined uniformly on each X-ray image to divide the image into 600 zones. The area corresponding to the large bowel within the ROI was divided into 4 segments (ascending colon, transverse colon, descending colon, and sigmoid colon?rectum). The percentage of barium in each segment relative to the total volume of barium used was calculated to evaluate the percent ROI occupancy. The large bowel covered 76.7% of the entire ROI, with the percent duplication being 55%. The duplicated area corresponded to the transverse colon region. When the method proposed by Arhan et al. was used, the percentage of the colon actually present in each segment relative to that determined theoretically was 99.6% for the right colon segment, 92.2% for the left colon segment, and 92.2% for the sigmoid/rectal segment. However, in cases in which the transverse colon descended partially from the fifth lumbar vertebra, the percentage occupied by the sigmoid colon?rectum decreased to 57.2%. We applied a new large bowel segmentation method especially for patients with ptosis, by devising a line joining the lateral side of the right lesser pelvis and the lower ends of both sacroiliac joints.

Sawa,Kiminari; Mizushima,Takaaki; Matsushita,Koki; Shirahige,Akinori; Ochi,Koji; Koide,Norio

2012-01-01

51

Potentialities of computed tomography in the diagnosis of recurrent cancer of the large bowel  

International Nuclear Information System (INIS)

To study the potentialities of computed tomography (CT) in the diagnosis of recurrent cancer of the large bowel, 325 patients underwent various surgical interventions for colorectal carcinoma were examined. The surgery-CT study interval ranged from 2.5 months to 11 years. It was found that CT might detect various intra- and extraintestinal relapses and generalize a tumorous process. With this, the efficiency of CT is higher than that of other diagnostic tools in the detection of extraintestinal relapses and generalising the tumorous process. To timely reveal a replace the CT interval should exceed 4-5 months

1995-01-01

52

A comparison of cell proliferation at different sites within the large bowel of the mouse.  

UK PubMed Central (United Kingdom)

This study was undertaken in order to compare cell proliferation at different sites along the length of the large bowel of the mouse. Simple morphometry has been used along with 3HTdR labelling studies and metaphase arrest with vincristine. Differences have been described in the shape and size of crypts, the distribution of proliferating cells, the duration of the cell cycle, as well as in the rate of cell production by the crypts. The findings explain some of the apparent inconsistencies in the literature.

Sunter JP; Appleton DR; Dé Rodriguez MS; Wright NA; Watson AJ

1979-12-01

53

Excision of a large abdominal wall lipoma improved bowel passage in a Proteus syndrome patient  

Directory of Open Access Journals (Sweden)

Full Text Available Proteus syndrome is an extremely rare congenital disorder that produces multifocal overgrowth of tissue. This report presents a surgical case of a large lipoma in the abdominal wall of a patient with Proteus syndrome. She was diagnosed with Proteus syndrome based on certain diagnostic criteria. The neoplasm increased in size gradually, producing hemihypertrophy of her left lower extremity and trunk, and spread to her retroperitoneum and her left abdominal wall. She experienced gradually progressive constipation, nausea, vomiting, and abdominal pain. Computed tomography (CT) of the abdomen demonstrated a large mass in the subcutaneous adipose tissue of the left lower abdominal wall which measured 12 cm × 8 cm x 6 cm in diameter and encased the left colon. This mass in the abdominal wall was excised. The weight of the excised mass was 1550 g. The histopathological diagnosis of this mass was lipoma. After surgery, the encasement of the left colon was improved, and the patient was able to move her bowels twice per day. The excision of the large lipoma in the abdominal wall contributed to the improved bowel passage in this patient with Proteus syndrome.

Yoshifumi Nakayama, Shinichi Kusuda, Naoki Nagata, Koji Yamaguchi

2009-01-01

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MRI for chronic inflammatory bowel disease  

International Nuclear Information System (INIS)

Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T1-weighted gradient echo and T2-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data. (orig.)

2001-01-01

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Double balloon enteroscopy procedure in patients with surgically altered bowel anatomy: analysis of a large prospectively collected database.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Patients with surgically altered bowel anatomy frequently undergo the double balloon enteroscopy (DBE) procedure to evaluate various small bowel diseases. There are limited data on the diagnostic yield and safety of DBE in these patients. We evaluated the diagnostic yield and complication rates of DBE in patients with surgical altered bowel anatomy. We also evaluated the success rate of DBE in achieving complete examination of the excluded segment of the small bowel and excluded stomach in these patients. SUBJECTS AND METHODS: Our study was a single-center retrospective analysis of a large prospectively collected DBE database. Patients with a history of surgically altered bowel anatomy who had a DBE procedure performed between January 2006 and August 2011 were included in the study analysis. Patients' demographics, procedure indications, findings, endoscopic interventions, and postprocedural recovery data were recorded. We used frequency statistics to calculate the diagnostic yield and complication rates of DBE in these patients. RESULTS: In total, 1215 DBEs were performed at our institution during the study period. Sixty-two patients with a history of altered bowel anatomy underwent 53 DBEs and 11 DBE-assisted endoscopic retrograde cholangiopancreatographies (ERCPs). The overall diagnostic yield of DBE was 61%, and that of DBE-assisted ERCP was 64%. No serious early or delayed DBE-associated complications were identified. In patients with surgically altered bowel anatomy containing excluded small bowel and excluded stomach, DBE success rate to achieve their complete examination was 92% (n=46). CONCLUSIONS: DBE including DBE-assisted ERCP is feasible, safe, and associated with reasonably high diagnostic yield in patients with surgically altered bowel anatomy.

Patel MK; Horsley-Silva JL; Gómez V; Stauffer JA; Stark ME; Lukens FJ

2013-05-01

56

Weekly large fraction radiotherapy and 5 fluorouracil as a palliative treatment for large bowel carcinoma: a pilot study  

Energy Technology Data Exchange (ETDEWEB)

Palliative radiotherapy for large bowel cancer is generally given in fraction sizes of 2-3 Gy. Theoretical considerations led us to believe that a larger fraction size would not lead to a decreased response rate and practical considerations led us to treat patients once a week. The results of a pilot study of 32 patients with large bowel cancer are presented. Patients were treated with a fraction size of 6 Gy given weekly and combined with 5 FU. The response rate of 58% and the median survival of 9 months seems comparable with other regimens, as does the rate of acute side effects. The late high dose effect of subcutaneous fibrosis was seen in 30% of the long term survivors; the implications of this are discussed. We draw the conclusion that this treatment is convenient and effective in terms of tumor response, but that the late high dose effects were more severe than expected and that these effects may be potentiated by 5 FU.

Habeshaw, T. (Western Infirmary, Glasgow, Scotland); Adam, J.S.; Kirk, J.

1982-07-01

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NiTi Shape Memory Compression Anastomosis Clip in Small- and Large-Bowel Anastomoses: First Experience.  

UK PubMed Central (United Kingdom)

The aim of the study was to present a clinical use of compression anastomosis clip (CAC) implants made of shape memory materials-nickel titanium alloys (NiTi). The concept involved in the use of CAC was to compress 2 bowel walls together, cause necrosis, and detach the CAC from the tissue to be expelled with the stool. The CAC is a double-ring elliptical device with a diameter of 30 mm. The device has the ability to recover its original closed shape when it senses a change in ambient temperature. In all, 20 anastomoses using CACs were performed: 6 of the small with the large bowel and 14 between the small bowel and small bowel. Two patients experienced complications. Although the anastomosis is not difficult to perform, the rules on how to apply the CAC must be well known. Because only a small number of anastomoses have been performed by us to date, this procedure requires further study.

Kusnierz K; Morawiec H; Lekston Z; Zhavoronkov D; Lucyga M; Lampe P

2013-01-01

58

NiTi Shape Memory Compression Anastomosis Clip in Small- and Large-Bowel Anastomoses: First Experience.  

Science.gov (United States)

The aim of the study was to present a clinical use of compression anastomosis clip (CAC) implants made of shape memory materials-nickel titanium alloys (NiTi). The concept involved in the use of CAC was to compress 2 bowel walls together, cause necrosis, and detach the CAC from the tissue to be expelled with the stool. The CAC is a double-ring elliptical device with a diameter of 30 mm. The device has the ability to recover its original closed shape when it senses a change in ambient temperature. In all, 20 anastomoses using CACs were performed: 6 of the small with the large bowel and 14 between the small bowel and small bowel. Two patients experienced complications. Although the anastomosis is not difficult to perform, the rules on how to apply the CAC must be well known. Because only a small number of anastomoses have been performed by us to date, this procedure requires further study. PMID:23355421

Kusnierz, Katarzyna; Morawiec, Henryk; Lekston, Zbigniew; Zhavoronkov, Dmytro; Lucyga, Magdalena; Lampe, Pawel

2013-01-24

59

Cirugía de colon abierta con "Fast Track" o recuperación acelerada "Fast Track" large bowel surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Introducción: La Cirugía resectiva de colon se asocia a una hospitalización de 6 a 10 días. En el último tiempo se ha desarrollado el concepto de rehabilitación multimodal o "Fast track" que involucra una combinación de técnicas que llevan a reducir la respuesta al stress quirúrgico, optimizar la recuperación y reducir los días de hospitalización. Objetivo: Evaluar el postoperatorio de pacientes sometidos a cirugía electiva de colon y recto superior utilizando un protocolo de "Fast track". Material y Método: Ingresaron a un protocolo prospectivo de recuperación acelerada, todos los enfermos sometidos a cirugía electiva de colon y recto superior en el Hospital Militar de Santiago en el período comprendido entre Agosto 2004 a Noviembre 2005. Se evalúa íleo postoperatorio, días de hospitalización, complicaciones postoperatorias y satisfacción de pacientes. Resultados: Ingresaron 40 pacientes consecutivos, 19 hombres (48%) y 21 mujeres (52%). La edad promedio fue 66 años (39-87), 24 pacientes (60%) eran ASA II y 38% ASA I. El 97,5% expulsó gases en las primeras 48 h. La primera defecación ocurrió dentro de las primeras 48 h en el 47,5% de los pacientes y en el 37,5% a las 72 h. El 78% de los paciente fueron dados de alta al 4° día. La escala visual análoga (EVA) para dolor a las 24 h era Introduction: Large Bowel resective surgery requires 6 to 10 days in-hospital stay. Recently the multimodality rehabilitation concept or "fast track" surgery, a combination of different techniques in order to reduce surgical stress, increase recuperation and decrease in-hospital stay, has become an option. Objective: Evaluate postoperative evolution of patients submitted for elective large bowel and rectum resection using "Fast Track" protocol. Material and Method: Prospective Fast track protocol includes all patients submitted for elective large bowel and rectum resection in Military Hospital of Santiago during August 2004 to November 2005. Outcomes concerning postoperative ileus, in-hospital stay, complications and patient satisfaction were recorded. Results: 40 patients, 19 male (48%) and 21 female (52%) consecutive patients were included. Average age 66 years (39-87), 24 patients (60%) were classified ASA II and 38% ASA I. During the first 48 hrs 97.5% had anal flatulence. First defecation occurred before 48 hrs in 47.5% and in 37.5% at 72 hrs. Hospital discharge at 4*11 day was possible in 78%. Pain visual analogical scale at 24 hrs was less than 2 in 95%. Satisfaction rate was very good in 70%. Morbidity was 18% without mortality. Anastomotic dehiscence was 2.5%. Conclusions: Fast Track protocol reduces in- hospital stay, pain and postoperative ileus.

LEONARDO ESPÍNDOLA S

2009-01-01

60

Ileal Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma with a Large-Cell Component That Regressed Spontaneously.  

Science.gov (United States)

Reported herein is a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the terminal ileum with a large-cell component, which regressed spontaneously. To the best of our knowledge, only five cases of spontaneously regressing MALT lymphoma have been reported in the English-language literature, and all of these cases were low-grade lymphomas. Spontaneous regression of a MALT lymphoma with a high-grade component is very rare. The present case suggests that MALT lymphoma cells have a reversible nature, even in the presence of a high-grade component. PMID:20479924

Makino, Yohsuke; Suzuki, Hidekazu; Nishizawa, Toshihiro; Kameyama, Kaori; Hisamatsu, Tadakazu; Imaeda, Hiroyuki; Mukai, Makio; Hibi, Toshifumi

2010-03-25

 
 
 
 
61

Ileal Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma with a Large-Cell Component That Regressed Spontaneously.  

UK PubMed Central (United Kingdom)

Reported herein is a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the terminal ileum with a large-cell component, which regressed spontaneously. To the best of our knowledge, only five cases of spontaneously regressing MALT lymphoma have been reported in the English-language literature, and all of these cases were low-grade lymphomas. Spontaneous regression of a MALT lymphoma with a high-grade component is very rare. The present case suggests that MALT lymphoma cells have a reversible nature, even in the presence of a high-grade component.

Makino Y; Suzuki H; Nishizawa T; Kameyama K; Hisamatsu T; Imaeda H; Mukai M; Hibi T

2010-03-01

62

Imaging findings of midgut volvuIus associated with a large small-bowel diverticulum in an aduIt patient: case report  

Energy Technology Data Exchange (ETDEWEB)

Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 .deg.. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament.

Kim, Jee Young; Rha, Sung Eun; Oh, Soon Nam; Bo, Seal Hwang; Byun, Jae Young [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

2004-05-01

63

Management of acute large bowel obstruction due to colorectal cancer: Diversion colostomy versus stent placement  

Directory of Open Access Journals (Sweden)

Full Text Available Background and Aim: Colonic stenting is a novel and privileged therapeutic option for malignant obstructions of the large bowel, especially as a bridging procedure to elective surgery. The aim of this retrospective study was to compare the efficacy of the traditional surgical approach with stent placement in the management of obstructing colorectal tumours. Patients and Methods: Thirty-three patients with malignant colonic obstruction were retrospectively studied. Of them, 17 underwent a diversion colostomy (group I), while 16 were treated with SEMS (group II). Early outcome, late outcome and duration of hospitalisation were evaluated. For statistical analysis chi-square and Student.s t-test were used (statistical significance level P<0.05). Results: One death in each group occurred within the first 3 days following colonic decompression. One case of pulmonary embolism (group I) and one case of asymptomatic colonic perforation (group II) were the only early morbid situations complicating decompressing interventions. Elective surgery was finally performed on 10 patients in group I and in 9 patients in group II. One case of early local recurrence after tumor resection was observed in the stenting group. The cumulated mortality rate was estimated at 6.9% and 9.1 % and cumulated morbidity rate at 20.7% and 9.1% for the two groups respectively. The mean time of hospitalization was significantly longer in the colostomy group. Conclusions: SEMS are effective for the temporary treatment of malignant occlusions of the large bowel and particularly advantageous not only because of their technical simplicity but also good tolerance and quality of life which they offer epecially in cases of locally or distally extended disease.

C. Fotiadis; A. Givry; P Baque; JL Bernard; A. Rahili; C. Pilichos; D. Benchimol; A. Bourgeon

2007-01-01

64

Liver uptake of sup(99m)Tc-labeled diphosphonate (DPD) by metastatic lesions from large bowel carcinoma  

International Nuclear Information System (INIS)

Accumulation of sup(99m)Tc-diphosphonate was observed in 2 of 12 patients with liver metastases who had primary adenocarcinoma of the large bowel. The area of excessive radionuclide concentration corresponded well to the location of the hepatic metastases. The literature on this subject is reviewed and a possible mechanism of radionuclide accumulation is discussed. (orig.).

1985-01-01

65

The nasal mucosa contains a large spectrum of human papillomavirus types from the betapapillomavirus and gammapapillomavirus genera.  

Science.gov (United States)

Background.?Human papillomavirus (HPV) types from the Betapapillomavirus and Gammapapillomavirus genera are common at cutaneous sites. The aim of this study was to analyze the prevalence of these HPV types in oral and nasal samples. Methods.?Nasal samples and oral samples were obtained from 312 volunteer Danish healthcare staff (240 women and 72 men), among whom the mean age was 42 years. A total of 311 oral samples and 304 nasal samples were eligible for HPV DNA analysis. HPV types were detected by use of polymerase chain reactions with modified general primers (MGP) and Forslund-Antonsson primers (FAP) and identified by Luminex (for types detected by MGP PCR) or direct sequencing or cloning before sequencing (for types detected by FAP PCR). Results.?HPV DNA was detected in 6% of the oral samples and 50% of the nasal samples. Seventy-five diverse HPV types or putative HPV types were identified. HPV types within the Alphapapillomavirus, Betapapillomavirus, and Gammapapillomavirus genera were detected in 3%, 31%, and 23% of the nasal samples, respectively. A putative subtype of HPV76, originally isolated from a feline oral squamous cell carcinoma, was detected in 7 nasal samples. Conclusion.?A large spectrum of HPV types from Betapapillomavirus and Gammapapillomavirus have tropism for the nasal mucosa. The implication of the relatively high prevalence of these viruses in the nasal mucosa is unknown. PMID:23878325

Forslund, Ola; Johansson, Hanna; Madsen, Klaus Gregaard; Kofoed, Kristian

2013-07-21

66

Cirugía de colon abierta con "Fast Track" o recuperación acelerada/ "Fast Track" large bowel surgery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Introducción: La Cirugía resectiva de colon se asocia a una hospitalización de 6 a 10 días. En el último tiempo se ha desarrollado el concepto de rehabilitación multimodal o "Fast track" que involucra una combinación de técnicas que llevan a reducir la respuesta al stress quirúrgico, optimizar la recuperación y reducir los días de hospitalización. Objetivo: Evaluar el postoperatorio de pacientes sometidos a cirugía electiva de colon y recto superior utilizand (more) o un protocolo de "Fast track". Material y Método: Ingresaron a un protocolo prospectivo de recuperación acelerada, todos los enfermos sometidos a cirugía electiva de colon y recto superior en el Hospital Militar de Santiago en el período comprendido entre Agosto 2004 a Noviembre 2005. Se evalúa íleo postoperatorio, días de hospitalización, complicaciones postoperatorias y satisfacción de pacientes. Resultados: Ingresaron 40 pacientes consecutivos, 19 hombres (48%) y 21 mujeres (52%). La edad promedio fue 66 años (39-87), 24 pacientes (60%) eran ASA II y 38% ASA I. El 97,5% expulsó gases en las primeras 48 h. La primera defecación ocurrió dentro de las primeras 48 h en el 47,5% de los pacientes y en el 37,5% a las 72 h. El 78% de los paciente fueron dados de alta al 4° día. La escala visual análoga (EVA) para dolor a las 24 h era < 2 en el 95%. Grado de satisfacción muy bueno en el 70%. Morbilidad de 18% y sin mortalidad. Dehiscencia de anastomosis fue 2,5%. Conclusiones: El protocolo de recuperación acelerada reduce la estadía hospitalaria, disminuye el dolor e íleo post-operatorio. Abstract in english Introduction: Large Bowel resective surgery requires 6 to 10 days in-hospital stay. Recently the multimodality rehabilitation concept or "fast track" surgery, a combination of different techniques in order to reduce surgical stress, increase recuperation and decrease in-hospital stay, has become an option. Objective: Evaluate postoperative evolution of patients submitted for elective large bowel and rectum resection using "Fast Track" protocol. Material and Method: Prospe (more) ctive Fast track protocol includes all patients submitted for elective large bowel and rectum resection in Military Hospital of Santiago during August 2004 to November 2005. Outcomes concerning postoperative ileus, in-hospital stay, complications and patient satisfaction were recorded. Results: 40 patients, 19 male (48%) and 21 female (52%) consecutive patients were included. Average age 66 years (39-87), 24 patients (60%) were classified ASA II and 38% ASA I. During the first 48 hrs 97.5% had anal flatulence. First defecation occurred before 48 hrs in 47.5% and in 37.5% at 72 hrs. Hospital discharge at 4*11 day was possible in 78%. Pain visual analogical scale at 24 hrs was less than 2 in 95%. Satisfaction rate was very good in 70%. Morbidity was 18% without mortality. Anastomotic dehiscence was 2.5%. Conclusions: Fast Track protocol reduces in- hospital stay, pain and postoperative ileus.

ESPÍNDOLA S, LEONARDO

2009-04-01

67

The effect of oral contrast on large bowel activity in FDG-PET/CT  

International Nuclear Information System (INIS)

The purpose of this study was to determine the effect of oral contrast on fluorodeoxyglucose (FDG) uptake in the colon and to determine the normal distribution of FDG in the colon. Sixty patients (30 patients in no contrast group and 30 patients in the received contrast group) underwent FDG-PET/CT scans. The pattern of FDG uptake was classified into 5 patterns (diffuse, segmental, single-nodular, multi-nodular, and other) in 5 segments (ascending, transverse, descending, and rectosigmoid colon). Standardized uptake values (SUVs) of the no oral contrast group were examined. The ratios of FDG uptake patterns were compared in the received contrast group and no contrast group to evaluate the effect of oral contast. The effect of attenuation correction on the uptake pattern was evaluated by comparison of the attenuation-corrected and non-attenuation-corrected PET images. In the no contrast group, there was no significant uptake in 72 segments (59%) and a diffuse pattern was seen in 29 segments (24%), most frequently in the ascending colon and descending colon. A segmental pattern was seen in 15 segments (13%), most frequently in the rectosigmoid colon. A single-nodular pattern was seen in 3 segments (3%) and multi-nodular pattern in 1 segment (1%). A nodular pattern was seen only in the ascending colon. SUVmax of the ascending colon and that of the rectosigmoid colon were significantly higher than those of the transverse and descending colon. The frequencies of diffuse, multi-nodular and 'other' patterns were significantly higher in the received contrast group than in no contrast group. There was no significant difference between the frequency of the segmental pattern or the single nodular pattern in the two groups. There was no significant difference between the uptake patterns with attenuation correction and those without attenuation correction in either the received contrast group or no contrast group. Normal FDG uptake in the large bowel may show various degrees and patterns of uptake among the colonic segments. Oral contrast agent can cause focal or diffuse increased FDG uptake, which may be induced not only by the high CT density of oral contrast but also by an accelerated physiologic reaction of the large bowel. (author)

2005-01-01

68

[The role of probiotics in the treatment of inflammatory bowel diseases].  

UK PubMed Central (United Kingdom)

The intestinal mucosa is the site of a fundamental interaction between a large amount of foreign substances, the immune system and bacteria that colonizes the mucosa. Many gastrointestinal diseases are due to an altered interaction between all these actors, particularly inflammatory bowel diseases. As such probiotics (bacteria providing a benefit to the host) could provide an interesting solution as a therapeutic agent. The evidences supporting such use are limited but there are still some quality randomized controlled trials. The purpose of this review is to discuss the most recent evidences from the literature on the use of probiotics in the treatment of inflammatory bowel diseases.

Girardin M; Frossard JL

2012-09-01

69

Management of malignant left-sided large bowel obstruction: a comparison between colonic stents and surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: Management of distal malignant large bowel obstruction (LBO) remains challenging. Acute surgical intervention is often associated with poorer clinical outcome compared to an elective procedure. Self-expandable metallic stents (SEMS) as a bridge to surgery (BTS) or palliation remain controversial and are not yet widely available. METHODS: From 1998 to 2008, a retrospective analysis of the patients presenting with an acute malignant LBO to The Tweed Public and John Flynn Private Hospitals was performed. RESULTS: Fifty-six admissions with malignant distal colonic obstruction were reviewed. On an intention to treat, patients underwent either stent 30 or surgery 26. American Association of Anaesthetists (ASA) scores, obesity rates and palliative procedures were all higher in the stent group. Inpatient deaths numbered four (two stent group, two surgery group). The technical success of inserted stents was 29/30, while clinical success was 27/30. Complications both medical, surgical and intensive care unit admissions were more common in the surgical group. Length of stay was 8.5 days for stent and 17.7 days for surgery. Of the 25 successful stent survivors, 14 were palliative and 11 were BTS. CONCLUSIONS: SEMS are effective in treatment of LBO either as palliation or BTS. They are associated with an overall better outcome and improved quality of life of patients. Surgery is indicated where SEMS are unavailable or have failed.

White SI; Abdool SI; Frenkiel B; Braun WV

2011-04-01

70

Cistadenoma mucinoso del apéndice cecal como causa de gangrena intestinal/ Appendiceal mucocele causing large bowel gangrene  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Introducción: Los tumores del Apéndice Cecal corresponden al 0,5% de las neoplasias gastrointestinales y se encuentran entre el 0,8% y el 1% de las apendicectomías. El término Mucocele Apendicular (AM), se refiere a un grupo de lesiones localizados a nivel del ciego cuyo rango de incidencia está entre el 0,2% y el 0,3% de todas las apendicectomías, y entre el 8-10% de todos los tumores apendiculares. Las presentaciones clínicas más frecuentes son: cuadro clínico (more) de apendicitis aguda, como hallazgo incidental como en el caso de esta paciente, o como masa abdominal en fosa ilíaca derecha. Caso clínico: Se presenta un caso de Cistade-noma Mucinoso Apendicular (CAM) encontrado como hallazgo incidental en un abdomen agudo quirúrgico con la particularidad de presentarse con una necrosis intestinal. Abstract in english Introduction: Appendiceal mucocele are lesions located in the cecum, which are found in 0.2 to 0.3% of appendectomies and correspond to 8-10% of all appendiceal tumors. Clinical case: We report a 83 years old female consulting for abdominal pain lasting 24 hours. On physical examination, signs of peritoneal irritation were found. The patient was operated, finding an appendiceal tumor that was coiled up in the mesentery with large bowel gangrene. An intestinal resection, t (more) erminal ileostomy, appendectomy and surgical lavage were performed. The pathological study of the surgical piece reported a mucinous cystadenoma.

Osnaya M, Humberto; Zaragoza S, Tahitiana Abelina; Mondragón C, Marco Antonio

2013-02-01

71

Cistadenoma mucinoso del apéndice cecal como causa de gangrena intestinal Appendiceal mucocele causing large bowel gangrene  

Directory of Open Access Journals (Sweden)

Full Text Available Introducción: Los tumores del Apéndice Cecal corresponden al 0,5% de las neoplasias gastrointestinales y se encuentran entre el 0,8% y el 1% de las apendicectomías. El término Mucocele Apendicular (AM), se refiere a un grupo de lesiones localizados a nivel del ciego cuyo rango de incidencia está entre el 0,2% y el 0,3% de todas las apendicectomías, y entre el 8-10% de todos los tumores apendiculares. Las presentaciones clínicas más frecuentes son: cuadro clínico de apendicitis aguda, como hallazgo incidental como en el caso de esta paciente, o como masa abdominal en fosa ilíaca derecha. Caso clínico: Se presenta un caso de Cistade-noma Mucinoso Apendicular (CAM) encontrado como hallazgo incidental en un abdomen agudo quirúrgico con la particularidad de presentarse con una necrosis intestinal.Introduction: Appendiceal mucocele are lesions located in the cecum, which are found in 0.2 to 0.3% of appendectomies and correspond to 8-10% of all appendiceal tumors. Clinical case: We report a 83 years old female consulting for abdominal pain lasting 24 hours. On physical examination, signs of peritoneal irritation were found. The patient was operated, finding an appendiceal tumor that was coiled up in the mesentery with large bowel gangrene. An intestinal resection, terminal ileostomy, appendectomy and surgical lavage were performed. The pathological study of the surgical piece reported a mucinous cystadenoma.

Humberto Osnaya M; Tahitiana Abelina Zaragoza S; Marco Antonio Mondragón C

2013-01-01

72

The demise of the instant/unprepared contrast enema in large bowel obstruction.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Imaging the colon in suspected acute large bowel obstruction (LBO) is traditionally carried out with a supine abdominal X-ray (AXR) and erect chest X-ray. If there is no clinical or radiological evidence to suggest a perforation, then an unprepared barium or water-soluble contrast enema (CE) can be performed to confirm the presence of and demonstrate the site of obstruction. The advent of modern, fast multidetector CT (MDCT) scanners has changed management strategies for acute abdominal conditions including suspected LBO in all groups of patients especially the elderly, infirm and those on ITU/HDU. METHOD: A retrospective case note analysis was carried over a 7-year period in a single centre. The study criteria involved investigation of suspected LBO with CE, CT and MDCT. RESULTS: It showed a reduction in the number of contrast enemas performed. CONCLUSION: MDCT was shown to be more accurate in the diagnosis of LBO, is usually available on a 24-h basis, and in many institutions has replaced the urgent CE in this group of patients. This also has the advantage of excluding incidental findings and in staging malignant disease.

Jacob SE; Lee SH; Hill J

2008-09-01

73

Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background A high dietary intake of n-6 compared to n-3 fatty acids (FAs) may promote the production of pro-inflammatory eicosanoids and cytokines. In two recent studies, short-term (10-day) duodenal administration of n-3 polyunsaturated fatty acid rich seal oil ameliorated joint pain in patients with inflammatory bowel disease (IBD). Using unpublished data from these two studies we here investigated whether normalisation of the n-6 to n-3 FA ratio in blood and tissues by seal oil administration was associated with improved health related quality of life (HRQOL) as assessed by the generic short-form 36 (SF-36) questionnaire. Results In the first pilot study, baseline n-6 to n-3 FA ratio in rectal mucosal biopsies from 10 patients with IBD (9 of those had joint pain) was significantly increased compared with that in 10 control patients without IBD or joint pain. Following seal oil administration, the n-6 to n-3 FA ratio of the IBD-patients was significantly lowered to the level seen in untreated controls. In the subsequent, randomized controlled study (n = 19), seal oil administration reduced the n-6 to n-3 FA ratio in blood similarly and also the SF-36 assessed bodily pain, while n-6 FA rich soy oil administration had no such effect. Conclusion In these two separate studies, short-term duodenal administration of seal oil normalised the n-6 to n-3 FA ratio in rectal mucosa and improved the bodily pain dimension of HRQOL of patients with IBD-related joint pain. The possibility of a causal relationship between n-6 to n-3 FA ratio in rectal mucosa and bodily pain in IBD-patients warrants further investigations.

Bjørkkjær Tormod; Brun Johan G; Valen Merete; Arslan Gülen; Lind Ragna; Brunborg Linn A; Berstad Arnold; Frøyland Livar

2006-01-01

74

Chemopreventive effects of ferulic acid on oral and rice germ on large bowel carcinogenesis.  

UK PubMed Central (United Kingdom)

Effects of ferulic acid (FA) known as a major constituent of rice bran or germ on 4-nitroquinoline-1-oxide (4NQO)-induced oral carcinogenesis were examined in 4 groups of male rats. The incidences of tongue carcinomas and preneoplastic lesions (severe dysplasia) in rats of the group given FA in the diet at a dose of 500 ppm after exposure to 4NQO for 5 weeks in drinking water at a dose of 20 ppm, was significantly lower on termination of the experiment (32 weeks) in the group with the carcinogen alone (P < 0.005 and P < 0.001 respectively). The results suggest chemopreventive activity for this phenolic compound on oral cancer. Modifying effects of rice germ on azoxymethane (AOM)-induced formation of aberrant crypt foci (ACF) were also examined, in 8 groups of male F344 rats. Numbers of ACF/colon, ACF/cm2 and aberrant crypts/colon in the group treated with AOM (15 mg/kg s.c. once a week for 3 weeks) and gamma-amino butylic acid (GABA)-enriched defatted rice germ (2.5% in diet) or the group with AOM and rice germ (2.5% in diet) were smaller than those of the group with AOM alone (P < 0.005). Exposure to defatted rice germ or rice germ during the initiation phase or the post-initiation phase also decreased incidences of AOM-induced large bowel neoplasms (P < 0.05). These results suggest chemopreventive potential for rice germ on colonic neoplasia.

Mori H; Kawabata K; Yoshimi N; Tanaka T; Murakami T; Okada T; Murai H

1999-09-01

75

Breath methane and large bowel cancer risk in contrasting African populations.  

UK PubMed Central (United Kingdom)

Breath methane has been measured in 1016 people from four populations resident in Southern Africa which experience widely different risks of bowel cancer and other colonic diseases. Highly significant differences in the proportion of subjects with detectable methane in breath were found; % producers--rural black 84, urban black 72, white 52, Indian 41 (chi 2 121 p less than 0.001 3 df). There was a slight preponderance of female producers over male (female producers 63%, males 57%) and an age trend with fewer producers in the older age groups in the urban blacks and Indians, these comparisons being significant when tested by stepwise logistic regression analysis. Bowel cancer risk, determined from a variety of sources, was lowest in rural blacks, greatest in whites, with intermediate rates for urban blacks and Indians. Methane production in the human colon shows significant interethnic differences but which bear no relation to bowel cancer risk in these populations.

Segal I; Walker AR; Lord S; Cummings JH

1988-05-01

76

[Colonoscopy as a diagnostic and therapeutic method of the large bowel diseases: analysis of 2,567 exams].  

UK PubMed Central (United Kingdom)

BACKGROUND: Since the sixties, when the optic fibers were reported, colonoscopy had emerged as the first line imaging investigation of the colon. AIM: To review the results of diagnostic and therapeutic colonoscopy at the Discipline of Coloproctology of the University of São Paulo Medical School, São Paulo, SP, Brazil, respecting the characteristics of an institution of medical education. METHODS: Retrospective analysis of basis related to 2,567 fibro colonoscopies between 1984 and 2002. The procedure was performed in hospitalized and in outpatients. The most common indications for colonoscopy were investigation of rectal bleeding and anemia (22.4%), change of bowel habit (14.76%), inflammatory bowel disease (8.65%) and carcinoma (7.25%). Bowel preparation with manitol was used by most of the patients. Sedation, when not contra-indicated, was administered. The most common combination was meperidine and benzodiazepine. All the exams were monitored with pulse oximeter. A normal colonoscopy to the point of maximum insertion was reported in 42.42% of procedures. The most common diagnosis was polyps (15.47%), followed by diverticular disease (12.86%). Inflammatory disease was recorded in 11.88% and carcinoma in 10.21%. Polypectomy was undertaken in 397 patients (2.21 polypectomy per patient with polyps). Colonoscopy was considered incomplete (when the colonoscope did not pass to the cecum or terminal ileum) in 181 (7.05%) cases. Perforation was reported in one patient who had a subestenosing retossigmoid tumor. In 0.42%, reasons for failing to complete the procedure included complication related to sedation, with no further prejudice for the patients. CONCLUSIONS: Colonoscopic examination of the entire colon remains the standard for visualization, biopsy and treatment of colonic affections. The incidence of complication of endoscopy of the large bowel is quite low, even in a school hospital.

Nahas SC; Marques CF; Araújo SA; Aisaka AA; Nahas CS; Pinto RA; Kiss DR

2005-04-01

77

High expression of the "A Disintegrin And Metalloprotease" 19 (ADAM19), a sheddase for TNF-? in the mucosa of patients with inflammatory bowel diseases.  

UK PubMed Central (United Kingdom)

BACKGROUND: Tumor necrosis factor ? (TNF-?) plays a major role in the tissue-damaging immune response in inflammatory bowel diseases (IBDs). The tissue concentration of TNF-? is related to the activity of "A Disintegrin And Metalloprotease" (ADAMs), enzymes that process membrane-bound TNF-? and liberate the TNF-? trimer into the extracellular environment. Although IBD-related inflammation is associated with high ADAM17 levels, the contribution of other members of the ADAMs family is not known. In this study, we characterized the expression of other TNF-? convertases (i.e., ADAM9, ADAM10, and ADAM19) in IBD. METHODS: Normal and IBD biopsies were examined for the content of ADAMs by real-time polymerase chain reaction, Western blotting and immunohistochemistry. ADAM19 was also analyzed in intestinal epithelial cells and normal colonic explants stimulated with inflammatory cytokines and in ex vivo biopsies taken from IBD patients before and after a successful infliximab treatment. RESULTS: ADAM19 RNA transcripts and protein were upregulated in patients with ulcerative colitis and, to a lesser extent, in patients with Crohn's disease compared with normal controls. In contrast, ADAM9 and ADAM10 expression did not differ between patients with IBD and controls. Immunohistochemical analysis showed that epithelial cells were the major source of ADAM19 in IBD. ADAM19 expression was increased in colonic epithelial cell lines and normal colonic explants by TNF-?, interleukin 21 and interleukin 6, and was downregulated in IBD tissue by infliximab. CONCLUSIONS: These findings suggest the existence of a positive feedback mechanism involving cytokines and ADAM19 that can amplify cytokine production in IBD.

Franzè E; Caruso R; Stolfi C; Sarra M; Cupi ML; Ascolani M; Sedda S; Antenucci C; Ruffa A; Caprioli F; MacDonald TT; Pallone F; Monteleone G

2013-03-01

78

Limitations in assessment of mucosal healing in inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available An emerging parameter to define the effectiveness of new therapeutic agents in clinical trials, and by extension, for use in day-to-day clinical practice has been labeled mucosal healing. It has been hypothesized that complete healing of the intestinal mucosa in inflammatory bowel diseases should result in reduced disease complications, reduced hospitalization and reduced surgical treatment. By implication, the natural history of inflammatory bowel disease might then be altered. Measurement of mucosal healing, however, is largely observational, requiring repeated invasive endoscopic examinations, sometimes with mucosal biopsies. Other indirect imaging methods may play a role in this assessment along with other surrogate markers, including intestinal permeability. These measurements may have significant limitations that prohibit precise correlation with symptom-based disease activity indices in clinical trials. This likely reflects the dynamic nature of this evolving and individualized inflammatory process that tends to be focused, but not limited, to the mucosa of the intestinal tract.

Hugh James Freeman

2010-01-01

79

Small bowel endoscopy in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.

Yamagami H; Watanabe K; Kamata N; Sogawa M; Arakawa T

2013-07-01

80

The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer.  

UK PubMed Central (United Kingdom)

BACKGROUND: This study was designed to investigate the early outcomes after surgical treatment of malignant large bowel obstruction (MBO) and to identify risk factors affecting operative mortality. METHODS: Data were prospectively collected from 1046 patients with MBO by 294 surgeons in 148 UK hospitals during a 12-month period from April 1998. A predictive model of in-hospital mortality was developed using a 3-level Bayesian logistic regression analysis. RESULTS: The median age of patients was 73 years (interquartile range 64-80). Of the 989 patients having surgery, 91.7% underwent bowel resection with an overall mortality of 15.7%. The multilevel model used the following independent risk factors to predict mortality: age (odds ratio [OR] 1.85 per 10 year increase), American Society of Anesthesiologists grade (OR for American Society of Anesthesiologists grade I versus II,III,IV-V = 3.3,11.7,22.2), Dukes' staging (OR for Dukes' A versus B,C,D = 2.0, 2.1, 6.0), and mode of surgery (OR for scheduled versus urgent, emergency = 1.6, 2.3). A significant interhospital variability in operative mortality was evident with increasing age (variance = 0.004, SE = 0.001, P < 0.001). No detectable caseload effect was demonstrated between specialist colorectal and other general surgeons. CONCLUSIONS: Using prognostic models, it was possible to develop a risk-stratification index that accurately predicted survival in patients presenting with malignant large bowel obstruction. The methodology and model for risk adjusted survival can set the reference point for more accurate and reliable comparative analysis and be used as an adjunct to the process of informed consent.

Tekkis PP; Kinsman R; Thompson MR; Stamatakis JD

2004-07-01

 
 
 
 
81

Large bowel leiomyosarcoma - a case report; Leiomiosarcoma do intestino grosso - relato de um caso  

Energy Technology Data Exchange (ETDEWEB)

The authors report a case of a 49-year-old male patient with leiomyosarcoma of the ascending colon. The patient presented with anemia and an abdominal mass, and the symptoms progressed until a final diagnosis was made nine months later. A plain abdominal x-ray showed the presence of gas outside the bowel, in the right hypochondrium. The double contrast barium enema showed a sublevel displacement of the hepatic flexure and diverticula. An abdominal ultrasound revealed a heterogeneous expansive lesion below the liver containing gas, and a computed tomography of the abdomen revealed an excavated mass below the liver containing liquid, that was not filled by contrast medium. The patient was submitted to a right hemicolectomy with ileocoloanastomosis and the histopathological analysis of the excised material revealed a leiomyosarcoma of the ascending colon. (author)

Lopes, Simone Goncalves; Marchiori, Edson; Brick, Julieta Figueiredo; Curty Neto, Eduardo; Scherman, Alexandre; Silva, Ana Carina Gamboa da; Machado, Bruno Beber [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br

2001-04-01

82

Innate immunity modulation by the IL-33/ST2 system in intestinal mucosa.  

UK PubMed Central (United Kingdom)

Innate immunity prevents pathogens from entering and spreading within the body. This function is especially important in the gastrointestinal tract and skin, as these organs have a large surface contact area with the outside environment. In the intestine, luminal commensal bacteria are necessary for adequate food digestion and play a crucial role in tolerance to benign antigens. Immune system damage can create an intestinal inflammatory response, leading to chronic disease including inflammatory bowel diseases (IBD). Ulcerative colitis (UC) is an IBD of unknown etiology with increasing worldwide prevalence. In the intestinal mucosa of UC patients, there is an imbalance in the IL-33/ST2 axis, an important modulator of the innate immune response. This paper reviews the role of the IL-33/ST2 system in innate immunity of the intestinal mucosa and its importance in inflammatory bowel diseases, especially ulcerative colitis.

García-Miguel M; González MJ; Quera R; Hermoso MA

2013-01-01

83

Acute pseudo-obstruction of the large bowel with caecal perforation following normal vaginal delivery: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Acute pseudo-obstruction of the large bowel following normal vaginal delivery is an extremely rare complication of normal vaginal delivery. It can be fatal if not recognized early. Only one previous report has been found in the English literature. Case presentation A 36-year old Caucasian, normally fit woman presented with abdominal distension and vomiting five days post-normal vaginal delivery at term. Localised peritonitis in the right iliac fossa developed in the next few days, and caecal perforation was found at laparotomy, without evidence of appendicitis or colitis. Conclusion Although very rare, Ogilvie's syndrome should be considered by obstetricians, general surgeons and general practitioners as a potential cause of vomiting and abdominal pain following normal vaginal delivery. Early recognition and management are essential to minimize the possibility of developing serious complications.

Cartlidge David; Seenath Marlon

2010-01-01

84

Effect of small bowel preparation with simethicone on capsule endoscopy*  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized pr...

Fang, You-hong; Chen, Chun-xiao; Zhang, Bing-ling

85

Asymptomatic perforation of large bowel and urinary bladder as a complication of ventriculoperitoneal shunt: Report of two cases  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. Insertion of a ventriculoperitoneal (VP) shunt, the method of choice in the treatment of hydrocephalus, is often followed by various mechanical and/or infective complications. We present two children with asymptomatic perforation of the large bowel and urinary bladder, relatively rare and potentially severe complications of this surgical procedure. Outline of Cases. In both patients a VP shunt was implanted in the first month after birth; in a boy due to congenital hydrocephalus and in a girl due to the consequences of intracranial haemorrhage. Immediately after surgery, as well as during the further course, in both children growth and development were optimal and without any signs of infection or VP shunt malfunction. In the boy at age 6 months and in the girl at age 4 years, without any signs of complications, mothers noted the prominence of the VP shunt tip from the anus in the first case and from the urethral orifice in the second one. The VP shunts were immediately changed, so that both complications were resolved without any consequences. Conclusion. Insertion of a VP shunt represents the most frequent method of choice of the surgical treat- ment of hydrocephalus, but also potentially a highly risky procedure followed by various complications about which parents should be informed when patients are children. Owing to adequate approach in the follow-up of children with implanted VP shunt, large bowel and urinary bladder perforation, examples of severe and potentially fatal complications of this surgical intervention, could be disclosed on time and adequately resolved.

Mihajlovi? Miljan; Tasi? Goran; Rai?evi? Mirjana; Mrdak Milan; Petrovi? Bojana; Radlovi? Vladimir

2012-01-01

86

Leiomiossarcoma do intestino grosso: relato de um caso/ Large bowel leiomyosarcoma: a case report  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Os autores relatam um caso de leiomiossarcoma de cólon ascendente acometendo um paciente do sexo masculino, de 49 anos de idade. O paciente iniciou o quadro com anemia e massa abdominal, e a evolução dos sintomas até o diagnóstico final foi de nove meses. Na radiografia simples do abdome havia presença de coleção aérea localizada no hipocôndrio direito, fora da topografia de alças; no clister opaco com duplo contraste foi demonstrado deslocamento inferior da fl (more) exura hepática e divertículos. A ultra-sonografia abdominal mostrou lesão expansiva heterogênea, com gás no seu interior, de localização sub-hepática. A tomografia computadorizada do abdome revelou massa escavada com nível líquido, sub-hepática, que não se impregnou pelo meio de contraste. Foi realizada hemicolectomia direita com ileocoloanastomose, e o diagnóstico histopatológico foi de leiomiossarcoma de cólon ascendente. Abstract in english The authors report a case of a 49-year-old male patient with leiomyosarcoma of the ascending colon. The patient presented with anemia and an abdominal mass, and the symptoms progressed until a final diagnosis was made nine months later. A plain abdominal x-ray showed the presence of gas outside the bowel, in the right hypochondrium. The double contrast barium enema showed a sublevel displacement of the hepatic flexure and diverticula. An abdominal ultrasound revealed a he (more) terogeneous expansive lesion below the liver containing gas, and a computed tomography of the abdomen revealed an excavated mass below the liver containing liquid, that was not filled in by contrast medium. The patient was submitted to a right hemicolectomy with ileocoloanastomosis and the histopathological analysis of the excised material revealed a leiomyosarcoma of the ascending colon.

Lopes, Simone Gonçalves; Marchiori, Edson; Brick, Julieta Figueiredo; Curty Neto, Eduardo; Scherman, Alexandre; Silva, Ana Carina Gamboa da; Machado, Bruno Béber

2001-04-01

87

The frequency of microscopic and focal active colitis in patients with irritable bowel syndrome  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. The frequency of microscopic colitis and focal active colitis in the colonic mucosa has been investigated in IBS patients. Methods Between June 2007 and September 2010, 378 patie...

Ozdil Kamil; Sahin Abdurrahman; Calhan Turan; Kahraman Resul; Nigdelioglu Adil; Akyuz Umit; Sokmen Hac? M

88

Bowel incontinence  

Science.gov (United States)

... if they have the urge to defecate. If toileting needs are often unanswered, a pattern of negative ... urge to have a bowel movement See also: Toileting safety SURGERY People who have bowel incontinence that ...

