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Sample records for previous large bowel

  1. Large bowel resection

    Science.gov (United States)

    ... Ileostomy and your diet Ileostomy - caring for your stoma Ileostomy - changing your pouch Ileostomy - discharge Ileostomy - what to ask your doctor Large bowel resection - discharge Low-fiber diet Preventing falls Surgical wound care - open Types of ileostomy When you have nausea ...

  2. Diverticulitis of the right large bowel

    International Nuclear Information System (INIS)

    Koch, H.L.; Treugut, H.

    1981-01-01

    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.) [de

  3. Diverticulitis of the right large bowel

    Energy Technology Data Exchange (ETDEWEB)

    Koch, H.L.; Treugut, H.

    1981-09-01

    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.

  4. Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)]. E-mail: rakesh.sinha@uhl-tr.nhs.uk; Verma, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)

    2005-10-01

    Large bowel obstruction may present as an emergency as high-grade colonic obstruction and can result in perforation. Perforated large bowel obstruction causes faecal peritonitis, which can result in high morbidity and mortality. Multidetector row computed tomography (MDCT) has the potential of providing an accurate diagnosis of large bowel obstruction. The rapid acquisition of images within one breath-hold reduces misregistration artefacts than can occur in critically ill or uncooperative patients. The following is a review of the various causes of large bowel obstruction with emphasis on important pathogenic factors, CT appearances and the use of multiplanar reformatted images in the diagnostic workup.

  5. Colon cancer and large bowel function in Denmark and Finland

    DEFF Research Database (Denmark)

    Cummings, J H; Branch, W J; Bjerrum, L

    1982-01-01

    for large bowel cancer. Mean transit time (37 +/- 1 hours, Copenhagen; 43 +/- 1 hours, Helsinki; 40 +/- 1 hours, Them; 37 +/- 1 hours, Parikkala) was not significantly different among populations, but average 24-hour stool weights (136 +/- 13 g, Copenhagen; 176 +/- 17 g, Helsinki; 169 +/- 16 g, Them; 196...... +/- 15 g, Parikkala) were different and had a significant inverse relationship to total large bowel cancer incidence, with larger stool weights being found in the low-risk population. A high proportion of study subjects, especially in Finland, were found to be taking medication or to have a history...... of gastrointestinal illness, but neither of these variables related to bowel habit....

  6. Large bowel leiomyosarcoma - a case report

    International Nuclear Information System (INIS)

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

    2001-01-01

    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)

  7. Colon cancer and large bowel function in Denmark and Finland

    DEFF Research Database (Denmark)

    Cummings, J H; Branch, W J; Bjerrum, L

    1982-01-01

    for large bowel cancer. Mean transit time (37 +/- 1 hours, Copenhagen; 43 +/- 1 hours, Helsinki; 40 +/- 1 hours, Them; 37 +/- 1 hours, Parikkala) was not significantly different among populations, but average 24-hour stool weights (136 +/- 13 g, Copenhagen; 176 +/- 17 g, Helsinki; 169 +/- 16 g, Them; 196...... +/- 15 g, Parikkala) were different and had a significant inverse relationship to total large bowel cancer incidence, with larger stool weights being found in the low-risk population. A high proportion of study subjects, especially in Finland, were found to be taking medication or to have a history...

  8. Localization and Treatment of Small and Large Bowel Bleeding

    Directory of Open Access Journals (Sweden)

    Richard H Hunt

    1992-01-01

    Full Text Available Bleeding from the small or large bowel may present a diagnostic dilemma for the clinician, requiring careful consideration and multidisciplinary consultation before the problem is located. Careful selection of the appropriate investigations in the most logical order is important to minimize delay to diagnosis, inconvenience, discomfort and risk to the patient and costs to health care delivery.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

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

    International Nuclear Information System (INIS)

    Markose, G.; Freeman, A.H.; Ng, C.S.

    2003-01-01

    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.)

  11. A case of endometriosis causing acute large bowel obstruction.

    Science.gov (United States)

    Allan, Zexi

    2018-01-01

    Endometriosis is a gynaecological condition which produce symptoms such as pelvic pain, abnormal menstruation and infertility. Intestinal endometriosis can occur however endometriosis causing acute large bowel obstruction is extremely rare. We present a 37-year-old lady with acute large bowel obstruction caused by endometriosis. Despite initial endoscopic decompression being unsuccessful due to severe mucosal stenosis, she underwent emergency laparoscopic wedge resection and decompression successfully. Diagnosing intestinal endometriosis is difficult. While different modalities of investigation help, definitive diagnosis is achieved via laparoscopy. Treatment of obstruction is decompression followed by surgical resection. Diagnosing intestinal endometriosis with or without obstruction is challenging. Correct diagnosis is needed for definitive management. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. [Diverticular disease of the large bowel - imaging methods].

    Science.gov (United States)

    Sečkařová, D; Bočanová-Mlejnková, J; Votrubová, J

    2013-07-01

    Imaging methods are fundamental for diagnosis in patients suffering from diverticular disease of the large bowel. In case of complications, radiological intervention can be helpful for treatment. The authors aim to summarize current possibilities of imaging methods, both in diagnosis and treatment of diverticular disease. Review of the literature and recent findings in the diagnosis of diverticular disease. The article presents the importance of imaging methods in the diagnosis and treatment of patients with diverticular disease.

  13. Reconstruction of short bowel syndrome after internal hernia in a pregnant woman with previous bariatric surgery.

    Science.gov (United States)

    Borghede, Märta Kristina; Vinter-Jensen, Lars; Andersen, Jens Christian; Mortensen, Peter Brøndum; Rasmussen, Henrik Højgaard

    2013-01-01

    Bariatric surgery is most often performed with the laparoscopic Roux-en-Y gastric bypass. A complication to the laparoscopic Roux-en-Y gastric bypass is internal hernia, which occurs in up to 16% of the patients. Since the laparoscopic Roux-en-Y gastric bypass is performed in women of fertile age, internal hernia may occur during pregnancy. A 22-year old woman with a history of laparoscopic Roux-en-Y gastric bypass suffered from massive internal hernia during pregnancy with widespread bowel necrosis. Extensive surgery was performed leaving the patient with an intact duodenum, 15cm of jejunum, 35cm of ileum and colon. Parenteral nutrition was initiated and ten months after the internal hernia, intestinal continuity was re-established. Ten weeks later the patient reached parenteral nutrition independence. Internal hernia after laparoscopic Roux-en-Y gastric bypass can be difficult to diagnose, especially during pregnancy and might be severe and life threatening for both mother and child. Obstetricians and abdominal surgeons must be aware of this condition. Surgery should be performed on a wide indication. When bowel necrosis is found it should be resected and in case of extensive bowel resection the patient should be evaluated in centres specialized in intestinal failure. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Combined small and large bowel MR imaging in patients with Crohn's disease: a feasibility study

    International Nuclear Information System (INIS)

    Narin, Burcu; Ajaj, Waleed; Goehde, Susanne; Lauenstein, Thomas C.; Langhorst, Jost; Gerken, Guido; Akgoez, Haldun; Ruehm, Stefan G.

    2004-01-01

    MRI of the small bowel is a new method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both the small and large bowel. Therefore, our goal was to assess the feasibility of displaying the small bowel and colon simultaneously by MR imaging. Eighteen patients with inflammatory bowel disease were studied. For small bowel distension, patients ingested a solution containing mannitol and locust bean gum. Furthermore, the colon was rectally filled with water. MR examinations were performed on a 1.5-T system. Before and after intravenous gadolinium administration, a T1w data set was collected. All patients underwent conventional colonoscopy as a standard of reference. The oral ingestion and the rectal application of water allowed an assessment of the small bowel and colon in all patients. By means of MRI (endoscopy), 19 (13) inflamed bowel segments in the colon and terminal ileum were detected. Furthermore, eight additional inflammatory lesions in the jejunum and proximal ileum that had not been endoscopically accessible were found by MRI. The simultaneous display of the small and large bowel by MRI is feasible. Major advantages of the proposed MR concept are related to its non-invasive character as well as to the potential to visualize parts of the small bowel that cannot be reached by endoscopy. (orig.)

  15. Effects of endotoxaemia on markers of permeability, metabolism and inflammation in the large bowel of healthy subjects

    DEFF Research Database (Denmark)

    Jørgensen, V L; Ibsen, M; Andresen, L

    2007-01-01

    Increased permeability and increased luminal concentrations of L-lactate have previously been shown in the large bowel in septic patients. To advance these observations, a human model of colorectal barrier failure in sepsis is desirable. Therefore, we assessed the effects of endotoxaemia on markers...

  16. Description of age, sex and site distribution of large bowel cancer in ...

    African Journals Online (AJOL)

    Aims/Objective: To determine the distribution of bowel cancer with special emphasis on age, sex and site. Methods: One hundred and sixty cases of histologically confirmed large bowel cancers at Jos University Teaching Hospital between January 1991 – December 2000 were reviewed. The records were collected from the ...

  17. Carcinoma of the large bowel after a single massive dose of radiation in healthy teenagers

    Energy Technology Data Exchange (ETDEWEB)

    Rotmensch, S.; Avigad, I.; Soffer, E.E.; Horowitz, A.; Bar-Meir, S.; Confino, R.; Czerniak, A.; Wolfstein, I.

    1986-02-15

    Three healthy teenagers were exposed to a single pelvic x-ray irradiation as part of sterilization experiments performed in the Auschwitz concentration camp in 1943. Single and multiple carcinomas of the colon and rectum developed 40 years later in the radiation field. Histologic examination of surgical specimens revealed severe radiation-induced changes in all layers of tumor-adjacent areas. In contrast to previous reports of radiation-induced large bowel cancers, these women had not undergone repeated courses of radiation, had no known co-existing disease that might raise the risk for colonic and rectal malignancies, and had an extremely long and remarkably similar latency period. These cases emphasize the need for long-term surveillance in previously radiated patients. Since thousands of teenagers were subjected to similar sterilization experiments, awareness of this association might help in the early diagnosis of additional cases.

  18. Carcinoma of the large bowel after a single massive dose of radiation in healthy teenagers

    International Nuclear Information System (INIS)

    Rotmensch, S.; Avigad, I.; Soffer, E.E.; Horowitz, A.; Bar-Meir, S.; Confino, R.; Czerniak, A.; Wolfstein, I.

    1986-01-01

    Three healthy teenagers were exposed to a single pelvic x-ray irradiation as part of sterilization experiments performed in the Auschwitz concentration camp in 1943. Single and multiple carcinomas of the colon and rectum developed 40 years later in the radiation field. Histologic examination of surgical specimens revealed severe radiation-induced changes in all layers of tumor-adjacent areas. In contrast to previous reports of radiation-induced large bowel cancers, these women had not undergone repeated courses of radiation, had no known co-existing disease that might raise the risk for colonic and rectal malignancies, and had an extremely long and remarkably similar latency period. These cases emphasize the need for long-term surveillance in previously radiated patients. Since thousands of teenagers were subjected to similar sterilization experiments, awareness of this association might help in the early diagnosis of additional cases

  19. Effect of the paclitaxel and radiation the large bowel mucosa of the rat

    International Nuclear Information System (INIS)

    Lee, Kyung Ja

    1999-01-01

    Paclitaxel is a chemotherapeutic agent with a potent microtubule stabilizing activity that arrests mitosis at G2-M phase of cell cycle which is the most radiosensitive period. Therefore paclitaxel is considered as a cell cycle-specific radiosensitizer. This study investigates the effect of paclitaxel on the radiation response of the normal large bowel mucosa of the rat. The rats were divided into the three groups i.e., single intraperitoneal infusion of paclitaxel (10 mg/kh), a single fraction of irradiation (8 Gy, x-ray) to the whole abdomen, and a combination of irradiation (8 Gy, x-ray) given 24 hours after pacilitaxel infusion. The histological changes as well as kinetics of mitotic arrest and apoptosis were evaluated on the large bowel mucosa at 6 hours, 1 day, 3 days and 5 days after treatment with paclitaxel infusion. The apoptosis appeared in 24 hours after paclitaxel infusion, and the histopathologic changes such as vesiculation, atypia and reduction of the goblet cell of the mucosa of the large bowel were demonstrated during the period from 6 hours to 3 days after, and returned to normal in 5 days after paclitaxel infusion. In irradiated group, the apoptosis was increased in 6 and 24 hours after irradiation, and the histopathologic changes of the mucosa were appeared in 24 hours and markedly increased in 3 days and returned to normal in 5 days. In combined group of irradiation and pacliation and paclitaxel infusion, the apoptosis was appeared in 3 days and the histopathologic changes appeared during the period from 6 hours to 2 days after infusion. On the basis of the incidence of apoptosis and the degree of the histopathologic changes of the large bowel mucosa, there seemed to be additive effect by paclitaxel on radiation rather than sensitizing effect. The histopathological changes of large bowel mucosa in combined group compared to radiation alone group suggested an additive effect of paclitaxel on radiation response in the large bowel of rat

  20. Does digestibility of meat protein help explain large bowel cancer risk?

    Science.gov (United States)

    Silvester, K R; Cummings, J H

    1995-01-01

    An association between meat eating and large bowel cancer risk has been shown in a variety of epidemiologic studies. One reason could be that meat is less well digested than other protein foods and leads to greater amounts of protein entering the large bowel and being metabolized by colonic bacteria to potential carcinogens. To test this hypothesis, five subjects with ileostomies were fed, for five days, a basal diet to which were added test meals of cheese, a small or a large fried beef steak, and a large steak with resistant starch (RS). Ileal true nitrogen digestibility was similar for all five diets: control, 86.3%; cheese, 89.4%; low beef, 88.6%; high beef, 89.6%; and high beef + RS, 88.7%. Beef, at both low and high intake levels, was as well digested as cheese, suggesting that poor digestibility of meat does not explain the association between meat intake and large bowel cancer risk. Ileal starch output on the high beef + RS diet was 27% greater than expected on the basis of the measurement of dietary RS in vitro (p = 0.005 for linear trend), and this was confirmed by a meta analysis with eight other published studies. The relation between meat and large bowel cancer may reflect higher protein intakes in meat eaters or may be explained by other mechanisms.

  1. Total colectomy in a gangrenous large bowel due to a rare double closed loop obstruction

    Directory of Open Access Journals (Sweden)

    Priyanka Akhilesh Sali

    2015-01-01

    Conclusion: To our knowledge, such gangrene of the entire large bowel due to a sigmoid volvulus and a competent ileocaecal valve has not been reported in literature so far. We also highlight here, the rapid ischaemic changes that follow a closed loop obstruction. In our case the CT has shown ischaemic changes only in the sigmoid. Hence, timely diagnosis and intervention is imperative.

  2. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes

    Directory of Open Access Journals (Sweden)

    Subramaniyan Ramanathan

    2017-01-01

    Full Text Available Although large bowel obstruction (LBO is less common than small bowel obstruction, it is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. Plain radiographs are sufficient to diagnose LBO in a majority of patients. However, further evaluation with multidetector computed tomography (MDCT has become the standard of care to identify the site, severity, and etiology of obstruction. In this comprehensive review, we illustrate the various causes of LBO emphasizing the role of MDCT in the initial diagnosis and detection of complications along with the tips to differentiate from disease which can mimic LBO.

  3. Hormone replacement therapy, oral contraceptive use, and distal large bowel cancer: a population-based case-control study.

    Science.gov (United States)

    Long, Millie D; Martin, Christopher F; Galanko, Joseph A; Sandler, Robert S

    2010-08-01

    Lower incidence rates of distal large bowel cancer in women when compared with men support the protective role of female hormones. We aimed to determine the associations between hormone replacement therapy, oral contraceptive use, and distal large bowel cancer. We conducted a population-based case-control study of incident distal large bowel cancer in North Carolina between 2001 and 2006. Data on hormone replacement therapy, oral contraceptive use, demographics, and risk factors were obtained through in-person interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between oral contraceptive use, hormone replacement therapy, and distal large bowel cancer were estimated through unconditional logistic regression models overall, by duration of use, and within strata of race. There were a total of 443 women with distal large bowel cancer and 405 controls. Ever use of hormone replacement therapy was strongly associated with a reduced risk of distal large bowel cancer (OR 0.52, 95% CI 0.38-0.72). Further reduction of distal large bowel cancer risk occurred with increased duration of use (or=15 years (OR 0.34, 95% CI 0.20-0.58)). Ever use of oral contraceptives was not associated with reduced incidence of distal large bowel cancer (OR 0.95, 95% CI 0.67-1.34) nor was duration of use. There were no differences by race. Hormone replacement therapy is associated with a lower risk of distal large bowel cancer. This risk is further reduced with increased duration of use. Hormone replacement therapy may be partially responsible for the reduced incidence of distal large bowel cancer in women compared with men.

  4. Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory.

    Science.gov (United States)

    Venara, A; Barbieux, J; Colas, P A; Le Fouler, A; Lermite, E; Hamy, A

    2017-07-01

    Malignant large bowel obstructions frequently require emergency surgery. Compliance with enhanced recovery after surgery programmes is significantly reduced due to non-removal of the nasogastric tube in the postoperative period. The first aim of the present study was to research factors associated with the failure of immediate nasogastric tube removal in patients who had undergone emergency surgery for malignant large bowel obstruction. The second aim was to assess the morbidity linked to nasogastric tube reinsertion. This retrospective and monocentric study included all consecutive patients admitted for acute malignant large bowel obstruction who underwent emergency surgery. Patients who were not primarily operated on were excluded (n = 178; 69.3%). The group of patients requiring nasogastric tube (NGT) reinsertion was compared with the group that did not require NGT reinsertion. Seventy-nine patients underwent emergency surgery, of which 18 (22.8%) required nasogastric tube reinsertion. There was no difference between the two groups with regard to (a) immediate nasogastric tube removal (p = 0.87) and (b) inclusion in an enhanced recovery programme (p = 0.75). However, preoperative small bowel dilatation was associated with a reduction in the need for NGT reinsertion (p = 0.04). A left-sided tumour was also associated with the need for NGT reinsertion in uni- (p = 0.034) and multivariate analysis (OR = 8; p reinsertion. The postoperative course influenced NGT reinsertion, which was significantly associated with postoperative ileus (OR = 4; p reinsertion was not affected by immediate removal of the tube. Left-sided tumours and patients at risk of postoperative ileus should be managed with caution. Immediate nasogastric tube removal is not contraindicated in the case of large bowel obstruction because it is not associated with a higher risk of NGT reinsertion.

  5. Role of stem cells in large bowel carcinogenesis

    Directory of Open Access Journals (Sweden)

    N. A. Nefedova

    2015-01-01

    Full Text Available Сancer stem cells (CSC play a significant role in the development and progression of colorectal cancer. They are capable of self-senewal and multipotent differentiation. CSC can be formed from stem cells or mutant by dedifferentiation of crypt epithelial cells. Recently, much attention is paid to CSC in colon cancer, but very little has been published regarding their expression in colon polyps. In 2010 The World Health Organization attributed the so-called serrated lesions, including hyperplastic polyp, serrated sessile adenoma and traditional serrated adenoma to a group of precancerous lesions of the colon in addition to the classical tubular, villous and tubulo-villous adenomas. Despite the large number of publications devoted to the newly selected category, a full understanding of the processes involved in the formation of polyps and their progression into colon cancer, there is still no. Identification of CSC in colon polyps will assess their potential malignancy conduct adequate therapy, determine the amount of the operation and further treatment strategy. This in turn will contribute to the early detection and prevention of cancer. Identification of CSC, an assessment of their localization and distribution in tubular adenomas, serrated adenoma broad-based, traditional serrated adenoma and hyperplastic polyps allow to evaluate the potential of malignancy and prognosis for each of the polyps. In this regard, the definition of markers characteristic of colon CSC, is interesting not only from a scientific, but also from a practical point of view.

  6. Resection of the large bowel suppresses hunger and food intake and modulates gastrointestinal fermentation.

    Science.gov (United States)

    Hettiarachchi, Priyadarshika; Wickremasinghe, A Rajitha; Frost, Gary S; Deen, Kemal I; Pathirana, Ajith A; Murphy, Kevin G; Jayaratne, SriLal D

    2016-08-01

    To assess appetite and gut hormone levels in patients following partial (PR) or total resection (TR) of the large bowel. A comparative cross sectional study was carried out with healthy controls (n = 99) and patients who had undergone PR (n = 64) or TR (n = 12) of the large bowel. Participants consumed a standard (720 kcal) breakfast meal at 0830 (t = 0) h followed by lactulose (15 g) and a buffet lunch (t = 210 min). Participants rated the subjective feelings of hunger at t = -30, 0, 30, 60, 120, and 180 min. Breath hydrogen (BH) concentrations were also evaluated. In a matched subset (11 controls, 11 PR and 9 TR patients) PYY and GLP-1 concentrations were measured following breakfast. The primary outcome measure was appetite, as measured using visual analogue scales and the buffet lunch. The secondary outcome was BH concentrations following a test meal. PR and TR participants had lower hunger and energy intake at the buffet lunch meal compared to controls. PR subjects had higher BH concentrations compared to controls and TR subjects. BH levels correlated with circulating GLP-1 levels at specific time points. PR or TR of the large bowel reduced feelings of hunger and energy intake, and PR increased gastrointestinal fermentation. © 2016 The Obesity Society.

  7. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix.

    Science.gov (United States)

    Randal Bollinger, R; Barbas, Andrew S; Bush, Errol L; Lin, Shu S; Parker, William

    2007-12-21

    The human vermiform ("worm-like") appendix is a 5-10cm long and 0.5-1cm wide pouch that extends from the cecum of the large bowel. The architecture of the human appendix is unique among mammals, and few mammals other than humans have an appendix at all. The function of the human appendix has long been a matter of debate, with the structure often considered to be a vestige of evolutionary development despite evidence to the contrary based on comparative primate anatomy. The appendix is thought to have some immune function based on its association with substantial lymphatic tissue, although the specific nature of that putative function is unknown. Based (a) on a recently acquired understanding of immune-mediated biofilm formation by commensal bacteria in the mammalian gut, (b) on biofilm distribution in the large bowel, (c) the association of lymphoid tissue with the appendix, (d) the potential for biofilms to protect and support colonization by commensal bacteria, and (e) on the architecture of the human bowel, we propose that the human appendix is well suited as a "safe house" for commensal bacteria, providing support for bacterial growth and potentially facilitating re-inoculation of the colon in the event that the contents of the intestinal tract are purged following exposure to a pathogen.

  8. Sigmoid endometriosis in a post-menopausal woman leading to acute large bowel obstruction: A case report

    Directory of Open Access Journals (Sweden)

    Bardia Bidarmaghz, MD

    2016-01-01

    Conclusion: This case report shows that colonic endometriosis, although rare, can be significantly infiltrative and lead to complications such as a large bowel obstruction. Diagnosing this condition can be challenging and usually requires histological confirmation.

  9. Experimental small bowel transplantation from non-heart-beating donors: a large-animal study.

    Science.gov (United States)

    Cobianchi, L; Zonta, S; Vigano, J; Dominioni, T; Ciccocioppo, R; Morbini, P; Bottazzi, A; Mazzilli, M; De Martino, M; Vicini, E; Filisetti, C; Botrugno, I; Dionigi, P; Alessiani, M

    2009-01-01

    The shortage of organs in the last 20 years is stimulating the development of new strategies to expand the pool of donors. The harvesting of a graft from non-heart-beating donors (NHBDs) has been successfully proposed for kidney and liver transplantation. To our knowledge, no studies are available for small bowel transplantation using NHBDs. In an experimental setting of small bowel transplantation, we studied the feasibility of using intestinal grafts retrieved from NHBDs. Twenty five Large White piglets underwent total orthotopic small bowel transplantation and were randomly divided as follow: NHBD group (n = 15) received grafts from NHBDs; heart-beating donor (HBD) group (n = 10) received grafts from HBDs. The NHBD pigs were sacrificed inducing the cardiac arrest by a lethal potassium injection. After 20 minutes (no touch period = warm ischemia), they underwent cardiac massage, laparotomy, and aorta cannulation for flushing and cooling the abdominal organs. In HBDs, the cardiac arrest was induced at the time of organ cold perfusion. In both groups, immunosuppression was based on tacrolimus oral monotherapy. The animals were observed for 30 days. The graft absorptive function was studied at day 30 using the D-xylose absorption test. Histological investigation included HE (Hematoxilin and Eosin) microscopical analysis and immunohistological staining. Animals in the NHBD group died due to infection (n = 3), acute cellular rejection (n = 2), technical complications (n = 2), and intestinal failure (n = 8). In the HBD group, all animals but two were alive at the end of the study. The D-xylose absorption was significantly lower among the NHBD compared with the HBD group (P intestinal mucosa is sensitive to ischemic injury. When the intestinal graft is harvested from NHBDs, the infectious-related mortality was higher and the absorptive function lower. Histological examination confirmed a higher grade of ischemic injury in the NHBD grafts that correlated with the

  10. Blood-based biomarkers at large bowel endoscopy and prediction of future malignancies

    DEFF Research Database (Denmark)

    Kring, Thomas S.; Piper, Thomas B.; Jørgensen, Lars Nannestad

    2015-01-01

    development of malignant diseases. In a major study of 4,990 subjects undergoing large bowel endoscopy, 691 were without pathology and comorbidity. Plasma levels of TIMP-1, CEA, CA19-9, and YKL-40 were determined in samples collected just before endoscopy and compared with subsequent development...... associated with subsequent development of a malignant disease (P = 0.002). The cumulative risk of developing malignant disease within the first 5 years after endoscopy was group 0, 3.3%; group 1, 5.8%; group 2, 7.8%. It is concluded that increased levels of plasma TIMP-1, CEA, CA19-9, and serum YKL-40...

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

    Science.gov (United States)

    Nakayama, Yoshifumi; Kusuda, Shinichi; Nagata, Naoki; Yamaguchi, Koji

    2009-01-01

    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. PMID:19598310

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

    Directory of Open Access Journals (Sweden)

    Seenath Marlon

    2010-04-01

    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.

  13. Colorectal carcinomas with microsatellite instability display a different pattern of target gene mutations according to large bowel site of origin

    International Nuclear Information System (INIS)

    Pinheiro, Manuela; Fragoso, Maria; Santos, Lúcio; Henrique, Rui; Lopes, Paula; Lopes, Carlos; Lothe, Ragnhild A; Teixeira, Manuel R; Ahlquist, Terje; Danielsen, Stine A; Lind, Guro E; Veiga, Isabel; Pinto, Carla; Costa, Vera; Afonso, Luís; Sousa, Olga

    2010-01-01

    Only a few studies have addressed the molecular pathways specifically involved in carcinogenesis of the distal colon and rectum. We aimed to identify potential differences among genetic alterations in distal colon and rectal carcinomas as compared to cancers arising elsewhere in the large bowel. Constitutional and tumor DNA from a test series of 37 patients with rectal and 25 patients with sigmoid carcinomas, previously analyzed for microsatellite instability (MSI), was studied for BAX, IGF2R, TGFBR2, MSH3, and MSH6 microsatellite sequence alterations, BRAF and KRAS mutations, and MLH1 promoter methylation. The findings were then compared with those of an independent validation series consisting of 36 MSI-H carcinomas with origin from each of the large bowel regions. Immunohistochemical and germline mutation analyses of the mismatch repair system were performed when appropriate. In the test series, IGFR2 and BAX mutations were present in one and two out of the six distal MSI-H carcinomas, respectively, and no mutations were detected in TGFBR2, MSH3, and MSH6. We confirmed these findings in the validation series, with TGFBR2 and MSH3 microsatellite mutations occurring less frequently in MSI-H rectal and sigmoid carcinomas than in MSI-H colon carcinomas elsewhere (P = 0.00005 and P = 0.0000005, respectively, when considering all MSI-carcinomas of both series). No MLH1 promoter methylation was observed in the MSI-H rectal and sigmoid carcinomas of both series, as compared to 53% found in MSI-H carcinomas from other locations (P = 0.004). KRAS and BRAF mutational frequencies were 19% and 43% in proximal carcinomas and 25% and 17% in rectal/sigmoid carcinomas, respectively. The mechanism and the pattern of genetic changes driving MSI-H carcinogenesis in distal colon and rectum appears to differ from that occurring elsewhere in the colon and further investigation is warranted both in patients with sporadic or hereditary disease

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

    International Nuclear Information System (INIS)

    Otsuka, Hideki; Grahaam, M.M.; Kubo, Akiko; Nishitani, Hiromu

    2005-01-01

    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. SUV max 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

  15. Increased chromogranin A cell density in the large intestine of patients with irritable bowel syndrome after receiving dietary guidance

    OpenAIRE

    Mazzawi, Tarek; Gundersen, Doris Irene; Hausken, Trygve; El-Salhy, Magdy

    2015-01-01

    The large intestine contains five types of endocrine cells that regulate its functions by sensing its luminal contents and releasing specific hormones. Chromogranin A (CgA) is a common marker for the gastrointestinal endocrine cells, and it is abnormal in irritable bowel syndrome (IBS) patients. Most IBS patients relate their symptoms to certain food elements. The present study investigated the effect of dietary guidance on the total endocrine cells of the large intestine as detected by CgA i...

  16. Effects of long-term administration of Senna occidentalis seeds in the large bowel of rats.

    Science.gov (United States)

    Nadal, Sidney Roberto; Calore, Edenilson Eduardo; Manzione, Carmem Ruth; Puga, Flavio Rodrigues; Perez, Nilda Maria

    2003-01-01

    Plants of the genus Senna that contain anthranoides derivatives are frequently used as cathartics. Radiological studies have demonstrated that patients with chronic constipation who have used stimulant laxative have colonic redundancy and dilatation more frequently than patients who have not. The objective of the present work was to study morphological and histochemical changes of the lower gut after administration of Senna occidentalis seeds for a long period to rats, as observed in skeletal muscle fibers. Fragments of the lower gut of young and adult rats treated with S. occidentalis seeds (2% for 171 days and 3% for 61 days in the diet) were submitted to histological and histochemical analysis and to densitometry. The most important finding was decreased oxidative enzyme activity in smooth muscle cells and in myenteric neurons of the large bowel. As oxidative metabolism is essential for ATP and energy production, these results suggest that the functional intestinal disturbance caused by the chronic use of Senna occidentalis as a laxative can be due to a metabolic effect involving energy production, which would decrease colonic motility and cause functional colonic dilatation, but without any irreversible anatomic change.

  17. Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries

    DEFF Research Database (Denmark)

    Jiménez-Pérez, J; Casellas, J; García-Cano, J

    2011-01-01

    To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging...... in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation....

  18. The expression of HSP60 and HSP10 in large bowel carcinomas with lymph node metastase

    International Nuclear Information System (INIS)

    Cappello, Francesco; David, Sabrina; Rappa, Francesca; Bucchieri, Fabio; Marasà, Lorenzo; Bartolotta, Tommaso E; Farina, Felicia; Zummo, Giovanni

    2005-01-01

    The involvement of Heat Shock Proteins (HSP) in cancer development and progression is a widely debated topic. The objective of the present study was to evaluate the presence and expression of HSP60 and HSP10 in a series of large bowel carcinomas and locoregional lymph nodes with and without metastases. 82 Astler and Coller's stage C2 colorectal cancers, of which 48 well-differentiated and 34 poorly-differentiated, were selected along with 661 lymph nodes, including 372 with metastases and 289 with reactive hyperplasia only, from the same tumours. Primitive tumours and both metastatic and reactive lymph nodes were studied; specifically, three different compartments of the lymph nodes, secondary follicle, paracortex and medullary sinus, were also analysed. An immunohistochemical research for HSP60 and HSP10 was performed and the semiquantitative results were analysed by statistical analysis to determine the correlation between HSPs expression and 1) tumour grading; 2) degree of inflammation; 3) number of lymph nodes involved; 4) lymph node compartment hyperplasia. Moreover, western blotting was performed on a smaller group of samples to confirm the immunohistochemical results. Our data show that the expression of HSP60, in both primary tumour and lymph node metastasis, is correlated with the tumoral grade, while the HSP10 expression is not. Nevertheless, the levels of HSP10 are commonly higher than the levels of HSP60. In addition, statistical analyses do not show any correlation between the degree of inflammation and the immunopositivity for both HSP60 and HSP10. Moreover, we find a significant correlation between the presence of lymph node metastases and the positivity for both HSP60 and HSP10. In particular, metastatic lymph nodes show a higher percentage of cells positive for both HSP60 and HSP10 in the secondary follicles, and for HSP10 in the medullary sinuses, when compared with hyperplastic lymph nodes. HSP60 and HSP10 may have diagnostic and prognostic

  19. Disability and participation in breast and bowel cancer screening in England: a large prospective study.

    Science.gov (United States)

    Floud, S; Barnes, I; Verfürden, M; Kuper, H; Gathani, T; Blanks, R G; Alison, R; Patnick, J; Beral, V; Green, J; Reeves, G K

    2017-11-21

    There is limited information about participation in organised population-wide screening programmes by people with disabilities. Data from the National Health Service routine screening programmes in England were linked to information on disability reported by the Million Women Study cohort participants. Of the 473 185 women offered routine breast or bowel cancer screening, 23% reported some disability. Women with disabilities were less likely than other women to participate in breast cancer screening (RR=0.64, 95% CI: 0.62-0.65) and in bowel cancer screening (RR=0.75, 0.73-0.76). Difficulties with self-care or vision were associated with the greatest reduction in screening participation. Participation in routine cancer screening programmes in England is reduced in people with disabilities and participation varies by type of disability.

  20. Disability and participation in breast and bowel cancer screening in England: a large prospective study

    OpenAIRE

    Floud, S; Barnes, I; Verfürden, M; Kuper, H; Gathani, T; Blanks, R G; Alison, R; Patnick, J; Beral, V; Green, J; Reeves, G K

    2017-01-01

    Background There is limited information about participation in organised population-wide screening programmes by people with disabilities. Methods Data from the National Health Service routine screening programmes in England were linked to information on disability reported by Million Women Study cohort participants. Results Of 473,185 women offered routine breast or bowel cancer screening, 23% reported some disability. Women with disabilities were less likely than oth...

  1. Rare Case of Large Bowel Injury due to Direct Blunt Trauma to a Preexisting Femoral Hernia

    Directory of Open Access Journals (Sweden)

    C. Tinner

    2017-01-01

    Full Text Available We report a case of an 85-year-old man with a known asymptomatic left femoral hernia who was admitted to the emergency ward a few hours after falling from a bicycle and suffering from blunt trauma of the handlebar to the left inguinal region. The clinical findings and a computed tomography (CT scan detecting free air in the femoral hernia sac suggested bowel perforation. Emergency laparotomy 6 hours after the incident confirmed a tear of the sigmoid colon accompanied by free blood and faeces in the left inguinal region of the abdomen. A segmental sigmoid resection and a primary end-to-end colorectal anastomosis were performed. The postoperative course was complicated by delayed oral feeding, a local infection, and a partial left testicle necrosis that led to secondary resection. The patient was discharged after 32 days of in-hospital care. Three months post trauma, we recorded a restitutio ad integrum. The case exemplifies that blunt trauma to preexisting femoral hernias may cause potentially lethal bowel perforation and that the time interval between time of injury and surgical treatment may be a prognostic factor. CT scans seem most suitable for ruling out bowel perforation. The scarce literature for blunt trauma to hernias is reviewed.

  2. The large bowel carcinogenic effects of hydrazines and related compounds occurring in nature and in the environment.

    Science.gov (United States)

    Toth, B

    1977-11-01

    Five substituted hydrazines that induce large bowel and other types of cancer in laboratory animals are described. Two of these compounds, which originate in nature, are 1,1-dimethylhydrazine, a tobacco ingredient, and methylhydrazine, formed from a chemical present in the edible wild mushroom Gyromitra esculenta. The human population is therefore exposed to them considerably. In addition, both compounds are manufactured and used in rocket fuel. The other three chemicals, 1,2-dimethylhydrazine dihydrochloride,1-methyl-2-butylhydrazine dihydrochloride and trimethylhydrazine hydrochloride, are manufactured synthetically only and apparently are not found in substantial quantities in the environment.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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)

  4. Correction of Large Oro-antral Communications From Previously Failed Implant Treatment: Reconstruction of Hard and Soft Tissues.

    Science.gov (United States)

    Petrungaro, Paul S; Gonzalez, Santiago; Villegas, Carlos

    2018-02-01

    As dental implants become more popular for the treatment of partial and total edentulism and treatment of "terminal dentitions," techniques for the management of the atrophic posterior maxillae continue to evolve. Although dental implants carry a high success rate long term, attention must be given to the growing numbers of revisions or retreatment of cases that have had previous dental implant treatment and/or advanced bone replacement procedures that, due to either poor patient compliance, iatrogenic error, or poor quality of the pre-existing alveolar and/or soft tissues, have led to large osseous defects, possibly with deficient soft-tissue volume. In the posterior maxillae, where the poorest quality of bone in the oral cavity exists, achieving regeneration of the alveolar bone and adequate volume of soft tissue remains a complex procedure. This is made even more difficult when dealing with loss of dental implants previously placed, aggressive bone reduction required in various implant procedures, and/or residual sinus infections precluding proper closure of the oral wound margins. The purpose of this article is to outline a technique for the total closure of large oro-antral communications, with underlying osseous defects greater than 15 mm in width and 30 mm in length, for which multiple previous attempts at closure had failed, to achieve not only the reconstruction of adequate volume and quality of soft tissues in the area of the previous fistula, but also total regeneration of the osseous structures in the area of the large void.

  5. Acute on Chronic Pancreatitis Causing a Highway to the Colon with Subsequent Road Closure: Pancreatic Colonic Fistula Presenting as a Large Bowel Obstruction Treated with Pancreatic Duct Stenting

    OpenAIRE

    Cochrane, Justin; Schlepp, Greg

    2015-01-01

    Context. Colonic complications associated with acute pancreatitis have a low incidence but carry an increased risk of mortality with delayed diagnosis and treatment. Pancreatic colonic fistula is most commonly associated with walled off pancreatic necrosis or abscess formation and rarely forms spontaneously. Classic clinical manifestations for pancreatic colonic fistula include diarrhea, hematochezia, and fever. Uncommonly pancreatic colonic fistula presents as large bowel obstruction. Case. ...

  6. Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome

    OpenAIRE

    Portincasa, Piero; Moschetta, Antonio; Baldassarre, Giuseppe; Altomare, Donato F.; Palasciano, Giuseppe

    2003-01-01

    AIM: Psychological factors, altered motility and sensation disorders of the intestine can be variably associated with irritable bowel syndrome (IBS). Such aspects have not been investigated simultaneously. The aim of this paper was to evaluate gastrointestinal motility and symptoms, psychological spectrum and quality of life in a large group of IBS patients in southern Italy.

  7. Increased Chromogranin A Cell Density in the Large Intestine of Patients with Irritable Bowel Syndrome after Receiving Dietary Guidance

    Directory of Open Access Journals (Sweden)

    Tarek Mazzawi

    2015-01-01

    Full Text Available The large intestine contains five types of endocrine cells that regulate its functions by sensing its luminal contents and releasing specific hormones. Chromogranin A (CgA is a common marker for the gastrointestinal endocrine cells, and it is abnormal in irritable bowel syndrome (IBS patients. Most IBS patients relate their symptoms to certain food elements. The present study investigated the effect of dietary guidance on the total endocrine cells of the large intestine as detected by CgA in 13 IBS patients. Thirteen control subjects were also included. Each patient received three sessions of dietary guidance. Colonoscopies were performed on controls and patients (at baseline and at 3–9 months after receiving guidance. Biopsy samples from the colon and rectum were immunostained for CgA and quantified by computerized image analysis. The densities of CgA cells in the total colon (mean ± SEM among the controls and the IBS patients before and after receiving dietary guidance were 83.3±10.1, 38.6±3.7, and 64.7±4.2 cells/mm2, respectively (P=0.0004, and were unchanged in the rectum. In conclusion, the increase in CgA cell density after receiving dietary guidance may reflect a change in the densities of the large intestinal endocrine cells causing an improvement in the IBS symptoms.

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

    Directory of Open Access Journals (Sweden)

    Simone Gonçalves Lopes

    2001-04-01

    Full Text Available 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 flexura 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.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 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.

  9. Self-reported disability in patients with inflammatory bowel disease largely determined by disease activity and illness perceptions

    NARCIS (Netherlands)

    Have, M. van der; Fidder, H.H.; Leenders, M.; Kaptein, A.A.; Valk, M.E. van der; Bodegraven, A.A. van; Dijkstra, G.; Jong, D.J. de; Pierik, M.; Ponsioen, C.Y.; Meulen-de Jong, A.E. van der; Woude, C.J. van der; Meeberg, P.C. van de; Romberg-Camps, M.J.; Clemens, C.H.; Jansen, J.M.; Mahmmod, N.; Bolwerk, C.J.; Vermeijden, J.R.; Siersema, P.D.; Oldenburg, B.

    2015-01-01

    BACKGROUND: The inflammatory bowel disease (IBD) disability index has recently been introduced to measure patients' physical, psychological, familial, and social limitations associated with IBD. We assessed factors related to self-reported disability and the relationship between disability and

  10. Self-reported disability in patients with inflammatory bowel disease largely determined by disease activity and illness perceptions

    NARCIS (Netherlands)

    van der Have, Mike; Fidder, Herma H; Leenders, Max; Kaptein, Ad A; van der Valk, Mirthe E; van Bodegraven, Ad A; Dijkstra, Gerard; de Jong, Dirk J; Pierik, Marieke; Ponsioen, Cyriel Y; van der Meulen-de Jong, Andrea E; van der Woude, C Janneke; van de Meeberg, Paul C; Romberg-Camps, Mariëlle J L; Clemens, Cees H M; Jansen, Jeroen M; Mahmmod, Nofel; Bolwerk, Clemens J M; Vermeijden, J Reinoud; Siersema, Peter D; Oldenburg, Bas

    BACKGROUND: The inflammatory bowel disease (IBD) disability index has recently been introduced to measure patients' physical, psychological, familial, and social limitations associated with IBD. We assessed factors related to self-reported disability and the relationship between disability and

  11. The fate of (13)C-labelled and non-labelled inulin predisposed to large bowel fermentation in rats.

    Science.gov (United States)

    Butts, Christine A; Paturi, Gunaranjan; Tavendale, Michael H; Hedderley, Duncan; Stoklosinski, Halina M; Herath, Thanuja D; Rosendale, Douglas; Roy, Nicole C; Monro, John A; Ansell, Juliet

    2016-04-01

    The fate of stable-isotope (13)C labelled and non-labelled inulin catabolism by the gut microbiota was assessed in a healthy rat model. Sprague-Dawley male rats were randomly assigned to diets containing either cellulose or inulin, and were fed these diets for 3 days. On day (d) 4, rats allocated to the inulin diet received (13)C-labelled inulin. The rats were then fed the respective non-labelled diets (cellulose or inulin) until sampling (d4, d5, d6, d7, d10 and d11). Post feeding of (13)C-labelled substrate, breath analysis showed that (13)C-inulin cleared from the host within a period of 36 hours. Faecal (13)C demonstrated the clearance of inulin from gut with a (13)C excess reaching maximum at 24 hours (d5) and then declining gradually. There were greater variations in caecal organic acid concentrations from d4 to d6, with higher concentrations of acetic, butyric and propionic acids observed in the rats fed inulin compared to those fed cellulose. Inulin influenced caecal microbial glycosidase activity, increased colon crypt depth, and decreased the faecal output and polysaccharide content compared to the cellulose diet. In summary, the presence of inulin in the diet positively influenced large bowel microbial fermentation.

  12. Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury.

    Science.gov (United States)

    Jordan, Polly A; Naidu, Madhu; Thakar, Ranee; Sultan, Abdul H

    2018-03-29

    Our primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit's standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. This is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark's Incontinence Score (SMIS), anal manometry and EAUS at both antepartum and 3-month postpartum visits. Data were analysed using Wilcoxon and Mann-Whitney U tests. Three hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.

  13. Chromogranin A cell density in the large intestine of Asian and European patients with irritable bowel syndrome.

    Science.gov (United States)

    El-Salhy, Magdy; Patcharatrakul, Tanisa; Hatlebakk, Jan Gunnar; Hausken, Trygve; Gilja, Odd Helge; Gonlachanvit, Sutep

    Patients with irritable bowel syndrome (IBS) in Asia show distinctive differences from those in the western world. The gastrointestinal endocrine cells appear to play an important role in the pathophysiology of IBS. The present study aimed at studying the density of chromogranin A (CgA) cells in the large intestine of Thai and Norwegian IBS patients. Thirty Thai IBS patients and 20 control subjects, and 47 Norwegian IBS patients and 20 control subjects were included. A standard colonoscopy was performed in both the patients and controls, and biopsy samples were taken from the colon and the rectum. The biopsy samples were stained with hematoxylin-eosin and immunostained for CgA. The density of CgA cells was determined by computerized image analysis. In the colon and rectum, the CgA cell densities were far higher in both IBS and healthy Thai subjects than in Norwegians. The colonic CgA cell density was lower in Norwegian IBS patients than in controls, but did not differ between Thai IBS patients and controls. In the rectum, the CgA cell densities in both Thai and Norwegian patients did not differ from those of controls. The higher densities of CgA cells in Thai subjects than Norwegians may be explained by a higher exposure to infections at childhood and the development of a broad immune tolerance, by differences in the intestinal microbiota, and/or differing diet habits. The normal CgA cell density in Thai IBS patients in contrast to that of Norwegians may be due to differences in pathophysiology.

  14. Bowel incontinence

    Science.gov (United States)

    ... Colectomy or bowel surgery. Not sensing that it's time to have a bowel movement. Emotional problems. Gynecological, prostate, or rectal surgery. Injury to the anal muscles due to childbirth (in women). Nerve or muscle damage (from injury, tumor, or radiation). ...

  15. Large bowel resection - discharge

    Science.gov (United States)

    ... few weeks. Ask your provider when you can shower or soak in a bathtub. It is OK if the tapes get wet. DO NOT soak or scrub them. Keep your wound dry at all other times. The tapes will fall off on their own ...

  16. Bowel Dysfunction

    Science.gov (United States)

    ... to PCF? Featured Fundraise for PCF: Many vs Cancer Contact Us Bowel Dysfunction The broad term of bowel dysfunction includes ... immodium) can be used to help with loose bowel movements. Increasing fiber intake through whole grains, ... mission 82% Join the fight against prostate ...

  17. What to do with a non-rolling stone? Surgical on-table dilemma in large bowel obstruction due to an impacted gallstone.

    Science.gov (United States)

    Das, Niloy; Plummer, Nicholas R; Raja, Hassan; Vashist, Ashok

    2014-07-06

    We present a rare case of large bowel obstruction secondary to colonic gallstones in a frail nonagenarian. Uniquely, the stone was impacted in the descending colon-sigmoid junction, in the absence of underlying bowel pathology distal to the stone. In light of worsening pain and distension after failed endoscopic treatment, the patient was treated with an emergency laparotomy. After an on-table dilemma, a proximal defunctioning loop colostomy was fashioned and the stone left in situ, with the eventual fate of the stone currently undecided. We also discuss alternative treatment options and explain the thought processes that lead to our decision. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2014.

  18. DIEP flap customization using Fluobeam® indocyanine green tissue perfusion assessment with large previous abdominal scar

    Directory of Open Access Journals (Sweden)

    Michael A. Fallucco

    2017-06-01

    Full Text Available The Fluobeam® is a portable, near-infrared camera that is held and controlled by the surgeon to visualize tissue perfusion using indocyanine green (ICG fluorescence imaging. This case report describes how data obtained from ICG imaging allows intraoperative customization in a previously surgically scarred abdomen during autologous Deep Inferior Epigastric Artery Perforator (DIEP flap bilateral breast reconstruction. The outcome was successful breast mound recreation without fat necrosis.

  19. Association between bowel habits and quality of bowel preparation for colonoscopy.

    Science.gov (United States)

    Lee, Dong-Won; Koo, Ja Seol; Kang, Seonghee; Kim, Seung Young; Hyun, Jong Jin; Jung, Sung Woo; Yim, Hyung Joon; Lee, Sang Woo

    2017-07-01

    The effectiveness of colonoscopy is highly dependent on the quality of bowel preparation. Although many studies have previously evaluated the role of cleansing methods and dosing regimens, few have examined the association between bowel habits and subsequent bowel preparation. Here, we aimed to evaluate the impact of bowel habits on the quality of bowel preparation.A total of 404 patients who underwent a total colonoscopy and completed a personal bowel habit questionnaire at Korea University Hospital between December 2012 and December 2013 were enrolled. The usual stool form of patients was classified into 7 categories according to the Bristol Stool Scale (BSS). The quality of bowel preparation was determined during colonoscopy according to the Ottawa Bowel Preparation Scale (OBPS). Segment scores of ≥3 or total OBPS scores of >7 were defined as poor bowel preparation.Poor bowel preparation was reported in 9.4% of observed colonoscopies. The odds ratio (OR) of poor bowel preparation being associated with infrequent bowel movements (preparation, but the association was statistically insignificant (OR: 2.38; 95% CI, 0.90-6.33, P = .082). After adjusting for age, sex, drinking, presence of diabetes mellitus, and bowel preparation regimen, infrequent bowel movement (preparation. When subdividing by colonic segment, it was significantly associated with poor bowel preparation in all segments.Infrequent bowel movement (preparation.

  20. Phenotypic & Genotypic Characteristics of Inflammatory Bowel Disease (IBD) in French-Canadians: comparison with a large North American repository

    Science.gov (United States)

    Bhat, Mamatha; Nguyen, Geoffrey C.; Pare, Pierre; Lahaie, Raymond; Deslandres, Colette; Bernard, Edmond-Jean; Aumais, Guy; Jobin, Gilles; Wild, Gary; Cohen, Albert; Langelier, Diane; Brant, Steven; Dassopoulos, Themistocles; McGovern, Dermot; Torres, Esther; Duerr, Richard; Regueiro, Miguel; Silverberg, Mark S; Steinhart, Hillary; Griffiths, Anne M.; Elkadri, Abdul; Cho, Judy; Proctor, Deborah; Goyette, Philippe; Rioux, John; Bitton, Alain

    2009-01-01

    BACKGROUND Phenotype characteristics of inflammatory bowel disease (IBD) may differ significantly among ethnic subpopulations. The aim of this study was to characterize the IBD phenotype in French-Canadians, the most prominent founder population in North America. METHODS Using well-characterized phenotype data in the NIDDK-IBD Genetics Consortium repository on IBD patients, we compared phenotypic characteristics of 202 French-Canadians to those of 1287 other Caucasian patients. These included: diagnosis, anatomical location, disease behaviour, extraintestinal manifestations, surgical history, and family history of IBD. RESULTS French-Canadian CD patients were less likely to have stricturing disease (11 vs 21%, P=0.005; OR 0.45, 95% CI: 0.24– 0.85). Using a stringent definition of ethnicity (3 out of 4 grandparents being French-Canadian, as opposed to self-report, n= 148), French-Canadians had a tendency towards developing fistulizing CD (37% vs 28%, p= 0.07), and there was an increased prevalence of sacroiliitis among French-Canadians with IBD (4% vs 2%, p=0.045). Among French-Canadians, the numbers of current smokers in CD (40 vs 25%, p=0.006) and former smokers in UC (35% vs 20%, p=0.03) were significantly higher. The prevalence of one of the three main variant NOD2 SNPs among French-Canadian CD patients was 43.2%. The 3020insC SNP correlated with small bowel disease in French-Canadians (75% versus 0%, P=0.006). CONCLUSION French-Canadians exhibit an IBD phenotype profile distinct from other Caucasian IBD populations, with an accentuated association between smoking status and IBD. This unique profile may have implications regarding the need for a different approach to management of IBD in this population. PMID:19513023

  1. Phenotypic and genotypic characteristics of inflammatory bowel disease in French Canadians: comparison with a large North American repository.

    Science.gov (United States)

    Bhat, Mamatha; Nguyen, Geoffrey C; Pare, Pierre; Lahaie, Raymond; Deslandres, Colette; Bernard, Edmond-Jean; Aumais, Guy; Jobin, Gilles; Wild, Gary; Cohen, Albert; Langelier, Diane; Brant, Steven; Dassopoulos, Themistocles; McGovern, Dermot; Torres, Esther; Duerr, Richard; Regueiro, Miguel; Silverberg, Mark S; Steinhart, Hillary; Griffiths, Anne M; Elkadri, Abdul; Cho, Judy; Proctor, Deborah; Goyette, Philippe; Rioux, John; Bitton, Alain

    2009-09-01

    Phenotype characteristics of inflammatory bowel disease (IBD) may differ significantly among ethnic subpopulations. The aim of this study was to characterize the IBD phenotype in French Canadians, the most prominent founder population in North America. Using well-characterized phenotype data in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)-IBD Genetics Consortium repository on patients with IBD, we compared phenotypic characteristics of 202 French Canadians with those of 1,287 other Caucasian patients. These included diagnosis, anatomical location, disease behavior, extraintestinal manifestations, surgical history, and family history of IBD. French-Canadian patients with Crohn's disease (CD) were less likely to have stricturing disease (11 vs. 21%, P=0.005; odds ratio (OR): 0.45, 95% confidence interval (95% CI): 0.24-0.85). Using a stringent definition of ethnicity (three out of four grandparents being French Canadians, as opposed to self-report, n=148), French Canadians had a tendency toward developing fistulizing CD (37 vs. 28%, P=0.07), and there was an increased prevalence of sacroiliitis among those with IBD (4 vs. 2%, P=0.045). Among French Canadians, the numbers of current smokers in CD (40 vs. 25%, P=0.006) and former smokers in ulcerative colitis (UC) (35 vs. 20%, P=0.03) were significantly higher. The prevalence of one of the three main variants of nucleotide-binding oligomerization domain containing 2 (NOD2) single-nucleotide polymorphisms (SNPs) among French-Canadian CD patients was 43.2%. The 3020insC SNP correlated with small bowel disease in French Canadians (25 [corrected] vs. 0%, P=0.006). French Canadians show an IBD phenotype profile distinct from other Caucasian IBD populations, with an accentuated association between smoking status and IBD. This unique profile may have implications regarding the need for a different approach to the management of IBD in this population.

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

    Directory of Open Access Journals (Sweden)

    Drossman Douglas A

    2008-07-01

    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.

  3. RNA–Stable-Isotope Probing Shows Utilization of Carbon from Inulin by Specific Bacterial Populations in the Rat Large Bowel

    Science.gov (United States)

    Lawley, Blair; Munro, Karen; Sims, Ian M.; Lee, Julian; Butts, Christine A.; Roy, Nicole

    2014-01-01

    Knowledge of the trophisms that underpin bowel microbiota composition is required in order to understand its complex phylogeny and function. Stable-isotope (13C)-labeled inulin was added to the diet of rats on a single occasion in order to detect utilization of inulin-derived substrates by particular members of the cecal microbiota. Cecal digesta from Fibruline-inulin-fed rats was collected prior to (0 h) and at 6, 12, 18 and 24 h following provision of the [13C]inulin diet. RNA was extracted from these cecal specimens and fractionated in isopycnic buoyant density gradients in order to detect 13C-labeled nucleic acid originating in bacterial cells that had metabolized the labeled dietary constituent. RNA extracted from specimens collected after provision of the labeled diet was more dense than 0-h RNA. Sequencing of 16S rRNA genes amplified from cDNA obtained from these fractions showed that Bacteroides uniformis, Blautia glucerasea, Clostridium indolis, and Bifidobacterium animalis were the main users of the 13C-labeled substrate. Culture-based studies of strains of these bacterial species enabled trophisms associated with inulin and its hydrolysis products to be identified. B. uniformis utilized Fibruline-inulin for growth, whereas the other species used fructo-oligosaccharide and monosaccharides. Thus, RNA–stable-isotope probing (RNA-SIP) provided new information about the use of carbon from inulin in microbiota metabolism. PMID:24487527

  4. The financial impact of a nurse-led telemedicine service for inflammatory bowel disease in a large district general hospital.

    Science.gov (United States)

    Squires, Seth Ian; Boal, Allan John; Naismith, Graham Douglas

    2016-07-01

    It has become increasingly recognised that outpatient management is more cost-effective in inflammatory bowel disease (IBD). IBD Standards (Revised 2013) recommend telephone advice for patients with regard to symptoms and medication management. This report attempts to quantify the net financial impact of this service at our hospital since it was introduced in August 2013. The Royal Alexandra Hospital in Paisley (National Health Service, Greater Glasgow and Clyde) is a district general hospital with a catchment population of 200 000 with approximately 2500 patients with IBD. Data relating to the use of the IBD telemedicine service were prospectively recorded on a daily basis for a period of 5 months. We documented reasons for calling and the likely action taken by the patient had the telephone advice line not been available. Cost savings based on alternative outcomes were made in accordance with the Department of Health figures (Department of Health reference costs 2011-2012). The mean number of calls per month was 88 (IQR 24)-(the mean number of calls which were deemed non-IBD issues was 30 calls per month (IQR 8.0)) The mean cost of staffing the IBD advice line with an IBD clinical nurse specialist was £482.00 per month (IQR 195.5). The mean time spent on calls per month was 28.5 h (IQR 11.5). Cost savings over 5 months for avoidance of general practitioner (GP) consultation was £3408.00. Savings for avoidance of a consultant appointment made over the 5-month period was £27 454.00. Savings made from patients avoiding either an accident and emergency (A&E) or a hospital admission were £540.00 and £11 488.00, respectively, over the 5-month period. The net saving was £42 890.00. A nurse-led telephone advice line appears to be a cost-effective intervention. It may prevent patients from unnecessary hospital attendance. Savings can be made to both primary care and secondary care. Overall, it appears that the advice line is providing a highly valuable

  5. Laparoscopic treatment of complex small bowel obstruction: is it safe?

    Science.gov (United States)

    Pearl, Jonathan P; Marks, Jeffrey M; Hardacre, Jeffrey M; Ponsky, Jeffrey L; Delaney, Conor P; Rosen, Michael J

    2008-06-01

    Laparoscopic treatment of small bowel obstruction has many reported advantages, yet it is infrequently performed. Criticisms include reduced working space, difficult abdominal access, and bowel injury. The experience with laparoscopic treatment of small bowel obstruction to determine its safety has been reviewed. Nineteen patients underwent laparoscopic treatment of small bowel obstruction. A cut-down technique was used for abdominal access and avoided manipulation of dilated bowel. The average number of prior operations was 1.4. The average size of maximally dilated bowel was 3.5 cm, including 6 patients whose diameter was greater than 4 cm. Laparoscopic treatment was successful in 16 patients; 3 patients required laparotomy. There were no complications from abdominal access and no iatrogenic bowel injuries. This series demonstrated that abdominal access and relief of bowel obstruction can be safely performed laparoscopically in patients with complex small bowel obstruction. Neither massively dilated bowel nor multiple previous abdominal operations precluded safe conduct of the operation laparoscopically.

  6. Ageing with neurogenic bowel dysfunction

    DEFF Research Database (Denmark)

    Nielsen, S D; Faaborg, Pia Møller; Finnerup, Nanna Brix

    2017-01-01

    at 18% in 1996 and 19% in 2015. During the 19-year period, there had been no significant change in the methods for bowel care, but 22 (20%) had undergone surgery for bowel dysfunction, including 11 (10%) who had some form of stoma. Conclusion: Self-assessed severity of constipation increased but quality...... of life remained stable in a cohort of people with SCI followed prospectively for 19 years. Methods for bowel care remained surprisingly stable but a large proportion had undergone stoma surgery....

  7. Linfoma Difuso de Grandes Células  de Intestino Delgado: Relato de Caso Diffuse Large -Cell Lymphoma of Small Bowel: Case Report

    Directory of Open Access Journals (Sweden)

    Gustavo Nunes Medina Coeli

    2012-06-01

    are subtype B cell. Case Report: It´s presented a case of rare small bowel lymphoma in a female patient of 77 years who sought medical care with nonspecific symptoms and an anemic framework. Radiological examinations were essential for diagnosis for diagnostic enlightenment and propaedeutics. Tumor markers were negative and the inflamatorious tests activities were positives. In hospitalization, the patient had an abrupt worsening in her clinic picture, needing a surgery. During the operation was identified in the proximal jejunum a perfurative damage with an ulcerated aspect with ulcers, adhesions in the bladder and in fundus of the uterus. The patient did not evaluated well and died after three days. The pathology confirmed a diffuse No Hodgkin lymphoma of Large B-cells with a high rate of cell proliferation. Discussion: The preoperative radiological diagnosis of tumor of the small intestine is only obtained in a small percentage of symptomatic patients. Imaging studies show infiltrative, polypoid, or aneurysmatic morphologicals types .Usually occurs circumferential involvement of the handle, with irregular thickening of the folds of variable length. Conclusion: The intent of this study is to document a rare tumor of the small bowel Non-Hodgkin Lymphoma Diffuse Large B-Cell type, multicentric, that was difficult to diagnose and with a rapid evolution of symptoms, which resulted in acute intestinal obstruction, requiring emergency surgery.

  8. Bowel perforation from occult ileal involvement after diagnosis in a case of primary mediastinal large B-cell lymphoma.

    Science.gov (United States)

    De Philippis, Chiara; Di Chio, Maria Chiara; Sabattini, Elena; Bolli, Niccolo

    2016-07-14

    Primary mediastinal large B-cell lymphoma (PMBCL) is confined to the mediastinum or contiguous nodal areas in most cases. Extramediastinal and abdominal involvement, especially at diagnosis, is extremely rare. Our case describes the first case of histologically proven ileal involvement of PMBCL at diagnosis that led to ileal perforation. Positron emission tomography CT could increase the sensitivity of staging by detecting unusual sites of disease localisation, and could impact clinical management. 2016 BMJ Publishing Group Ltd.

  9. Examination of Physicians’ Perception of the Indications of Colorectal Stents in the Management of Malignant Large Bowel Obstruction: A Provincial Survey

    Directory of Open Access Journals (Sweden)

    Jean-Frédéric LeBlanc

    2016-01-01

    Full Text Available Introduction. Data are conflicting when assessing indications for colorectal self-expandable metallic stents (SEMS in managing acute malignant large bowel obstruction (MLO. In November 2014, European and American Societies published guidelines to aid in understanding which patients might benefit from colorectal stenting. Yet, there remain marked disparities in clinical practice. Methods. A web-based survey was sent to Gastroenterologists and Surgical Specialists across Quebec to assess physicians’ knowledge and adherence to the indications for colonic SEMS placement in the management of MLO using eight clinical scenarios. Results. Out of 112 respondents, 74% preferred surgical intervention in young, healthy individuals with MLO. Advanced age and comorbidities motivated 56.3% (95% CI 47.1–65.5% of participants to opt for SEMS placement. In palliative settings of patients undergoing chemotherapy including bevacizumab, a minority of respondents followed guidelines, 12.5% (95% CI 6.4–18.6% for young patients and 25.0% for elderly patients (95% CI 17.0–33.0%. The pooled overall adherence to guidelines was 50.4% (95% CI 40.7–59.3%. Conclusion. This survey suggests that guidelines recommendations are not being implemented by at least half of specialists involved in the care of patients with MLO. Future studies should attempt to identify possible barriers responsible for this impaired knowledge translation and tailored educational initiatives planned accordingly.

  10. Three-dimensional visualisation of the large bowel: a potential tool for assessing targeted drug delivery and colonic pathology

    International Nuclear Information System (INIS)

    Perkins, A.C.; Mann, C.; Wilson, C.G.

    1995-01-01

    A study has been undertaken to assess the feasibility of three-dimensional imaging of the dispersion of a non-absorbable tracer released into the colon of normal subjects. Six healthy volunteers were selected who were participating in a scintigraphic study designed to assess the spreading of 1 MBq indium-111 Amberlite resin delivered from a delayed capsule system targeted to release in the ascending colon. In each case subjects were imaged using a rotating gamma camera over a data collection period of approximately 20 min. Three-dimensional volume rendered images demonstrated good visualisation of the dispersion of the tracer throughout the ascending, transverse and descending colon and provided good anatomical visualisation of the shape of the colon, not previously apparent from the planar views. The present study demonstrates for the first time, the successful three-dimensional imaging of a radiolabelled tracer dispersed throughout the colon and opens up the prospects for more detailed study of quantification of the volume and distribution of tracers contained within the colon. (orig.). With 1 fig

  11. Enteroendocrine, Musashi 1 and neurogenin 3 cells in the large intestine of Thai and Norwegian patients with irritable bowel syndrome.

    Science.gov (United States)

    El-Salhy, Magdy; Patcharatrakul, Tanisa; Hatlebakk, Jan Gunnar; Hausken, Trygve; Gilja, Odd Helge; Gonlachanvit, Sutep

    2017-12-01

    The prevalence, gender distribution and clinical presentation of IBS differ between Asian and Western countries. This study aimed at studying and comparing enteroendocrine, Musashi 1 (Msi 1) and neurogenin 3 (neurog 3) cells in Thai and Norwegian IBS patients. Thirty Thai and 61 Norwegian IBS patients as well as 20 Thai and 24 Norwegian controls were included. Biopsy samples were taken from each of the sigmoid colon and the rectum during a standard colonoscopy. The samples were immunostained for serotonin, peptide YY, oxyntomodulin, pancreatic polypeptide, somatostatin, Msi 1 and neurog 3. The densities of immunoreactive cells were determined with computerized image analysis. The densities of several enteroendocrine cell types were altered in both the colon and rectum of both Thai and Norwegian IBS patients. Some of these changes were similar in Thai and Norwegian IBS patients, while others differed. The findings of abnormal densities of the enteroendocrine cells in Thai patients support the notion that enteroendocrine cells are involved in the pathophysiology of IBS. The present observations highlight that IBS differs in Asian and Western countries, and show that the changes in large-intestine enteroendocrine cells in Thai and Norwegian IBS patients might be caused by different mechanisms.

  12. Solid Organ Transplantation in Patients with Inflammatory Bowel Diseases (IBD: Analysis of Transplantation Outcome and IBD Activity in a Large Single Center Cohort.

    Directory of Open Access Journals (Sweden)

    Fabian Schnitzler

    Full Text Available Currently, limited data of the outcome of inflammatory bowel disease (IBD in patients after solid organ transplantation (SOT are available. We aimed to analyze effects of SOT on the IBD course in a large IBD patient cohort.Clinical data from 1537 IBD patients were analyzed for patients who underwent SOT (n = 31 between July 2002 and May 2014. Sub-analyses included SOT outcome parameters, IBD activity before and after SOT, and efficacy of IBD treatment.4.74% of patients with ulcerative colitis (UC and 0.84% of patients with Crohn's disease (CD underwent SOT (p = 2.69 x 10(-6, UC vs. CD. 77.4% of patients with SOT underwent liver transplantation (LTx with tacrolimus-based immunosuppressive therapy after SOT. All LTx were due to primary sclerosing cholangitis (PSC or PSC overlap syndromes. Six patients (19.4% required renal transplantation and one patient (3.2% heart transplantation. A survival rate of 83.9% after a median follow-up period of 103 months was observed. Before SOT, 65.0% of patients were in clinical remission and 5 patients received immunosuppressive therapy (16.1%. After SOT, 61.0% of patients were in remission (p = 1.00 vs. before SOT and 29.0% required IBD-specific immunosuppressive or anti-TNF therapy (p = 0.54 vs. before SOT. 42.9% of patients with worsening of IBD after SOT were at higher risk of needing steroid therapy for increased IBD activity (p = 0.03; relative risk (RR: 10.29; 95% CI 1.26-84.06. Four patients (13.0% needed anti-TNF therapy after SOT (response rate 75%.SOT was more common in UC patients due to the higher prevalence of PSC-related liver cirrhosis in UC. Despite mainly tacrolimus-based immunosuppressive regimens, outcome of SOT and IBD was excellent in this cohort. In this SOT cohort, concomitant immunosuppressive therapy due to IBD was well tolerated.

  13. Daily bowel care program

    Science.gov (United States)

    ... gov/ency/patientinstructions/000133.htm Daily bowel care program To use the sharing features on this page, ... Work with your health care provider. Basic Bowel Program Keeping active helps prevent constipation. Try to walk, ...

  14. Small Bowel Bleeding

    Science.gov (United States)

    ... Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity Digestive Health Topics Abdominal Pain Syndrome Belching, Bloating, and Flatulence Common GI Symptoms Gastroparesis See All Topics (A-Z) GI Procedures ...

  15. Hemorragia maciça do intestino grosso: o que está ao nosso alcance? Massive large bowel bleeding: what is within our reach?

    Directory of Open Access Journals (Sweden)

    Júlio César M Santos Jr.

    2010-06-01

    demonstrate with simplicity how to treat the patients with acute lower intestinal hemorrhage. Diseases of the large bowel account for the ¼ of the cases of digestive hemorrhages on the hospital admission and have as main etiological agents the diverticula, in the diverticular disease, and small vascular malformation, in the angiodysplasias. Sometime, it can be seen as a life-threatening condition, however, most of the times, the hemorrhage stops spontaneously. The serious circulatory disturbances are not common; the most frequent signs are the decrease in hemoglobin occurring on about one half of patients and some form of circulatory disturbance as orthostatic changes in 30%; as syncope in 10% and as cardiovascular collapse in 9%. However, the age group, the conditions of the senility, the eventually associated diseases and the lack of material and human resources to handle with that kind of problem are the reasons for concern. The simple clinical approach with a well elaborated history; the physical examination released with attention and objectivity, the inclusion of the proctologic exam, the obligatory readiness for an endoscope for colonoscopy, the basic knowledge on the event are necessary and, in most of the times, enough for the good professional acting in the elaboration of the cares that it should be given to those patient ones.

  16. MRI for chronic inflammatory bowel disease

    International Nuclear Information System (INIS)

    Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M.; Elsing, C.

    2001-01-01

    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 1 -weighted gradient echo and T 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.) [de

  17. Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age.

    Science.gov (United States)

    Vessey, M; Jewell, D; Smith, A; Yeates, D; McPherson, K

    1986-04-26

    Since the start in 1968 of the Oxford Family Planning Association contraceptive study 31 women have developed ulcerative colitis and 18 have developed Crohn's disease, giving incidences of 0.15 and 0.09/1000 woman years respectively. The incidence of ulcerative colitis in women who were non-smokers on entry to the study was 0.17/1000 woman years and the incidence in smokers was 0.11/1000 woman years. The findings for Crohn's disease were entirely different, the corresponding incidences being 0.05 and 0.17/1000 woman years respectively. Both ulcerative colitis and Crohn's disease were more common among women currently using oral contraceptives than among those not doing so. Incidences per 1000 woman years for ulcerative colitis were 0.26 in users and 0.11 in non-users; for Crohn's disease the incidences were 0.13 and 0.07 respectively. Though the association between the use of oral contraceptives and chronic inflammatory bowel disease cannot be regarded as established, the effects of smoking have been shown consistently in many studies. This observation provides an important clue to the aetiology of chronic inflammatory bowel disease.

  18. Use of preoperative bowel preparation in elective colorectal surgery in Denmark remains high

    DEFF Research Database (Denmark)

    Andersen, Julie; Thorup, Jens; Wille-Jørgensen, Peer

    2011-01-01

    Previous studies have shown that preoperative bowel preparation does not influence the frequency of postoperative complications after elective open colonic resections. The Danish Colorectal Cancer Group (DCCG) recommends that mechanical bowel preparation (MBP) should be omitted prior to elective...

  19. Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

    International Nuclear Information System (INIS)

    Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F.

    2004-01-01

    About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

  20. Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

    2004-12-01

    About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

  1. Evolutionary relationships of the Critically Endangered frog Ericabatrachus baleensis Largen, 1991 with notes on incorporating previously unsampled taxa into large-scale phylogenetic analyses

    Science.gov (United States)

    2014-01-01

    Background The phylogenetic relationships of many taxa remain poorly known because of a lack of appropriate data and/or analyses. Despite substantial recent advances, amphibian phylogeny remains poorly resolved in many instances. The phylogenetic relationships of the Ethiopian endemic monotypic genus Ericabatrachus has been addressed thus far only with phenotypic data and remains contentious. Results We obtained fresh samples of the now rare and Critically Endangered Ericabatrachus baleensis and generated DNA sequences for two mitochondrial and four nuclear genes. Analyses of these new data using de novo and constrained-tree phylogenetic reconstructions strongly support a close relationship between Ericabatrachus and Petropedetes, and allow us to reject previously proposed alternative hypotheses of a close relationship with cacosternines or Phrynobatrachus. Conclusions We discuss the implications of our results for the taxonomy, biogeography and conservation of E. baleensis, and suggest a two-tiered approach to the inclusion and analyses of new data in order to assess the phylogenetic relationships of previously unsampled taxa. Such approaches will be important in the future given the increasing availability of relevant mega-alignments and potential framework phylogenies. PMID:24612655

  2. Short bowel syndrome

    International Nuclear Information System (INIS)

    Engels, L.G.J.B.

    1983-01-01

    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.)

  3. A dedicated inflammatory bowel disease service quantitatively and qualitatively improves outcomes in less than 18 months: a prospective cohort study in a large metropolitan centre.

    Science.gov (United States)

    Phan, Vinh-An Huu; van Langenberg, Daniel R; Grafton, Rachel; Andrews, Jane M

    2012-07-01

    Maintaining high efficacy and quality of care in inflammatory bowel disease (IBD) management is a priority. The authors examined whether the introduction of a formal IBD Service (IBDS) positively influenced outcomes for their patients. In 2007-2008, all IBD patients attending the Royal Adelaide Hospital were surveyed regarding clinical/demographic data, IBD knowledge, quality of life, mental health and satisfaction. Survey responders were re-surveyed ≥15 months later. 162 responded to survey 1 and 81 again responded to survey 2. Within the responders, 61% had Crohn's disease and 48% were men. Compared with survey 1, the proportions of patients with improved knowledge, adherence, satisfaction with care, QoL (≥5 points), anxiety and depression scores were 63% (95% CI 51 to 73), 62% (95% CI 50 to 72), 65% (95% CI 54 to 76), 42% (95% CI 31 to 54), 52% (95% CI 40 to 63) and 43% (95% CI 32 to 55), respectively. When comparing survey 2 with survey 1, reductions in hospitalisation (48% vs 30%, p=0.02), courses of corticosteroids and opiates (mean 1.63 vs 0.91 and 1.00 vs 0.61, both pimproved patient outcomes with significant reductions in negative markers for IBD morbidity including: hospitalisations, polypharmacy, steroid and opiate use. Despite increased costs in additional staff, these measures are likely to be cost effective.

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

    Science.gov (United States)

    Kerckhoffs, Angèle P M; ter Linde, José J M; Akkermans, Louis M A; Samsom, Melvin

    2012-05-01

    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.

  5. Expression Profile of p53 and p21 in Large Bowel Mucosa as Biomarkers of Inflammatory-Related Carcinogenesis in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Cristiana Popp

    2016-01-01

    Full Text Available Ulcerative colitis (UC is a chronic, relapsing inflammatory bowel disease that slightly increases the risk of colorectal cancer in patients with long-standing extended disease. Overexpression of p53 and p21 in colonic epithelia is usually detected in UC patients when no dysplasia is histologically seen and it is used by pathologists as a discriminator between regenerative changes and intraepithelial neoplasia, as well as a tissue biomarker useful to predict the risk of evolution toward malignancy. We present a one-year prospective observational study including a cohort of 45 patients with UC; p53 and p21 were evaluated in epithelial cells. p53 was positive in 74 samples revealed in 5% to 90% of epithelial cells, while 63 biopsies had strong positivity for p21 in 5% to 50% of epithelial cells. Architectural distortion was significantly correlated with p53 overexpression in epithelial cells. Thus, we consider that architectural distortion is a good substitute for p53 and p21 expression. We recommend use of p53 as the most valuable tissue biomarker in surveillance of UC patients, identifying the patients with higher risk for dysplasia. Association of p21 is also recommended for a better quantification of risk and for diminishing the false-negative results.

  6. Small bowel angiodysplasia and novel disease associations: a cohort study.

    LENUS (Irish Health Repository)

    Holleran, Grainne

    2013-04-01

    Gastrointestinal angiodysplasias recurrently bleed, accounting for 3-5% of obscure gastrointestinal bleeding. The advent of small bowel capsule endoscopy (SBCE) has led to an increased recognition of small bowel angiodysplasias (SBAs) but little is known about their etiology. Previous small cohorts and case reports suggest an equal gender incidence and associations with cardiovascular disease, renal impairment, and coagulopathies.

  7. Retro-ureteral Small Bowel Herniation After Radical Cystectomy

    Directory of Open Access Journals (Sweden)

    Abbey L. Cole-Clark

    2017-11-01

    Full Text Available Small bowel obstruction caused by internal herniation under ureteric bands is a rare occurrence. Only 6 previous cases have been documented. This case report reviews the case of a 79-year-old male who presented to emergency with abdominal pain requiring subsequent laparotomy and release of internal herniation of bowel under ureter.

  8. Bowel Diseases and Kidneys

    Directory of Open Access Journals (Sweden)

    A.E. Dorofeiev

    2015-09-01

    Full Text Available This review of contemporary publications analyzes the prevalence of combinations of bowel and renal diseases. Special attention is paid to the problem of correlation between bowel diseases and urolithiasis. We consider the possible pathogenic mechanisms of lesions, such as genetically determined violations of intestinal absorption and secretion, changes in the intestinal microbiota, systemic inflammatory response, water and electrolyte disturbances.

  9. Irritable Bowel Syndrome

    Science.gov (United States)

    ... your belly area), constipation (when you can't poop), and diarrhea (when you poop too much). If you have irritable bowel syndrome, ... food particles are also known as stool, a bowel movement, or poop. Here's why an intestine gets "irritable." ...

  10. Patient Understanding of the Risks and Benefits of Biologic Therapies in Inflammatory Bowel Disease: Insights from a Large-scale Analysis of Social Media Platforms.

    Science.gov (United States)

    Martinez, Bibiana; Dailey, Francis; Almario, Christopher V; Keller, Michelle S; Desai, Mansee; Dupuy, Taylor; Mosadeghi, Sasan; Whitman, Cynthia; Lasch, Karen; Ursos, Lyann; Spiegel, Brennan M R

    2017-07-01

    Few studies have examined inflammatory bowel disease (IBD) patients' knowledge and understanding of biologic therapies outside traditional surveys. Here, we used social media data to examine IBD patients' understanding of the risks and benefits associated with biologic therapies and how this affects decision-making. We collected posts from Twitter and e-forum discussions from >3000 social media sites posted between June 27, 2012 and June 27, 2015. Guided by natural language processing, we identified posts with specific IBD keywords that discussed the risks and/or benefits of biologics. We then manually coded the resulting posts and performed qualitative analysis using ATLAS.ti software. A hierarchical coding structure was developed based on the keyword list and relevant themes were identified through manual coding. We examined 1598 IBD-related posts, of which 452 (28.3%) centered on the risks and/or benefits of biologics. There were 5 main themes: negative experiences and concerns with biologics (n = 247; 54.6%), decision-making surrounding biologic use (n = 169; 37.4%), positive experiences with biologics (n = 168; 37.2%), information seeking from peers (n = 125; 27.7%), and cost (n = 38; 8.4%). Posts describing negative experiences primarily commented on side effects from biologics, concerns about potential side effects and increased cancer risk, and pregnancy safety concerns. Posts on decision-making focused on nonbiologic treatment options, hesitation to initiate biologics, and concerns about changing or discontinuing regimens. Social media reveals a wide range of themes governing patients' experience and choice with IBD biologics. The complexity of navigating their risk-benefit profiles suggests merit in creating online tailored decision tools to support IBD patients' decision-making with biologic therapies.

  11. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy.