89

Chemotherapy of large bowel carcinoma--fluorouracil (FU) + hydroxyurea (HU) vs. methyl-CCNU, oncovin, fluorouracil, and streptozotocin (MOF-Strep). An Eastern Cooperative Oncology Group study.  

UK PubMed Central (United Kingdom)

In this prospective randomized study of initial chemotherapy for advanced measurable metastatic large bowel carcinoma, the response rate was 6/32 (19%) for FU + HU and 5/32 (16%) for MOF-Strep; the estimated median survival is 43 weeks for both treatments. Patients who received MOF-Strep experienced substantially greater vomiting and hematologic toxicity than patients who received FU + HU (p less than 0.001).

Engstrom PF; MacIntyre JM; Schutt AJ; Douglass HO Jr

1985-10-01

90

Increased pain sensitivity among adults reporting irritable bowel syndrome symptoms in a large population-based study.  

UK PubMed Central (United Kingdom)

The aim of this study was to examine whether irritable bowel syndrome (IBS) is associated with increased somatic pain sensitivity in a large population-based sample and to test whether this association was independent of sex, age, comorbid chronic pain, and psychological distress. Pain sensitivity tests included assessment of heat-pain threshold (N=4054) and pressure-pain threshold (N=4689) and of cold-pressor pain intensity and tolerance (N=10,487). Cox regression and analysis of variance (ANOVA) were used to assess the relationship between IBS and pain sensitivity in stepwise multivariate models. The prevalence of IBS symptoms meeting the ROME II criteria was 5.3%. Compared with control subjects, IBS cases had reduced cold-pressor tolerance (hazard ratio=1.4, P<.01), increased cold-pressor pain intensity ratings (z-score=+0.20, P<0.01), and lower heat-pain thresholds (z-score=-0.20, P<0.01), after adjusting for sex and age. These results were only slightly attenuated and remained significant when controlling for comorbid chronic pain and psychological distress. Results for pressure-pain threshold were not significant. Heat- and cold-pressor pain sensitivity was greatest for the IBS reporting severe chronic abdominal pain, indicating that hyperalgesia in IBS is related to degree of clinical pain rather than to the diagnosis per se. Because all pain tests were all carried out on the upper extremities, our findings indicate the presence of widespread hyperalgesia in IBS, which may be a contributing factor to the high rate of comorbid pain seen in this patient group.

Stabell N; Stubhaug A; Flægstad T; Nielsen CS

2013-03-01

91

Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals.  

UK PubMed Central (United Kingdom)

BACKGROUND: The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study. METHODS: The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey. RESULTS: A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management, either primary repair (70.0 %) or bowel resection (30.0 %). Postoperative complications were diagnosed in 15 patients. Immediate treatment resulted in fewer intestinal resections and shorter hospital stays (p < 0.05). Smoking [odds ratio (OR) 14.4, 95 % confidence interval (CI) 1.16-179.8] and a large size perforation site (15 ± 10 vs. 8 ± 5 mm; OR 1.19, 95 % CI 1.03-1.38) were risk factors for developing a postoperative complication after curative surgery. Six patients died. All deaths were related to diagnostic colonoscopy. CONCLUSIONS: Total incidence of large bowel full-thickness injury in Lithuanian hospitals is 0.07 %. Incidence of this complication after diagnostic and therapeutic colonoscopies is 0.056 and 0.169 %, respectively. The most common site of perforation is sigmoid colon and rectosigmoid junction, at 70 %. Risk rises when colonoscopy is performed in low-volume practice centers. Urgent surgical management resulted in overall mortality rate of 15.0 % and morbidity of 37.5 %.

Samalavicius NE; Kazanavicius D; Lunevicius R; Poskus T; Valantinas J; Stanaitis J; Grigaliunas A; Gradauskas A; Venskutonis D; Samuolis R; Sniuolis P; Gajauskas M; Kaselis N; Leipus R; Radziunas G

2013-05-01

92

Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy  

Science.gov (United States)

... Reservoir, and Continent Ileostomy Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy On this page: ... large intestine. Some bowel diversion surgeries—those called ostomy surgery—divert the bowel to an opening in ...

93

Lymphoma risk in children and young adults with inflammatory bowel disease: analysis of a large single-center cohort.  

UK PubMed Central (United Kingdom)

BACKGROUND: Prior studies suggest an increased risk of lymphoma in adults with inflammatory bowel disease (IBD). Cases of lymphoma have also been reported in children with IBD. However, the precise risk of lymphoma in relation to drug exposure has not been ascertained in children. METHODS: We conducted a single-center, retrospective study of 1560 children and young adults with IBD evaluated at Children's Hospital Boston between 1979 and 2008. Of this group, 186 patients were excluded due to incorrect diagnosis, one-time second-opinion visits, or missing hospital records. The remaining 1374 patients had charts reviewed to determine whether lymphoma developed while they were receiving their clinical care at our institution and the duration of exposure to various IBD medications. The rate of lymphoma was calculated in patient-years of exposure for each class of medications utilized in IBD. RESULTS: Of 1374 patients (741 male; age at diagnosis 12.1 ± 4.0 years; 791 Crohn's disease [CD], 535 ulcerative colitis [UC], 48 IBD unclassified), we identified two patients who developed lymphoma (one Hodgkin, one anaplastic large cell), in 6624 patient-years of follow-up (mean duration follow-up 4.8 years per patient). Both patients were males (ages 12 and 18 years at time of lymphoma onset) and were receiving thiopurines but had not yet received biologics at the time of their cancer diagnosis. They were both treated with chemotherapy and are alive without cancer 32+ and 76+ months since diagnosis. The absolute incidence rate of lymphoma for patients having received thiopurines was 4.5 per 10,000 patient-years compared to the expected rate of 0.58 per 10,000 patient-years, with a standardized incidence ratio (SIR) of 7.51 (95% confidence interval [CI] 0.74-41.98). CONCLUSIONS: The overall risk of lymphoma in children with IBD is low, with only two cases seen in our hospital over a 30-year period. The lymphoma risk (as estimated by SIR) in children receiving thiopurines is comparable to that reported in studies of adults. While there may be an increased risk of lymphoma in children treated with thiopurines, the risk did not reach statistical significance in this large cohort.

Ashworth LA; Billett A; Mitchell P; Nuti F; Siegel C; Bousvaros A

2012-05-01

94

Secondary syphilis mimicking inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

This study reports the case of a 15-year-old male patient with extensive anal inflammation, cobblestone-like mucosa and areas of ulceration, loose bloody stool and weight loss for 8 weeks, suggestive of inflammatory bowel disease. Genital lesions of syphilides were later observed and Venereal Disease Research Laboratory test was positive, thus benzyl penicillin treatment was prescribed with total resolution of genital and bowel symptoms.

Vasconcelos P; Borges-Costa J; Loreto H; Marques S

2013-03-01

95

Bowel preparation for CT colonography.  

UK PubMed Central (United Kingdom)

Bowel preparation represents an essential part of CT colonography, as the accuracy of the exam is strongly related to the adequacy of colonic cleansing, and a poor bowel preparation may compromise the diagnostic quality even despite optimization of all other acquisition parameters. Residual stool and fluid in the large bowel may affect the interpretation of the exam and may increase the number of false positives and false negatives. In this regard, the majority of patients having undergone CT colonography state that bowel preparation is the most unpleasant part. Unfortunately, to date no definite consensus has been reached about the ideal bowel preparation technique, and there is great variability in preparation strategies across diagnostic centers. The purpose of this review article is to describe the development and evolution of bowel preparation techniques in order to choose the best approach for optimizing the diagnostic quality of CT colonography in each patient.

Neri E; Lefere P; Gryspeerdt S; Bemi P; Mantarro A; Bartolozzi C

2013-08-01

96

Enhancement of 1,2-dimethylhydrazine-induced large bowel tumorigenesis in Balb/c mice by corn, soybean, and wheat brans  

Energy Technology Data Exchange (ETDEWEB)

This study was designed to determine the effects of four well-characterized dietary brans on large bowel tumorigenesis induced in mice with 1,2-dimethylhydrazine (DMH). Eight-week-old barrier-derived male Balb/c mice were fed a semisynthetic diet with 20% bran added (either corn, soybean, soft winter wheat, or hard spring wheat) or a no-fiber-added control diet. Half of each group was given DMH (20 mg/kg body weight/week, subcutaneously for 10 weeks) beginning at 11 weeks of age. Surviving mice were killed 40 weeks after the first DMH injection. Tumors were not found in mice not subjected to DMH. In DMH-treated mice, tumors were found almost exclusively in the distal colon. Tumor incidences were as follows: controls, 11%; soybean group, 44%; soft winter wheat group, 48%; hard spring wheat group, 58%; and corn group, 72%. Tumors per tumor-bearing mouse ranged from 1.4 to 1.6, except in the corn group, which had 2.1. A positive correlation was found between percentage of neutral detergent fiber in the brans and tumor incidences but not between the individual components of cellulose, hemicellulose, or lignin. The enhancement of DMH-induced large bowel tumorigenesis by all four bran types may reflect a species and/or mouse strain effect that is bran-source related. These data emphasize the importance of using well-defined bran in all fiber studies.

Clapp, N.K.; Henke, M.A.; London, J.F.; Shock, T.L.

1984-01-01

97

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery.  

UK PubMed Central (United Kingdom)

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann's procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial.

Grundmann RT

2013-01-01

98

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery.  

Science.gov (United States)

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann's procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial. PMID:23515179

Grundmann, Reinhart T

2013-01-27

99

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery  

Directory of Open Access Journals (Sweden)

Full Text Available There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann’s procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial.

Reinhart T Grundmann

2013-01-01

100

Relato de caso: metástase de carcinoma de mama para o intestino grosso/ Case report: metastasis from breast cancer to the large bowel  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O envolvimento metastático do trato gastrointestinal é relativamente infreqüente. Tumores malignos de mama, entretanto, podem muito raramente produzir metástases para o intestino. Relatamos aqui o caso de uma paciente com quadro clínico compatível com o de um abdômen agudo obstrutivo submetida a laparotomia exploradora com colectomia. O exame anátomo-patológico da peça cirúrgica revelou tratar-se de um carcinoma metastático, sendo que a história clínica da p (more) aciente indicava o tratamento cirúrgico prévio de um carcinoma lobular de mama. Nossa revisão da literatura demonstrou que o carcinoma lobular, dentre as neoplasias malignas da mama, é o que mais freqüentemente leva ao comprometimento metastático do intestino, sendo o estômago o local mais afetado. Como a disseminação sistêmica é comum nestes casos, o tratamento conservador, quando possível, é o mais indicado, sendo a cirurgia reservada para as complicações. Abstract in english Gastrointestinal manifestations of breast cancer are not commom. We report a case of a female patient who was submitted to a laparotomy with clinical and radiological signs of large bowell obstruction. Her clinical hitory showed that she was treated for breast cancer several years before. Pathology indicated that a metastatic carcinoma within the bowell wall was the cause of the obstruction. Previous reports described the lobular carcinoma of the breast as the most commom (more) type of breast cancer to produce bowell metastases. The stomach is described as the most frequent site of this metastatic dissemination. Since sistemic disease is common within these patients, surgical ressection is indicated only in the presence of complications like obstruction or bleeding.

Fillmann, Lúcio Sarubbi; Pinho, Cláudia Müller; Fillmann, Henrique Sarubbi; Fillmann, Érico Ernesto Pretzel

2007-12-01

 
 
 
 
101

MRI for chronic inflammatory bowel disease; MRT chronisch entzuendlicher Darmerkrankungen  

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Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T{sub 1}-weighted gradient echo and T{sub 2}-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data. (orig.) [German] Zusammenfassung: Die Standardverfahren in der Diagnostik und der Verlaufskontrolle chronisch entzuendlicher Darmerkrankungen, speziell des Morbus Crohn und der Colitis ulcerosa, sind die Koloskopie und das Enteroklysma. Die MRT hat sich dazu ihren festen Platz in der Diagnostik perirektaler Fisteln erobert. Mit schnellen, T{sub 1}-gewichteten Gradienten-Echo-Sequenzen und T{sub 2}-gewichteten Turbo-Spin-Echo-Sequenzen koennen auch Duenn- und Dickdarm nach oraler oder rektaler Fuellung zuverlaessig dargestellt werden. Die Hydro-MRT als spezielles MR-Untersuchungsprotokoll mit Bildakquisition in Atemstillstand unter medikamentoeser Darmhypotonie und Verwendung intestinaler MR-Kontrastmittel erlaubt die Abbildung intestinaler und extraintestinaler pathologischer Veraenderungen beim M. Crohn. Hierzu rechnen einerseits entzuendliche Darmwandverdickung und Stenosen, andererseits Fisteln, entzuendliche Konglomerate und Abszesse. Bei der Colitis ulcerosa ist im Gegensatz zum Morbus Crohn in der Hydro-MRT eine deutlich geringere entzuendliche Wandverdickung typisch. Ferner ist bei der Colitis ulcerosa die Ausdehnung der Befunde in der MRT regelmaessig geringer als in der Endoskopie. Die Hydro-MRT kann nach unseren eigenen Erfahrungen an mehr als 200 Patienten und den Ergebnissen anderer Zentren das Enteroklysma in der Diagnostik chronisch entzuendlicher Darmerkrankungen und die Mehrzahl von Wiederholungsendoskopien beim Morbus Crohn ersetzen. Weiterentwicklungen der Technik erlauben interaktive multiplanare Nachverarbeitungen der MR-Datensaetze. (orig.)

Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M. [Heidelberg Univ. (Germany). Abt. Roentgendiagnostik; Elsing, C. [Heidelberg Univ. (Germany). Abt. IV - Gastroenterologie

2001-01-01

102

Reduction of CD68+ macrophages and decreased IL-17 expression in intestinal mucosa of patients with inflammatory bowel disease strongly correlate with endoscopic response and mucosal healing following infliximab therapy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Antibodies against tumor necrosis factor represent an effective therapy for patients with inflammatory bowel disease. Despite their successful results, the exact mechanism by which infliximab suppresses intestinal inflammation is still a matter of debate. In this study, we used a translational approach to identify the key mechanisms associated with resolution of mucosal inflammation induced by infliximab. METHODS: A total of 16 patients with active inflammatory bowel disease (9 with Crohn's disease and 7 with ulcerative colitis) and 16 controls were enrolled in the study. Patients received infliximab infusions at 0, 2, and 6 weeks. At enrollment and at week 6, patients underwent flexible sigmoidoscopy, and biopsies were taken from the sigmoid colon. RNA was extracted, and mucosal expression of 96 immune-related genes was evaluated by qRT-PCR and confirmed by immunofluorescence microscopy on tissue. Correlation between infliximab-induced gene expression modulation and endoscopic response to therapy was calculated. Lamina propria mononuclear cell apoptosis induced by infliximab was evaluated on tissue sections by the terminal deoxynucleotidyl transferase dUTP nick end labeling assay. RESULTS: We found that infliximab-induced downregulation of macrophage and Th17 pathway genes was significantly associated with both endoscopic response to the therapy and achievement of mucosal healing. Importantly, the observed reduction of lamina propria CD68 macrophages was associated with an increased rate of macrophage apoptosis. CONCLUSIONS: The 2 mechanisms associated with infliximab-induced resolution of intestinal inflammation are the reduction of lamina propria infiltrating CD68 macrophages and the downregulation of interleukin 17A. Moreover, the data suggest that infliximab-induced macrophage apoptosis may represent a key mechanism for the therapeutic success of anti-tumor necrosis factor antibodies.

Caprioli F; Bosè F; Rossi RL; Petti L; Viganò C; Ciafardini C; Raeli L; Basilisco G; Ferrero S; Pagani M; Conte D; Altomare G; Monteleone G; Abrignani S; Reali E

2013-03-01

103

Complementary and alternative medicine use and cost in functional bowel disorders: A six month prospective study in a large HMO  

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Full Text Available Abstract Background Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. Methods 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. Results CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. Conclusion CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

van Tilburg Miranda AL; Palsson Olafur S; Levy Rona L; Feld Andrew D; Turner Marsha J; Drossman Douglas A; Whitehead William E

2008-01-01

104

CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases.  

Science.gov (United States)

Computed tomographic (CT) enterography combines the improved spatial and temporal resolution of multi-detector row CT with large volumes of ingested neutral enteric contrast material to permit visualization of the small bowel wall and lumen. Adequate luminal distention can usually be achieved with oral hyperhydration, thereby obviating nasoenteric intubation and making CT enterography a useful, well-tolerated study for the evaluation of diseases affecting the mucosa and bowel wall. Unlike routine CT, which has been used to detect the extraenteric complications of Crohn disease such as fistula and abscess, CT enterography clearly depicts the small bowel inflammation associated with Crohn disease by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory changes. As a result, CT enterography is becoming the first-line modality for the evaluation of suspected inflammatory bowel disease. CT enterography has also become an important alternative to traditional fluoroscopy in the assessment of other small bowel disorders such as celiac sprue and small bowel neoplasms. PMID:16702444

Paulsen, Scott R; Huprich, James E; Fletcher, Joel G; Booya, Fargol; Young, Brett M; Fidler, Jeff L; Johnson, C Daniel; Barlow, John M; Earnest, Franklin

105

Neuroinflammation in inflammatory bowel disease  

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Full Text Available Abstract Inflammatory bowel disease is a chronic intestinal inflammatory condition, the pathology of which is incompletely understood. Gut inflammation causes significant changes in neurally controlled gut functions including cramping, abdominal pain, fecal urgency, and explosive diarrhea. These symptoms are caused, at least in part, by prolonged hyperexcitability of enteric neurons that can occur following the resolution of colitis. Mast, enterochromaffin and other immune cells are increased in the colonic mucosa in inflammatory bowel disease and signal the presence of inflammation to the enteric nervous system. Inflammatory mediators include 5-hydroxytryptamine and cytokines, as well as reactive oxygen species and the production of oxidative stress. This review will discuss the effects of inflammation on enteric neural activity and potential therapeutic strategies that target neuroinflammation in the enteric nervous system.

Lakhan Shaheen E; Kirchgessner Annette

2010-01-01

106

Oral mucosa at Crohn’s disease  

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Full Text Available Introduction: Crohn’s disease (CD) is an inflammatory disorder of unclear etiology. Beside the systemic symptoms, often some oral mucosa manifestations are present. Oral symptoms may occur even before the bowel ones. The most common presentations are lip swelling, buccal cobblestoning, deep linear sulcal ulceration, gingival hyperplasia and angular cheillitis. Aim of study Aim of study: The purpose of this study was to present the occurence of oral mucosa changes at patients with CD. Material and methods: A number of 15 patients (10 men and 5 women) diagnosed for CD, cured in Clinics of Gastroenterology and Hepatology of Wroc?aw Piasts University, had the dental examination. Results: Oral mucosa changes were present at 13 of 15 patients. The most common were buccal cobblestoning and aphthae. The other observed changes were coated tongue, lingua scrotalis, cheilitis, erythromatous changes at the palate, taste disorders and lip swelling. Halitosis was self-estimated at 6 of 15 patients. A number of 4 interviewed patients suffered from dry mouth. Conclusions: Oral mucosa changes are very frequent at patients with CD. Curing of CD should be interdisciplinary and involve a dentist.

Anna Paradowska

2008-01-01

107

The cytokines in inflammatory bowel disease  

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Full Text Available Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease. It is a group of chronic disorders of unknown etiology characterized by inflammation of the gastrointestinal tract. The etiopathogenesis of inflammatory bowel disease is multifactorial. Recent data show that the development of inflammatory bowel disease is associated with the interplay of genetic, bacterial, and environmental factors and dysregulation of the intestinal immune system. The latest research is focused on the key role of cytokines in inflammatory bowel disease. In patients with inflammatory bowel disease, a number of recruited monocytes and activated macrophages are the source of cytokines in the inflamed alimentary tract mucosa. The role of pro-inflammatory cytokines (IL-1?, IL-1?, IL-2, -6, -8, -12, -17, -23, TNF, IFN) in inflammatory bowel disease is associated with the initiation and progression of ulcerative colitis and Crohn’s disease. Anti-inflammatory cytokines (IL-4, -10, -13) also contribute to the pathogenesis of inflammatory bowel disease, decreasing the inflammatory response by down-regulating proinflammatory cytokine production.

Beata Poli?ska; Joanna Matowicka-Karna; Halina Kemona

2009-01-01

108

Irritable Bowel Syndrome  

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Full Text Available Irritable Bowel Syndrome Introduction Irritable bowel syndrome, or IBS, is a very common intestinal disorder. About 15% of all American adults have symptoms of IBS. Irritable bowel syndrome is an intestinal ...

109

Cytokines in canine inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

Canine inflammatory bowel disease is a group of chronic enteropathies characterized by persistent or recurring gastric symptoms with an unknown etiology which are related to histopathological changes in the mucosa of the small and large bowel in the form of cellular infiltration in the mucosal lamina propria. Recent years have witnessed a growing number of investigations into the role of the immune system and, in particular, cytokines in the development of IBD. In this article, the expression of pro-inflammatory (IL-1, IL-2, IL-5, IL-6, IL-12, IL-18, IFN-gamma, TNF-alpha) and anti-inflammatory cytokines (IL-4, IL-10) was compared in canine patients with IBD based on clinical presentation, breed, lamina propria cell infiltrate and histopathological grade. Only selected studies confirmed higher mRNA expression levels of cytokines IL-2, IL-4, IL-5, IL-12p40, IFN-gamma, TNF-alpha and TGF-beta in dogs with IBD in comparison with healthy subjects. GSD were strongly represented in most study populations. Dogs with LPE were characterized by elevated levels of IL-1alpha, IL-1beta, IL-2, IL-5, IL-6, IL-12, TNF-alpha, TGF-beta. The present studies of canine patients with LPC revealed the mRNA expression of cytokines IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p35, IL-12p40, IFN-gamma, TNF-alpha, TGF-beta. In the reviewed studies, the progression of IBD was not accompanied by changes in the mRNA express-

Ko?odziejska-Sawerska A; Rychlik A; Depta A; Wdowiak M; Nowicki M; Kander M

2013-01-01

110

Non-transplant surgery for short bowel syndrome.  

UK PubMed Central (United Kingdom)

The goal of any treatment programme for short bowel syndrome SBS is to achieve nutritional enteral autonomy. This must begin with conservation of as much bowel as possible from the time of first presentation. Frequent causes of the short bowel syndrome are intestinal atresia, necrotizing enterocolitis, midgut volvulus, extended intestinal aganglionosis, 'vanished gut' often associated with gastroschisis and occasionally catastrophic trauma. Atresia is more amenable to successful surgery than other causes, except when associated with gastroschisis. Intrinsic dysmotility has a poor prognosis. Intestinal lengthening procedures are only indicated if there is sufficient bowel dilatation. Extended intestinal aganglionosis is rarely amenable to any form of non-transplant surgery. Options available are to conserve bowel, close stomas early (use all available bowel to the maximum or even re-feed stoma effluent into the distal unused bowel), release adhesions causing obstruction, resect strictures, taper or excise localized dilatations and finally address dilated bowel with lengthening and tailoring operations. These procedures aim to improve effective peristalsis, thereby reducing bacterial overgrowth and improving nutrient contact with enteral mucosa to maximize absorption and intestinal adaptation. The Bianchi longitudinal splicing operation and the serial transverse enteroplasty operations have stood the test of time in providing considerable improvement in enteral nutritional autonomy in around 60 % of cases. In SBS without dilatation attempts at 'mechanically' delaying transit (nipple valves, reversed bowel segments, colon interposition) have had inconsistent outcomes. Growing neomucosa and lengthening bowel by longitudinal stretch are still experimental.

Millar AJ

2013-10-01

111

Non-transplant surgery for short bowel syndrome.  

Science.gov (United States)

The goal of any treatment programme for short bowel syndrome SBS is to achieve nutritional enteral autonomy. This must begin with conservation of as much bowel as possible from the time of first presentation. Frequent causes of the short bowel syndrome are intestinal atresia, necrotizing enterocolitis, midgut volvulus, extended intestinal aganglionosis, 'vanished gut' often associated with gastroschisis and occasionally catastrophic trauma. Atresia is more amenable to successful surgery than other causes, except when associated with gastroschisis. Intrinsic dysmotility has a poor prognosis. Intestinal lengthening procedures are only indicated if there is sufficient bowel dilatation. Extended intestinal aganglionosis is rarely amenable to any form of non-transplant surgery. Options available are to conserve bowel, close stomas early (use all available bowel to the maximum or even re-feed stoma effluent into the distal unused bowel), release adhesions causing obstruction, resect strictures, taper or excise localized dilatations and finally address dilated bowel with lengthening and tailoring operations. These procedures aim to improve effective peristalsis, thereby reducing bacterial overgrowth and improving nutrient contact with enteral mucosa to maximize absorption and intestinal adaptation. The Bianchi longitudinal splicing operation and the serial transverse enteroplasty operations have stood the test of time in providing considerable improvement in enteral nutritional autonomy in around 60 % of cases. In SBS without dilatation attempts at 'mechanically' delaying transit (nipple valves, reversed bowel segments, colon interposition) have had inconsistent outcomes. Growing neomucosa and lengthening bowel by longitudinal stretch are still experimental. PMID:23982389

Millar, Alastair J W

2013-10-01

112

Respiratory burst activity of intestinal macrophages in normal and inflammatory bowel disease.  

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Macrophages isolated from normal mucosa (greater than 5 cm from tumour) and inflamed mucosa (from patients with inflammatory bowel disease) of colon and ileum were studied for their ability to undergo a respiratory burst as assessed by reduction of nitroblue tetrazolium to formazan. Using phorbol my...

Mahida, YR; Wu, KC; Jewell, DP

113

Bowel Retraining: Strategies for Establishing Bowel Control  

Science.gov (United States)

... Overview Biofeedback Bowel Retraining Dietary Fiber Fruit Juice Hirschsprung's Disease Laxatives Stool Form Guide Worksheet Living With ... Overview Biofeedback Bowel Retraining Dietary Fiber Fruit Juice Hirschsprung's Disease Laxatives Stool Form Guide Worksheet Other IFFGD ...

114

Comparison of two cathartic preparations, peg-electrolytes solution and sodium phosphate salts, as means for large bowel preparation for colonoscopy  

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Full Text Available SUMMARY The ideal bowel preparation for colonoscopy must combine the characteristics of effectiveness with the least side effects. We compared the relatively novel cathartic preparation of sodium phosphate salts (Fleet Phospho-sodaR) with the widely used PEG-electrolytes solution (Klean-prepR). Fiftytwo consecutive patients referred for colonoscopy were randomised to receive either sodium phospate salts or PEG electrolytes. The evaluation of the two preparations was based on two separate questionnaires, one completed by the endoscopist who ignored the kind of bowel preparation used and the other by the patient. Bowel preparation with sodium phospate salts was more effective in bowel cleansing and better tolerated than PEG-electrolytes solution in terms of difficulty in intake and swallowing, fatigue, the presence of colicky abdominal pain, flatulence, vomiting and perianal irritation (p<0,05). Key words: cathartic preparation, PEG-electrolytes, sodium phosphate salts

N. Antonakopoulos, I. Kyrlagkitsis, V. Xourgias, D.G. Karamanolis

2007-01-01

115

Changes in the symptom pattern and the densities of large-intestinal endocrine cells following Campylobacter infection in irritable bowel syndrome: a case report.  

UK PubMed Central (United Kingdom)

BACKGROUND: Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder. Post-infectious IBS (PI-IBS) is a subset of IBS that accounts for a large proportion of IBS patients. The PI-IBS symptoms meet the Rome criteria for IBS with diarrhoea (IBS-D) or IBS with mixed bowel habits (IBS-M). A low-grade inflammation has been reported to occur in PI-IBS. Abnormalities in intestinal endocrine cells have been reported in both sporadic IBS and PI-IBS. CASE PRESENTATION: A 20-year-old female with a diagnosis of IBS with constipation (IBS-C), according to Rome III criteria, contracted Campylobacter-induced gastroenteritis, after which her symptom pattern changed to IBS-M. She showed an intestinal low-grade inflammation that was manifested by an increase in the number of intraepithelial and lamina propria leucocytes and lymphocytes and an increase in the density of mast cells in lamina propria. There was also an increase in the density of intestinal serotonin and peptide YY (PYY) cells and a decrease in the density of rectal somatostatin cells. Follow-up of the patient at 4-months post-infection revealed reduction of IBS symptoms and an improvement in her quality of life. However, 6 months following the Campylobacter infection, the patient switched back from IBS-D to IBS-C, probably due to recovery from PI-IBS. The patient was treated with prucalopride, which is serotonin 5HT4 receptor agonist. Six months later following this treatment, the symptoms were reduced and the quality of life improved in the reported patient. CONCLUSIONS: Gastroenteritis in patients with IBS-C causes a post-infectious, low-grade inflammation. Interaction between immune-cells and intestinal endocrine cells increases the density of certain endocrine cells, which in turn might be responsible for the change in the symptom pattern, the milder symptoms and the improvement in the quality of life seen in the reported patient. The findings in this case raise the question as to whether intestinal infections are responsible for the previously reported switching of IBS from one subtype to another over time.

El-Salhy M; Mazzawi T; Gundersen D; Hatlebakk JG; Hausken T

2013-09-01

116

Microscopic inflammatory changes in colon of patients with both active psoriasis and psoriatic arthritis without bowel symptoms.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate colonic mucosa of patients with both active psoriasis and psoriatic arthritis (PsA) without bowel symptoms. METHODS: Fifteen persons (9 men, 6 women) who had both active psoriasis and PsA without bowel symptoms underwent colonoscopy with multiple biopsies of bowel mucosa. Ten nonhospitalized healthy subjects in followup colonoscopy after resection of benign polyps (8 men, 2 women) took part as a control group. RESULTS: Six psoriatic patients (40%) showed macroscopically normal colonic mucosa. In the remaining 9 reddening was frequently recorded (6 cases). while edema and granular changes appeared less commonly (3 cases each, respectively). Friability was markedly rare (only one case) and bleeding and ulcerations were absent. All 15 patients showed microscopic changes. Increase in lamina propria cellularity (consisting of plasma cells and lymphocytes) and lymphoid aggregates were found in all cases. Active inflammation, evident as neutrophilic polymorph infiltration occurred in 9 patients. Glandular atrophy was found in 3 cases; mucosal surface changes and crypt abnormalities occurred in one case each. No control had macroscopic or microscopic inflammatory changes of bowel mucosa. CONCLUSION: Bowel mucosa of patients with PsA without bowel symptoms show microscopic lesions even when mucosa appeared macroscopically normal. This result may support a pathogenetic link between skin, joints, and gut in psoriatic patients with arthritis even in the absence of bowel symptoms.

Scarpa R; Manguso F; D'Arienzo A; D'Armiento FP; Astarita C; Mazzacca G; Ayala F

2000-05-01

117

Intravenous iron in inflammatory bowel diseases.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: Anemia and iron deficiency are the most common extraintestinal complications of inflammatory bowel diseases (IBDs) and are often undertreated. We review the evidence on intravenous (i.v.) iron overcoming the limitations of oral iron in IBD. RECENT FINDINGS: Recent reports demonstrate that i.v. iron is at least as effective, quicker, and better tolerated than oral iron. Moreover, experimental data confirm that oral and parenteral iron have divergent effects on intestinal mucosa: oral iron severely increasing inflammation. Observational and randomized studies prove that i.v. iron is not only effective but also well tolerated with no negative influence in the activity of IBD. A new formulation, iron carboxymaltose, which permits higher individual doses, has been shown more effective and less costly than standard iron sucrose. Another formulation, iron isomaltoside, shows promising in in-vitro and small clinical studies, but data from large trials are not available yet. SUMMARY: Oral iron is not an ideal option for treating anemia and iron deficiency in IBD. i.v. iron should be preferred at least in five scenarios: intolerance to oral iron, severe anemia, failure of oral therapy, need for a quick recovery, and use of erythropoietin. Direct evidence in IBD patients not only confirms the effectiveness of i.v. iron, but also demonstrates that new, more convenient preparations probably will become the standard in the near future.

Gomollón F; Gisbert JP

2013-03-01

118

Probiotics in Inflammatory Bowel Diseases and Associated Conditions  

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A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD). Probiotics offer a method ...

David R. Mack

119

Mucosa-associated bacterial diversity in relation to human terminal ileum and colonic biopsy samples.  

UK PubMed Central (United Kingdom)

Little is known about bacterial communities that colonize mucosal surfaces in the human gastrointestinal tract, but they are believed to play an important role in host physiology. The objectives of this study were to investigate the compositions of these populations in the distal small bowel and colon. Healthy mucosal tissue from either the terminal ileum (n = 6) or ascending (n = 8), transverse (n = 8), or descending colon (n = 4) of 26 patients (age, 68.5 +/- 1.2 years [mean +/- standard deviation]) undergoing emergency resection of the large bowel was used to study these communities. Mucosa-associated eubacteria were characterized by using PCR-denaturing gradient gel electrophoresis (DGGE), while real-time PCR was employed for quantitative analysis. Mucosal communities were also visualized in situ using confocal laser scanning microscopy. DGGE banding profiles from all the gut regions exhibited at least 45% homology, with five descending colon profiles clustering at ca. 75% concordance. Real-time PCR showed that mucosal bacterial population densities were highest in the terminal ileum and that there were no significant differences in overall bacterial numbers in different parts of the colon. Bifidobacterial numbers were significantly higher in the large bowel than in the terminal ileum (P = 0.006), whereas lactobacilli were more prominent in the distal large intestine (P = 0.019). Eubacterium rectale (P = 0.0004) and Faecalibacterium prausnitzii (P = 0.001) were dominant in the ascending and descending colon. Site-specific colonization in the gastrointestinal tract may be contributory in the etiology of some diseases of the large intestine.

Ahmed S; Macfarlane GT; Fite A; McBain AJ; Gilbert P; Macfarlane S

2007-11-01

120

Why is damage limited to the mucosa in ulcerative colitis but transmural in Crohn's disease?  

Science.gov (United States)

It has been a big puzzle as why the inflammation of ulcerative colitis (UC) is limited to the mucosa, while in Crohn's disease (CD) the inflammation is transmural and can be seen in all layers of the gut. Here, I give a tentative explanation extended from the unified hypothesis I proposed on the etiology of inflammatory bowel disease. This hypothesis suggested that both UC and CD are caused by weakening of the gut barrier due to damage of the protective mucus layer and the underlying tissue by the poorly inactivated digestive proteases resulting from a reduction of gut bacteria by dietary chemicals like saccharin and sucralose. However, the large amounts of bacteria in the colon make the recruitment of neutrophils and formation of crypt abscess the main manifestation of UC, while the infiltration of antigens and dietary particles in the small and large intestine mainly cause the recruitment of macrophages and formation of granulomas as the main manifestations in CD. The fast reacting and short life span of neutrophils make the fight and damage limited to the surface of the mucosa. In contrast, the long life span and constant movement of macrophages may bring the harmful agents deep into the tissue. Therefore, the pathogenesis of UC may be more like bacterial pneumonia, while CD may be more like pneumoconiosis or tuberculosis of the lung. PMID:23946890

Qin, Xiaofa

2013-08-15

 
 
 
 
121

Why is damage limited to the mucosa in ulcerative colitis but transmural in Crohn's disease?  

UK PubMed Central (United Kingdom)

It has been a big puzzle as why the inflammation of ulcerative colitis (UC) is limited to the mucosa, while in Crohn's disease (CD) the inflammation is transmural and can be seen in all layers of the gut. Here, I give a tentative explanation extended from the unified hypothesis I proposed on the etiology of inflammatory bowel disease. This hypothesis suggested that both UC and CD are caused by weakening of the gut barrier due to damage of the protective mucus layer and the underlying tissue by the poorly inactivated digestive proteases resulting from a reduction of gut bacteria by dietary chemicals like saccharin and sucralose. However, the large amounts of bacteria in the colon make the recruitment of neutrophils and formation of crypt abscess the main manifestation of UC, while the infiltration of antigens and dietary particles in the small and large intestine mainly cause the recruitment of macrophages and formation of granulomas as the main manifestations in CD. The fast reacting and short life span of neutrophils make the fight and damage limited to the surface of the mucosa. In contrast, the long life span and constant movement of macrophages may bring the harmful agents deep into the tissue. Therefore, the pathogenesis of UC may be more like bacterial pneumonia, while CD may be more like pneumoconiosis or tuberculosis of the lung.

Qin X

2013-08-01

122

Bowel microbiota moderate host physiological responses to dietary konjac in weanling rats.  

Science.gov (United States)

Diets rich in complex carbohydrates that resist digestion in the small bowel can alter large bowel ecology and microbiota biochemistry because the carbohydrates become substrates for bacterial growth and metabolism. Conventional or germ-free weanling rats were fed a control diet or diets containing 1.25, 2.5, or 5% konjac (KJ), a commonly used ingredient in Asian foods, for 28 d. In the absence of bowel microbiota, 5% KJ elicited a significant increase in colonic goblet cell numbers and increased expression of mast cell protease genes and of genes that were overrepresented in the KEGG pathway "Metabolism of xenobiotics by cytochrome P450" relative to the control diet. In contrast, feeding 5% KJ caused few changes in mucosal gene expression in conventional rats. Analysis of the colonic microbiota of conventional rats fed KJ showed modest increases in the proportions of Actinobacteria and Bacteroidetes relative to rats fed the control diet, with a concomitant reduction in Firmicutes, which included a 50% reduction in Lactobacillus abundance. Colonic concentrations of short-chain fatty acids and colonic crypt lengths were increased by feeding KJ. Goblet cell numbers were greater in conventional rats fed KJ relative to the control diet but were lower compared with germ-free animals. Serum metabolite profiles were different in germ-free and conventional rats. Metabolites that differed in concentration included several phospholipids, a bile acid metabolite, and an intermediate product of tryptophan metabolism. Overall, KJ in the diet was potentially damaging to the bowel mucosa and produced a protective response from the host. This response was reduced by the presence of the bowel microbiota, which therefore ameliorated potentially detrimental effects of dietary KJ. PMID:23700349

Young, Wayne; Roy, Nicole C; Lee, Julian; Lawley, Blair; Otter, Don; Henderson, Gemma; Tannock, Gerald W

2013-05-22

123

Review article: the potential role of nitric oxide in chronic inflammatory bowel disorders.  

DEFF Research Database (Denmark)

The aetiology of the chronic inflammatory bowel diseases-ulcerative colitis and Crohn's disease-as well as 'microscopic colitis'-both collagenous (COC) and lymphocytic colitis (LC)-remains unknown. Autoimmune mechanisms, cytokine polymorphism, commensal bacteria, infectious agents and vascular impairment have all been proposed as playing important roles in the pathogenesis of this spectrum of diseases. A variety of proinflammatory mediators, including tumour necrosis factor alpha, interleukin-1beta, interferon gamma, leukotriene B4 and platelet activating factor, promote the adherence of phagocytes to the venular endothelium and extravasation of these cells into the colonic mucosa. In addition to large amounts of nitric oxide (NO), injurious peroxynitrite may be formed in the epithelium by the inducible nitric oxide synthase (iNOS), which is considered to elicit cytotoxicity by the generation of superoxide with reduced L-arginine availability. In active ulcerative colitis, and to a lesser extent in Crohn's disease, a greatly increased production of NO has been demonstrated by indirect and direct measurements. Surprisingly, even higher rates of production have been observed in COC-a condition which is never associated with injurious inflammation. The latter observation favours the notion that NO promotes mucosal integrity. Further evidence for a protective role of NO in chronic inflammatory bowel disorders is provided by the observation of increased susceptibility to the induction of experi mental colitis in 'knock-out' mice deficient in iNOS. Selective inhibitors of iNOS activity, as well as topical L-arginine, may therefore prove beneficial in inflammatory bowel disease by reducing the production of superoxide by iNOS, while only the former option may be expected to reduce diarrhoea in chronic inflammatory bowel disorders. Clearly, further experimental work needs to be done before testing topical L-arginine in human inflammatory bowel disease.

Perner, A; Rask-Madsen, J

1999-01-01

124

Inflammatory bowel disease: an impaired barrier disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: The intestinal barrier is a delicate structure composed of a single layer of epithelial cells, the mucus, commensal bacteria, immune cells, and antibodies. Furthermore, a wealth of antimicrobial peptides (AMPs) can be found in the mucus and defend the mucosa. Different lines of investigations now point to a prominent pathophysiological role of defensins, an important family of AMPs, in the pathogenesis of inflammatory bowel disease and, particularly, in small intestinal Crohn's disease. PURPOSE: In this review, we introduce the different antimicrobial peptides of the intestinal mucosa and describe their function, their expression pattern along the gastrointestinal tract, and their spatial relationship to the mucus layer. We then focus on the alterations found in inflammatory bowel disease. Small intestinal Crohn's disease (CD) is closely linked to defects in Paneth cells (specialized secretory epithelial cells at the bottom crypts) which secrete ?-defensin human defensin (HD)-5 in huge quantities in healthy individuals. Decreased expression of these antimicrobial peptides is found in ileal CD, and single nucleotide polymorphisms with the highest linkage to CD affect genes involved in Paneth cell biology and defensin secretion. Additionally, antimicrobial peptides have a role in ulcerative colitis, where the depleted mucus layer cannot fulfill its crucial function of binding defensins and other AMPs to their proper site of action. CONCLUSION: Inflammatory bowel disease arises when the mucosal barrier is compromised in its defense against challenges from the intestinal microbiota. In ileal CD, a strong association can be found between diminished expression or defective function of defensins and the advent of intestinal inflammation.

Jäger S; Stange EF; Wehkamp J

2013-01-01

125

Inflammatory bowel disease: beyond the boundaries of the bowel.  

Science.gov (United States)

Dysregulated inflammation in the gut, designated clinically as inflammatory bowel disease (IBD), is manifested by the prototypic phenotypes of an Arthus-like reaction restricted to the mucosa of the colon, as in ulcerative colitis, or a transmural granulomatous reaction, as in Crohn's disease, or an indeterminate form of the two polar types. That the inflammation of IBD can trespass the boundaries of the bowel has long been known, with articular, ophthalmologic, cutaneous, hepatobiliary or other complications/associations - some autoimmune and others not - affecting significant numbers of patients with IBD. Also notable is the frequency of diagnosis of IBD-type diseases on a background of systemic, (mostly myelo-hematological) disorders, associated with alterations of either (or both) innate or adaptive arms of the immune response. Finally, cases of IBD are reported to occur as an adverse effect of TNF inhibitors. Bone marrow transplant has been proven to be the only curative measure for some of the above cases. Thus, in effect, the IBDs should now be regarded as a systemic, rather than bowel-localized, disease. Genome-wide association studies have been informative in consolidating the view of three phenotypes of IBD (ulcerative colitis, Crohn's disease and mixed) and, notably, are revealing that the onset of IBD can be linked to polymorphisms in regulatory miRNAs, or to nucleotide sequences coding for regulatory lymphokines and/or their receptors. At the effector level, we emphasize the major role of the Th17/IL-23 axis in dictating the perpetuation of intestinal inflammation, augmented by a failure of physiological control by regulatory T-cells. In conclusion, there is a central genesis of the defects underlying IBD, which therefore, in our opinion, is best accommodated by the concept of IBD as more of a syndrome than an autonomous disease. This altered mindset should upgrade our knowledge of IBD, influence its medical care and provide a platform for further advances. PMID:21651357

Actis, Giovanni C; Rosina, Floriano; Mackay, Ian R

2011-06-01

126

Inflammatory bowel disease: beyond the boundaries of the bowel.  

UK PubMed Central (United Kingdom)

Dysregulated inflammation in the gut, designated clinically as inflammatory bowel disease (IBD), is manifested by the prototypic phenotypes of an Arthus-like reaction restricted to the mucosa of the colon, as in ulcerative colitis, or a transmural granulomatous reaction, as in Crohn's disease, or an indeterminate form of the two polar types. That the inflammation of IBD can trespass the boundaries of the bowel has long been known, with articular, ophthalmologic, cutaneous, hepatobiliary or other complications/associations - some autoimmune and others not - affecting significant numbers of patients with IBD. Also notable is the frequency of diagnosis of IBD-type diseases on a background of systemic, (mostly myelo-hematological) disorders, associated with alterations of either (or both) innate or adaptive arms of the immune response. Finally, cases of IBD are reported to occur as an adverse effect of TNF inhibitors. Bone marrow transplant has been proven to be the only curative measure for some of the above cases. Thus, in effect, the IBDs should now be regarded as a systemic, rather than bowel-localized, disease. Genome-wide association studies have been informative in consolidating the view of three phenotypes of IBD (ulcerative colitis, Crohn's disease and mixed) and, notably, are revealing that the onset of IBD can be linked to polymorphisms in regulatory miRNAs, or to nucleotide sequences coding for regulatory lymphokines and/or their receptors. At the effector level, we emphasize the major role of the Th17/IL-23 axis in dictating the perpetuation of intestinal inflammation, augmented by a failure of physiological control by regulatory T-cells. In conclusion, there is a central genesis of the defects underlying IBD, which therefore, in our opinion, is best accommodated by the concept of IBD as more of a syndrome than an autonomous disease. This altered mindset should upgrade our knowledge of IBD, influence its medical care and provide a platform for further advances.

Actis GC; Rosina F; Mackay IR

2011-06-01

127

Heat Shock Proteins in Inflammatory Bowel Disease  

Directory of Open Access Journals (Sweden)

Full Text Available Stress or heatshock proteins (HSPs) belong to five families of highly conserved intracellular proteins functioning as constitutive chaperones maintaining protein trafficking, structural integrity and repair. Their synthesis is induced by numerous stimuli ranging from environmental stress to inflammation regardless of etiology or malignancy. In normal mucosa HSP27 and HSP70 an normally expressed in the surface epithelium of the colon, an area continually subjected to inducible signals from the enteric flora and short chain fatty acids, rendering the epithelium resistant to bacterial toxins and inflammation associated stress. In inflammatory bowel disease (IBD) the heatshock proteins may play in important role as there is accumulating evidence that they suppress proinflammatory genes relevant to its pathogenesis. The mechanisms of suppression or induction of HSPS in inflamed gut mucosa need further research with the ultimate purpose that these molecules could be a target for therapeutic interventions.