    Science.gov (United States)

    Fanning, J; Yu-Brekke, S

    1999-06-01

    Postoperative traditional feeding protocols are not based on scientific studies, but rather on anecdotal evidence. We present the first prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy in an attempt to determine its effect on the length of hospital stay. Twenty consecutive patients undergoing radical hysterectomy were entered onto a prospective trial of aggressive postoperative bowel stimulation, which consisted of 30 cc milk of magnesia p.o. b.i.d. starting on postoperative day 1 and biscolic suppositories q.d. starting on day 2. A clear liquid diet was begun following flatus or bowel movement and patients were discharged 12 h after tolerating a clear liquid diet. Diet was slowly advanced at home. Median time to flatus was 3 days, bowel movement 3 days, and clear liquid diet 3 days. Median time to discharge was 4 days. No patients developed ileus or bowel obstructions and there were no readmissions for bowel complications. Our median time to discharge of 4 days represents a 50% reduction in hospital stay compared to our previous prospective study using traditional postoperative bowel management (8 days), which was statistically significant at P = 0.001. Aggressive bowel stimulation with milk of magnesia and biscolic suppositories resulted in early return of bowel function and early discharge with no noticeable complications. Copyright 1999 Academic Press.

  12. Role of wireless capsule endoscopy in the follow-up of inflammatory bowel disease.

    Science.gov (United States)

    Mitselos, Ioannis V; Christodoulou, Dimitrios K; Katsanos, Konstantinos H; Tsianos, Epameinondas V

    2015-06-10

    The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction of colon capsule endoscopy, a promising alternative method has been available for the evaluation of large bowel mucosa. The advantages of wireless capsule endoscopy include its non-invasive character and its ability to visualize proximal and distal parts of the intestine, while important disadvantages include the procedure's inability of tissue sampling and significant incompletion rate. Its greatest limitation is the prohibited use in cases of known or suspected stenosis of the intestinal lumen due to high risk of retention. Wireless capsule endoscopy plays an important role in the early recognition of recurrence, on Crohn's disease patients who have undergone ileocolonic resection for the treatment of Crohn's disease complications, and in patients' management and therapeutic strategy planning, before obvious clinical and laboratory relapse. Although capsule endoscopy cannot replace traditional endoscopy, it offers valuable information on the evaluation of intestinal disease and has a significant impact on disease reclassification of patients with a previous diagnosis of ulcerative colitis or inflammatory bowel disease unclassified/indeterminate colitis. Moreover, it may serve as an effective alternative where colonoscopy is contraindicated and in cases with incomplete colonoscopy studies. The use of patency capsule maximizes safety and is advocated in cases of suspected small or large bowel stenosis.

  13. Biologic targeting in the treatment of inflammatory bowel diseases [Retraction

    Directory of Open Access Journals (Sweden)

    Bosani M

    2014-01-01

    Full Text Available Bosani M, Ardizzone S, Porro GB. Biologics: Targets and Therapy. 2009;3:77–97.This paper has been retracted after we were made aware that it contains a large amount of reused, and uncited material that was not placed within quotation marks.The following statement has been supplied by Dr Sandro Ardizzone:The review entitled "Biologic targeting in the treatment of inflammatory bowel disease" has been commissioned by this journal and published in 2009 (Matteo Bosani, Sandro Ardizzone, Gabriele Bianchi Porro. Biologics: Targets & Therapy 2009;3:77–97. The paper was written by our young coworker (Dr M Bosani. He has consulted many papers, including our previous reviews published years before. The not perfect knowledge of English language has greatly influenced the writing of the paper itself. So he saved in word file several parts of our previous papers (Ardizzone S, Bianchi Porro G. Inflammatory bowel disease: new insights into pathogenesis and treatment. J Intern Med 2002;252:475–496 – Ardizzone S, Bianchi Porro G. Biologic therapy for inflammatory bowel disease. Drugs 2005:2253–2286, and then transferred to the final paper. He was unaware as we are, of the fact that he could not reuse previously published material in other journals. The reuse of this material was made in good faith.Taking our responsibility for what happened, we intend to apologize for this inconvenience to the Editor (Dr Doris Benbrook and Publisher (Dr Tim Hill. Moreover, for the reasons mentioned above, I consider appropriate to retract the paper itself.This retraction relates to this paper.

  14. Irritable Bowel Syndrome

    Science.gov (United States)

    ... quality of life. Research indicates that people with IBS miss three times as many days from work as do those without bowel symptoms. Mood disorders. Experiencing the signs and symptoms of IBS can ...

  15. Accidental Bowel Leakage

    Science.gov (United States)

    ... nerve stimulation, injections, and surgery. What types of lifestyle changes can help treat accidental bowel leakage? Having ... Journal Clinical Updates Practice Management Coding Health Info Technology Professional Liability Managing Your Practice Patient Safety & Quality ...

  16. Small bowel bacterial overgrowth

    Science.gov (United States)

    ... Surgical procedures that create a loop of small intestine where excess bacteria can grow. An example is a Billroth II type of stomach removal ( gastrectomy ). Some cases of irritable bowel syndrome (IBS).

  17. The Dose-Volume Relationship of Small Bowel Irradiation and Acute Grade 3 Diarrhea During Chemoradiotherapy for Rectal Cancer

    International Nuclear Information System (INIS)

    Robertson, John M.; Lockman, David; Yan Di; Wallace, Michelle

    2008-01-01

    Purpose: Previous work has found a highly significant relationship between the irradiated small-bowel volume and development of Grade 3 small-bowel toxicity in patients with rectal cancer. This study tested the previously defined parameters in a much larger group of patients. Methods and Materials: A total of 96 consecutive patients receiving pelvic radiation therapy for rectal cancer had treatment planning computed tomographic scans with small-bowel contrast that allowed the small bowel to be outlined with calculation of a small-bowel dose-volume histogram for the initial intended pelvic treatment to 45 Gy. Patients with at least one parameter above the previously determined dose-volume parameters were considered high risk, whereas those with all parameters below these levels were low risk. The grade of diarrhea and presence of liquid stool was determined prospectively. Results: There was a highly significant association with small-bowel dose-volume and Grade 3 diarrhea (p ≤ 0.008). The high-risk and low-risk parameters were predictive with Grade 3 diarrhea in 16 of 51 high-risk patients and in 4 of 45 low-risk patients (p = 0.01). Patients who had undergone irradiation preoperatively had a lower incidence of Grade 3 diarrhea than those treated postoperatively (18% vs. 28%; p = 0.31); however, the predictive ability of the high-risk/low-risk parameters was better for preoperatively (p = 0.03) than for postoperatively treated patients (p = 0.15). Revised risk parameters were derived that improved the overall predictive ability (p = 0.004). Conclusions: The highly significant dose-volume relationship and validity of the high-risk and low-risk parameters were confirmed in a large group of patients. The risk parameters provided better modeling for the preoperative patients than for the postoperative patients

  18. Bowel vaginoplasty in children

    Directory of Open Access Journals (Sweden)

    Sarin Yogesh

    2006-01-01

    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.

  19. Inflammatory Bowel Disease (For Children)

    Science.gov (United States)

    ... For Kids / Inflammatory Bowel Disease Print en español Enfermedad inflamatoria del intestino What Is Inflammatory Bowel Disease? ... of IBD? There are two kinds of IBD: Crohn's disease and ulcerative colitis (say: UL-sur-uh- ...

  20. Diagnosis of Irritable Bowel Syndrome

    Science.gov (United States)

    ... of digestive diseases, such as celiac disease , colon cancer , or inflammatory bowel disease medicines you take recent infections stressful events ... of digestive diseases, such as celiac disease, colon cancer, or inflammatory bowel disease whether you have symptoms that could be ...

  1. Unusual causes of mechanical small bowel obstruction

    International Nuclear Information System (INIS)

    Shatnawi, Nawaf J.; Bani-Hani, Kamal E.

    2005-01-01

    We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients (5 resections were due to bowel strangulation). Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause. (author)

  2. Bowel Endometriosis Syndrome

    DEFF Research Database (Denmark)

    Riiskjær, M; Egekvist, A G; Hartwell, D

    2017-01-01

    STUDY QUESTION: Is it possible to develop a validated score that can identify women with Bowel Endometriosis Syndrome (BENS) and be used to monitor the effect of medical and surgical treatment? SUMMARY ANSWER: The BENS score can be used to identify women with BENS and to monitor the effect...... of medical and surgical treatment of women suffering from bowel endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is a heterogeneous disease with extensive variation in anatomical and clinical presentation, and symptoms do not always correspond to the disease burden. Current endometriosis scoring systems...... are mainly based on anatomical and surgical findings. STUDY DESIGN, SIZE, DURATION: The score was developed and validated from a cohort of 525 women with medically or surgically treated bowel endometriosis from Aarhus and Copenhagen University Hospitals, Denmark. PARTICIPANTS/MATERIALS, SETTING AND METHODS...

  3. Does bowel preparation for inflammatory bowel disease surgery matter?

    Science.gov (United States)

    Shwaartz, C; Fields, A C; Sobrero, M; Divino, C M

    2017-09-01

    The purpose of this study was to determine if bowel preparation influences outcomes in patients with inflammatory bowel disease undergoing surgery. The database of the American College of Surgeons National Surgical Quality Improvement Program, Procedure Targeted Colectomy, from 2012 to 2014 was analyzed. Inflammatory bowel disease patients undergoing colorectal resection with or without bowel preparation were included in the study. In all, 3679 patients with inflammatory bowel disease were identified. 42.5% had no bowel preparation, 21.5% had mechanical bowel preparation only, 8.8% had oral antibiotic bowel preparation only and 27.2% had combined mechanical and oral antibiotic preparation. Combined mechanical and oral antibiotic preparation is associated with lower rates of anastomotic leak, ileus, surgical site infection, organ space infection, wound dehiscence and sepsis/septic shock. Combined mechanical and oral antibiotic preparation for inflammatory bowel disease patients undergoing colectomy is associated with decreased rates of surgical site infection, anastomotic leak, ileus. Combined bowel preparation should be the standard of care for inflammatory bowel disease patients undergoing colorectal resection. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  4. Inflammatory Bowel Disease.

    Science.gov (United States)

    Wehkamp, Jan; Götz, Martin; Herrlinger, Klaus; Steurer, Wolfgang; Stange, Eduard F

    2016-02-05

    Inflammatory bowel diseases are common in Europe, with prevalences as high as 1 in 198 persons (ulcerative colitis) and 1 in 310 persons (Crohn's disease). This review is based on pertinent articles retrieved by a search in PubMed and in German and European guidelines and Cochrane reviews of controlled trials. Typically, the main clinical features of inflammatory bowel diseases are diarrhea, abdominal pain, and, in the case of ulcerative colitis, peranal bleeding. These diseases are due to a complex immunological disturbance with both genetic and environmental causes. A defective mucosal barrier against commensal bowel flora plays a major role in their pathogenesis. The diagnosis is based on laboratory testing, ultrasonography, imaging studies, and, above all, gastrointestinal endoscopy. Most patients with Crohn's disease respond to budesonide or systemic steroids; aminosalicylates are less effective. Refractory exacerbations may be treated with antibodies against tumor necrosis factor (TNF) or, more recently, antibodies against integrin, a protein of the cell membrane. In ulcerative colitis, aminosalicylates are given first; if necessary, steroids or antibodies against TNF-α or integrin are added. Maintenance therapy to prevent further relapses often involves immunosuppression with thiopurines and/or antibodies. Once all conservative treatment options have been exhausted, surgery may be necessary. The treatment of chronic inflammatory bowel diseases requires individually designed therapeutic strategies and the close interdisciplinary collaboration of internists and surgeons.

  5. Small bowel resection

    Science.gov (United States)

    ... Ileostomy and your diet Ileostomy - caring for your stoma Ileostomy - changing your pouch Ileostomy - discharge Ileostomy - what to ask your doctor Low-fiber diet Preventing falls Small bowel resection - discharge Surgical wound care - open Types of ileostomy Ulcerative colitis - discharge When ...

  6. Inflammatory bowel disease epidemiology

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2013-01-01

    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 t...... in the epidemiology of IBD....

  7. PREVIOUS SECOND TRIMESTER ABORTION

    African Journals Online (AJOL)

    PNLC

    PREVIOUS SECOND TRIMESTER ABORTION: A risk factor for third trimester uterine rupture in three ... for accurate diagnosis of uterine rupture. KEY WORDS: Induced second trimester abortion - Previous uterine surgery - Uterine rupture. ..... scarred uterus during second trimester misoprostol- induced labour for a missed ...

  8. Surgical treatment of bowel occlusion as late radiation effect

    International Nuclear Information System (INIS)

    Moeschl, P.; Miholic, J.; Wolner, E.

    1989-01-01

    67 patients were operated for intestinal complications following radiotherapy. The lesions were located in the small bowel (n = 41) and in the sigmoid colon/rectum (n = 33). 98.5% of the patients were females, the most frequent cause for irradiation being ovarian cancer. Bowel stenosis with resultant chronic or acute ileus was the most frequent indication for operation. Percutaneous irradiation resulted in a significantly higher proportion of small bowel lesions (77%, p = 0.001), whilst endocavitary irradiation was followed in 67% of cases by colorectal lesions. Different application modality of irradiation also resulted in completely different symptoms for small and large bowel lesions. The operative mortality was 9.5%. Peritonitis following anastomotic leakage was the cause of death in 6 of 7 cases. In the treatment of small bowel ileus mortality following bowel resection (9%, one of 11 cases) was comparable to that of the bypass operation (6%, one of 18 cases). Both operation methods seem to be justified. Single-layer anastomosis resulted in zero mortality (21 cases) for ileus operation compared with 19% mortality (16 cases) in double-layer anastomosis and should be prefered for operations on the irradiated bowel. (author)

  9. Bowel disease after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-06-01

    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.

  10. Short bowel syndrome.

    LENUS (Irish Health Repository)

    Donohoe, Claire L

    2012-02-01

    The short bowel syndrome (SBS) is a state of malabsorption following intestinal resection where there is less than 200 cm of intestinal length. The management of short bowel syndrome can be challenging and is best managed by a specialised multidisciplinary team. A good understanding of the pathophysiological consequences of resection of different portions of the small intestine is necessary to anticipate and prevent, where possible, consequences of SBS. Nutrient absorption and fluid and electrolyte management in the initial stages are critical to stabilisation of the patient and to facilitate the process of adaptation. Pharmacological adjuncts to promote adaptation are in the early stages of development. Primary restoration of bowel continuity, if possible, is the principle mode of surgical treatment. Surgical procedures to increase the surface area of the small intestine or improve its function may be of benefit in experienced hands, particularly in the paediatric population. Intestinal transplant is indicated at present for patients who have failed to tolerate long-term parenteral nutrition but with increasing experience, there may be a potentially expanded role for its use in the future.

  11. Bowel disease after radiotherapy

    International Nuclear Information System (INIS)

    Schofield, P.F.; Holden, D; Carr, N.D.

    1983-01-01

    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)

  12. Physiologic effects of bowel preparation

    DEFF Research Database (Denmark)

    Holte, Kathrine; Nielsen, Kristine Grubbe; Madsen, Jan Lysgård

    2004-01-01

    healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance...... preparation has significant adverse physiologic effects, which may be attributed to dehydration. The majority of these findings is small and may not be of clinical relevance in otherwise healthy patients undergoing bowel preparation and following recommendations for oral fluid intake....

  13. Early bowel complications following radiotherapy of uterine cervix carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Won Dong [College of Medicine, Chungbuk National Univ., Cheongju (Korea, Republic of)

    1999-06-01

    This study evaluated early bowel complications in cervix cancer patients, following external radiotherapy (ERT) and high dose rate intracavitary radiation (HDR ICR). Factors affecting the risk of developing early bowel complications and its incidence are analyzed and discussed. The study is the retrospective review of 66 patients who received radiotherapy at Chungbuk National University Hospital from April 1994 to December 1998. The patients underwent 41.4 or 50.4 Gy ERT according to FIGO stage and tumor size, then A point dose was boosted to 71.4 or 74.4 Gy using a remotely controlled after loading Buchler HDR ICR. The EORTC/RTOG morbidity criteria were used to grade early bowel complications, which are valid from day 1, the commencement of therapy, through day 90. The actuarial incidence, severity of complications were investigated and clinical pretreatment factors relevant to complications were found through univariate (Wilcoxon) and multivariate (Cox proportional hazard model) analysis. Of the 66 patients, 30 patients (46%) developed early bowel complications; 25 patients (38%) with grade 1 or 2, 4 patients (6%) with grade 3 and 1 patient (2%) with grade 4. The complications usually began to occur 3 weeks after the commencement of radiotherapy. The actuarial incidence of early bowel complications was 41% at 10 weeks. The early bowel complications were associated significantly with an old age and a history of previous abdomino-pelvic surgery. All three patients who had a protracted overall treatment time (about 2 weeks) due to severe bowel complication, suffered from pelvic recurrences. Forty six percent of patients experienced early bowel complications, most of which were grade 1 or 2 and relieved spontaneously or by medication. The patients with an old age or a previous surgery have a high probability of early complications and they may be less compliant with planned radiotherapy. So more careful precaution is necessary for these patients.

  14. Managing neonatal bowel obstruction: clinical perspectives

    Directory of Open Access Journals (Sweden)

    Desoky SM

    2018-02-01

    Full Text Available Sarah M Desoky,1 Ranjit I Kylat,2 Unni Udayasankar,1 Dorothy Gilbertson-Dahdal1 1Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA; 2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA Abstract: Neonatal intestinal obstruction is a common surgical emergency and occurs in approximately 1 in 2,000 live births. The causes of obstruction are diverse with varied embryological origins, and some underlying etiologies are not yet well described. Some findings of neonatal bowel obstruction can be detected prenatally on ultrasound imaging. The obstruction is classified as “high” when the level of obstruction is proximal to the ileum, and “low” when the level of obstruction is at the ileum or colon. Early diagnosis of the type of intestinal obstruction and localization of the obstructive bowel segment guides timely and appropriate management of the underlying pathologic entity. Neonatal bowel obstructions are ideally managed at specialized centers with a large volume of neonatal surgery and dedicated pediatric surgical and anesthesia expertise. Although surgical intervention is necessary in most cases, initial management strategies often target underlying metabolic, cardiac, or respiratory abnormalities. Imaging plays a key role in early and accurate diagnosis of the abnormalities. When bowel obstruction is suspected clinically, initial imaging workup usually involves abdominal radiography, which may direct further evaluation with fluoroscopic examination such as upper gastrointestinal (UGI contrast study or contrast enema. This article provides a comprehensive review of clinical and radiological features of common and less common causes of intestinal obstruction in the neonatal age group, including esophageal atresia, enteric duplication cysts, gastric volvulus, congenital microgastria, hypertrophic pyloric stenosis, duodenal atresia

  15. Butyricimonas virosa bacteraemia and bowel disease: case report and review

    Directory of Open Access Journals (Sweden)

    C.U. Enemchukwu

    2016-09-01

    Full Text Available Only two cases of human infection with the anaerobic Gram-negative bacillus Butyricimonas virosa have been previously reported. We describe the case of a 69-year-old man with B. virosa and diverticulitis, further supporting an association of bacteraemia with this pathogen to bowel disease. We also summarize the characteristics of the previously described cases.

  16. Laparoscopy After Previous Laparotomy

    Directory of Open Access Journals (Sweden)

    Zulfo Godinjak

    2006-11-01

    Full Text Available Following the abdominal surgery, extensive adhesions often occur and they can cause difficulties during laparoscopic operations. However, previous laparotomy is not considered to be a contraindication for laparoscopy. The aim of this study is to present that an insertion of Veres needle in the region of umbilicus is a safe method for creating a pneumoperitoneum for laparoscopic operations after previous laparotomy. In the last three years, we have performed 144 laparoscopic operations in patients that previously underwent one or two laparotomies. Pathology of digestive system, genital organs, Cesarean Section or abdominal war injuries were the most common causes of previouslaparotomy. During those operations or during entering into abdominal cavity we have not experienced any complications, while in 7 patients we performed conversion to laparotomy following the diagnostic laparoscopy. In all patients an insertion of Veres needle and trocar insertion in the umbilical region was performed, namely a technique of closed laparoscopy. Not even in one patient adhesions in the region of umbilicus were found, and no abdominal organs were injured.

  17. Small bowel faeces sign in patients without small bowel obstruction

    International Nuclear Information System (INIS)

    Jacobs, S.L.; Rozenblit, A.; Ricci, Z.; Roberts, J.; Milikow, D.; Chernyak, V.; Wolf, E.

    2007-01-01

    Aim: To evaluate frequency and clinical relevance of the 'small bowel faeces' sign (SBFS) on computed tomography (CT) in patients with and without small bowel obstruction (SBO) presenting with acute abdominal or acute abdominal and flank pain. Methods: Abdominal CTs of consecutive patients presenting to the emergency department with abdominal or flank pain over a 6 month period were retrospectively reviewed by six radiologists, independently, for the presence of the SBFS. Examinations with positive SBFS were further evaluated in consensus by three radiologists, blinded to the final diagnosis. The small bowel was graded as non-dilated ( 4 cm) dilated. The location of SBFS and presence of distal small bowel collapse indicative of SBO was recorded. Imaging findings were subsequently correlated with the final diagnosis via chart review and compared between patients with and without SBO. Results: Of 1642 CT examinations, a positive SBFS was found in 100 (6%) studies. Of 100 patients with a positive SBFS, 32 (32%) had documented SBO. The remaining 68 patients had other non-obstructive diagnoses. SBFS was located in proximal, central, distal and multisegmental bowel loops in one (3.1%), eight (25.0%), 21 (65.6%) and two (6.3%) patients with SBO, and in zero (0%), 10 (14.7%), 53 (77.9%) and five (7.4%) of patients without SBO (p < 0.273). The small bowel was non-dilated and mildly, moderately or severely dilated in one (3%), five (16%), 20 (62%) and six (19%) patients with SBO, and in 61(90%), seven (10%), zero (0%) and zero (0%) patients without SBO. Normal or mildly dilated small bowel was seen in all (100%) patients without SBO, but only in six (19%) of 32 patients with SBO (p < 0.0001). Moderate or severe small bowel dilatation was seen in 26 (81%) patients with SBO (p < 0.0001), but it was absent in patients without SBO. Distal small bowel collapse was found in 27 (84.4%) of 32 patients with SBO, but not in patients without SBO (p < 0.0001). A combination of SBFS

  18. Multislice computed tomography angiography findings of chronic small bowel volvulus with jejunal diverticulosis.

    Science.gov (United States)

    Li, Xiao-Bing; Guan, Wen-Xian; Gao, Yuan

    2010-07-01

    A volvulus, which is torsion of the bowel and its mesentery, is a medical emergency. Small bowel volvulus rarely occurs in adults, although it has been reported in the presence of small bowel diverticulum. Multislice computed tomography (CT) angiography, by demonstrating the mesenteric vessels, can be of help in the diagnosis of small bowel volvulus, especially when CT or gastrointestinal studies fail to show the diverticulum. We present the multislice CT angiography findings of a 64-year-old woman with chronic intermittent volvulus resulting from jejunal diverticulosis, surgically confirmed. To our knowledge, no similar case has been reported previously in the literature.

  19. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  20. Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

    Directory of Open Access Journals (Sweden)

    Natalie Chen

    2012-01-01

    Full Text Available Double balloon enteroscopy (DBE is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

  1. Only one previous owner .

    International Nuclear Information System (INIS)

    Snieckus, Darius

    1999-01-01

    In the light of the large number of offshore platforms earmarked for decommissioning in the next 30 years, a case for re-use is advanced. Henk Vreeswijk of the Netherlands believes that governments should encourage re-use; it makes sense from both an economical and an environmental perspective. Indeed, in the Netherlands, platforms are now being produced with re-use in mind. Elf has recently taken the unprecedented step of advertising a used platform and a subsea installation on the internet. (UK)

  2. CT evaluation of bowel obstruction

    International Nuclear Information System (INIS)

    Megibow, A.J.; Cho, K.C.; Balthazar, E.J.; Medwid, S.W.; Birnbaum, B.A.; Nox, M.E.

    1990-01-01

    This paper determines the ability of CT to help diagnose the presence and etiology of bowel obstruction. The authors reviewed the records of 169 patients with a clinical diagnosis of small bowel or colonic obstruction. Ninety-five patients had CT scans, and 83 were available for review. Diagnosis was established by surgery (38), barium radiography (17), or clinical course (28). Etiologies included adhesions (37), metastases (six), primary tumor (six), Crohn disease (four), hernias (three, hematoma (two), colonic diverticulitis (two), and other (four). Six patients with nonobstructive ileus were evaluated. Thirteen patients with suspected obstruction proved to not have obstruction. The scans were retrospectively evaluated by a pair of readers (without knowledge of histories) for the presence of bowel obstruction, grade, level, and etiology; 83 randomly selected scans in patients without history of bowel obstruction served as controls. Obstruction was defined as the presence of a marked discrepancy in the caliber of proximal and distal bowel loops

  3. Physiologic effects of bowel preparation

    DEFF Research Database (Denmark)

    Holte, Kathrine; Nielsen, Kristine Grubbe; Madsen, Jan Lysgård

    2004-01-01

    , plasma and extracellular volume, balance function, and biochemical parameters were measured. RESULTS: Bowel preparation led to a significant decrease in exercise capacity (median, 9 percent) and weight (median, 1.2 kg). Plasma osmolality was significantly increased from 287 to 290 mmol kg(-1), as well......PURPOSE: Despite the universal use of bowel preparation before colonoscopy and colorectal surgery, the physiologic effects have not been described in a standardized setting. This study was designed to investigate the physiologic effects of bowel preparation. METHODS: In a prospective study, 12...... healthy volunteers (median age, 63 years) underwent bowel preparation with bisacodyl and sodium phosphate. Fluid and food intake were standardized according to weight, providing adequate calorie and oral fluid intake. Before and after bowel preparation, weight, exercise capacity, orthostatic tolerance...

  4. Irritable bowel syndrome

    Science.gov (United States)

    Enck, Paul; Aziz, Qasim; Barbara, Giovanni; Farmer, Adam D.; Fukudo, Shin; Mayer, Emeran A.; Niesler, Beate; Quigley, Eamonn M. M.; Rajilić-Stojanović, Mirjana; Schemann, Michael; Schwille-Kiuntke, Juliane; Simren, Magnus; Zipfel, Stephan; Spiller, Robin C.

    2016-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain–gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer. PMID:27159638

  5. Altered gastric emptying in patients with irritable bowel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Caballero-Plasencia, A.M.; Valenzuela-Barranco, M. [Department of Medicine, School of Medicine, University of Granada (Spain); Herrerias-Gutierrez, J.M. [Division of Gastroenterology, University Hospital ``Virgen de la Macarena``, Sevilla (Spain); Esteban-Carretero, J.M. [Central Service of Investigation in Health Sciences, University of Cadiz, Cadiz (Spain)

    1999-04-29

    Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut. (orig.) With 1 fig., 3 tabs., 48 refs.

  6. Altered gastric emptying in patients with irritable bowel syndrome

    International Nuclear Information System (INIS)

    Caballero-Plasencia, A.M.; Valenzuela-Barranco, M.; Herrerias-Gutierrez, J.M.; Esteban-Carretero, J.M.

    1999-01-01

    Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut. (orig.)

  7. CT findings of small bowel metastases from primary lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2002-11-01

    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

  8. Randomized Phase II Study of R-CHOP With or Without Bortezomib in Previously Untreated Patients With Non-Germinal Center B-Cell-Like Diffuse Large B-Cell Lymphoma.

    Science.gov (United States)

    Leonard, John P; Kolibaba, Kathryn S; Reeves, James A; Tulpule, Anil; Flinn, Ian W; Kolevska, Tatjana; Robles, Robert; Flowers, Christopher R; Collins, Robert; DiBella, Nicholas J; Papish, Steven W; Venugopal, Parameswaran; Horodner, Andrew; Tabatabai, Amir; Hajdenberg, Julio; Park, Jaehong; Neuwirth, Rachel; Mulligan, George; Suryanarayan, Kaveri; Esseltine, Dixie-Lee; de Vos, Sven

    2017-11-01

    Purpose To evaluate the impact of the addition of bortezomib to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) on outcomes in previously untreated patients with non-germinal center B-cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL). Patients and Methods After real-time determination of non-GCB DLBCL using the Hans immunohistochemistry algorithm, 206 patients were randomly assigned (1:1; stratified by International Prognostic Index [IPI] score) to six 21-day cycles of standard R-CHOP alone or R-CHOP plus bortezomib 1.3 mg/m 2 intravenously on days 1 and 4 (VR-CHOP). The primary end point, progression-free survival (PFS), was evaluated in 183 patients with centrally confirmed non-GCB DLBCL who received one or more doses of study drug (91 R-CHOP, 92 VR-CHOP). Results After a median follow-up of 34 months, with 25% (R-CHOP) and 18% (VR-CHOP) of patients having had PFS events, the hazard ratio (HR) for PFS was 0.73 (90% CI, 0.43 to 1.24) with VR-CHOP ( P = .611). Two-year PFS rates were 77.6% with R-CHOP and 82.0% with VR-CHOP; they were 65.1% versus 72.4% in patients with high-intermediate/high IPI (HR, 0.67; 90% CI, 0.34 to 1.29), and 90.0% versus 88.9% (HR, 0.85; 90% CI, 0.35 to 2.10) in patients with low/low-intermediate IPI. Overall response rate with R-CHOP and VR-CHOP was 98% and 96%, respectively. The overall survival HR was 0.75 (90% CI, 0.38 to 1.45); 2-year survival rates were 88.4% and 93.0%, respectively. In the safety population (100 R-CHOP and 101 VR-CHOP patients), grade ≥ 3 adverse events included neutropenia (53% v 49%), thrombocytopenia (13% v 29%), anemia (7% v 15%), leukopenia (26% v 25%), and neuropathy (1% v 5%). Conclusion Outcomes for newly diagnosed, prospectively enrolled patients with non-GCB DLBCL were more favorable than expected with R-CHOP and were not significantly improved by adding bortezomib.

  9. Inflammatory bowel disease and colorectal cancer

    Directory of Open Access Journals (Sweden)

    Andreja Ocepek

    2006-12-01

    Full Text Available Background: Colorectal cancer is one of the most frequent cancers in developed countries and Slovenia, and the incidence is still rising. Groups of people with higher risk for colorectal cancer are well defined. Among them are patients with inflammatory bowel disease. The risk is highest in patients in whom whole large bowel is affected by inflammation, it rises after 8 to 10 years and increases with the duration of the disease. Precancerous lesion is a displastic, chronically inflammed mucosa and not an adenoma as in cases of sporadic colorectal carcinoma.Conclusions: Many studies suggest that the influence of genetic factors differs between sporadic and inflammatory bowel disease related colorectal cancer. Symptomatic patients at the time of diagnosis have a much worse prognosis. The goal of prevention programes is therefore discovering early precancerous lesions. Established screening protocols are based on relatively frequent colonoscopies which are inconvinient for the patient as well as the endoscopist. Use of specific genetic markers, mutations of candidate genes, as a screening method and a prognostic predictor could greatly lighten therapeutic decisions.

  10. Sensory characterization of bowel cleansing solutions.

    Science.gov (United States)

    Sharara, Ala I; Daroub, Hamza; Georges, Camille; Shayto, Rani; Nader, Ralph; Chalhoub, Jean; Olabi, Ammar

    2016-08-10

    To evaluate the sensory characteristics of commercial bowel cleansing preparations. Samples of 4 commercially available bowel cleansing preparations, namely polyethylene glycol electrolyte solution (PEG), PEG + ascorbic acid (PEG-Asc), sodium picosulfate (SPS), and oral sodium sulfate (OSS) were prepared according to the manufacturer's instructions. Descriptive analysis was conducted (n = 14) using a 15-cm line scale with the Compusense at-hand(®) sensory evaluation software. Acceptability testing (n = 80) was conducted using the 9-point hedonic scale. In addition, a Just-About-Right (JAR) scale was included for the four basic tastes to determine their intensity compatibility with acceptability levels in the products. Samples were significantly different, in descriptive analysis, for all attributes (P sweetness. SPS received the highest ratings for turbidity, viscosity appearance, orange odor and orange flavor; PEG-Asc for citrus odor and citrus flavor; OSS for sweetener taste, sweet aftertaste, bitterness, astringency, mouthcoating, bitter aftertaste and throatburn, and along with PEG-Asc, the highest ratings for saltiness, sourness and adhesiveness. Acceptability results showed significant differences between the various samples (P sweet, while SPS, PEG-Asc and OSS were slightly too sour and OSS slightly too bitter. While using small sample volumes was necessary to avoid unwanted purgative effects, acceptability ratings do not reflect the true effect of large volumes intake thus limiting the generalization of the results. Further improvements are needed to enhance the sensory profile and to optimize the acceptability for better compliance with these bowel cleansing solutions.

  11. Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Rauf Fozia

    2011-09-01

    Full Text Available Abstract Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.

  12. CT assessment of anastomotic bowel leak

    International Nuclear Information System (INIS)

    Power, N.; Atri, M.; Ryan, S.; Haddad, R.; Smith, A.

    2007-01-01

    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

  13. Wireless capsule endoscopy for evaluation of phenotypic expression of small-bowel polyps in patients with Peutz-Jeghers syndrome and in symptomatic first-degree relatives.

    Science.gov (United States)

    Soares, J; Lopes, L; Vilas Boas, G; Pinho, C

    2004-12-01

    Peutz-Jeghers syndrome (PJS) is an inherited gastrointestinal hamartomatous polyposis disorder. Small-bowel intussusception and bleeding are the most common complications, and malignancy may also occur. Survey of the gastrointestinal tract, particularly of the small bowel, is difficult and current recommendations for management syndrome are ambiguous. We evaluated the feasibility of capsule endoscopy for identifying phenotypic expression of small-bowel polyps in patients with full-blown PJS and a previous diagnosis of gastrointestinal polyposis, and in symptomatic kindred of PJS patients with no previous diagnosis of gastrointestinal polyposis. Two groups were studied: group A consisted of 14 patients with gastrointestinal polyposis, eight of whom had undergone previous small-intestine surgery; group B consisted of six symptomatic first-degree relatives of PJS patients; these patients had previous negative gastrointestinal endoscopic examinations. Numerous polyps were detected in all patients in group A. Most polyps were sessile, but the larger polyps tended to be pedunculated. Polyp density was highest in the jejunum (greater than in the ileum and duodenum). Seven patients had at least one large polyp (> 11 mm) and five of these patients subsequently underwent enteroscopy, which revealed that capsule endoscopy had correctly identified all the patients with large polyps, but had missed 20 % of the total number of large polyps in these patients. No polyps were detected by capsule endoscopy in group B patients, despite the excellent visualization of the small intestine. In all patients, the capsules were expelled within 24 hours, without complications, and the procedure was well tolerated. Capsule endoscopy is an effective and well-tolerated method for evaluating small-bowel pathology in patients with PJS.

  14. Functional bowel disease

    DEFF Research Database (Denmark)

    Rumessen, J J; Gudmand-Høyer, E

    1988-01-01

    Twenty-five patients with functional bowel disease were given fructose, sorbitol, fructose-sorbitol mixtures, and sucrose. The occurrence of malabsorption was evaluated by means of hydrogen breath tests and the gastrointestinal symptoms, if any, were recorded. One patient could not be evaluated...... of fructose caused marked abdominal distress in patients with demonstrable malabsorption. Ingestion of sucrose in these patients gave less pronounced symptoms of abdominal distress. Malabsorption of a 5-g dose of sorbitol could be detected in 8 of 13 patients. Mixtures of 25 g of fructose and 5 g of sorbitol...... caused significantly increased abdominal distress, and more than additive malabsorption was found in several cases. The present study shows that pronounced gastrointestinal distress may be provoked by malabsorption of small amounts of fructose, sorbitol, and fructose-sorbitol mixtures in patients...

  15. A new genus of athecate interstitial dinoflagellates, Togula gen. nov., previously encompassed within Amphidinium sensu lato: Inferred from light and electron microscopy and phylogenetic analyses of partial large subunit ribosomal DNA sequences

    DEFF Research Database (Denmark)

    Jørgensen, Mårten Flø; Murray, Shauna; Daugbjerg, Niels

    2004-01-01

    subunit ribosomal DNA as well as in size and shape. Based on morphological similarity and partial large subunit ribosomal DNA evidence, we erect the new genus, Togula gen. nov. with the emended type species Togula britannica (Herdman) comb. nov. Based on differences in division pattern and partial large...

  16. Supra-transumbilical laparotomy (STL) approach for small bowel ...

    African Journals Online (AJOL)

    Background: Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with ...

  17. Gastrografin in the management of adhesive small bowel ...

    African Journals Online (AJOL)

    Background/purpose Adhesive small bowel obstruction (ASBO) is a common emergency problem in children with previous abdominal surgery. Management protocols usually start with a conservative approach that may be successful in some cases, whereas in others it will end eventually by laparotomy with its associated ...

  18. Intestinal Failure (Short Bowel Syndrome)

    Science.gov (United States)

    Intestinal Failure (Short Bowel Syndrome) What is intestinal failure? Intestinal failure occurs when a significant portion of the small ... intestine does. Who is at risk for intestinal failure? N Babies (usually premature) who have had surgery ...

  19. Antibiotics and inflammatory bowel diseases.

    Science.gov (United States)

    Scribano, Maria Lia; Prantera, Cosimo

    2013-01-01

    Inflammatory bowel diseases are characterized by an altered composition of gut microbiota (dysbiosis) that may contribute to their development. Antibiotics can alter the bacterial flora, and a link between antibiotic use and onset of Crohn's disease (CD), but not ulcerative colitis, has been reported. The hypothesis that Mycobacterium avium subspecies paratuberculosis (MAP) could be an etiologic agent of CD has not been confirmed by a large study on patients treated by an association of antibiotics active against MAP. The observations supporting a role of intestinal microbiota in CD pathogenesis provide the rationale for a therapeutic manipulation of the intestinal flora through the employment of antibiotics. However, current data do not strongly support a therapeutic benefit from antibiotics, and there is still controversy regarding their use as primary therapy for treatment of acute flares of CD, and for postoperative recurrence prevention. Nevertheless, clinical practice and some studies suggest that a subgroup of patients with colonic involvement, early disease, and abnormal laboratory test of inflammation may respond better to antibiotic treatment. Since their long-term use is frequently complicated by a high rate of side effects, the use of antibiotics that work locally appears to be promising.

  20. Diet in irritable bowel syndrome

    OpenAIRE

    El-Salhy, Magdy; Gundersen, Doris Irene

    2015-01-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that is characterized by intermittent abdominal pain/discomfort, altered bowel habits and abdominal bloating/distension. This review aimed at presenting the recent developments concerning the role of diet in the pathophysiology and management of IBS. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, and there is no evidence that gluten causes the debated new diagnosis of non-coel...

  1. Primary Amyloidosis Presenting as Small Bowel Encapsulation

    Directory of Open Access Journals (Sweden)

    Jennifer Jones

    2004-01-01

    Full Text Available Amyloidosis is a pathological process which encompasses a spectrum of diseases that result from extracellular deposition of pathological fibrillar proteins. Clinical presentations vary depending on the organs involved. There is no documented case of amyloidosis presenting as small bowel encapsulation. A previously healthy 62-year-old man developed a small bowel obstruction in 1997. At surgery, a peculiar membrane encasing his entire small bowel was discovered. This appeared to have no vascularity and was removed without difficulty, exposing a grossly normal bowel. Histopathology revealed thick bands of collagen overlying the peritoneal surface, which was congo red positive and showed apple green birefringence. The findings were consistent with encapsulating peritonitis due to amyloidosis. There was no history or symptoms of any chronic inflammatory condition and he became symptom-free postoperatively. An abdominal fat pad biopsy failed to demonstrate amyloidosis. Endoscopic duodenal biopsies revealed classical primary amyloidosis. Quantitative immunoglobulins, lactate dehydrogenase, C3, C4 and beta-2 microglobulin were normal. Protein electrophoresis identified monoclonal paraprotein, immunoglobulin G lambda 3.7 g/L. Bone marrow biopsy and aspirate revealed only a mild plasmacytosis (5% to 10%. Echocardiogram and skeletal survey were normal. He had mild proteinuria. Complete blood count, C-reactive protein, calcium, albumin and total protein were normal. No specific therapy was instituted. In January of 1998 the patient remained asymptomatic with no gastrointestinal, cardiovascular or constitutional symptoms. He had developed nephrotic range proteinuria (3.95 g/24 h, microalbuminuria, hypoalbuminemia and a renal biopsy consistent with renal amyloidosis. In 1999 there was an increase in the monoclonal paraprotein (6.2 g/L. The remaining investigations were normal except for an echocardiogram which showed left ventricular hypertrophy but a normal

  2. Small-bowel neoplasms in patients undergoing video capsule endoscopy

    DEFF Research Database (Denmark)

    Rondonotti, E; Pennazio, M; Toth, E

    2008-01-01

    BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency...... of the neoplasm seen in 29 centers of 10 European Countries. RESULTS: Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm...

  3. Acute small bowel obstruction due to chicken bone bezoar

    Directory of Open Access Journals (Sweden)

    Vetpillai P

    2012-12-01

    Full Text Available Preadeepan Vetpillai,1 Ayo Oshowo21CT2 Surgery in General, Charing Cross Hospital, 2Colorectal and Laparoscopic Surgery, Whittington Hospital, London, UKAbstract: Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted undigested chicken bone.Keywords: small bowel obstruction, chicken bone, bezoar

  4. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

    Directory of Open Access Journals (Sweden)

    Zuhal Ozisler

    2015-01-01

    Full Text Available In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80% of the 55 patients before bowel program. Constipation (56%, 31/55 and incontinence (42%, 23/55 were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55 and after (73%, 40/55 bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

  5. Irritable bowel syndrome: Is it "irritable brain" or "irritable bowel"?

    Directory of Open Access Journals (Sweden)

    Susanta Kumar Padhy

    2015-01-01

    Full Text Available Irritable bowel syndrome (IBS has been recognized as one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. In the Western world, IBS appears to affect up to 20% of the population at any given time but in Asian countries, the median value of IBS prevalence defined by various criteria ranges between 6.5% and 10.1%, and community prevalence of 4% is found in North India. Those attending gastroenterology clinics represent only the tip of the iceberg. The disorder substantially impairs the quality of life, and the overall health-care costs are high. IBS has therefore gained increased attention from clinicians, researchers, and pharmaceutical industries. It is often frustrating to both patients and physicians as the disease is usually chronic in nature and difficult to treat. However, the understanding of IBS has been changing from time to time and still most of its concepts are unknown. In this review we have discussed, debated, and synthesized the evidence base, focusing on underlying mechanisms in the brain and bowel. We conclude that it is both brain and bowel mechanisms that are responsible. The clinical implication of such mechanisms is discussed.

  6. Fibre intake and the development of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Chan, Simon; Luben, Robert

    2018-01-01

    Background and Aims: Population-based prospective cohort studies investigating fibre intake and development of inflammatory bowel disease are lacking. Our aim was to investigate the association between fibre intake and the development of Crohn's disease [CD] and ulcerative colitis [UC] in a large...

  7. Tuberculosis in an inflammatory bowel disease cohort from South ...

    African Journals Online (AJOL)

    Background. Potent immunosuppressive therapy is standard treatment for inflammatory bowel disease (IBD) but carries a risk of reactivating latent tuberculosis (TB). No data exist on the burden of TB in South African patients with IBD. Objective. To evaluate the burden of TB in IBD patients attending a large tertiary IBD clinic.

  8. Pharmacokinetics of mesalazine pellets in children with inflammatory bowel disease

    NARCIS (Netherlands)

    Wiersma, Heleen; Escher, Johanna C.; Dilger, Karin; Trenk, Dietmar; Benninga, Marc A.; van Boxtel, Chris J.; Taminiau, Jan

    2004-01-01

    Mesalazine is a first-line drug in pediatric inflammatory bowel disease (IBD), and is customarily used to induce and maintain remission in mild to moderate disease. In children, pharmacokinetic data are scarce, and dosage recommendations are largely extrapolated from studies in adults. Aim of the

  9. Targeting Small Bowel Receptors to Treat Constipation and Diarrhea.

    Science.gov (United States)

    John, Elizabeth S; Chokhavatia, Sita

    2017-07-01

    The options for the treatment of diarrhea and constipation are evolving as emerging therapies target small bowel receptors. The goal of this review is to discuss small bowel receptors involved in intestinal absorption, secretion, and motility. The review highlights therapies already approved or currently being studied for the modulation of these receptors. The articles cited in this review focus on the molecular level of pathways involved in diarrhea and constipation, and highlight the respective pharmacotherapies. The majority of the studies in the current literature investigate the effects of both the small and large intestine receptors on diarrhea and constipation. There are fewer studies that isolate the effects of these receptors solely on the small bowel, and focusing more on the receptors found distinctly in the small intestine may be an area of interest for future studies as this can inspire more targeted therapies.

  10. Effectiveness of anti-tumour necrosis factor-α therapy in Danish patients with inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bank, Steffen; Andersen, Paal Skytt; Burisch, Johan

    2015-01-01

    INTRODUCTION: The objective of this study was to evaluate the outcome of anti-tumour necrosis factor-α (anti-TNF) treatment in a large cohort of patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) in clinical practice and to establish a cohort...... response rates were found. Heavy smoking was associated with non-response, whereas young age at treatment initiation was associated with a beneficial response among patients with CD. Thus, the results obtained in this cohort recruited from clinical practice were similar to those previously obtained...

  11. Effectiveness of anti-tumour necrosis factor-α therapy in Danish patients with inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bank, Steffen; Andersen, Paal Skytt; Burisch, Johan

    2015-01-01

    Introduction: The objective of this study was to evaluate the outcome of anti-tumour necrosis factor-α (anti-TNF) treatment in a large cohort of patients with inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) in clinical practice and to establish a cohort...... response rates were found. Heavy smoking was associated with non-response, whereas young age at treatment initiation was associated with a beneficial response among patients with CD. Thus, the results obtained in this cohort recruited from clinical practice were similar to those previously obtained...

  12. Treatment of irritable bowel syndrome.

    Science.gov (United States)

    Hadley, Susan K; Gaarder, Stephen M

    2005-12-15

    Irritable bowel syndrome affects 10 to 15 percent of the U.S. population to some degree. This condition is defined as abdominal pain and discomfort with altered bowel habits in the absence of any other mechanical, inflammatory, or biochemical explanation for these symptoms. Irritable bowel syndrome is more likely to affect women than men and is most common in patients 30 to 50 years of age. Symptoms are improved equally by diets supplemented with fiber or hydrolyzed guar gum, but more patients prefer hydrolyzed guar gum. Antispasmodic agents may be used as needed, but anticholinergic and other side effects limit their use in some patients. Loperamide is an option for treatment of moderately severe diarrhea. Antidepressants have been shown to relieve pain and may be effective in low doses. Trials using alosetron showed a clinically significant, although modest, gain over placebo, but it is indicated only for women with severe diarrhea-predominant symptoms or for those in whom conventional treatment has failed. Tegaserod has an advantage over placebo in constipation-predominant irritable bowel syndrome; it is indicated for up to 12 weeks of treatment in women. However, postmarketing reports of severe diarrhea and ischemic colitis further limit its use. Herbal therapies such as peppermint oil also may be effective in the treatment of irritable bowel syndrome. Therapies should focus on specific gastrointestinal dysfunctions (e.g., constipation, diarrhea, pain), and medications only should be used when nonprescription remedies do not work or when symptoms are severe.

  13. Primary small bowel anastomosis in generalised peritonitis

    NARCIS (Netherlands)

    deGraaf, JS; van Goor, Harry; Bleichrodt, RP

    Objective: To find out if primary small bowel anastomosis of the bowel is safe in patients with generalised peritonitis who are treated by planned relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects. 10 Patients with generalised purulent peritonitis

  14. HIV risk perception and testing behaviours among men having sex with men (MSM reporting potential transmission risks in the previous 12 months from a large online sample of MSM living in Germany

    Directory of Open Access Journals (Sweden)

    Ulrich Marcus

    2016-10-01

    Full Text Available Abstract Background HIV testing and serostatus awareness are essential to implement biomedical strategies (treatment as prevention; oral chemoprophylaxis, and for effective serostatus-based behaviours (HIV serosorting; strategic positioning. The analysis focuses on the associations between reported sexual risks, the perceived risk for HIV infection, and HIV testing behaviour in order to identify the most relevant barriers for HIV test uptake among MSM living in Germany. Methods MSM were recruited to a nationwide anonymous online-survey in 2013 on MSM social networking/dating sites. Questions covered testing behaviours, reasons for testing decisions, and HIV risk perception (5-point scale. Additional questions addressed arguments in favour of home/ home collection testing (HT. Using descriptive statistics and logistic regression we compared men reporting recent HIV testing (RT; previous 12 month with men never tested (NT in a subsample not previously diagnosed with HIV and reporting ≥2 episodes of condomless anal intercourse (CLAI with a non-steady partner of unknown HIV serostatus in the previous 12 months. Results The subsample consisted of 775 RT (13 % of RT and 396 NT (7 % of NT. The number of CLAI episodes in the last 12 months with non-steady partners of unknown HIV status did not differ significantly between the groups, but RT reported significantly higher numbers of partners (>5 AI partners: 65 vs. 44 %. While perceived risks regarding last AI were comparable between the groups, 49vs. 30 % NT were <30 years, lived more often in towns/villages <100,000 residents (60 vs. 39 %, were less out-particularly towards care providers-about being attracted to men (aOR 10.1; 6.9–14.8, more often identified as bisexual (aOR 3.5; 2.5–4.8, and reported lower testing intentions (aOR 0.08; 0.06–0.11. Perceived risks (67 % and routine testing (49 % were the most common testing reasons for RT, while the strong belief not to be infected

  15. Heritability in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Gordon, Hannah; Trier Moller, Frederik; Andersen, Vibeke

    2015-01-01

    estimation regard genetic and environmental variance as separate entities, although it is now understood that there is a complex multidirectional interplay between genetic are environmental factors mediated by the microbiota, the epigenome, and the innate and acquired immune systems. Due to the limitations......Since Tysk et al's pioneering analysis of the Swedish twin registry, twin and family studies continue to support a strong genetic basis of the inflammatory bowel diseases. The coefficient of heritability for siblings of inflammatory bowel disease probands is 25 to 42 for Crohn's disease and 4 to 15...... of heritability estimates, it is unlikely that a true value for heritability will be reached. Further work aimed at quantifying the variance explained across GWAS, epigenome-wide, and microbiota-wide association studies will help to define factors leading to inflammatory bowel disease....

  16. Whole Exome Sequencing and Segregation Analysis Confirms That a Mutation in COL17A1 Is the Cause of Epithelial Recurrent Erosion Dystrophy in a Large Dominant Pedigree Previously Mapped to Chromosome 10q23-q24.

    Directory of Open Access Journals (Sweden)

    Benjamin R Lin

    Full Text Available To report identification of a COL17A1 mutation in a family with a corneal dystrophy previously mapped to chromosome 10q23-q24.Whole-exome sequencing was performed on DNA samples from five affected family members and two unrelated, unaffected individuals. Identified variants were filtered for those that were: located in the linked interval on chromosome 10q23-q24; novel or rare (minor allele frequency ≤0.01; heterozygous; present in all affected individuals and not in controls; and present in genes that encode proteins expressed in human corneal epithelial cells (reads per kilobase per million ≥1. Sanger sequencing of identified variants (SNVs was performed in additional family members. In silico analysis was used to predict the functional impact of non-synonymous variants.Three SNVs located in two genes were identified that met the filtering criteria: one rare synonymous c.3156C>T variant in the collagen, type XVII, alpha I (COL17A1 gene; and two rare variants, one synonymous and one missense, in the dynamin binding protein (DNMBP gene. Sanger sequencing of additional family members determined that only the COL17A1 variant segregates with the affected phenotype. In silico analysis predicts that the missense variant in DNMBP would be tolerated.The corneal dystrophy mapped to chromosome 10q23-q24 is associated with the c.3156C>T variant in COL17A1. As this variant has recently been identified in five other families with early onset recurrent corneal erosions, and has been shown in vitro to introduce a cryptic splice donor site, this dystrophy is likely caused by aberrant splicing of COL17A1 and should be classified as epithelial recurrent erosion dystrophy.

  17. Small Bowel Review - Part I

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1997-01-01

    Full Text Available Significant advances have been made in the study of the small bowel. Part I of this two-part review of the small bowel examines carbohydrates, including brush border membrane hydrolysis and sugar transport; amino acids, dipeptides, proteins and food allergy, with a focus on glutamine, peptides and macromolecules, and nucleosides, nucleotides and polyamines; salt and water absorption, and diarrhea, including antidiarrheal therapy and oral rehydration treatment; lipids (digestion and absorption, fatty acid binding proteins, intracellular metabolism, lipoproteins and bile acids; and metals (eg, iron and vitamins.

  18. Evaluation of clinical and biological prognostic factors in relapsed or refractory diffuse large B-cell lymphoma patients after previous treatment with rituximab and chemotherapy: results of the PRO-R-IPI study.

    Science.gov (United States)

    Panizo, Carlos; Rodríguez, Anny Jaramillo; Gutiérrez, Gonzalo; Díaz, Francisco Javier; González-Barca, Eva; de Oña, Raquel; Grande, Carlos; Sancho, Juan Manuel; García-Álvarez, María Flor; Sánchez-González, Blanca; Peñalver, Francisco Javier; Cannata, Jimena; Espeso, Manuel; Requena, María José; Gardella, Santiago; Durán, Soledad; González, Ana Pilar; Alfonso, Ana; Caballero, María Dolores

    2015-07-01

    Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity, showing a highly variable outcome. In patients with DLBCL relapsed/refractory to first-line treatment with rituximab the usefulness of the revised International Prognostic Index (R-IPI) as a prognostic tool remains unexplored. Some biological parameters (B-cell lymphoma 6 [Bcl-6], Bcl-2, p53, and multiple myeloma 1 [MUM1]) and blood populations (lymphocyte and monocyte counts) have been described as International Prognostic Index-independent prognostic factors. The objective was to evaluate the R-IPI to predict the outcome of DLBCL patients at the time of relapse after a front-line treatment with chemotherapy and rituximab and to establish in this population the relationship between biological parameters and outcome. We included patients with refractory/relapsed DLBCL after first-line treatment with rituximab-containing regimens; patients must have already finished a rescue treatment also including rituximab. Immunohistochemical assessment of Bcl-2, Bcl-6, p53, and MUM1 expression were undertaken in available biopsies. R-IPI factors were identified from the clinical data at diagnosis and at relapse. Response was assessed using National Cancer Institute-sponsored Working Group guidelines. R-IPI prognosis at relapse was not significantly associated with overall response rate (ORR) after Rituximab-chemotherapy rescue therapy. None of the immunohistochemical parameters analyzed correlated with rescue therapy results. In contrast, patients with absolute lymphocyte count (ALC) ≥ 1 × 10(9)/L at relapse were more likely to respond than patients with ALC IPI score calculated at relapse could not predict the ORR to second-line treatment. Lymphopenia is a simple and useful predictor for outcome in relapsed/refractory DLBCL and the only prognostic factor that in our hands could predict the overall response to a second-line treatment with rituximab and chemotherapy. Copyright © 2015 Elsevier Inc. All rights

  19. Risk indicators for inflammatory bowel disease.

    Science.gov (United States)

    Persson, P G; Leijonmarck, C E; Bernell, O; Hellers, G; Ahlbom, A

    1993-04-01

    We investigated the association between different risk indicators and inflammatory bowel disease in a case-control study based on the population of Stockholm County during 1980-1984. Information on physical activity, oral contraceptives, some previous diseases and childhood characteristics was collected using a postal questionnaire for 152 cases of Crohn's disease, 145 cases of ulcerative colitis, and 305 controls. The relative risk (RR) of Crohn's disease was inversely related to regular physical activity and estimated at 0.6 (95% CI: 0.4-0.9) and 0.5 (95% CI: 0.3-0.9) for weekly and daily exercise, respectively. Having psoriasis prior to the inflammatory bowel disease was associated with an increased relative risk of Crohn's disease (RR = 2.9, 95% CI: 1.1-7.9). Use of oral contraceptives was associated with an increased RR of 1.7 for both Crohn's disease and ulcerative colitis. Crohn's disease confined to the colon and total ulcerative colitis at diagnosis were most strongly associated with oral contraceptives.

  20. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints.

    Science.gov (United States)

    Goldstein, R; Braverman, D; Stankiewicz, H

    2000-08-01

    Carbohydrate malabsorption of lactose, fructose and sorbitol has already been described in normal volunteers and in patients with functional bowel complaints including irritable bowel syndrome. Elimination of the offending sugar(s) should result in clinical improvement. To examine the importance of carbohydrate malabsorption in outpatients previously diagnosed as having functional bowel disorders, and to estimate the degree of clinical improvement following dietary restriction of the malabsorbed sugar(s). A cohort of 239 patients defined as functional bowel complaints was divided into a group of 94 patients who met the Rome criteria for irritable bowel syndrome and a second group of 145 patients who did not fulfill these criteria and were defined as functional complaints. Lactose (18 g), fructose (25 g) and a mixture of fructose (25 g) plus sorbitol (5 g) solutions were administered at weekly intervals. End-expiratory hydrogen and methane breath samples were collected at 30 minute intervals for 4 hours. Incomplete absorption was defined as an increment in breath hydrogen of at least 20 ppm, or its equivalent in methane of at least 5 ppm. All patients received a diet without the offending sugar(s) for one month. Only 7% of patients with IBS and 8% of patients with FC absorbed all three sugars normally. The frequency of isolated lactose malabsorption was 16% and 12% respectively. The association of lactose and fructose-sorbitol malabsorption occurred in 61% of both patient groups. The frequency of sugar malabsorption among patients in both groups was 78% for lactose malabsorption (IBS 82%, FC 75%), 44% for fructose malabsorption and 73% for fructose-sorbitol malabsorption (IBS 70%, FC 75%). A marked improvement occurred in 56% of IBS and 60% of FC patients following dietary restriction. The number of symptoms decreased significantly in both groups (P malabsorption patterns are common in functional bowel disorders and may contribute to symptomatology in most patients

  1. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient

    DEFF Research Database (Denmark)

    Klarskov, Louise; Mogensen, Anne Mellon; Jespersen, Niels

    2011-01-01

    Klarskov L, Mogensen AM, Jespersen N, Ingeholm P, Holck S. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient. APMIS 2011; 119: 393-8. A 54-year-old man, previously colectomized for inflammatory bowel disease, developed carcinoma in the i......Klarskov L, Mogensen AM, Jespersen N, Ingeholm P, Holck S. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient. APMIS 2011; 119: 393-8. A 54-year-old man, previously colectomized for inflammatory bowel disease, developed carcinoma...... during the adenoma carcinoma sequence included the acquisition of CK7 expression in the malignant portion. Gastric mucin may play a role in the initial step of the neoplastic evolution and CK7 may denote neoplastic progression. This case confirms the notion of a widely variegated morphology of precursor...

  2. Vascular anatomy of strictured small bowel.

    Science.gov (United States)

    Mansard, Magnus Jayaraj; Rao, Upender; Pradeep, R; Sekaran, Anuradha; Rao, G V; Reddy, D N

    2011-01-01

    To investigate the role of ischemia in the pathogenesis of small bowel strictures. Vascular anatomy of 39 small bowel strictures was studied using modified Spalteholtz method. Ten normal small bowel segments were studied as controls. 71.8% of small bowel strictures showed block in the mesenteric vessels (p=0.008). Subset analysis of tuberculous strictures showed block in the mesenteric vessels in 70.8% of strictures (p=0.0098). Ischemia plays a significant role in the pathogenesis of small bowel strictures. Mesenteric vasculopathy has a significant association with tuberculous strictures of the intestine.

  3. CT enteroclysis in small bowel Crohn's disease

    International Nuclear Information System (INIS)

    Kohli, Marc D.; Maglinte, Dean D.T.

    2009-01-01

    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.

  4. Inflammatory Bowel Disease: Future Therapies

    NARCIS (Netherlands)

    van Deventer, Sander J.H.

    2002-01-01

    Current medical therapies for people with inflammatory bowel disease are not satisfactory, and it is unlikely that improvement of traditional drugs will have a major clinical impact. The immunopathogensis of Crohn's disease and ulcerative colitis are rapidly being deciphered, which is providing

  5. Ankylosing spondylitis and bowel disease

    NARCIS (Netherlands)

    Rudwaleit, Martin; Baeten, Dominique

    2006-01-01

    Between 5 and 10% of cases of ankylosing spondylitis (AS) are associated with inflammatory bowel disease (IBD), either Crohn's disease or ulcerative colitis. A much larger percentage of AS patients have subclinical gut inflammation manifested either by endoscopic findings or by histology. The

  6. Position paper : Whole bowel irrigation

    NARCIS (Netherlands)

    2004-01-01

    Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that

  7. Bacteria, genetics and irritable bowel syndrome.

    LENUS (Irish Health Repository)

    Craig, Orla F

    2010-06-01

    EVALUATION OF: Villani AC, Lemire M, Thabane M et al. Genetic risk factors for post-infectious irritable bowel syndrome following a waterborne outbreak of gastroenteritis. Gastroenterology 138, 1502-1513 (2010). While the pathogenesis of irritable bowel syndrome (IBS) remains to be fully defined, two clinical observations - the occurrence, de novo, of IBS following bacterial gastroenteritis and the history, commonly obtained from IBS patients, of other instances of the syndrome within their families - have instigated investigations, in IBS, of the potential roles, on the one hand, of the gut microbiota and the host response and, on the other hand, of genetic factors. The study reviewed here relates to both of these factors by studying genetic predisposition to postinfective IBS in a large population of individuals who were exposed to a multimicrobial enteric infection, which resulted in a severe outbreak of gastroenteritis and was followed by the development of IBS in over a third. In this detailed study, the investigators identified a number of genes that were linked significantly to the development of postinfectious-IBS in the Toll-like receptor 9, IL-6 and cadherin 1 regions. These genes play important roles in bacterial recognition, the inflammatory response and epithelial integrity, respectively, and provide considerable support for the hypothesis that links IBS onset to disturbances in the microbiota and the host response.

  8. Incidence and predictive factors of irritable bowel syndrome after acute diverticulitis in Korea.

    Science.gov (United States)

    Jung, Sungmo; Lee, Hyuk; Chung, Hyunsoo; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2014-11-01

    Evidence indicates that irritable bowel syndrome can occur after gastroenteritis. However, little is known about its incidence after diverticulitis. This study was designed to identify the incidence and risk factors of irritable bowel syndrome after diverticulitis in Korea. A survey regarding irritable bowel syndrome was performed in patients allocated to the cases hospitalized for acute diverticulitis and controls hospitalized for non-gastrointestinal disorders between January 2007 and June 2012. Patients meeting criteria for irritable bowel syndrome before hospitalization or with a history of bowel resection were excluded for analysis. Response rate of telephone interviews was 28.1 % (139 of 494) and 73.3 % (220 of 300) in cases and controls, respectively. After exclusion, 102 patients in the cases and 205 patients in the controls were analyzed. At 31 months median follow-up, irritable bowel syndrome had developed in 13 patients (12.8 %) in the cases and 11 patients (5.4 %) in the controls with significant statistical difference (p = 0.02). No clinical difference was seen between the two groups. No clinical factor was significant for the development of irritable bowel syndrome after diverticulitis, and no independent factor was associated with the development of irritable bowel syndrome. Among the 13 patients who developed post-diverticulitis irritable bowel syndrome, the diarrhea-predominant type (53.9 %) was most common. A higher incidence of irritable bowel syndrome after diverticulitis was evident in this study. However, no clinical feature for prediction of its development after diverticulitis was found. Further large-scale analysis will be needed to generalize this result.

  9. Bombesin in short bowel syndrome.

    Science.gov (United States)

    Uluutku, Ahmet Haldun; Akin, Mehmet Levhi; Kurt, Yavuz; Yucel, Ergun; Cermik, Hakan; Avsar, Kadir; Celenk, Tuncay

    2004-01-01

    Short bowel syndrome comprises the sequel of nutrient, fluid, and weight loss that occurs subsequent to greatly reduced functional surface area of the small intestine. The aim of this study is to investigate the trophic and functional effects of bombesin on remaining gut in rats with experimentally induced short bowel syndrome. Thirty-two rats were allocated randomly and experimental short bowel syndrome was induced by 80% bowel resection in all rats. A regular enteral diet and isocaloric elemental enteral nutrition for 12 days were given in the control group and the elemental nutrition group, respectively. In the bombesin group 10 microg/kg subcutaneous bombesin (t.i.d.) for 10 days with regular enteral diet for 12 days was given. In the elemental nutrition and bombesin group the diet consisted of 10 microg/kg subcutaneous bombesin (t.i.d.) for 10 days with isocaloric elemental enteral nutrition for 12 days was given. All rats underwent physical, histological, and biochemical evaluation. Reduction in weight loss, bowel diameter, fecal fat content, and glycemia, increase in cellularity, and d-xylose absorption were observed in all treatment groups. These changes were more evident in the bombesin treatment groups. Increases in serum protein and albumin levels were seen with bombesin treatment with or without elemental diet, whereas reductions in villous height and crypt depth were observed only with bombesin treatment without elemental diet. Serum calcium, iron, and vitamin B(12) levels were not affected with any treatment. It is concluded that bombesin may be a useful trophic agent contributing to increased absorptive capacity and improved biochemical values even in the absence of elemental nutrition.

  10. A RARE CASE OF BOWEL GANGRENE WITH PREGNANCY WITH IUD

    Directory of Open Access Journals (Sweden)

    Jasbir Kaur Saluja

    2017-06-01

    Full Text Available PRESENTATION OF CASE A 26 year primigravida was referred with the diagnosis of 28 week pregnancy with intestinal obstruction. She complained of distension, pain in abdomen, not passing stool and flatus since 2 days, vomiting since 1 day. No history of previous surgery. On examination, her condition was poor, pulse 120/min., respiration 44/min. and blood pressure 100/60 mmHg. Abdominal inspection revealed gross distension. On palpation, abdomen was tense, guarding and tenderness was present, no fluid thrill or shifting dullness found, bowel sounds absent. Height of uterus was not clearly marked. Vaginal examination showed foetal head deep in pelvis and cervical os closed and posteriorly placed. Per rectal examination revealed an empty rectum. Investigation- HB 8.7 g%, blood group- O negative, WBC 20.95 x 10 3 /UL, urine examination positive for blood cells, pus cells 40-50/hpf and RBC 30-40/hpf. USG whole abdomen showed subacute intestinal obstruction with mild ascites. USG obstetrics showed 28 weeks pregnancy with intrauterine dead foetus. X-ray abdomen standing showed multiple free fluid levels suggestive of intestinal obstruction. Fluid resuscitation and intravenous antibiotics were started, nasogastric tube suctioning had large amount of bilious fluid (approximately 1000 mL. Surgical referral suggested subacute intestinal obstruction.

  11. Probiotic bacteria in the prevention and the treatment of inflammatory bowel disease.

    Science.gov (United States)

    Fedorak, Richard; Demeria, Denny

    2012-12-01

    Definitive curative strategies for inflammatory bowel disease remain challenging for physicians and patients. For decades, probiotic organisms have been used in various gastrointestinal diseases. Only recently has comprehension of the pathophysiology of inflammatory bowel disease developed to the point where the significance of the host gastrointestinal microbial population is seen to have marked influence on the initiation and ongoing inflammatory processes of Crohn disease and ulcerative colitis. Well-designed, large randomized controlled trials using probiotics in patients with inflammatory bowel disease are required for probiotics to become mainstream therapy. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Resection of peritoneal metastases causing malignant small bowel obstruction

    Directory of Open Access Journals (Sweden)

    Merrie Arend EH

    2007-10-01

    Full Text Available Abstract Background Resection of peritoneal metastases has been shown to improve survival in patients with abdominal metastatic disease from abdominal or extra abdominal malignancy. This study evaluates the benefit of peritoneal metastatic resection in patients with malignant small bowel obstruction and a past history of treated cancer. Patients and methods Patients undergoing laparotomy for resection of peritoneal metastases from recurrence of previous cancer between 1992–2003 were reviewed retrospectively. Data were collected about type of primary cancer, interval to recurrence, extent of the disease and completeness of resection, morbidity and mortality and long-term survival. Results Between 1992 and 2003 there were 79 patients (median age 62, range 19–91 who had laparotomy for small bowel obstruction due to recurrent cancer. The primary cancer was colorectal (31, gynaecologic cancer (19, melanoma (16 and others (13. Overall, the rate of complications was 35% and mortality was 10%. Median survival was 5 months; patients with history of colorectal cancer had better survival than other cancer (median survival 7 months vs. 4 months; p = 0.02. Multivariate analysis showed that the extent of recurrent disease was the only factor that affected overall survival. Conclusion Laparotomy for small bowel obstruction is a worthwhile option for patients with malignant small bowel obstruction. Although it is associated with significant morbidity and mortality it offers a reasonable survival benefit in particular for patients with completely resectable disease.

  13. Indicators for surgery in adhesive bowel obstruction.

    Science.gov (United States)

    Rajanikmanth, P V; Kate, V; Ananthakrishnan, N

    2001-01-01

    There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.

  14. Reconstruction of short bowel syndrome after internal hernia in a pregnant woman with previous bariatric surgery ?

    OpenAIRE

    Borghede, M?rta Kristina; Vinter-Jensen, Lars; Andersen, Jens Christian; Mortensen, Peter Br?ndum; Rasmussen, Henrik H?jgaard

    2013-01-01

    INTRODUCTION Bariatric surgery is most often performed with the laparoscopic Roux-en-Y gastric bypass. A complication to the laparoscopic Roux-en-Y gastric bypass is internal hernia, which occurs in up to 16% of the patients. Since the laparoscopic Roux-en-Y gastric bypass is performed in women of fertile age, internal hernia may occur during pregnancy. PRESENTATION OF CASE A 22-year old woman with a history of laparoscopic Roux-en-Y gastric bypass suffered from massive internal hernia during...

  15. The effect of cis-diammine dichloro platinum(II) on radiation injury in the rat bowel

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Rhee, Chung Sik

    1995-01-01

    This experimental study was performed for evaluate the effects of cis-diamminedichloroplatinum(II) (cis-DDP) on the radiation injury of rat bowel by histopathologic changes. Rats were exposed to entire abdomen by a single doses of X-ray(6-10 Gy) without or with cis-DDP(2.5mg/kg). Rats were divided into 3 groups such as radiation alone, cis-DDP alone and combined group. In combined group, cis-DDP was given 30 minutes before or immediately after irradiation. Cis-DDP induced the inflammatory cell infiltrations with focal necrosis of the mucosa in the small bowel and no abnormal change in the large bowel. In radiation alone group, mucosal necrosis, submucosal fibrosis and muscular necrosis were prominent changes in small bowel and submucosal fibrosis in the large bowel. The submucosal fibrosis in the small bowel was appeared in 10 Gy of radiation alone group and 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the large bowel, submucosal fibrosis was noted in 8 Gy of radiation alone group 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the small bowel, the enhancement ratio was 1.67 in a group of cis-DDP infusion before radiation and 1.25 in group of cis-DDP infusion after radiation as the end point was the submucosal fibrosis. In the large bowel, the enhancement ratio was 1.33 in a group of cis-DDP infusion before radiation and 1.0 in a group of cis-DDP infusion after radiation as the end point was the submucosal fibrosis. This study suggested that cis-DDP enhance the radiation effect in the small and large bowel especially when cis-DDP was infused before radiation

  16. Extraskeletal Myxoid Chondrosarcoma with Small Bowel Metastasis Causing Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Ernesto Bustinza-Linares

    2012-01-01

    Full Text Available A 28-year-old female with history of chest wall extraskeletal myxoid chondrosarcoma (EMC presented to the emergency department complaining of two weeks of lightheadedness and fatigue. Laboratories showed hemoglobin of 7.6 g/dL and a positive hemoccult test. Upper and lower endoscopies were unremarkable, and the patient was discharged after blood transfusion. The next day she returned to the ED with left-sided weakness and perioral numbness. Brain CT scan revealed a 6 cm right frontal mass with midline shift and edema that required urgent craniotomy with resection of a hemorrhagic tumor. The patient continued dropping her hemoglobin, and CT scans showed a rounded 3 cm small bowel mass in the mid ileum. Repeat upper endoscopy revealed a 2 × 2 cm ulcerated mass in the fourth portion of the duodenum. The patient was taken to the operating room and was found to have two lesions; one in the distal duodenum and a second one in the mid ileum causing small bowel intussusception. Pathology was consistent with metastatic EMC grade 2/3, involving the bowel and mesenteric fat. Extraskeletal myxoid chondrosarcoma (EMC is a rare soft-tissue sarcoma with unique features that distinguishes, it from other sarcomas. It has been often described as a low-grade sarcoma although there are certain characteristics like high mitotic activity and the presence of focal regions of Ki67 staining above 25% that correlate with aggressive behavior of the tumor. This is the first case of EMC metastatic to the small bowel to be reported to the medical community.

  17. Transvaginal small-bowel evisceration: a case report.

    Science.gov (United States)

    Rollinson, D; Brodman, M L; Friedman, F; Sperling, R

    1995-05-01

    Transvaginal small-bowel evisceration is rare. Only 47 case reports appear in the literature in English. Review of this literature shows that vaginal evisceration occurs mainly in women who are older, multiparous, and have undergone vaginal surgery. The immediate cause of evisceration is either sudden, increased intraabdominal pressure, trauma, or a spontaneous event. The small bowel and omentum are most commonly involved. Surgical repair is performed vaginally, abdominally, or by both methods. We present a case of transvaginal small bowel evisceration caused by inadvertent self-induced trauma, a heretofore unreported cause of this complication, in a 79-year-old woman with known weakness of her pelvic structural support. She experienced sudden evisceration of small bowel following manual decompression of her cystocele during voiding. We used a combined abdominal and vaginal approach to examine the small and large intestines and mesentery for trauma, attach the vaginal vault to the shortened uterosacral ligament, obliterate the cul-de-sac using the Moschowitz procedure, and repair the defect in the levator plate. To limit risk, patients should be evaluated for predisposing conditions. We recommend a combined abdominal and vaginal surgical approach to adequately evaluate the involved tissues and to effect repair.

  18. Pyometra presenting in conjunction with bowel cancer in a post-menopausal women: a case report.

    Science.gov (United States)

    Soleymani Majd, Hooman; Watermeyer, Sean; Ismail, Lamiese

    2008-07-08

    This case describes a 71 year old, post-menopausal woman who developed vaginal discharge. This complaint ultimately led to the discovery of bowel cancer in conjunction with a large sterile pyometra.The pyometra was not due to genital malignancy. The most likely conclusion is that the pyometra may have arisen as an inflammatory response to the adjacent bowel pathology. This case report highlights the need for clinicians to consider non-gynaecological cancer as a possible cause for otherwise unexplained pyometra.

  19. Pyometra presenting in conjunction with bowel cancer in a post-menopausal women: a case report

    OpenAIRE

    Soleymani majd, Hooman; Watermeyer, Sean; Ismail, Lamiese

    2008-01-01

    This case describes a 71 year old, post-menopausal woman who developed vaginal discharge. This complaint ultimately led to the discovery of bowel cancer in conjunction with a large sterile pyometra. The pyometra was not due to genital malignancy. The most likely conclusion is that the pyometra may have arisen as an inflammatory response to the adjacent bowel pathology. This case report highlights the need for clinicians to consider non-gynaecological cancer as a possible cause for otherwise u...

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

    Science.gov (United States)

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

    2000-10-01

    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.

  1. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Trier Møller, Frederik; Andersen, Vibeke; Jess, Tine

    2014-01-01

    Background The inflammatory bowel diseases (IBD) – ulcerative colitis (UC) and Crohn’s disease (CD) - are caused by complex gene-environment interactions. This study provides updated familial aggregation patterns in a large population-based Danish IBD cohort. Methods: Our cohort study was based...... on the entire Danish population during 1977-2011 (n=8,295,773). Through a unique personal identification number assigned to each Danish citizen, sex, date and location of birth, identity of parents, and information on vital status and emigration were available. This information was used to establish kinship...... in the entire population. Individuals receiving at least 2 diagnoses of IBD during the time period (n=45,780) were identified using the Danish National Registry of Patients. Risk of IBD in family members to individuals with IBD was assessed by Poisson regression analysis. Results: The overall proportion...

  2. [Inflammatory bowel diseases: conservative therapy].

    Science.gov (United States)

    Bansky, G

    1991-07-01

    Recent advances in the medical treatment of the inflammatory bowel diseases are reviewed with emphasizes on controlled clinical trials. The newly developed mesalazine contains the active moiety of sulfasalazine, the 5-aminosalicylic acid. In ulcerative colitis mesalazine appears to be as efficacious as the time-honored sulfasalazine; it has however less adverse effects. Corticosteroids remain the most effective drugs in severe attacks of all forms of inflammatory bowel diseases. The immunosuppressive agents 6-mercoptopurine and azathioprine are useful second-line drugs in otherwise refractory Crohn's disease. The place of cyclosporin is at present uncertain. Metronidazole is the only efficient antibiotics in the treatment of Crohn's disease. The relative merits of various diets are discussed.

  3. The Immune System in Irritable Bowel Syndrome

    Science.gov (United States)

    Cremon, Cesare; Carini, Giovanni; Bellacosa, Lara; Zecchi, Lisa; De Giorgio, Roberto; Corinaldesi, Roberto; Stanghellini, Vincenzo

    2011-01-01

    The potential relevance of systemic and gastrointestinal immune activation in the pathophysiology and symptom generation in the irritable bowel syndrome (IBS) is supported by a number of observations. Infectious gastroenteritis is the strongest risk factor for the development of IBS and increased rates of IBS-like symptoms have been detected in patients with inflammatory bowel disease in remission or in celiac disease patients on a gluten free diet. The number of T cells and mast cells in the small and large intestine of patients with IBS is increased in a large proportion of patients with IBS over healthy controls. Mediators released by immune cells and likely from other non-immune competent cells impact on the function of enteric and sensory afferent nerves as well as on epithelial tight junctions controlling mucosal barrier of recipient animals, isolated human gut tissues or cell culture systems. Antibodies against microbiota antigens (bacterial flagellin), and increased levels of cytokines have been detected systemically in the peripheral blood advocating the existence of abnormal host-microbial interactions and systemic immune responses. Nonetheless, there is wide overlap of data obtained in healthy controls; in addition, the subsets of patients showing immune activation have yet to be clearly identified. Gender, age, geographic differences, genetic predisposition, diet and differences in the intestinal microbiota likely play a role and further research has to be done to clarify their relevance as potential mechanisms in the described immune system dysregulation. Immune activation has stimulated interest for the potential identification of biomarkers useful for clinical and research purposes and the development of novel therapeutic approaches. PMID:22148103

  4. Inflammatory Bowel Disease in Primary Immunodeficiencies.

    Science.gov (United States)

    Kelsen, Judith R; Sullivan, Kathleen E

    2017-08-01

    Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease. The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis. This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

  5. Evaluation of bowel distension and bowel wall visualization according to patient positions during administration of oral contrast media for CT enterography.