C. Barbatis; M. Tsopanomichalou

2009-01-01

128

Respiratory involvement in inflammatory bowel diseases  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD) and are due to a dysregulation of the antimicrobial defense normally provided by the intestinal mucosa. This inflammatory process may extend outside the bowel to many organs and also to the respiratory tract. The respiratory involvement in IBD may be completely asymptomatic and detected only at lung function assessment, or it may present as bronchial disease or lung parenchymal alterations. Corticosteroids, both systemic and aerosolized, are the mainstay of the therapeutical approach, while antibiotics must be also administered in the case of infectious and suppurative processes, whose sequels sometimes require surgical intervention. The relatively high incidence of bronchopulmonary complications in IBD suggests the need for a careful investigation of these patients in order to detect a possible respiratory involvement, even when they are asymptomatic.

D'Andrea Nadia; Vigliarolo Rossana; Sanguinetti Claudio M

2010-01-01

129

Mucosa associated lymphoid tissue lymphoma presenting within a solitary anti-mesenteric dilated segment of ileum: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Mucosa associated lymphoid tissue (MALT) lymphoma is the third most common non-Hodgkin's lymphoma subtype. Clinical presentation is often insidious as a low-grade lesion and disease tends to remain localised for a long period of time. Ileal involvement is rare and presentation within an area of focal anti-mesenteric ileal wall dilation simulating a large diverticulum has not been reported. Case presentation A 59-year-old man of Caucasian origin presented to a general surgical outpatients clinic with an 18-month history of intermittent upper abdominal pain following meals. Following normal gastroscopy and abdominal ultrasound, a focally dilated segment of ileum was seen on computed tomography and further clarified by barium investigation. Histology of this segment demonstrated MALT lymphoma of the small bowel. Conclusion A solitary focally dilated segment of ileal wall may be neoplastic in nature and surgical resection needs to be considered.

Storey Rowland; Gatt Marcel; Bradford Ian

2009-01-01

130

Relationship between overactive bladder and irritable bowel syndrome: a large-scale internet survey in Japan using the overactive bladder symptom score and Rome III criteria.  

UK PubMed Central (United Kingdom)

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There is known to be an association between overactive bladder (OAB) and irritable bowel syndrome (IBS). The study investigates the association between OAB and IBS using an internet-based survey in Japan. It is the first to investigate the prevalence and severity of OAB in the general population using the OAB symptom score questionnaire. OBJECTIVE: To investigate the association between overactive bladder (OAB) and irritable bowel syndrome (IBS) by using an internet-based survey in Japan. SUBJECTS AND METHODS: Questionnaires were sent via the internet to Japanese adults. The overactive bladder symptom score was used for screening OAB, and the Japanese version of the Rome III criteria for the diagnosis of IBS was used for screening this syndrome. RESULTS: The overall prevalence of OAB and IBS was 9.3% and 21.2%, respectively. Among the subjects with OAB, 33.3% had concurrent IBS. The prevalence of OAB among men was 9.7% and among women it was 8.9%, while 18.6% of men and 23.9% of women had IBS. Concurrent IBS was noted in 32.0% of men and 34.8% of women with OAB. CONCLUSION: Taking into account a high rate of concurrent IBS in patients with OAB, it seems to be important for physicians to assess the defaecation habits of patients when diagnosing and treating OAB.

Matsumoto S; Hashizume K; Wada N; Hori J; Tamaki G; Kita M; Iwata T; Kakizaki H

2013-04-01

131

Short bowel syndrome  

International Nuclear Information System (INIS)

This thesis describes some aspects of short bowel syndrome. When approximately 1 m or less small bowel is retained after extensive resection, a condition called short bowel syndrome is present. Since the advent of parenteral nutrition, the prognosis of patients with a very short bowel has dramatically improved. Patients with 40 to 100 cm remaining jejunum and/or ileum can generally be maintained with oral nutrition due to increased absorption of the small bowel remnant as result of intestinal adaptation. This study reports clinical, biochemical and nutritional aspects of short bowel patients on oral or parenteral nutrition, emphasizing data on absorption of various nutrients and on bone metabolism. Furthermore, some technical apsects concerning long-term parenteral nutrition are discussed. (Auth.)

1983-01-01

132

Spontaneous transvaginal bowel evisceration.  

Science.gov (United States)

Transvaginal prolapse of bowel segments after major abdominal surgery is of rare occurrence and is commonly reported to follow after hysterectomy and enterocele repair. However, spontaneous bowel evisceration through vagina following cystectomy is even rare. We report and discuss a case of spontaneous transvaginal bowel evisceration in a postmenopausal woman with the intent of increasing its awareness among surgeons and proposing a precautionary measure for this entity. PMID:23956518

Chhabra, Sarabjeet; Hegde, Padmaraj

2013-04-01

133

Spontaneous transvaginal bowel evisceration.  

UK PubMed Central (United Kingdom)

Transvaginal prolapse of bowel segments after major abdominal surgery is of rare occurrence and is commonly reported to follow after hysterectomy and enterocele repair. However, spontaneous bowel evisceration through vagina following cystectomy is even rare. We report and discuss a case of spontaneous transvaginal bowel evisceration in a postmenopausal woman with the intent of increasing its awareness among surgeons and proposing a precautionary measure for this entity.

Chhabra S; Hegde P

2013-04-01

134

Confocal laser endomicroscopy in inflammatory bowel diseases: Dream or reality?  

Science.gov (United States)

Confocal laser endomicroscopy (CLE) is a newly introduced procedure that provide real-time, high-resolution imaging of the gastrointestinal mucosa during endoscopy, allowing the visualization of the pathology of the mucosal epithelium with its cellular and subcellular structures. Recently, the use of CLE was reported in the study of colonic mucosa in patients with inflammatory bowel diseases and in particular in patients affected by ulcerative colitis. CLE has the potential to have an important role in management of inflammatory bowel diseases (IBD) patients as it can be used to assess the grading of colitis and in detection of microscopic colitis in endoscopically silent segments. Moreover, CLE can be used in surveillance programs especially in high-risk patients. Finally, CLE has been effectively used in diagnosing a biliary dysplasia/neoplasia in patients with primary sclerosing cholangitis, a pathological condition frequently associated with IBD, with a coexisting bile duct stricture. PMID:24039350

De Palma, Giovanni Domenico; Rispo, Antonio

2013-09-14

135

Confocal laser endomicroscopy in inflammatory bowel diseases: Dream or reality?  

Science.gov (United States)

Confocal laser endomicroscopy (CLE) is a newly introduced procedure that provide real-time, high-resolution imaging of the gastrointestinal mucosa during endoscopy, allowing the visualization of the pathology of the mucosal epithelium with its cellular and subcellular structures. Recently, the use of CLE was reported in the study of colonic mucosa in patients with inflammatory bowel diseases and in particular in patients affected by ulcerative colitis. CLE has the potential to have an important role in management of inflammatory bowel diseases (IBD) patients as it can be used to assess the grading of colitis and in detection of microscopic colitis in endoscopically silent segments. Moreover, CLE can be used in surveillance programs especially in high-risk patients. Finally, CLE has been effectively used in diagnosing a biliary dysplasia/neoplasia in patients with primary sclerosing cholangitis, a pathological condition frequently associated with IBD, with a coexisting bile duct stricture.

De Palma, Giovanni Domenico; Rispo, Antonio

2013-01-01

136

Small bowel radiology  

International Nuclear Information System (INIS)

[en] This book deals mainly with technique, experiences and results of the biphasic small bowel enema (enteroclysis) with barium and methyl cellulose. The method allows the evaluation of both morphology and function of the small bowel. The introduction describes the examination technique, basic patterns, interpretation and indications, while the atlas shows a broad spectrum of small bowel diseases (Crohn's disease, other inflammatory diseases, tumors, motility disorders, obstructions and malformations). The possibilities of small bowel radiology are demonstrated with reference to clinical findings and differential diagnoses

1987-01-01

137

Balloon cell nevus of the oral mucosa.  

Science.gov (United States)

The balloon cell nevus is an uncommon variant of melanocytic nevi in which the majority of the proliferation consists of cells demonstrating peculiarly large clear, foamy, or finely vacuolated cytoplasm. The vacuolated cells represent altered nevus cells and upon immunoperoxidase evaluation react positively with several melanocytic markers. Complete excision results in cure. This report describes the second balloon cell nevus of the oral mucosa documented in the English-language literature. PMID:18280759

Damm, Douglas D; White, Dean K; Lyu, Peter E; Puno, Pauline

2008-02-20

138

Why is damage limited to the mucosa in ulcerative colitis but transmural in Crohn’s disease?  

Directory of Open Access Journals (Sweden)

Full Text Available It has been a big puzzle as why the inflammation of ulcerative colitis (UC) is limited to the mucosa, while in Crohn’s disease (CD) the inflammation is transmural and can be seen in all layers of the gut. Here, I give a tentative explanation extended from the unified hypothesis I proposed on the etiology of inflammatory bowel disease. This hypothesis suggested that both UC and CD are caused by weakening of the gut barrier due to damage of the protective mucus layer and the underlying tissue by the poorly inactivated digestive proteases resulting from a reduction of gut bacteria by dietary chemicals like saccharin and sucralose. However, the large amounts of bacteria in the colon make the recruitment of neutrophils and formation of crypt abscess the main manifestation of UC, while the infiltration of antigens and dietary particles in the small and large intestine mainly cause the recruitment of macrophages and formation of granulomas as the main manifestations in CD. The fast reacting and short life span of neutrophils make the fight and damage limited to the surface of the mucosa. In contrast, the long life span and constant movement of macrophages may bring the harmful agents deep into the tissue. Therefore, the pathogenesis of UC may be more like bacterial pneumonia, while CD may be more like pneumoconiosis or tuberculosis of the lung.

Xiaofa Qin

2013-01-01

139

Effect of small bowel preparation with simethicone on capsule endoscopy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. METHODS: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. RESULTS: Simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). CONCLUSION: Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

Fang YH; Chen CX; Zhang BL

2009-01-01

140

Irritable bowel syndrome.  

UK PubMed Central (United Kingdom)

Irritable bowel syndrome (IBS) is a disease of unclear, complex pathophysiology characterised by abdominal pain and discomfort and altered bowel activity. It affects an estimated 10-15% of individuals worldwide and has a large impact on quality of life (QOL) and both direct and indirect healthcare costs. Symptoms of IBS are usually triggered by disruption of gastrointestinal (GI) function secondary to infection, dietary factors, lifestyle changes or psychological stress. While most currently available pharmacological treatments of IBS focus on symptomatic treatment of the syndrome, agents that attempt to address the pathophysiology of the disease, in particular the role of serotonin, have received much attention in recent years. However, there is growing concern that serotonergic agents as a class may be associated with rare, but serious, episodes of ischaemic colitis, with several cases of this complication having been reported in association with use of serotonergic agents that have reached the market. Thus, there remains an important need for safe and effective agents that treat the symptoms of IBS. Otilonium bromide, a spasmolytic agent, has been widely used worldwide and has been found to be effective and safe for managing abdominal pain. Clinical trials indicate that it improves baseline abdominal pain and distension, and is particularly effective in reducing diarrhoea. Combining otilonium bromide with benzodiazepines, such as diazepam, may improve the efficacy of the agent with respect to GI symptoms, while also treating underlying anxiety disorders. More research is required to confirm the efficacy and mechanisms of action associated with this combination therapy in IBS. Safety data from clinical trials and postmarketing sources indicate that otilonium bromide is well tolerated, with a safety profile comparable to placebo in clinical trials and only two reported cases of adverse reactions (urticaria) among 10-year postmarketing data. This article reviews the pathophysiology and treatment of IBS with a particular focus on the role of otilonium bromide in the management of this condition.

Spinelli A

2007-01-01

 
 
 
 
141

Irritable bowel syndrome.  

Science.gov (United States)

Irritable bowel syndrome (IBS) is a disease of unclear, complex pathophysiology characterised by abdominal pain and discomfort and altered bowel activity. It affects an estimated 10-15% of individuals worldwide and has a large impact on quality of life (QOL) and both direct and indirect healthcare costs. Symptoms of IBS are usually triggered by disruption of gastrointestinal (GI) function secondary to infection, dietary factors, lifestyle changes or psychological stress. While most currently available pharmacological treatments of IBS focus on symptomatic treatment of the syndrome, agents that attempt to address the pathophysiology of the disease, in particular the role of serotonin, have received much attention in recent years. However, there is growing concern that serotonergic agents as a class may be associated with rare, but serious, episodes of ischaemic colitis, with several cases of this complication having been reported in association with use of serotonergic agents that have reached the market. Thus, there remains an important need for safe and effective agents that treat the symptoms of IBS. Otilonium bromide, a spasmolytic agent, has been widely used worldwide and has been found to be effective and safe for managing abdominal pain. Clinical trials indicate that it improves baseline abdominal pain and distension, and is particularly effective in reducing diarrhoea. Combining otilonium bromide with benzodiazepines, such as diazepam, may improve the efficacy of the agent with respect to GI symptoms, while also treating underlying anxiety disorders. More research is required to confirm the efficacy and mechanisms of action associated with this combination therapy in IBS. Safety data from clinical trials and postmarketing sources indicate that otilonium bromide is well tolerated, with a safety profile comparable to placebo in clinical trials and only two reported cases of adverse reactions (urticaria) among 10-year postmarketing data. This article reviews the pathophysiology and treatment of IBS with a particular focus on the role of otilonium bromide in the management of this condition. PMID:17177577

Spinelli, Antonella

2007-01-01

142

Managing irritable bowel syndrome.  

UK PubMed Central (United Kingdom)

OVERVIEW: Irritable bowel syndrome (IBS), characterized by abdominal pain or discomfort associated with a change in bowel patterns, is one of the most common functional gastrointestinal disorders. Because no single drug effectively relieves all IBS symptoms, management relies on dietary and lifestyle modifications, as well as pharmacologic and nonpharmacologic therapies. The authors review current approaches to treatment and discuss nursing implications.

Anastasi JK; Capili B; Chang M

2013-07-01

143

Avaliação e seguimento de pacientes adultos com síndrome do intestino curto pelo exame contrastado de trânsito intestinal/ Barium follow through in the assessment and follow-up of adult patients with short bowel syndrome  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A síndrome do intestino curto é definida pela incapacidade da superfície do intestino delgado em manter as condições adequadas de absorção de nutrientes, ocasionando deficiências nutricionais. Em adultos, as principais causas de síndrome do intestino curto são as ressecções cirúrgicas amplas ou múltiplas, secundárias a infarto mesentérico, doença de Crohn e enterite actínica. Além de avaliar o tempo de trânsito até o intestino grosso, o exame contrast (more) ado de trânsito intestinal pode ser utilizado na medição da extensão do intestino remanescente e no acompanhamento dos fenômenos de adaptação estrutural das alças delgadas e colônicas. Em pacientes com síndrome do intestino curto, a adaptação estrutural do intestino delgado consiste na hiperplasia das vilosidades e das pregas mucosas, que se tornam mais numerosas, profundas e de maior diâmetro, assim como a dilatação do segmento remanescente. Esses achados morfológicos são mais pronunciados e bem estabelecidos nas alças ileais, evidenciando sua maior capacidade adaptativa. O conhecimento dos achados por imagem das características morfológicas e adaptativas do intestino delgado é de grande importância na abordagem multidisciplinar da síndrome do intestino curto. Abstract in english Short bowel syndrome is defined as the small bowel functional absorptive surface inability to provide adequate nutrition, leading to intestinal failure and chronic malnutrition. In adult individuals the main etiologies for short bowel syndrome are related to extensive or multiple surgical bowel resections secondary to mesenteric ischemia, Crohn's disease and actinic enteritis. Besides evaluating the transit time through the large bowel, barium follow through may be utiliz (more) ed in the measurement of bowel remnants length as well as in the follow-up of structural adaptation phenomena of small bowel and colonic loops. In patients with short bowel syndrome, structural small bowel adaptation consists in hyperplasia of villi and mucosal folds, which become more numerous, deeper and larger in diameter, as well as remnant segment dilation. Such morphological findings are more prominent and best established in the ileal loops, whose remarkable adaptive capacity has been well documented. Therefore, the knowledge of imaging findings regarding morphological and adaptive characteristics of the small bowel is extremely relevant in the multidisciplinary approach to short bowel syndrome.

Chagas Neto, Francisco Abaeté das; Barreto, André Rodrigues Façanha; Muglia, Valdair Francisco; Elias Junior, Jorge; Bellucci, Ângela Delete; Marchini, Júlio Sérgio; Cunha, Selma Freire de Carvalho da

2011-06-01

144

Avaliação e seguimento de pacientes adultos com síndrome do intestino curto pelo exame contrastado de trânsito intestinal Barium follow through in the assessment and follow-up of adult patients with short bowel syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available A síndrome do intestino curto é definida pela incapacidade da superfície do intestino delgado em manter as condições adequadas de absorção de nutrientes, ocasionando deficiências nutricionais. Em adultos, as principais causas de síndrome do intestino curto são as ressecções cirúrgicas amplas ou múltiplas, secundárias a infarto mesentérico, doença de Crohn e enterite actínica. Além de avaliar o tempo de trânsito até o intestino grosso, o exame contrastado de trânsito intestinal pode ser utilizado na medição da extensão do intestino remanescente e no acompanhamento dos fenômenos de adaptação estrutural das alças delgadas e colônicas. Em pacientes com síndrome do intestino curto, a adaptação estrutural do intestino delgado consiste na hiperplasia das vilosidades e das pregas mucosas, que se tornam mais numerosas, profundas e de maior diâmetro, assim como a dilatação do segmento remanescente. Esses achados morfológicos são mais pronunciados e bem estabelecidos nas alças ileais, evidenciando sua maior capacidade adaptativa. O conhecimento dos achados por imagem das características morfológicas e adaptativas do intestino delgado é de grande importância na abordagem multidisciplinar da síndrome do intestino curto.Short bowel syndrome is defined as the small bowel functional absorptive surface inability to provide adequate nutrition, leading to intestinal failure and chronic malnutrition. In adult individuals the main etiologies for short bowel syndrome are related to extensive or multiple surgical bowel resections secondary to mesenteric ischemia, Crohn's disease and actinic enteritis. Besides evaluating the transit time through the large bowel, barium follow through may be utilized in the measurement of bowel remnants length as well as in the follow-up of structural adaptation phenomena of small bowel and colonic loops. In patients with short bowel syndrome, structural small bowel adaptation consists in hyperplasia of villi and mucosal folds, which become more numerous, deeper and larger in diameter, as well as remnant segment dilation. Such morphological findings are more prominent and best established in the ileal loops, whose remarkable adaptive capacity has been well documented. Therefore, the knowledge of imaging findings regarding morphological and adaptive characteristics of the small bowel is extremely relevant in the multidisciplinary approach to short bowel syndrome.

Francisco Abaeté das Chagas Neto; André Rodrigues Façanha Barreto; Valdair Francisco Muglia; Jorge Elias Junior; Ângela Delete Bellucci; Júlio Sérgio Marchini; Selma Freire de Carvalho da Cunha

2011-01-01

145

SERT and TPH-1 mRNA expression are reduced in irritable bowel syndrome patients regardless of visceral sensitivity state in large intestine.  

UK PubMed Central (United Kingdom)

Colorectal visceral hypersensitivity has been demonstrated in a subset of irritable bowel syndrome (IBS) patients. Serine protease and serotonergic signaling modulate gastrointestinal visceral sensitivity. We evaluated whether altered mucosal serine protease and serotonergic pathway components are related to rectal visceral hypersensitivity in IBS patients. Colorectal mucosal biopsies of 23 IBS patients and 15 controls were collected. Gene transcripts of protease-activated receptor (PAR)-2, trypsinogen IV, tryptophan hydroxylase (TPH)-1, and serotonin reuptake transporter (SERT) were quantified using real-time polymerase chain reaction. Substance P and 5-HT contents were measured by ELISA. The number of enterochromaffin cells, mast cells, and intraepithelial lymphocytes was determined using immunohistochemistry. Rectal visceral sensitivity was determined in IBS patients using barostat programmed for phasic ascending distension. Rectal hypersensitivity (+) and (-) IBS patients showed lower TPH-1 and SERT mRNA levels in the rectum compared with controls (P ? 0.05). Rectal hypersensitivity (+) IBS patients (n = 12) showed lower TPH-1 mRNA level in the sigmoid compared with controls (P = 0.015). No significant differences were observed in PAR-2 and trypsinogen IV expression between controls and IBS patients. Rectal substance P content was increased in IBS patients compared with controls (P = 0.045). No significant differences were found in transcript levels, cell counts, and substance P and 5-HT contents between rectal hypersensitivity (+) and (-) IBS patients. In conclusion, regardless of visceral hypersensitivity state, several serotonergic signaling components are altered in IBS patients.

Kerckhoffs AP; ter Linde JJ; Akkermans LM; Samsom M

2012-05-01

146

Neurotensin receptor 1 overexpression in inflammatory bowel diseases and colitis-associated neoplasia  

Digital Repository Infrastructure Vision for European Research (DRIVER)

AIM: To explore the association of neurotensin receptor 1 (NTSR1) with inflammatory bowel diseases (IBD) and colitis-associated neoplasia. METHODS: NTSR1 was detected by immunohistochemistry in clinical samples of colonic mucosa with IBD colitis, colitis-associated raised low-grade dysplasia (LGD) i...

Xianyong Gui; Shuhong Liu; Yuchu Yan; Zuhua Gao

147

Assessing patient satisfaction in inflammatory bowel disease using the QUOTE-IBD survey: A small step for clinicians, a potentially large step for improving quality of care.  

UK PubMed Central (United Kingdom)

BACKGROUND: Patient satisfaction is thought integral to high quality of care (QoC) in chronic disease models, including inflammatory bowel disease (IBD). Here we utilized the QUOTE-IBD survey in IBD clinic patients, in order to examine potential deficiencies in QoC from the patients' perspective, thus possibly amenable to change. METHODS: Consecutive patients attending a single clinic were asked to complete the QUOTE-IBD survey, where 22 items (in seven domains) were rated for importance (I), and actual performance (P), and a quality index (QI) was derived. A QI <9.0 indicated suboptimal satisfaction. Other data were extracted from hospital records and CRP was measured. Factorial ANOVA examined effects of relevant clinical and demographic factors on satisfaction (QI) scores per domain. RESULTS: Of 367 potential participants, 187 (51%) responded. 86 (46%) had Crohn's disease, 101 (54%) ulcerative colitis; 52% were females, and median age was 45y (range 18,82). The only QI score <9.0 was 'kept in waiting room >15min' (QI 8.73). In bivariate analyses, those with Crohn's, post-resection and longer IBD duration each had lower domain QI's than their respective counterparts, whereas those on concurrent anti-TNF therapy gave higher QI scores (each p<0.05). Factorial ANOVA showed female gender and IBD duration ?5years were each associated with significantly lower mean QI scores in multiple domains. CONCLUSIONS: Patients with adverse disease characteristics (e.g. longer duration, post-resection) and females reported lower satisfaction. Conversely, those on anti-TNF therapy reported higher satisfaction. Targeting these 'at-risk' groups and assessing satisfaction longitudinally may enhance QoC in IBD.

Vasudevan A; Arachchi A; van Langenberg DR

2013-10-01

148

Small bowel resection rates in Crohn's disease and the indication for surgery over time: experience from a large tertiary care center.  

UK PubMed Central (United Kingdom)

BACKGROUND: Our primary aim was to determine if the rate of small bowel resection (SBR) has declined over time among Crohn's disease (CD) patients seen at a single academic institution. A secondary aim was to establish whether the indication for surgery has changed. METHODS: Patients with a primary or secondary ICD-9 code for CD (555.0-555.9) who underwent SBR at the University of Pittsburgh were included. Patients were divided into 4 separate time periods based on when they had surgery: 1995-1998 (Period 1), 1999-2001 (Period 2), 2002-2004 (Period 3), and 2005-2007 (Period 4). Medical records were reviewed for the 6 months preceding surgery. Use of 5-ASAs, immunomodulators (IMs), tumor necrosis factor (TNF) antagonists, and corticosteroids were noted. Disease behavior was defined as nonstricturing, nonpenetrating (B1), stricturing (B2), and penetrating (B3). Proportions of patients undergoing SBR were calculated according to calendar cohort and these rates were examined for time trends. RESULTS: In all, 227 unique patients were analyzed for a total of 236 surgeries. The rates of 5-ASA, IM, and corticosteroid use were similar across the 4 time periods. By contrast, TNF antagonist usage progressively increased over time (0%, 18%, 34%, 35%; P = 0.0002). The annual rate of SBR per period did not change (1.6%, 1.9%, 1.6%, 1.9%; P = 0.93). Similarly, the disease behavior did not change over time. CONCLUSIONS: While the frequency of TNF antagonist use in CD at the University of Pittsburgh has increased over time, the rate of SBR and indication for surgery has remained unchanged. These findings may be explained by long-standing, complicated disease refractory to medical therapy.

Lazarev M; Ullman T; Schraut WH; Kip KE; Saul M; Regueiro M

2010-05-01

149

Change in Bowel Habits  

Science.gov (United States)

... Side effect of medications Lactose intolerance Gluten sensitivity (celiac sprue) Crohn's disease Diverticulitis (infection of a diverticulum) Food ... that can cause flatulence include: Gallstones Gluten sensitivity (celiac sprue) Food intolerance (especially lactose intolerance) Irritable bowel syndrome ...

150

Irritable Bowel Syndrome  

Medline Plus

Full Text Available ... that seem to produce symptoms of IBS include diet, emotional stress, and hormones. Patients with irritable bowel ... step in reducing symptoms of IBS. Changing the diet in various ways can help to reduce IBS ...

151

Short Bowel Syndrome  

Science.gov (United States)

... The small intestine includes three sections—the duodenum, jejunum, and ileum. [ Top ] What causes short bowel syndrome? ... the small intestine, where iron is absorbed the jejunum, the middle section of the small intestine, where ...

152

Irritable Bowel Syndrome  

Medline Plus

Full Text Available ... patient eats, how much the patient eats, emotional stress, and menstrual cycle in women. Therefore, it is ... to produce symptoms of IBS include diet, emotional stress, and hormones. Patients with irritable bowel syndrome are ...

153

Bleeding peptic ulcer caused by ectopic gastric mucosa in a duplicated segment of jejunum  

Energy Technology Data Exchange (ETDEWEB)

The authors present a case in which a patient suffered a bleeding jejunal ulcer caused by heterotopic gastric mucosa in a congenital duplication of a segment of jejunum. This is the first case diagnosed preoperatively by two different radiographic means. These lesions were shown by both pertechnetate flow and barium small bowel studies. The rarity of these entities and the modalities used for diagnosis are described.

Newmark, H.; Ching, G.; Halls, J.; Levy, I.J.

1981-02-01

154

Bleeding peptic ulcer caused by ectopic gastric mucosa in a duplicated segment of jejunum  

International Nuclear Information System (INIS)

The authors present a case in which a patient suffered a bleeding jejunal ulcer caused by heterotopic gastric mucosa in a congenital duplication of a segment of jejunum. This is the first case diagnosed preoperatively by two different radiographic means. These lesions were shown by both pertechnetate flow and barium small bowel studies. The rarity of these entities and the modalities used for diagnosis are described.

1981-01-01

155

REG gene expression in inflamed and healthy colon mucosa explored by in situ hybridisation.  

Science.gov (United States)

The regenerating islet-derived (REG) gene family encodes a group of proteins highly expressed in several human pathologies, many of which are associated with epithelial inflammation. All human family members, namely REG1A, REG1B, REG3A and REG4, are closely related in genomic sequence and all are part of the c-type lectin superfamily. REGs are highly expressed during inflammatory bowel disease (IBD)-related colonic inflammation and the in vivo expression pattern of REG1A and REG4 has been localised by using immunohistochemistry. However, the function of the encoded proteins is largely unknown and the cellular localisation of REG expression during colonic inflammation has not been described. Therefore, we have used in situ hybridisation to demonstrate the cellular localisation of REG expression in healthy and diseased colonic mucosa. Samples drawn from an IBD cohort including both inflamed and un-inflamed colonic mucosa are described, as are samples from non-IBD inflammation and healthy controls. Immunohistochemistry against known cell-type markers on serial sections has localised the expression of REGs to metaplastic Paneth cells (REG1A, REG1B and REG3A) and enteroendocrine cells (REG4), with a marked expansion of expression during inflammation. The group of REGs can, based on gene expression patterns, be divided into at least two groups; REG1A, REG1B and REG3A with their expression focused in the crypt base spreading from Paneth cells and REG4 being more highly expressed towards the luminal face. This exploration of expression pattern forms provides the background for further exploration of REG function in the intestine. PMID:23519454

van Beelen Granlund, Atle; Østvik, Ann Elisabet; Brenna, Øystein; Torp, Sverre H; Gustafsson, Bjørn I; Sandvik, Arne Kristian

2013-03-22

156

Household bowel clearing device  

UK PubMed Central (United Kingdom)

The utility model discloses a household bowel clearing device belonging to the hygiene article, which can be matched with the water heater in particular to the storage water heater. The household bowel clearing device comprises an inner tube body(1) one end of the inner tube body(1) is connected with a water outlet of the water heater(3) through a water tube(2), and a flexible soft connector (4) is sheathed on the tube body(1) and is corresponding to the other end of the tube body(1) wherein, the material of the flexible soft connector (4) is softer than the material of the tube body(1). While in use, the temperature and the pressure of leaving water of the storage water heater can be adjusted, the flexible soft connector is aligned with the anus, the filtering water current can flow into the rectum, and purpose of clearing the bowel is achieved because the flexible soft connector contacted with the anus is replaceable, the household bowel clearing device is sanitary, and because the household bowel clearing device can be matched with the storage water heater and can be used as the selectable accessory of the storage water heater, the cost of clearing the bowel is low, the use is convenient and sanitary.

WANG YONG

157

Epithelial expression of interleukin-37b in inflammatory bowel disease.  

Science.gov (United States)

Interleukin (IL)-37 is a member of the IL-1 cytokine family. We investigated IL-37b expression in the inflamed mucosa of inflammatory bowel disease (IBD) patients. Furthermore, we analysed IL-37b expression in human colonic epithelial cells. The human colonic epithelial cell line T84 and human colonic subepithelial myofibroblasts (SEMFs) were used. IL-37b expression in the IBD mucosa was evaluated by immunohistochemistry. IL-37b mRNA and protein expression were determined by real time-polymerase chain reaction (PCR) and Western blotting, respectively. IL-37b was not detected in the normal colonic mucosa. In the inflamed mucosa of IBD patients, epithelial IL-37b expression was increased markedly. In ulcerative colitis (UC) and Crohn's disease (CD) patients, IL-37b expression was enhanced in the affected mucosa. In the intestinal epithelial cell line T84, the expression of IL-37b mRNA and protein was enhanced by tumour necrosis factor (TNF)-?. This IL-37b induction by TNF-? was mediated by nuclear factor (NF)-?B and activator protein (AP)-1 activation. Furthermore, IL-37b inhibited TNF-?-induced interferon-?-inducible protein (IP)-10 expression significantly in human colonic SEMFs. Epithelial IL-37b expression was increased in IBD patients, especially UC patients. IL-37b may be involved in the pathophysiology of IBD as an anti-inflammatory cytokine and an inhibitor of both innate and acquired immune responses. PMID:23600829

Imaeda, H; Takahashi, K; Fujimoto, T; Kasumi, E; Ban, H; Bamba, S; Sonoda, H; Shimizu, T; Fujiyama, Y; Andoh, A

2013-06-01

158

Epithelial expression of interleukin-37b in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

Interleukin (IL)-37 is a member of the IL-1 cytokine family. We investigated IL-37b expression in the inflamed mucosa of inflammatory bowel disease (IBD) patients. Furthermore, we analysed IL-37b expression in human colonic epithelial cells. The human colonic epithelial cell line T84 and human colonic subepithelial myofibroblasts (SEMFs) were used. IL-37b expression in the IBD mucosa was evaluated by immunohistochemistry. IL-37b mRNA and protein expression were determined by real time-polymerase chain reaction (PCR) and Western blotting, respectively. IL-37b was not detected in the normal colonic mucosa. In the inflamed mucosa of IBD patients, epithelial IL-37b expression was increased markedly. In ulcerative colitis (UC) and Crohn's disease (CD) patients, IL-37b expression was enhanced in the affected mucosa. In the intestinal epithelial cell line T84, the expression of IL-37b mRNA and protein was enhanced by tumour necrosis factor (TNF)-?. This IL-37b induction by TNF-? was mediated by nuclear factor (NF)-?B and activator protein (AP)-1 activation. Furthermore, IL-37b inhibited TNF-?-induced interferon-?-inducible protein (IP)-10 expression significantly in human colonic SEMFs. Epithelial IL-37b expression was increased in IBD patients, especially UC patients. IL-37b may be involved in the pathophysiology of IBD as an anti-inflammatory cytokine and an inhibitor of both innate and acquired immune responses.

Imaeda H; Takahashi K; Fujimoto T; Kasumi E; Ban H; Bamba S; Sonoda H; Shimizu T; Fujiyama Y; Andoh A

2013-06-01

159

Xanthomatosis of the gastrointestinal tract with focus on small bowel involvement  

DEFF Research Database (Denmark)

Accumulation of foamy lipid-laden histiocytic cells is most often seen in the skin and tendons, usually associated with congenital or acquired hyperlipidaemia, as seen in patients with diabetes mellitus, obstructive jaundice, and familial hypercholesterolaemia. The pathogenesis of xanthomatous lesions in other sites, including the urinary bladder, prostate, and gastrointestinal tract seems to be less consistent. Within the gastrointestinal tract the gastric mucosa is the most frequently cited location. Involvement of the oesophagus and bowel has rarely been described. Only three such cases largely confined to the small bowel have previously been documented. We here present an additional small bowel example accompanied by a short review of the existing literature in English on gastrointestinal xanthomatous lesions, including a discussion on its possible pathogenesis. Histologically, the lesion is unique and a correct diagnosis does not pose significant difficulties. Identification of diverse phagocytosed cytoplasmic deposits in other histiocytic lesions may require ancillary studies. More importantly, malignant lesions composed of clear cells or signet ring cells, primary or metastatic, need consideration. With a high index of suspicion coupled with appropriate histochemical and immunohistochemical reactions, the correct diagnosis will easily be accomplished. The process is characterised by aggregates of foamy histiocytes, unaccompanied by fibrosis or giant cells as seen in xanthogranulomatous lesions.  Well-defined clusters of such foamy histiocytes have been labelled xanthoma. The diffusely infiltrating counterpart has been termed xanthomatosis. When forming a bulky mass lesion, the label xanthomatous pseudotumour has been applied 11 12 and the subtle collection of xanthoma cells is often referred to as xanthelasma. 13 In this letter we collectively refer to these lesions, which may be related, as xanthomatous lesions (XAN).

Nielsen, S.L.; Ingeholm, P.

2007-01-01

160

Colonoscopia como método diagnóstico e terapêutico das moléstias do instestino grosso: análise de 2.567 exames/ Colonoscopy as a diagnostic and therapeutic method of the large bowel diseases: analysis of 2,567 exams  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese RACIONAL: Com o surgimento das fibras ópticas na área médica, houve grande avanço tecnológico na observação do aparelho digestivo, com a introdução dos endoscópios flexíveis, usados anteriormente para o trato digestivo superior. OBJETIVO: Rever os resultados da aplicação da colonoscopia diagnóstica e terapêutica na Disciplina de Coloproctologia da Faculdade de Medicina da Universidade de São Paulo, respeitando as características de instituição de ensino (more) e aprimoramento médico. CASUÍSTICA E MÉTODOS: Análise retrospectiva dos dados referentes a 2.567 exames de fibrocolonoscopia realizados entre os anos de 1984 e 2002, seja em regime de internação hospitalar ou ambulatorial. As principais indicações de exame nesta casuística foram o sangramento retal/anemia em 571 (22,24%) doentes, alteração do hábito intestinal em 379 (14,76%), moléstia inflamatória em 222 (8,65%) e pós-operatório de neoplasia em 186 (7,25%). O preparo intestinal com manitol foi realizado na maioria dos doentes. A sedação, quando não contra-indicada, foi feita com meperidina e benzodiazepínico. Todos exames foram feitos com monitorização com oxímetro de pulso. RESULTADOS: O resultado do exame foi normal em 1.089 (42,42%) casos. Pólipos foram diagnosticados em 397 (15,47%) casos, doença diverticular em 330 (12,86%), doença inflamatória em 305 (11,88%) e câncer colorretal em 262 (10,21%). Foram realizadas 819 polipectomias em 397 doentes, gerando a média de 2,21 polipectomias por doente com pólipo. A colonoscopia foi considerada incompleta (quando não atingiu o ceco) em 181 (7,05%) casos. Houve um caso de perfuração por fratura de tumor subestenosante de retossigmóide. Complicações relacionadas à sedação levaram à interrupção do exame em 0,42% das vezes, sem maiores prejuízos aos pacientes. CONCLUSÃO: A colonoscopia foi método eficaz no diagnóstico e tratamento de afecções colorretais, sendo seguro e com baixo índice de morbidade em ambiente universitário. Abstract in english BACKGROUND: Since the sixties, when the optic fibers were reported, colonoscopy had emerged as the first line imaging investigation of the colon. AIM: To review the results of diagnostic and therapeutic colonoscopy at the Discipline of Coloproctology of the University of São Paulo Medical School, São Paulo, SP, Brazil, respecting the characteristics of an institution of medical eduction. METHODS: Retrospective analysis of basis related to 2,567 fibro colonoscopies betwe (more) en 1984 and 2002. The procedure was performed in hospitalized and in outpatients. The most common indications for colonoscopy were investigation of rectal bleeding and anemia (22.4%), change of bowel habit (14.76%), inflammatory bowel disease (8.65%) and carcinoma (7.25%). Bowel preparation with manitol was used by most of the patients. Sedation, when not contra-indicated, was administered. The most common combination was meperidine and benzodiazepine. All the exams were monitored with pulse oximeter. A normal colonoscopy to the point of maximum insertion was reported in 42.42% of procedures. The most common diagnosis was polyps (15.47%), followed by diverticular disease (12.86%). Inflammatory disease was recorded in 11.88% and carcinoma in 10.21%. Polypectomy was undertaken in 397 patients (2.21 polypectomy per patient with polyps). Colonoscopy was considered incomplete (when the colonoscope did not pass to the cecum or terminal ileum) in 181 (7.05%) cases. Perforation was reported in one patient who had a subestenosing retossigmoid tumor. In 0.42%, reasons for failing to complete the procedure included complication related to sedation, with no further prejudice for the patients. CONCLUSIONS: Colonoscopic examination of the entire colon remains the standard for visualization, biopsy and treatment of colonic affections. The incidence of complication of endoscopy of the large bowel is quite low, even in a school hospital.

Nahas, Sergio Carlos; Marques, Carlos Frederico Sparapan; Araújo, Sérgio Alonso; Aisaka, Adilson Akihide; Nahas, Caio Sérgio Rizkallah; Pinto, Rodrigo Ambar; Kiss, Desidério Roberto

2005-06-01

 
 
 
 
161

Colonoscopia como método diagnóstico e terapêutico das moléstias do instestino grosso: análise de 2.567 exames Colonoscopy as a diagnostic and therapeutic method of the large bowel diseases: analysis of 2,567 exams  

Directory of Open Access Journals (Sweden)

Full Text Available RACIONAL: Com o surgimento das fibras ópticas na área médica, houve grande avanço tecnológico na observação do aparelho digestivo, com a introdução dos endoscópios flexíveis, usados anteriormente para o trato digestivo superior. OBJETIVO: Rever os resultados da aplicação da colonoscopia diagnóstica e terapêutica na Disciplina de Coloproctologia da Faculdade de Medicina da Universidade de São Paulo, respeitando as características de instituição de ensino e aprimoramento médico. CASUÍSTICA E MÉTODOS: Análise retrospectiva dos dados referentes a 2.567 exames de fibrocolonoscopia realizados entre os anos de 1984 e 2002, seja em regime de internação hospitalar ou ambulatorial. As principais indicações de exame nesta casuística foram o sangramento retal/anemia em 571 (22,24%) doentes, alteração do hábito intestinal em 379 (14,76%), moléstia inflamatória em 222 (8,65%) e pós-operatório de neoplasia em 186 (7,25%). O preparo intestinal com manitol foi realizado na maioria dos doentes. A sedação, quando não contra-indicada, foi feita com meperidina e benzodiazepínico. Todos exames foram feitos com monitorização com oxímetro de pulso. RESULTADOS: O resultado do exame foi normal em 1.089 (42,42%) casos. Pólipos foram diagnosticados em 397 (15,47%) casos, doença diverticular em 330 (12,86%), doença inflamatória em 305 (11,88%) e câncer colorretal em 262 (10,21%). Foram realizadas 819 polipectomias em 397 doentes, gerando a média de 2,21 polipectomias por doente com pólipo. A colonoscopia foi considerada incompleta (quando não atingiu o ceco) em 181 (7,05%) casos. Houve um caso de perfuração por fratura de tumor subestenosante de retossigmóide. Complicações relacionadas à sedação levaram à interrupção do exame em 0,42% das vezes, sem maiores prejuízos aos pacientes. CONCLUSÃO: A colonoscopia foi método eficaz no diagnóstico e tratamento de afecções colorretais, sendo seguro e com baixo índice de morbidade em ambiente universitário.BACKGROUND: Since the sixties, when the optic fibers were reported, colonoscopy had emerged as the first line imaging investigation of the colon. AIM: To review the results of diagnostic and therapeutic colonoscopy at the Discipline of Coloproctology of the University of São Paulo Medical School, São Paulo, SP, Brazil, respecting the characteristics of an institution of medical eduction. METHODS: Retrospective analysis of basis related to 2,567 fibro colonoscopies between 1984 and 2002. The procedure was performed in hospitalized and in outpatients. The most common indications for colonoscopy were investigation of rectal bleeding and anemia (22.4%), change of bowel habit (14.76%), inflammatory bowel disease (8.65%) and carcinoma (7.25%). Bowel preparation with manitol was used by most of the patients. Sedation, when not contra-indicated, was administered. The most common combination was meperidine and benzodiazepine. All the exams were monitored with pulse oximeter. A normal colonoscopy to the point of maximum insertion was reported in 42.42% of procedures. The most common diagnosis was polyps (15.47%), followed by diverticular disease (12.86%). Inflammatory disease was recorded in 11.88% and carcinoma in 10.21%. Polypectomy was undertaken in 397 patients (2.21 polypectomy per patient with polyps). Colonoscopy was considered incomplete (when the colonoscope did not pass to the cecum or terminal ileum) in 181 (7.05%) cases. Perforation was reported in one patient who had a subestenosing retossigmoid tumor. In 0.42%, reasons for failing to complete the procedure included complication related to sedation, with no further prejudice for the patients. CONCLUSIONS: Colonoscopic examination of the entire colon remains the standard for visualization, biopsy and treatment of colonic affections. The incidence of complication of endoscopy of the large bowel is quite low, even in a school hospital.

Sergio Carlos Nahas; Carlos Frederico Sparapan Marques; Sérgio Alonso Araújo; Adilson Akihide Aisaka; Caio Sérgio Rizkallah Nahas; Rodrigo Ambar Pinto; Desidério Roberto Kiss

2005-01-01

162

Bowel vaginoplasty in children  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVES: To describe our experience with bowel vaginoplasty done in children. MATERIALS AND METHODS: This is a retrospective study of eight children aged 10 months to 8 years, who underwent bowel vaginoplasty over a period of 5 years (2000-2005). The indications of bowel vaginoplasty included anorectovestibular fistula (ARVF) associated with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (n=6) and cloaca (n=2). The bowel segment used for vaginoplasty included colon (n=3), ileum (n=2) and duplicated rectum (n=1). In two patients of ARVF associated with uterovaginal agenesis, the distal- most part of ARVF was transected at the level of peritoneal reflection and left as neovagina, whereas the proximal bowel was pulled through at the proposed neo-anal site. All the patients were advised daily home dilatation of the neo vaginal orifice with Hegar?s dilators, for a period of six weeks. RESULTS: Bowel vaginoplasty was done in eight patients. None had any significant per-operative complication. Two patients had abdominal wound dehiscence, requiring secondary suturing. Two patients had mucosal prolapse of the neovagina, which required trimming. One patient died two months after discharge, because of meningitis. Out of the eight patients, seven are in regular follow-up. Six patients have neovagina, cosmetically acceptable to the parents; all have been radiologically proven to have adequate length. One patient had unacceptable perineal appearance with nipple-like vaginal orifice and scarred perineal wound, that merits a revision. None of the patients had vaginal stenosis and excessive mucus discharge, during follow-up visits. Although post surgical results are acceptable to the parents cosmetically, the sexual and psychological outcome is yet to be assessed. Conclusions: Bowel vaginoplasty is a safe and acceptable procedure to treat the pediatric patients of uterovaginal agenesis and cloaca.

Sarin Yogesh; Pathak D; Sengar M

2006-01-01

163

Role of scintigraphy in inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available The diagnosis of inflammatory bowel disease (IBD) depends on direct endoscopic visualization of the colonic and ileal mucosa and the histological study of the obtained samples. Radiological and scintigraphic methods are mainly used as an adjunct to endoscopy. In this review, we focus on the diagnostic potential of nuclear medicine procedures. The value of all radiotracers is described with special reference to those with greater experience and more satisfactory results. Tc-99m hexamethylpropylene amine oxime white blood cells remain a widely acceptable scintigraphic method for the diagnosis of IBD, as well as for the evaluation of disease extension and severity. Recently, pentavalent Tc-99m dimercaptosuccinic acid has been recommended as an accurate variant and a complementary technique to endoscopy for the follow-up and assessment of disease activity. Positron emission tomography alone or with computed tomography using fluorine-18 fluorodeoxyglucose appears to be a promising method of measuring inflammation in IBD patients.