    Science.gov (United States)

    Lee, Seul Bi; Kim, Seung Ho; Son, Jung Hee; Baik, Ji Yeon

    2017-12-01

    To compare small bowel distension and bowel wall visualization among three different patients' positions (supine, sitting and right decubitus) during administration of oral contrast media in preparation for CT enterography (CTE). A total of 150 consecutive patients (104 males and 46 females; mean age 34.6 years, range 15-78 years) who were scheduled to undergo CTE were recruited. Patients were randomly allocated into the three position groups during oral contrast media administration, and there were 50 patients in each group. Two blinded radiologists independently scored the luminal distension and visualization of the bowel wall using a continuous 5-point scale (1: worst and 5: best) at the jejunum and ileum. The Mann-Whitney U test was used to evaluate differences between any two groups among the three positions for bowel distension and wall visualization. For ileal distension, the supine and sitting positions performed better than the right decubitus position [for reader 1, mean: 3.4/3.2/2.9 (hereafter, supine/sitting/right decubitus in order), p = 0.002/0.033; for reader 2, 3.3/3.0/2.6, p 0.05, respectively). For bowel wall visualization, the supine and sitting positions were superior to the right decubitus position for the ileum when scored by one reader (4.0/3.8/3.4, p = 0.001/0.015). Supine and sitting positions during the administration of oral contrast media provided better ileal distension than the right decubitus position in obtaining CTE. Advances in knowledge: The performance of CTE largely depends on adequate luminal distension and wall visualization. As the terminal ileum is the predominant site of small bowel pathology for inflammatory bowel disease, the supine or sitting position would be preferable for patients who are suspected of having small bowel pathology.

  6. The State of Mechanical Bowel Preparation in Colorectal Surgery

    NARCIS (Netherlands)

    H.P. van 't Sant (Hans Pieter)

    2014-01-01

    markdownabstract__Abstract__ Surgical resection is the cornerstone of treatment for patients with colorectal cancer and has an important role in patients with inflammatory bowel disease or other benign bowel conditions requiring surgical treatment. Generally, restoration of bowel continuity

  7. Late radiation-induced bowel syndromes, tobacco smoking, age at treatment and time since treatment - gynecological cancer survivors.

    Science.gov (United States)

    Steineck, Gunnar; Sjöberg, Fei; Skokic, Viktor; Bull, Cecilia; Wilderäng, Ulrica; Alevronta, Eleftheria; Dunberger, Gail; Bergmark, Karin; Jörnsten, Rebecka

    2017-05-01

    It is unknown whether smoking; age at time of radiotherapy or time since radiotherapy influence the intensity of late radiation-induced bowel syndromes. We have previously identified 28 symptoms decreasing bowel health among 623 gynecological-cancer survivors (three to twelve years after radiotherapy) and 344 matched population-based controls. The 28 symptoms were grouped into five separate late bowel syndromes through factor analysis. Here, we related possible predictors of bowel health to syndrome intensity, by combining factor analysis weights and symptom frequency on a person-incidence scale. A strong (p bowel health among gynecological-cancer survivors. Furthermore, by understanding the mechanism for the decline in urgency-syndrome intensity over time, we may identify new strategies for prevention and alleviation.

  8. CT findings in acute small bowel diverticulitis

    International Nuclear Information System (INIS)

    Ferstl, F.J.; Obert, R.

    2004-01-01

    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.) [de

  9. Small-bowel permeability in collagenous colitis

    DEFF Research Database (Denmark)

    Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

    2006-01-01

    OBJECTIVE: Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestin......OBJECTIVE: Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small...

  10. Definition and Facts for Irritable Bowel Syndrome

    Science.gov (United States)

    ... For Health Professionals Diabetes Discoveries & Practice Blog Health Communication Programs FAQs ... Syndrome (IBS) Definition & Facts Related Topics Section Navigation Irritable Bowel Syndrome ( ...

  11. Socioeconomic status as an independent risk factor for severe late bowel toxicity after primary radiotherapy for cervical cancer.

    Science.gov (United States)

    Laan, J J; van Lonkhuijzen, L R C W; van Os, R M; Tytgat, K M; Dávila Fajardo, R; Pieters, B R; Stalpers, L J A; Westerveld, G H

    2017-12-01

    To evaluate the frequency of and risk factors for severe late bowel toxicity after curative radiotherapy in women treated for locally advanced cervical cancer. Included were 515 women treated for locally advanced cervical cancer with primary radiotherapy with curative intent from 1992 to 2013. Bowel toxicity was graded according to the Common Terminology Criteria for Adverse Events. Associations between risk factors and severe late bowel toxicity were assessed using Cox proportional hazards regression models. Median follow-up was 78months. Fifty-nine patients developed severe late bowel toxicity. The actuarial 3-year and 5-year severe late bowel toxicity rates were both 13%. In the multivariable analysis, factors significantly associated with severe late bowel toxicity were: smoking (HR 2.59 [1.48-4.55]), severe acute bowel toxicity (HR 2.46 [1.24-4.49]), previous major abdominal surgery (HR 2.35 [1.20-4.60]), hypertension (HR 2.33 [1.23-4.40]), parametrial boost (HR 2.18 [1.10-4.33]), low socioeconomic status (HR 2.05 [1.17-3.59]) and low BMI (HR 0.93 [0.88-0.99]). First symptoms of severe late bowel toxicity were reported after a median follow-up of 9months, but occurred up to 10years after end of treatment. Only one third of the patients with severe late bowel toxicity were referred to a gastroenterologist. Severe late bowel toxicity is a frequent complication of definitive radiotherapy for cervical cancer. Several independent risk factors were found which warrant further research. A standardized and structured approach in the early diagnostics and management of bowel toxicity is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Diospyrobezoar as a Cause of Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Andréia Padilha de Toledo

    2012-09-01

    Full Text Available Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki. We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

  13. Deep organ space infection after emergency bowel resection and anastomosis: The anatomic site does not matter.

    Science.gov (United States)

    Benjamin, Elizabeth; Siboni, Stefano; Haltmeier, Tobias; Inaba, Kenji; Lam, Lydia; Demetriades, Demetrios

    2015-11-01

    Deep organ space infection (DOSI) is a serious complication after emergency bowel resection and anastomosis. The aim of this study was to identify the incidence and risk factors for the development of DOSI. National Surgical Quality Improvement Program database study including patients who underwent large bowel or small bowel resection and primary anastomosis. The incidence, outcomes, and risk factors for DOSI were evaluated using univariate and multivariate analyses. A total of 87,562 patients underwent small bowel, large bowel, or rectal resection and anastomosis. Of these, 14,942 (17.1%) underwent emergency operations and formed the study population. The overall mortality rate in emergency operations was 12.5%, and the rate of DOSI was 5.6%. A total of 18.0% required ventilatory support in more than 48 hours, and 16.0% required reoperation. Predictors of DOSI included age, steroid use, sepsis or septic shock on admission, severe wound contamination, and advanced American Society of Anesthesiologists classification. The anatomic location of resection and anastomosis was not significantly associated with DOSI. Patients undergoing emergency bowel resection and anastomosis have a high mortality, risk of DOSI, and systemic complications. Independent predictors of DOSI include wound and American Society of Anesthesiologists classification, sepsis or septic shock on admission, and steroid use. The anatomic location of resection and anastomosis was not significantly associated with DOSI. Epidemiologic/prognostic study, level III.

  14. Proton pump inhibitor therapy did not increase the prevalence of small-bowel injury: A propensity-matched analysis.

    Directory of Open Access Journals (Sweden)

    Atsuo Yamada

    Full Text Available Previous studies have reported that the suppression of acid secretion by using proton pump inhibitors (PPIs results in dysbiosis of the small-bowel microbiota, leading to exacerbated small-bowel injuries, including erosions and ulcers. This study was designed to assess the association between PPI therapy and small-bowel lesions after adjustment for the differences in baseline characteristics between users and non-users of PPIs.We retrospectively studied patients suspected to be suffering from small-bowel diseases, who underwent capsule endoscopy between 2010 and 2013. We used propensity matching to adjust for the differences in baseline characteristics between users and non-users of PPIs. The outcomes included the prevalence of small-bowel lesions: erosion, ulcer, angioectasia, varices, and tumor.We selected 327 patient pairs for analysis after propensity matching, and found no significant differences in the prevalence of small-bowel injuries, including erosions and ulcers, between users and non-users of PPIs. Two subgroup analyses of the effect of the type of PPI and the effect of PPI therapy in users and non-users of nonsteroidal anti-inflammatory drugs indicated no significant differences in the prevalence of small-bowel injuries in these two groups.PPI therapy did not increase the prevalence of small-bowel injury, regardless of the type of PPI used and the use of nonsteroidal anti-inflammatory drugs.

  15. Meta-Analysis of the Effect of Bowel Preparation on Adenoma Detection: Early Adenomas Affected Stronger than Advanced Adenomas.

    Science.gov (United States)

    Sulz, Michael C; Kröger, Arne; Prakash, Meher; Manser, Christine N; Heinrich, Henriette; Misselwitz, Benjamin

    2016-01-01

    Low-quality bowel preparation reduces efficacy of colonoscopy. We aimed to summarize effects of bowel preparation on detection of adenomas, advanced adenomas and colorectal cancer. A systematic literature search was performed regarding detection of colonic lesions after normal and low-quality bowel preparation. Reported bowel preparation quality was transformed to the Aronchick scale with its qualities "excellent", "good", "fair", "poor", and "insufficient" or "optimal" (good/excellent), "suboptimal" (fair/poor/insufficient), "adequate" (good/excellent/fair) and "inadequate" (poor/insufficient). We identified two types of studies: i) Comparative studies, directly comparing lesion detection according to bowel preparation quality, and ii) repeat colonoscopy studies, reporting results of a second colonoscopy after previous low-quality preparation. The detection of early adenomas was reduced with inadequate vs. adequate bowel preparation (Odds Ratio (OR) 0.53, CI: 0.46-0.62, panalysis resulted in smaller confidence intervals compared to earlier studies. Classifying the bowel-preparation quality as suboptimal vs. optimal led to the same qualitative conclusion (OR: 0.81, CI: 0.74-0.89, pdetection were insufficient. Inadequate bowel preparation affects detection of early colonic lesions stronger than advanced lesions.

  16. Giant small bowel diverticulum presenting after percutaneous gastrostomy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, G.J.; Clark, J.A.; Pugash, R.A. [St. Michael' s Hospital, Wellesley Central Site, Dept. of Medical Imaging, Toronto, Ontario (Canada)

    2000-10-01

    The standard technique for percutaneous gastrostomy requires insufflation of air into the stomach via a nasogastric tube before percutaneous gastric puncture. We present a previously undescribed complication in which the insertion of a percutaneous gastrostomy tube resulted in the distention of a previously undiagnosed giant small bowel diverticulum. This led to discomfort for the patient, further radiologic investigation and a delay in discharge. Symptoms resolved with conservative management. We suggest a strategy for avoiding this complication, as well as for reducing the incidence of post-procedure ileus. (author)

  17. Histamine, mast cells, and the enteric nervous system in the irritable bowel syndrome, enteritis, and food allergies

    OpenAIRE

    Wood, J D

    2006-01-01

    There is altered expression of histamine H1 and H2 receptor subtypes in mucosal biopsies from the terminal ileum and large intestine of patients with symptoms of food allergy and/or irritable bowel syndrome

  18. Inflammatory bowel disease and irritable bowel syndrome: similarities and differences.

    Science.gov (United States)

    Barbara, Giovanni; Cremon, Cesare; Stanghellini, Vincenzo

    2014-07-01

    Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are classically viewed as dichotomous conditions. The former is perceived as a typical organic disease, and the latter is regarded as a disorder of gut function driven by mood. Recent research identified some shared contributing factors, which will be discussed here. Mounting evidence shows the importance in both IBD and IBS of genetic, microbiological, epithelial, and immunological factors. In some instances, these factors overlap in the two conditions as shown by: involvement of brain-gut axis dysfunction in IBD, implication of TNFSF gene in Crohn's disease and IBS, evidence of abnormal microbiota and its impact on host functions, identification of low-grade inflammation in subsets of IBS patients, and development of IBS symptoms in patients with IBD in remission. IBD and IBS remain separate conditions although there are some overlapping mechanisms. Both research and clinical management would benefit from considering a functional approach for certain manifestations of IBD and accepting an organic view in subsets of IBS patients.

  19. Small-bowel permeability in collagenous colitis

    DEFF Research Database (Denmark)

    Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

    2006-01-01

    Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies...

  20. Familial occurrence of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, M; Munkholm, P; Langholz, E

    1991-01-01

    BACKGROUND AND METHODS: We assessed the familial occurrence of inflammatory bowel disease in Copenhagen County, where there has been a long-term interest in the epidemiology of such disorders. In 1987 we interviewed 662 patients in whom inflammatory bowel disease had been diagnosed before 1979, a...

  1. Video capsule endoscopy of the small bowel.

    Science.gov (United States)

    Eliakim, Rami

    2013-03-01

    Small bowel capsule endoscopy (SBCE) was introduced 13 years ago by Given Imaging (Yokneam, Israel). It has become one of the most important investigational tools of the small bowel. The capsule is swallowed with water after a 12 h fast, propelled via peristalsis through the gastrointestinal tract and excreted naturally. A nonvideo patency capsule was developed to confirm functional patency of the gastrointestinal tract. Four additional companies have introduced competitive small bowel video capsules, some of which are Food and Drug Admistration (FDA) approved. Due to the easiness of the procedure, SBCE has become a first-line tool to detect small bowel abnormalities. The main indications for SBCE include obscure gastrointestinal bleeding, suspected Crohn's disease, small bowel tumors and practically any abnormal small bowel imaging. New indications are emerging like small bowel motility and monitoring of drug therapy and mucosal healing. The present review will describe the available capsules in the market, the procedure itself, present indications and future expectations. It will focus on the PillCam SB of Given Imaging as it is the one on which most of the literature is written. Over the past 10 years, SBCE has become a routine, first-line investigational tool of many small bowel pathologies.

  2. Bowel injury following gynecological laparoscopic surgery | Elbiss ...

    African Journals Online (AJOL)

    The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed. Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and ...

  3. Surgical perspectives on inflammatory bowel disease

    African Journals Online (AJOL)

    VikasC

    Xia B, Crusius JBA, Meuwissen SGM, Pena AS. Inflammatory bowel disease: Definition, epidemiology, etiologic aspects, and immunologic studies. World J. Gastroentero 1998;4:44658. 2. Fry DR, Mahmood N, Maron DJ, Ross HM, Rombeau. J. Inflammatory bowel disease in Towsend: Sabiston. Textbook of Surgery.

  4. Bowel injury as a complication of laparoscopy

    NARCIS (Netherlands)

    van der Voort, M.; Heijnsdijk, E. A. M.; Gouma, D. J.

    2004-01-01

    Background: Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. Methods: The review was carried out using the MeSH browser within

  5. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    Abstract. Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication. Methods: We performed a narrative review on bowel ...

  6. Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review.

    Science.gov (United States)

    Iversen, Maja L; Seyer-Hansen, Mikkel; Forman, Axel

    2017-06-01

    Reduced fertility is a major concern in women with endometriosis. The influence of surgery of deep infiltrating endometriosis (DIE) affecting the bowel wall on fertility is controversial and the literature on this field is heterogeneous. In this review we addressed whether surgery for bowel DIE improves the spontaneous pregnancy rate, and the results of in vitro fertilization (IVF), and the potential risk of such surgery. We conducted a literature search including the terms "deep", "deep infiltrating", "bowel", rectovaginal", "endometriosis", "fertility", "infertility" and "IVF" in PubMed. No randomized controlled studies were found. Other publications of relevance included four retrospective and three prospective observational studies. Moreover, one retrospective study compared results of IVF treatment with or without previous surgery for bowel DIE. All studies reported detailed data on surgical complications. The poor data quality precluded firm conclusions. The results indicate, however, the possibility that surgery for bowel DIE may improve the spontaneous pregnancy rate, and positive effects on IVF outcome cannot be excluded. Such surgery will be associated with risk of major complications. The lack of proper data precludes conclusions on the potential role for bowel DIE surgery to improve the spontaneous pregnancy rate and results of IVF treatment. Positive effects cannot be excluded, but the definite risk of major complications must be taken into account. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  7. Diet and Inflammatory Bowel Disease.

    Science.gov (United States)

    Knight-Sepulveda, Karina; Kais, Susan; Santaolalla, Rebeca; Abreu, Maria T

    2015-08-01

    Patients with inflammatory bowel disease (IBD) are increasingly becoming interested in nonpharmacologic approaches to managing their disease. One of the most frequently asked questions of IBD patients is what they should eat. The role of diet has become very important in the prevention and treatment of IBD. Although there is a general lack of rigorous scientific evidence that demonstrates which diet is best for certain patients, several diets-such as the low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet; the specific carbohydrate diet; the anti-inflammatory diet; and the Paleolithic diet-have become popular. This article discusses the diets commonly recommended to IBD patients and reviews the supporting data.

  8. Immunotherapy in inflammatory bowel disease.

    Science.gov (United States)

    Ahluwalia, Jatinder P

    2012-05-01

    Inflammatory bowel disease affects an increasing number of patients worldwide and is associated with significant morbidity. The dysregulation of the immune system with increased expression of proinflammatory cytokines and increased mucosal expression of vascular adhesion molecules play an important role in its pathogenesis. Strategies targeting TNF-alpha and alpha4-integrin have led to the development of novel therapies for treatment of patients with IBD. This article discusses the efficacy of immunologic agents currently approved for treating Crohn disease and ulcerative colitis and reviews the risks and challenges associated with their use. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Small Bowel Review: Part I

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    2000-01-01

    Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. More than 1500 papers were assessed in preparation for this review. Some were selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope, and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

  10. Efficacy of a multifactorial strategy for bowel preparation in diabetic patients undergoing colonoscopy: a randomized trial.

    Science.gov (United States)

    Alvarez-Gonzalez, Marco Antonio; Flores-Le Roux, Juana A; Seoane, Agustin; Pedro-Botet, Juan; Carot, Laura; Fernandez-Clotet, Agnés; Raga, Agnés; Pantaleon, Miguel A; Barranco, Luis; Bory, Felipe; Lorenzo-Zuñiga, Vicente

    2016-11-01

    Background and study aims: Previous studies have reported that diabetes mellitus is an independent risk factor for inadequate bowel preparation. Current guidelines do not recommend a specific preparation for this patient population. The aims of this study were to assess the efficacy, safety, and tolerability of an adapted preparation protocol for colon cleansing in patients with type 2 diabetes mellitus. Patients and methods: This randomized, single-blind, parallel group, superiority trial compared a conventional bowel preparation protocol (CBP) with a diabetes-specific preparation protocol (DSP). The CBP included a low-fiber diet for 3 days followed by a clear liquid diet for 24 hours before colonoscopy. The DSP included a multifactorial strategy combining an educational intervention, a low-fiber diet, and adjustment of blood glucose-lowering agents. All patients received 4 L of a polyethylene glycol solution in a split-dose regimen. The endoscopists were blinded to the preparation protocol. The primary outcome measure was inadequate bowel preparation according to the Boston Bowel Preparation Scale. Secondary outcome measures included hypoglycemic events, tolerability, and acceptability. Results: A total of 150 patients were included in the study (74 CBP and 76 DSP). Both groups were comparable in terms of baseline characteristics. Inadequate bowel cleansing was more frequent following CBP than DSP (20 % vs. 7 %, P  = 0.014; risk ratio 3.1, 95 % confidence interval 1.2 - 8). Only CBP and performance status were independently associated with inadequate bowel preparation. Both preparations were equally tolerated and accepted by patients, and side-effects were similar between the groups. Conclusions: A multifactorial strategy for bowel preparation in patients with diabetes undergoing colonoscopy showed a threefold reduction in the rate of inadequate bowel preparation, with no differences in safety and tolerability compared with conventional

  11. [The character of the morphological changes of the mucous membrane of the large intestine and the genetic polymorphism of IL-1RA, IL-1B, IL-4 TNFA in patient with irritable bowel syndrome].

    Science.gov (United States)

    Sarsenbaeva, A S; Ivanova, E L; Burmistrova, A L; Drozdov, I V

    2013-01-01

    The aim of this study was to evaluate the presence or absence of a relationship between the variants of the course of IBS and their association with genetic polymorphisms of genes and intergenic interaction of cytokines. The sample consisted of 81 patients, the diagnosis was verified according to the criteria of the Rome III, were isolated psychopathological, morphological complications, extra-intestinal symptoms. Polymorphism genotyping IL-1Ra, IL-b, IL-4, TNFa performed by PCR. Statistical treatment are a non-parametric analysis of multiple comparisons, hierarchical log-linear analysis. It is found out the relation between the clinical variants with morphological changes of the mucous membrane of the large intestine, the association between gender characteristics of patients with IBS is established and with genetic polymorphisms of cytokines.

  12. Irritable bowel syndrome: contemporary nutrition management strategies.

    Science.gov (United States)

    Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

    2014-09-01

    Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome. © 2014 American Society for Parenteral and Enteral Nutrition.

  13. Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel: A Prospective Cohort Study.

    Science.gov (United States)

    Kent, Andrew; Shakir, Fevzi; Rockall, Tim; Haines, Pat; Pearson, Carol; Rae-Mitchell, Wendy; Jan, Haider

    2016-01-01

    Endometriosis can affect 10% of women at reproductive age. Of those, 5.3% to 12% will have endometriosis affecting the bowel. Although outcomes after surgery for severe endometriosis affecting the bowel have previously been studied and have shown improvement in generic quality of life indices and sexual function, few studies have evaluated bowel function or symptoms specific to endometriosis. Our aim was to determine the quality of life after radical excision of rectovagina endometriosis compromising the bowel. Single-center prospective cohort study (Canadian Task Force classification II-2). Specialist referral center for the management of advanced endometriosis. Women with severe rectovaginal endometriosis compromising the bowel. Comparison of preoperative data with a 2-, 6-, and 12-month follow-up was made for consecutive patients who underwent surgery for endometriosis with bowel involvement. The main outcome measures were quality of life using the Endometriosis Health Profile 30 and EuroQol-5 dimension questionnaires. Bowel symptoms were measured using the Gastrointestinal Quality of Life Index. Dysmenorrhea, dyspareunia, dyschezia, and chronic pain were measured using a visual analogue scale. To compare preoperative and postoperative scores, a Freidman test was performed followed by a preoperative and 12-month postoperative Wilcoxon signed-rank test. A Mann-Whitney U test was used to compare the results between those who had pelvic clearance and those who did not. In total, 137 patients had surgery, of which 100 completed follow-up to 12 months. The serious perioperative and postoperative complication rate was 7.3%. The results show significant improvement in almost all variables measured (p < .01). At 12 months patients who had a pelvic clearance (hysterectomy with bilateral salpingo-oophorectomy) had significantly less pain with better bowel function. Additionally, they had higher quality of life scores and greater satisfaction with their treatment

  14. Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection.

    Science.gov (United States)

    Fanning, James; Hojat, Rod; Deimling, Timothy

    2011-01-01

    To review the success and morbidity of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection. Review of a prospective surgical database of all cases of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection. No cases were excluded. Bowel diagnoses and procedures were total colectomy for inflammatory bowel disease (4), partial colectomy for colon cancer (6), partial small bowel resection for obstruction (1), and Whipple for pancreatic cancer (2). Two patients had 3 prior laparotomies, 8 patients had 2 prior laparotomies, and 3 patients had 1 prior laparotomy. All prior abdominal incisions were midline. Gynecologic diagnoses and procedures were laparoscopic cytoreduction for ovarian cancer (1), lsh/bso/staging for ovarian cancer (1), lavh/bso/lymphadenectomy for endometrial cancer (4), and lavh/bso, lsh/bso, or bso for large ovarian mass (7). Median patient age was 57 years, median BMI was 31kg/m(2), and all patients had medical comorbidities. All 13 laparoscopic gynecologic surgeries were successful without trocar insertion injury, conversion to laparotomy, and without enterotomy. Abdominal adhesions were present in all cases. Median operative time was 2 hours, median blood loss was 100cc, and median hospital stay was 1 day. There were no postoperative complications. Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection is feasible for experienced laparoscopic surgeons.

  15. Quantitative analysis of bowel gas by plain abdominal radiograph combined with computer image processing

    International Nuclear Information System (INIS)

    Gao Yan; Peng Kewen; Zhang Houde; Shen Bixian; Xiao Hanxin; Cai Juan

    2003-01-01

    Objective: To establish a method for quantitative analysis of bowel gas by plain abdominal radiograph and computer graphics. Methods: Plain abdominal radiographs in supine position from 25 patients with irritable bowel syndrome (IBS) and 20 health controls were studied. A gastroenterologist and a radiologist independently conducted the following procedure on each radiograph. After the outline of bowel gas was traced by axe pen, the radiograph was digitized by a digital camera and transmitted to the computer with Histogram software. The total gas area was determined as the pixel value on images. The ratio of the bowel gas quantity to the pixel value in the region surrounded by a horizontal line tangential to the superior pubic symphysis margin, a horizontal line tangential to the tenth dorsal vertebra inferior margin, and the lateral line tangential to the right and left anteriosuperior iliac crest, was defined as the gas volume score (GVS). To examine the sequential reproducibility, a second plain abdominal radiograph was performed in 5 normal controls 1 week later, and the GVS were compared. Results: Bowel gas was easily identified on the plain abdominal radiograph. Both large and small intestine located in the selected region. Both observers could finish one radiographic measurement in less than 10 mins. The correlation coefficient between the two observers was 0.986. There was no statistical difference on GVS between the two sequential radiographs in 5 health controls. Conclusion: Quantification of bowel gas based on plain abdominal radiograph and computer is simple, rapid, and reliable

  16. Minimization of small bowel volume within treatment fields using customized small bowel displacement system (SBDS)

    International Nuclear Information System (INIS)

    Lim, D. H.; Huh, S. J.; Ahn, Y. C.; Kim, D. Y.; Wu, H. G.; Kim, M. K.; Choi, D. R.; Shin, K. H.

    1997-01-01

    Authors designed a customized Small Bowel Displacement System(SBDS) to displace the small bowel from the pelvic radiation fields and minimize treatment-related bowel morbidities. From August 1995 to May 1996, 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized styrofoam compression device which can displace the small bowel from the radiation fields and an individualized immobilization abdominal board for easy daily setup in prone position. After opacifying the small bowel with Barium, the patients were laid prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The areas of the small bowel included in the radiation fields with and without the SBDS were compared. Using the SBDS, the mean small bowel area was reduced by 59% on PA and 51% on LAT films (P=0.0001). In six patients (6/55, 11%), it was possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Only 15% (8/55) of patients treated with the SBDS manifested diarrhea requiring medication. The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and reduce the radiation therapy morbidities. Compliance with setup is excellent when the SBDS is used. (author)

  17. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Trier Møller, Frederik; Andersen, Vibeke; Jess, Tine

    2014-01-01

    Background The inflammatory bowel diseases (IBD) – ulcerative colitis (UC) and Crohn’s disease (CD) - are caused by complex gene-environment interactions. This study provides updated familial aggregation patterns in a large population-based Danish IBD cohort. Methods: Our cohort study was based.......92(5.28-9.06) 2.62(1.63-4.23) 1.15(0.29-4.62) One CD relative 2.57(2.28-2.90) 1.51(1.22-1.86) 1.47(1.00-2.17) One UC relative 4.09(3.81-4.38) 1.85(1.60-2.13) 1.51(1.07-2.13) Conclusion: This large-scale population-based study provides updated numbers of familial aggregation of IBD. Familial exposure to CD...... in the entire population. Individuals receiving at least 2 diagnoses of IBD during the time period (n=45,780) were identified using the Danish National Registry of Patients. Risk of IBD in family members to individuals with IBD was assessed by Poisson regression analysis. Results: The overall proportion...

  18. The value of MR enteroclysis with air infusion in the diagnosis of small bowel disease

    International Nuclear Information System (INIS)

    Zhang Shizheng; Ren Xiaojun; Zhang Qiaowei

    2004-01-01

    enhancement but no stenosis. 1 irritable bowel syndrome is disfunction, so its shape and signal is normal. Except 1 Crohn disease, which showed a large mass, was misdiagnosed as lymphoma and no abnormality was found in 1 irritable bowel syndrome, the other diagnosis of MRI was correct. The sensitivity in diagnosing small intestinal disease was 100%, and the specificity was 83%. Conclusion: MR enteroclysis with air infusion is a sensitive method in diagnosing the small bowel disease, especially in Crohn disease and tumor. It can clearly display the mural thickening and the extraluminal inflammatory mass

  19. Five personality dimensions in patients with irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Alireza Farnam

    2008-08-01

    Full Text Available Alireza Farnam, Mohammad H Somi, Firouz Sarami, Sara FarhangLiver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IranAim: Irritable bowel syndrome (IBS as a functional disorder of the gastrointestinal tract has been related to psychological factors. Aim of this study is to study the differences of personality factors between IBS patients compared to our general population.Methods: This study was performed in clinics of Tabriz Medical University during 2006–2007. IBS was diagnosed using the Rome II diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview and after any comorbid psychiatry disorder was ruled out. Personality traits and score of each factor was evaluated using NEO five factor personality inventory compared to results of a previous study on general population of Iran.Results: One hundred and sixty six patients were studied. The mean age (±SD of them was 33.6(±11.4 years (60.8% female. Our study population had their symptoms for a mean interval of 47.3 month. The bowel problems were provoked by distress in more than 80% of patients. Pain in female patients was reported to be more frequent but both gender described the association between stressors and their symptoms. NEO Five-Factor Inventory showed a significantly higher level of neuroticism and conscientiousness and lower level of openness and agreeableness in theses nonpsychiatric IBS patients. Women with IBS had significantly higher levels of openness, conscientiousness, and extraversion compared to men.Conclusion: Differences were observed between IBS patients and general population. Patients with IBS may benefit from psychological interventions.Keywords: irritable bowel syndrome, personality, five-factor model

  20. Defining bowel dose volume constraints for bladder radiotherapy treatment planning.

    Science.gov (United States)

    McDonald, F; Waters, R; Gulliford, S; Hall, E; James, N; Huddart, R A

    2015-01-01

    Increases to radiotherapy dose are constrained by normal tissue effects. The relationship between bowel dose volume data and late bowel toxicity in patients with muscle-invasive bladder cancer treated with radical radiotherapy was assessed. The bowel was contoured retrospectively on radiotherapy plans of 47 patients recruited to the BC2001 trial (CRUK/01/004). The relationship between bowel volume at various dose levels and prospectively collected late bowel toxicity was explored. Fifteen per cent and 6% of patients experienced grade 1 and grade 2 or more late bowel toxicity, respectively. The mean bowel volume was significantly less at doses ≥50 Gy in those treated with reduced high dose volume radiotherapy compared with standard radiotherapy. The probability of late bowel toxicity increased as bowel volume increased (P ≤ 0.05 for dose levels 30-50 Gy). No grade 2 or more late bowel toxicity was observed in patients with bowel volumes under the thresholds given in the model that predict for 25% probability of late bowel toxicity. There is a dose volume effect for late bowel toxicity in radical bladder radiotherapy. We have modelled the probability of late bowel toxicity from absolute bowel volumes to guide clinicians in assessing radical bladder radiotherapy plans. Thresholds predicting for a 25% probability of late bowel toxicity are proposed as dose volume constraints. Copyright © 2014. Published by Elsevier Ltd.

  1. Towards an integrated psychoneurophysiological approach of irritable bowel syndrome

    NARCIS (Netherlands)

    Veek, Patrick Petrus Johannes van der

    2009-01-01

    Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by recurrent abdominal pain or discomfort accompanied by disturbed bowel habits. It is among the most frequently occurring functional bowel syndromes, but the pathophysiology is poorly understood. A variety of mechanisms

  2. Does MRI with oral contrast medium allow single-study depiction of inflammatory bowel disease enteritis and colitis?

    Energy Technology Data Exchange (ETDEWEB)

    Cronin, Carmel G.; Lohan, Derek G.; Browne, Ann Michelle; Roche, Clare; Murphy, Joseph M. [University College Hospital, Department of Radiology, Galway (Ireland)

    2010-07-15

    To assess the feasibility and utility of magnetic resonance (MR) imaging of the bowel in concurrent small- and large-bowel evaluation for the presence of inflammatory bowel disease (IBD). Over a 5-year period, 62 MR examinations performed on 53 patients demonstrated evidence of IBD. Sixteen of these 53 (30.1%) patients had imaging findings of colonic disease and underwent 19 formal MR small bowel examinations. These were further evaluated for bowel distention and image quality. The sensitivity and specificity of the technique compared with colonoscopy as the 'gold standard' was evaluated. Simultaneous imaging of the colon is feasible at MR small bowel follow-through with moderate-to-excellent colonic visibility and colon distention obtained when the contrast medium is present in the colon at the time of image acquisition. MR imaging had a sensitivity of 80% (0.56-0.93), specificity of 100% (0.77-1.00), positive predictive value (PPV) of 1 and a negative predictive value (NPV) of 0.8 for the identification of colitis (based on available concurrent correlation of 38/62 examinations with colonoscopy). Small and large bowel MR imaging with orally consumed contrast medium represents a promising, feasible, non-invasive, non-radiating single mode of assessment of the entire gastrointestinal tract, performed at a single sitting. (orig.)

  3. Does MRI with oral contrast medium allow single-study depiction of inflammatory bowel disease enteritis and colitis?

    International Nuclear Information System (INIS)

    Cronin, Carmel G.; Lohan, Derek G.; Browne, Ann Michelle; Roche, Clare; Murphy, Joseph M.

    2010-01-01

    To assess the feasibility and utility of magnetic resonance (MR) imaging of the bowel in concurrent small- and large-bowel evaluation for the presence of inflammatory bowel disease (IBD). Over a 5-year period, 62 MR examinations performed on 53 patients demonstrated evidence of IBD. Sixteen of these 53 (30.1%) patients had imaging findings of colonic disease and underwent 19 formal MR small bowel examinations. These were further evaluated for bowel distention and image quality. The sensitivity and specificity of the technique compared with colonoscopy as the 'gold standard' was evaluated. Simultaneous imaging of the colon is feasible at MR small bowel follow-through with moderate-to-excellent colonic visibility and colon distention obtained when the contrast medium is present in the colon at the time of image acquisition. MR imaging had a sensitivity of 80% (0.56-0.93), specificity of 100% (0.77-1.00), positive predictive value (PPV) of 1 and a negative predictive value (NPV) of 0.8 for the identification of colitis (based on available concurrent correlation of 38/62 examinations with colonoscopy). Small and large bowel MR imaging with orally consumed contrast medium represents a promising, feasible, non-invasive, non-radiating single mode of assessment of the entire gastrointestinal tract, performed at a single sitting. (orig.)

  4. 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)

    Sergio Carlos Nahas

    2005-06-01

    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.

  5. Transabdominal Ultrasonography of the Small Bowel

    Directory of Open Access Journals (Sweden)

    Rudolf Kralik

    2013-01-01

    Full Text Available In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism, is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT and magnetic resonance imaging (MRI in small bowel examination.

  6. Bowel injuries secondary to induced abortion: a dilemma

    International Nuclear Information System (INIS)

    Rehman, A.; Fatima, S.; Soomro, N.

    2006-01-01

    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)

  7. Crohn's disease in the small bowel (radiological features)

    International Nuclear Information System (INIS)

    Pomakov, P.; Lyutzkanova, E.; Kondova, M.; Natzkov, V.

    2002-01-01

    The radiological characteristic features of Crohn's disease located in the small bowel are made up of three main syndromes. Prestenotic - involving the small bowel loops proximally to the pathological process. Strong peristalsis with retroperistalsis, along with fluid and mucus collection, intestinal lumen widening up to 3 - 6 am diameter and formation of gas fluid levels are observed. Stenotic - presenting irregularly narrowed section with rigid walls, uneven rough polymorphic contours with gradual transition to the other part of the intestine. Ulcero-polypoid syndrome mirroring changes in the small-bowel mucosa - longitudinal, circular and oval contrast material depots are seen - ulcer destructions. When fistulas are formed, long spicular added shadows appear along the contour. Not infrequently such fistulas communicate with other parts of gastrointestinal tract; large polymorphic clear zones are also visualized - pseudo polyps. The images observed upon fractionated contrast material passage are supplemented be computerized tomography and percutaneous abdominal sonography - the so called cockade symptom associated with thickening of the intestinal wall, mesenteric hypervascularization and the like. Enteroclysis which are method of choice is not used owing to technical reasons. (authors)

  8. Intestino Corto Short bowel syndrome

    Directory of Open Access Journals (Sweden)

    María Matilde Socarrás Suárez

    2004-06-01

    Full Text Available El intestino corto está asociado a pérdida o disfunción del intestino delgado por resección del mismo, que causa diarreas, tránsito intestinal acelerado, malabsorción intestinal, y eventualmente la pérdida de peso y el desgaste muscular. El objetivo de este trabajo fue actualizar el conocimiento acerca de este síndrome. Se realiza una revisión del tema de intestino corto donde se refiere a su definición, causas fundamentales frecuentes e infrecuentes en el niño y en el adulto, cómo se adapta el intestino a la resección de diferentes extensiones, las funciones del íleon terminal. Se hacen una valoración clínica inicial, con el interrogatorio médico, revisión minuciosa de la historia clínica para cuantificar la capacidad de absorción. Se habla de los síntomas y signos de deficiencia nutricional. Se explican las estrategias del tratamiento, que tienen 3 etapas de evolución clínica. Se concluye que se indica la dietoterapia adecuada según el estado nutricional del paciente y la resección intestinal realizada, evitando las complicaciones para lograr una calidad máxima de vidaShort bowel is associated with loss or dysfunction of the small bowel due to its resection, which causes diarrheas, accelerated intestinal transit, intestinal malabsorption and, eventually, weight loss ansd muscular waste. The objective of this paper was to update knowledge about this syndrome. A review of the short intestine topic is made, making reference to its definition, common and uncommon main cuases in the child and adult, how the bowel adapts itslef to resection of different extensions, and the functions of the terminal ileum. An initial clinical assessment is made with the medical questionnaire and a detailed review of the medical history to quantify the absorption capacity. The symptoms and signs of nutritional deficiency are dealt with. The strategies of the treatment consisting of 3 stages of clinical evolution are explained. It is concluded

  9. Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome.

    Science.gov (United States)

    Pereira, Ester; Estanqueiro, Paula; Almeida, Susana; Ferreira, Ricardo; Tellechea, Oscar; Salgado, Manuel

    2014-09-01

    Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

  10. Small Bowel Transplantation: Current Clinical Status

    Directory of Open Access Journals (Sweden)

    David Sigalet

    1991-01-01

    Full Text Available With recent refinements in immunosuppression techniques, the first successful reports of small bowel transplantation in humans have now been made, increasing interest in bowel transplantation among clinicians and patients alike. This article reviews recent developments in understanding of the functional capabilities and requirements for effective immune suppression in bowel transplantation. Both experimental and clinical experience with transplantation are discussed, as are the areas which appear to offer the most promise for future developments. Finally guidelines for consideration of patient selection for this procedure are reviewed.

  11. Murine Ileocolic Bowel Resection with Primary Anastomosis

    Science.gov (United States)

    Perry, Troy; Borowiec, Anna; Dicken, Bryan; Fedorak, Richard; Madsen, Karen

    2014-01-01

    Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn’s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease. PMID:25406841

  12. Prevalence of irritable bowel syndrome, influence of lifestyle factors and bowel habits in Korean college students.

    Science.gov (United States)

    Kim, You Joung; Ban, D J

    2005-03-01

    Irritable bowel syndrome (IBS) is considered to be prevalent in the general population, but there are little data on bowel habits and IBS in Korea. Because nurses are frequently called on to help this patient population with IBS and help manage their symptoms, it is very necessary to get some practical information about patients' experiences and to outline a multifaceted approach to the practical management of patient with IBS. So this study aims to describe the bowel habits and the prevalence of IBS in young university students in Korea and to investigate the influence of lifestyle factors, including dietary habits, on IBS prevalence. Finally, we discuss the nursing needs for an holistic approach. A cross-sectional study, using the self-reported questionnaire based on previous studies done abroad and the Rome alpha criteria was applied with 1717 young university students. The answers of 747 men and 970 women were included in the study. The prevalence of IBS, as defined by the Rome alpha criteria, was 5.7% of the subjects. The proportion of women (70.7%) was significantly higher than the proportion of men in the IBS group as compared to that in the non-IBS group (odds ratio 2.07, 95% CI 1.2-3.7). Residential type (odds ratio 1.27, 95% 1.06-1.5) and frequency of meals (odds ratio 1.69, 95% CI 1.2-2.5) significantly differed between the IBS group and non-IBS group. There was a trend towards the higher prevalence of IBS with fewer hours of exercise (odds ratio 0.99, 95% CI 0.95-1.04). 90.6% of respondents reported stool frequencies between three times per day and three times per week. Characteristics of defecation differed significantly between men and women (pstudy shows that proportionately more women suffered from IBS than men and dietary factors and lifestyle were significantly related to IBS. From our study results, we found that there are multifaceted nursing aspects required to reduce symptoms, such as dietary education and encouragement to change lifestyle

  13. Infections in inflammatory bowel disease.

    Science.gov (United States)

    Rodríguez de Santiago, Enrique; Albillos Martínez, Agustín; López-Sanromán, Antonio

    2017-05-10

    Patients with inflammatory bowel disease constitute a population with a special predisposition to develop bacterial, viral and fungal infections. Iatrogenic immunosuppression, frequent contact with healthcare facilities and surgical interventions are some of the risk factors that explain why these infections are one of the main causes of morbi-mortality in this disease. Some of these infections follow a subtle and paucisymptomatic evolution; their diagnosis and management may become a real challenge for the attending physician if their screening is not systematized or they are not considered in the differential diagnosis. The objective of this review is to provide an update from a practical and concise perspective on the knowledge regarding the epidemiology, prevention, diagnosis and treatment of the most common infections. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  14. Disturbances in small bowel motility.

    LENUS (Irish Health Repository)

    Quigley, E M

    2012-02-03

    Recently, the small intestine has become the focus of investigation as a potential site of dysmotility in the irritable bowel syndrome (IBS). A number of motor abnormalities have been defined in some studies, and include \\'clustered\\' contractions, exaggerated post-prandial motor response and disturbances in intestinal transit. The significance of these findings remains unclear. The interpretation of available studies is complicated by differences in subject selection, the direct influence of certain symptoms, such as diarrhoea and constipation, and the interference of compounding factors, such as stress and psychopathology. Dysmotility could also reflect autonomic dysfunction, disturbed CNS control and the response to heightened visceral sensation or central perception. While motor abnormalities may not explain all symptoms in IBS, sensorimotor interactions may be important in symptom pathogenesis and deserve further study.

  15. Biomarkers in inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bennike, Tue; Birkelund, Svend; Stensballe, Allan

    2014-01-01

    or stool later can be screened for. When considering the protein complexity encountered in intestinal biopsy-samples and the recent development within the field of mass spectrometry driven quantitative proteomics, a more thorough and accurate biomarker discovery endeavor could today be performed than ever......Unambiguous diagnosis of the two main forms of inflammatory bowel diseases (IBD): Ulcerative colitis (UC) and Crohn's disease (CD), represents a challenge in the early stages of the diseases. The diagnosis may be established several years after the debut of symptoms. Hence, protein biomarkers...... for early and accurate diagnostic could help clinicians improve treatment of the individual patients. Moreover, the biomarkers could aid physicians to predict disease courses and in this way, identify patients in need of intensive treatment. Patients with low risk of disease flares may avoid treatment...

  16. Probiotics and irritable bowel syndrome.

    Science.gov (United States)

    Dai, Cong; Zheng, Chang-Qing; Jiang, Min; Ma, Xiao-Yu; Jiang, Li-Juan

    2013-09-28

    Irritable bowel syndrome (IBS) is common gastrointestinal problems. It is characterized by abdominal pain or discomfort, and is associated with changes in stool frequency and/or consistency. The etiopathogenesis of IBS may be multifactorial, as is the pathophysiology, which is attributed to alterations in gastrointestinal motility, visceral hypersensitivity, intestinal microbiota, gut epithelium and immune function, dysfunction of the brain-gut axis or certain psychosocial factors. Current therapeutic strategies are often unsatisfactory. There is now increasing evidence linking alterations in the gastrointestinal microbiota and IBS. Probiotics are living organisms which, when ingested in certain numbers, exert health benefits beyond inherent basic nutrition. Probiotics have numerous positive effects in the gastrointestinal tract. Recently, many studies have suggested that probiotics are effective in the treatment of IBS. The mechanisms of probiotics in IBS are very complex. The purpose of this review is to summarize the evidence and mechanisms for the use of probiotics in the treatment of IBS.

  17. Ankylosing spondylitis and bowel disease.

    Science.gov (United States)

    Rudwaleit, Martin; Baeten, Dominique

    2006-06-01

    Between 5 and 10% of cases of ankylosing spondylitis (AS) are associated with inflammatory bowel disease (IBD), either Crohn's disease or ulcerative colitis. A much larger percentage of AS patients have subclinical gut inflammation manifested either by endoscopic findings or by histology. The association with HLA-B27 is less strong in IBD-associated AS than in idiopathic AS, and there is evidence for an association between gut inflammation in AS with the Crohn's-disease-related CARD15 mutations. Despite the different genetics, the immunopathology suggests common inflammatory pathways in gut and joint inflammation in AS, and in gut inflammation in AS and IBD. Although this observation is of interest to unravel the pathophysiology of the disease, systematic screening of AS patients by ileocolonoscopy is not indicated in the absence of gut symptomatology as only a small proportion of AS patients with subclinical gut inflammation will develop overt IBD over time. Treatment of AS associated with IBD with non-steroidal anti-inflammatory drugs (NSAIDs) is problematic because of concerns of potential re-activation of IBD by NSAIDs. Major advances have been made in recent years with the establishment of anti-tumour necrosis factor (TNF) therapy in AS, the other spondyloarthritides and IBD. Anti-TNF agents are of particular relevance to AS patients with concomitant IBD who are at risk of exacerbation of the underlying bowel disease when treated with NSAIDs. In IBD, infliximab, unlike etanercept, is effective in treating clinical symptoms, inducing and maintaining remission, and mucosal healing. Adalimumab appears to be effective in treating both AS and IBD; however, official approval is pending. Currently, infliximab is the drug of choice for the treatment of patients with active AS associated with IBD.

  18. Prediction of radiation-related small-bowel damage

    International Nuclear Information System (INIS)

    Potish, R.A.

    1980-01-01

    In order to predict which patients have a high risk for radiation-related small-bowel damage, the concept of the dose-response curve was applied to the predisposing factors (number of previous laparotomies, extent of surgery, thin physique, hypertension, age, cancer stage, number of treatment days, fractionation, and weight change during radiotherapy) present in 92 patients receiving identical radiation doses and volumes This analysis allows an estimate of the probability of complication to be assigned to individual patients. The utility and limitations of the dose-response concept are discussed

  19. The incidence of inflammatory bowel disease in Denmark 1980-2013

    DEFF Research Database (Denmark)

    Lophaven, S. N.; Lynge, E.; Burisch, J.

    2017-01-01

    Background: Globally, the incidence rates of inflammatory bowel disease (IBD) are increasing; however, data from high-incidence areas are conflicting. Previous studies in Denmark have assessed incidence rates of Crohn's disease (CD) and ulcerative colitis (UC) using short observation periods. Aim...

  20. Penetrating ectopic peptic ulcer in the absence of Meckel's diverticulum ultimately presenting as small bowel obstruction.

    LENUS (Irish Health Repository)

    Hurley, Hilary

    2012-02-03

    We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a patient with multiple previous negative investigations. The clinical presentation, radiographic features and pathological findings of this case are described, along with the salient lessons learnt. The added value of wireless capsule endoscopy (WCE) in such circumstances is debated.

  1. Immunosuppression after liver transplantation for primary sclerosing cholangitis influences activity of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Jørgensen, Kristin Kaasen; Lindström, Lina; Cvancarova, Milada

    2013-01-01

    Previous studies have shown conflicting results regarding the course of inflammatory bowel disease (IBD) after liver transplantation in patients with primary sclerosing cholangitis (PSC). We studied the progression of IBD in patients with PSC who have undergone liver transplantation. We also...

  2. Post-kidney transplant large bowel lymphoproliferative disorder

    Directory of Open Access Journals (Sweden)

    Neeraj Singh

    2014-01-01

    Full Text Available Epstein-Barr virus (EBV-associated post-transplant lymphoproliferative disorder (PTLD is a serious complication of organ transplantation. The gastrointestinal (GI tract is a common site involved, but non-specific signs and symptoms often delay the diagnosis. We report a case of EBV-associated GI-PTLD in a 68-year-old kidney transplant patient who received the kidney ten months earlier. He presented with chronic diarrhea and developed massive pneumo-peritoneum secondary to multiple colonic perforations.

  3. Abdominal War Wounds With Large Bowel Involvement: The Medina ...

    African Journals Online (AJOL)

    Marco Baldan, ICRC Regional Surgeon for Africa, ICRC Nairobi Regional Delegation,. P.O.Box 73226, Nairobi-Kenya. ... present their experience in the treatment of penetrating abdominal war wounds involving the colon in Medina Hospital. ... surgical care and "on the job training" to six "local surgeons" who were young ...

  4. Advances in the treatment of malignant large-bowel obstruction

    African Journals Online (AJOL)

    2007-07-19

    Jul 19, 2007 ... Douglas Stupart is a specialist general surgeon working at Groote Schuur Hospital. His post- fellowship training in colorectal surgery has been in Cape. Town and Melbourne (Australia). His particular interests are in colorectal cancer, laparoscopic colorectal surgery, and colonic stenting, as well as having.

  5. Omphalocele minor associated with complete absence of the large bowel.

    LENUS (Irish Health Repository)

    Ferede, Atakelet

    2012-02-01

    Colonic atresia, unlike small intestine atresia, is a rare congenital malformation. Congenital absence of the entire colon is exceptionally rare. Moreover, an association of omphalocele and complete absence of the colon has not yet been reported in the literature. We present an infant born with such combination of congenital anomalies.

  6. Adult large bowel obstruction: A review of clinical experience

    African Journals Online (AJOL)

    A corrugated drain was inserted through a separate stab incision. The vertical midline incisions were closed by mass closure using monofilament nylon one. The clinical course and postoperative outcome were carefully documented. Wound infection was defined as the presence of pus either discharging spontaneously or.

  7. Diverticulosis of the small bowel with Diverticulitis

    International Nuclear Information System (INIS)

    Barner, L.; Doldt, H.; Strecker, E.P.

    1980-01-01

    Case report of diverticulosis of the small bowel complicated by diverticulitis. Radiography is the method of choice to demonstrate this finding preoperatively. This entity should be included in the differential diagnosis of right lower quadrant abdominal pecin. (orig.) [de

  8. Diverticulosis of the small bowel with Diverticulitis

    Energy Technology Data Exchange (ETDEWEB)

    Barner, L.; Doldt, H.; Strecker, E.P.

    1980-11-01

    Case report of diverticulosis of the small bowel complicated by diverticulitis. Radiography is the method of choice to demonstrate this finding preoperatively. This entity should be included in the differential diagnosis of right lower quadrant abdominal pecin.

  9. Stem cell therapy for inflammatory bowel disease

    NARCIS (Netherlands)

    Duijvestein, Marjolijn

    2012-01-01

    Hematopoietic stem cell transplantation (HSCT) and mesenchymal stromal (MSC) cell therapy are currently under investigation as novel therapies for inflammatory bowel diseases (IBD). Hematopoietic stem cells are thought to repopulate the immune system and reset the immunological response to luminal

  10. Irritable Bowel Syndrome and Complementary Health Practices

    Science.gov (United States)

    ... may decrease the severity of IBS symptoms, including psychological distress, compared to attending a support group. The ... management of irritable bowel syndrome: a comprehensive review. World Journal of Gastroenterology . 2012;18(7):589–600. ...

  11. Nutritional Support Process for a Patient with Short Bowel Syndrome in Conjunction with Panperitonitis: A Case Report

    OpenAIRE

    Kim, Sun Jung; Kim, Bo Ram; Lee, Song Mi; Kong, Hee Jung; Shin, Cheung Soo

    2013-01-01

    Short Bowel Syndrome (SBS) is a condition that causes malabsorption and nutrient deficiency because a large section of the small intestine is missing or has been surgically removed. SBS may develop congenitally or from gastroenterectomy, which often change the motility, digestive, and/or absorptive functions of the small bowel. The surgical procedure for SBS and the condition itself have high mortality rates and often lead to a range of complications associated with long-term parenteral nutri...

  12. Mechanical bowel preparation for elective colorectal surgery

    DEFF Research Database (Denmark)

    Güenaga, Katia F; Matos, Delcio; Wille-Jørgensen, Peer

    2011-01-01

    The presence of bowel contents during colorectal surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only.An enema before...... the rectal surgery to clean the rectum and facilitate the manipulation for the mechanical anastomosis is used for many surgeons. This is analysed separately...

  13. Modern treatment of short bowel syndrome

    DEFF Research Database (Denmark)

    Jeppesen, Palle B

    2013-01-01

    Recently, the US Food and Drug Administration and the European Medicines Agency approved the glucagon-like peptide 2 analogue, teduglutide, for the treatment of short bowel syndrome (SBS), and this review describes the physiological basis for its clinical use.......Recently, the US Food and Drug Administration and the European Medicines Agency approved the glucagon-like peptide 2 analogue, teduglutide, for the treatment of short bowel syndrome (SBS), and this review describes the physiological basis for its clinical use....

  14. Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine

    Directory of Open Access Journals (Sweden)

    Mauro Bafutto

    2011-03-01

    Full Text Available 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 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<0.0001. The stool frequency was significantly reduced (P<0.0001, and stool consistency, improved (P<0.0001. Abdominal pain (P<0.0001 and abdominal distension were significantly reduced (P<0.0001. Noninfective irritable bowel syndrome group presented a statistically significant reduction of total symptom score (P<0.0001. Also, the stool frequency was significantly reduced (P<0.0001 and stool consistency, improved (P<0.0001. Abdominal pain (P<0.0001 and abdominal distention were significantly reduced (P<0.0001. There was no statistical difference between

  15. Morphological abnormalities in the innervation of the atretic segment of bowel in neonates with intestinal atresia.

    Science.gov (United States)

    Ramachandran, P; Vincent, P; Ganesh, S; Sridharan, S

    2007-12-01

    The aim of this study was to examine precisely the morphological abnormalities in the myenteric plexus at the atretic end of the bowel in jejunoileal atresia (JIA). Although changes in the myenteric plexus has been examined in the proximal and distal segments of bowel in JIA, a histochemical analysis of the atretic segment is lacking. Specimens from the atretic end of bowel were obtained from six neonates with JIA. Whole-mount preparations were made of the myenteric plexus, and the cholinergic and nitrergic components were studied by staining with acetylcholine esterase (Ach E) and NADPH diaphorase, respectively. Controls were obtained from two neonates undergoing small bowel resection for Meckel's diverticulum. At the blind end of bowel in type 3a atresia (5 neonates), the intensity of NADPH staining was comparable with controls. However, there was distortion of polygonal architecture of the primary and secondary plexuses at the blind end arranged in concentric fashion parallel to the circular muscle fibres. The ganglia were large and irregularly shaped and contained round neuronal cells. In the sausage shaped segment of bowel in multiple atresia, there was total loss of polygonal architecture with abnormal ganglia, and whorls of nerve fibers. Neuronal cells could not be made out in the ganglia. In specimens stained with Ach E, the findings were similar except that the staining intensity was markedly reduced compared with controls. The morphological abnormalities in the atretic bowel in type 3a were restricted to the architecture of the plexuses and ganglia. The neuronal cells were normal. However, the total loss of polygonal architecture and absence of neuronal cells in the ganglia in multiple atresia probably indicate a different etiology for this type of atresia.

  16. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

    Science.gov (United States)

    Elliott, Jason E; Maslow, Ken D

    2012-02-01

    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

  17. [Treatment of inflammatory bowel diseases].

    Science.gov (United States)

    Gomollón, Fernando

    2015-09-01

    In addition to immunosuppressive drugs and anti-TNF, there are a number of new options in the treatment of inflammatory bowel diseases. Vedolizumab has been approved by the FDA and EMA and has demonstrated utility both in the treatment of ulcerative colitis (UC) and Crohn's disease (CD), even in anti-TNF refractory patients. Other monoclonal antibodies with different targets such as PF-005447659 (antiMAd-CAM1), ustekinumab (anti-IL23/IL12) or MEDI2070 (anti-IL23) have shown promising results in distinct clinical scenarios. Mongersen (antisense oligonucleotide anti-Smad7) and oznimod (an SP-1 modulator) are new alternatives with proven efficacy in clinical trials in CD and UC, respectively. Some data suggest that faecal microbiota transplantation could be efficacious in individual patients, although controlled data do not show clear differences with placebo. Autologous stem-cell transplantation has shown long-term efficacy in "ultra-refractory" CD. The number of possible treatments is constantly increasing, and future research should focus both on the selection of the most appropriate treatment for any given patient and on comparative trials between options. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  18. [Parasitosis and irritable bowel syndrome].

    Science.gov (United States)

    Ibarra, Catalina; Herrera, Valentina; Pérez de Arce, Edith; Gil, Luis Carlos; Madrid, Ana María; Valenzuela, Lucía; Beltrán, Caroll J

    2016-06-01

    Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterised by multi-factorial aetiology. In IBS physiopathology are involved diverse factors between them biological, psychosocial, and environmental components which affect the immune activation status of gut mucosa. Among these factors is recognized the intestinal parasitosis. Post-infection IBS (PI-IBS) is recognised as a subgroup of functional disorders whose symptoms onset appear after a symptomatic intestinal infection caused by microbial agents. There are few studies regarding of relationship between IBS and intestinal parasitosis in Chile. However, is has been well described a positive association between IBS and Blastocystis hominis infections, one of prevalent parasites in Chile. In other countries, is also described a relationship between IBS and amebiasis and giardiasis. Both, characterized by a common mode of transmission through water as well as contaminated food. Because the high prevalence of parasitosis in our country it is necessary to expand the association studies to clarify the strength of the parasites ethiology in IBS.

  19. Exercise and Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Neeraj Narula

    2008-01-01

    Full Text Available Crohn’s disease and ulcerative colitis are both idiopathic inflammatory bowel diseases (IBDs that affect 0.5% of Canadians. As yet, there is no known cure for either disease, and symptoms are treated with an array of medicines. The objective of the present review was to present the role of exercise and its impact on all facets of IBD. Exercise has been speculated to be protective against the onset of IBD, but the literature is inconsistent and weak. Preliminary studies reveal that exercise training may be beneficial to reduce stress and symptoms of IBD. Current research also recommends exercise to help counteract some IBD-specific complications by improving bone mineral density, immunological response, psychological health, weight loss and stress management ability. However, the literature advises that some patients with IBD may have limitations to the amount and intensity of exercise that they can perform. In summary, exercise may be beneficial to IBD patients, but further research is required to make a convincing conclusion regarding its role in the management of IBD and to help establish exercise regimens that can account for each IBD patient’s unique presentation.

  20. Exercise and inflammatory bowel disease.

    Science.gov (United States)

    Narula, Neeraj; Fedorak, Richard N

    2008-05-01

    Crohn's disease and ulcerative colitis are both idiopathic inflammatory bowel diseases (IBDs) that affect 0.5% of Canadians. As yet, there is no known cure for either disease, and symptoms are treated with an array of medicines. The objective of the present review was to present the role of exercise and its impact on all facets of IBD. Exercise has been speculated to be protective against the onset of IBD, but the literature is inconsistent and weak. Preliminary studies reveal that exercise training may be beneficial to reduce stress and symptoms of IBD. Current research also recommends exercise to help counteract some IBD-specific complications by improving bone mineral density, immunological response, psychological health, weight loss and stress management ability. However, the literature advises that some patients with IBD may have limitations to the amount and intensity of exercise that they can perform. In summary, exercise may be beneficial to IBD patients, but further research is required to make a convincing conclusion regarding its role in the management of IBD and to help establish exercise regimens that can account for each IBD patient's unique presentation.

  1. Nutrition in inflammatory bowel disease

    Science.gov (United States)

    Martínez Gómez, María Josefa; Melián Fernández, Cristóbal; Romeo Donlo, María

    2016-07-12

    Inflammatory bowel disease (IBD) is a chronic pathology that has an outbreaks course that in recent years have seen an increase in incidence, especially at younger ages. Malnutrition is frequently associated with this condition, therefore, it is very important to ensure a right nutritional intervention, especially in pediatric patients, to ensure an optimal growth and also an improvement in the clinic. Our goal will be updated the role of nutrition in this disease and in its treatment based on the published evidence. Malnutrition in these patients is frequent and is influenced by various factors such as, decreased food intake, increased nutrient requirements, increased protein loss and malabsorption of nutrients. Therefore there should be a nutritional monitoring of all of them, in which anthropometric measurements, laboratory tests and densitometry were made to establish the needs and sufficient caloric intake tailored to each patient. The use of enteral nutrition as a treatment in Crohn’s disease with mild to moderate outbreak in child population, is amply demonstrated, has even shown to be superior to the use of corticosteroids. Therefore we can conclude by stressing that nutritional intervention is a mainstay in the management of patients with IBD, which aims to prevent and / or control disease-related malnutrition to decrease morbidity and mortality and improve quality of life.

  2. Coagulation factor Xa signaling : the link between coagulation and inflammatory bowel disease?

    NARCIS (Netherlands)

    Borensztajn, Keren; Peppelenbosch, Maikel P.; Spek, C. Arnold

    Inflammatory bowel disease (IBD) is characterized by activation of the coagulation cascade and it has long been suspected that coagulation is an essential component of this still largely idiopathic group of diseases. The realization that coagulation factors are not only passive mediators in the

  3. Coagulation factor Xa signaling: the link between coagulation and inflammatory bowel disease?

    NARCIS (Netherlands)

    Borensztajn, Keren; Peppelenbosch, Maikel P.; Spek, C. Arnold

    2009-01-01

    Inflammatory bowel disease (IBD) is characterized by activation of the coagulation cascade and it has long been suspected that coagulation is an essential component of this still largely idiopathic group of diseases. The realization that coagulation factors are not only passive mediators in the

  4. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis

    NARCIS (Netherlands)

    Weismueller, Tobias J.; Trivedi, Palak J; Bergquist, Annika; Imam, Mohamad; Lenzen, Henrike; Ponsioen, Cyriel Y.; Holm, Kristian; Gotthardt, Daniel; Faerkkilae, Martti A.; Marschall, Hanns-Ulrich; Thorburn, Douglas; Weersma, Rinse K.; Fevery, Johan; Mueller, Tobias; Chazouilleres, Olivier; Schulze, Kornelius; Lazaridis, Konstantinos N.; Almer, Sven; Pereira, Stephen P.; Levy, Cynthia; Mason, Andrew L.; Naess, Sigrid; Bowlus, Christopher L.; Floreani, Annarosa; Halilbasic, Emina; Yimam, Kidist K.; Milkiewicz, Piotr; Beuers, Ulrich; Huynh, Dep K.; Pares, Albert; Manser, Christine N.; Dalekos, George N.; Eksteen, Bertus; Invernizzi, Pietro; Berg, Christoph P.; Kirchner, Gabi I.; Sarrazin, Christoph; Zimmer, Vincent; Fabris, Luca; Braun, Felix; Marzioni, Marco; Juran, Brian D.; Said, Karouk; Rupp, Christian; Jokelainen, Kalle; de Valle, Maria Benito; Saffioti, Francesca; Cheung, Angela; Trauner, Michael; Schramm, Christoph; Chapman, Roger W.; Karlsen, Tom H.; Schrumpf, Erik; Strassburg, Christian P.; Manns, Michael P.; Lindor, Keith D; Hirschfield, Gideon M.; Hansen, Bettina E.; Boberg, Kirsten M.

    BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. METHODS: We

  5. Patient Age, Sex, and Inflammatory Bowel Disease Phenotype Associate With Course of Primary Sclerosing Cholangitis

    NARCIS (Netherlands)

    Weismuller, Tobias J.; Trivedi, Palak J.; Bergquist, Annika; Imam, Mohamad; Lenzen, Henrike; Ponsioen, Cyriel Y.; Holm, Kristian; Gotthardt, Daniel; Farkkila, Martti A.; Marschall, Hanns-Ulrich; Thorburn, Douglas; Weersma, Rinse K.; Fevery, Johan; Mueller, Tobias; Chazouilleres, Olivier; Schulze, Kornelius; Lazaridis, Konstantinos N.; Almer, Sven; Pereira, Stephen P.; Levy, Cynthia; Mason, Andrew; Naess, Sigrid; Bowlus, Christopher L.; Floreani, Annarosa; Halilbasic, Emina; Yimam, Kidist K.; Milkiewicz, Piotr; Beuers, Ulrich; Huynh, Dep K.; Pares, Albert; Manser, Christine N.; Dalekos, George N.; Eksteen, Bertus; Invernizzi, Pietro; Berg, Christoph P.; Kirchner, Gabi I.; Sarrazin, Christoph; Zimmer, Vincent; Fabris, Luca; Braun, Felix; Marzioni, Marco; Juran, Brian D.; Said, Karouk; Rupp, Christian; Jokelainen, Kalle; Benito de Valle, Maria; Saffioti, Francesca; Cheung, Angela; Trauner, Michael; Schramm, Christoph; Chapman, Roger W.; Karlsen, Tom H.; Schrumpf, Erik; Strassburg, Christian P.; Manns, Michael P.; Lindor, Keith D.; Hirschfield, Gideon M.; Hansen, Bettina E.; Boberg, Kirsten M.

    2017-01-01

    Primary sclerosing cholangitis (PSC) is an orphan hepatobiliary disorder associated with inflammatory bowel disease (IBD). We aimed to estimate the risk of disease progression based on distinct clinical phenotypes in a large international cohort of patients with PSC. We performed a retrospective

  6. Ruptured Jejunal Diverticulum Due to a Single-Band Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Rajaraman Durai

    2008-01-01

    Full Text Available Jejunal diverticulosis is rare and often goes unnoticed until complications occur. The diverticula are true, acquired diverticula and often asymptomatic. Jejunal diverticulosis can be associated with diverticulosis of the duodenum, ileum, and colon. Here we describe a patient with known severe diverticular disease of the large bowel, who presented acutely with abdominal pain and signs of generalised peritonitis. Laparotomy showed ruptured jejunal diverticulosis with a single band over the terminal ileum, causing small bowel obstruction. Spontaneous perforation of a jejunal diverticulum is rare and is usually an intraoperative finding. One should exclude a precipitating cause, such as coexisting distal obstruction, stricture, or a foreign body.

  7. Ruptured Jejunal Diverticulum Due to a Single-Band Small Bowel Obstruction

    Science.gov (United States)

    Durai, Rajaraman; Sinha, Ashish; Khan, Mihir; Hoque, Happy; Kerwat, Rajab

    2008-01-01

    Jejunal diverticulosis is rare and often goes unnoticed until complications occur. The diverticula are true, acquired diverticula and often asymptomatic. Jejunal diverticulosis can be associated with diverticulosis of the duodenum, ileum, and colon. Here we describe a patient with known severe diverticular disease of the large bowel, who presented acutely with abdominal pain and signs of generalised peritonitis. Laparotomy showed ruptured jejunal diverticulosis with a single band over the terminal ileum, causing small bowel obstruction. Spontaneous perforation of a jejunal diverticulum is rare and is usually an intraoperative finding. One should exclude a precipitating cause, such as coexisting distal obstruction, stricture, or a foreign body. PMID:18836661

  8. Small bowel obstruction and perforation secondary to primary enterolithiasis in a patient with jejunal diverticulosis.

    Science.gov (United States)

    Chaudhery, Baber; Newman, Peter Alexander; Kelly, Michael Denis

    2014-03-13

    We describe a rare case of small bowel obstruction and perforation secondary to a primary enterolith in an 84-year-old female patient with jejunal diverticulosis. She underwent an emergency laparotomy, small bowel resection and primary anastomosis. Multiple jejunal diverticula and a large stone were identified at the time of operation. Analysis of the stone demonstrated mainly faecal material consistent with a true primary enterolith. A literature search of Medline and PubMed revealed three cases similar to the one described. The pathogenesis and management of enterolithiasis in jejunal diverticular disease is considered.

  9. Small bowel obstruction secondary to migration of a fragment of lithobezoar: a case report.

    LENUS (Irish Health Repository)

    Medani, Mekki

    2009-01-01

    INTRODUCTION: Small bowel obstruction is a common world-wide condition that has a range of etiological factors. The management is largely dependent on the cause of the obstruction. Small bowel obstruction caused by foreign body ingestion is rare; many items have been reported as responsible, but there are no reports implicating polyurethane foam. CASE PRESENTATION: We report the case of a 44-year-old Irish male who presented following ingestion of polyurethane foam. He was asymptomatic on presentation but developed a small bowel obstruction shortly thereafter. CONCLUSION: Patients presenting following ingestion of polyurethane foam should be scheduled for elective laparotomy, gastrotomy, and retrieval of the cast on the next available theatre list - given that they are suitable for surgery.

  10. Prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Gallagher, M.J.; Brereton, H.D.; Rostock, R.A.; Zero, J.M.; Zekoski, D.A.; Poyss, L.F.; Richter, M.P.; Kligerman, M.M.

    1986-09-01

    The volume, distribution, and mobility of opacified pelvic small bowel (PSB) were determined by fluoroscopy and orthogonal radiographs in 150 consecutive patients undergoing pelvic irradiation. Various techniques including uteropexy, omental transposition, bladder distention, inclining the patient, and anterior abdominal wall compression in the supine and prone treatment position were studied for their effect on the volume and location of small bowel within the pelvis. Abdominal wall compression in the prone position combined with bladder distention was selected for further investigation because of its simplicity, reproducibility, patient comfort, and ability to displace the small bowel. Factors correlating with the volume of pelvic small bowel (PSB) included prior pelvic surgery, pelvic irradiation (XRT), and body mass index. After pelvic surgery, especially following abdominoperineal resection (APR), there was a greater volume of PSB which was also less mobile. The severity of acute gastrointestinal effects positively correlated with the volume of irradiated small bowel. Overall, 67% of patients experienced little or no diarrhea, 30% developed mild diarrhea, and no patient required treatment interruption. Late gastrointestinal effects correlated with the prior pelvic surgery and with the volume of small bowel receiving greater than 45 Gy. Small bowel obstruction was not observed in 75 patients who had no previous pelvic surgery. However, following pelvic surgery excluding APR, 2/50 patients and following APR, 3/25 patients developed small bowel obstruction.

  11. [Neonatal outcome of fetal hyperechogenic bowel].

    Science.gov (United States)

    Maillet, L; Rudigoz, R C; Buffin, R; Massardier, J; Gaucherand, P; Huissoud, C

    2014-06-01

    Echogenic bowel (EB) represents 1 % of pregnancy and is a risk factor of fetal pathology (infection, cystic fibrosis, aneuploidy). The aim of our study was to determine the fetuses' outcomes with isolated EB. This is a retrospective study of all patients who presented singleton gestations with a fetal isolated echogenic bowel between 2004 and 2011 in two prenatal diagnosis centers. Search of aneuploidy, infection and cystic fibrosis was systematically proposed as well as an ultrasound monitoring. On 109 fetus addressed for isolate echogenic bowel five had other signs associated and 74 had a real isolated echogenic bowel (without dilatation, calcification, intrauterine growth restriction). In 30 cases, the EB was not found. Eighty-five percent of the patients had in the first trimester a screening for trisomy 21. None fetus with isolated EB had trisomy, infection or cystic fibrosis. One fetus died in utero and one newborn died of a metabolic disease without digestive repercussions. The risk of trisomy 21 and the risk to have a serious disease appear low for the fetus with EB. It does not seem necessary to propose a systematic amniocentesis in case of isolated echogenic bowel. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. [Classical medications in the treatment of inflammatory bowel diseases].

    Science.gov (United States)

    Duvnjak, Marko; Bilić, Ante; Barsić, Neven; Tomasić, Vedran; Stojsavljević, Sanja

    2013-04-01

    The treatment of inflammatory bowel diseases is complex and requires individual approach to every single patient. Traditionally, the approach is based on introduction of so called "classical" medication into the treatment regimen, from ones less potent and with fewer side effects to the ones more toxic but also therapeutically more effective. Aminosalicylates were the first choice of treatment for a long time. However, the role of aminosalicylates is becoming more and more diminished, although they are still the drug of choice in the treatment of mild to moderate ulcerative colitis. Corticosteroids are the therapy of choice in treatment of active IBD for achieving remission in moderate to severe disease. Azathioprine and 6- mercaptopurine belong to a group of thiopurines with an immunomodulatory effect which, in Crohn's disease as well as in ulcerative colitis, primarily have a role in a steroid dependant or steroid refractory type of disease and in maintenance of remission. Lately, early introduction of these medications is proposed to enhance the number of patients that remain in remission. Methotrexate is used for the therapy of active and relapsing Crohn's disease and represents an alternative in patients who do not tolerate or do not respond to azathioprine or 6-mercaptopurine therapy. Cyclosporine is used in treating steroid refractory ulcerative colitis and in some patients can postpone the need for colectomy. Antibiotics do not have a proven effect on the course of inflammatory bowel diseases and their primary role is to treat septic complications. Classic medications today represent a standard in the management of inflammatory bowel diseases, and the combination of the previously mentioned drugs often has a more potent effect on the course of the disease than any medication on its own and their combination is still an object of investigations and clinical studies.

  13. Nephrolithiasis in patients with inflammatory bowel disease in the community

    Directory of Open Access Journals (Sweden)

    Cury DB

    2013-07-01

    Full Text Available Dídia Bismara Cury,1,2 Alan C Moss,2 Nestor Schor3 1Scope Clinic, Campo Grande, Brazil; 2Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 3Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil Background: Inflammatory bowel disease (IBD has been associated with renal stone formation. The objective of this study was to determine prospectively the prevalence of nephrolithiasis in a community-based population of patients with IBD and to analyze factors associated with renal calculus formation. Methods: Screening renal ultrasound was performed in a well characterized cohort of patients seen between 2009 and 2012 at an IBD clinic. We enrolled 168 patients, including 93 with Crohn’s disease and 75 with ulcerative colitis. Clinical and phenotypic variables associated with asymptomatic nephrolithiasis were determined. Results: Nephrolithiasis was detected in 36 patients with Crohn’s disease and in 28 patients with ulcerative colitis (38% for both. Although none of the patients had been previously hospitalized for symptomatic nephrolithiasis, nine with Crohn’s disease and five with ulcerative colitis had recurrent urinary tract infections or hydronephrosis. In patients with Crohn’s disease, ileocolonic (L3 disease was associated with a greater risk of nephrolithiasis than was ileal (L1 or colonic (L2 disease (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.8–7. Active ulcerative colitis (regardless of severity represented a significant risk factor for formation of renal calculi (OR 4.2, 95% CI 1.1–15, P = 0.02. Conclusion: In surgery-naïve patients with IBD in the community, asymptomatic nephrolithiasis is common and should be considered when renal dysfunction or infection is detected. Keywords: clinical activity indices, Crohn’s disease, inflammatory bowel disease, nephrolithiasis, ulcerative colitis

  14. Cannabis use amongst patients with inflammatory bowel disease.

    Science.gov (United States)

    Lal, Simon; Prasad, Neeraj; Ryan, Manijeh; Tangri, Sabrena; Silverberg, Mark S; Gordon, Allan; Steinhart, Hillary

    2011-10-01

    Experimental evidence suggests the endogenous cannabinoid system may protect against colonic inflammation, leading to the possibility that activation of this system may have a therapeutic role in inflammatory bowel disease (IBD). Medicinal use of cannabis for chronic pain and other symptoms has been reported in a number of medical conditions. We aimed to evaluate cannabis use in patients with IBD. One hundred patients with ulcerative colitis (UC) and 191 patients with Crohn's disease (CD) attending a tertiary-care outpatient clinic completed a questionnaire regarding current and previous cannabis use, socioeconomic factors, disease history and medication use, including complimentary alternative medicines. Quality of life was assessed using the short-inflammatory bowel disease questionnaire. A comparable proportion of UC and CD patients reported lifetime [48/95 (51%) UC vs. 91/189 (48%) CD] or current [11/95 (12%) UC vs. 30/189 (16%) CD] cannabis use. Of lifetime users, 14/43 (33%) UC and 40/80 (50%) CD patients have used it to relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite. Patients were more likely to use cannabis for symptom relief if they had a history of abdominal surgery [29/48 (60%) vs. 24/74 (32%); P=0.002], chronic analgesic use [29/41 (71%) vs. 25/81 (31%); Puse [36/66 (55%) vs. 18/56 (32%); P=0.01] and a lower short inflammatory bowel disease questionnaire score (45.1±2.1 vs. 50.3±1.5; P=0.03). Patients who had used cannabis [60/139 (43%)] were more likely than nonusers [13/133 (10%); Ptherapeutic trial of cannabis for IBD. Cannabis use is common amongst patients with IBD for symptom relief, particularly amongst those with a history of abdominal surgery, chronic abdominal pain and/or a low quality of life index. The therapeutic benefits of cannabinoid derivatives in IBD may warrant further exploration.

  15. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

    Science.gov (United States)

    Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

    2015-06-01

    The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

  16. Visceral hypersensitivity in Irritable Bowel Syndrome:pathophysiological mechanisms

    NARCIS (Netherlands)

    Kerckhoffs, A.P.M.

    2009-01-01

    Irritable Bowel Syndrome (IBS) is a functional bowel disease characterized by abdominal pain or discomfort associated with a disordered defecation. No unique pathophysiological mechanism has been identified. It is most likely a multifactorial disease involving alterations in intestinal microbiota

  17. Cannabis for inflammatory bowel disease.

    Science.gov (United States)

    Naftali, Timna; Mechulam, Raphael; Lev, Lihi Bar; Konikoff, Fred M

    2014-01-01

    The marijuana plant Cannabis sativa has been used for centuries as a treatment for a variety of ailments. It contains over 60 different cannabinoid compounds. Studies have revealed that the endocannabinoid system is involved in almost all major immune events. Cannabinoids may, therefore, be beneficial in inflammatory disorders. In murine colitis, cannabinoids decrease histologic and microscopic inflammation. In humans, cannabis has been used to treat a plethora of gastrointestinal problems, including anorexia, emesis, abdominal pain, diarrhea, and diabetic gastroparesis. Despite anecdotal reports on medical cannabis in inflammatory bowel disease (IBD), there are few controlled studies. In an observational study in 30 patients with Crohn's disease (CD), we found that medical cannabis was associated with improvement in disease activity and reduction in the use of other medications. In a more recent placebo-controlled study in 21 chronic CD patients, we showed a decrease in the CD activity index >100 in 10 of 11 subjects on cannabis compared to 4 of 10 on placebo. Complete remission was achieved in 5 of 11 subjects in the cannabis group and 1 of 10 in the placebo group. Yet, in an additional study, low-dose cannabidiol did not have an effect on CD activity. In summary, evidence is gathering that manipulating the endocannabinoid system can have beneficial effects in IBD, but further research is required to declare cannabinoids a medicine. We need to establish the specific cannabinoids, as well as appropriate medical conditions, optimal dose, and mode of administration, to maximize the beneficial effects while avoiding any potential harmful effects of cannabinoid use. © 2014 S. Karger AG, Basel.