Maria I Stathaki, Sophia I Koukouraki, Nikolaos S Karkavitsas, Ioannis E Koutroubakis

2009-01-01

164

Osteoporosis in patients with inflammatory bowel disease.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Bone mineral content in spinal trabecular and peripheral cortical bone was measured in 75 unselected patients with small and/or large intestinal inflammatory bowel disease. Osteoporosis, defined as a bone mineral content greater than 2 SD below the age and sex matched normal mean value was present i...

Compston, J E; Judd, D; Crawley, E O; Evans, W D; Evans, C; Church, H A; Reid, E M; Rhodes, J

165

Inflammatory bowel disease  

Energy Technology Data Exchange (ETDEWEB)

Radiology is of considerable value in all forms of inflammatory bowel disease to establish its presence and extent, and to differentiate lesions. The most common inflammatory bowel diseases are Crohn's disease and ulcerative colitis. Crohn's disease may occur anywhere in the disgestive tract, but is most common in the terminal ileum. Since there is no practical endoscopic method of examining the small bowel, barium studies of the latter are most important. Modern radiological techniques, especially the double contrast barium enema, show excellent correlation between the macroscopic changes and the radiological features. Radiology alone does not provide the answers and the radiological features must be interpreted in conjunction with clinical investigation.

Kottler, R.E.; Freson, M. (Groote Schuur Hospital, Cape Town (South Africa). Dept. of Radiology)

1985-06-01

166

Tumor-bowel fistula: what radiologists should know.  

Science.gov (United States)

Tumor-bowel fistula is an under reported complication of abdomino-pelvic malignancies which may occur spontaneously due to tumor growth or can be associated with cancer treatment. Chemotherapy and radiotherapy are commonly responsible for tumor-bowel fistulas. Molecular targeted therapies are a new class of drugs that can cause tumor fistulization due to their antiangiogenic properties. Clinically, the fistula can be asymptomatic or can result in devastating complications. Imaging helps in the prompt detection of these fistulas and the complications associated with them. Management of tumor-bowel fistula is individualized but often involves discontinuation of the associated treatment. Radiologists should promptly alert the oncology team about the presence of tumor-bowel fistula and any risk factors for its occurrence like pneumatosis or large metastatic deposits close to bowel loops. PMID:23455947

Tirumani, Sree Harsha; Baez, Juan C; Jagannathan, Jyothi P; Shinagare, Atul B; Ramaiya, Nikhil H

2013-10-01

167

Radical surgical approach to radiation injury of the small bowel  

Energy Technology Data Exchange (ETDEWEB)

During a period of 12 years, 52 patients without tumor recurrence were treated for chronic radiation injury to the small bowel. Eighteen patients also had concomitant large bowel injuries. Forty-seven patients were treated surgically, 42 of whom presented with obstruction, necrosis, or perforation of the bowel and had emergency operations. Thirty-eight patients underwent wide resection of the injured bowel, and six had bypass procedures. Anastomotic leakage occurred in 6 percent of the patients. The operative morbidity rate was 34 percent, and the mortality rate, 9 percent. Based on this experience, when surgery for small intestinal radiation injury is mandatory, the procedure should be a generous small bowel resection whenever possible, and probably should be performed only by experienced surgeons.

Harling, H.; Balslev, I.

1986-06-01

168

Intramucosal nevus of buccal mucosa in a male child.  

UK PubMed Central (United Kingdom)

Nevus (mole or birthmark) is a benign tumour of skin and mucosa characterised by the presence of melanin-producing, neuroectodermally derived cells, which can be light to dark brown, reddish brown, blue or flesh coloured. It varies in shape from oval to round. Oral melanotic nevi are uncommon oral lesions causing focal pigmentation. They were found only in 0.1% of population in a large survey. Nevi can be acquired over time or congenital. Acquired nevi are considered benign neoplasms whereas congenital nevi are hamartomas. They are located usually on the palate but less commonly on buccal mucosa, gingiva and lips. This article presents a case report of an intramucosal nevus of buccal mucosa in a 5-year-old boy with its surgical removal.

Pandey P; Chaudhary CP; Ansari AA; Singh R

2013-01-01

169

Intramucosal nevus of buccal mucosa in a male child.  

Science.gov (United States)

Nevus (mole or birthmark) is a benign tumour of skin and mucosa characterised by the presence of melanin-producing, neuroectodermally derived cells, which can be light to dark brown, reddish brown, blue or flesh coloured. It varies in shape from oval to round. Oral melanotic nevi are uncommon oral lesions causing focal pigmentation. They were found only in 0.1% of population in a large survey. Nevi can be acquired over time or congenital. Acquired nevi are considered benign neoplasms whereas congenital nevi are hamartomas. They are located usually on the palate but less commonly on buccal mucosa, gingiva and lips. This article presents a case report of an intramucosal nevus of buccal mucosa in a 5-year-old boy with its surgical removal. PMID:23887988

Pandey, Pallavi; Chaudhary, Chandra P; Ansari, Afroz Alam; Singh, Raghvendra

2013-07-25

170

[Idiopatic bowel disease  

UK PubMed Central (United Kingdom)

On the basis of retrospective five years analysis the authors process the problematic of idiopatic bowel disease--Morbus Crohn and ulcerative colitis. They pay main attention to surgical issue--types of operations, differences between acute and elective surgery, perioperative problems and results.

Krska Z; Sváb J; Lukás M; Pesková M

2006-05-01

171

[Idiopatic bowel disease].  

Science.gov (United States)

On the basis of retrospective five years analysis the authors process the problematic of idiopatic bowel disease--Morbus Crohn and ulcerative colitis. They pay main attention to surgical issue--types of operations, differences between acute and elective surgery, perioperative problems and results. PMID:16805343

Krska, Z; Sváb, J; Lukás, M; Pesková, M

2006-05-01

172

Small bowel tissue smear  

Science.gov (United States)

Small bowel tissue smear is a laboratory test that checks for disease in a sample of tissue from the small intestine. ... A laboratory smear poses no risks to the patient. For risks related to obtaining a sample of intestinal tissue, see EGD .

173

[Disease concept and definition of irritable bowel syndrome].  

UK PubMed Central (United Kingdom)

Irritable bowel syndrome (IBS) is a disease entity characterized by recurrent abdominal pain or discomfort associated with altered bowel movement, in which no obvious pathogenetic lesion is identified to explain the symptoms. Postulated pathogenesis for IBS are; motility disorder, visceral sensation abnormalities, complex relationship between brain and gut, relationship to personality, and post-infectious abnormalities in the colonic mucosa. Though many possibilities are presented, diagnostic criteria for IBS are entirely based on the subjective symptoms of the patients. Stress or psychological distress seem to play some roles in the pathogenesis, any of the diagnostic criteria for IBS do not include such aspects. Manning's criteria seem to be the first one to mention the diagnostic criteria. Rome consensus (1988) provoked the attention to IBS among the investigators, with followers like Rome II (1999), and BMW(2000) in Japan. Recently, Rome III criteria was published, which is more clinical oriented.

Hongo M; Sato Y

2006-08-01

174

[Disease concept and definition of irritable bowel syndrome].  

Science.gov (United States)

Irritable bowel syndrome (IBS) is a disease entity characterized by recurrent abdominal pain or discomfort associated with altered bowel movement, in which no obvious pathogenetic lesion is identified to explain the symptoms. Postulated pathogenesis for IBS are; motility disorder, visceral sensation abnormalities, complex relationship between brain and gut, relationship to personality, and post-infectious abnormalities in the colonic mucosa. Though many possibilities are presented, diagnostic criteria for IBS are entirely based on the subjective symptoms of the patients. Stress or psychological distress seem to play some roles in the pathogenesis, any of the diagnostic criteria for IBS do not include such aspects. Manning's criteria seem to be the first one to mention the diagnostic criteria. Rome consensus (1988) provoked the attention to IBS among the investigators, with followers like Rome II (1999), and BMW(2000) in Japan. Recently, Rome III criteria was published, which is more clinical oriented. PMID:16898604

Hongo, Michio; Sato, Yasuhiro

2006-08-01

175

[Genetics and environment in chronic inflammatory bowel diseases].  

UK PubMed Central (United Kingdom)

Inflammatory bowel diseases are both environmental and genetic illnesses. More than one hundred genes or loci involved in the regulation of innate or acquired immune response as well as intestinal mucosa homeostasis have been identified. Environmental studies have been less numerous up to now and only smoking and appendectomy have been validated, as protector for ulcerative colitis, while smoking is clearly associated with an increased risk and more severe forms of Crohn's disease. An important role is also currently suspected for the intestinal flora and the dysbiosis described in inflammatory bowel disease could contribute to the triggering or the persistence of the inflammation. New therapeutic strategies are currently studied, particularly aiming at targeting immune, inflammatory or homeostatic pathways corresponding to the predisposing gene variants.

Louis E; Van Kemseke C; Latour P; Belaiche J; Reenaers C

2012-05-01

176

Drug Reactions in Oral Mucosa  

Directory of Open Access Journals (Sweden)

Full Text Available Both immunologic and nonimmunologic drug reactions can be seen in oral mucosa. Since considerable number of these reactions heals spontaneously without being noticed by the patients, exact frequency of the lesions is unknown. Most common lesions are xerostomia, taste disorders, mucosal ulcerations and edema. In this article, oral lesions resulting from drug intake similar to those from oral lesions of local and systemic diseases, and diagnostic problems caused by these similarities, have been reviewed.

Emine Dervi?

2012-01-01

177

Small bowel endoscopy in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

The last decade has witnessed a revolution in small bowel (SB) endoscopy technologies. Endoscopists are no longer confined to the use of push enteroscopy or the significantly more invasive intra-operative enteroscopy: SB capsule endoscopy (SBCE) and device assisted enteroscopy (DAE) have rapidly enabled endoscopic visualisation of the entire SB without the need for surgery. DAE goes a step further by allowing tissue sampling and the application of endotherapy. These developments have also been parallelled by rapid advances in dedicated radiological SB imaging technologies. Although it is clear that SBCE and DAE may have a significant role in the diagnosis and management of IBD patients, their respective place in relation to other technologies within the clinical paradigm of IBD is as yet unclear. This review outlines the current evidence base relating to these endoscopic technologies and their impact in the diagnosis and management of IBD and highlights current international recommendations.

Despott EJ; Fraser C

2012-06-01

178

Gut-homing CD4+ T cell receptor alpha beta+ T cells in the pathogenesis of murine inflammatory bowel disease  

DEFF Research Database (Denmark)

We studied which T cell subsets from the gut-associated lymphoid tissue (GALT) can migrate out of the gut mucosa and repopulate GALT compartments of an immunodeficient (semi)syngeneic host. Many distinct lymphocyte subsets were found in GALT of immunocompetent H-2d (BALB/c, BALB/cdm2, C.B-17+/+) mice. No antigen receptor-expressing lymphoid cells were found in GALT of congenic C.B-17 scid/scid (scid) mice. The heterotopic transplantation of a full-thickness gut wall graft from the ileum or colon of immunocompetent (C.B-17+/+, BALB/cdm2) donor mice onto immunodeficient scid mice selectively reconstituted a CD3+ T cell receptor alpha beta+ CD4+ T cell subset. CD4+ cells of this subset expressed the surface phenotype of mucosa-seeking, memory T cells. In the immunodeficient scid host, this gut-derived CD4+ T cell subset was found in spleen, peritoneal cavity, mesenteric lymph nodes (LN), epithelial layer and lamina propria of the small and large intestine, but not in peripheral LN. Scid mice heterotopically transplanted with gut from a congenic, immunocompetent donor developed clinical and histological signs of inflammatory bowel disease (IBD). Hence, the selective repopulation of GALT compartments with CD4+ T cells from normal GALT plays an essential role in the pathogenesis of IBD in an immunodeficient host.

Rudolphi, A; Boll, G

1994-01-01

179

[Changes in the small intestine mucosa in chronic alcoholism  

UK PubMed Central (United Kingdom)

Morphologic and enzyme induction phenomena changes in the small bowel mucosa produced by excessive alcohol intake were studied. Both aspects may have nutritional repercussions in alcoholic patients. Three groups of patients were included in the study: group I made up of 20 healthy controls, group II with 30 alcoholic patients with active alcohol intake at the time of the study and group III made up of 30 alcoholics following abstinence. The nutritional status, possible existence of associated liver disease, intestinal morphology and the mucosal and serum gamma glutamyltranspeptidase (GGT) levels were evaluated. The morphologic changes observed under the study conditions, with normal levels of ingestion in alcoholic with active alcohol intake, were mild and could be related with the nutritional status and folate deficiency which some presented than being secondary to a direct toxic effect of the alcohol. Moreover, significant increases were observed in the GGT in the intestinal mucosa of alcoholics with active intake (3.97 +/- 1.37 mU/g of tissue) with respect to the control group (1.86 +/- 0.7 mU/g). The changes were rapidly reversible following abstinence and correlated with the changes observed in serum, thus suggesting an enzymatic induction mechanism.

García-Pugés AM; Elena M; Bordas JM; Bombí JM; Barragán V; Terés J

1995-06-01

180

Tc-99m sucralfate scanning for inflammatory bowel disease  

International Nuclear Information System (INIS)

The authors investigated 14 patients with idiopathic inflammatory bowel disease (IBD) by administering Tc-99m sucralfate (TcS) orally and imaging the abdomen 4 and 24 hours after dose. All patients had either barium radiographic studies or colonoscopy before the scan. The scan identified seven of nine patients who had radiologically demonstrated small-bowel lesions and four of five patients with colonic disease. The authors' preliminary experience suggests that TcS maybe a useful procedure to document location and extent of active disease. It provides information about both small and large bowel in one procedure, is noninvasive, easy to perform, and has low radiation absorbed dose.

1987-12-04

 
 
 
 
181

Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time. Methods Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded. Results Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE. Conclusion The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.

Fork Frans-Thomas; Karlsson Nils; Kadhem Sattar; Ohlsson Bodil

2012-01-01

182

Products used on female genital mucosa.  

UK PubMed Central (United Kingdom)

A wide variety of products are used by women in the genital area and, therefore, come into contact with the genital mucosa. The largest category of such products would be those used for cleanliness and odor control, such as soaps and body washes, douches, premoistened wipes and towelettes, dusting powder and deodorant sprays. A second large category of products are those intended to absorb fluids, such as products used for menstrual protection (tampons, pads and panty liners) and incontinence protection. Lubricants and moisturizers, and aesthetic products (hair removal products and dyes) are also fairly common. In addition, over the counter medications are now available for the treatment of fungal infections. This chapter briefly discusses the products women use on or around the genital area, the perceived or real benefits, and the potential health effects of these products.

Farage MA; Lennon L; Ajayi F

2011-01-01

183

Products used on female genital mucosa.  

Science.gov (United States)

A wide variety of products are used by women in the genital area and, therefore, come into contact with the genital mucosa. The largest category of such products would be those used for cleanliness and odor control, such as soaps and body washes, douches, premoistened wipes and towelettes, dusting powder and deodorant sprays. A second large category of products are those intended to absorb fluids, such as products used for menstrual protection (tampons, pads and panty liners) and incontinence protection. Lubricants and moisturizers, and aesthetic products (hair removal products and dyes) are also fairly common. In addition, over the counter medications are now available for the treatment of fungal infections. This chapter briefly discusses the products women use on or around the genital area, the perceived or real benefits, and the potential health effects of these products. PMID:21325843

Farage, Miranda A; Lennon, Lisa; Ajayi, Funmi

2011-02-10

184

Inflammatory bowel disease epidemiology.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: The occurrence of inflammatory bowel disease (IBD) is increasing worldwide, yet the reasons remain unknown. New therapeutic approaches have been introduced in medical IBD therapy, but their impact on the natural history of IBD remains uncertain. This review will summarize the recent findings in the epidemiology of IBD. RECENT FINDINGS: The incidence of IBD in western Europe is twice as high as in eastern Europe, whereas the highest IBD incidence in the world is found in the Faroe Islands. Early intervention with immunosuppressant and biological agents seems to have reduced the colectomy rates for ulcerative colitis, whereas the impact on Crohn's disease has yet to be determined. Mortality in Crohn's disease has not changed despite improvements in medical and surgical management. Specialized care in IBD centres, treatments to target and obtaining mucosal healing, early intervention at relapse and avoiding Clostridium difficile super infection might reduce the mortality rate in the future. The risk of colorectal cancer in Crohn's disease seems to be equivalent to the risk in ulcerative colitis. Patients with small bowel Crohn's disease are at increased risk of small bowel adenocarcinoma. SUMMARY: The natural disease course of IBD seems to change along with the new 'treat to target' goal of achieving intestinal mucosal healing. Future population-based studies of unselected IBD cohorts should be considered the gold standard for studies investigating these issues.

Burisch J; Munkholm P

2013-07-01

185

Bowel disease after radiotherapy  

International Nuclear Information System (INIS)

The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery. (author)

1983-01-01

186

Bowel disease after radiotherapy  

Energy Technology Data Exchange (ETDEWEB)

The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery.

Schofield, P.F.; Holden, D.; Carr, N.D. (Christie Hospital and Holt Radium Inst., Manchester (UK))

1983-06-01

187

Diagnosis of ectopic gastric mucosa using Tc99m-pertechnetate: spectrum of findings and utility of delayed imaging  

International Nuclear Information System (INIS)

[en] Introduction: The utility of Tc99m-pertechnetate scintigraphy in the diagnosis of ectopic gastric mucosa is well established, particularly in the case of Meckel's diverticulum. However, there is substantial variation in the reported sensitivity of Tc99m-pertechnetate scintigraphy for the diagnosis of ectopic gastric mucosa. None of these authors used delayed imaging. Aims and Objectives: We highlight spectrum of scintigraphic findings likely to be encountered in patients with ectopic gastric mucosa with illustrative cases for each such finding and the utility of delayed imaging as a part of Tc99m-pertechnetate scintigraphy in the diagnosis of ectopic gastric mucosa, when initial images are equivocal or negative. Materials and Methods: Six children (aged 4 months to 48 months, all males) underwent Tc99m-pertechnetate scintigraphic evaluation for ectopic gastric mucosa. Static images were obtained for 1 minute for every 5 minutes during the first 60 minutes and subsequently at 6 hours post injection. Results: Ectopic gastric mucosa was found in intrathoracic fore-gut duplication cysts in two, in small bowel duplications in two, in a gastric duplication in one and in a Meckel's diverticulum in one patient. In the two patients with intrathoracic duplication cysts, the ectopic gastric mucosa was evident only in delayed images. Conclusion: A variety of scintigraphic patterns may be found in patients with ectopic gastric mucosa undergoing Tc99m-pertechnetate scintigraphy depending upon the location and size of the ectopic tissue. Acquisition of delayed images may be useful when the initial images are negative, particularly in infants with intrathoracic ectopic gastric mucosa

2002-10-02

188

Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging.  

UK PubMed Central (United Kingdom)

AIM: To evaluate the effects of the various methods of small bowel preparation on the quality of visualization of the small bowel and the gastrointestinal transit time of capsule endoscopy (CE). METHODS: Ninety patients referred for CE were prospectively randomized to three equal groups according to the preparation used: (a) a control group, in which patients were requested to drink 1 L of clear liquids only, 12 h before the examination; (b) a purgative group, in which patients were requested to ingest 1 L of a polyethylene glycol (PEG)/electrolyte solution only, 12 h before the examination; or (c) a purgative combined with simethicone group (P-S group), in which patients were requested to ingest 1 L of PEG, 12 h before the examination, and 300 mg of simethicone, 20 min before the examination. Effects of the different bowel preparations on the gastric transit time (GTT), small bowel transit time (SBTT), examination completion rate, quality of images of the entire small intestine, and cleansing of the proximal small bowel and distal ileum were evaluated. RESULTS: The number of patients with "adequate" cleansing of the entire small intestine was 17 in the P-S group, 12 in the purgative group, and seven in the control group (P= 0.002). The P-S group had significantly better image quality than the control group (P= 0.001). The P-S group had significantly better image quality for the proximal small bowel (segment A [Seg A]) than the control group (P= 0.0001). Both the P-S group (P= 0.0001) and the purgative group (P= 0.0002) had significantly better image quality for the distal ileum (segment B [Seg B]) than the control group; the P-S group had significantly better image quality than the purgative group as well (P= 0.0121). Gastrointestinal transit time was not different among the three groups, nor was the examination completion rate. CONCLUSIONS: Purgative bowel cleansing combined with simethicone before CE improved the quality of imaging of the entire small bowel as well as the visualization of the mucosa in the proximal and distal small intestine.

Wei W; Ge ZZ; Lu H; Gao YJ; Hu YB; Xiao SD

2008-01-01

189

Use of buccal mucosa in hypospadias repair.  

Science.gov (United States)

Hypospadias is an embryological disorder that results in an abnormal ventral positioning of the urethral meatus. Among multiple surgical techniques described to correct this anomaly, the use of buccal mucosa grafts has gained popularity among pediatric urologists, pediatric surgeons and plastic surgeons. Buccal mucosa grafts have shown favorable histological changes that result in an excellent scaffold for urethral reconstructive surgery. This review describes the evolution of the use of buccal mucosa grafts in hypospadias repair. PMID:23686357

Cruz-Diaz, Omar; Castellan, Miguel; Gosalbez, Rafael

2013-08-01

190

Use of buccal mucosa in hypospadias repair.  

UK PubMed Central (United Kingdom)

Hypospadias is an embryological disorder that results in an abnormal ventral positioning of the urethral meatus. Among multiple surgical techniques described to correct this anomaly, the use of buccal mucosa grafts has gained popularity among pediatric urologists, pediatric surgeons and plastic surgeons. Buccal mucosa grafts have shown favorable histological changes that result in an excellent scaffold for urethral reconstructive surgery. This review describes the evolution of the use of buccal mucosa grafts in hypospadias repair.

Cruz-Diaz O; Castellan M; Gosalbez R

2013-08-01

191

[Oral mucosa for reconstructive urethral surgery].  

UK PubMed Central (United Kingdom)

The use of oral mucosa for urethral stricture repair has become the standard approach in reconstructive urethral surgery. Compared to other tissues oral mucosa shows several advantages, such as simple harvesting, good urine tolerance and low harvesting morbidity. For defects of the male bulbar urethra measuring 2 cm or longer, urethral reconstruction with oral mucosa is the procedure of choice. The oral mucosa graft can be used as an inlay or as an onlay graft. Most repairs can be completed in one stage but for complex strictures two stages are needed.

Mayr R; Pycha A

2013-05-01

192

Mucolytic bacteria with increased prevalence in IBD mucosa augment in vitro utilization of mucin by other bacteria.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Mucosa-associated bacteria are increased in inflammatory bowel disease (IBD), which suggests the possibility of an increased source of digestible endogenous mucus substrate. We hypothesized that mucolytic bacteria are increased in IBD, providing increased substrate to sustain nonmucolytic mucosa-associated bacteria. METHODS: Mucolytic bacteria were characterized by the ability to degrade human secretory mucin (MUC2) in pure and mixed anaerobic cultures. Real-time PCR was used to enumerate mucosa-associated mucolytic bacteria in 46 IBD and 20 control patients. Bacterial mucolytic activity was tested in vitro using purified human MUC2. RESULTS: We confirm increased total mucosa-associated bacteria 16S rRNA gene in macroscopically and histologically normal intestinal epithelium of both Crohn's disease (CD) (mean 1.9-fold) and ulcerative colitis (UC) (mean 1.3-fold). We found a disproportionate increase in some mucolytic bacteria. Mean Ruminococcus gnavus were increased >4-fold and Ruminococcus torques ?100-fold in macroscopically and histologically normal intestinal epithelium of both CD and UC. The most abundantly detected mucolytic bacterium in controls, Akkermansia muciniphila, was reduced many fold in CD and in UC. Coculture of A. muciniphila with MUC2 as the sole carbon source led to reduction in its abundance while it augmented growth of other bacteria. CONCLUSIONS: Mucolytic bacteria are present in healthy humans, where they are an integral part of the mucosa-associated bacterial consortium. The disproportionate increase in R. gnavus and R. torques could explain increased total mucosa-associated bacteria in IBD.

Png CW; Lindén SK; Gilshenan KS; Zoetendal EG; McSweeney CS; Sly LI; McGuckin MA; Florin TH

2010-11-01

193

Treatment of irritable bowel syndrome.  

UK PubMed Central (United Kingdom)

WHAT IS KNOWN AND OBJECTIVE: The complexity and diversity of irritable bowel syndrome's (IBS) presentation make treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the efficacy of medications to treat IBS symptoms, reported by IBS subtype, including secondary symptom endpoints that are often underreported. METHODS: A review of PubMed for articles published through December 2009 using the keywords: 'irritable bowel syndrome', 'therapeutics', 'antidiarrhoeals', 'laxatives', 'loperamide', 'dietary fibre', 'psyllium', 'calcium polycarbophil', 'bulking agents', 'lubiprostone', 'antidepressant agents, tricyclics' and its representative entities, 'serotonin reuptake inhibitors' and its representative entities, 'dicyclomine', hyoscyamine', 'peppermint oil', 'parasympatholytics' and its representative entities, 'rifaximin', 'pregabalin', 'gabapentin', 'clonidine', 'octreotide', 'atropine' and 'probiotics' is provided. Placebo-controlled trials were evaluated for the strength of evidence supporting the efficacy of each medication for explicit IBS symptoms. The efficacy of each medication for the symptoms of abdominal pain, bloating, stool form, mucus, urgency, feeling of incomplete evacuation, flatulence, frequency, or borborgymi and overall symptoms are reported by IBS subtype. RESULTS AND DISCUSSION: The literature search identified 58 placebo-controlled trials of the efficacy of medications for treating IBS symptoms, which were critically evaluated and reported. The available studies suggest improvement in various IBS symptoms with loperamide, fibre supplements, lubiprostone, tricyclic antidepressants (TCAs), selective serotonin receptor inhibitors (SSRIs), antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide and probiotic treatments. WHAT IS NEW AND CONCLUSion: This review is the first to compile the available evidence on the efficacy of the various pharmacological treatments for IBS on the basis of IBS subtype and specific symptoms. This evidence is limited and more well-designed studies are required to better inform therapeutic decision-making in the management of this difficult syndrome.

Trinkley KE; Nahata MC

2011-06-01

194

Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives. Zollinger-Ellison Syndrome (ZES) results in hypersecretion of gastric acid (via gastrinoma) leading to peptic ulcers, diarrhea, and abdominal pain. We describe the novel discovery of hypertrophic, heterotopic gastric mucosa in the proximal duodenal bulb in patients with ZES, which we hypothesize results in an increased incidence of postbulbar ulcers in patients with ZES (a mechanism previously unreported). We determined the incidence of the novel finding of duodenal gastric oxyntic hypertrophic heterotopia (GOH) in patients with ZES. Methods. Seven patients with ZES were enrolled. The diagnosis of ZES was established by hypergastrinemia, gastric acid hypersecretion, and a positive secretin test or based on biopsy specimens (evaluated via tissue staining). Basal acid output (BAO) and baseline gastrin secretion were determined by established methods. Endoscopic examinations with methylene blue staining and biopsy of the gastric and duodenal mucosa were conducted in all patients every 3–6 months for an average of 5 years. Results. The duodenal mucosa demonstrated hypertrophic GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. Biopsies from the bowel mucosa demonstrated patchy replacement of surface epithelium by gastric-type epithelium with hypertrophic oxyntic glands in the lamina propria in 5 patients. Two of the patients had no evidence of GOH in the duodenal bulb. Patients with GOH had an average serum gastrin level of 1245?pg/mL and BAO of 2.92?mEq/hr versus 724?pg/mL and 0.8?mEq/hr in patients without GOH. Conclusions. This study demonstrated the presence of duodenal mucosa with GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. The presence of hypertrophic and heterotopic gastric mucosa is proposed to result from increased gastrin levels and may contribute to the increased incidence of postbulbar ulcers in these patients.

Emil Kohan; David Oh; Hank Wang; Salar Hazany; Gordon Ohning; Joseph R. Pisegna

2009-01-01

195

Gluten affects epithelial differentiation-associated genes in small intestinal mucosa of coeliac patients  

Science.gov (United States)

In coeliac disease gluten induces an immunological reaction in genetically susceptible patients, and influences on epithelial cell proliferation and differentiation in the small-bowel mucosa. Our aim was to find novel genes which operate similarly in epithelial proliferation and differentiation in an epithelial cell differentiation model and in coeliac disease patient small-bowel mucosal biopsy samples. The combination of cDNA microarray data originating from a three-dimensional T84 epithelial cell differentiation model and small-bowel mucosal biopsy samples from untreated and treated coeliac disease patients and healthy controls resulted in 30 genes whose mRNA expression was similarly affected. Nine of 30 were located directly or indirectly in the receptor tyrosine kinase pathway starting from the epithelial growth factor receptor. Removal of gluten from the diet resulted in a reversion in the expression of 29 of the 30 genes in the small-bowel mucosal biopsy samples. Further characterization by blotting and labelling revealed increased epidermal growth factor receptor and beta-catenin protein expression in the small-bowel mucosal epithelium in untreated coeliac disease patients compared to healthy controls and treated coeliac patients. We found 30 genes whose mRNA expression was affected similarly in the epithelial cell differentiation model and in the coeliac disease patient small-bowel mucosal biopsy samples. In particular, those genes involved in the epithelial growth factor-mediated signalling pathways may be involved in epithelial cell differentiation and coeliac disease pathogenesis. The epithelial cell differentiation model is a useful tool for studying gene expression changes in the crypt–villus axis.

Juuti-Uusitalo, K; Maki, M; Kainulainen, H; Isola, J; Kaukinen, K

2007-01-01

196

[Inflammatory bowel diseases].  

Science.gov (United States)

COX-2 specific anti-inflammatory agents appear as able to induce a flare of inflammatory bowel disease as classical anti-inflammatory agents. The use of steroids, immunomodulators or infliximab prior to surgery does not appear to increase post-operative complication rates. Cases of hepatitis B reactivation have been described after infliximab therapy, suggesting that hepatitis B serological status should be verified prior to infliximab therapy. Adalimubab, a fully humanized antibody directed against TNF-alpha, is efficacious in patients that have lost response or did not tolerate infliximab. Approval of this agent is still awaited. Leucoapheresis is a promising tool in ulcerative colitis. PMID:15770816

Felley, C; Guyot, J; Hess, J; Mottet, C; Delarive, J; Michetti, P

2005-01-19

197

[Inflammatory bowel diseases  

UK PubMed Central (United Kingdom)

COX-2 specific anti-inflammatory agents appear as able to induce a flare of inflammatory bowel disease as classical anti-inflammatory agents. The use of steroids, immunomodulators or infliximab prior to surgery does not appear to increase post-operative complication rates. Cases of hepatitis B reactivation have been described after infliximab therapy, suggesting that hepatitis B serological status should be verified prior to infliximab therapy. Adalimubab, a fully humanized antibody directed against TNF-alpha, is efficacious in patients that have lost response or did not tolerate infliximab. Approval of this agent is still awaited. Leucoapheresis is a promising tool in ulcerative colitis.

Felley C; Guyot J; Hess J; Mottet C; Delarive J; Michetti P

2005-01-01

198

Small bowel mesentery fibroma  

Directory of Open Access Journals (Sweden)

Full Text Available Fibromas are rarely localized in the abdomen, but almost always in the mesentery or omentum. We present a 63-year old woman in whom the examination of the upper abdominal pain showed a well distinct abdominal mass at the level of the lower edge of the pancreas. During the operation a tumor 100 ? 87 x 70 mm in size, from the radix of small bowel mesentery, was excised, Seven months later the patient is symptom-free with normal ultrasonographic and CT findings.

?olovi? Radoje B.; Micev Marjan; Zogovi? Sergej; Grubor Nikica M.; Stojkovi? Mirjana

2002-01-01

199

Transabdominal ultrasound for bowel evaluation.  

UK PubMed Central (United Kingdom)

This article considers the case for a strategic place for ultrasound (US) bowel evaluation focusing on three common clinical contexts. These include imaging for suspected acute appendicitis and acute diverticulitis, as well as the role of US in a multimodality approach for the diagnosis and management of inflammatory bowel disease and associated complications.

Rodgers PM; Verma R

2013-01-01

200

Lipoma in Oral Mucosa: Two Case Reports  

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Lipoma is a common tumor of soft tissue. Its location on the oral mucosa is rare, representing 1% to 5% of benign oral tumors although it is the most mesenchymal tumor of the trunk and proximal por-tions of extremities. Lipoma of the oral cavity may occur in any region. The buccal mucosa, tongue, an...

Hoseini, Ali Tavakoli; Razavi, Seyed Mohammad; Khabazian, Arezu

 
 
 
 
201

[Eosinophilic ulcer of the oral mucosa  

UK PubMed Central (United Kingdom)

The eosinophilic ulcer is a rare lesion of the oral mucosa; it is a benign disease, the etiology and the pathogenesis are unknown. The authors describe a patient with eosinophilic ulcer of the oral mucosa. The clinical, pathologic and therapeutic aspects of this rare disease are discussed.

Pierleoni L; Nardi P; Rubino I; Ficarra G

1996-07-01

202

Oral purgative and simethicone before small bowel capsule endoscopy  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate small bowel cleansing quality, diagnostic yield and transit time, comparing three cleansing protocols prior to capsule endoscopy. METHODS: Sixty patients were prospectively enrolled and randomized to one of the following cleansing protocols: patients in Group A underwent a 24 h liquid diet and overnight fasting; patients in Group B followed protocol A and subsequently were administered 2 L of polyethylene glycol (PEG) the evening before the procedure; patients in Group C followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. RESULTS: There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). CONCLUSION: Preparation with 2 L of PEG before small bowel capsule endoscopy (SBCE) may improve small bowel cleansing and the quality of visualization. Simethicone may further reduce intraluminal bubbles. No significant differences were found regarding GET, SBTT and the proportion of complete exploration or diagnostic yield among the three different cleansing protocols.

Bruno Joel Ferreira Rosa; Mara Barbosa; Joana Magalhães; Ana Rebelo; Maria João Moreira; José Cotter

2013-01-01

203

Oral purgative and simethicone before small bowel capsule endoscopy.  

UK PubMed Central (United Kingdom)

AIM: To evaluate small bowel cleansing quality, diagnostic yield and transit time, comparing three cleansing protocols prior to capsule endoscopy. METHODS: Sixty patients were prospectively enrolled and randomized to one of the following cleansing protocols: patients in Group A underwent a 24 h liquid diet and overnight fasting; patients in Group B followed protocol A and subsequently were administered 2 L of polyethylene glycol (PEG) the evening before the procedure; patients in Group C followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. RESULTS: There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). CONCLUSION: Preparation with 2 L of PEG before small bowel capsule endoscopy (SBCE) may improve small bowel cleansing and the quality of visualization. Simethicone may further reduce intraluminal bubbles. No significant differences were found regarding GET, SBTT and the proportion of complete exploration or diagnostic yield among the three different cleansing protocols.

Rosa BJ; Barbosa M; Magalhães J; Rebelo A; Moreira MJ; Cotter J

2013-02-01

204

Imaging of inflammatory bowel disease. How?  

Energy Technology Data Exchange (ETDEWEB)

Traditionally the small bowel (barium) follow through (SBFT) has been the investigation of choice for that otherwise inaccessible length of gut between the duodenum and the ileocaecal valve. Whilst it is still a widely practised examination by radiologists it is being largely overtaken by other imaging modalities with CT, MRI and capsule endoscopy (CE) all competing for the territory. At the end of the last century, proponents of enteroclysis were predicting the eventual decline of the SBFT (in adults) although at that stage, in a 'state of the art' article, they were still brave enough to say that 'only in the small bowel does barium radiography remain unchallenged'. The same authors now write of how radiological investigations complement other techniques but are no longer the mainstay. (orig.)

Hiorns, Melanie P. [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom)

2008-06-15

205

Inflammatory bowel disease in children: Indian perspective.  

UK PubMed Central (United Kingdom)

The magnitude of inflammatory bowel disease in childhood in India is largely unknown. At the Pediatric Gastroenterology section of PGIMER, Chandigarh, 15 out of 294 children (5%) admitted for colonic disorders were diagnosed to have ulcerative colitis. Diagnosis is suspected on the basis of clinical presentation and established by sigmoidoscopy, rectal biopsy and double contrast barium enema. Widely prevalent bacillary dysentery, acute amoebic colitis and antibiotic induced colitis need to be kept in differential diagnosis of acute presentation of ulcerative colitis. Chronic or recurrent colitis needs to be differentiated from tuberculous colitis. Inflammatory bowel disease deserves clinical suspicion in all unusual cases of colitis which do not respond to treatment of common infective agents.

Mehta S

1999-01-01

206

Incidence, presentation, and prognosis of small bowel adenocarcinoma in patients with small bowel Crohn's disease: a prospective observational study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Patients with Crohn's disease (CD) of the colon are at risk for colorectal cancer and should be screened for dysplasia and cancer of the colon. Small bowel adenocarcinoma (SBA) is a complication of small bowel CD and carries a poor prognosis. However, there is no screening test for SBA in patients with small bowel CD. The aim of this study was to assess the risk and incidence of SBA in a large prospective cohort of patients with small bowel CD and to compare it with the risk of colorectal cancer in patients with CD involving the colon, recruited in the same cohort. METHODS: In a nationwide French cohort, 11,759 patients with CD were enrolled by 680 gastroenterologists. The SBA risk was obtained by dividing the observed cases in our cohort to the expected cases in the general population. RESULTS: At baseline, 8222 (69.9%) patients had small bowel CD (either alone or associated with colonic CD); their median follow-up was 35 months (interquartile range, 29-40). Five new cases of SBA were diagnosed, all in patients with small bowel CD, within inflamed areas. Among the 5 patients with incident SBA, 4 died of SBA and 1 is in remission 7 years after the diagnosis of SBA. The incidence rates of SBA were 0.235 per 1000 patient-years (95% confidence interval [CI], 0.076-0.547) among patients with small bowel CD and 0.464 per 1000 patient-years (95% CI, 0.127-1.190) among those with small bowel CD for >8 years. This accounted for approximately 30% of the risk of colorectal cancer in patients with CD of the colon. Patients with small bowel CD and small bowel CD for >8 years had an SBA standardized incidence ratio of 34.9 (95% CI, 11.3-81.5) and 46.0 (95% CI, 12.5-117.8), respectively. CONCLUSIONS: SBA in patients with small bowel CD carries a poor prognosis, and its risk is approximately 30% of colorectal cancer risk in patients with CD of the colon. Further studies should determine if small bowel endoscopic screening in high-risk patients is feasible and effective.

Elriz K; Carrat F; Carbonnel F; Marthey L; Bouvier AM; Beaugerie L

2013-08-01

207

Laser treatment of oral mucosa tattoo.  

UK PubMed Central (United Kingdom)

The most common oral solitary pigmented lesion is the dental amalgam tattoo. It occurs as a result of colouring of the tissue by alien pigment which was administered intra or subepidermaly either intentionally or accidentally. The most common material used for the colouring of the oral mucosa is amalgam from amalgam fillings and metal particles from prosthetic restorations which are absorbed accidentally. The oral mucosa tattoos are most often found in the area of the marginal gingiva or the buccal mucosa. The metal particles may accidentally reach the area of the oral mucosa during various dentistry interventions. The therapy most often involves surgical intervention with excisional biopsy while in the recent period the low power laser therapy has provided exceptional results. The aim of the paper was to present the successful removal of the oral mucosa tattoo in a single visit.

Gojkov-Vukelic M; Hadzic S; Pasic E

2011-12-01

208

Laser Treatment of Oral Mucosa Tattoo  

Science.gov (United States)

The most common oral solitary pigmented lesion is the dental amalgam tattoo. It occurs as a result of colouring of the tissue by alien pigment which was administered intra or subepidermaly either intentionally or accidentally. The most common material used for the colouring of the oral mucosa is amalgam from amalgam fillings and metal particles from prosthetic restorations which are absorbed accidentally. The oral mucosa tattoos are most often found in the area of the marginal gingiva or the buccal mucosa. The metal particles may accidentally reach the area of the oral mucosa during various dentistry interventions. The therapy most often involves surgical intervention with excisional biopsy while in the recent period the low power laser therapy has provided exceptional results. The aim of the paper was to present the successful removal of the oral mucosa tattoo in a single visit.

Gojkov-Vukelic, Mirjana; Hadzic, Sanja; Pasic, Enes

2011-01-01

209

Association of HLA-DQ gene with bowel transit, barrier function, and inflammation in irritable bowel syndrome with diarrhea.  

Science.gov (United States)

Patients with irritable bowel syndrome (IBS) with diarrhea (IBS-D) carrying human leukocyte antigen (HLA)-DQ2/8 genotypes benefit from gluten withdrawal. Our objective was to compare gastrointestinal barrier function, mucosal inflammation, and transit in nonceliac IBS-D patients and assess association with HLA-DQ2/8 status. In 45 IBS-D patients who were naive to prior exclusion of dietary gluten, we measured small bowel (SB) and colonic mucosal permeability by cumulative urinary lactulose and mannitol excretion (0-2 h for SB and 8-24 h for colon), inflammation on duodenal and rectosigmoid mucosal biopsies (obtained in 28 of 45 patients), tight junction (TJ) protein mRNA and protein expression in SB and rectosigmoid mucosa, and gastrointestinal and colonic transit by validated scintigraphy. SB mucosal biopsies were stained with hematoxylin-eosin to assess villi and intraepithelial lymphocytes, and immunohistochemistry was used to assess CD3, CD8, tryptase, and zonula occludens 1 (ZO-1); colonic biopsy intraepithelial lymphocytes were quantitated. Associations of HLA-DQ were assessed using Wilcoxon's rank-sum test. Relative to healthy control data, we observed a significant increase in SB permeability (P DQ2/8-positive patients, ZO-1 protein expression in the rectosigmoid mucosa was reduced compared with that in HLA-DQ2/8-negative patients and colonic transit was slower than in HLA-DQ2/8-negative patients. No other associations with HLA genotype were identified. There is abnormal barrier function (increased SB permeability and reduced mRNA expression of TJ proteins) in IBS-D relative to health that may be, in part, related to immunogenotype, given reduced ZO-1 protein expression in rectosigmoid mucosa in HLA-DQ2/8-positive relative to HLA-DQ2/8-negative patients. PMID:23042942

Vazquez-Roque, Maria I; Camilleri, Michael; Smyrk, Thomas; Murray, Joseph A; O'Neill, Jessica; Carlson, Paula; Lamsam, Jesse; Eckert, Deborah; Janzow, Denise; Burton, Duane; Ryks, Michael; Rhoten, Deborah; Zinsmeister, Alan R

2012-10-04

210

Olfactory Mucosa Transplantation for Spinal Cord Injury  

Directory of Open Access Journals (Sweden)

Full Text Available Carlos Lima et al. who are pioneers in this field reported their clinical pilot study of olfactory mucosa transplantation for chronic spinal cord injury. They showed the safety and feasibility of it. Olfactory mucosa contains the olfactory ensheathing cells and neural stem cells. Recent studies have demonstrated the potential therapeutic role of both cells in spinal cord injury. We have already reported the effectiveness of olfactory mucosa transplantation for rat spinal cord injury. Furthermore we indicated the reconstruction of cortico-spinal tract by BDA (biotinylated dextran amine) tracer study with the olfactory mucosa transplantation. We elucidated how grafts of nasal olfactory mucosa repair the injured rat spinal cord as compared with the nasal respiratory mucosa containing no olfactory ensheathing cell and neural stem cell. The spinal cord of recipient rats (adult female Sprague-Dawlley rats; 10 rats; 160-180g) was exposed at The 8-9 level, and a contusion injury was produced using the weight drop device developed at New York University. The exposed cord was moderately contused by a 10g weight that dropped from a height of 75 mm. A couple of weeks after injury, the injury site were exposed and posterior sulcus of the spinal cord was opened. Minced olfactory mucosa or respiratory mucosa derived from GFP rats were transplanted into the sulcuses. The BBB score in each animal was observed at 1, 2, 4 and 8 weeks after the transplantation. The recovery of the hind limb movement in the olfactory mucosa transplanted rats improved significantly compared to the respiratory mucosa transplanted rats. In histological assessment, the expression of p75NGFR and GFAP was strong in the olfactory mucosa grafts at 1 and 2 weeks after the transplantation and it was decreased at 8 weeks after the transplantation. The expression of p75NGFR and GFAP was not observed in the respiratory mucosa graft. The expression of Neurofilament was observed strongly at the site in the olfactory mucosa transplanted rats. The numerous fibres strongly stained with Neurofilament were surrounding the GFP positive cells and penetrating the transplanted olfactory mucosa. There were no apparent Neurofilament stained fibres at the marginal spinal cord. As we have already reported, olfactory mucosa transplantation for spinal cord injury has a certain effectiveness for the hind limb motor recovery. In this study, we recognized the numerous axons which surround the transplanted cells and penetrate the mucosa at the transplanted site without marginal spinal white matter. Olfactory mucosa might be more suitable niche than white matter which contains inhibiting factor for axonal regeneration in spinal cord. To succeed the neuronal regenerative therapy, cells, factors and scaffold have been required. Olfactory mucosa might have all of them. We are now performing the clinical trial of olfactory mucosa transplantation for chronic complete spinal cord injuries in Japan. We could have four patients so far and recognize the voluntary EEG of their thigh.

Koichi Iwatsuki

2011-01-01

211

Canine gut dendritic cells in the steady state and in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

Alongside the intestinal border, dendritic cells (DCs) sample large amounts of endogenous and potentially pathogenic antigens followed by initiation of protective immune responses or induction of tolerance. Breakdown of oral tolerance towards commensal bacteria is suggested to be crucial for the development of both human and canine inflammatory bowel disease (IBD). The aim of this study was to investigate canine intestinal DCs in the steady state and in dogs with IBD using multicolour immunofluorescence. In the healthy gut, DC-like cells expressed MHC II, CD1a8.2 and CD11c, and, in lower amounts, CD11b, within lamina propria, Peyer's patches (PPs) and mesenteric lymph nodes (MLNs), whereas those expressing CD80 and CD86 were only present in PPs and MLNs. Occasionally, DC-like cells were in contact with the intestinal lumen through transepithelial projections. In canine IBD, CD1a8.2+, CD11b+ and CD11c+ DC-like cells were decreased within the stomach, duodenum and colon, whereas the colonic mucosa revealed elevation of CD86+ DC-like cells. The complex network of DC-like cells in the gut indicates their important role in canine mucosal immunity, including active sampling of luminal antigens. Furthermore, their shift in diseased dogs suggests a pathogenetic significance for canine IBD.

Junginger J; Lemensieck F; Moore PF; Schwittlick U; Nolte I; Hewicker-Trautwein M

2013-05-01

212

Reduced T Cell Receptor Excision Circle Levels in the Colonic Mucosa of Microscopic Colitis Patients Indicate Local Proliferation rather than Homing of Peripheral Lymphocytes to the Inflamed Mucosa  

Science.gov (United States)

Dysregulated T cell responses in the intestine may lead to chronic bowel inflammation such as collagenous colitis (CC) and lymphocytic colitis (LC), together known as microscopic colitis (MC). Having demonstrated increased local T cell responses in the intestinal mucosa of MC patients, we investigated the recent thymic emigrants by measuring T cell receptor excision circle (TREC) levels in the colonic biopsies from CC (n = 8), LC (n = 5), and CC or LC patients in histopathological remission (CC-HR, n = 3) (LC-HR, n = 6), non-inflamed diarrhoea patients (n = 17), and controls (n = 10) by real-time PCR. We observed lower median TREC levels in both CC and LC patients as well as in LC-HR patients compared to controls. In contrast to MC patients, non-inflamed diarrhoea patients presented with enhanced TREC levels compared to controls. None of the recorded differences did, however, reach statistical significance. A trend towards increased relative expression of CD3 was noted in all MC subgroups examined and reached statistical significance in LC patients compared to controls. In conclusion, reduced TRECs level in the colonic mucosa, together with our previously demonstrated enhanced expression of Ki67+ T cells, suggests local expansion of resident T lymphocytes in the inflamed mucosa of MC patients.

Elgbratt, Kristina; Tysk, Curt; Bohr, Johan; Hultgren Hornquist, Elisabeth

2013-01-01

213

[Inflammatory bowel diseases: diagnosis (including new procedures for small intestine examination)].  

Science.gov (United States)

Medical history, clinical examination, general laboratory data and microbial stool examinations are basic diagnostics in inflammatory bowel diseases. Specific immunologic parameters can make classification easier in indefinite disease, their use is still in an experimental state. Ultrasound and endoscopic examinations have largely replaced conventional radiological procedures. For the experienced examiner, ultrasound allows assessment of small bowel and colon as well as other organs. Ileo-colonoscopy with biopsies remains the gold standard in the diagnosis of inflammatory bowel diseases. For small bowel examination, modern methods like push-enteroscopy, capsule endoscopy or the Hydro-MRI can be employed. At the moment, their usage is limited to specialized centers. Because of its broad availability small bowel follow through is still the standard in small bowel examination. After 8 years of colitis ulcerosa, ileo-colonoscopy with biopsy should be performed every year according to the guidelines. If these recommendations also apply to Crohn's disease is not sure yet. PMID:12501497

Hahne, M; Riemann, J F

2002-11-20

214

Adenocarcinoma of the small bowel  

International Nuclear Information System (INIS)

[en] Adenocarcinoma of small bowel is generally a rather rare primary tumour of small bowel with a prevalence rate of 0.5 - 3.0 / 100.000 population, but the most frequent tumour of small intestine. It more often involves the duodenum and jejunum than the ileum. The aim of this paper is also to point out the value of small bowel follow through (SBFT) in the diagnosis of stenosing lesions. An 83 - year old male patient suffered from abdominal pain, malaise, vomiting, cachexia and diarrhoea for 3 months. The result of occult blood testing was negative. Haemoglobin level was normal. Proctoscopy, colonoscopy, upper gastrointestinal (GI) endoscopy, and ultrasonography (US) did not explain the patient's problems. Ileus of the small bowel was established with abdominal plain film. Small bowel follow through (SBFT) and computer tomography (CT) showed a stenosing tumour in the jejunum. Adenocarcinoma of the small bowel was established with histological examination after resection of the tumor. SBFT, with manual compression of all segments of the small bowel, can be a very accurate diagnostic investigation for evaluation of stenosing lesions in this part of the intestine. (author)

2007-01-01

215

CT findings of small bowel metastases from primary lung cancer  

International Nuclear Information System (INIS)

[en] To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and pattern of small bowel metastases as well as in demonstrating their complication

216

Alteraciones histológicas asociadas a la preparación mecánica en cirugía colorrectal electiva/ Bowel wall alterations associated with mechanical bowel cleansing before elective colonic surgery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Introducción: La preparación mecánica anterograda de colon en cirugía electiva es una práctica común utilizada en distintas operaciones sobre el segmento distal del tubo digestivo. La limpieza intestinal ha demostrado provocar alteraciones fisiológicas significativas y algunos autores han relacionado su uso con una mayor incidencia de complicaciones sépticas, aunque sin demostrar un sustrato anatómico o histológico que avale estas afirmaciones. Objetivo: Demostr (more) ar la aparición de alteraciones histológicas asociadas al uso de preparación mecánica anterograda en cirugía colorrectal electiva. Material y método: Durante un periodo de 10 meses se incluyeron en este estudio todos los pacientes sometidos a cirugía electiva de colon. Se excluyeron los pacientes que recibieron radioterapia pre operatoria y quienes recibieron preparación mecánica la semana previa a la cirugía. Los pacientes fueron randomizados en dos grupos: con y sin preparación de colon. Un patólogo evaluó las alteraciones histológicas en mucosa sana en forma ciega. Los datos fueron analizados con el programa Stata 8.0. Resultados: Participaron 34 pacientes en este estudio, de los que se excluyeron 2 por no haber sido resecados, ambos en el grupo que recibió preparación mecánica. El estudio de siete parámetros no demostró alteración significativa en los pacientes que recibieron preparación mecánica anterograda (p > 0,05). Conclusión: En esta serie prospectiva y aleatoria no se encontraron alteraciones histológicas atribuibles al uso de la preparación mecánica anterograda Abstract in english Background: Anterograde mechanical bowel cleansing is a common practice in colorectal surgery. However it can produce physiological disturbances and can be associated to a higher frequency of septic complications. Aim: To evaluate the appearance of histological alterations in the colon wall, associated to anterograde bowel cleansing. Material and methods: All patients subjected to elective colon surgery were randomized to a group with and other group without anterograde m (more) echanical bowel cleansing before surgery. Patients subjected to preoperative radiotherapy and those that were subjected to bowel cleansing the week previous to surgery, were excluded. A sample was obtained from normal colon mucosa, far from the lesion that motivated surgery, for pathological study. The pathologist was unaware of the group assignation of patients. Results: Thirty four patients were studied. Eighteen (nine women) were randomized to receive mechanical bowel cleansing, 14 (eight women) did not receive cleansing and two were excluded from the study. No significant pathological bowel wall alterations were detected in the group subjected to mechanical cleansing. Conclusions: No pathological alterations of the bowel wall, attributed to anterograde bowel cleansing, were detected in this group of patients

BARRERA E, ALEJANDRO; PEÑALOZA M, PAULINA; BANNURA C, GUILLERMO; ZÚÑIGA T, CLAUDIO; CONTRERAS P, JAIME; CUMSILLE G, MIGUEL ANGEL; CID B, HÉCTOR

2008-02-01

217

Alteraciones histológicas asociadas a la preparación mecánica en cirugía colorrectal electiva Bowel wall alterations associated with mechanical bowel cleansing before elective colonic surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Introducción: La preparación mecánica anterograda de colon en cirugía electiva es una práctica común utilizada en distintas operaciones sobre el segmento distal del tubo digestivo. La limpieza intestinal ha demostrado provocar alteraciones fisiológicas significativas y algunos autores han relacionado su uso con una mayor incidencia de complicaciones sépticas, aunque sin demostrar un sustrato anatómico o histológico que avale estas afirmaciones. Objetivo: Demostrar la aparición de alteraciones histológicas asociadas al uso de preparación mecánica anterograda en cirugía colorrectal electiva. Material y método: Durante un periodo de 10 meses se incluyeron en este estudio todos los pacientes sometidos a cirugía electiva de colon. Se excluyeron los pacientes que recibieron radioterapia pre operatoria y quienes recibieron preparación mecánica la semana previa a la cirugía. Los pacientes fueron randomizados en dos grupos: con y sin preparación de colon. Un patólogo evaluó las alteraciones histológicas en mucosa sana en forma ciega. Los datos fueron analizados con el programa Stata 8.0. Resultados: Participaron 34 pacientes en este estudio, de los que se excluyeron 2 por no haber sido resecados, ambos en el grupo que recibió preparación mecánica. El estudio de siete parámetros no demostró alteración significativa en los pacientes que recibieron preparación mecánica anterograda (p > 0,05). Conclusión: En esta serie prospectiva y aleatoria no se encontraron alteraciones histológicas atribuibles al uso de la preparación mecánica anterogradaBackground: Anterograde mechanical bowel cleansing is a common practice in colorectal surgery. However it can produce physiological disturbances and can be associated to a higher frequency of septic complications. Aim: To evaluate the appearance of histological alterations in the colon wall, associated to anterograde bowel cleansing. Material and methods: All patients subjected to elective colon surgery were randomized to a group with and other group without anterograde mechanical bowel cleansing before surgery. Patients subjected to preoperative radiotherapy and those that were subjected to bowel cleansing the week previous to surgery, were excluded. A sample was obtained from normal colon mucosa, far from the lesion that motivated surgery, for pathological study. The pathologist was unaware of the group assignation of patients. Results: Thirty four patients were studied. Eighteen (nine women) were randomized to receive mechanical bowel cleansing, 14 (eight women) did not receive cleansing and two were excluded from the study. No significant pathological bowel wall alterations were detected in the group subjected to mechanical cleansing. Conclusions: No pathological alterations of the bowel wall, attributed to anterograde bowel cleansing, were detected in this group of patients

ALEJANDRO BARRERA E; PAULINA PEÑALOZA M; GUILLERMO BANNURA C; CLAUDIO ZÚÑIGA T; JAIME CONTRERAS P; MIGUEL ANGEL CUMSILLE G; HÉCTOR CID B

2008-01-01

218

[Irritable bowel syndrome  

UK PubMed Central (United Kingdom)

The prevalence of irritable bowel syndrome (IBS) ranges in all countries of the world between 6 and 25%, in Germany between 15 and 22%. The divergent rates of prevalence are mainly due to different definitions of IBS in epidemiological studies. In Germany, 20-50% of persons with IBS symptoms seek medical help. IBS patients produce high direct and indirect costs. The following psychophysiological mechanisms of IBS are presumed to be empirically validated: visceral hypersensitivity, postinfectious sequelae, psychiatric disorders, and psychosocial stress. Tricyclic antidepressant agents and psychotherapy (hypnosis, cognitive behavioral therapy, and psychodynamic therapy) are effective for treatment of IBS forms dominated by pain. In one controlled study, the combination of pharmacological therapy and cognitive behavioral therapy was superior to pharmacological therapy alone.

Häuser W; Lempa M

2004-04-01

219

Common polymorphisms in the microsomal epoxide hydrolase and N-acetyltransferase 2 genes in association with inflammatory bowel disease in the Danish population  

DEFF Research Database (Denmark)

Chronic inflammatory bowel disease (IBD) is characterized by recurrent inflammation of the intestinal mucosa. Reactive molecules play a central role in altering the intestinal permeability, which may induce or sustain an immune response. Changes in detoxification of substances that causes epithelial damage may confer susceptibility to IBD. Hence, polymorphic enzymes involved in the detoxification processes may be risk factors of IBD.

Ernst, Anja; Andersen, Vibeke

2011-01-01

220

Pseudopathologies and Examination of the Oral Mucosa  

Directory of Open Access Journals (Sweden)

Full Text Available Oral mucosa for shedding light on diagnosis of many cutaneous and systemic diseases, is an area not to be overlooked during the physical examination. Unlike cutaneous lesions, oral mucosa includes the non-keratinized sections and since it has anatomically and histologically special structures such as salivary glands and papillaries, the physician must recognize some detail, and features during the examination. To distinguish of usual and unusual changes in this area is important for both diagnostic and therapeutic aspects. In this presentation, a detailed explanation of how each area of the mouth should be examined is provided and normal variations of oral mucosa are emphasized.

Can Ceylan

2012-01-01

 
 
 
 
221

CT assessment of anastomotic bowel leak  

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Aim: To evaluate the predictors of clinically important gastrointestinal anastomotic leaks using multidetector computed tomography (CT). Subjects and methods: Ninety-nine patients, 73 with clinical suspicion of anastomotic bowel leak and 26 non-bowel surgery controls underwent CT to investigate postoperative sepsis. Fifty patients had undergone large bowel and 23 small bowel anastomoses. The time interval from surgery was 3-30 days (mean 10 {+-} 5.9 SD) for the anastomotic group and 3-40 days (mean 14 {+-} 11 SD) for the control group (p = 0.3). Two radiologists blinded to the final results reviewed the CT examinations in consensus and recorded the presence of peri-anastomotic air, fluid or combination of the two; distant loculated fluid or combination of fluid and air; free air or fluid; and intestinal contrast leak. Final diagnosis of clinically important anastomotic leak (CIAL) was confirmed at surgery or by chart review of predetermined clinical and laboratory criteria. Results: The prevalence of CIAL in the group undergoing CT was 31.5% (23/73). The CT examinations with documented leak were performed 5-28 (mean; 11.4 {+-} 6 SD) days after surgery. Nine patients required repeat operation, 10 percutaneous abscess drainage, two percutaneous drainage followed by surgery, and two prolonged antibiotic treatment and total parenteral nutrition (TPN). Of the CT features examined, only peri-anastomotic loculated fluid containing air was more frequently seen in the CIAL group as opposed to the no leak group (p = 0.04). There was no intestinal contrast leakage in this cohort. Free air was present up to 9 days and loculated air up to 26 days without CIAL. Conclusion: Most postoperative CT features overlap between patients with and without CIAL. The only feature seen statistically more frequently with CIAL is peri-anastomotic loculated fluid containing air.

Power, N. [Department of Radiology, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada); Atri, M. [Department of Radiology, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada)]. E-mail: mostafa.atri@sw.ca; Ryan, S. [Department of Radiology, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada); Haddad, R. [Department of Surgery, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada); Smith, A. [Department of Surgery, Sunnybrook Hospital, Toronto, Ontario M4N 3M5 (Canada)

2007-01-15

222

MicroRNA expression patterns in indeterminate inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

A diagnosis of idiopathic inflammatory bowel disease requires synthesis of clinical, radiographic, endoscopic, surgical, and histologic data. While most cases of inflammatory bowel disease can be specifically classified as either ulcerative colitis or Crohns disease, 5-10% of patients have equivocal features placing them into the indeterminate colitis category. This study examines whether microRNA biomarkers assist in the classification of classically diagnosed indeterminate inflammatory bowel disease. Fresh frozen colonic mucosa from the distal-most part of the colectomy from 53 patients was used (16 indeterminate colitis, 14 Crohns disease, 12 ulcerative colitis, and 11 diverticular disease controls). Total RNA extraction and quantitative reverse-transcription-PCR was performed using five pairs of microRNA primers (miR-19b, miR-23b, miR-106a, miR-191, and miR-629). Analysis of variance was performed assessing differences among the groups. A significant difference in expressions of miR-19b, miR-106a, and miR-629 was detected between ulcerative colitis and Crohns disease groups (P<0.05). The average expression level of all five microRNAs was statistically different between indeterminate colitis and Crohns disease groups (P<0.05); no significant difference was present between indeterminate and ulcerative colitis groups. Among the 16 indeterminate colitis patients, 15 showed ulcerative colitis-like and one Crohns disease-like microRNA pattern. MicroRNA expression patterns in indeterminate colitis are far more similar to those of ulcerative colitis than Crohns disease. MicroRNA expression patterns of indeterminate colitis provide molecular evidence indicating that most cases are probably ulcerative colitis-similar to the data from long-term clinical follow-up studies. Validation of microRNA results by additional long-term outcome data is needed, but the data presented show promise for improved classification of indeterminate inflammatory bowel disease.

Lin J; Cao Q; Zhang J; Li Y; Shen B; Zhao Z; Chinnaiyan AM; Bronner MP

2013-01-01

223

Up-regulation and pre-activation of TRAF3 and TRAF5 in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

OBJECTIVE: TRAF3 and TRAF5 share a common ancestral gene, and interact as essential components of signaling pathways in immunity. TRAF3 and TRAF5 are overexpressed in the colon of rat/mouse models with colitis. However, the expressions of TRAF3 and TRAF5 in patients with inflammatory bowel disease have not been elucidated. The aim of the present study is to explore the potential roles of TRAF3 and TRAF5 in patients with inflammatory bowel disease. METHODS: Plasma levels of TRAF3 and TRAF5 proteins were detected by Enzyme-linked Immunosorbent Assay (ELISA). Colonic expression of TRAF3 and TRAF5 proteins was detected by western blot analysis. Quantitative Real-time PCR (qRT-PCR) was applied for gene expression. Inflamed intestinal mucosa and non-inflamed intestinal mucosa in patients with inflammatory bowel disease and normal mucosa was analyzed from healthy controls. RESULTS: The plasma levels of TRAF3 and TRAF5 were significantly higher both in patients with Crohn's disease and ulcerative colitis than in healthy controls. Only soluble TRAF5 showed a weak correlation with endoscopic disease activity index (Baron score) in patients with ulcerative colitis (spearman's r=0.358, P=0.022). Gene expressions of TRAF3 and TRAF5 in peripheral blood mononuclear cells were significantly higher both in patients with Crohn's disease and ulcerative colitis than in healthy controls (all P<0.0001). Gene and protein expressions of TRAF3 and TRAF5 were significantly higher in inflamed colonic mucosa of patients with Crohn's disease and ulcerative colitis than in non-inflamed colonic mucosa and normal mucosa of healthy controls (all P<0.0001). Furthermore, gene and protein expressions of TRAF3 and TRAF5 were also significantly higher in non-inflamed colonic mucosa of patients with Crohn's disease and ulcerative colitis than in normal mucosa of healthy controls. CONCLUSIONS: TRAF3 and TRAF5 are overexpressed in inflammatory bowel disease. Although the endoscopic appearance can be normal, TRAF3 and TRAF5 pre-activation can be detected in non-inflamed colonic segments.

Shen J; Qiao YQ; Ran ZH; Wang TR

2013-01-01

224

Up-regulation and Pre-activation of TRAF3 and TRAF5 in Inflammatory Bowel Disease  

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Full Text Available Objective: TRAF3 and TRAF5 share a common ancestral gene, and interact as essential components of signaling pathways in immunity. TRAF3 and TRAF5 are overexpressed in the colon of rat/mouse models with colitis. However, the expressions of TRAF3 and TRAF5 in patients with inflammatory bowel disease have not been elucidated. The aim of the present study is to explore the potential roles of TRAF3 and TRAF5 in patients with inflammatory bowel disease.Methods: Plasma levels of TRAF3 and TRAF5 proteins were detected by Enzyme-linked Immunosorbent Assay (ELISA). Colonic expression of TRAF3 and TRAF5 proteins was detected by western blot analysis. Quantitative Real-time PCR (qRT-PCR) was applied for gene expression. Inflamed intestinal mucosa and non-inflamed intestinal mucosa in patients with inflammatory bowel disease and normal mucosa was analyzed from healthy controls.Results: The plasma levels of TRAF3 and TRAF5 were significantly higher both in patients with Crohn's disease and ulcerative colitis than in healthy controls. Only soluble TRAF5 showed a weak correlation with endoscopic disease activity index (Baron score) in patients with ulcerative colitis (spearman's r=0.358, P=0.022). Gene expressions of TRAF3 and TRAF5 in peripheral blood mononuclear cells were significantly higher both in patients with Crohn's disease and ulcerative colitis than in healthy controls (all P<0.0001). Gene and protein expressions of TRAF3 and TRAF5 were significantly higher in inflamed colonic mucosa of patients with Crohn's disease and ulcerative colitis than in non-inflamed colonic mucosa and normal mucosa of healthy controls (all P<0.0001). Furthermore, gene and protein expressions of TRAF3 and TRAF5 were also significantly higher in non-inflamed colonic mucosa of patients with Crohn's disease and ulcerative colitis than in normal mucosa of healthy controls.Conclusions: TRAF3 and TRAF5 are overexpressed in inflammatory bowel disease. Although the endoscopic appearance can be normal, TRAF3 and TRAF5 pre-activation can be detected in non-inflamed colonic segments.

Jun Shen, Yu-qi Qiao, Zhi-hua Ran, Tian-rong Wang

2013-01-01

225

Irritable bowel syndrome in women.  

UK PubMed Central (United Kingdom)

Irritable bowel syndrome is a gastrointestinal disorder characterized by abdominal pain and changes in bowel habits. It adversely affects the quality of life for women who have it and is a significant health care burden. The syndrome results from the interaction of many factors that are not clearly understood, including stress, environment (internal and external), and biological mechanisms. It affects women more than men, and clear biological, psychological, and physical differences exist between the sexes, creating the need for a specialized approach to management in women. The objective of this article is to explore the pathophysiology of irritable bowel syndrome and how it relates specifically to women and to apply these differences to the diagnosis and treatment of irritable bowel syndrome in women.

Roisinblit KC

2013-01-01

226

Symptoms and signs in individuals with serology positive for celiac disease but normal mucosa  

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Full Text Available Abstract Background Antibody serology is an important tool in the investigation of celiac disease (CD), but does not always correlate with mucosal appearance in the small intestine. Patients with positive CD serology but normal mucosa (Marsh 0) are at increased risk of future CD. In this study we describe a model for identifying and characterizing individuals with normal mucosa but positive CD serology. Such individuals are sometimes referred to as having latent CD. Methods The records of ten Swedish pathology departments were used to identify individuals with biopsies indicating normal duodenal/jejunal mucosa. Using the national personal identification number, these data were linked with CD serology data (antigliadin, antiendomysial and tissue transglutaminase antibodies); and we thereby identified 3,736 individuals with normal mucosa but positive CD serology. Two independent reviewers then manually reviewed their biopsy reports to estimate comorbidity. We also randomly selected 112 individuals for validation through patient chart review. Results The majority of the 3,736 individuals were females (62%). Children (0–15 years) made up 21.4%. The median number of biopsy specimen was 3. Our review of biopsy reports found that other gastrointestinal comorbidity was rare (inflammatory bowel disease: 0.4%; helicobacter pylori infection: 0.2%). Some 22% individuals selected for patient chart review had a relative with CD. The most common symptoms among these individuals were diarrhea (46%) and abdominal pain (45%), while 26% had anemia. Although 27% of the individuals selected for validation had been informed about gluten-free diet, only 13% were adhering to a gluten-free diet at the end of follow-up. Conclusion Individuals with positive CD serology but normal mucosa often have CD-like symptoms and a family history of CD.

Ludvigsson Jonas F; Brandt Lena; Montgomery Scott M

2009-01-01

227

Oral mucosa: variations from normalcy, part II.  

UK PubMed Central (United Kingdom)

This is the second article in a 2-part series on the variations of oral mucosa. We describe the following 5 conditions that deviate from normalcy: lateral soft palate fistulas, double lip, fissured tongue, racial gingival pigmentation, and geographic tongue.

Leston JM; Santos AA; Varela-Centelles PI; Garcia JV; Romero MA; Villamor LP

2002-03-01

228

[Urethral reconstruction using buccal mucosa transplants].  

UK PubMed Central (United Kingdom)

Buccal mucosa is the ideal material for urethral reconstruction because it is easy to harvest, is accustomed to permanent moisture and can be used at any location in the urethra. Stricture length and local conditions of the urethra have to be considered to decide which technique is required to reconstruct the urethra. Open urethroplasty with buccal mucosa has a success rate over 85% and should be used after unsuccessful internal urethrotomy and primarily in longer strictures.

Engel O; Ahyai S; Rink M; Eichelberg C; Dahlem R; Fisch M

2013-05-01

229

[Urethral reconstruction using buccal mucosa transplants].  

Science.gov (United States)

Buccal mucosa is the ideal material for urethral reconstruction because it is easy to harvest, is accustomed to permanent moisture and can be used at any location in the urethra. Stricture length and local conditions of the urethra have to be considered to decide which technique is required to reconstruct the urethra. Open urethroplasty with buccal mucosa has a success rate over 85% and should be used after unsuccessful internal urethrotomy and primarily in longer strictures. PMID:23589043

Engel, O; Ahyai, S; Rink, M; Eichelberg, C; Dahlem, R; Fisch, M

2013-05-01

230

Autofluorescence spectroscopy of oral mucosa  

Science.gov (United States)

We report the results of an in-vitro study on autofluorescence from pathologically characterized normal and malignant squamous tissues from the oral cavity. The study involved biopsy samples from 47 patients with oral cancer of which 11 patients had cancer of tongue, 17 of buccal mucosa and 19 of alveolus. The results of excitation and emission spectroscopy at several wavelengths (280 nm less than or equal to (lambda) exless than or equal to 460 nm; 340 nm less than or equal to (lambda) em less than or equal to 520 nm) showed that at (lambda) ex equals 337 nm and 400 nm the mean value for the spectrally integrated fluorescence intensity [(Sigma) (lambda ) IF((lambda) )] from the normal tissue sites was about a factor of 2 larger than that from the malignant tissue sites. At other excitation wavelengths the difference in (Sigma) (lambda ) IF((lambda) ) was not statistically significant. Similarly, for (lambda) em equals 390 nm and 460 nm, the intensity of the 340 nm band of the excitation spectra from normal tissues was observed to be a factor of 2 larger than that from malignant tissues. Analysis of these results suggests that NADH concentration is higher in normal oral tissues compared to the malignant. This contrasts with our earlier observation of an reduced NADH concentration in normal sites of breast tissues vis a vis malignant sites. For the 337 nm excited emission spectra a 10-variable MVLR score (using (Sigma) (lambda ) IF((lambda) ) and normalized intensities at nine wavelengths as input parameters) provided a sensitivity and specificity of 95.7% and 93.1% over the sample size investigated.

Majumder, S. K.; Uppal, A.; Gupta, P. K.

1998-06-01

231

Expression of integrin alphavbeta6 in the intestinal epithelial cells of patients with inflammatory bowel disease  

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Full Text Available Background and aims: The prevalence of inflammatory bowel disease (IBD) is about 0.05% in industrialized countries. The pathogenesis of IBD remains to be further understood. The present study aims to elucidate the expression of integrin ?v?6 in the intestinal mucosa of patients with IBD. Materials and Methods: Colonic biopsy was obtained from a group of IBD patients. The expression of ?v?6 in the intestinal mucosa was detected by Western blotting. Human colonic epithelial cell line T84 cells were stimulated by microbial antigen flagellin. The expression of ?v?6 in T84 cells was evaluated by quantitative RT-PCR and Western blotting. Results: The levels of ?v?6 in the intestinal mucosa were much lower than it in normal control subjects. The serum levels of myeloperoxidase (MPO) were higher in IBD patients that were negatively correlated with the levels of ?v?6 in the intestinal mucosa. The expression of ?v?6 was detectable in T84 cells at naïve status that could be upregulated by exposure to microbial antigen flagellin. Pretreatment with MPO dramatically suppressed the expression of ?v?6 in T84 cells. Conclusions: We conclude that the expression of ?v?6 was suppressed in IBD intestinal mucosa, which could be resulted from the high levels of MPO.

Bai-Sui Feng; Xiao Chen; Ping Li; Peng-Yuan Zheng; Jasmine Chong; Dan-Bi Cho; Shao-Heng He; Shang-Guo Tang; Ping-Chang Yang

2009-01-01

232

Simethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Capsule endoscopy is a new imaging method for visualization of the entire small bowel. However, no standardized protocol for bowel preparation for capsule endoscopy has been evaluated. METHODS: Capsule endoscopy was performed in 36 consecutive patients, all of whom fasted for 12 hours before ingestion of the capsule. Before capsule endoscopy, 18 patients received 80 mg simethicone and 18 had no supplemental medication for bowel preparation. Two observers, both experienced endoscopists, independently reviewed the examinations in a single-blinded and randomly assigned fashion. Mucosal visibility and intraluminal gas bubbles were assessed and graded by both observers. RESULTS: Bowel preparation with simethicone resulted in significantly better visibility because of fewer intraluminal bubbles (p<0.01). Interobserver agreement was excellent (r>/=0.8; k 0.78: 95% CI[0.57, 0.98] ). No adverse effect of simethicone was observed. CONCLUSIONS: Simethicone may be added to the routine preparation for capsule endoscopy to improve the visibility of small bowel mucosa.

Albert J; Göbel CM; Lesske J; Lotterer E; Nietsch H; Fleig WE

2004-04-01

233

Úlcera eosinófila de la mucosa oral Eosinophilic ulcer of oral mucosa  

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Full Text Available La Úlcera Eosinófila de la Mucosa Oral, es una entidad poco frecuente, pobremente descrita en la literatura mundial. Se define como una lesión benigna autolimitada que si bien puede presentarse en distintas áreas de la cavidad bucal, presenta una marcada predilección por la mucosa ventral de la lengua. Clínicamente, se presenta como una lesión ulcerada de bordes indurados y sobreelevados. Los hallazgos histopatológicos son característicos y consisten en un infiltrado mixto rico en eosinófilos, acompañado de una población de grandes células mononucleadas. Recientes artículos basados en estudios inmunohistoquimicos, permiten afirmar la presencia de grandes linfocitos atípicos CD30+ y por lo tanto, incluir esta lesión en el espectro de las entidades simuladoras de desordenes linfoproliferativos. A pesar de esto, el mecanismo etiopatogenico permanece oscuro y el trauma local juega un rol todavía no dilucidado; aunque se halla presente en la mayoría de las publicaciones, explicando el fenómeno como un mecanismo reactivo. La importancia de esta lesión, radica en su diagnostico diferencial por su semejanza clínica al carcinoma espinocelular, histoplasmosis, chancro sifilítico, Úlcera tuberculosa, carcinoma epidermoide y otras. En nuestro trabajo se revisa la literatura y se discuten la características clínicas, histopatológicas y alternativas terapéuticas, a partir del artículo de un caso clínico en una paciente joven, que luego de la biopsia escisión como método para el diagnostico de certeza, se produce una recidiva de la lesión; lo que orientó el tratamiento hacia la cirugía combinada con corticoterapia local intralesional, logrando su remisión.Eosinophilic Ulcer of the Oral Mucosa, an entity, poorly deciphers in world-wide literature. It is defined as a self-limited, benign injury that although it can appear in different areas of the buccal cavity it presents a noticeable predilection via the ventral mucosa of the tongue. Clinically, one looks like an ulcer with hard and risen edges. The histo-pathological findings are typical and consist of a rich infiltrated mix of eosinophils, as well as a population of large mononuclear cells. Recent reports based on immunohistochemical studies allow us to confirm the presence of large atypical lymphocytes CD30+ and therefore include this lesion injury in the spectrum of lympho proliferative disorder simulators. Despite this the etiopathogenic mechanism remains unknown and local trauma still plays an unexplained roll; although the majority of publications have explained the phenomena as a reactive mechanism. The importance of this injury is established by its differential diagnostic because of its clinical similarity to Spinocellular Carcinoma, Histoplasmosis, syphilitic chancre, Ulcer Tuberculosis, Epidermoid Carcinoma and others. In our work the literature is reviewed and clinical characteristics, histo-pathologies and alternative therapies are discussed. We use the case of a young patient who has a biopsy in an effort to diagnose with certainty has a relapse of the lesion which directs the treatment towards combined surgery and local intra lesion cortico therapy which led to successful remission.

A.C. Bencini; C.A. Bencini; V. Strada; M. Florencia Soldavini; G.M. Bruno; M.F. Cordeu; M.A. Cotignola

2009-01-01

234

[Irritable bowel syndrome].  

Science.gov (United States)

Patients with irritable bowel syndrome (IBS) are highly prevalent among subjects seeking medical attention at the general practitioner or specialist level. While IBS lacks any disease associated excess mortality, this disorders is relevant to the affected subjects due to the considerable burden with regard to the symptoms and an impaired quality of life. Furthermore, this disease has a substantial impact on society due to the economical consequences. In recent years substantial progress has been achieved regarding our pathophysiological understanding. However, as usual, there has been a substantial delay between the discovery of disease mechanisms and its translation into improved patient care. For diagnosing IBS standardized criteria have been established (i. e. Rome II- or the DGVS-criteria). Regarding treatment, life style advice such as avoidance of specific nutrients that precipitate or aggravate or the "little psychotherapy" (addressing patients concerns and anxiety regarding the symptoms) are considered essential. However, the overall response rate is disappointing. Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists. At present no cure for patients with IBS exists. Thus, all currently available treatments target palliation of symptoms. This, however, may change in the future. PMID:15717250

Adam, B; Liebregts, T; Holtmann, G

2005-02-25

235

[Irritable bowel syndrome  

UK PubMed Central (United Kingdom)

Patients with irritable bowel syndrome (IBS) are highly prevalent among subjects seeking medical attention at the general practitioner or specialist level. While IBS lacks any disease associated excess mortality, this disorders is relevant to the affected subjects due to the considerable burden with regard to the symptoms and an impaired quality of life. Furthermore, this disease has a substantial impact on society due to the economical consequences. In recent years substantial progress has been achieved regarding our pathophysiological understanding. However, as usual, there has been a substantial delay between the discovery of disease mechanisms and its translation into improved patient care. For diagnosing IBS standardized criteria have been established (i. e. Rome II- or the DGVS-criteria). Regarding treatment, life style advice such as avoidance of specific nutrients that precipitate or aggravate or the "little psychotherapy" (addressing patients concerns and anxiety regarding the symptoms) are considered essential. However, the overall response rate is disappointing. Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists. At present no cure for patients with IBS exists. Thus, all currently available treatments target palliation of symptoms. This, however, may change in the future.

Adam B; Liebregts T; Holtmann G

2005-02-01

236

Pediatric Inflammatory Bowel Disease.  

UK PubMed Central (United Kingdom)

The combination of an unprecedented number of new therapeutic options (Fig. 1), along with new insights in how to optimize currently available therapies and advances in our understanding of disease pathogenesis, present many exciting new aspects to the management of patients with inflammatory bowel disease (IBD). Clinical management paradigms must evolve in parallel to keep pace with these advances. Traditional pediatric IBD regimens have underutilized combination therapies (Fig. 2) and immunomodulatory agents. Increased appreciation for steroid side effects is leading to a shift away from their inclusion in maintenance regimens. Immunomodulators are being introduced earlier in the course of disease for maintenance of remission and growth promotion. Recognition that the sole signs of active disease in children and adolescents may be growth and maturational delay, despite a relative lack of gastrointestinal symptoms, should prompt earlier, more aggressive interventions. When more potent, rapidly acting interventions such as infliximab, cyclosporine (CSA), or tacrolimus are considered, they should generally be co-administered with agents such as 6-mercaptopurine (6-MP) or azathioprine (AZA) for longer-term disease suppression.

Vasiliauskas E

2000-10-01

237

Pediatric Inflammatory Bowel Disease.  

Science.gov (United States)

The combination of an unprecedented number of new therapeutic options (Fig. 1), along with new insights in how to optimize currently available therapies and advances in our understanding of disease pathogenesis, present many exciting new aspects to the management of patients with inflammatory bowel disease (IBD). Clinical management paradigms must evolve in parallel to keep pace with these advances. Traditional pediatric IBD regimens have underutilized combination therapies (Fig. 2) and immunomodulatory agents. Increased appreciation for steroid side effects is leading to a shift away from their inclusion in maintenance regimens. Immunomodulators are being introduced earlier in the course of disease for maintenance of remission and growth promotion. Recognition that the sole signs of active disease in children and adolescents may be growth and maturational delay, despite a relative lack of gastrointestinal symptoms, should prompt earlier, more aggressive interventions. When more potent, rapidly acting interventions such as infliximab, cyclosporine (CSA), or tacrolimus are considered, they should generally be co-administered with agents such as 6-mercaptopurine (6-MP) or azathioprine (AZA) for longer-term disease suppression. PMID:11096601

Vasiliauskas

2000-10-01

238

Irritable bowel syndrome.  

UK PubMed Central (United Kingdom)

INTRODUCTION: The prevalence of irritable bowel syndrome (IBS) varies depending on the criteria used to diagnose it, but it ranges from about 5% to 20%. IBS is associated with abnormal gastrointestinal motor function and enhanced visceral perception, as well as psychosocial and genetic factors. People with IBS often have other bodily and psychiatric symptoms, and have an increased likelihood of having unnecessary surgery compared with people without IBS. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with IBS? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5HT(3) receptor antagonists (alosetron and ramosetron), 5HT(4) receptor agonists (tegaserod), antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors [SSRIs]), antispasmodics (including peppermint oil), cognitive behavioural therapy (CBT), hypnotherapy, loperamide, and soluble and insoluble fibre supplementation.

Ford AC; Vandvik PO

2012-01-01

239

Taming the irritable bowel.  

UK PubMed Central (United Kingdom)

This narrative review covers the mechanisms of actions of trendy drugs approved for or proposed for calming the irritable bowel. Many drugs that target functional gastrointestinal disorders (FGIDS), which includes IBS, have their actions in the enteric nervous system (i.e., the brain-in-the-gut). The in-depth insight into fundamental neurophysiology, which is essential for understanding how the drugs act to achieve their effects, is covered from a neurogastroenterological view point. Pharmacotherapeutic research in FGIDS, which is now lagging, is focused mainly on symptom control. Major progress will require a change to orientation on the malfunction underlying each of the symptoms that constitute Manning, Rome I and Rome II symptom-based criteria for FIGD diagnoses. A high incidence of autoimmune degenerative neuropathy in the enteric nervous system occurs in IBS and is postulated to be the cause of symptoms emerging from failure of normal neural control of motility, blood flow and secretory glands, in concert with sensitization of spinal and vagal sensory mechanisms.

Wood JD

2013-01-01

240

Small bowel tumors  

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Full Text Available SUMMARY Small intestinal neoplasms are uncommonly encountered in clinical practice. Small intestinal neoplasms may occur sporadically, or in association with genetic diseases such as familial adenomatous polyposis coli or Peutz-Jeghers syndrome, or in association with chronic intestinal inflammatory disorders such as Crohn?s disease or celiac sprue. Benign small intestinal tumors such as leiomyoma, lipoma, hamartoma or desmoid tumor, are usually asymptomatic but may present with intussception. Primary malignancies of the small intestine, including adenocarcinoma, leiomyosarcoma, carcinoid, and lymphoma, may present with intestinal obstruction, jaundice, bleeding, or pain. Extraintestinal neoplasms may involve the intestine via contiguous spread or peritoneal metastasis. Hematogenous metastases to the intestine from an extraintestinal primary are unusual and are most typical of melanoma. Because the small intestine is relatively inaccessible to routine endoscopy, diagnosis of small intestinal neoplasms is often delayed for months after onset of symptoms. When the diagnosis is suspected, enteroclysis is the most useful imaging study. Small bowel endoscopy (enteroscopy) is increasingly widely available and may permit earlier, non-operative diagnosis.

Xynopoulos D.; Mihas A.A.; Paraskevas E.; Dimitroulopoulos D.; Heuman D.M.; Mihas A.A.

2007-01-01

 
 
 
 
241

Association of HLA-DQ gene with bowel transit, barrier function, and inflammation in irritable bowel syndrome with diarrhea.  

UK PubMed Central (United Kingdom)

Patients with irritable bowel syndrome (IBS) with diarrhea (IBS-D) carrying human leukocyte antigen (HLA)-DQ2/8 genotypes benefit from gluten withdrawal. Our objective was to compare gastrointestinal barrier function, mucosal inflammation, and transit in nonceliac IBS-D patients and assess association with HLA-DQ2/8 status. In 45 IBS-D patients who were naive to prior exclusion of dietary gluten, we measured small bowel (SB) and colonic mucosal permeability by cumulative urinary lactulose and mannitol excretion (0-2 h for SB and 8-24 h for colon), inflammation on duodenal and rectosigmoid mucosal biopsies (obtained in 28 of 45 patients), tight junction (TJ) protein mRNA and protein expression in SB and rectosigmoid mucosa, and gastrointestinal and colonic transit by validated scintigraphy. SB mucosal biopsies were stained with hematoxylin-eosin to assess villi and intraepithelial lymphocytes, and immunohistochemistry was used to assess CD3, CD8, tryptase, and zonula occludens 1 (ZO-1); colonic biopsy intraepithelial lymphocytes were quantitated. Associations of HLA-DQ were assessed using Wilcoxon's rank-sum test. Relative to healthy control data, we observed a significant increase in SB permeability (P < 0.001), a borderline increase in colonic permeability (P = 0.10), and a decrease in TJ mRNA expression in rectosigmoid mucosa in IBS-D. In HLA-DQ2/8-positive patients, ZO-1 protein expression in the rectosigmoid mucosa was reduced compared with that in HLA-DQ2/8-negative patients and colonic transit was slower than in HLA-DQ2/8-negative patients. No other associations with HLA genotype were identified. There is abnormal barrier function (increased SB permeability and reduced mRNA expression of TJ proteins) in IBS-D relative to health that may be, in part, related to immunogenotype, given reduced ZO-1 protein expression in rectosigmoid mucosa in HLA-DQ2/8-positive relative to HLA-DQ2/8-negative patients.

Vazquez-Roque MI; Camilleri M; Smyrk T; Murray JA; O'Neill J; Carlson P; Lamsam J; Eckert D; Janzow D; Burton D; Ryks M; Rhoten D; Zinsmeister AR

2012-12-01

242

Oral mucosa grafts for urethral reconstruction  

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Full Text Available Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are flexible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution.

Mungadi I; Ugboko V

2009-01-01

243

Novel specific microRNA biomarkers in idiopathic inflammatory bowel disease unrelated to disease activity.  

UK PubMed Central (United Kingdom)

The diagnosis of idiopathic inflammatory bowel disease can be challenging. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate protein synthesis through post-transcriptional suppression. This study is to identify new miRNA markers in inflammatory bowel disease, and to examine whether miRNA biomarkers might assist in the diagnosis of inflammatory bowel disease. Illumina small RNA sequencing was performed on non-dysplastic fresh-frozen colonic mucosa samples of the distalmost colectomy tissue from 19 patients with inflammatory bowel disease (10 ulcerative colitis and 9 Crohn disease) and 18 patients with diverticular disease serving as controls. To determine differentially expressed miRNAs, the USeq software package identified 44 miRNAs with altered expression (fold change ?2 and false discovery rate ?0.10) compared with the controls. Among them, a panel of nine miRNAs was aberrantly expressed in both ulcerative colitis and Crohn disease. Validation assays performed using quantitative reverse transcription PCR (qRT-PCR) on additional frozen tissue from ulcerative colitis, Crohn disease, and control groups confirmed specific differential expression in inflammatory bowel disease for miR-31, miR-206, miR-424, and miR-146a (P<0.05). The expression of these four miRNAs was further evaluated on formalin-fixed, paraffin-embedded tissue of the distalmost colectomy mucosa from cohorts of diverticular disease controls (n=29), ulcerative colitis (n=36), Crohn disease (n=26), and the other diseases mimicking inflammatory bowel disease including infectious colitis (n=12) and chronic ischemic colitis (n=19), again confirming increased expression specific to inflammatory bowel disease (P<0.05). In summary, we demonstrate that miR-31, miR-206, miR-424, and miR-146a are novel specific biomarkers of inflammatory bowel disease. Furthermore, miR-31 is universally expressed in both ulcerative colitis and Crohn disease not only in fresh-frozen but also in formalin-fixed, paraffin-embedded tissues.Modern Pathology advance online publication, 20 September 2013; doi:10.1038/modpathol.2013.152.

Lin J; Welker NC; Zhao Z; Li Y; Zhang J; Reuss SA; Zhang X; Lee H; Liu Y; Bronner MP

2013-09-01

244

[Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome].  

UK PubMed Central (United Kingdom)

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS (41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

Arévalo F; Aragon V; Montes P; Guzmán E; Monge E

2011-10-01

245

Probiotics in Inflammatory Bowel Diseases and Associated Conditions  

Directory of Open Access Journals (Sweden)

Full Text Available A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD). Probiotics offer a method to potentially alter the intestinal microbiome exogenously or may provide an option to deliver microbial metabolic products to alter the chronicity of intestinal mucosal inflammation characterizing IBD. At present, there is little evidence for the benefit of currently used probiotic microbes in Crohn’s disease or associated conditions affecting extra-intestinal organs. However, clinical practice guidelines are now including a probiotic as an option for recurrent and relapsing antibiotic sensitive pouchitis and the use of probiotics in mild ulcerative colitis is provocative and suggests potential for benefit in select patients but concerns remain about proof from trials.

David R. Mack

2011-01-01

246

Interleukin-33 expression is specifically enhanced in inflamed mucosa of ulcerative colitis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Interleukin (IL)-33 is a cytokine belonging to the IL-1 family. IL-33 has been shown to elicit a Th2-like cytokine response in immune cells. In this study, we investigated IL-33 expression in the inflamed mucosa of patients with inflammatory bowel disease (IBD), and characterized the molecular mechanisms responsible for IL-33 expression in human colonic subepithelial myofibroblasts (SEMFs). METHODS: IL-33 mRNA expression was determined by real-time polymerase chain reaction (PCR). IL-33 expression in the IBD mucosa was evaluated by immunohistochemical methods. RESULTS: IL-33 mRNA expression was significantly elevated in active lesions from patients with ulcerative colitis (UC), but was not detected in inactive lesions from UC patients or in lesions from patients with either active or inactive Crohn's disease. Colonic SEMFs were identified as a major source of IL-33 in the mucosa. IL-1? and tumor necrosis factor-? (TNF-?) significantly enhanced IL-33 mRNA and protein expression in isolated colonic SEMFs. IL-1? and TNF-? did not affect IL-33 expression in intestinal epithelial cell lines (HT-29 and Caco-2 cells). This IL-1?- and TNF-?-induced IL-33 mRNA expression was mediated by p42/44 mitogen activated protein kinase (MAPK) pathway-dependent activation of nuclear factor (NF)-?B and activator protein (AP)-1. CONCLUSIONS: IL-33, derived from colonic SEMFs, may play an important role in the pathophysiology of UC.