  18. Role of alimentation in irritable bowel syndrome.

    Science.gov (United States)

    Dapoigny, M; Stockbrügger, R W; Azpiroz, F; Collins, S; Coremans, G; Müller-Lissner, S; Oberndorff, A; Pace, F; Smout, A; Vatn, M; Whorwell, P

    2003-01-01

    Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients. Copyright 2003 S. Karger AG, Basel

  19. Inflammatory Bowel Disease: Genetics, Epigenetics and Pathogenesis

    Directory of Open Access Journals (Sweden)

    Italia eLoddo

    2015-11-01

    Full Text Available Inflammatory Bowel Diseases (IBDs are complex, multifactorial disorders characterized by chronic relapsing intestinal inflammation. Although aetiology remains largely unknown, recent research has suggested that genetic factors, environment, microbiota and immune response are involved in the pathogenesis.Epidemiological evidence for a genetic contribution is defined: 15% of patients with Crohn’s Disease (CD have an affected family member with IBD, and twin studies for CD have shown 50% concordance in monozygotic twins compared to less than 10% in dizygotics. The most recent and largest genetic association studies, which employed genome-wide association data for over 75,000 patients and controls, identified 163 susceptibility loci for IBD. More recently, a trans-ethnic analysis, including over 20,000 individuals, identified an additional 38 new IBD loci.Although most cases are correlated with polygenic contribution toward genetic susceptibility, there is a spectrum of rare genetic disorders that can contribute to early onset IBD (before 5 years or very early IBD (before 2 years. Genetic variants that cause these disorders have a wide effect on gene function. These variants are so rare in allele frequency that the genetic signals are not detected in genome-wide association studies of patients with IBD. With recent advances in sequencing techniques, approximately 50 genetic disorders have been identified and associated with IBD-like immunopathology. Monogenic defects have been found to alter intestinal immune homeostasis through many mechanisms. Candidate gene resequencing should be carried out in early-onset patients in clinical practice.The evidence that genetic factors contribute in small part to disease pathogenesis confirms the important role of microbial and environmental factors. Epigenetic factors can mediate interactions between environment and genome. Epigenetic mechanisms could affect development and progression of IBD. Epigenomics is

  20. Malignant bowel obstruction in advanced ovarian cancer.

    Science.gov (United States)

    Dean, Emma; Khoja, Leila; Clamp, Andrew; Jayson, Gordon C; Goonetilleke, Dilly; Conway, Alicia M; Hasan, Jurjees

    2017-03-01

    Malignant bowel obstruction (MBO) in ovarian cancer is poorly understood. This retrospective cohort study analyzed 129 patients with ovarian cancer and MBO. At presentation, 69 (53%) had platinum-resistant, 37 (29%) platinum-sensitive and 23 (18%) chemotherapy-naive disease. In patients receiving chemotherapy following the MBO episode, median overall survival (OS) was 107 days for chemotherapy-naive patients compared with 83 and 86 for platinum-sensitive or platinum-resistant patients (p = 0.98). OS was inferior for best supportive care (45 days) compared with chemotherapy (152 days) or surgery (124 days; p Bowel Obstruction Score using Eastern Cooperative Oncology Group and obstruction level discriminated patients by median OS of 181 days (neither) versus 98 days (one) versus 42 days (both; p Bowel Obstruction Score may aide treatment stratification.

  1. Confocal Laser Endomicroscopy in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Rasmussen, Ditlev Nytoft; Karstensen, John Gásdal; Riis, Lene Buhl

    2015-01-01

    included. Next, eligible studies were analysed with respect to several parameters, such as technique and clinical aim and definitions of outcomes. RESULTS: Confocal laser endomicroscopy has been used for a wide range of purposes in inflammatory bowel disease, covering assessment of inflammatory severity...... of confocal laser endomicroscopy for inflammatory bowel disease. METHODS: Available literature was searched systematically for studies applying confocal laser endomicroscopy in Crohn's disease or ulcerative colitis. Relevant literature was reviewed and only studies reporting original clinical data were...... of histological features such as colonic crypts, epithelial gaps and epithelial leakiness to fluorescein. CONCLUSIONS: Confocal laser endomicroscopy remains an experimental but emerging tool for assessment of inflammatory bowel disease. It is the only method that enables in vivo functional assessment...

  2. Diet and risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Olsen, Anja; Carbonnel, Franck

    2012-01-01

    Library were searched for studies on diet and risk of inflammatory bowel disease. Results: Established non-diet risk factors include family predisposition, smoking, appendectomy, and antibiotics. Retrospective case–control studies are encumbered with methodological problems. Prospective studies...... on European cohorts, mainly including middle-aged adults, suggest that a diet high in protein from meat and fish is associated with a higher risk of inflammatory bowel disease. Intake of the n-6 polyunsaturated fatty acid linoleic acid may confer risk of ulcerative colitis, whereas n-3 polyunsaturated fatty...... dioxide and aluminium silicate). Conclusions: A diet high in protein, particular animal protein, may be associated with increased risk of inflammatory bowel disease and relapses. N-6 polyunsaturated fatty acids may predispose to ulcerative colitis whilst n-3 polyunsaturated fatty acid may protect...

  3. Radiologic examination of the small bowel: 1987

    International Nuclear Information System (INIS)

    Carlson, H.C.; Maglinte, D.D.T.

    1987-01-01

    Effective clinical imaging of the small intestine is accomplished only with methods capable of accurately demonstrating bowel morphology. The two major approaches to barium enema examination of this segment of gut - orally and enteroclysis - will be described and illustrated with short videotape presentations. Pursued vigorously and with interest, both methods can yield excellent results in an efficient manner. Careful execution of the examination rather than use of a particular methodology is probably the most important factor in realizing such results. However, each method has its advantages and disadvantages, and these will be presented and discussed. A cursory small bowel examination has no role in modern medicine. Radiologists assume primary responsibility for the diagnostic evaluation of the small bowel and should strive to refine and advance the accuracy of the examination

  4. Small Bowel Obstruction due to Intestinal Xanthomatosis

    Directory of Open Access Journals (Sweden)

    L. E. Barrera-Herrera

    2015-01-01

    Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

  5. BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen DEHGHANI

    2015-12-01

    Full Text Available Background - Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. Objectives - The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. Methods - This study included children with the range of ages (2-21 who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA were used for data analysis. Results - In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%, 36 (94.73%, and 14 (82.35% of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05. For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. Conclusion - There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.

  6. BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods.

    Science.gov (United States)

    Dehghani, Seyed Mohsen; Javaherizadeh, Hazhir; Haghighat, Mahmood; Imanieh, Mohammad-Hadi; Ghanbari, Saeed

    2015-12-01

    Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. This study included children with the range of ages (2-21) who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA) were used for data analysis. In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%), 36 (94.73%), and 14 (82.35%) of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05). For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.

  7. Multidetector CT findings of bowel Transection in blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hyun Suk; Woo, Ji Young; Hong, Hye Suk; Park, Mee Hyun; Yang, Ik; Lee, Yul; Jung, Ah Young; Hwang, Ji Young [Dept. of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Ha, Hong Il [Dept. of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2013-08-15

    Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

  8. Bedside Ultrasound for the Diagnosis of Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Alexander Anshus

    2017-09-01

    Full Text Available History of present illness: An elderly female with no history of prior abdominal surgeries presented to the emergency department (ED with acute onset of abdominal pain and distention. Upon arrival, she began having large volume bilious emesis. While waiting for a computed tomography (CT scan of her abdomen and pelvis, a point of care ultrasound (POCUS was performed which showed evidence of a small bowel obstruction (SBO. The patient had a nasogastric tube placed that put out over two liters of bilious contents. A subsequent CT scan confirmed the diagnosis of SBO from a left inguinal hernia and the patient was admitted to the surgical service. Significant findings: The POCUS utilizing the low frequency curvilinear probe demonstrates fluid-filled, dilated bowel loops greater than 2.5cm with to-and-fro peristalsis, and thickened bowel walls greater than 3mm, concerning for SBO. Discussion: Gastrointestinal obstruction is a common diagnosis in the ED, accounting for approximately 15% of all ED visits for acute abdominal pain.1 SBO accounts for approximately 80% of all obstructions.2 In the diagnosis of SBO, studies show that abdominal x-rays have a sensitivity of 66-77% and specificity of 50-57%,3 CT scans have a sensitivity of 92% and specificity of 93%,4 and ultrasound has a sensitivity of 88% and specificity of 96%.5 While CT scan remains a widely accepted modality for diagnosing SBO, ultrasound is more cost effective, well tolerated, does not involve ionizing radiation, and can be done in a timely manner at the patient’s bedside. Ultrasound can also identify transition points as well as distinguish between functional and mechanical obstruction.6 In addition to SBO, ultrasound can be used to diagnose external hernias, intussusception, tumors, superior mesenteric artery (SMA syndrome, foreign bodies, bezoars, and ascariasis.7

  9. The bowel habit of young children.

    OpenAIRE

    Weaver, L T; Steiner, H

    1984-01-01

    The bowel habit of 350 preschool children from a single general practice was studied. Eighty five per cent of 1 to 4 year olds eating a predominantly low fibre diet opened their bowels once or twice a day and 96% of the children fell within the range of three times a day to every other day. At all ages most children produced soft stools of about 25 ml volume. Mean intestinal transit time of 35 (10%) randomly selected children was 33 hours. There is a significant correlation between infrequenc...

  10. Small bowel imaging - still a radiologic approach?

    Science.gov (United States)

    Markova, Ingrid; Kluchova, Katerina; Zboril, Radek; Mashlan, Miroslav; Herman, Miroslav

    2010-06-01

    In recent years, there has been renewed interest in small bowel imaging using a variety of radiologic or endoscopic techniques. This article gives an overview and comparison of old and new techniques used in small bowel imaging. New imaging methods as computed tomography (CT), CT enteroclysis (CTEc), CT enterography (CTEg), ultrasound (US), contrast-enhanced ultrasound (CEUS), US enteroclysis, US enterography, magnetic resonance imaging (MRI), MR enteroclysis (MREc) and MR enterography (MREg) are compared with the older techniques such as small- bowel follow- through (SBFT), conventional enteroclysis (CE) and endoscopic techniques including push enteroscopy, ezofagogastroduodenoscopy (EGD), sonde enteroscopy, ileocolonoscopy, double-balloon enteroscopy, intraoperative enteroscopy and wireless capsule enteroscopy (WCE). Systematic scan of Pubmed, Medline, Ovid, Elsevier search engines was used.. Additional information was found through the bibliographical review of relevant articles. SBFT has only secondary role in small bowel imaging. US is still the method of choice in imaging for pediatric populations. US and CEUS are also accepted as a method of choice especially in inflammatory cases. CE has been replaced by new cross - sectional imaging techniques (CTEc/CTEg or MREc/MREg). CTEc combines the advantages of CT and CE. MREc combines the advantages of MRI and CE. Some authors prefer CTEg or MREg with peroral bowel preparation and they strictly avoid nasojejunal intubation under fluoroscopic control. MREc has better soft tissue contrast, showing it to be more sensitive in detecting mucosal lesions than CTEc in inflammatory diseases. CTEg/MREg are techniques preferred for patients in follow-up of the inflammatory diseases. The radiologic community is not unanimous however about their role in the imaging process. CTEc/MREc as well as CTEg/MREg are superior to endoscopic methods in the investigation of small-bowel tumors. WCE gives unparalleled imaging of the mucosal

  11. Computed tomography features of small bowel volvulus

    International Nuclear Information System (INIS)

    Loh, Y.H.; Dunn, G.D.

    2000-01-01

    Small bowel volvulus is a cause of acute abdomen and commonly occurs in neonates and young infants. Although it is rare in adults in the Western world,' it is a relatively common surgical emergency in the Middle East, India and Central Africa. It is associated with a mortality rate of 10-67% and, hence, it is important to make an early diagnosis to expedite surgical intervention. Computed tomography has become an important imaging modality in diagnosis and a number of signs have been recognized in a handful of documented case reports. We describe a case of small bowel volvulus that illustrates these important CT signs. Copyright (1999) Blackwell Science Pty Ltd

  12. The molecular biology of inflammatory bowel diseases.

    Science.gov (United States)

    Corfield, Anthony P; Wallace, Heather M; Probert, Chris S J

    2011-08-01

    IBDs (inflammatory bowel diseases) are a group of diseases affecting the gastrointestinal tract. The diseases are multifactorial and cover genetic aspects: susceptibility genes, innate and adaptive responses to inflammation, and structure and efficacy of the mucosal protective barrier. Animal models of IBD have been developed to gain further knowledge of the disease mechanisms. These topics form an overlapping background to enable an improved understanding of the molecular features of these diseases. A series of articles is presented based on the topics covered at the Biochemical Society Focused Meeting The Molecular Biology of Inflammatory Bowel Diseases.

  13. Intestinal barrier integrity and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Holmberg, Fredrik Eric Olof; Pedersen, Jannie; Jørgensen, Peter

    2017-01-01

    of antimicrobial peptides. Inflammatory bowel disease is associated with life-long morbidity for affected patients, and both the incidence and prevalence is increasing globally, resulting in substantial economic strain for society. Mucosal healing and re-establishment of barrier integrity is associated......, novel treatment strategies to accomplish mucosal healing and to re-establish normal barrier integrity in inflammatory bowel disease are warranted, and luminal stem cell-based approaches might have an intriguing potential. Transplantation of in vitro expanded intestinal epithelial stem cells derived...

  14. Prolonged release oxycodone and naloxone treatment counteracts opioid-induced constipation in patients with severe pain compared to previous analgesic treatment.

    Science.gov (United States)

    Koopmans-Klein, Gineke; Van Op den Bosch, Joeri; van Megen, Yvonne; Prenen, Hans; Huygen, Frank; Mancini, Isabelle

    2017-12-01

    Treatment with prolonged-release oxycodone/naloxone (PR OXN) has been shown to improve opioid induced constipation (OIC) in constipated patients. This publication reports on a real-life observational study investigating the efficacy of PR OXN with regard to bowel function in patients switching to PR OXN from WHO step 1, step 2 and step 3 opioids. Patients with chronic pain experiencing insufficient pain relief and/or unacceptable side effects were switched to PR OXN and monitored in this observational study with respect to efficacy regarding bowel function and efficacy regarding pain relief in comparison with previous analgesic therapy. A patient was considered a responder with respect to efficacy if this assessment was "slightly better", "better" or "much better" compared with previous therapy. Bowel function index, pain intensity, quality of life, laxative medication use, and safety analgesic were also evaluated. A total of 1338 patients (mean [SD] age 64.3 [14.9], 63% female) were observed for 43 [3-166] days (median [range]) during treatment with PR OXN. Overall response rate regarding bowel function efficacy was 82.5%. Patients with symptoms of constipation at study entry obtained a clinically relevant improvement of the bowel function index (BFI) within the first 2 weeks of PR OXN treatment. Non-constipated patients at study entry maintained normal bowel function despite switching to treatment with the opioid PR OXN. In conclusion, treatment with PR OXN results in a significant and clinically relevant improvement of bowel function. During the observation of the treatment with PR OXN patients reported an improvement of quality of life (QoL). More interestingly, non-constipated patients maintained a normal bowel function, showing prevention of constipation despite the use of an opioid.

  15. The Short Health Scale: a valid and reliable measure of health related quality of life in English speaking inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    McDermott, Edel

    2013-09-01

    Health related quality of life in inflammatory bowel disease is influenced both by disease activity as well as by the psychosocial characteristics of the individual patient. The Short Health Scale (SHS) is a four-part visual analogue scale questionnaire using open-ended questions that are designed to assess the impact of inflammatory bowel disease on a health related quality of life. The four dimensions include bowel symptoms, activities of daily life, worry and general wellbeing. It has previously been validated in Swedish and Norwegian speaking patients.

  16. Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2010-01-15

    The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels.

  17. Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report

    International Nuclear Information System (INIS)

    Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang

    2010-01-01

    The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels

  18. Systematic review and meta-analysis: Sodium picosulphate with magnesium citrate as bowel preparation for colonoscopy

    Science.gov (United States)

    Munsterman, Isabelle D; Eskes, Anne M; Maaskant, Jolanda M; van der Hulst, René

    2016-01-01

    Background An effective and tolerable bowel preparation is important to secure quality of colonoscopies. It remains unclear if sodium picosulphate with magnesium citrate (SPMC), which is considered a tolerable bowel preparation agent, is also an effective alternative for polyethylene glycol (PEG) and sodium phosphate (NaP). Aim The aim of this article is to compare effectiveness of SPMC to PEG and NaP through assessment of quality of bowel cleansing measured by validated tools. Methods We searched electronic databases up to January 2015. Only randomised controlled trials (RCTs) were included. Two authors independently performed selection of studies, risk of bias assessment and data extraction. Results Thirteen RCTs were included, with overall good quality, but large heterogeneity. SPMC had slightly better quality of bowel cleansing than PEG (pooled RR 1.06; 95% CI 1.02 to 1.11). In most trials SPMC was significantly better tolerated than PEG. There were no significant differences in effectiveness or tolerability between SPMC and NaP. Side effects were similar between agents, except for dizziness (pooled RR 1.71; 95% CI 1.32 to 2.21 in favour of PEG vs. SPMC) and vomiting (pooled RR 0.35; 95% CI 0.13 to 0.95 in favour of single-dose SPMC vs. split-dose). Conclusions SPMC is equally effective to NaP and little superior to PEG in terms of bowel cleansing. SPMC preparations were better tolerated than PEG preparations. SPMC may be considered as standard bowel preparation for colonoscopy. PMID:29163958

  19. Use of Bristol Stool Form Scale to predict the adequacy of bowel preparation - a prospective study.

    Science.gov (United States)

    Malhotra, A; Shah, N; Depasquale, J; Baddoura, W; Spira, R; Rector, T

    2016-02-01

    Inadequate bowel preparation continues to be a substantial problem for colonoscopy. The seven-point Bristol Stool Form Scale (BSFS) has been associated with delayed colonic transit in adults. We evaluated the utility of the BSFS to identify patients more likely to present with an inadequate preparation. Two large community-based academic medical centres in New Jersey, USA, studied a prospective cohort of 411 consecutive patients undergoing outpatient colonoscopy who were prescribed similar bowel preparations. The BSFS and several other study variables were collected by gastroenterology fellows during an outpatient visit prior to scheduling colonoscopy. All colonoscopy examinations were performed in the morning by a gastroenterologist who graded the adequacy of bowel preparation. Inadequate preparation was defined as one resulting in a repeat colonoscopy at a shorter time interval than would generally be recommended based solely on risk factors or pathological findings. The ability of study variables to discriminate those who did or did not have an adequate preparation was summarized by the c-statistic. The relationship between variables that provided some discrimination and the probability of an adequate preparation was modelled using logistic regression. The mean age of the study sample was 56 ± 8 (SD) years and 63% were women. Bowel preparation was adequate in 337 (82%) of the patients. The BSFS ratings ranged from 1 to 7. The score was <3 in 144 (35%) indicating lower gastrointestinal motility. There was a statistically significant association between the score and the probability of an adequate bowel preparation (odds ratio 1.4; 95% confidence interval 1.2-1.7; P < 0.001) and the c-statistic was 0.64 (0.58-0.70). Use of the BSFS may help identify patients for whom standard bowel preparation most probably will not be adequate. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  20. An in vivo investigation of photoplethysmographic signals and preliminary pulse oximetry estimation from the bowel using a new fiberoptic sensor.

    Science.gov (United States)

    Hickey, Michelle; Samuels, Neal; Randive, Nilesh; Langford, Richard M; Kyriacou, Panayiotis A

    2011-05-01

    The continuous monitoring of splanchnic organ oxygen saturation could make the early detection of inadequate tissue oxygenation feasible, reducing the risk of hypoperfusion, severe ischemia, multiple organ failure, and, ultimately, death. Current methods for assessing splanchnic perfusion have not been widely accepted for use in the clinical care environment. In an attempt to overcome the limitations of the current techniques, a new fiberoptic photoplethysmographic (PPG)/pulse oximetry sensor was developed as a means of assessing splanchnic organ perfusion during surgery in humans. A new fiberoptic splanchnic pulse oximeter and an optically identical fiberoptic finger pulse oximeter have been developed. Simultaneous PPG signals and preliminary estimates of arterial oxygen saturation from the bowel (small and large) and finger were obtained in 17 patients (3 men and 14 women) undergoing open laparotomy. Good quality PPG signals were obtained from the small and large bowel and from the finger in all patients (lower 95% confidence limit for the proportion was 0.64). Comparisons of blood oxygen saturation values acquired when using the splanchnic and the finger fiberoptic sensors and a commercial finger pulse oximeter indicated that there was no statistically significant difference between them (all P>0.454). A Bland and Altman plot of the difference between blood oxygen saturation values from the bowel fiberoptic pulse oximeter and the fiberoptic finger pulse oximeter against their mean showed that the limits of agreement between the 2 pulse oximeters were -3.8% and 4.2% for small bowel measurements, and -3.4% and 4.3% for large bowel measurements. The 95% prediction interval for the difference between the 2 devices was between -4.2% and 4.7%. This study demonstrated that good quality PPG signals can be obtained from the bowel using a new fiberoptic sensor. Further evaluation is required to determine whether fiberoptic pulse oximetry of the bowel may provide a

  1. Acute small bowel obstruction as a result of a Meckel's diverticulum encircling the terminal ileum: A case report

    Directory of Open Access Journals (Sweden)

    Thakor Avnesh S

    2007-03-01

    Full Text Available Abstract Background In the developed world, small bowel obstruction accounts for 20% of all acute surgical admissions. The aetiology for majority of these cases includes postoperative adhesions and herniae. However, a relatively uncommon cause is a Meckel's diverticulum. Although this diagnosis is primarily reported in the adolescent population, it should also be considered in adults. Case Presentation In the present report, we present a rare case where a fit and healthy 74-year-old gentleman, with no previous history of abdominal surgery, presented with the cardinal symptoms and signs of small bowel obstruction as the result of a Meckel's diverticulum encircling his terminal ileum. Initial investigations included a supine abdominal x-ray showing dilated loops of small bowel and computerised tomographic imaging of the abdomen, which revealed a stricture in the terminal ileum of unknown aetiology. At laparotomy, multiple loops of distended small bowel were seen from the duodeno-jeujenal junction to the terminal ileum, which was encircled by a Meckel's diverticulum. The Meckel's diverticulum was then divided to release the obstruction, mobilised and subsequently removed. Finally, the small bowel contents were decompressed into the stomach and the nasogastric tube aspirated, before returning the loops of bowel into the abdomen in sequence. The patient made a good postoperative recovery and was discharged home 5 days later. Conclusion This report highlights the importance of considering a Meckel's diverticulum as a cause of small bowel obstruction in individuals from all age groups and especially in a person with no previous abdominal pathology or surgery.

  2. Self-reported participation and beliefs about bowel cancer screening in New South Wales, Australia.

    Science.gov (United States)

    Varlow, Megan; Stacey, Ingrid; Dunlop, Sally; Young, Jane; Kite, James; Dessaix, Anita; McAulay, Claire

    2014-08-01

    To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. This study used data from the International Cancer Benchmarking Partnership Module 2, a representative population-based telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n=2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. SO WHAT? Education strategies that promote the need for screening in the absence of symptoms and correct misconceptions about bowel cancer screening amongst subgroups of the NSW population may improve screening rates and decrease the burden of bowel cancer in NSW.

  3. Inflammatory bowel disease: potential therapeutic strategies

    DEFF Research Database (Denmark)

    Nielsen, O H; Vainer, B; Bregenholt, S

    1997-01-01

    This review deals with potential and possibly primary therapeutics that, through insight into the inflammatory cascade, result in more rational treatment principles replacing the classical therapy of inflammatory bowel disease (IBD), i.e. Crohn's disease (CD) and ulcerative colitis (UC). These ne...

  4. Role of alimentation in irritable bowel syndrome

    NARCIS (Netherlands)

    Dapoigny, M.; Stockbrügger, R. W.; Azpiroz, F.; Collins, S.; Coremans, G.; Müller-Lissner, S.; Oberndorff, A.; Pace, F.; Smout, A.; Vatn, M.; Whorwell, P.

    2003-01-01

    BACKGROUND: Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. AIMS: During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between

  5. Preoperative bowel preparation in children: Polyethylene glycol ...

    African Journals Online (AJOL)

    Background: Colorectal surgeries frequently require bowel preparation. In children, (is this standard of care?: this method is mostly followed) this is usually performed using normal saline, which is very cumbersome and causes unnecessary discomfort. This study compared polyethylene glycol (PEG) with normal saline for ...

  6. Bowel wall visualisation at CT colonography

    International Nuclear Information System (INIS)

    Svensson, M.H.; Hellstroem, M.; Svensson, E.

    2002-01-01

    Purpose: To evaluate the quality of bowel wall visualisation at CT colonography and the impact of examination in the supine and prone positions. Material and Methods: After bowel preparation, 111 patients underwent CT colonography. Air distension, degree of fluid redistribution with change in body position (supine and prone), influence of residual stool on bowel wall assessability, and quality of overall colon visualisation were evaluated using scales. Results: Thirty of 110 patients (27%) had complete overall visualisation of the colon wall and 52 (47%) had subtotal visualisation of a limited part of the colon. The entire colon was more often air-filled in the prone position (46%) than in the supine position (18%). Joint review of supine and prone data showed that for all colon segments, except the sigmoid (86%), 95% of the patients had complete air filling. All patients had residual fluid. In 75% to 99%, depending on segment, fluid did not interfere with the bowel wall visualisation in the combined evaluation of supine and prone data sets. Thirty-one patients had residual stool with potential negative influence on polyp detection. Conclusions: The colon wall was completely, or almost completely, visualised in 75% of the patients, and examination in the supine and prone positions was necessary for complete visualisation

  7. Future directions in inflammatory bowel disease management

    NARCIS (Netherlands)

    D'Haens, Geert R.; Sartor, R. Balfour; Silverberg, Mark S.; Petersson, Joel; Rutgeerts, Paul

    2014-01-01

    Clinical management of inflammatory bowel diseases (IBD), new treatment modalities and the potential impact of personalised medicine remain topics of intense interest as our understanding of the pathophysiology of IBD expands. Potential future strategies for IBD management are discussed, based on

  8. Neuroimmune mechanisms in functional bowel disorders.

    Science.gov (United States)

    Wouters, M M; Boeckxstaens, G E

    2011-02-01

    The enteric nervous system regulates diverse functions including gastrointestinal motility and nociception. The sensory neurons detect mechanical and chemical stimuli while motor neurons control peristalsis and secretion. In addition to this extensive neuronal network, the gut also houses a highly specialised immune system which plays an important role in the induction and maintenance of tolerance to food and other luminal antigens and in the protection of the epithelial barrier against pathogenic invasion. It is now increasingly recognised that the gastrointestinal immune system and the enteric nervous system closely interact. This review will focus on two common functional gastrointestinal disorders in which neuroimmune interaction is involved in the pathophysiology: i.e. postoperative ileus and irritable bowel syndrome. Postoperative ileus arises after almost every abdominal surgical procedure. Handling of the bowel results in local inflammation and activation of inhibitory neuronal pathways resulting in a generalised impairment of gastrointestinal motor function or ileus. On the other hand, postinfectious irritable bowel syndrome (PI-IBS) occurs in 10 to 30% of patients who suffer from infectious gastroenteritis. PI -IBS patients develop abnormal gastrointestinal sensitivity, motility and secretion which contribute to abdominal pain and discomfort, bloating and abnormal bowel function (diarrhoea and/or constipation). Biopsy studies revealed persistent low-grade inflammation and altered immunological function which may lead to abnormal pain perception and motor activity within the gastrointestinal tract.

  9. Review of Irritable Bowel Syndrome Treatment

    Directory of Open Access Journals (Sweden)

    Ghadir M.R.

    2010-06-01

    Full Text Available Background and Objectives: Irritable bowel syndrome is one of the most common functional gastrointestinal disorders striking 10-20% of the world population. Although most patients do not take medical assistance, this disease enforces significant cost on the patient and health systems and has negative effects on quality of life of the individual. After diagnosis ,treatment of this disease is the next step. Many pathways of treatment has been introduced and the efficacy of each other has been established in one way or another. The first step in the path of treatment is education and confidence of patients that might also be the most important step. Fiber diet, probiotic, anti-cholinergic and anti antispasmodics, laxatives, anti-diarrhea, the drugs affecting serotonin receptors, antidepressants and anti-anxiety, the chloride channel activator and non-drug methods such as cognitive-behavior therapy, hypnotherapy, acupuncture and herbal medicine each of which has been tested on irritable bowel syndrome and efficacy of each one has been indicated in one way or another. This paper tried to outline new treatments available in addition to categorization and discussion of various treatments for irritable bowel syndrome.Keywords: Irritable Bowel Syndrome; Probiotics; Parasmpatholytics; Laxatives.

  10. Vedolizumab in pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Ledder, Oren; Assa, Amit; Levine, Arie

    2017-01-01

    Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with Inflammatory Bowel Disease (IBD), but the data in pediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-center pediatric IBD cohort. Method: Retro...

  11. Clostridium difficile and pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Martinelli, Massimo; Strisciuglio, Caterina; Veres, Gabor

    2014-01-01

    BACKGROUND: Clostridium difficile infection is associated with pediatric inflammatory bowel disease (IBD) in several ways. We sought to investigate C. difficile infection in pediatric patients with IBD in comparison with a group of children with celiac disease and to evaluate IBD disease course o...

  12. Dynamic bowel obstruction: aetiology, clinical presentation ...

    African Journals Online (AJOL)

    This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation ...

  13. Cancer surveillance in inflammatory bowel disease.

    Science.gov (United States)

    Bernstein, C N

    1999-12-01

    This article reviews the rationale and approach to dysplasia surveillance colonoscopy in inflammatory bowel disease. Recent developments in the field are also highlighted, including approaches to polyps that arise in patients with colitis and new diagnostic markers that may complement morphologic assessment for dysplasia.

  14. Dynamic bowel obstruction: aetiology, clinical presentation ...

    African Journals Online (AJOL)

    2005). This makes it essential that studies are made periodically in every region to define the local causes with the idea to do work on their prevention (Adhikari et al., 2010). This study was conducted to describe in our region, the aetiology, clinical presentation, management and outcome of dynamic bowel obstruction.

  15. Irritable bowel syndrome | Watermeyer | Continuing Medical Education

    African Journals Online (AJOL)

    functional diseases' such as fibromyalgia, interstitial cystitis and non-ulcer ... On the basis of the predominant bowel habit IBS can be categorised into the following subgroups: IBS with constipation (IBS-C) – more commom in women, IBS with ...

  16. Recent advances in inflammatory bowel disease

    African Journals Online (AJOL)

    2009-05-12

    May 12, 2009 ... virus, mycobacteria and paromyxoviruses remain unproved, but a recent ... colonoscopy with ileoscopy, computer tomography enterography and push ... A history of an appendicectomy is rare in patients with UC. A recent meta-analysis comparing capsule endoscopy with small- bowel barium radiology,.

  17. Pediatric inflammatory bowel disease in South India.

    Science.gov (United States)

    Avinash, B; Dutta, A K; Chacko, A

    2009-07-01

    Among 34 children diagnosed to have inflammatory bowel disease (IBD) over past 8 years, 23 had Crohns disease and 11 had ulcerative colitis. Pediatric patients accounted for 7% of new cases of IBD seen annually. Median delay in diagnosis was 15 months. Nutritional impairment was significantly more common in Crohns disease.

  18. Childhood Inflammatory Bowel Disease in Libya: Epidemiological ...

    African Journals Online (AJOL)

    The aim is to determine the prevalence of juvenile onset inflammatory bowel disease in Libya. Setting: Al-Fateh childrens' hospital, Benghazi, Libya. Methods: This is a retrospective study of all cases diagnosed over 10 years (1997-2006) with either ulcerative colitis, Crohn's disease or indeterminate colitis. Inclusion criteria ...

  19. Anatomy and Physiology of the Small Bowel.

    Science.gov (United States)

    Volk, Neil; Lacy, Brian

    2017-01-01

    Comprehension of small intestine physiology and function provides a framework for the understanding of several important disease pathways of the gastrointestinal system. This article reviews the development, anatomy and histology of the small bowel in addition to physiology and digestion of key nutrients. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

    Energy Technology Data Exchange (ETDEWEB)

    Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen (Germany); Schneemann, Hubert [Institute of Pharmacy and Pharmaceutical Sciences, University Hospital Essen, Essen (Germany)

    2004-03-01

    The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

  1. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

    International Nuclear Information System (INIS)

    Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C.; Schneemann, Hubert

    2004-01-01

    The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

  2. Role of Rifaximin in Inflammatory Bowel Disease Treatment.

    Science.gov (United States)

    Scribano, Maria Lia

    2015-01-01

    Inflammatory bowel diseases are characterised by an altered composition of the intestinal microbiota, which may contribute to their development and maintenance in susceptible hosts. The involvement of bacteria in the inflammation has provided the rationale for a therapeutic manipulation of the gut flora through the use of antibiotics. However, the role of antibiotics has not been clearly demonstrated and their long-term employment is often restricted by an elevated number of adverse events. The use of rifaximin, which is characterised by an excellent safety profile thanks to its negligible intestinal absorption, appears to have some promise. Study results suggest that rifaximin could be useful in Crohn's disease, and a new gastroresistant formulation (rifaximin-extended intestinal release) has recently shown its efficacy in patients with moderate Crohn's disease. Less consistent data support the use of rifaximin in ulcerative colitis and in pouchitis, although the results of some studies have been encouraging. Further large controlled trials are warranted to confirm the role of rifaximin in inflammatory bowel disease treatment.

  3. Microbiome Heterogeneity Characterizing Intestinal Tissue and Inflammatory Bowel Disease Phenotype.

    Science.gov (United States)

    Tyler, Andrea D; Kirsch, Richard; Milgrom, Raquel; Stempak, Joanne M; Kabakchiev, Boyko; Silverberg, Mark S

    2016-04-01

    Inflammatory bowel disease has been associated with differential abundance of numerous organisms when compared to healthy controls (HCs); however, few studies have investigated variability in the microbiome across intestinal locations and how this variability might be related to disease location and phenotype. In this study, we have analyzed the microbiome of a large cohort of individuals recruited at Mount Sinai Hospital in Toronto, Canada. Biopsies were taken from subjects with Crohn's disease, ulcerative colitis, and HC, and also individuals having undergone ileal pouch-anal anastomosis for treatment of ulcerative colitis or familial adenomatous polyposis. Microbial 16S rRNA was sequenced using the Illumina MiSeq platform. We observed a great deal of variability in the microbiome characterizing different sampling locations. Samples from pouch and afferent limb were comparable in microbial composition. When comparing sigmoid and terminal ileum samples, more differences were observed. The greatest number of differentially abundant microbes was observed when comparing either pouch or afferent limb samples to sigmoid or terminal ileum. Despite these differences, we were able to observe modest microbial variability between inflammatory bowel disease phenotypes and HCs, even when controlling for sampling location and additional experimental factors. Most detected associations were observed between HCs and Crohn's disease, with decreases in specific genera in the families Ruminococcaceae and Lachnospiraceae characterizing tissue samples from individuals with Crohn's disease. This study highlights important considerations when analyzing the composition of the microbiome and also provides useful insight into differences in the microbiome characterizing these seemingly related phenotypes.

  4. Melatonin for the treatment of irritable bowel syndrome.

    Science.gov (United States)

    Siah, Kewin Tien Ho; Wong, Reuben Kong Min; Ho, Khek Yu

    2014-03-14

    Irritable bowel syndrome (IBS) is a common disorder characterized by recurrent abdominal pain or discomfort, in combination with disturbed bowel habits in the absence of identifiable organic cause. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced by the pineal gland and also large number by enterochromaffin cells of the digestive mucosa. Melatonin plays an important part in gastrointestinal physiology which includes regulation of gastrointestinal motility, local anti-inflammatory reaction as well as moderation of visceral sensation. Melatonin is commonly given orally. It is categorized by the United States Food and Drug Administration as a dietary supplement. Melatonin treatment has an extremely wide margin of safety though it may cause minor adverse effects, such as headache, rash and nightmares. Melatonin was touted as a potential effective candidate for IBS treatment. Putative role of melatonin in IBS treatment include analgesic effects, regulator of gastrointestinal motility and sensation to sleep promoter. Placebo-controlled studies in melatonin suffered from heterogeneity in methodology. Most studies utilized 3 mg at bedtime as the standard dose of trial. However, all studies had consistently showed improvement in abdominal pain, some showed improvement in quality of life of IBS patients. Melatonin is a relatively safe drug that possesses potential in treating IBS. Future studies should focus on melatonin effect on gut mobility as well as its central nervous system effect to elucidate its role in IBS patients.

  5. Inflammatory bowel disease and mutations affecting the interleukin-10 receptor.

    Science.gov (United States)

    Glocker, Erik-Oliver; Kotlarz, Daniel; Boztug, Kaan; Gertz, E Michael; Schäffer, Alejandro A; Noyan, Fatih; Perro, Mario; Diestelhorst, Jana; Allroth, Anna; Murugan, Dhaarini; Hätscher, Nadine; Pfeifer, Dietmar; Sykora, Karl-Walter; Sauer, Martin; Kreipe, Hans; Lacher, Martin; Nustede, Rainer; Woellner, Cristina; Baumann, Ulrich; Salzer, Ulrich; Koletzko, Sibylle; Shah, Neil; Segal, Anthony W; Sauerbrey, Axel; Buderus, Stephan; Snapper, Scott B; Grimbacher, Bodo; Klein, Christoph

    2009-11-19

    The molecular cause of inflammatory bowel disease is largely unknown. We performed genetic-linkage analysis and candidate-gene sequencing on samples from two unrelated consanguineous families with children who were affected by early-onset inflammatory bowel disease. We screened six additional patients with early-onset colitis for mutations in two candidate genes and carried out functional assays in patients' peripheral-blood mononuclear cells. We performed an allogeneic hematopoietic stem-cell transplantation in one patient. In four of nine patients with early-onset colitis, we identified three distinct homozygous mutations in genes IL10RA and IL10RB, encoding the IL10R1 and IL10R2 proteins, respectively, which form a heterotetramer to make up the interleukin-10 receptor. The mutations abrogate interleukin-10-induced signaling, as shown by deficient STAT3 (signal transducer and activator of transcription 3) phosphorylation on stimulation with interleukin-10. Consistent with this observation was the increased secretion of tumor necrosis factor alpha and other proinflammatory cytokines from peripheral-blood mononuclear cells from patients who were deficient in IL10R subunit proteins, suggesting that interleukin-10-dependent "negative feedback" regulation is disrupted in these cells. The allogeneic stem-cell transplantation performed in one patient was successful. Mutations in genes encoding the IL10R subunit proteins were found in patients with early-onset enterocolitis, involving hyperinflammatory immune responses in the intestine. Allogeneic stem-cell transplantation resulted in disease remission in one patient. 2009 Massachusetts Medical Society

  6. Risk factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization

    Directory of Open Access Journals (Sweden)

    Sabino Riestra

    Full Text Available Aims: To determine risk factors for active tuberculosis in patients with inflammatory bowel diseases. Methods: Retrospective, case-control study at 4 referral hospitals in Spain. Cases developed tuberculosis after a diagnosis of inflammatory bowel disease. Controls were inflammatory bowel disease patients who did not develop tuberculosis. For each case, we randomly selected 3 controls matched for sex, age (within 5 years and time of inflammatory bowel disease diagnosis (within 3 years. Inflammatory bowel disease characteristics, candidate risk factors for tuberculosis and information about the tuberculosis episode were recorded. Multivariate analysis and a Chi-squared automatic interaction detector were used. Results: Thirty-four cases and 102 controls were included. Nine of the 34 cases developed active tuberculosis between 1989 and 1999, and 25 became ill between 2000 and 2012. Multivariate regression showed an association between active tuberculosis and anti-TNF (tumor necrosis factor therapy in the previous 12 months (OR 7.45; 95% CI, 2.39-23.12; p = 0.001; hospitalization in the previous 6 months (OR 4.38; 95% CI, 1.18-16.20; p = 0.027; and albumin levels (OR 0.88; 95% CI, 0.81-0.95; p = 0.001. The median time between the start of biologic therapy and the onset of active tuberculosis was 13 (interquartile range, 1-58 months. Tuberculosis developed after a year of anti-TNF therapy in 53%, and late reactivation occurred in at least 3 of 8 patients. Conclusions: The main risks factors for developing tuberculosis were anti-TNF therapy and hospitalization. Over half the cases related to anti-TNF treatment occurred after a year.

  7. Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis.