Kobori A; Yagi Y; Imaeda H; Ban H; Bamba S; Tsujikawa T; Saito Y; Fujiyama Y; Andoh A

2010-10-01

247

Bowel infarction: Complication of ethanol ablation of renal tumor  

International Nuclear Information System (INIS)

A case of infarction of the large bowel resulting from transcatheder ablation of a malignant renal tumor with absolute ethanol is presented. The causal mechanism of this complication is described to that preventive steps can be taken to avoid this accident in the future. (orig.)

1983-01-01

248

Bowel infarction: Complication of ethanol ablation of renal tumor  

Energy Technology Data Exchange (ETDEWEB)

A case of infarction of the large bowel resulting from transcatheder ablation of a malignant renal tumor with absolute ethanol is presented. The causal mechanism of this complication is described to that preventive steps can be taken to avoid this accident in the future.

Mulligan, B.D.; Espinosa, G.A.

1983-04-01

249

Increased interleukin 8 expression in the colon mucosa of patients with inflammatory bowel disease.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

To test whether there is a difference in the expression of interleukin 8 (IL8) between Crohn's disease and ulcerative colitis and to determine the main site of its synthesis this study analysed IL8 in mucosal biopsy specimens of patients with Crohn's disease and ulcerative colitis by enzyme linked i...

Daig, R; Andus, T; Aschenbrenner, E; Falk, W; Schölmerich, J; Gross, V

250

Primary malignant small bowel tumor  

International Nuclear Information System (INIS)

[en] Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings

1990-01-01

251

Molecular evidence that the hepatitis C virus replicates in the oral mucosa.  

UK PubMed Central (United Kingdom)

BACKGROUND/AIMS: Patients infected with the hepatitis C virus (HCV) often have extrahepatic manifestations, which significantly contribute to HCV-related morbidity, but whose pathogenesis is largely unknown. Our aim was to evaluate the HCV replication in oral mucosa of chronic hepatitis C patients. METHODS: We collected oral mucosa specimens from 17 anti-HCV-positive and four anti-HCV-negative patients. Fifteen had oral lichen (12 anti-HCV-positive). Total mucosa RNA was extracted and analyzed for presence and titer of genomic and negative-strand HCV RNA. Findings were compared with clinical and pathological features. RESULTS: Genomic and negative-strand HCV RNA were detected, respectively, in 12 of 17 (70.6%) and four of 17 (23.5%) specimens from the chronic hepatitis C patients. No negative-strand HCV RNA was detected in five anti-HCV-positive patients without lichen (including three with normal mucosa). Presence and titer of the negative-strand HCV RNA were independent of HCV genotype, serum viral load, and histological diagnosis of liver lesions. The phylogenetic analysis of the envelope 2 region cloned from a normal mucosa and the corresponding serum further suggested that only lichen tissues appear to harbor replicating HCV. CONCLUSIONS: HCV may occasionally replicate in oral lichen tissue, possibly contributing to the pathogenesis of mucosa damage.

Carrozzo M; Quadri R; Latorre P; Pentenero M; Paganin S; Bertolusso G; Gandolfo S; Negro F

2002-09-01

252

If I Had - Bowel Control Issues  

Medline Plus

Full Text Available ... patient manage to hold this in?” But, in effect, under perfect healthy conditions, the bowel should be ... in the pelvis that can have a profound effect on bowel function and can drive patients towards ...

253

If I Had - Bowel Control Issues  

Medline Plus

Full Text Available ... that doctors give to patients who have problems controlling the bowel, and typically controlling gas is less of a problem than controlling the stool or the bowel movement. This is ...

254

If I Had - Bowel Control Issues  

Medline Plus

Full Text Available ... radiation treatments that may be given in the pelvis that can have a profound effect on bowel ... abdominal distention or pain or discomfort in the pelvis, then we must get the bowel emptying better, ...

255

Recovery After Stroke: Bladder and Bowel Function  

Science.gov (United States)

Recovery After Stroke: Bladder & Bowel Function Problems with bladder and bowel function are common but distressing for ... your doctor, “Where am I on my stroke recovery journey?” Note: This fact sheet is compiled from ...

256

If I Had - Bowel Control Issues  

Medline Plus

Full Text Available ... Had - Bowel Control Issues - Dr. Niall Galloway, MD, FRCS Back to Home Page If I Had - Bowel Control Issues - Dr. Niall Galloway, MD, FRCS (March 27, 2008 - Insidermedicine) Welcome to Insidermedicine's If ...

257

[Fertility and inflammatory bowel diseases].  

UK PubMed Central (United Kingdom)

BACKGROUND: Data concerning fertility during inflammatory bowel disease are insufficient and sometimes contradictory. The aims of this review are to precise the impact of inflammatory bowel disease on fertility. METHODS: Literature review. RESULTS: The risk of infertility seems to be raised at one under group of patients and made to intervene several factors of which, in particular for the Crohn's disease, the activity of the disease and the psychological impact leads by this chronic disorder. The decrease of the fertility, as very feminine as male, during the ulcerative colitis is essentially bound to the surgery. Data concerning the impact of various therapeutic used during inflammatory bowel disease on the fertility are very insufficient and interest especially male fertility.

Serghini M; Fekih M; Karoui S; Ben Mustapha N; Kallel L; Matri S; Boubaker J; Filali A

2010-09-01

258

Biologic targeting in the treatment of inflammatory bowel diseases  

Directory of Open Access Journals (Sweden)

Full Text Available Matteo Bosani, Sandro Ardizzone, Gabriele Bianchi PorroChair of Gastroenterology, “L. Sacco” University Hospital, Milan, ItalyAbstract: The etiology of inflammatory bowel disease (IBD) has not yet been clarified and immunosuppressive agents which nonspecifically reduce inflammation and immunity have been used in the conventional therapies for IBD. Evidence indicates that a dysregulation of mucosal immunity in the gut of IBD causes an overproduction of inflammatory cytokines and trafficking of effector leukocytes into the bowel, thus leading to an uncontrolled intestinal inflammation. Under normal situations, the intestinal mucosa is in a state of “controlled” inflammation regulated by a delicate balance of proinflammatory (tumor necrosis factor [TNF-?], interferon-gamma [IFN-?], interleukin-1 [IL-1], IL-6, IL-12 and anti-inflammatory cytokines IL-4, IL-10, IL-11). The mucosal immune system is the central effector of intestinal inflammation and injury, with cytokines playing a central role in modulating inflammation. Cytokines may therefore be a logical target for inflammatory bowel disease therapy using specific cytokine inhibitors. Biotechnology agents targeted against TNF, leukocyte adhesion, Th1 polarization, T cell activation, nuclear factor-kappaB (NF-?B), and other miscellaneous therapies are being evaluated as potential therapies for the treatment of inflammatory bowel disease. In this context, infliximab and adalimumab are currently the only biologic agents approved in Europe for the treatment of inflammatory Crohn’s disease. Other anti-TNF biologic agents have emerged, including CDP571, certolizumab pegol, etanercept, onercept. However, ongoing research continues to generate new biologic agents targeted at specific pathogenic mechanism involved in the inflammatory process. Lymphocyte-endothelial interactions mediated by adhesion molecules are important in leukocyte migration and recruitment to sites of inflammation, and selective blockade of these adhesion molecules is a novel and promising strategy to treat Crohn’s disease. Therapeutics agents to inhibit leukocyte trafficking include natalizumab (approved for use in Crohn’s disease in USA), MLN-02, and ISIS 2302. Other agents being investigated for the treatment of Crohn’s disease include inhibitors of T cell activation, proinflammatory cytokine receptors, Th1 polarization, growth hormone, and growth factors. Agents being investigated for treatment of ulcerative colitis include many of those mentioned above. Controlled clinical trials are currently being conducted, exploring the safety and efficacy of old and new biologic agents, and the search certainly will open new and exciting perspective on the development of therapies for inflammatory bowel disease. A review is made of the main areas of research exploring the mechanisms associated with the pathogenesis of IBD, providing advances in the agents currently in use, and identifying a host of new therapeutic biologic targets.Keywords: Crohn’s disease, ulcerative colitis, biological therapy

Matteo Bosani; Sandro Ardizzone; Gabriele Bianchi Porro

2009-01-01

259

An unusual cause of small bowel obstruction in a child: ingested rhubarb.  

Science.gov (United States)

Small bowel obstruction is rarely caused by bezoars concretions formed from undigested foreign material in the gastrointestinal tract. An important cause of bezoars is phytobezoars, formed from vegetables or fruits. A four-year-old boy presented to our emergency department with symptoms of acute intestinal obstruction. Upright plain abdominal radiography revealed multiple air fluid levels. Ultrasound showed no abnormalities, and because of worsening symptoms computed tomography of abdomen was performed. It showed intraluminal obstruction of the terminal ileum. Exploratory laparotomy revealed a phytobezoar consisting of undigested rhubarb. The mass was milked through the large bowel and out the anus. Although rare in humans, bezoars are a well-documented cause of small bowel obstruction and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction may require surgical treatment. PMID:23878756

Glatstein, Miguel; Danino, Dana; Rimon, Ayelet; Keidar, Sergei; Scolnik, Dennis

2013-06-25

260

Mucosal healing in inflammatory bowel diseases: a systematic review.  

UK PubMed Central (United Kingdom)

Recent studies have identified mucosal healing on endoscopy as a key prognostic parameter in the management of inflammatory bowel diseases (IBD), thus highlighting the role of endoscopy for monitoring of disease activity in IBD. In fact, mucosal healing has emerged as a key treatment goal in IBD that predicts sustained clinical remission and resection-free survival of patients. The structural basis of mucosal healing is an intact barrier function of the gut epithelium that prevents translocation of commensal bacteria into the mucosa and submucosa with subsequent immune cell activation. Thus, mucosal healing should be considered as an initial event in the suppression of inflammation of deeper layers of the bowel wall, rather than as a sign of complete healing of gut inflammation. In this systematic review, the clinical studies on mucosal healing are summarised and the effects of anti-inflammatory or immunosuppressive drugs such as 5-aminosalicylates, corticosteroids, azathioprine, ciclosporin and anti-TNF antibodies (adalimumab, certolizumab pegol, infliximab) on mucosal healing are discussed. Finally, the implications of mucosal healing for subsequent clinical management in patients with IBD are highlighted.

Neurath MF; Travis SP

2012-11-01

 
 
 
 
261

Intestinal anisakiasis as a rare cause of small bowel obstruction.  

UK PubMed Central (United Kingdom)

Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. The patient underwent urgent laparotomy because strangulated small bowel obstruction was suspected. A localized portion of the intestine around jejunoileal junction was found to be erythematous, edematous, and hardened, which was resected. The resected specimen showed a linear whitish worm, Anisakis simplex, penetrating into the intestinal mucosa. It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish.

Kojima G; Usuki S; Mizokami K; Tanabe M; Machi J

2013-09-01

262

Intestinal anisakiasis as a rare cause of small bowel obstruction.  

Science.gov (United States)

Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. The patient underwent urgent laparotomy because strangulated small bowel obstruction was suspected. A localized portion of the intestine around jejunoileal junction was found to be erythematous, edematous, and hardened, which was resected. The resected specimen showed a linear whitish worm, Anisakis simplex, penetrating into the intestinal mucosa. It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish. PMID:23786678

Kojima, Gotaro; Usuki, Shinichiro; Mizokami, Ken; Tanabe, Marianne; Machi, Junji

2013-06-18

263

Small bowel protection with 'STEP'  

International Nuclear Information System (INIS)

This is a case report of a patient presenting with rectal carcinoma and Crohn's disease. Adjuvant treatment was considered to be mandatory on the basis of local extention. Therefore a Silastic Tissue Expander Prosthesis (STEP), connected with a subcutaneously located self-sealing valve system, was introduced surgically to push small bowel up of the treatment portals. Patient received 55 Gy without any acute or late complication. This easy technique allows radiotherpay in conditions where complete elimination of small bowel outside the treatment volume is required. (orig.).

1992-01-01

264

Perforated small bowel in omphalocele at birth  

Directory of Open Access Journals (Sweden)

Full Text Available The rupture of an omphalocele sac during birth is a well recognized entity. The associated lesions due to vascular compromise can result in necrosis of the bowel with perforation. Spontaneous bowel perforation in an omphalocele at birth is not reported in the literature. We describe a case with bowel perforation at the fundus of an omphalocele in a newborn.

Kale R; Handa R; Harjai Man

2006-01-01

265

Scintigraphic diagnosis of inflammatory small bowel stenoses in Crohn's disease using 111In-labelled leucocytes  

International Nuclear Information System (INIS)

17 patients with known small bowel involvement in Crohn's disease (clinically active, n=14; clinically inactive, n=3) were examined within 8 days via barium enemas of the small bowel (Pansdorf's method or enteroclysma) and by 111In-oxin labelled leucocytes. From 19 radiologically diagnosed small bowel stenoses 14 were classified as inflammatory and 5 as non-inflammatory. The leucocyte scan also showed 14 inflammatory stenoses. The not inflamed stenoses could not be diagnosed scintigraphically. The barium enemas of the small bowel and the leukocyte scans both correctly diagnosed the acute inflamed segments. The inability to show non-inflamed segments (n=5) and to localise small bowel stenoses exactly is disadvantageous in the scan. The advantage of the leucocyte scan is a non invasive examination without specific bowel preparation and the possibility to diagnose additionally inflamed large bowel segments (n=4), fistulas and abscesses (n=2). The leucocyte scan offers a useful expansion of the diagnostic tools in small bowel diseases, especially in radiological problems in patients with Crohn's disease. (orig.).

1986-01-01

266

Epithelial restitution and wound healing in inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available Inflammatory bowel disease is characterized by a chronic inflammation of the intestinal mucosa. The mucosal epithelium of the alimentary tract constitutes a key element of the mucosal barrier to a broad spectrum of deleterious substances present within the intestinal lumen including bacterial microorganisms, various dietary factors, gastrointestinal secretory products and drugs. In addition, this mucosal barrier can be disturbed in the course of various intestinal disorders including inflammatory bowel diseases. Fortunately, the integrity of the gastrointestinal surface epithelium is rapidly reestablished even after extensive destruction. Rapid resealing of the epithelial barrier following injuries is accomplished by a process termed epithelial restitution, followed by more delayed mechanisms of epithelial wound healing including increased epithelial cell proliferation and epithelial cell differentiation. Restitution of the intestinal surface epithelium is modulated by a range of highly divergent factors among them a broad spectrum of structurally distinct regulatory peptides, variously described as growth factors or cytokines. Several regulatory peptide factors act from the basolateral site of the epithelial surface and enhance epithelial cell restitution through TGF-?-dependent pathways. In contrast, members of the trefoil factor family (TFF peptides) appear to stimulate epithelial restitution in conjunction with mucin glycoproteins through a TGF-?-independent mechanism from the apical site of the intestinal epithelium. In addition, a number of other peptide molecules like extracellular matrix factors and blood clotting factors and also non-peptide molecules including phospholipids, short-chain fatty acids (SCFA), adenine nucleotides, trace elements and pharmacological agents modulate intestinal epithelial repair mechanisms. Repeated damage and injury of the intestinal surface are key features of various intestinal disorders including inflammatory bowel diseases and require constant repair of the epithelium. Enhancement of intestinal repair mechanisms by regulatory peptides or other modulatory factors may provide future approaches for the treatment of diseases that are characterized by injuries of the epithelial surface.

Andreas Sturm, Axel U Dignass

2008-01-01

267

Genetic variants of membrane metallopeptidase genes in inflammatory bowel diseases.  

UK PubMed Central (United Kingdom)

BACKGROUND: The substance P pathway modulates neuroimmune interactions during intestinal inflammation. AIMS: To analyse mucosal expression and genetic variants of the genes coding for substance P, neurokinin-1 receptor and neutral endopeptidase in patients with inflammatory bowel disease. METHODS: qRT-PCR was used to analyse mRNA levels in matched, paired samples of inflamed colonic mucosa and adjacent non-inflamed endoscopic tissue from 26 Crohn's disease and 25 ulcerative colitis patients. Allele and genotype frequencies of tag-SNPs were determined in 908 Crohn's disease, 929 ulcerative colitis, and 853 controls. Expression levels and genotype distributions were examined within patients' clinical sub-phenotypes. RESULTS: All 3 evaluated genes were overexpressed in inflamed tissues from Crohn's disease (P=0.033, P=4×10(-5), P=0.001), while in ulcerative colitis only higher levels of the gene coding for neutral endopeptidase were statistically significant (P=2.5×10(-5)). Smoking habit and perianal disease were significantly associated with substance P (P=0.002) and neurokinin-1 receptor levels (P=0.02) in Crohn's disease. Neutral endopeptidase rs701109 variant was associated with inflammatory bowel disease (Crohn's disease: P=0.022; ulcerative colitis: P=0.045), and with the need for colectomy in ulcerative colitis (P=0.008, OR=2.46, 95% CI=1.27-4.76). CONCLUSIONS: Genetic variants of the gene coding for neutral endopeptidase might affect the neuroimmune interaction during intestinal inflammation and influence clinical sub-phenotypes in patients with inflammatory bowel disease.

Tavano F; Palmieri O; di Mola FF; Latiano A; Burbaci FP; Valvano MR; Corritore G; Augello B; Merla G; Annese V; Andriulli A; di Sebastiano P

2013-07-01

268

A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on bowel frequency and intestinal function.  

UK PubMed Central (United Kingdom)

BACKGROUND & AIMS: Patients with diarrhea-predominant irritable bowel syndrome (IBS-D) could benefit from a gluten-free diet (GFD). METHODS: We performed a randomized controlled 4-week trial of a gluten-containing diet (GCD) or GFD in 45 patients with IBS-D; genotype analysis was performed for HLA-DQ2 and HLA-DQ8. Twenty-two patients were placed on the GCD (11 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive) and 23 patients were placed on the GFD (12 HLA-DQ2/8 negative and 11 HLA-DQ2/8 positive). We measured bowel function daily, small-bowel (SB) and colonic transit, mucosal permeability (by lactulose and mannitol excretion), and cytokine production by peripheral blood mononuclear cells after exposure to gluten and rice. We collected rectosigmoid biopsy specimens from 28 patients, analyzed levels of messenger RNAs encoding tight junction proteins, and performed H&E staining and immunohistochemical analyses. Analysis of covariance models was used to compare data from the GCD and GFD groups. RESULTS: Subjects on the GCD had more bowel movements per day (P = .04); the GCD had a greater effect on bowel movements per day of HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .019). The GCD was associated with higher SB permeability (based on 0-2 h levels of mannitol and the lactulose:mannitol ratio); SB permeability was greater in HLA-DQ2/8-positive than HLA-DQ2/8-negative patients (P = .018). No significant differences in colonic permeability were observed. Patients on the GCD had a small decrease in expression of zonula occludens 1 in SB mucosa and significant decreases in expression of zonula occludens 1, claudin-1, and occludin in rectosigmoid mucosa; the effects of the GCD on expression were significantly greater in HLA-DQ2/8-positive patients. The GCD vs the GFD had no significant effects on transit or histology. Peripheral blood mononuclear cells produced higher levels of interleukin-10, granulocyte colony-stimulating factor, and transforming growth factor-? in response to gluten than rice (unrelated to HLA genotype). CONCLUSIONS: Gluten alters bowel barrier functions in patients with IBS-D, particularly in HLA-DQ2/8-positive patients. These findings reveal a reversible mechanism for the disorder. Clinical trials.govNCT01094041.

Vazquez-Roque MI; Camilleri M; Smyrk T; Murray JA; Marietta E; O'Neill J; Carlson P; Lamsam J; Janzow D; Eckert D; Burton D; Zinsmeister AR

2013-05-01

269

A Retrospective Study of 5-year Outcomes of Radiotherapy for Gastric Mucosa-associated Lymphoid Tissue Lymphoma Refractory to Helicobacter pylori Eradication Therapy.  

UK PubMed Central (United Kingdom)

BACKGROUND: The favorable response rate of radiotherapy for localized gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication has been demonstrated. However, there are limited data available on the long-term outcomes. The aim of this retrospective study was to evaluate the long-term outcomes of radiotherapy for localized gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication. METHODS: Thirty-four consecutive patients with localized gastric mucosa-associated lymphoid tissue lymphoma that were refractory to eradication were treated with radiotherapy (a total dose of 30 Gy). The response and adverse events of radiotherapy were retrospectively analyzed as short-term outcomes, and recurrence-free, overall and disease-specific survival rates were calculated as long-term outcomes. RESULTS: Thirty-three (97.1%) patients achieved complete remission and radiotherapy was well tolerated. One patient underwent emergency gastrectomy due to severe hematemesis. Of the 34 patients during the median follow-up period of 7.5 (1.2-13.0) years, one patient had local recurrence after 8.8 years, one patient underwent surgery for bowel obstruction secondary to small bowel metastasis after 5.1 years and one patient had pulmonary metastasis after 10.9 years. Pathologically, all three recurrences revealed mucosa-associated lymphoid tissue lymphoma without any transformation to high-grade lymphoma. None died of gastric mucosa-associated lymphoid tissue lymphoma. The 5-year recurrence-free survival rate was 97.0%. The 5-year overall survival rates and disease-specific survival rates were 97.0 and 100%, respectively. CONCLUSIONS: Radiotherapy in patients with localized gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication can achieve excellent overall survival. However, long-term surveillance is necessary to identify late recurrences.

Abe S; Oda I; Inaba K; Suzuki H; Yoshinaga S; Nonaka S; Morota M; Murakami N; Itami J; Kobayashi Y; Miyagi Maeshima A; Saito Y

2013-09-01

270

Cancer in inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Many of the molecular alterations responsible for sporadic colorectal cancer, namely chromosomal instability, microsatellite instability, and hypermethylation, also play a role in colitis-associated colon carcinogenesis. Colon cancer risk in inflammatory bowel disease increases with longer duration of colitis, greater anatomic extent of colitis, the presence of primary sclerosing cholangitis, family history of CRC and degree of inflammation of the bowel. Chemoprevention includes aminosalicylates, ursodeoxycholic acid, and possibly folic acid and statins. To reduce CRC mortality in IBD, colonoscopic surveillance with random biopsies remains the major way to detect early mucosal dysplasia. When dysplasia is confirmed, proctocolectomy is considered for these patients. Patients with small intestinal Crohn’s disease are at increased risk of small bowel adenocarcinoma. Ulcerative colitis patients with total proctocolectomy and ileal pouch anal-anastomosis have a rather low risk of dysplasia in the ileal pouch, but the anal transition zone should be monitored periodically. Other extra intestinal cancers, such as hepatobiliary and hematopoietic cancer, have shown variable incidence rates. New endoscopic and molecular screening approaches may further refine our current surveillance guidelines and our understanding of the natural history of dysplasia.

Jianlin Xie, Steven H Itzkowitz

2008-01-01

271

The wealth of Tajikistan bowels  

International Nuclear Information System (INIS)

[en] There are more than 350 deposits discover and explore now on the territory of Tajikistan, about 100 from which develop by industry. There are 36 kinds of minerals are mining. The Tajikistan bowels have lead, zinc, copper, antimony, mercury, gold, silver, tungsten, molybdenum, bismuth, iron

1989-01-01

272

Surgery for inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available Despite the new and ever expanding array of medications for the treatment of inflammatory bowel disease (IBD), there are still clear indications for operative management of IBD and its complications. We present an overview of indications, procedures, considerations, and controversies in the surgical therapy of IBD.

John M Hwang, Madhulika G Varma

2008-01-01

273

CT enteroclysis in small bowel Crohn's disease  

International Nuclear Information System (INIS)

The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

2009-01-01

274

Glycosphingolipids of guinea pig gastric mucosa.  

UK PubMed Central (United Kingdom)

Glycosphingolipids have beenn isolated from guinea pig gastric mucosa and their composition and content determined. The neutral glycospingolipids were found to consist of mono-, di-, tri- and pentaglycosylceramide. The acidic glycosphingolipids wee represented by galactosyl and lactosyl sulfatides, and GM4, GM3 and GD3 gangliosides. None of the analyzed glycolipids contained N-acetylglucosamine and fucose.

Kojima K; Slomiany A; Murty VL; Galicki NI; Slomiany BL

1980-08-01

275

[Urethroplasties with bladder mucosa in hypospadias  

UK PubMed Central (United Kingdom)

Urethroplasty with free grafting of tubulized vesical mucosa is a method of great interest for the solution of complex hypospadias, especially in multioperated patients. We prefer its use when the penis is erect and there is no redundant dorsal prepuce. We present 13 cases with an evolution that allows us to be optimistic about this technique.

Garat JM

1990-01-01

276

Manuka honey: histological effect on respiratory mucosa.  

UK PubMed Central (United Kingdom)

BACKGROUND: Chronic rhinosinusitis (CRS) is an inflammatory disease in which bacteria are commonly implicated often in the form of a biofilm. Manuka honey has been shown in vitro to be an effective treatment against two common CRS pathogens both in the planktonic and in the biofilm forms. The purpose of this study was to determine if the application of manuka honey to respiratory epithelium would result in histological evidence of epithelial injury. METHODS: Using a rabbit animal model, a nonrandomized controlled trial of four treatment regimes was performed with two rabbits in each group. The left nasal cavity was irrigated with a 1.5-mL manuka honey solution once daily and the right nasal cavity was not treated. Groups 1-3 were treated for 3, 7, and 14 consecutive days, respectively, and killed the morning after the last treatment. Group 4 was treated for 14 consecutive days followed by a 14-day washout period and then killed the following morning. The nasal respiratory mucosa was immediately harvested after death. The mucosa was examined by light microscopy for histological change in comparison with the control side. RESULTS: Cilia were not measured quantitatively but were equally present on the treated and untreated mucosa. There was no histological evidence of inflammation, epithelial injury, or significant morphological changes. CONCLUSION: The application of a manuka honey solution to rabbit nasal respiratory mucosa over different treatment intervals did not show evidence of histological epithelial injury.

Kilty SJ; AlMutairi D; Almutari D; Duval M; Groleau MA; De Nanassy J; Gomes MM

2010-03-01

277

Ectopic gastric mucosa in the duodenal bulb  

Energy Technology Data Exchange (ETDEWEB)

The radiological and clinical findings of 12 patients with ectopic gastric mucosa in the duodenal bulb are presented. This is a defined disease with characteristic radiological features: multiple small nodular defects of the contrast medium of 1-3 mm diameter. Histology shows complete heterotopia. Pathogenesis and clinical significance are discussed with reference to the literature on this subject.

Schnell, H.; Oehler, G.; Schulz, A.; Rau, W.S.

1989-02-01

278

Laser Treatment of Oral Mucosa Tattoo  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The most common oral solitary pigmented lesion is the dental amalgam tattoo. It occurs as a result of colouring of the tissue by alien pigment which was administered intra or subepidermaly either intentionally or accidentally. The most common material used for the colouring of the oral mucosa is ama...

Gojkov-Vukelic, Mirjana; Hadzic, Sanja; Pasic, Enes

279

Autofluorescence imaging of potentially malignant mucosa lesions.  

UK PubMed Central (United Kingdom)

OBJECTIVE AND STUDY DESIGN: Several noninvasive adjunctive methods have been proposed for identification of potentially malignant mucosa lesions. The VELscope is an optical device for detecting spatial changes in mucosa autofluorescence caused by premalignant lesions in conjunction with an intraoral exam. The aim of our prospective study was to correlate loss of autofluorescence from undiagnosed mucosa lesions with histology. RESULTS: In total 64 patients considered at risk for squamous cell carcinoma (20 had previous OSCC) were included in the study. Regions with fluorescence visualization loss were considered as malignant or dysplastic. All patients underwent biopsy after VELscope examination. In 22 patients (34.4%) a loss of autofluorescence indicating a squamous intraepithelial neoplasia (SIN) or malignant mucosal lesion was detected. The sensitivity of identification of malignant and dysplastic areas with the VELscope was 100% and the specificity was 80.8%, respectively, compared with histology as gold standard. The positive predictive value was 54.5% and the negative predictive value was 100% respectively. CONCLUSION: Evaluation of autofluorescence imaging with VELscope can assist in the identification of malignant and potentially malignant oral lesions from normal mucosa in high-risk patients but does not help discriminating benign lesions from malignant or premalignant mucosal conditions.

Scheer M; Neugebauer J; Derman A; Fuss J; Drebber U; Zoeller JE

2011-05-01

280

Oral mucosa: variations from normalcy, part II.  

Science.gov (United States)

This is the second article in a 2-part series on the variations of oral mucosa. We describe the following 5 conditions that deviate from normalcy: lateral soft palate fistulas, double lip, fissured tongue, racial gingival pigmentation, and geographic tongue. PMID:11930907

Leston, J M Seoane; Santos, A Aguado; Varela-Centelles, P I; Garcia, Juan Vazquez; Romero, M A; Villamor, L Pias

2002-03-01

 
 
 
 
281

Overexpression of microRNAs-155 and 21 targeting mismatch repair proteins in inflammatory bowel diseases.  

UK PubMed Central (United Kingdom)

Microsatellite instability (MSI) due to mismatch repair (MMR) deficiency is reported in 5-10% of colorectal cancers (CRCs) complicating inflammatory bowel diseases (IBD). The molecular mechanisms underlying MMR deficiency may be different in IBD CRCs, and in sporadic and hereditary MSI tumors. Here, we hypothesize that overexpression of miR-155 and miR-21, two inflammation-related microRNAs that target core MMR proteins, may constitute a pre-neoplastic event for the development of MSI IBD CRCs. We studied miR-155 and miR-21 expression using real-time quantitative PCR in MSI (n = 10) and microsatellite stable (n = 10) IBD CRCs, and in MSI (n = 32) and microsatellite stable (n = 30) non-IBD CRCs. We also screened colonic samples from IBD patients without cancer (n = 18) and used healthy colonic mucosa as controls (n = 20). MiR-155 and miR-21 appeared significantly overexpressed not only in the colonic mucosa of IBD subjects without CRC but also in neoplastic tissues of IBD patients compared with non-IBD controls (P < 0.001). Importantly, in patients with IBD CRCs, miR-155 and miR-21 overexpression extended to the distant non-neoplastic mucosa (P < 0.001). Ratios of expressions in tumors versus matched distant mucosa revealed a nearly significant association between miR-155 overexpression and MSI in IBDs (P = 0.057). These results show a strong deregulation of both MMR-targeting microRNAs in IBD subjects with or without cancer. MiR-155 overexpression being particularly associated to MSI IBD CRCs and extending to distant non-neoplastic mucosa, strongly suggests that a pre-neoplastic miR-155 field defect may promote MSI-driven transformation of the colonic mucosa. The detection and monitoring of miR-155 field defect may, therefore, have implications for the prevention and treatment of MSI IBD CRCs.

Svrcek M; El-Murr N; Wanherdrick K; Dumont S; Beaugerie L; Cosnes J; Colombel JF; Tiret E; Fléjou JF; Lesuffleur T; Duval A

2013-04-01

282

Intestinal absorption and permeability in paediatric short-bowel syndrome: a pilot study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Sugar absorption tests are an effective, noninvasive way to assess intestinal permeability. The role of intestinal barrier integrity in complications and outcome of short-bowel syndrome is not known. The purpose of the study was to evaluate whether such tests provide information on the status of intestinal mucosa of these patients. METHODS: Six children with short-bowel syndrome--median age, 12 months, and median small bowel length at birth, 30 cm--had a sugar test with 3-o-methyl-D-glucose, D-xylose, D-rhamnose, and melibiose approximately 2 months after operation. The melibiose/L-rhamnose ratio was used as an index of permeability, and percentages of 3-o-methyl-D-glucose and D-xylose absorbed were used as indices of absorption. Parenteral nutrition requirement, bowel length, liver disease, recent sepsis, and bacterial overgrowth were recorded. RESULTS: Three patients had increased permeability, and all of them had had a recent episode of sepsis and severe liver disease. All subjects had malabsorption of 3-o-methyl-D-glucose, and five of six had malabsorption of D-xylose and L-rhamnose. The absorption of 3-o-methyl-D-glucose correlated with bowel length (r2 = 0.78; P = 0.04), whereas the absorption of D-xylose correlated with parenteral requirement (r2 = 0.66; P = 0.04) at that time. CONCLUSIONS: Increased permeability was observed in three of six patients with short-bowel syndrome associated with a recent episode of sepsis and severe liver disease. Other indices of malabsorption correlated significantly with different clinical features of the disease. A prospective larger scale study in a homogeneous population is indicated to assess at multiple points during the disease course whether the test can be helpful in the management of these patients.

D'Antiga L; Dhawan A; Davenport M; Mieli-Vergani G; Bjarnason I

1999-11-01

283

Management of patients with a short bowel.  

Science.gov (United States)

There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good. PMID:11819867

Nightingale, J M

2001-12-01

284

Bowel resection in Nigerian children  

Directory of Open Access Journals (Sweden)

Full Text Available Background : Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung?s disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median, five months). There were 16 (22.9%) neonates, 26 (37.1%) infants, and 28 (40%) grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5%) infants had intussusception, 2 (7.7%) had midgut vovulusm and 1 (3.8%) had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP) was seen in 14 (50.0%), intussusception in 5 (17.9%), and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days). The overall mortality was 17.1% -; which was highest among neonates (56.3%), followed by the infants (26.9% -). Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality.

Abdur-Rahman L; Adeniran J; Taiwo J; Nasir A; Odi T

2009-01-01

285

Small bowel obstruction: the art of management.  

UK PubMed Central (United Kingdom)

Strategies for the management of small bowel obstructions have changed significantly over the years. Nonoperative medical management has become the mainstay of treatment of many small bowel obstructions. However, the key to the management of small bowel obstructions is identifying those patients who need surgical intervention. Identification of those at risk for bowel ischemia and bowel death is an art as much as it is a science. Using the current literature and the past knowledge regarding small bowel obstructions, the clinician must carefully identify the signs and symptoms that suggest the need for operative intervention. Classification of the obstruction, history and physical examination, imaging, response to decompression and resuscitation, and resolution or progression of symptoms are the key factors influencing the management of small bowel obstructions.

Trevino C

2010-04-01

286

Ectopic intestinal glands after segmental small bowel irradiation in the cat  

International Nuclear Information System (INIS)

Following segmental irradiation of the small bowel, 5 of 64 cats demonstrated ectopic intestinal glands in the submucosal tissue. In addition, one of these 5 cats had foci of abnormal glands in the muscularis mucosae. In 2 of the 5 animals, cellular polymorphism, nucleolar irregularity and loss of cellular polarity were present in irradiation-induced ectopic intestinal glands. The review of the literature indicates that intestinal irradiation may induce intestinal adenocarcinomas with metastatic growth. The possibility that ectopic intestinal glands are precancerous lesions in the irradiated cat is discussed. (Auth.)

1983-01-01

287

Genotoxic effect of two bleaching agents on oral mucosa.  

UK PubMed Central (United Kingdom)

UNLABELLED: Aim: To analyze the genotoxic effect of two hydrogen peroxide-containing bleaching products on oral mucosal cells. MATERIALS AND METHODS: The research was conducted on 22 individuals divided into two groups. Group 1 used ZOOM2 and group 2 the Opalescence BOOST bleaching agent. Specimens of the gingival and the upper lip mucosa were obtained before, immediately after, and 72 h after the bleaching procedure and were analyzed using a micronucleus test. RESULTS: Seventy-two hours after bleaching treatment with BOOST, samples collected from the oral mucosa exhibited a statistically significant increase of all genotoxicity markers, with large effect sizes (Cohen's d>0.8) observed in the total number of micronuclei (MN), number of cells with 3+ MN, karyolysis and bi-nuclear cells. ZOOM2 treatment showed a significant increase, with medium-to-large effect sizes, in the number of cells with 1 MN, karyolysis, nuclear buds and bi-nuclear cells. CONCLUSION: Both preparations demonstrated potential genotoxic effects.

Klaric E; Par M; Profeta I; Kopjar N; Rozgaj R; Kasuba V; Zeljezic D; Tarle Z

2013-09-01

288

Radioprotective effect of captopril on the mouse jejunal mucosa  

Energy Technology Data Exchange (ETDEWEB)

Captopril, an inhibitor of angiotensin I converting enzyme, has been shown to modify radiation damage and prevent radiation injury of normal tissue in rats and pigs. The present study was carried out to determine whether captopril would reduce radiation changes in the proximal small bowel in mice. Mice were subjected to whole body irradiation with 9 Gy or 15 Gy. Captopril was administered in drinking water at a regimen of 62.5 mg/kg/day (captopril group I) and 125 mg/kg/day (captopril group II), continuously from 7 days before irradiation to the end of each designed experiment. The jejunal damage was evaluated microscopically by crypt count per circumference and by histologic damage grading. Crypt number in the sham-irradiated control was 133 {plus_minus} 6.8/circumference. In both captopril group I and II, crypt numbers and histologic scores were not significantly different from those in the normal group. The 9 Gy and 15 Gy radiation alone groups showed significantly lower crypt counts and histologic scores compared with the sham-irradiated control group (p<0.05). The groups exposed to 9 Gy radiation plus captopril I and II showed significantly higher crypt counts and lower histologic damage scores on the third day, and lower histologic damage scores on the fifth day compared with the 9 Gy radiation alone group (p<0.05). The 15 Gy radiation plus captopril I and II groups had significantly higher crypt counts and lower histologic damage scores on the third day than those of the 15 Gy radiation alone group (p<0.05). All mice of the 15 Gy radiation group succumbed to intestinal radiation death. Our results suggest that captopril provides protection from acute radiation damage to the jejunal mucosa in mice. 28 refs., 5 figs., 4 tabs.

Yoon, Se-Chul; Park, Jeong-Mi; Jang, Hong-Seok [Catholic University Medical College, Seoul (Korea, Republic of)] [and others

1994-11-15

289

Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey.  

UK PubMed Central (United Kingdom)

PURPOSE: Suboptimal bowel preparation can result in decreased neoplasia detection, shortened surveillance intervals, and increased costs. We assessed bowel preparation recommendations and the relationship to self-reported proportion of suboptimal bowel preparations in practice; and evaluated the impact of suboptimal bowel preparation on colonoscopy surveillance practices. A random sample of a national organization of gastroenterologists in the U.S. was surveyed. METHODS: Demographic and practice characteristics, bowel preparation regimens, and proportion of suboptimal bowel preparations in practice were ascertained. Recommended follow-up colonoscopy intervals were evaluated for optimal and suboptimal bowel preparation and select clinical scenarios. RESULTS: We identified 6,777 physicians, of which 1,354 were randomly selected; 999 were eligible, and 288 completed the survey. Higher proportion of suboptimal bowel preparations/week (?10 %) was associated with hospital/university practice, teaching hospital affiliation, >25 % Medicaid insured patients, recommendation of PEG alone and sulfate-free. Those reporting >25 % Medicare and privately insured patients, split dose recommendation, and use of MoviPrep® were associated with a <10 % suboptimal bowel preparations/week. Shorter surveillance intervals for three clinical scenarios were reported for suboptimal preparations and were shortest among participants in the Northeast who more often recommended early follow-up for normal findings and small adenomas. Those who recommended 4-l PEG alone more often advised <1 year surveillance interval for a large adenoma. CONCLUSIONS: Our study demonstrates significantly shortened surveillance interval recommendations for suboptimal bowel preparation and that these interval recommendations vary regionally in the United States. Findings suggest an interrelationship between dietary restriction, purgative type, and practice and patient characteristics that warrant additional research.

Hillyer GC; Basch CH; Lebwohl B; Basch CE; Kastrinos F; Insel BJ; Neugut AI

2013-01-01

290

[Morphologic peculiarities of gastric mucosa before and after bariatric surgery].  

UK PubMed Central (United Kingdom)

Morphological state of gastric mucosa was studied up in patients, suffering morbid obesity before and after gastric banding and gastric shunting operations. According to histologic investigation data gastric mucosa in patients, suffering morbid obesity, is not changed or has moderate inflammatory changes. Gastric banding and gastric shunting did not change gastric mucosa trustworthily morphologically.

Homoliako IV; Bury? OM; Tereshkevych IS; Kostiuk MP; Sira HD; Il'chuk OS

2011-09-01

291

Electrically induced transport of macromolecules through oral buccal mucosa.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the feasibility of iontophoretic delivery of large molecules across buccal mucosa, and to establish its potential for enhanced drug delivery. METHODS: Qualitative (6h) and quantitative (8 and 36 h) assessment of porcine buccal mucosa, using a diffusion cell in vitro model, was carried out by fluorescent microscopy and UV/Vis spectroscopy respectively, with four fluorescently-labeled model species (3 and 10 kDa dextrans, 12 kDa parvalbumin and 66 kDa bovine serum albumin, BSA). Passive and iontophoresis parameters were obtained. The experimental iontophoresis data were compared with theoretical predictions. RESULTS: The two dextrans and parvalbumin showed enhanced permeation through buccal mucosa after anodal iontophoresis (1-6h). Passive diffusion and cathodal iontophoresis resulted in minimal permeation. BSA could not be measured by either mode. Iontophoretic delivery profiles compared to passive delivery, had reduced time lags (30-50 versus ~270 min) and increased flux (~37 times faster). Time lag factor/enhancement ratio (TLF/ER) data confirmed that iontophoresis significantly enhanced permeation. The diffusion coefficients (D, passive) for dextrans were significantly higher than for parvalbumin, with the converse obtained for solubility (C0); permeability coefficients (P) were similar for all three species. Potential differences (V) for the two higher kDa species were significantly higher than for the lowest kDa species. Experimental and theoretical data were in reasonable agreement. SIGNIFICANCE: The experimental and theoretical data, confirming enhanced delivery of the model species via iontophoresis, gave a suitable basis for its potential application in the mouth, in a clinical setting and opens pathways to further research for delivering precious drugs topically and systemically.

Patel MP; Churchman ST; Cruchley AT; Braden M; Williams DM

2013-06-01

292

[Levels of various lipid fractions in mucosa tissues of the rat oral cavity in experimental gastrointestinal pathology  

UK PubMed Central (United Kingdom)

The content of main lipid fractions was determined by thin-layer chromatography in mucosa tissues of the rat oral cavity under chemical damage of the stomach, large intestine and extrahepatic cholestasis. A decrease in the amount of phospholipids, free fatty acids, free cholesterol, di- and triglycerides is found in the mucosa of the animal oral cavity independently of the character and level of the gastrointestinal tract damage. There are topographic differences in the extent and manifestation of the observed disorders.

Skliar VE; Pakhomova VA; Kozlianina NP; Skiba VIa

1982-01-01

293

Photodynamic therapy of the rabbit bowel and bladder after installation and injection of delta aminolevulinic acid (ALA): uptake of protoporphyrin IX and depth of necrosis  

Science.gov (United States)

Management of neurogenic bladders with high pressures and poor compliance often requires surgical enlargement of the bladder utilizing small or large bowel or stomach. The bowel segments usually retain their absorptive and secretory properties causing several complications which include hyperchloremic metabolic acidosis for small and large bowel segments, hypochloremic metabolic alkalosis for stomach segments, increased risk of bacteriuria, stone formation, altered hepatic metabolism and altered drug metabolism. There is also the potential risk of developing cancer at the anastomotic site.

Merguerian, Paul A.; Pugach, Jeff L.; Park, Jane; Sepers, Marja; Lilge, Lothar D.

1999-06-01

294

Small bowel intubation using guide wire: use in decompression of small bowel obstruction  

Energy Technology Data Exchange (ETDEWEB)

Small bowel intubation is a useful method in the non-operative decompression of small bowel obstruction and enteral hyperalimentation in malnourished patients. We have tried small bowel intubation with Ventrol tube guided by small bowel enteroclysis guide wire (Bilbao-Dotter wire) in 12 patients. Ten cases were successfully intubated. In 11 cases of bowel obstruction, 9 cases were intubated and 8 cases were effectively drained. One malnourished patient was improved in nutritional state after enteral hyperalimentation through the intubated tube. We believe this method is an easy and time-saving method in the small bowel decompression.

Kim, Kyo Yeoun; Kim, Ki Whang [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

1987-06-15

295

Evaluation of small bowel bleeding.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: The review focuses on the latest techniques that are evolving in the management of small bowel bleeding. RECENT FINDINGS: Video capsule endoscopy has the highest yield of diagnosis when it is performed within 48?h of the bleeding event (78 versus 48%). The pooled detection rate of double balloon endoscopy was noted to be 68.1% for obscure gastrointestinal bleeding according to a systematic review of 66 studies in the last 10 years. Also a recent review, which focused on analysis of 68 studies found that the procedural characteristics were comparable for double balloon, single balloon and spiral enteroscopy though the procedure time was fastest for the spiral enteroscopy group. Medical therapy for vascular lesions is in its infancy but shows promise. SUMMARY: Advanced diagnostic and therapeutic endoscopic techniques are changing the paradigm of care for patients with small bowel bleeding.

Singh A; Baptista V; Stoicov C; Cave DR

2013-03-01

296

Intestinal dysbiosis in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

The worldwide incidence of inflammatory bowel disease (IBD) is increasing. Abundant literature has suggested that an imbalance between harmful and protective bacteria, or dysbiosis, of the intestine is largely responsible for the rising incidence of IBD. In this review, data supporting dysbiosis as a cause of IBD are presented. A comparison of the number of scientific publications in the US versus Europe on intestinal dysbiosis and microbiota revealed the US scientific community has a lower level of interest in studying dysbiosis and microbiota compared the research community in Europe. The rising trend of antibiotic use in the US provides further evidence of the lack of concern for the effect of dysbiosis on human health. Further research to understand the causal relationship between dysbiosis and IBD are needed to better guide clinical practice in using probiotics.

Kaur N; Chen CC; Luther J; Kao JY

2011-07-01

297

Lipoma in Oral Mucosa: Two Case Reports  

Science.gov (United States)

Lipoma is a common tumor of soft tissue. Its location on the oral mucosa is rare, representing 1% to 5% of benign oral tumors although it is the most mesenchymal tumor of the trunk and proximal por-tions of extremities. Lipoma of the oral cavity may occur in any region. The buccal mucosa, tongue, and floor of the mouth are among the common locations. The clinical presentation is typically as an asymptomatic yellowish mass. The overlying epithelium is intact, and superficial blood vessels are usually evident over the tumor. Other benign connective tissue lesions such as granular cell tumor, neurofibroma, traumatic fibroma and salivary gland lesions (mucocele and mixed tumor) might be included in differential diagnosis. We present two cases of oral lipoma in unusual locations: one in junction of soft and hard palate and the other in tongue. Both were rare in the literature.

Hoseini, Ali Tavakoli; Razavi, Seyed Mohammad; Khabazian, Arezu

2010-01-01

298

Isolated fetal ascites caused by bowel perforation due to colonic atresia.  

Science.gov (United States)

An isolated fetal ascites is a rare ultrasonographic finding. It is commonly diagnosed in association with fetal genitourinary or gastrointestinal conditions, mainly bowel obstruction. We present the sonographic features and neonatal outcome of a fetus with a large bowel obstruction, perforation and subsequent development of meconium peritonitis, prenatally diagnosed as isolated fetal ascites. A colonic atresia should be also included in the differential diagnosis of isolated fetal ascites. PMID:16147839

Agrawala, Geetika; Predanic, Mladen; Perni, Sriram C; Chasen, Stephen T

2005-04-01

299

Isolated fetal ascites caused by bowel perforation due to colonic atresia.  

UK PubMed Central (United Kingdom)

An isolated fetal ascites is a rare ultrasonographic finding. It is commonly diagnosed in association with fetal genitourinary or gastrointestinal conditions, mainly bowel obstruction. We present the sonographic features and neonatal outcome of a fetus with a large bowel obstruction, perforation and subsequent development of meconium peritonitis, prenatally diagnosed as isolated fetal ascites. A colonic atresia should be also included in the differential diagnosis of isolated fetal ascites.

Agrawala G; Predanic M; Perni SC; Chasen ST

2005-04-01

300

Benign Papules and Nodules of Oral Mucosa  

Directory of Open Access Journals (Sweden)

Full Text Available This article reviews some of the more common benign oral papules and nodules of oral mucosa with emphasis on their etiology, epidemiology, clinical presentation, histopathology, and treatment. These lesions include mucocele, traumatic fibroma, epulis, pyogenic granuloma, oral papilloma, oral warts, lymphangioma, hemangioma, lipoma, oral nevi and some soft tissue benign tumors. These benign lesions must be separated clinically and histologically from precancerous and malign neoplastic lesions. Accurate clinico-pathological diagnosis is mandatory to insure appropriate therapy.

Mehmet Salih Gürel; Ebru Sar?kaya

2012-01-01

 
 
 
 
301

Neurostimulation for neurogenic bowel dysfunction.  

UK PubMed Central (United Kingdom)

Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI). Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD.

Worsøe J; Rasmussen M; Christensen P; Krogh K

2013-01-01

302

Neurostimulation for neurogenic bowel dysfunction.  

Science.gov (United States)

Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI). Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD. PMID:23573076

Worsøe, J; Rasmussen, M; Christensen, P; Krogh, K

2013-03-21

303

Neurostimulation for neurogenic bowel dysfunction  

DEFF Research Database (Denmark)

Background. Loss of normal bowel function caused by nerve injury, neurological disease or congenital defects of the nervous system is termed neurogenic bowel dysfunction (NBD). It usually includes combinations of fecal incontinence, constipation, abdominal pain and bloating. When standard treatment of NBD fails surgical procedures are often needed. Neurostimulation has also been investigated, but no consensus exists about efficacy or clinical use. Methods. A systematic literature search of NBD treated by sacral anterior root stimulation (SARS), sacral nerve stimulation (SNS), peripheral nerve stimulation, magnetic stimulation, and nerve re-routing was made in Pubmed, Embase, Scopus, and the Cochrane Library. Results. SARS improves bowel function in some patients with complete spinal cord injury (SCI). Nerve re-routing is claimed to facilitate defecation through mechanical stimulation of dermatomes in patients with complete or incomplete SCI or myelomeningocele. SNS can reduce NBD in selected patients with a variety of incomplete neurological lesions. Peripheral stimulation using electrical stimulation or magnetic stimulation may represent non-invasive alternatives. Conclusion. Numerous methods of neurostimulation to treat NBD have been investigated in pilot studies or retrospective studies. Therefore, larger controlled trials with well-defined inclusion criteria and endpoints are recommended before widespread clinical use of neurostimulation against NBD.

WorsØe, Jonas; Rasmussen, M

2013-01-01

304

Reoperative inflammatory bowel disease surgery.  

Science.gov (United States)

With the advent of restorative proctocolectomy or ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), not only has there been potential for cure of UC but also patients have enjoyed marked improvements in bowel function, continence, and quality of life. However, IPAA can be complicated by postoperative small bowel obstruction, disease recurrence, and pouch failure secondary to pelvic sepsis, pouch dysfunction, mucosal inflammation, and neoplastic transformation. These may necessitate emergent or expeditious elective reoperation to salvage the pouch and preserve adequate function. Local, transanal, and transabdominal approaches to IPAA salvage are described, and their indications, outcomes, and the clinical parameters that affect the need for salvage are discussed. Pouch excision for failed salvage reoperation is reviewed as well. Relaparotomy is also frequently required for recurrent Crohn's disease (CD), especially given the nature of this as yet incurable illness. Risk factors for CD recurrence are examined, and the various surgical options and margins of resection are evaluated with a focus on bowel-sparing policy. Stricturoplasty, its outcomes, and its importance in recurrent disease are discussed, and segmental resection is compared with more extensive procedures such as total colectomy with ileorectal anastomosis. Lastly, laparoscopy is addressed with respect to its long-term outcomes, effect on surgical recurrence, and its application in the management of recurrent CD. PMID:20011321

Ramirez, Rowena L; Fleshner, Phillip

2006-11-01

305

Reoperative inflammatory bowel disease surgery.  

UK PubMed Central (United Kingdom)

With the advent of restorative proctocolectomy or ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), not only has there been potential for cure of UC but also patients have enjoyed marked improvements in bowel function, continence, and quality of life. However, IPAA can be complicated by postoperative small bowel obstruction, disease recurrence, and pouch failure secondary to pelvic sepsis, pouch dysfunction, mucosal inflammation, and neoplastic transformation. These may necessitate emergent or expeditious elective reoperation to salvage the pouch and preserve adequate function. Local, transanal, and transabdominal approaches to IPAA salvage are described, and their indications, outcomes, and the clinical parameters that affect the need for salvage are discussed. Pouch excision for failed salvage reoperation is reviewed as well. Relaparotomy is also frequently required for recurrent Crohn's disease (CD), especially given the nature of this as yet incurable illness. Risk factors for CD recurrence are examined, and the various surgical options and margins of resection are evaluated with a focus on bowel-sparing policy. Stricturoplasty, its outcomes, and its importance in recurrent disease are discussed, and segmental resection is compared with more extensive procedures such as total colectomy with ileorectal anastomosis. Lastly, laparoscopy is addressed with respect to its long-term outcomes, effect on surgical recurrence, and its application in the management of recurrent CD.

Ramirez RL; Fleshner P

2006-11-01

306

Updates on treatment of irritable bowel syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated to affect 10%-15% of the Western population, and has a large impact on quality of life and (in)direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and post-infectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications (alosetron and tegaserod) because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologically-based overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder.

Christopher W Hammerle, Christina M Surawicz

2008-01-01

307

MR findings of bowel ischemia with mesenteric vascular occlusion : comparison with pathologic findings in a cat model  

International Nuclear Information System (INIS)

[en] In order to determine the characteristic MR findings for the early diagnosis of bowel ischemia, we analysed the dynamic enhanced MR images of ischemic bowel induced by mesenteric vascular occlusion in a cat model, and compared the T1-and T2-weighted images (W1) of extracted bowel with the pathologic findings. According to the ischemic period, twelve cats were assigned to either the normal control group (no ischemic period, N=3D2), the acute ischemic group (ligation of mesenteric vessels for 3 hours, n=3D6) or the subacute ischemic group (ligation of mesenteric vessels for 10 hours, n=3D4). Under general anesthesia, laparotomy was performed. The ileal artery and vein were ligated, and a columnar surface coil was applied to the expected bowel ischemia. Using a 4.7 T MR scanner, contrast-enhanced T1W1 were obtained, after bolus injection of contrast media, at 10, 20, 30, 60, and 90 minutes. After formalin fixation of the extracted bowel, T1- and T2W1 were obtained, and the specimens were pathologically examined. MR signal intensity at each layer of the bowel wall was measured and compared with the histopathologic findings. On contrast enhanced MR images, the submucosal layer showed most intensive enhancement, followed-in decreasing order of signal intensity- by muscle and mucosa. Time to peak enhancement of bowel wall was 10-minutes in the normal control group, and 20 and 60 minutes in the acute and subacute bowel ischemia groups, respectively. On T1W1, no significant differences in signal intensity were observed between the ischemic group and the normal control group. On T2W1, the signal intensity of the submucosal layer of the acute ischemic group was significantly higher than that of the normal control or subacute ischemic group, and the signal intensity of the muscular layer of the ischemic group was significantly higher than that of the normal control group. Time to peak enhancement of bowel wall was a helpful criterion for assessment of the ischemic period. Analysis of the signal intensity of the bowel wall layer was useful for the early detection of bowel ischemia. (author)

2000-01-01

308

Analysis of gangliosides from carp intestinal mucosa.  

Science.gov (United States)

The gangliosides of carp intestinal mucosa were isolated and analysed by thin-layer chromatography (TLC), TLC immunostaining test, and TLC/secondary ion mass spectrometry (TLC/SIMS). Four species of gangliosides, designated as G-1, G-2, G-3 and G-4, were separated on TLC. The TLC/SIMS analysis of the G-1 ganglioside of carp intestinal mucosa revealed a series of [M-H](-)ions from m/z 1061 to m/z 1131 representing the molecular mass range of GM4-like ganglioside with NeuAc. G-2, G-3 and G-4 gangliosides were analysed by the TLC immunostaining test. G-2 ganglioside was recognised by the monoclonal antibody specific for ganglioside GM1 (AGM-1 monoclonal antibody). However, G-3 ganglioside migrating on TLC between GM3 and GM1 ganglioside was not recognised by anti-GM3 monoclonal antibody and by AGM-1 monoclonal antibody. Furthermore, G-4 ganglioside with a similar TLC mobility as GD1a ganglioside did not show the reactivity to the anti-GD1a monoclonal antibody. In addition using the AGM-1 monoclonal antibody, the expression of GM1 ganglioside in the carp intestinal tissue was studied. GM1 ganglioside was detected on the epithelial cell surface of carp intestinal mucosa. PMID:15123316

Irie, Takuya; Watarai, Shinobu; Kushi, Yasunori; Kasama, Takeshi; Kodama, Hiroshi

2004-02-01

309

Dopamine receptors in human gastrointestinal mucosa  

Energy Technology Data Exchange (ETDEWEB)

Dopamine is a putative enteric neurotransmitter that has been implicated in exocrine secretory and motility functions of the gastrointestinal tract of several mammalian species including man. This study was designed to determine the presence of dopamine binding sites in human gastric and duodenal mucosa and to describe certain biochemical characteristics of these enteric receptor sites. The binding assay was performed in triplicate with tissue homogenates obtained from healthy volunteers of both sexes using /sup 3/H-dopamine as a ligand. The extent of nonspecific binding was determined in the presence of a 100-fold excess of unlabeled dopamine. Scatchard analysis performed with increasing concentrations of /sup 3/H-dopamine (20-500 nM) revealed a single class of saturable dopamine binding sites in gastric and duodenal mucosa. The results of this report demonstrate the presence of specific dopamine receptors in human gastric and duodenal mucosa. These biochemical data suggest that molecular abnormalities of these receptor sites may be operative in the pathogenesis of important gastrointestinal disorders. 33 references, 2 figures.

Hernandez, D.E.; Mason, G.A.; Walker, C.H.; Valenzuela, J.E.

1987-12-21

310

Candidiasis de la mucosa bucal: Revisión bibliográfica  

Directory of Open Access Journals (Sweden)

Full Text Available Se presenta una revisión de la literatura actualizada de una de las enfermedades más frecuentes de la mucosa bucal y la afección micótica más común en esta localización: la candidiasis de la mucosa bucal. Se detallan los factores predisponentes generales y locales que favorecen la aparición de esta alteración patológica como son los tratamientos prolongados con antibióticos, la diabetes, la anemia, la radioterapia y quimioterapia antineoplásicas, las drogas inmunosupresoras y el SIDA, entre otros. Se exponen las diferentes clasificaciones clínicas, según el criterio de distintos autores y el cuadro clínico de la enfermedad. Finalmente se presentan alternativas terapéuticas tanto en el campo de la medicina convencional como en el de la medicina tradicional y natural.This paper presents an updated literature review of one of the most frequent diseases in the oral mucosa and the most common mycotic affection in this site, i.e, oral mucosal candidiasis. The general and local predisposing factors that favor the occurrence of this pathological disorder such as extended antibiotic treatments, diabetes, anemia, anti-neoplastic radiotherapy and chemotherapy, immunosuppresive drugs, AIDS, among others. Different clinical classifications, according to several authors´ criteria and the clinical picture of the disease, are stated. Finally, therapeutical options in the fields of conventional medicine and traditional and natural medicine are presented.

Judy Rodríguez Ortega; Josefa Miranda Tarragó; Haydée Morejón Lugones; Julio C Santana Garay

2002-01-01

311

[Bullous autoimmune diseases of the oral mucosa].  

Science.gov (United States)

Autoimmune bullous diseases (AIBD) are characterized by autoantibodies targeted against adhesion molecules, impairing their formation. According to localization criteria, pemphigus (intraepidermal blister and desmosomal involvement) and pemphigoid (subepidermal blister and dermoepidermal junction involvement) can be distinguished. In two-thirds of the cases, pemphigus vulgaris begins with oral lesions (mainly the buccal mucosa and palate, rarely the gingiva). Skin lesions are usual. Excepting paraneoplastic pemphigus (a recently individualized entity), oral lesions are uncommon in other types of pemphigus. Cicatricial pemphigoid mainly involves oral mucosa, frequently other mucous membranes, and rarely the skin. Gingival involvement is frequent. In case of desquamative gingivitis, the clip sign gives the diagnosis of cicatricial pemphigoid. Ocular involvement is frequent and causes blindness. Epidermolysis bullosa acquisita and IgA linear dermatosis are rare. Bullous pemphigoid and bullous lupus rarely involve the oral mucosa. Diagnosis of AIBD requires a biopsy within the mucosal membrane lesion for pathology examination and another biopsy in a lesion-free area for direct immunofluorescence detection of antibody fixation. Immunoelectron microscopy or immunoblast transfer may be needed for positive diagnosis. Corticosteroids are used to treat pemphigus and dapsone is used for cicatricial pemphigoid. Immunosuppressive therapy is rarely needed. PMID:10604215

Vaillant, L

1999-10-01

312

Calcium secretion in canine tracheal mucosa  

Energy Technology Data Exchange (ETDEWEB)

Calcium (Ca) affects many cellular functions of the respiratory tract mucosa and might alter the viscoelastic properties of mucus. To evaluate Ca homeostasis in a respiratory epithelium we investigated transport of Ca by the canine tracheal mucosa. Mucosal tissues were mounted in Ussing-type chambers and bathed with Krebs-Henseleit solution at 37 degrees C. Unidirectional fluxes of 45Ca were determined in tissues that were matched by conductance and short-circuit current (SCC). Under short-circuit conditions there was a significant net Ca secretion of 1.82 +/- 0.36 neq . cm-2 . h-1 (mean +/- SE). Under open-circuit conditions, where the spontaneous transepithelial potential difference could attract Ca toward the lumen, net Ca secretion increased significantly to 4.40 +/- 1.14 compared with 1.54 +/- 1.17 neq . cm-2 . h-1 when the preparation was short-circuited. Addition of a metabolic inhibitor, 2,4-dinitrophenol (2 mM in the mucosal bath), decreased tissue conductance and SCC and slightly decreased the unidirectional movement of Ca from submucosa to lumen. Submucosal epinephrine (10 microM) significantly enhanced Ca secretion by 2.0 +/- 0.63 neq . cm-2 . h-1. Submucosal ouabain (0.1 mM) failed to inhibit Ca secretion. The data suggest that canine tracheal mucosa secretes Ca; this secretory process is augmented by epinephrine or by the presence of a transepithelial potential difference as found under in vivo conditions.

Al-Bazzaz, F.J.; Jayaram, T.

1985-10-01

313

Tissue engineering airway mucosa: a systematic review.  

UK PubMed Central (United Kingdom)

Objective Effective treatments for hollow organ stenosis, scarring or agenesis are suboptimal or lacking. Tissue engineered implants may provide a solution but those performed to date are limited by poor mucosalization after transplantation. We aimed to perform a systematic review of the literature on tissue engineered airway mucosa. Our objectives were to assess the success of this technology, its potential application to airway regenerative medicine and determine the direction of future research to maximise its therapeutic and commercial potential. Data Sources and Review Methods A systematic review of the literature was performed searching Medline (1996 - December 2012) and Embase (1980 - December 2012) using search terms "tissue engineering" or "tissue" and "engineering" or "tissue engineered" and "mucous membrane" or "mucous" and "membrane" or "mucosa". Original studies utilising tissue engineering to regenerate airway mucosa within the trachea or main bronchi in animal models or human studies were included. Results 719 papers matched the search criteria with 17 fulfilling the entry criteria. Of these 17, four investigated mucosal engineering in humans with the remaining 13 studies investigating mucosal engineering in animal models. The review demonstrated how an intact mucosal layer protects against infection and suggests a role for fibroblasts in facilitating epithelial regeneration in-vitro. A range of scaffold materials were used but no one material was clearly superior to the others. Conclusion The review highlights gaps in the literature and recommends key directions for future research as epithelial tracking and the role of the extracellular environment.

Hamilton N; Bullock A; Macneil S; Janes S; Birchall M

2013-10-01

314

Active electrolyte transport in mammalian buccal mucosa  

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The transmural electrical potential difference (PD) was measured in vivo across the buccal mucosa of humans and experimental animals. Mean PD was {minus}31 {plus minus} 2 mV in humans, {minus}34 {plus minus} 2 mV in dogs, {minus}39 {plus minus} 2 mV in rabbits, and {minus}18 {plus minus} 1 mV in hamsters. The mechanisms responsible for this PD were explored in Ussing chambers using dog buccal mucosa. Fluxes of ({sup 14}C)mannitol, a marker of paracellular permeability, varied directly with tissue conductance. The net fluxes of {sup 22}Na and {sup 36}Cl were +0.21 {plus minus} 0.05 and {minus}0.04 {plus minus} 0.02 {mu}eq/h{center dot}cm{sup 2}, respectively, but only the Na{sup +} flux differed significantly from zero. I{sub sc} was reduced by luminal amiloride, serosal ouabain, or by reducing luminal Na{sup +} below 20 mM. This indicated that the I{sub sc} was determined primarily by active Na{sup +} absorption and that Na{sup +} traverses the apical membrane at least partly through amiloride-sensitive channels and exists across the basolateral membrane through Na{sup +}-K{sup +}-ATPase activity. The authors conclude that buccal mucosa is capable of active electrolyte transport and that this capacity contributes to generation of the buccal PD in vivo.

Orlando, R.C.; Tobey, N.A.; Schreiner, V.J.; Readling, R.D. (Univ. of North Carolina School of Medicine, Chapel Hill (USA))

1988-09-01

315

Active electrolyte transport in mammalian buccal mucosa  

International Nuclear Information System (INIS)

The transmural electrical potential difference (PD) was measured in vivo across the buccal mucosa of humans and experimental animals. Mean PD was -31 ± 2 mV in humans, -34 ± 2 mV in dogs, -39 ± 2 mV in rabbits, and -18 ± 1 mV in hamsters. The mechanisms responsible for this PD were explored in Ussing chambers using dog buccal mucosa. Fluxes of [14C]mannitol, a marker of paracellular permeability, varied directly with tissue conductance. The net fluxes of 22Na and 36Cl were +0.21 ± 0.05 and -0.04 ± 0.02 ?eq/h?cm2, respectively, but only the Na+ flux differed significantly from zero. Isc was reduced by luminal amiloride, serosal ouabain, or by reducing luminal Na+ below 20 mM. This indicated that the Isc was determined primarily by active Na+ absorption and that Na+ traverses the apical membrane at least partly through amiloride-sensitive channels and exists across the basolateral membrane through Na+-K+-ATPase activity. The authors conclude that buccal mucosa is capable of active electrolyte transport and that this capacity contributes to generation of the buccal PD in vivo.

1988-01-01

316

Roentgenographic findings of experimental bowel ischaemia in dogs following occlusion of the superior mesenteric artery  

International Nuclear Information System (INIS)

[en] The results after ligation of the superior mesenteric artery in 17 dogs demonstrate that a gasless abdomen and small bowel pseudoobstruction are unspecific early roentgenographic findings and bowel-wall thickening with narrowed lumen and increased distance to neighbouring loops are a specific early roentgenographic plain-film finding of acute bowel ischemia following mesenteric vascular occlusion. Approximately 10 hours after ligation a combined distension of small and large bowel with dilatation and air-fluid levels is demonstrable as a sign of paralytic ileus with diffuse peritonitis without possibility of differentiation from other causes of this entity. Gas in the bowel wall, in the superior mesenteric vein and in the portal venous system is a late specific plain-film finding resulting from the invasion of gas-forming bacteria into the devitalized bowel wall with advanced gangrene and a sign of infaust prognosis. The results of the plain-film examinations are correlated to angiographic, clinical and laboratory findings, as well as to histology and bacteriology of the ischemic bowel segments. (orig.)

1980-01-01

317

Roentgenographic findings of experimental bowel ischaemia in dogs following occlusion of the superior mesenteric artery  

Energy Technology Data Exchange (ETDEWEB)

The results after ligation of the superior mesenteric artery in 17 dogs demonstrate that a gasless abdomen and small bowel pseudoobstruction are unspecific early roentgenographic findings and bowel-wall thickening with narrowed lumen and increased distance to neighbouring loops are a specific early roentgenographic plain-film finding of acute bowel ischemia following mesenteric vascular occlusion. Approximately 10 hours after ligation a combined distension of small and large bowel with dilatation and air-fluid levels is demonstrable as a sign of paralytic ileus with diffuse peritonitis without possibility of differentiation from other causes of this entity. Gas in the bowel wall, in the superior mesenteric vein and in the portal venous system is a late specific plain-film finding resulting from the invasion of gas-forming bacteria into the devitalized bowel wall with advanced gangrene and a sign of infaust prognosis. The results of the plain-film examinations are correlated to angiographic, clinical and laboratory findings, as well as to histology and bacteriology of the ischemic bowel segments.

Beyer, D.; Horsch, S.; Bohr, M.; Schmitz, T.

1980-04-01

318

An unusual white blood cell scan in a child with inflammatory bowel disease: a case report.  

UK PubMed Central (United Kingdom)

Technetium-99m-labeled leukocyte (WBC) imaging is a valuable screening method for inflammatory bowel disease, especially in children, because of its high rate of sensitivity, low cost, and ease of preparation. A 14-year-old girl is described who had juvenile arthritis and iritis complicated by inflammatory bowel disease. She was examined for recurrent abdominal pain. A Tc-99m stannous colloid WBC scan was performed, and tracer accumulation was seen in the small bowel in the region of the distal ileum on the initial 1-hour image. Delayed imaging at 3 hours also revealed tracer accumulation in the cecum and ascending colon, which was not seen on the early image. A biopsy of the colon during endoscopy showed no evidence of active inflammation in the colon. The small bowel was not seen. Computed tomography revealed changes suggestive of inflammatory bowel disease in the distal ileum. The appearance on the WBC study was most likely a result of inflammatory bowel disease involving the distal ileum, with transit of luminal activity into the large bowel.

Porn U; Howman-Giles R; O'Loughlin E; Uren R; Chaitow J

2000-10-01

319

Efeitos da injeção de solução bicarbonatada de ácido acetilsalicílico em mucosa colorretal de coelhos, com vistas a aplicação no preparo pré-operatório do cólon Local effects of rectal washout with acetylsalicylic acid solution on the colonic mucosa of rabbits  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUÇÃO: A recidiva local no câncer colorretal tem como principal causa o implante de células tumorais nas anastomoses. 11-15 Dessa maneira, lavagem química do lúmen intestinal é preconizada para evitar tanto o implante quanto à recidiva local. 11-28 Em estudos prévios constatamos que a solução bicarbonatada de ácido acetilsalicílico tem efeitos citolíticos e anti-tumorais in-vitro.31 OBJETIVOS: Avaliar a toxicidade da solução de aspirina na mucosa colônica de coelhos com o objetivo de usá-la no preparo intestinal de portadores de câncer colorretal. MATERIAIS E MÉTODOS: Foram utilizados 20 coelhos. Um clampe vascular foi colocado acima do cólon sigmóide. Os animais foram submetidos a um enema com 50 ml da solução de aspirina ou soro fisiológico de acordo com o grupo. Os animais foram sacrificados ao término do procedimento ou tardiamente de acordo com o grupo. RESULTADOS: A solução de aspirina não altera a mucosa colônica de coelhos. CONCLUSÃO: O uso da solução bicarbonatada de ácido acetilsalicílico no preparo intestinal de portadores de câncer colorretal é clinicamente possível.BACKGROUND: The implantation of viable exfoliated intraluminal tumour cells is the major cause of local recurrence in colorectal cancer. 11-28 Therefore, the bowel lumen wash with a tumoricidal agent has been recommended. 11-28 In previous study we observe that acetylsalicylic acid solution cause neoplastic cell death in vitro.31 PURPOSE: Assess the local effect of acetylsalicylic acid solution on the colonic mucosa of rabbits, in order to use this agent in the bowel lumen wash. METHODS: 20 rabbits were used. A vascular clamp was placed on the distal colon, followed by the instillation per rectum of 50 ml of acetylsalicylic acid solution or saline solution, according to the group. The euthanasia was performed immediately or later according to the group. RESULTS: The acetylsalicylic acid solution doesn't cause any injury on the colonic mucosa of rabbits. Conclusion: The use of acetylsalicylic acid solution in the bowel lumen wash seems clinically feasible.

Enrico Salomão Ioriatti; Maria A. M. Rodrigues; Juliana Menezes Siqueira; Rogério Saad Hossne

2007-01-01

320

Efeitos da injeção de solução bicarbonatada de ácido acetilsalicílico em mucosa colorretal de coelhos, com vistas a aplicação no preparo pré-operatório do cólon/ Local effects of rectal washout with acetylsalicylic acid solution on the colonic mucosa of rabbits  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese INTRODUÇÃO: A recidiva local no câncer colorretal tem como principal causa o implante de células tumorais nas anastomoses. 11-15 Dessa maneira, lavagem química do lúmen intestinal é preconizada para evitar tanto o implante quanto à recidiva local. 11-28 Em estudos prévios constatamos que a solução bicarbonatada de ácido acetilsalicílico tem efeitos citolíticos e anti-tumorais in-vitro.31 OBJETIVOS: Avaliar a toxicidade da solução de aspirina na mucosa col? (more) ?nica de coelhos com o objetivo de usá-la no preparo intestinal de portadores de câncer colorretal. MATERIAIS E MÉTODOS: Foram utilizados 20 coelhos. Um clampe vascular foi colocado acima do cólon sigmóide. Os animais foram submetidos a um enema com 50 ml da solução de aspirina ou soro fisiológico de acordo com o grupo. Os animais foram sacrificados ao término do procedimento ou tardiamente de acordo com o grupo. RESULTADOS: A solução de aspirina não altera a mucosa colônica de coelhos. CONCLUSÃO: O uso da solução bicarbonatada de ácido acetilsalicílico no preparo intestinal de portadores de câncer colorretal é clinicamente possível. Abstract in english BACKGROUND: The implantation of viable exfoliated intraluminal tumour cells is the major cause of local recurrence in colorectal cancer. 11-28 Therefore, the bowel lumen wash with a tumoricidal agent has been recommended. 11-28 In previous study we observe that acetylsalicylic acid solution cause neoplastic cell death in vitro.31 PURPOSE: Assess the local effect of acetylsalicylic acid solution on the colonic mucosa of rabbits, in order to use this agent in the bowel lume (more) n wash. METHODS: 20 rabbits were used. A vascular clamp was placed on the distal colon, followed by the instillation per rectum of 50 ml of acetylsalicylic acid solution or saline solution, according to the group. The euthanasia was performed immediately or later according to the group. RESULTS: The acetylsalicylic acid solution doesn't cause any injury on the colonic mucosa of rabbits. Conclusion: The use of acetylsalicylic acid solution in the bowel lumen wash seems clinically feasible.

Ioriatti, Enrico Salomão; Rodrigues, Maria A. M.; Siqueira, Juliana Menezes; Hossne, Rogério Saad

2007-12-01

 
 
 
 
321

Analysis of small bowel tumors.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Small bowel tumors are remarkably rare. The colon is affected 40 times than the small bowel. Even though the small intestine accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3-6% of the gastrointestinal malignancies arise from the small bowel. The aim of the study is to enlighten the subject in our community including: therapeutic intervention, the histopathologic types, the risk factors and outcome. METHODS: Between January 1997 and January 2002, 40 patients with primary small bowel tumors were followed in Baghdad Hospital, Gastroenterology and Hepatology Hospital, Al-Mansour Hospital for Pediatrics at Medical City Teaching Centre and the Al-Zahraa Private Hospital, for presentations, preoperative investigations, operative procedures and outcome. Chi-square test or where appropriate Fishers exact test was used to assess for the statistical significance of the site of the tumor and outcome. The relative risk (RR) and odds ratio (OR) where possible, were used to measure the magnitude of developing a certain outcome (like death) in the presence of risk factor compared to its absence. P value less than the 0.05 level of significance is considered statistically significant. The 95% confidence interval was used to express the expected range of incidence rate of certain outcomes in the target population. RESULTS: The most frequent age group affected is 46-60. The most frequent symptoms in decreasing order were abdominal pain (75%), vomiting (72.5%), and weight loss (52.5%). The most sensitive diagnostic procedure was barium study (84.6%). Lymph nodes were the most common site of metastases 15 (37.5%). The duration of follow up was from 2-60-months. The site: duodenum has the highest case fatality rate (62.5 %) with an RR=9.9 which was statistically significant (p=0.006) as compared to the jejunum (25%) that has an RR=3.9 (p=0.16 NS)], then the ileum (6.3%). CONCLUSION: Overall, the prognosis for patients with small intestinal tumors is poor. The duodenum as a site of the small bowel tumors was the only significant risk factor with regard to case fatality rate. Despite current advanced diagnostic modalities, the small intestine remains a difficult area to image with both radiographs and the endoscope.

Abdul-Rahman MM; Al-Waali MM; Al-Naaimi AS

2004-12-01

322

Pleiotropic effects of bombesin and neurotensin on intestinal mucosa: Not just trefoil peptides  

Directory of Open Access Journals (Sweden)

Full Text Available Bombesin and neurotensin are neuropeptides which exert a wide spectrum of biological actions on gastrointestinal tissues influencing intestinal growth and adaptation, intestinal motility, blood flow, secretion, nutrient absorption and immune response. Based mainly on their well-established potent enterotrophic effect, numerous experimental studies investigated their potential positive effect on the atrophic or injured intestinal mucosa. These peptides proved to be effective mucosa-healing factors, but the potential molecular and cellular mechanisms for this action remained unresolved. In a recently published study (World J Gastroenterol 2008; 14(8): 1222-1230), it was shown that their protective effect on the intestine in experimentally induced inflammatory bowel disease was related to anti-inflammatory, antioxidant and antiapoptotic actions. These results are in close agreement with our previous studies on jaundiced and hepatectomized rats that showed a regulatory effect of bombesin and neurotensin on critical cellular processes such as enterocyte’ proliferation and death, oxidative stress and redox equilibrium, tight junctions’ formation and function, and inflammatory response. The pleiotropic effects of bombesin and neurotensin on diverse types of intestinal injury may justify their consideration for clinical trials.

Stelios F Assimakopoulos, Chrisoula D Scopa, Vassiliki N Nikolopoulou, Constantine E Vagianos

2008-01-01

323

Elderly diabetic patient with surgical site mucormycosis extending to bowel  

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Full Text Available Mucormycosis is rare in clinical practice. Most infections are acquired by inhalation; other portals of entry are traumatic implantation and ingestion in immunocompromised host. Mucormycosis is life threatening infection in immunocompromised host with variable moratlity ranging from 15 -81% depending upon site of infection. General treatment principles include early diagnosis, correction of underlying immunosuppression and metabolic disturbances, adequate surgical debridement along with amphotericin therapy. We describe surgical site mucormycosis extended to involve large bowel in elderly diabetic patient.

Patel Atul; Vora Himanshu; Patel Ketan; Patel Bhavin

2010-01-01

324

CT findings in acute small bowel diverticulitis  

International Nuclear Information System (INIS)

Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are non-specific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum. (orig.)

2004-01-01

325

Weight loss and morphometric study of intestinal mucosa in rats after massive intestinal resection: influence of a glutamine-enriched diet/ Perda de peso e estudo morfométrico da mucosa intestinal de ratos submetidos à ressecção subtotal de intestino delgado: influência do uso de dieta com glutamina  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A síndrome do intestino curto é responsável por alterações metabólicas que comprometem o estado nutricional do paciente. A glutamina é nutriente essencial para os enterócitos. OBJETIVOS: Estudou-se o efeito da administração de dieta com glutamina, em ratos submetidos à ressecção subtotal do intestino delgado, avaliando a perda de peso pós-operatória e a morfometria da mucosa intestinal. MÉTODOS: Foram constituídos três grupos de ratos Wistar machos receb (more) endo as seguintes dietas: com glutamina (grupo EG), sem glutamina (grupo EsG), e a dieta padrão do laboratório (grupo ER). A ressecção intestinal foi realizada em todos os animais incluindo-se a válvula íleo-cecal, com remanescente jejunal de apenas 25cm a partir do piloro, anastomosado látero-lateralmente ao cólon ascendente. A diferença entre o peso inicial real e ao final do experimento no 20º dia pós-operatório foi registrada antes do sacrifício. Fragmentos de mucosa do duodeno e jejuno foram colhidos e corados com hematoxilina-eosina. Realizou-se o estudo morfométrico da mucosa intestinal, por meio de sistema digital associado ao microscópio ótico. Mediu-se a altura das vilosidades, a profundidade das criptas e a extensão total da mucosa intestinal. RESULTADOS: A perda de peso entre os três grupos não diferiu estatisticamente. A análise da morfometria da mucosa intestinal mostrou diferença significativa: 1) animais do grupo Enterectomia com Glutamina (EG) apresentaram vilosidade duodenal significativamente maior que o grupo EsG (p Abstract in english Short-bowel syndrome is responsible for significant metabolic alterations that compromise nutritional status. Glutamine is considered an essential nutrient for enterocytes, so beneficial effects from supplementation of the diet with glutamine are hypothesized. PURPOSE: In this study, the effect of a diet enriched with glutamine was evaluated in rats undergoing extensive small bowel resection, with analysis of postoperative weight loss and intestinal morphometrics of villi (more) height, crypt depth, and thickness of the duodenal and remnant jejunal mucosa. METHODS: Three groups of male Wistar rats were established receiving the following diets: with glutamine, without glutamine, and the standard diet of laboratory ration. All animals underwent an extensive small bowel resection, including the ileocecal valve, leaving a remnant jejunum of only 25 cm from the pylorus that was anastomosed lateral-laterally to the ascendant colon. The animals were weighed at the beginning and end of the experiment (20th postoperative day). Then they were killed and the remnant intestine was removed. Fragments of duodenal and jejunal mucosa were collected from the remnant intestine and submitted to histopathologic exam. The morphometric study of the intestinal mucosa was accomplished using a digital system (KS 300) connected to an optic microscope. Morphometrics included villi height, crypt depth, and the total thickness of intestinal mucosa. RESULTS: The weight loss comparison among the 3 groups showed no significant loss difference. The morphometric studies showed significantly taller duodenal villi in the glutamine group in comparison to the without glutamine group, but not different from the standard diet group. The measurements obtained comparing the 3 groups for villi height, crypt depth, and thickness of the remnant jejunum mucosa were greater in the glutamine-enriched diet group than for the without-glutamine diet group, though not significantly different from with standard-diet group. CONCLUSIONS: In rats with experimentally produced short-bowel syndrome, glutamine-enrichment of an isonitrogenous test diet was associated with an improved adaptation response by the intestinal mucosa but not reduced weight loss. However, the adaptation response in the group receiving the glutamine-enriched diet was not improved over that for the group fed regular chow.

Ribeiro, Sidney Resende; Pinto Júnior, Paulo Engler; Miranda, Ariney Costa de; Bromberg, Sansom Henrique; Lopasso, Fábio Pinatel; Irya, Kiyoshi

2004-01-01

326

The diagnostic value of different imaging modalities in evaluation of bowel obstruction.  

UK PubMed Central (United Kingdom)

The aim of the study was analysing of the diagnostic value of different imaging modalities in evaluation patients with bowel obstruction. The material comprises a group of 47 patients with diagnosed acute abdomen. Erect radiography, and radiographs in supine and left lateral patients' positions, US and CT examination were performed in those patients. CT examination was performed in 5 mm--and 10-mm thick axial sections before and after administering the contrast agent. In 6 patients small barium enema was performed. In 5 cases water-soluble contrast was administered orally. In 6 cases on plane radiographs the presence of high small bowel obstruction was found. In 3 cases the level of small bowel obstruction was in the distal ileum. In 12 patients the obstruction of large bowel was seen on plain radiographs. In 3 patients intussusception of sigmoid bowel was found. The mesenteric ischemia was found to be a reason of bowel obstruction in 5 cases. On CT section soft tissue mass with irregular contrast enhancement was found, reflecting ischemic intestinal loops. In 2 patients the gall stone small bowel obstruction was found. In one of them the presence of gas in the biliary tree was seen on CT images. The determining of the level of the obstruction is facilitated on plain radiographs, erect and in supine and left lateral patients' position. In small bowel obstruction, normal or equivocal initial radiographs may result in a delayed diagnosis. As the bowel diameter cannot be assessed the plain radiographic diagnosis is difficult or impossible. If there is persistent diagnostic difficulty, follow-up plain radiographs taken a few hours later will often resolve the problem and, if not, a barium study or CT may be performed. Orally administering of water-soluble contrast agent, diluted barium, barium enema are also helpful in differentiating the character and etiology of obstruction.

Pas?awski M; Gwizdak J; Z?omaniec J

2004-01-01

327

Mucosal bacterial microflora and mucus layer thickness in adolescents with inflammatory bowel disease  

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Full Text Available AIM: To assess the mucosa-associated bacterial microflora and mucus layer in adolescents with inflammatory bowel disease (IBD).METHODS: Sixty-one adolescents (mean age 15 years, SD ± 4.13) were included in the study. Intestinal biopsies from inflamed and non-inflamed mucosa of IBD patients and from controls with functional abdominal pain were cultured under aerobic and anaerobic conditions. The number of microbes belonging to the same group was calculated per weight of collected tissue. The mucus thickness in frozen samples was measured under a fluorescent microscope.RESULTS: The ratios of different bacterial groups in inflamed and non-inflamed mucosa of IBD patients and controls were specific for particular diseases. Streptococcus spp. were predominant in the inflamed mucosa of Crohn’s disease (CD) patients (80% of all bacteria), and Lactobacillus spp. were predominant in ulcerative colitis patients (90%). The differences were statistically significant (P = 0.01-0.001). Lower number of bifidobacteria was observed in the whole IBD group. A relation was also found between clinical and endoscopic severity and decreased numbers of Lactobacillus and, to a lesser extent, of Streptococcus in biopsies from CD patients. The mucus layer in the inflamed sites was significantly thinner as compared to controls (P = 0.0033) and to non-inflamed areas in IBD patients (P = 0.031).CONCLUSION: The significantly thinner mucosa of IBD patients showed a predominance of some aerobes specific for particular diseases, their numbers decreased in relation to higher clinical and endoscopic activity of the disease.

Krzysztof Fyderek, Magdalena Strus, Kinga Kowalska-Duplaga, Tomasz Gosiewski, Andrzej W?drychowicz, Urszula Jedynak-W?sowicz, Ma?gorzata S?adek, Stanis?aw Pieczarkowski, Pawe? Adamski, Piotr Kochan, Piotr B Heczko

2009-01-01

328

Small bowel motility in functional chronic constipation.  

UK PubMed Central (United Kingdom)

In functional constipation, three pathophysiological subgroups have been identified: slow-transit constipation (STC); normal-transit constipation (NTC) and outlet delay (OD). Extracolonic manifestations, especially disturbed small bowel motility, are well known to occur in STC, but have rarely been studied in NTC and OD. To perform 24-h-ambulatory jejunal manometry in a large prospective series of clinical patients with chronic constipation of all subtypes. A total of 61 consecutive patients, referred to our tertiary gastroenterologic centre for chronic constipation (48 female, 13 male; mean age 57 (range 20-87) years), underwent jejunal 24-h-ambulatory manometry (standardized meal) after a transit-time study (radio-opaque markers), anorectal manometry, defecography and colonoscopy. Computerized and visual analysis by two independent observers was compared with the normal range of manometric variables, defined by data previously obtained in 50 healthy subjects (Gut 1996;38:859). Five patients were excluded from the study because of coexistence of OD and STC. No patient with OD (n = 8), but all patients with STC (n = 32) and 94% of patients with NTC (n = 16) showed small bowel motor abnormalities; both in postprandial response and fasting motility. The abnormal findings ranged from severe disturbances with complete loss of MMC to subtle changes of contraction parameters that could only be assessed by computerized analysis. No significant differences between STC- and NTC-patients were found. Most findings pointed to an underlying enteric neuropathy. Intestinal prolonged-ambulatory manometry adds valuable information to the pathophysiologic understanding of functional chronic constipation of STC- and NTC-type, however there are no distinct manometric features to differentiate between both.

Seidl H; Gundling F; Pehl C; Pfeiffer A; Schepp W; Schmidt T

2009-12-01

329

Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine/ Tratamento da síndrome do intestino irritável pós-infecciosa e da síndrome do intestino irritável não-infecciosa com mesalazina  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese CONTEXTO: Estudos recentes sustentam a hipótese que a síndrome do intestino irritável pós-infecciosa e alguns pacientes com síndrome do intestino irritável mostram sinais menores de inflamação persistente da mucosa. A mesalazina tem propriedades anti-inflamatórias intestinais, incluindo a inibição da ciclooxigenase e das prostaglandinas. Os efeitos da mesalazina na síndrome do intestino irritável pós-infecciosa e em pacientes com síndrome do intestino irrit (more) ável não-infecciosa ainda são desconhecidos. OBJETIVO- Observar os efeitos da mesalazina em pacientes com síndrome do intestino irritável pós-infecciosa e síndrome do intestino irritável com diarréia não-infecciosa. MÉTODOS: Com base nos critérios de Roma III, 61 pacientes síndrome do intestino irritável acompanhado de diarréia (18 anos ou mais de idade) foram incluídos na avaliação. Os pacientes foram divididos em dois grupos: grupo síndrome do intestino irritável pós-infecciosa, com 18 pacientes medicados com mesalazina 800 mg 3 vezes ao dia por 30 dias; grupo síndrome do intestino irritável não-infecciosa, com 43 pacientes medicados com mesalazina 800 mg 3 vezes ao dia por 30 dias. Avaliações dos sintomas no início e após o tratamento foram realizadas por meio de uma escala Likert de 4 pontos, incluindo a frequência das evacuações, forma e consistência das fezes (Bristol Stool Scale), dor e distensão abdominal (pontuação máxima: 16; pontuação mínima: 4). RESULTADOS: O grupo síndrome do intestino irritável pós-infecciosa apresentou redução estatisticamente significante do escore total de sintomas (P Abstract in english CONTEXT: Recent studies support the hypothesis that postinfectious irritable bowel syndrome and some irritable bowel syndrome patients display persistent signs of minor mucosal inflammation. Mesalazine has intestinal anti-inflammatory properties including cyclooxygenase and prostaglandin inhibition. The effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome patients are still unknown. OBJECTIVE: To observe the effects of (more) mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients. METHODS: Based on Rome III criteria, 61 irritable bowel syndrome with diarrhea patients (18 years old or more) were included in the evaluation. Patients were divided into two groups: postinfectious irritable bowel syndrome group, with 18 patients medicated with mesalazine 800 mg 3 times a day for 30 days; noninfective irritable bowel syndrome group, with 43 patients medicated with mesalazine 800 mg 3 times a day for 30 days. Symptom evaluations at baseline and after treatment were performed by means of a four-point Likert scale including stool frequency, stool form and consistency (Bristol Stool Scale), abdominal pain and distension (maximum score: 16; minimum score: 4). RESULTS: Postinfectious irritable bowel syndrome group presented a statistically significant reduction of the total symptom score (P

Bafutto, Mauro; Almeida, José Roberto de; Leite, Nayle Vilela; Oliveira, Enio Chaves; Gabriel-Neto, Salustiano; Rezende-Filho, Joffre

2011-03-01

330

[Irritable bowel syndrome--irritable bowel or irritable mind?].  

Science.gov (United States)

Irritable bowel syndrome (IBS) is one of the most common disorders of gastrointestinal tract, affecting significant number of western population. The characteristic features are chronic and(or) recurrent abdominal pain and discomfort associated with changes in the bowel habit with or without bloating. According to Rome Criteria III there is an improved focus on the intestinal transit time which allows for better diagnosis and characterization of patients either with diarrhea, constipation predominant or mixed type IBS. Patients with IBS also frequently manifest various symptoms related to central nervous system (CNS) as depression or personality disorders. In this review we present current knowledge concerning etiopathogenesis of IBS with emphasis on the role of microbiota and describe promissing profilatic and treatment modalities with anti-biotics and probiotics capable to modulate microbiota and gut-brain axis. Most recent studies concerning clinical efficacy of antibiotic rifaximin and probiotic strain Lactobacillus plantarum 299v in symptom prevention (reduction) of this common gastrointestinal disorder are briefly described. PMID:22400184

Marlicz, Wojciech; Zawada, Iwona; Starzy?ska, Teresa

2012-01-01

331

[Irritable bowel syndrome--irritable bowel or irritable mind?].  

UK PubMed Central (United Kingdom)

Irritable bowel syndrome (IBS) is one of the most common disorders of gastrointestinal tract, affecting significant number of western population. The characteristic features are chronic and(or) recurrent abdominal pain and discomfort associated with changes in the bowel habit with or without bloating. According to Rome Criteria III there is an improved focus on the intestinal transit time which allows for better diagnosis and characterization of patients either with diarrhea, constipation predominant or mixed type IBS. Patients with IBS also frequently manifest various symptoms related to central nervous system (CNS) as depression or personality disorders. In this review we present current knowledge concerning etiopathogenesis of IBS with emphasis on the role of microbiota and describe promissing profilatic and treatment modalities with anti-biotics and probiotics capable to modulate microbiota and gut-brain axis. Most recent studies concerning clinical efficacy of antibiotic rifaximin and probiotic strain Lactobacillus plantarum 299v in symptom prevention (reduction) of this common gastrointestinal disorder are briefly described.

Marlicz W; Zawada I; Starzy?ska T

2012-01-01

332

Inactivation of corticosteroids in intestinal mucosa by 11 beta-hydroxysteroid: NADP oxidoreductase (EC 1. 1. 1. 146)  

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Activity of the enzyme 11 beta-hydroxysteroid:NADP oxidoreductase (EC 1.1.1.146) in human intestinal mucosa was determined by incubating scraped mucosa with /sup 3/H-cortisone and /sup 14/C-cortisol; these steroids were then extracted, separated chromatographically, and the radioactivity assayed to determine simultaneously both reductase and dehydrogenase activities. This was the only significant metabolic alteration which the substrate underwent. Only two cases had slight (5 and 13%) reductase activity. In 35 patients, 16 male and 19 female, including seven cases of Crohn's disease, three ulcerative colitis, five diverticulitis, two undergoing surgery for repair of injuries and 18 for carcinoma of colon or rectum, cortisol was converted to cortisone in 15 min with a wide range of values distributed uniformly up to 85% dehydrogenation, with a mean of 42%. When tissue homogenates were fortified with coenzymes, excess NADPH lowered dehydrogenase activity 81%; excess NADP increased dehydrogenase activity 2-fold in three cases. It is possible that a value is characteristic of an individual but perhaps more likely enzyme activity varies with metabolic events involving changes in the coenzyme levels in mucosa, and a random sampling might be expected to yield such a distribution of values. In any event, where activity is high most of the cortisol is inactivated within minutes. It is suggested that synthetic corticoids which escape such metabolic alteration might, except during pregnancy, prove superior in the treatment of conditions such as inflammatory bowel disease.

Burton, A.F.; Anderson, F.H.

1983-10-01

333

Epidemiology and inflammatory bowel diseases  

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Full Text Available The role of alcohol in causing or aggravating the pathogenesis of inflammatory bowel disease is unclear. For finding a conclusive answer for this valuable question we conducted this review. Only two studies were identified that successfully fulfilled our inclusive criteria. Usual consumption of alcohol reduced the risk compared with less frequent use (odds ratio = 0.57, 95%CI: 0.37-0.86). Light alcoholic drinking has protective effects against development of ulcerative colitis. But this inverse association disappeared when smoking was included.

Ahmed Mahmoud El-Tawil

2013-01-01

334

Adenoid cystic carcinoma of buccal mucosa.  

Science.gov (United States)

Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in the salivary glands of head and neck region. The clinical and pathological findings typical of this tumour include slow growth, perineural invasion and potential local recurrence. Up to 50% of these tumours occur in the intraoral minor salivary glands usually in the hard palate. We present a case report of a 26-year-old woman who was diagnosed with adenoid cystic carcinoma of the right buccal mucosa. The peculiarity of the lesion and the approach we made is the key factor in the presentation. PMID:23761566

Kumar, Anoop N; Harish, M; Alavi, Yasin A; Mallikarjuna, Rachappa

2013-06-11

335

The role of surgery for bowel incontinence  

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Full Text Available It is now recognised that the results of surgical treatment for bowel incontinence are frequently rather disappointing. It is wrong to raise patients expectations and push patients into surgical treatment for bowel incontinence unless they are aware of the likely outcome measures. Frequently there is deterioration in continence with age, often surgical treatments last only a short period.

Kieghley M.R.B.

2002-01-01

336

Bowel endometriosis: Recent insights and unsolved problems  

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Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endome...

Ferrero, Simone; Camerini, Giovanni; Maggiore, Umberto Leone Roberti; Venturini, Pier L; Biscaldi, Ennio; Remorgida, Valentino

337

Radiopathological review of small bowel carcinoid tumours  

International Nuclear Information System (INIS)

Full text: Small bowel carcinoid tumours are endocrine tumours of the gastrointestinal tract. This pictorial essay will review the pathology, clinical features, treatment and prognosis and illustrate the radiographic, computed tomographic, sonographic, magnetic resonance and nuclear medicine appearances of small bowel carcinoid tumours.

2009-01-01

338

Hypertrophic osteoarthropathy of chronic inflammatory bowel disease  

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The case of a 14-year old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

Oppenheimer, D.A.; Jones, H.H.

1982-12-01

339

Alosetron and irritable bowel syndrome.  

UK PubMed Central (United Kingdom)

Alosetron (Lotronex, GlaxoSmithKline) is a potent and selective 5-HT(3)-receptor antagonist approved by the FDA for the treatment of women with diarrhoea-predominant irritable bowel syndrome (IBS) in whom conventional therapy has failed. Studies involving healthy volunteers and IBS patients have demonstrated a beneficial effect of treatment with alosetron on global IBS symptoms, abdominal pain and discomfort, altered bowel function as well as improvement of quality of life (QOL). Data from animals studies suggest the involvement of 5-HT(3) receptors on intrinsic primary afferent neurons in the mediation of the effect of alosetron on gastrointestinal motility and secretion. While definitive proof of a visceroanalgesic action is not available, an additional central mechanism of action is suggested by findings obtained in animal models, as well as from human brain imaging studies. Alosetron shows a greater effectiveness in women, and the role of genetic factors underlying inter-individual differences in the response to alosetron is currently under investigation. The most frequent adverse event associated with the use of alosetron is constipation and in some rare cases, the development of colonic mucosal ischaemia. In the following review, the most recent reported effects of alosetron on gastrointestinal motility, visceral sensitivity and anxiety, both in terms of preclinical and clinical data will be discussed. The impact of alosetron on QOL in IBS patients and the safety of treatment with alosetron, will also be covered.

Mayer EA; Bradesi S

2003-11-01

340

Scintigraphic diagnosis of inflammatory small bowel stenoses in Crohn's disease using /sup 111/In-labelled leucocytes  

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17 patients with known small bowel involvement in Crohn's disease (clinically active, n=14; clinically inactive, n=3) were examined within 8 days via barium enemas of the small bowel (Pansdorf's method or enteroclysma) and by /sup 111/In-oxine labelled leucocytes. From 19 radiologically diagnosed small bowel stenoses 14 were classified as inflammatory and 5 as non-inflammatory. The leucocyte scan also showed 14 inflammatory stenoses. The not inflamed stenoses could not be diagnosed scintigraphically. The barium enemas of the small bowel and the leukocyte scans both correctly diagnosed the acute inflammed segments. The inability to show non-inflammed segments (n=5) and to localise small bowel stenoses exactly is disadvantageous in the scan. The advantage of the leucocyte scan is a noninvasive examination without specific bowel preparation and the ability to diagnose additionally inflammed large bowel segments (n=4), fistulas and abscesses (n=2). The leucocyte scan offers a useful expansion of the diagnostic tools in small bowel diseases, especially in radiological problems in patients with Crohn's disease.

Becker, W.; Jenett, M.; Fischbach, W.; Boerner, W.

1986-07-01

 
 
 
 
341

Thrombospondin and VEGF-R: Is There a Correlation in Inflammatory Bowel Disease?  

Science.gov (United States)

Up to date several authors discussed interactions between cells forming inflammatory infiltrates in the course of inflammatory bowel disease (IBD), mainly dealing with endoscopic biopsy specimens. These usually contain only mucosa. We have evaluated full bowel wall sections, which seems to be especially important in patients with Crohn's disease (CD). The purpose of our study was to evaluate the relationship between vascular density and expression of thrombospondin-1 (TSP-1) and vascular endothelial growth factor receptor 1 (VEGFR-1) in full-thickness tissue fragments of intestinal wall taken from patients after colectomy, comparing those with IBD to non-IBD control group. Histological sections were immunostained with antibodies against CD-31, TSP-1, and VEGFR-1 and analyzed by pathologists with the use of computer-assisted morphometrics. Our research showed significantly higher vascular density and vascular area percentage in all layers of bowel wall in patients with CD when compared to control. We have also demonstrated differences in vascular density distribution between ulcerative colitis (CU) and CD and between CU and control. However we have not found statistically significant correlation between those findings and VEGFR-1 or TSP-1 expression. Our results might suggest existence of different, TSP-1 independent pathways of antiangiogenesis in IBD.

Jarosz, Dorota; Tarnowski, Wieslaw; Szewczyk, Grzegorz

2013-01-01

342

Cholesterol esterase activity of human intestinal mucosa  

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It has been suggested that cholesterol absorption in humans is dependent on bile acid pool composition and that expansion of the cholic acid pool size is followed by an increase of the absorption values. Similar observations were reported in rats. In the present study, therefore, the authors investigated some general properties of human intestinal cholesterol esterase, with particular emphasis on the effect of bile acids on this enzymatic activity. Twenty-nine segments of small intestine were taken during operations; the enzymatic activity was studied by using mucosal homogenate as a source of enzyme and oleic acid, cholesterol, and UC-labeled cholesterol as substrates. The time-activity relationship was linear within the first two hours; optimal pH for esterification ranged between 5 and 6.2. There was little difference between the esterifying activity of the jejunal and ileal mucosa. Esterification of cholesterol was observed with all the investigated fatty acids but was maximal with oleic acid. Bile acids did not affect cholesterol esterase activity when present in the incubation mixture at 0.1 and 1.0 mM; the enzymatic activity, however, was significantly inhibited when bile acids were added at 20 mM. In conclusion, this study has shown that the human intestinal mucosa possesses a cholesterol esterase activity; at variance with the rat, however, the human enzyme does not seem to be stimulated by trihydroxy bile acids.

Ponz de Leon, M.; Carubbi, F.; Di Donato, P.; Carulli, N.

1985-11-01

343

Honey and Apoptosis in Human Gastric Mucosa  

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Full Text Available Background: Gastric cancer is the fourth most common malignancy in the world. Honey is acomplex mixture of special biological active constituents. Honey possesses antioxidant and antitumorproperties. Nutritional studies have indicated that consumption of honey modulates therisk of developing gastric cancer. On the other hand, apoptosis has been reported to play a decisiverole in precancerous changes. Our chief study was conducted to assess the relationship betweenconsumption of honey and apoptosis in human gastric mucosa.Method: This cross-sectional study was conducted on 98 subjects over 18 years old, referred totwo hospitals in Tabriz, Iran. Subjects were undergone an upper gastrointestinal endoscopy, 62subjects were finally enrolled. Honey consumption was assessed by a Food Frequency Questionnaire(FFQ) and apoptosis was detected by TUNEL technique. We tested polynomial curve tofind the best fit between honey consumption and apoptosis.Results: A positive relation between honey consumption and apoptosis was found (P=0.024).Our results indicated that the final and the best fit curve was: apoptosis = 1.714+1.648(honeyamount) - 0.533(honey amount)2 +1.833×10-5(honey amount)7.Conclusion: Honey consumption had positive effects on gastric cancer by inducing apoptosis ingastric mucosa.

Aida Ghaffari; Mohammad H Somi; Abdolrasoul Safaiyan; Jabiz Modaresi; Alireza Ostadrahimi

2012-01-01

344

Computed tomography of the whole bowel in patients suspected of Crohn's disease. Preliminary report - assessment of examination technique and image quality  

International Nuclear Information System (INIS)

Evaluation of the usefulness of new technique - computed tomography (CT) of the whole bowel in patients with Crohn's disease and correlation of obtained images with other modalities (MR of the bowel, enteroclysis, barium enema, colonoscopy) and operation results. CT examination was performed in 20 patients suspected of having Crohn's disease, which was confirmed in 16 cases. CT was performed after filling small bowel with fluid administered by catheter placed in duodenum (in 10 patients) or orally (in 10 patients), distension of large bowel with air and intravenous injection of contrast material. Distension of small bowel was assessed in both groups by two radiologists. In 7 patients immediately after CT examination MR of the bowel was performed with contrast enhanced T1-weighted images. Distension of small bowel was better in patients examined after administration of fluid directly to duodenum, although the difference was not statistically significant. In 16 CT studies performed in patients with confirmed Crohn's disease all narrowed bowel segments (n = 25) were diagnosed and extraintestinal abnormalities were visualized (thickening of the mesenteries, enlarged lymph nodes, perirectal changes, abscess, fistula). In 7 patients examined by MR 2 of 10 narrowing (20%) were not diagnosed. CT of the whole bowel is promising method in diagnosis of patients with Crohn's disease. The best views of the small bowel were obtained with the use of CT enteroclysis. (author)

2004-01-01

345

Nup88 expression in normal mucosa, adenoma, primary adenocarcinoma and lymph node metastasis in the colorectum.  

UK PubMed Central (United Kingdom)

OBJECTIVES: It was the aim of this study to investigate Nup88 expression in normal colorectal mucosa, adenoma, adenocarcinoma and lymph node metastasis, as well as the relationship between Nup88 expression and clinicopathological features. METHODS: Nup88 expression was examined by immunohistochemistry in 84 normal mucosa samples, 32 adenomas, 181 primary adenocarcinomas, and 18 lymph node metastases from colorectal tumour patients. RESULTS: Nup88 expression was observed in normal epithelial and tumour cells. The frequency of strong Nup88 expression was increased from normal mucosa or adenoma to primary tumour and lymph node metastasis (p < 0.0001). There was no significant difference in the expression between normal mucosa and adenoma (p = 0.41). The frequency of strong Nup88 expression was higher in ulcerated tumours (40%) than in polypoid/large fungating tumours (23%; p = 0.048). The frequency of strong Nup88 expression was significantly different among tumours with good (21%), moderate (42%) and poor differentiation (48%; p = 0.01). Nup88 expression was not related to the patients' gender, age, tumour location, size, histological type, invasive depth, lymph node status and Dukes stage (p > 0.05). CONCLUSION: Our results suggest that Nup88 may play a role during the development, aggressiveness and differentiation of colorectal tumours.

Zhang ZY; Zhao ZR; Jiang L; Li JC; Gao YM; Cui DS; Wang CJ; Schneider J; Wang MW; Sun XF

2007-01-01

346

What is the evidence for the use of probiotics in the treatment of inflammatory bowel disease?  

UK PubMed Central (United Kingdom)

AIMS AND OBJECTIVES: The purpose of this article is to investigate the use of probiotics in the treatment of inflammatory bowel disease. BACKGROUND: Probiotics have been successfully used to treat various acute illnesses such as Clostridium difficile infection, rotovirus diarrhoea and traveller's diarrhoea. Recently, some studies have reported success with probiotics in the treatment of chronic intestinal diseases such as inflammatory bowel disease. DESIGN: Literature review. METHODS: A literature search was performed to include studies on Bifidobacteria-fermented milk, Escherichia coli, Lactobacillus, Saccharomyces boulardii, VSL #3 and probiotic use. Results of the literature are analysed, and a discussion is made regarding evaluation of the literature and implications for care. RESULTS: The majority of probiotics studied have proven to have beneficial effects in the treatment of inflammatory bowel disease, especially when taken as a dietary adjunctive to standard treatment. All probiotics studied, with the exception of Lactobacillus GG and LA1, demonstrated positive results. CONCLUSIONS: The increasing use of probiotics combined with the insufficient knowledge regarding the use of probiotics in treating inflammatory bowel disease requires that future multilevel, multicentre large randomised control trials be conducted to understand better the specific measures and effectiveness of such treatment. RELEVANCE TO CLINICAL PRACTICE: Given that few clinical trials exist to study the potential role of probiotics in the treatment of inflammatory bowel disease, it is imperative that healthcare providers become knowledgeable about the use of probiotics and their effects on inflammatory bowel disease.

Cary VA; Boullata J

2010-04-01

347

From intestinal stem cells to inflammatory bowel diseases  

Directory of Open Access Journals (Sweden)

Full Text Available The pathogenesis of both entities of inflammatory bowel disease (IBD), namely Crohn’s disease (CD) and ulcerative colitis (UC), is still complex and under investigation. The importance of the microbial flora in developing IBD is beyond debate. In the last few years, the focus has changed from adaptive towards innate immunity. Crohn’s ileitis is associated with a deficiency of the antimicrobial shield, as shown by a reduced expression and secretion of the Paneth cell defensin HD5 and HD6, which is related to a Paneth cell differentiation defect mediated by a diminished expression of the Wnt transcription factor TCF4. In UC, the protective mucus layer, acting as a physical and chemical barrier between the gut epithelium and the luminal microbes, is thinner and in part denuded as compared to controls. This could be caused by a missing induction of the goblet cell differentiation factors Hath1 and KLF4 leading to immature goblet cells. This defective Paneth and goblet cell differentiation in Crohn’s ileitis and UC may enable the luminal microbes to invade the mucosa and trigger the inflammation. The exact molecular mechanisms behind ileal CD and also UC must be further clarified, but these observations could give rise to new therapeutic strategies based on a stimulation of the protective innate immune system.

Michael Gersemann; Eduard Friedrich Stange; Jan Wehkamp

2011-01-01

348

Effects of oral parenteral nutrition solution on the morphology and mechanical resistance of the small bowel in rats  

Directory of Open Access Journals (Sweden)

Full Text Available The objective of this study was to investigate the effect of an elemental diet (ED) on the strength and on the morphology of the small bowel. Male Wistar rats were randomized to two groups to receive during 14 days either standard laboratory rat chow (N=16) or ED (N=16) containing total parenteral nutrition (TPN) solution. After this period they were killed and necropsied. The small bowel was measured and weighted with and without the contents. Bursting pressure (BP) was taken from the jejunum and ileum and histological sections of these two portions was performed to register the crypt depth (CD), vilus height (VH) and wall width (WW). All animals significantly gain weight. The bowel of animals fed with TPN solution had significantly less weight when compared with the controls either with (9.9 ± 1.9g x 7.8 ± 1.5g, p<0.05) or without (8.3 ± 1.3g x 6.5 ± 0.8g; p<0.05) the luminal contents. BP was lower in animals receiving TPN solution compared with controls in both studied segments but the difference only reached significance at the ileum (287 ± 60 x 234 ± 46 mm of Hg; p<0.05). VH, CD and WW were significantly shorter at the ileum in TPN-fed animals when compared to controls (p<0.05). This contrast was also seen at the jejunum though without significant difference. The small bowel looses mass and become less resistant when rats are fed with elemental diet though the nutritional state is maintained. The loss of mass appeared to be not only at the mucosa layer but through all the bowel wall. This occurs predominantly at the terminal part of the small bowel.

Aguilar-Nascimento José E.; Lima Stenio A.; Pereira Alexandre C. C.

1997-01-01

349

Enhanced transferrin receptor expression by proinflammatory cytokines in enterocytes as a means for local delivery of drugs to inflamed gut mucosa.  

UK PubMed Central (United Kingdom)

Therapeutic intervention in inflammatory bowel diseases (IBDs) is often associated with adverse effects related to drug distribution into non-diseased tissues, a situation which attracts a rational design of a targeted treatment confined to the inflamed mucosa. Upon activation of immune cells, transferrin receptor (TfR) expression increases at their surface. Because TfR is expressed in all cell types we hypothesized that its cell surface levels are regulated also in enterocytes. We, therefore, compared TfR expression in healthy and inflamed human colonic mucosa, as well as healthy and inflamed colonic mucosa of the DNBS-induced rat model. TfR expression was elevated in the colonic mucosa of IBD patients in both the basolateral and apical membranes of the enterocytes. Increased TfR expression was also observed in colonocytes of the induced colitis rats. To explore the underlying mechanism CaCo-2 cells were treated with various proinflammatory cytokines, which increased both TfR expression and transferrin cellular uptake in a mechanism that did not involve hyper proliferation. These findings were then exploited for the design of targetable carrier towards inflamed regions of the colon. Anti-TfR antibodies were conjugated to nano-liposomes. As expected, iron-starved Caco-2 cells internalized anti-TfR immunoliposomes better than controls. Ex vivo binding studies to inflamed mucosa showed that the anti-TfR immunoliposomes accumulated significantly better in the mucosa of DNBS-induced rats than the accumulation of non-specific immunoliposomes. It is concluded that targeting mucosal inflammation can be accomplished by nano-liposomes decorated with anti-TfR due to inflammation-dependent, apical, elevated expression of the receptor.

Harel E; Rubinstein A; Nissan A; Khazanov E; Nadler Milbauer M; Barenholz Y; Tirosh B

2011-01-01

350

Bowel endometriosis: Recent insights and unsolved problems  

Directory of Open Access Journals (Sweden)

Full Text Available Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.

Simone Ferrero, Giovanni Camerini, Umberto Leone Roberti Maggiore, Pier L Venturini, Ennio Biscaldi, Valentino Remorgida

2011-01-01

351

A Strange Case of Left Bowel Ischemia after Right Hernioplasty.  

Science.gov (United States)

We report the first observed case of a young man who suffered of large and unsuspected left bowel ischemia following an elective right open hernioplasty. A 54-year-old man had a 2-year history of right inguinal reducible mass and was admitted to hospital for an elective day case open inguinal hernioplasty for a direct right inguinal hernia. Apart from mild hypertension controlled with ACE inhibitor, he was medically fit and well. The patient was submitted to open tension-free mesh repair with polypropylene preshaped mesh with local infiltration anesthesia and additive sedation with midazolam. The local anesthesia and surgery were uneventful and he was discharged home on the same day as per day case protocol. He was readmitted about 12 h after discharge with a history of central and left lower abdominal pain with palpable mass, and distension and fever (38°C). After imaging and laboratory studies the patient was submitted to explorative surgery with the suspicion of left colonic ischemia. After intraoperative confirmation we performed standard left hemicolectomy. The postoperative course was uneventful; the patient was discharged in good general condition on the 7th postoperative day. Actually, the patient is in follow-up, with normal coagulation and hemochromocytometric pattern, asymptomatic for hypercholesterolemia and atrial flutter/fibrillation. Complications relating to bowel during open techniques of hernia repair are limited to two situations: the freeing of an incarcerated or strangulated segment of bowel and inadvertent laceration of large bowel in the presence of a sliding hernia. Following this strange case of colonic ischemia, a boolean Medline search (terms: hernia, complication, repair, groin, herniorrhaphy, hernioplasty, all major MESH subjects without language restriction) revealed no previous similar cases reported. However, to our knowledge, there is another trouble hypothesis: not causality but casualty. In conclusion, to our knowledge this is the first reported case of large left bowel ischemia following right open hernioplasty. We can conclude that the presence of a dolichocolon is an added risk factor for this rare and uneventful complication, but further investigations and case reports are necessary to estabilish the real causality. PMID:21103221

Geraci, Girolamo; Pisello, Franco; Modica, Giuseppe; Li Volsi, Francesco; Cajozzo, Massimo; Sciumè, Carmelo

2010-02-03

352

A Strange Case of Left Bowel Ischemia after Right Hernioplasty.  

UK PubMed Central (United Kingdom)

We report the first observed case of a young man who suffered of large and unsuspected left bowel ischemia following an elective right open hernioplasty. A 54-year-old man had a 2-year history of right inguinal reducible mass and was admitted to hospital for an elective day case open inguinal hernioplasty for a direct right inguinal hernia. Apart from mild hypertension controlled with ACE inhibitor, he was medically fit and well. The patient was submitted to open tension-free mesh repair with polypropylene preshaped mesh with local infiltration anesthesia and additive sedation with midazolam. The local anesthesia and surgery were uneventful and he was discharged home on the same day as per day case protocol. He was readmitted about 12 h after discharge with a history of central and left lower abdominal pain with palpable mass, and distension and fever (38°C). After imaging and laboratory studies the patient was submitted to explorative surgery with the suspicion of left colonic ischemia. After intraoperative confirmation we performed standard left hemicolectomy. The postoperative course was uneventful; the patient was discharged in good general condition on the 7th postoperative day. Actually, the patient is in follow-up, with normal coagulation and hemochromocytometric pattern, asymptomatic for hypercholesterolemia and atrial flutter/fibrillation. Complications relating to bowel during open techniques of hernia repair are limited to two situations: the freeing of an incarcerated or strangulated segment of bowel and inadvertent laceration of large bowel in the presence of a sliding hernia. Following this strange case of colonic ischemia, a boolean Medline search (terms: hernia, complication, repair, groin, herniorrhaphy, hernioplasty, all major MESH subjects without language restriction) revealed no previous similar cases reported. However, to our knowledge, there is another trouble hypothesis: not causality but casualty. In conclusion, to our knowledge this is the first reported case of large left bowel ischemia following right open hernioplasty. We can conclude that the presence of a dolichocolon is an added risk factor for this rare and uneventful complication, but further investigations and case reports are necessary to estabilish the real causality.

Geraci G; Pisello F; Modica G; Li Volsi F; Cajozzo M; Sciumè C

2010-01-01

353

Diclofenac sodium and Imipenem action on rat intestinal mucosa: a biomechanical and histological study Ação do Diclofenaco de sódio e Imipenem na mucosa intestinal do rato: estudo biomecânico e histológico  

Directory of Open Access Journals (Sweden)

Full Text Available PURPOSE: To study diclofenac sodium induced histological and mechanical alterations and their prevention with Imipenem in rat intestine. METHODS: Male Wistar rats (n=240) were randomly assigned to four experimental groups: GI: n=60 treated with 0.9% saline IM; GII: n=60 treated with 6mg/kg body weight diclofenac sodium IM for four days; GIII: n=60 treated with 30mg/kg body weight Imipenem IM for four days, and GIV n=60 treated with diclofenac sodium plus Imipenem at the above doses IM for 4 days. Each group was further divided into 4 subgroups of 15 rats each and sacrificed at 4, 7, 14, and 21 days of follow-up, respectively. Abdominal cavity macroscopy and histology, and small bowel breaking strength were analyzed at each sacrifice moment. RESULTS: There were no histological or mechanical alterations in normal control rats throughout the study. Ulcerated lesions in intestinal mucosa were observed and breaking strength decreased in all diclofenac sodium treated rats. Ulcerated lesions in intestinal mucosa were prevented by Imipenem in all rats. CONCLUSION: Diclofenac sodium induced ulcerated lesions in rat intestinal mucosa can be prevented by Imipenem treatment.OBJETIVO: Avaliar as alterações histológicas e biomecânicas do diclofenaco de sódio na mucosa intestinal do rato e a associação com o uso de Imipenem. MÉTODOS: Foram estudados 240 ratos Wistar distribuídos aleatoriamente em quatro grupos experimentais: GI: 60 ratos tratados com injeção IM de soro fisiológico 0,9%; GII: 60 ratos tratados com injeção IM de diclofenaco de sódio na dose de 6mg/kg de peso por 4 dias; GIII: 60 ratos tratados com injeção IM de Imipenem na dose de 30 mg/kg de peso por 4 dias; GIV: 60 ratos tratados com injeção IM de soro fisiológico e diclofenaco de sódio nas doses acima. Em cada grupo os animais foram posteriormente divididos em 4 momentos de 15 animais em cada um para sacrifício, respectivamente, no 4º, 7º, 14º e 21º dias após o início do tratamento. As alterações da cavidade abdominal, assim como as características histológicas e de força de ruptura do intestino delgado foram analisadas em cada momento, em cada grupo. RESULTADOS: Não foram encontradas alterações histológicas e biomecânicas nos animais do Grupo I nesse estudo. Lesões ulceradas na mucosa do intestino delgado foram observadas nos animais tratados com diclofenaco de sódio, assim como diminuição da força de ruptura. As lesões ulceradas encontradas foram prevenidas pelo uso de Imipenem. CONCLUSÃO: O diclofenaco de sódio induz lesões ulceradas na mucosa intestinal do rato que podem ser prevenidas pelo uso de Imipenem.

Irio Gonçalves Junior; Luiz Eduardo Naresse; Maria Aparecida Marchesan Rodrigues; Shoiti Kobayasi

2012-01-01

354

Diclofenac sodium and Imipenem action on rat intestinal mucosa: a biomechanical and histological study/ Ação do Diclofenaco de sódio e Imipenem na mucosa intestinal do rato: estudo biomecânico e histológico  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Avaliar as alterações histológicas e biomecânicas do diclofenaco de sódio na mucosa intestinal do rato e a associação com o uso de Imipenem. MÉTODOS: Foram estudados 240 ratos Wistar distribuídos aleatoriamente em quatro grupos experimentais: GI: 60 ratos tratados com injeção IM de soro fisiológico 0,9%; GII: 60 ratos tratados com injeção IM de diclofenaco de sódio na dose de 6mg/kg de peso por 4 dias; GIII: 60 ratos tratados com injeção IM de I (more) mipenem na dose de 30 mg/kg de peso por 4 dias; GIV: 60 ratos tratados com injeção IM de soro fisiológico e diclofenaco de sódio nas doses acima. Em cada grupo os animais foram posteriormente divididos em 4 momentos de 15 animais em cada um para sacrifício, respectivamente, no 4º, 7º, 14º e 21º dias após o início do tratamento. As alterações da cavidade abdominal, assim como as características histológicas e de força de ruptura do intestino delgado foram analisadas em cada momento, em cada grupo. RESULTADOS: Não foram encontradas alterações histológicas e biomecânicas nos animais do Grupo I nesse estudo. Lesões ulceradas na mucosa do intestino delgado foram observadas nos animais tratados com diclofenaco de sódio, assim como diminuição da força de ruptura. As lesões ulceradas encontradas foram prevenidas pelo uso de Imipenem. CONCLUSÃO: O diclofenaco de sódio induz lesões ulceradas na mucosa intestinal do rato que podem ser prevenidas pelo uso de Imipenem. Abstract in english PURPOSE: To study diclofenac sodium induced histological and mechanical alterations and their prevention with Imipenem in rat intestine. METHODS: Male Wistar rats (n=240) were randomly assigned to four experimental groups: GI: n=60 treated with 0.9% saline IM; GII: n=60 treated with 6mg/kg body weight diclofenac sodium IM for four days; GIII: n=60 treated with 30mg/kg body weight Imipenem IM for four days, and GIV n=60 treated with diclofenac sodium plus Imipenem at the a (more) bove doses IM for 4 days. Each group was further divided into 4 subgroups of 15 rats each and sacrificed at 4, 7, 14, and 21 days of follow-up, respectively. Abdominal cavity macroscopy and histology, and small bowel breaking strength were analyzed at each sacrifice moment. RESULTS: There were no histological or mechanical alterations in normal control rats throughout the study. Ulcerated lesions in intestinal mucosa were observed and breaking strength decreased in all diclofenac sodium treated rats. Ulcerated lesions in intestinal mucosa were prevented by Imipenem in all rats. CONCLUSION: Diclofenac sodium induced ulcerated lesions in rat intestinal mucosa can be prevented by Imipenem treatment.

Gonçalves Junior, Irio; Naresse, Luiz Eduardo; Rodrigues, Maria Aparecida Marchesan; Kobayasi, Shoiti

2012-02-01

355

[Bowel endometriosis: a benign disease?].  

UK PubMed Central (United Kingdom)

Endometriosis is generally assumed to be a benign disease, but it is estimated that 1% of cases are associated with cancer, especially when both conditions are present in the ovary. Extra-ovarian lesions in the rectovaginal septum, colon, bladder, vagina and peritoneum were already associated with malign neoplasia. Several characteristics of endometrial tissue are very similar to the neoplasia phenotype. Endometriosis itself typically behaves as a neoplasia process, spreading over adjacent stroma and being associated with distant lesions. This is an update on the diagnostic, clinical, and therapeutic knowledge of, management of bowel implants of endometrial tissue, as well as the relation with neoplastic processes to better understand its benign nature or eventual potential for malignancy.

Bassi MA; Podgaec S; Dias Júnior JA; Sobrado CW; D Amico Filho N

2009-09-01

356

Pharmacotherapy of inflammatory bowel disease.  

Science.gov (United States)

The standard treatments for inflammatory bowel disease have been aminosalicylates and corticosteroids, administered both systemically and topically. They are frequently extremely effective, especially at higher doses. Unfortunately steroid side effects are too frequent and agents with low systemic bioavailability (budesonide, beclamethasone and tixocortol) are being investigated. Azathioprine, although a useful adjunct to steroids, has occasional and unpredictable severe side effects. Cyclosporin is an important new therapy in severe refractory disease. Several new phospholipid mediator inhibitors, mepacrine, zileuton, and ridogrel, may be useful in moderate colitis. Other topical treatments, butyrate, acetarsol and bismuth subsalicylate, can be beneficial in refractory distal disease. Quadruple antimycobacterials, antioxidants and antimicrobials warrant further study, while newer immunosuppressives such as methotrexate, FK 506 and monoclonal antibodies against helper T lymphocytes show some early promise. PMID:8306490

Reynolds, P D; Hunter, J O

357

Pharmacotherapy of inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

The standard treatments for inflammatory bowel disease have been aminosalicylates and corticosteroids, administered both systemically and topically. They are frequently extremely effective, especially at higher doses. Unfortunately steroid side effects are too frequent and agents with low systemic bioavailability (budesonide, beclamethasone and tixocortol) are being investigated. Azathioprine, although a useful adjunct to steroids, has occasional and unpredictable severe side effects. Cyclosporin is an important new therapy in severe refractory disease. Several new phospholipid mediator inhibitors, mepacrine, zileuton, and ridogrel, may be useful in moderate colitis. Other topical treatments, butyrate, acetarsol and bismuth subsalicylate, can be beneficial in refractory distal disease. Quadruple antimycobacterials, antioxidants and antimicrobials warrant further study, while newer immunosuppressives such as methotrexate, FK 506 and monoclonal antibodies against helper T lymphocytes show some early promise.

Reynolds PD; Hunter JO

1993-11-01

358

[Psoriasis and inflammatory bowel diseases].  

UK PubMed Central (United Kingdom)

Psoriasis and inflammatory bowel diseases (Crohn's disease and ulcerative colitis) are among the immune-mediated inflammatory diseases. This group includes approximately 80 disorders, some of which can at times be associated in a single patient. In psoriasis, Crohn's disease may be observed slightly more frequently, but ulcerative colitis and celiac disease are also an issue. The underlying relations between these disorders comprise: i) genetic data obtained by genome-wide association studies that show the involvement of shared predisposing loci and/or genes, for example, in innate immunity; ii) immunological data: these disorders share inflammation effector mechanisms, particularly the activation pathway of Th17 lymphocytes, which explains the efficacy of anti-TNF antibodies and anti-IL-12/23; and iii) environmental co-factors such as smoking, possibly certain food proteins (gliadin, etc.), and bacterial infections that are probably decisive elements in the genesis of these diseases.

Delaporte E

2012-04-01

359

[Immunopathogenesis of inflammatory bowel disease].  

UK PubMed Central (United Kingdom)

Inflammatory bowel diseases (IBD) are idiopathic, chronic and relapsing inflammatory conditions of the gastrointestinal tract. New insights into the pathogenesis of IBD have been provided by three lines of research: (1) studying susceptibility genes involved in the detection of bacterial components and in the regulation of the host immune response, (2) highlighting the disruption of tolerance towards the commensal microbiota and (3) unravelling the critical role of environmental factors such as sanitation and hygiene. This review presents current etiological hypothesis of IBD which argue that pathogenic intestinal bacteria and/or infectious agents initiate and perpetuate the inflammation of the gut in an individual with genetic vulnerability leading to impaired epithelial barrier function and abnormal mucosal immune responses.

Matricon J

2010-04-01

360

Anemia and inflammatory bowel diseases  

Directory of Open Access Journals (Sweden)

Full Text Available Too often anemia is considered a rare or unimportant manifestation in inflammatory bowel disease (IBD). However, over the last 10 years a number of studies have been conducted and the most relevant conclusions obtained are: (1) anemia is quite common in IBD; (2) although in many cases anemia parallels the clinical activity of the disease, many patients in remission have anemia, and iron, vitamin B12 and/or folic acid deficiency; (3) anemia, and also iron deficiency without anemia, have important consequences in the clinical status and quality of life of the patient; (4) oral iron can lead to gastrointestinal intolerance and failure of treatment; (5) intravenous iron is an effective and safe way to treat iron deficiency; (6) erythropoietin is needed in a significant number of cases to achieve normal hemoglobin levels. Thus, the clinician caring for IBD patients should have a comprehensive knowledge of anemia, and apply recently published guidelines in clinical practice.

Fernando Gomollón, Javier P Gisbert

2009-01-01

 
 
 
 
361

Anemia and inflammatory bowel diseases.  

UK PubMed Central (United Kingdom)

Too often anemia is considered a rare or unimportant manifestation in inflammatory bowel disease (IBD). However, over the last 10 years a number of studies have been conducted and the most relevant conclusions obtained are: (1) anemia is quite common in IBD; (2) although in many cases anemia parallels the clinical activity of the disease, many patients in remission have anemia, and iron, vitamin B12 and/or folic acid deficiency; (3) anemia, and also iron deficiency without anemia, have important consequences in the clinical status and quality of life of the patient; (4) oral iron can lead to gastrointestinal intolerance and failure of treatment; (5) intravenous iron is an effective and safe way to treat iron deficiency; (6) erythropoietin is needed in a significant number of cases to achieve normal hemoglobin levels. Thus, the clinician caring for IBD patients should have a comprehensive knowledge of anemia, and apply recently published guidelines in clinical practice.

Gomollón F; Gisbert JP

2009-10-01

362

Angiogenesis and inflammatory bowel disease  

Directory of Open Access Journals (Sweden)

Full Text Available Inflammatory bowel disease (IBD) has gained immense attention recently due primarily to increasing prevalence. The exact disease mechanism is still unknown. There is considerable evidence of interrelation between the mechanisms of angiogenesis and the chronic inflammation of IBD. This evidence was obtained from animal models of colitis and confirmed in human studies. Serum levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF) have been found to be significantly higher in patients with IBD than in controls. In addition, it was found that these factors correlate well with disease activity and decrease with the use of steroids. Therefore pharmacological inhibition of angiogenesis has the potential to be a therapeutic strategy in IBD.

Azzam Nahla

2007-01-01

363

Bowel injuries secondary to induced abortion: a dilemma  

International Nuclear Information System (INIS)

To study the pattern of bowel injuries incurred by induced abortion, and the morbidity and mortality associated with them. All patients with bowel injuries due to induced abortion. Detailed data of all the patients was collected and analyzed. A total of 22 patients, mostly young with an average age of 26.86 years, presented with bowel injuries following induced abortion. Severe hemorrhage occurred in 8(36.4%) patients while 11(50%) had ileal perforation; 9(40.9%) underwent primary repair and 2(9.1%) ileostomy formation. Two (9.1%) patients with jejunal perforation had primary repair, whereas two with both jejunal and ileal perforations underwent resections with anastomosis in one and ileostomy in another. Seven (31.8%) with large gut involvement had colostomy formation. Septicemia and wound infection occurred in 7(31.8%) patients each, faecal fistula and abdominal wound dehiscence in 3(13.6%), and pelvic abscess in 1(4.6%) patient. The total mortality in this series was 6(27.3%) patients. Iatrogenic injuries during induced abortion, most commonly caused by quacks, can be minimized substantially if the procedure is performed by qualified medical personnel in proper health care facilities. There is a need for radical overhauling of the mind set in our society together with legislation. (author)

2006-01-01

364

Computed tomography enterography for evaluation of inflammatory bowel disease.  

Science.gov (United States)

Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality. PMID:23964329

Park, Min Jung; Lim, Joon Seok

2013-07-31

365

Computed tomography enterography for evaluation of inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality.

Park MJ; Lim JS

2013-07-01

366

The modern bowel preparation in colonoscopy.  

UK PubMed Central (United Kingdom)

Adequate bowel preparation is essential for optimal colonoscopy. Suboptimal bowel preparation occurs in 25% to 40% of cases and is associated with canceled procedures, prolonged procedure time, incomplete examination, increased cost, and missed pathology. There are several effective formulations for colon cleansing with a good safety profile. Split dosing should be implemented whenever possible in an effort to enhance tolerance and adherence, and improve mucosal visibility and overall quality of the examination. In this review, modern bowel preparations are discussed including their mechanism of action, mode of use, safety, and how to optimize outcomes.

Sharara AI; Abou Mrad RR

2013-09-01

367

Management of irritable bowel syndrome.  

Science.gov (United States)

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, characterised by abdominal pain and change in bowel habit, with a fluctuating natural history. The exact etiology remains unknown, but it is unlikely there is a single unifying explanation. The prevalence in the general population is between 5% and 20%, and the condition represents a considerable financial burden to the health service. Guidelines for the management of IBS recommend that symptom-based diagnostic criteria should be used to make a positive diagnosis, without the need for recourse to investigations to exclude organic disease. However, current evidence demonstrates that these have either not been well-validated in prospective studies or perform suboptimally. Investigations to exclude underlying organic disease in IBS have a low yield, and the diagnosis is unlikely to be revised during extended follow-up, although screening for celiac disease with serology appeared to be of value in a recent systematic review and meta-analysis, Despite the fact that no therapy is established to alter the natural history of IBS, a series of systematic reviews and meta-analyses, conducted to inform the American College of Gastroenterology's updated monograph on IBS, have demonstrated that fibre, antispasmodics, antidepressants, psychological therapies, 5-HT3 antagonists, 5-HT4 agonists, and probiotics are all more effective than placebo. Anti-diarrheal agents may be of some benefit, in terms of improved stool frequency and consistency in diarrhea-predominant IBS, and lubiprostone may have a role in constipation-predominant IBS, though data for this drug are preliminary at present. PMID:19829284

Ford, A C

2009-09-01

368

Bacteriolytic activity of lysozyme in the nasal mucosa.  

UK PubMed Central (United Kingdom)

During an experiment to study the localization of the lysozyme in the nasal mucosa of humans by the protein A-gold technique, we observed the accumulation of lysozymes around bacteria possibly causing bacteriolysis. The lysozyme, therefore, seems to play a preventive role against some kind of bacterial infection in the nasal mucosa in situ.

Tachibana M; Morioka H; Machino M; Mizukoshi O

1986-01-01

369

Micronucleus level in exfoliated buccal mucosa cells of cancer patients  

Directory of Open Access Journals (Sweden)

Full Text Available Micronucleus levels in exfoliated buccal mucosa cells of patients with primary breast, lung, cervix uteri cancer, and patients with Hodgkin's disease were studied (n=59). Significantly increased number of micronuclei in cells of cancer patients was observed compared with healthy persons (n=45). The evaluation of micronuclei number in buccal mucosa cells shows genomic instability in somatic cells of humans.

Nersesyan Armen K.; Vardazaryan Nina S.; Gevorgyan Ani L.; Arutyunyan Rouben M.

2002-01-01

370

Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities.  

UK PubMed Central (United Kingdom)

BACKGROUND: Bipolar radiofrequency (RF) induced tissue fusion is believed to have the potential to seal and anastomose intestinal tissue thereby providing an alternative to current techniques which are associated with technical and functional complications. This study examines the mechanical and cellular effects of RF energy and varying compressive pressures when applied to create ex vivo intestinal seals. METHODS: A total of 299 mucosa-to-mucosa fusions were formed on ex vivo porcine small bowel segments using a prototype bipolar RF device powered by a closed-loop, feedback-controlled RF generator. Compressive pressures were increased at 0.05 MPa intervals from 0.00 to 0.49 MPa and RF energy was applied for a set time period to achieve bowel tissue fusion. Seal strength was subsequently assessed using burst pressure and tensile strength testing, whilst morphological changes were determined through light microscopy. To further identify the subcellular tissue changes that occur as a result of RF energy application, the collagen matrix in the fused area of a single bowel segment sealed at an optimal pressure was examined using transmission electron microscopy (TEM). RESULTS: An optimal applied compressive pressure range was observed between 0.10 and 0.25 MPa. Light microscopy demonstrated a step change between fused and unfused tissues but was ineffective in distinguishing between pressure levels once tissues were sealed. Non uniform collagen damage was observed in the sealed tissue area using TEM, with some areas showing complete collagen denaturation and others showing none, despite the seal being complete. This finding has not been described previously in RF-fused tissue and may have implications for in vivo healing. CONCLUSIONS: This study shows that both bipolar RF energy and optimal compressive pressures are needed to create strong intestinal seals. This finding suggests that RF fusion technology can be effectively applied for bowel sealing and may lead to the development of novel anastomosis tools.

Arya S; Hadjievangelou N; Lei S; Kudo H; Goldin RD; Darzi AW; Elson DS; Hanna GB

2013-09-01

371

A Disguised Tuberculosis in Oral Buccal Mucosa  

Science.gov (United States)

Tuberculosis is a major cause of morbidity and mortality worldwide. It is a chronic granulomatous disease that can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, are seen in both the primary and secondary stages of the disease. This article presents a case of tuberculosis of the buccal mucosa, manifesting as non-healing, non-painful ulcer. The diagnosis was confirmed based on histopathology, sputum examination and immunological investigation. The patient underwent anti-tuberculosis therapy and her oral and systemic conditions improved rapidly. Although oral manifestations of tuberculosis are rare, clinicians should include them in the differential diagnosis of various types of oral ulcers. An early diagnosis with prompt treatment can prevent complications and potential contaminations.

Nanda, Kanwar Deep Singh; Mehta, Anurag; Marwaha, Mohita; Kalra, Manpreet; Nanda, Jasmine

2011-01-01

372