    Science.gov (United States)

    Seyer-Hansen, Mikkel; Egekvist, Anne; Forman, Axel; Riiskjaer, Mads

    2018-01-01

    Women with endometriosis often experience pain and infertility. Medical treatment interferes with the possibility of attaining pregnancy. For infertile women with endometriosis, surgery is a possible treatment, but with advanced disease there is an increased risk of serious complications. With only limited pain, women will often be referred for in vitro fertilization treatment instead. The disease is estrogen-dependent and during in vitro fertilization treatment the women could theoretically experience worsening of their symptoms. The study is a retrospective cohort study of 76 women with bowel endometriosis who were treated conservatively and underwent in vitro fertilization treatment. Nine (11.8%) of the women experienced severe worsening of their bowel-related symptoms, including two patients presenting with colon ileus. One additional woman had no previous diagnosis of endometriosis before she presented with subocclusion of the bowel during in vitro fertilization. In all cases the in vitro fertilization treatment was stopped. Our study revealed that bowel endometriosis increases the risk of complications during in vitro fertilization treatment. This is in contrast to several publications. However, our study population is different due to the fact that none of these women had previous operations for bowel endometriosis. In all, 88% of the women completed fertility treatment without need for surgery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  8. CT and {sup 99m}Tc-WBC vs colonoscopy in the evaluation of inflammation and complications of inflammatory bowel diseases

    Energy Technology Data Exchange (ETDEWEB)

    Charron, M. [Children' s Hospital of Philadelphia, PA (United States); Lorenzo, C.D.; Kocoshis, S.

    2002-01-01

    The goal of this study was to evaluate the accuracy of computerized tomography (CT) and {sup 99m}Tc-white blood cell (WBC) scintigraphy versus colonoscopy in assessing inflammatory bowel diseases (IBD) in a large population of children. In a patient population of 313 consecutive children who had a {sup 99m}Tc-WBC scan, 106 colonoscopies were done within a median time interval of 8 days of the {sup 99m}Tc-WBC scan. One hundred and three CT scans were performed on 84 patients. Of the 42 CT scans obtained within a short time interval after the {sup 99m}Tc-WBC scan, 21 (50%) were normal. In the 21 children with a positive {sup 99m}Tc-WBC scan, 62% (13/21) of the CT scans underestimated the bowel wall inflammation in at least one segment. In the children with a negative {sup 99m}Tc-WBC study, there were 17 negative CT examinations and 4 examinations showing an abnormal terminal ileum. When CT was compared with colonoscopy in assessing inflammation, there were five true-negative CT, two true-positive CT, no false-positive, and seven false-negative CT examinations. When {sup 99m}Tc-WBC scintigraphy was compared with colonoscopy in assessing inflammation, there were seven true-positive, two false-negative, five true-negative, and no false-positive {sup 99T}c-WBC studies. The {sup 99m}Tc-WBC scan was positive in five patients with a false-negative CT examination. Of the total 103 CT scans obtained, 53 (51%) were normal. Four abscesses (3.8%) were demonstrated by CT. {sup 99m}Tc-WBC scintigraphy is more sensitive than CT for detecting inflammation of the bowel wall. The incidence of complications from IBD in this retrospective study was much lower than had been previously reported. (author)

  9. PROSPECTIVE EVALUATION OF AETIOPATHOGENESIS AND MANAGEMENT OF SMALL BOWEL OBSTRUCTION IN ADULTS

    Directory of Open Access Journals (Sweden)

    Ramani Ranjan

    2016-05-01

    Full Text Available INTRODUCTION Small bowel obstruction is a common surgical emergency. The small bowel is involved in about 80 percent of cases of mechanical intestinal obstruction. Mode of presentation is same in all but underlying cause varies in each age group. The dictum of never let the sun set or rise in small bowel obstruction has made early surgical intervention for small intestinal obstruction. This in turn has reduced the incidence of strangulation of bowel, which was major cause of mortality in already ill patient. Success in treatment of patient with acute intestinal obstruction depends largely upon early diagnosis, skilful management and appreciation of importance of treating the pathological effects of obstruction just as much as the cause itself. METHODS This is a prospective study which was done on patient with small bowel obstruction between September 2013 to August 2015 in M.K.C.G. Medical College and Hospital, Brahmapur, Odisha. All the patients were subjected to questionnaires and clinical examination, routine and special investigations like abdominal X-ray in erect posture, treatment modality based on laparotomy findings and postoperative observation for any complications. RESULT In this study, it is observed that bands and adhesions followed by hernia were the commonest causes of small bowel obstruction in adults. Pain abdomen, vomiting, distention, constipation, tenderness over abdomen and increased bowel sounds are seen in majority of cases. Maximum incidence occurred in 3 rd decade of life with M:F ratio of 1.73:1. Plain X-ray erect abdomen was almost conclusive in all cases. Resection and anastomosis followed by adhesiolysis were the two procedures which were commonly performed. Morbidity increased in old age patients and those whose presentation was late. CONCLUSION Small bowel obstruction remains a frequently encountered problem in abdominal surgery. The risk of strangulation with adhesive and neoplastic SBO is relatively low as

  10. Effects of personality traits on the manifestations of irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Tayama Jun

    2012-10-01

    Full Text Available Abstract Objective Previous studies have reported that patients with irritable bowel syndrome (IBS show high neuroticism. However, the precise association between the IBS subtypes and the degree of neuroticism in younger populations is largely unknown. We tested our hypothesis that subjects with diarrhea-predominant IBS may have a higher degree of neuroticism than subjects without IBS or those with other subtypes of IBS. We also verified the additional hypothesis that the severity of neuroticism might be correlated with the severity of IBS in younger populations. Methods We conducted a cross-sectional survey of 557 university students, ranging in age from 18 to 21 years. Presence/ absence of IBS and determination of the IBS subtype was by the Rome II Modular Questionnaire, while the severity of IBS was determined by the IBS severity index (IBS-SI. The degree of neuroticism was evaluated using the Maudsely Personality Inventory (MPI. The presence/absence of psychological distress was measured with the K6 scale. Results Neuroticism scores in the subjects with diarrhea-predominant IBS were significantly higher than those in the non-IBS subjects or subjects with constipation-predominant IBS. The neuroticism scores were significantly correlated with the IBS-SI scores in all subjects with IBS. Conclusion These results suggest that neuroticism is involved in the pathophysiology of IBS in young subjects, especially in that of the diarrhea-predominant subtype.

  11. Inflammatory bowel disease in travelers: choosing the right vaccines and check-ups.

    Science.gov (United States)

    Esteve, Maria; Loras, Carme; García-Planella, Ester

    2011-06-14

    The majority of patients with inflammatory bowel disease (IBD) achieve good control of the inflammatory activity using available therapies. When remission is achieved and quality of life recovered, a considerable proportion of IBD patients express their desire to travel abroad, be it for business, academic or leisure purposes. Their physicians should help and encourage them whenever possible. However, preventive measures are warranted to minimize the risk, since IBD patients are exposed to the same infections affecting the general population, plus opportunistic infections (OI) related to the immunosuppression. There are a large number of potential OI that might affect patients with IBD. The true prevalence of these infections is unknown, and can vary from country to country. Therefore, reactivation or de novo acquisition of infections such as tuberculosis, malaria, and viral hepatitis will be much more frequent in endemic areas. Therefore, physicians should be aware of these aspects when planning specific preventive measures for patients traveling to a particular country. This includes good control of environmental exposure, chemoprophylaxis when indicated, and the use of a specific vaccination program to prevent endemic infections. In addition, it should be noted that, though the risk of acquiring an infectious disease is probably greater for IBD patients traveling from a developed to a developing country, the inverse situation can also occur; it depends on the previous acquired immunity of the host against infections in any particular environment.

  12. A theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer.

    Science.gov (United States)

    Landers, Margaret; McCarthy, Geraldine; Savage, Eileen

    2013-08-01

    A paucity of research is available on patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer. Most research undertaken to date on patients' bowel symptoms following surgery for rectal cancer has been largely atheoretical. The purpose of this paper is to describe the process of choosing a theoretical framework to guide a study of patients' bowel symptoms and self-care strategies following sphincter-saving surgery for rectal cancer. As a result of a thorough literature review, we determined that the Symptom Management Theory provided the most comprehensive framework to guide our research. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Intestinal or bowel obstruction - discharge

    Science.gov (United States)

    ... to take care of yourself at home. Eat small amounts of food several times a day. DO NOT eat 3 large meals. You should: Space out your small meals. Add new foods back into your diet slowly. Take sips of ...

  14. T Cell Repertoire and Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Kenneth Croitoru

    1996-01-01

    Full Text Available The diversity of the T cell receptor repertoire is generated through rearrangement of the variable, junctional and constant region genes. Selection processes in the thymus and periphery serve to eliminate self-reacting T cells, thereby preventing autoimmune disease. The possibility that inflammatory bowel disease (IBD is an autoimmune disease has led to the search for an auto-antigen. In addition, studies are exploring the T cell receptor repertoire in IBD patients for changes that may provide clues regarding etiopathogenesis. Using monoclonal antibodies to T cell receptor variable-gene products or polymerase chain reaction analysis of variable-gene mRNA expression, the mucosal T cell repertoire has been examined in humans. The intestinal intraepithelial lymphocytes show a significant degree of oligoclonal expansion that may represent local antigen exposure or unique selection processes. This is in keeping with studies that show that murine intestinal intraepithelial lymphocytes undergo positive and possibly negative selection independent of the thymus. In the inflamed human gut, shifts in the T cell receptor repertoire may also reflect recruitment of peripheral T cells to the gut. In one study, a subset of Crohn’s disease patients was shown to have an increase in the proportion of variable β8 peripheral blood lymphocyte and mesenteric lymph node cells, suggesting a superantigen effect. The authors hypothesized that changes in the functional T cell receptor repertoire can also occur which might be independent of changes in the distribution of T cells expressing variable β T cell receptors. In fact, the authors have shown there is a selective decrease in the cytotoxic function of peripheral variable β8 T cells in Crohn’s disease. Furthermore, stimulation with the variable β8 selective bacterial enterotoxin staphylococcal enterotoxin E failed to increase the cytotoxic function in this subset of Crohn’s disease patients compared with

  15. [What useful developments for my inflammatory bowel disease practice have come from Digestive Disease Week 2014?].

    Science.gov (United States)

    Chaparro, María

    2014-09-01

    The objective of this article is to summarize reports presented at Digestive Disease Week 2014 that relate to fertility and pregnancy, inflammatory bowel disease in elderly patients, the risk of cancer and its relationship to treatment and finally, developments regarding psychological aspects that may affect patients with inflammatory bowel disease. Studies were selected at the discretion of the author, mainly considering those with conclusions that can be applied immediately to clinical practice. Using anti-TNF drugs during pregnancy is safe in the short term. This currently seems to be true for the medium and the long term. To limit fetal exposure, the mother can safely stop taking the anti-TNF drugs in the second trimester of the pregnancy if she is in remission. Elderly patients with inflammatory bowel disease require stricter monitoring than younger patients due to the risk of complications, especially infections associated with the disease and treatments. The effect of inflammatory bowel disease and the drugs for its treatment on the risk of development is still not well established, but the magnitude of the effect seems possibly lower than previously described. The causal link between psychological factors and the occurrence of IBD relapse is by no means established. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  16. Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection

    Energy Technology Data Exchange (ETDEWEB)

    Maconi, G. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy)]. E-mail: giovanni.maconi@unimi.it; Radice, E. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Greco, S. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Bezzio, C. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Bianchi Porro, G. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy)

    2007-08-15

    Aim: To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. Patients and methods: In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. Results: Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p = 0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. Conclusion: Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease.

  17. Methodological issues in the study of intestinal microbiota in irritable bowel syndrome.

    Science.gov (United States)

    Taverniti, Valentina; Guglielmetti, Simone

    2014-07-21

    Irritable bowel syndrome (IBS) is an intestinal functional disorder with the highest prevalence in the industrialized world. The intestinal microbiota (IM) plays a role in the pathogenesis of IBS and is not merely a consequence of this disorder. Previous research efforts have not revealed unequivocal microbiological signatures of IBS, and the experimental results are contradictory. The experimental methodologies adopted to investigate the complex intestinal ecosystem drastically impact the quality and significance of the results. Therefore, to consider the methodological aspects of the research on IM in IBS, we reviewed 29 relevant original research articles identified through a PubMed search using three combinations of keywords: "irritable bowel syndrome + microflora", "irritable bowel syndrome + microbiota" and "irritable bowel syndrome + microbiome". For each study, we reviewed the quality and significance of the scientific evidence obtained with respect to the experimental method adopted. The data obtained from each study were compared with all considered publications to identify potential inconsistencies and explain contradictory results. The analytical revision of the studies referenced in the present review has contributed to the identification of microbial groups whose relative abundance significantly alters IBS, suggesting that these microbial groups could be IM signatures for this syndrome. The identification of microbial biomarkers in the IM can be advantageous for the development of new diagnostic tools and novel therapeutic strategies for the treatment of different subtypes of IBS.

  18. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome.

    Science.gov (United States)

    Pyleris, Emmannouil; Giamarellos-Bourboulis, Evangelos J; Tzivras, Dimitrios; Koussoulas, Vassilios; Barbatzas, Charalambos; Pimentel, Mark

    2012-05-01

    Many studies have linked irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO), although they have done so on a qualitative basis using breath tests even though quantitative cultures are the hallmark of diagnosis. The purpose of this study was to underscore the frequency of SIBO in a large number of Greeks necessitating upper gastrointestinal (GI) tract endoscopy by using quantitative microbiological assessment of the duodenal aspirate. Consecutive subjects presenting for upper GI endoscopy were eligible to participate. Quantitative culture of aspirates sampled from the third part of the duodenum during upper GI tract endoscopy was conducted under aerobic conditions. IBS was defined by Rome II criteria. Among 320 subjects enrolled, SIBO was diagnosed in 62 (19.4%); 42 of 62 had IBS (67.7%). SIBO was found in 37.5% of IBS sufferers. SIBO was found in 60% of IBS patients with predominant diarrhea compared with 27.3% without diarrhea (P = 0.004). Escherichia coli, Enterococcus spp and Klebsiella pneumoniae were the most common isolates within patients with SIBO. A step-wise logistic regression analysis revealed that IBS, history of type 2 diabetes mellitus and intake of proton pump inhibitors were independently and positively linked with SIBO; gastritis was protective against SIBO. Using culture of the small bowel, SIBO by aerobe bacteria is independently linked with IBS. These results reinforce results of clinical trials evidencing a therapeutic role of non-absorbable antibiotics for the management of IBS symptoms.

  19. Intestinal Radiation-Induced Stricture Favours Small Bowel Obstruction by Phytobezoar: Report of a Case

    Directory of Open Access Journals (Sweden)

    Alessandra Quercioli

    2009-01-01

    Full Text Available Bezoars represent the fifth most frequent cause of acute small bowel obstruction. Phytobezoar is the most common type of bezoar. It is a concretion of undigestible fibers derived from ingested vegetables and fruits. We report a case of a woman with a 1-year history of recurrent epigastric and periumbilical abdominal pain with intermittent vomiting caused by phytobezoar of the terminal ileum. After careful investigation of the case and review of literature, we identified the factor involved in bezoar formation as radiation-induced ileal stenosis due to previous treatment for a pelvic tumour. This report provides evidence to consider phytobezoar as a possible cause of small bowel obstruction in patients previously treated with abdominal radiotherapy.

  20. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Tahsin Colak

    2013-01-01

    Full Text Available Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT. The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass.

  1. Inflammatory bowel disease in relation to contact allergy

    DEFF Research Database (Denmark)

    Engkilde, Kåre; Menné, Torkil; Johansen, Jeanne Duus

    2007-01-01

    number. The patients were patch tested at a dermatology department with a long history of research in CA. By record linking with the Danish National Patient Registry, patients were identified who had either an International Classification of Disease (ICD) code for Crohn's disease (CD) or an ICD code......OBJECTIVE: Inflammatory bowel disease (IBD) has previously been investigated with relation to allergic conditions; however, diverging results were found and there are only a few small studies focusing on delayed hypersensitivity. The aim of this study was to investigate whether.......71 (CI 95% 0.53-0.94), which is mainly the result of an inverse association between CA and CD, odds ratio adjusted for age and gender 0.42 (CI 95% 0.23-0.76). CONCLUSIONS: The association found between CA and IBD might be related to shared genetic factors or common environmental determinates. It may also...

  2. [Changes in the epidemiology of inflammatory bowel diseases].

    Science.gov (United States)

    Lakatos, László; Lakatos, Péter László

    2007-02-04

    Significant changes have been observed in the epidemiology of inflammatory bowel diseases (IBD) in the last two decades. Traditionally, the incidence of IBD was higher in the developed, industrialized countries, in contrast, nowadays it became more prevalent in the previously low incidence areas. In particular, the incidence of ulcerative colitis (UC) is similar to that observed in North America and Western Europe, while the incidence of Crohn's disease (CD) in developing countries is still low, suggesting that the environmental factors may act faster or differently in UC than in CD. In Europe, the North to South gradient disappeared, and also the West to East gradient is diminishing. Smoking and appendectomy may be considered as important environmental factors in both UC and CD, however, with opposite effects. In addition, the use of oral contraceptives is associated to disease susceptibility in both diseases. The role of diet, perinatal events, stress and nonsteroidal anti-inflammatory drugs in the pathogenesis is still controversial.

  3. Bactericidal permeability increasing protein gene polymorphism is associated with inflammatory bowel diseases in the Turkish population.

    Science.gov (United States)

    Can, Güray; Akın, Hakan; Özdemir, Filiz T; Can, Hatice; Yılmaz, Bülent; Eren, Fatih; Atuğ, Özlen; Ünsal, Belkıs; Hamzaoğlu, Hülya O

    2015-01-01

    Inflammatory bowel disease, a chronic inflammatory disease with unknown etiology, affects the small and large bowel at different levels. It is increasingly considered that innate immune system may have a central position in the pathogenesis of the disease. As a part of the innate immune system, bactericidal permeability increasing protein has an important role in the recognition and neutralization of gram-negative bacteria. The aim of our study was to investigate the involvement of bactericidal permeability increasing protein gene polymorphism (bactericidal permeability increasing protein Lys216Glu) in inflammatory bowel disease in a large group of Turkish patients. The present study included 528 inflammatory bowel disease patients, 224 with Crohn's disease and 304 with ulcerative colitis, and 339 healthy controls. Bactericidal permeability increasing protein Lys216Glu polymorphism was found to be associated with both Crohn's disease and ulcerative colitis (P = 0.0001). The frequency of the Glu/Glu genotype was significantly lower in patients using steroids and in those with steroid dependence (P = 0.012, OR, 0.80; 95% confidence interval [CI]: 0.68-0.94; P = 0.0286, OR, 0.75; 95% CI: 0.66-0.86, respectively). There was no other association between bactericidal permeability increasing protein gene polymorphism and phenotypes of inflammatory bowel disease. Bactericidal permeability increasing protein Lys216Glu polymorphism is associated with both Crohn's disease and ulcerative colitis. This is the first study reporting the association of bactericidal permeability increasing protein gene polymorphism with steroid use and dependence in Crohn's disease.

  4. Spontaneous transmesenteric hernia: a rare cause of small bowel obstruction in an adult

    Directory of Open Access Journals (Sweden)

    Poras Chaudhary

    2013-02-01

    Full Text Available The authors report a case of spontaneous transmesenteric hernia with strangulation in an adult. Transmesenteric hernia (TMH is a rare cause of small bowel obstruction and is seldom diagnosed preoperatively, and most TMHs in adults are related to predisposing factors, such as previous surgery, abdominal trauma, and peritonitis. TMH are more likely to develop volvulus and strangulation or ischemia. A brief review of etiology, clinical features, diagnosis, and treatment is discussed.

  5. The relationship between faecal-associated and mucosal-associated microbiota in irritable bowel syndrome patients and healthy subjects

    NARCIS (Netherlands)

    Rangel, I.; Sundin, J.; Fuentes Enriquez de Salamanca, S.; Repsilber, D.; Vos, de W.M.; Brummer, R.J.

    2015-01-01

    BACKGROUND: The faecal-associated microbiota is commonly seen as a surrogate of the mucosal-associated microbiota. However, previous studies indicate that they are different. Furthermore, analyses of the mucosal microbiota are commonly done after standard bowel cleansing, affecting the microbial

  6. Concomitant functional dyspepsia and irritable bowel syndrome decrease health-related quality of life in gastroesophageal reflux disease

    NARCIS (Netherlands)

    de Vries, Durk R.; van Herwaarden, Margot A.; Baron, Astrid; Smout, André J. P. M.; Samsom, Melvin

    2007-01-01

    OBJECTIVE: Previous studies have reported an overlap between gastroesophageal reflux symptoms, functional dyspepsia (FD) and irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of FD and IBS in gastroesophageal reflux disease (GERD) and the effect on

  7. Mast cells: a possible link between psychological stress, enteric infection, food allergy and gut hypersensitivity in the irritable bowel syndrome.

    Science.gov (United States)

    Gui, X Y

    1998-10-01

    Intestinal mast cell activation (degranulation), which results from previous enteric infection and/or intestinal allergy, may play a central role in the gut hypersensitivity in both motor response and visceral perception in the Irritable Bowel syndrome. This occurs through various mediators acting on enteric neurons and smooth muscle cells. Psychological stress may trigger this sensitive alarm system via the brain-gut axis.

  8. Bowel Preparation of Outpatients for Intravenous Urography: Efficacy of Castor Oil Versus Bisacodyl

    Directory of Open Access Journals (Sweden)

    Huei-Chen Yang

    2005-04-01

    Full Text Available The purpose of this study was to compare the efficacy of two laxatives, castor oil and bisacodyl, in the routine bowel preparation of outpatients for intravenous urography (IVU. We used castor oil in patients undergoing IVU for 1 month, and then used bisacodyl in patients undergoing IVU for another month. Two uroradiologists, unaware of the method of bowel preparation, reviewed the standard radiographs and graded the residue in the large bowel and the clearness of the opacified urinary collecting system. In total, 71 consecutive outpatients received castor oil, and 84 received bisacodyl. For the castor oil group, grades from the two uroradiologists did not differ in terms of fecal residue on plain abdominal images (p = 0.54, and visualization of the urinary system on the left (p = 0.36 and right sides (p = 0.63. Findings were similar for bisacodyl recipients (p = 0.11, 0.59, and 0.32, respectively. When the laxative effect of the two agents was compared, we found no difference in the grading of fecal residue on plain abdominal images (p = 0.14, or in visualization of the urinary system on the left (p = 0.31 and right sides (p = 0.98. In conclusion, we observed no difference in laxative efficacy between castor oil and bisacodyl; thus, bisacodyl may be a useful alternative for bowel preparation before IVU.

  9. Diseases of the small bowel in chronic diarrhea: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    M. Simadibrata

    2002-09-01

    Full Text Available The incidence of chronic diarrhea in Asia is between 0.8-1.0%. The diseases and abnormalities according to the location, which can cause chronic diarrhea, are divided into three locations: the small bowel, the large bowel and extraintestinal. The small bowel diseases include infectious and non-infectious diseases. The infectious diseases are bacterial infections, parasitic infections etc. The non-infectious diseases include of Crohn’s disease, Celiac sprue, NSAID enteropathy, lactose intolerance, benign tumor, carcinoid tumor, carcinoma, post surgery complications, laxative etc. The approaches to diagnosis include good anamnesis, careful physical examination, supporting laboratory tests, more specialized supporting examinations including X-ray of the colon, esophagogastroduodenum follow-through, enteroclysis, ileo-colonoscopy and endoscopy on the upper portion of the digestive tract including the small intestine with biopsy for histopathology examinations. The treatment for chronic diarrhea is divided into supportive and causal therapy. (Med J Indones 2002; 11: 179-89 Keywords: small bowel, chronic diarrhea, approaches to diagnosis, treatment

  10. A retrospective analysis comparing small bowel follow-through with wireless capsule endoscopy in the evaluation of obscure gastrointestinal bleeding.

    Science.gov (United States)

    Nutter, Melanie; Dunston, Diana; Ieyoub, Jonathan; Hart, Albert; Harper, Jeannie; Burke, Mary S

    2010-01-01

    A comparative retrospective study was conducted to evaluate diagnostic findings between small bowel follow-through (SBFT) and wireless capsule endoscopy in the presence of obscure gastrointestinal bleeding. A convenience sample of 31 patients with previous negative upper and lower endoscopy was included in the study. Wireless capsule endoscopy established a significant source of obscure gastrointestinal bleeding 53% of the time. The diagnostic capacity of radiographic SBFT was measured at 17% as compared with that of the wireless capsule endoscopy. The clinical findings along with the digital images obtained from the wireless capsule endoscopy was found to be the optimum diagnostic tool in the evaluation of obscure gastrointestinal bleeding in the small bowel.

  11. Clinical peculiarities of antibiotic associated bowels impairment and its significance in irritable bowel syndrome appearance

    Directory of Open Access Journals (Sweden)

    І. O. Pasichna

    2016-06-01

    Full Text Available Aim: the main objective of this study was to investigate bowels impairment due to treatment with antibiotics, its incidence and clinical peculiarities; to evaluate its role in appearance of in irritable bowel syndrome. Material and Methods. We studied 110 patients (33 males and 77 females, age range 16-83 years, who received treatment with antibiotic. We evaluated the function of the intestine before treatment with antibiotic, then in 1 week, 3 months after treatment finish (1, 2, 3, 4 visits respectively. Control group included 20 healthy persons, who haven't had antibiotics administered during recent two years. Results. We revealed that the signs of bowel function impairment took place at the first visit in 18.2% of patients, at the second visit – in 60.0% of patients, at the third visit – in 45.5% of patients and at the fourth visit – in 41.1% of patients. At the second, third and fourth visits the signs of bowels function impairment were observed reliably more often then at the first visit (before antibiotic administration, p<0.001. At the second visit the signs bowels function disorders were the most prominent: abdominal pain – in 44.5%, distention – in 46.4%, diarrhea – in 29.1%, constipation – in 18.2%, presence of both (diarrhea and periodically constipation manifestations – in 2.7%; and extraintestinal manifestations (depression. depressed mood, sorrow, apathy, decreased stamina, sleep disturbances – in 29.1% of patients. Clinical manifestations of irritable bowel syndrome occured in 6 months of observation in 32.2% of patients. Conclusions. The signs of bowel function impairment were observed in 60.0% of patients after finishing treatment with antibiotic. This incidence is much higher than in control group (р<0.001. Bowel disorders mostly manifested as the changes in quantity and consistency of feaces, pain, abdominal distention and extraintestinal manifestations. In 32.2% of patients clinical manifestations of

  12. Influence of perception of colorectal cancer risk and patient bowel preparation behaviors: a study in minority populations

    Directory of Open Access Journals (Sweden)

    Gaduputi V

    2015-01-01

    Full Text Available Vinaya Gaduputi, Chaitanya Chandrala, Hassan Tariq, Sailaja Sakam, Anil Dev, Sridhar Chilimuri Bronx Lebanon Hospital Center, Department of Medicine, Bronx, New York, NY, USA Background: Large disparities exist in the utilization rates of screening modalities for colorectal cancer (CRC in different socioeconomic areas. In this study, we evaluated whether the quality of bowel preparation differed significantly among populations with a high risk of CRC compared with that among the general population after matching for potential confounding factors.Methods: Hispanic and African American patients who underwent routine screening or surveillance colonoscopies in an outpatient setting between 2003 and 2013 were included in this retrospective study. Patients who underwent colonoscopies for emergent indications and repeat routine screening colonoscopies because of prior history of inadequate bowel preparation were excluded from this study. The patients were divided into three groups: patients having an average risk of being diagnosed with CRC (group 1; patients having a high risk of being diagnosed with CRC because of a personal history of adenomatous polyps (group 2; and patients having a high risk of being diagnosed with CRC because of a family history of CRC in first-degree relatives (group 3. All the patients were given preprocedural counseling and written instructions for bowel preparation. Data on demographic information, method of bowel preparation, quality of bowel preparation, comorbidities, and prescription medications were collected.Results: In all, 834 patients had a "high-risk for CRC" surveillance colonoscopy in view of their personal history of adenomatous polyps and were included in group 2. In total, 250 patients had a "high-risk for CRC" screening colonoscopy in view of their family history of CRC in first-degree relatives and were included in group 3. Further, 1,000 patients were selected to serve as controls (after matching for age

  13. Physical activity during video capsule endoscopy correlates with shorter bowel transit time.

    Science.gov (United States)

    Stanich, Peter P; Peck, Joshua; Murphy, Christopher; Porter, Kyle M; Meyer, Marty M

    2017-09-01

     Video capsule endoscopy (VCE) is limited by reliance on bowel motility for propulsion, and lack of physical activity has been proposed as a cause of incomplete studies. Our aim was to prospectively investigate the association between physical activity and VCE bowel transit.  Ambulatory outpatients receiving VCE were eligible for the study. A pedometer was attached at the time of VCE ingestion and step count was recorded at the end of the procedure. VCE completion was assessed by logistic regression models, which included step count (500 steps as one unit). Total transit time was analyzed by Cox proportional hazards models. The hazard ratios (HR) with 95 % confidence interval (CI) indicated the "hazard" of completion, such that HRs > 1 indicated a reduced transit time.  A total of 100 patients were included. VCE was completed in 93 patients (93 %). The median step count was 2782 steps. Step count was not significantly associated with VCE completion (odds ratio 1.45, 95 %CI 0.84, 2.49). Pedometer step count was significantly associated with shorter total, gastric, and small-bowel transit times (HR 1.09, 95 %CI 1.03, 1.16; HR 1.05, 95 %CI 1.00, 1.11; HR 1.07, 95 %CI 1.01, 1.14, respectively). Higher body mass index (BMI) was significantly associated with VCE completion (HR 1.87, 95 %CI 1.18, 2.97) and shorter bowel transit times (HR 1.05, 95 %CI 1.02, 1.08).  Increased physical activity during outpatient VCE was associated with shorter bowel transit times but not with study completion. In addition, BMI was a previously unreported clinical characteristic associated with VCE completion and should be included as a variable of interest in future studies.

  14. The impact of stoma for bowel management after spinal cord injury.

    Science.gov (United States)

    Coggrave, M J; Ingram, R M; Gardner, B P; Norton, C S

    2012-11-01

    Multi-centre, retrospective self-report postal survey. To characterise spinal cord injured (SCI) individuals with a stoma, their stoma management and outcomes, to identify sources of information and support for decision making and to explore the impact of a stoma on life satisfaction. Five UK spinal cord injury centres. A study-specific questionnaire accompanied by self-concept, life satisfaction and mood measures, and three simple rating scales for satisfaction, impact and restriction on life were sent to all known ostomates at five participating centres. Respondents were 92 individuals, mean age 56 years, mean duration of injury 26 years, 91% with colostomy. Multiple sources of information were utilised in deciding on surgery; discussion with other SCI ostomates was important. Duration of bowel care, faecal incontinence, bowel-related autonomic dysreflexia, dietary manipulation and laxative use were all significantly reduced following surgery. Rectal mucous discharge was the most common and bothersome post-stoma problem. Satisfaction with stoma was high; provision of sufficient information preoperatively was important, those with ileostomy were more dependent and less satisfied. Life satisfaction and physical self-concept were both lower in this sample than in previously reported samples of SCI individuals without reported bowel difficulties or stoma. The findings of this study of self-selected respondents with a stoma for bowel management after SCI emphasised the benefits of stoma in selected individuals and the importance of timely intervention, the complexity of the associated decision-making and of preoperative counselling. The impact of bowel dysfunction on physical self-concept warrants investigation.

  15. Effect of prucalopride on intestinal gas tolerance in patients with functional bowel disorders and constipation.

    Science.gov (United States)

    Malagelada, Carolina; Nieto, Adoración; Mendez, Sara; Accarino, Anna; Santos, Javier; Malagelada, Juan-R; Azpiroz, Fernando

    2017-08-01

    Patients with functional bowel disorders develop gas retention and symptoms in response to intestinal gas loads that are well tolerated by healthy subjects. Stimulation of 5HT-4 receptors in the gut has both prokinetic and antinociceptive effects. The aim of this study is to determine the effect of prucalopride, a highly selective 5HT-4 agonist, on gas transit and tolerance in women with functional bowel disorders complaining of constipation. Twenty-four women with functional bowel disorders complaining of constipation were included in the study. Patients were studied twice on separate days in a cross-over design. On each study day, an intestinal gas challenge test was performed. During the five previous days, prucalopride (2 mg/day) or placebo was administered. Abdominal symptoms, stool frequency, and stool consistency were recorded during the treatment period on daily questionnaires. During the gas challenge test, prucalopride did not decrease the volume of gas retained in the subset of patients who had significant gas retention (≥ 200 mL) while on placebo. However, in those patients who had increased symptoms during the gas test (≥ 3 on a 0 to 6 scale) when on placebo, prucalopride did significantly reduce the perception of symptoms (2.3 ± 0.5 mean score vs 3.5 ± 0.3 on placebo; P = 0.045). During the treatment period with prucalopride, patients exhibited an increase in the total number of bowel movements and decreased stool consistency compared with placebo. Prucalopride reduces abdominal symptoms without modifying gas retention when patients with functional bowel disorders are challenged with the gas transit and tolerance test. European Clinical Trials Database (EudraCT2011-006354-86). © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  16. Leukocyte migration in experimental inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    E. P. Van Rees

    1997-01-01

    Full Text Available Emigration of leukocytes from the circulation into tissue by transendothelial migration, is mediated subsequently by adhesion molecules such as selectins, chemokines and integrins. This multistep paradigm, with multiple molecular choices at each step, provides a diversity in signals. The influx of neutrophils, monocytes and lymphocytes into inflamed tissue is important in the pathogenesis of chronic inflammatory bowel disease. The importance of each of these groups of adhesion molecules in chronic inflammatory bowel disease, either in human disease or in animal models, will be discussed below. Furthermore, the possibilities of blocking these different steps in the process of leukocyte extravasation in an attempt to prevent further tissue damage, will be taken into account.

  17. Innovative therapeutics for inflammatory bowel disease

    OpenAIRE

    Yamamoto-Furusho, Jesus K

    2007-01-01

    Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the gastrointestinal tract, which clinically present as one of two disorders, Crohn’s disease or ulcerative colitis. Mainstays of drug treatments for IBD include aminosalicylates, corticosteroids and immunosuppressants such as azathioprine, methotrexate and cyclosporin. Advances in basic research of the pathophysiological process in IBD have been applied to generate a variety of new therapeutics targeting at different le...

  18. Stem cell therapy for inflammatory bowel disease

    OpenAIRE

    Duijvestein, Marjolijn

    2012-01-01

    Hematopoietic stem cell transplantation (HSCT) and mesenchymal stromal (MSC) cell therapy are currently under investigation as novel therapies for inflammatory bowel diseases (IBD). Hematopoietic stem cells are thought to repopulate the immune system and reset the immunological response to luminal antigens. MSCs have the capacity to differentiate into a wide variety of distinct cell lineages and to suppress immune responses in vitro and in vivo. The main goal of this thesis was to study the s...

  19. Dietary fiber in irritable bowel syndrome (Review)

    OpenAIRE

    El-Salhy, Magdy; Ystad, Synne Otterasen; Mazzawi, Tarek; Gundersen, Doris

    2017-01-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly ferm...

  20. Novel targeted therapies for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Coskun, Mehmet; Vermeire, Severine; Nielsen, Ole Haagen

    2017-01-01

    Our growing understanding of the immunopathogenesis of inflammatory bowel disease (IBD) has opened new avenues for developing targeted therapies. These advances in treatment options targeting different mechanisms of action offer new hope for personalized management. In this review we highlight...... to intestinal sites of inflammation (e.g., sphingosine 1-phosphate receptor modulators). We also provide an update on the current status in clinical development of these new classes of therapeutics....

  1. The evolving epidemiology of inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Shanahan, Fergus

    2009-07-01

    Epidemiologic studies in inflammatory bowel disease (IBD) include assessments of disease burden and evolving patterns of disease presentation. Although it is hoped that sound epidemiologic studies provide aetiological clues, traditional risk factor-based epidemiology has provided limited insights into either Crohn\\'s disease or ulcerative colitis etiopathogenesis. In this update, we will summarize how the changing epidemiology of IBD associated with modernization can be reconciled with current concepts of disease mechanisms and will discuss studies of clinically significant comorbidity in IBD.

  2. Irritable bowel syndrome and its psychological management

    Directory of Open Access Journals (Sweden)

    Ravikesh Tripathi

    2015-01-01

    Full Text Available Irritable Bowel Syndrome (IBS is a chronic and disabling gastrointestinal problem that affects psychosocial functioning as well as the quality of life. This case study reports the utility of cognitive behavior therapy as a psychological intervention procedure in a chronic case of IBS. The use of psychological intervention was found to result in a reduction of anxiety; amelioration of the symptoms associated with IBS and improved functioning.

  3. A case of combined laparoscopic reduction and open preperitoneal mesh repair for incarcerated small bowel in a retroperitoneal hernia between the external and internal iliac vessels.

    Science.gov (United States)

    Morisue, R; Inaba, M; Shoji, R; Kawamoto, H

    2017-08-01

    We report a rare case of an incarcerated retroperitoneal hernia with or involving the small bowel through the orifice between the right external and internal iliac vessels. A 39-year-old woman was admitted to our hospital because of vomiting and abdominal pain. She had a history of right oophorocystectomy and appendectomy. Abdominal computed tomography revealed small bowel obstruction resulting from an incarcerated retroperitoneal hernia. The small bowel herniated into the retroperitoneal fossa through the orifice between the right external and internal iliac vessels. Laparoscopic reduction of the small bowel was performed, followed by ligation of the sac and placement of a mesh prosthesis through the preperitoneal approach, using a lower midline incision along the previous laparotomy scar. Her postoperative course was uneventful and no recurrence has been observed after surgery.

  4. CT scanning of blunt trauma to bowel and mesentery

    International Nuclear Information System (INIS)

    Federle, M.P.; Griffiths, B.G.; Donohue, J.H.; Minagi, H.

    1986-01-01

    In a 6-year period, 1,500 consecutive CT scans were performed for the evaluation of blunt abdominal trauma. The patient population included 25 patients with a preoperative diagnosis of mesenteric or bowel injury. The preoperative diagnosis was proved correct in 23 cases. An additional 12 patients were diagnosed from CT findings as having bowel or mesenteric injuries, but did not undergo laparotomy. Of the patients who underwent operation, bowel wall thickening, intraperitoneal fluid, or both were noted on CT in all cases but one. Less frequently noted CT signs of bowel or mesenteric injury included extraluminal gas (seven cases) and extravasated contrast material (one). Both of these signs were regarded as indications for surgery, as were hematomas in the bowel wall or mesentery when accompanied by substantial amounts of intraperitoneal fluid. The importance of meticulous scanning technique and photography is emphasized. Potential sources of error in the assessment of bowel or mesenteric injuries are described

  5. The prevention of radiation-induced small bowel complications

    Energy Technology Data Exchange (ETDEWEB)

    Letschert, J.G.J. [Amsterdam Univ. (Netherlands). Academisch Ziekenhuis

    1995-07-01

    Moderate dose pelvic radiotherapy is associated with a 5% severe complication risk related to the small bowel. Strictures and/or fistulation can occur many years after treatment. These complications are difficult to treat, and surgical treatment (excision, bypass) bears a significant morbidity risk. The risk of chronic diarrhoea or malabsorption may increase to 40%, depending on the irradiated small bowel volume. Late small bowel complications are generally irreversible due to vascular aetiology. Prevention of these complications can be achieved by limiting the volume of small bowel treated. Consequence for radiotherapeutic techniques in treatment for rectal cancer are multiple beam set-up, customised blocking based on visualisation of the small bowel in the treatment position, and the use of a special open table-top device that results in a small bowel shift from the treatment field. (author).

  6. Psychological factors in the irritable bowel syndrome.

    Science.gov (United States)

    Solmaz, M; Kavuk, I; Sayar, K

    2003-12-09

    The role of psychological factors in the irritable bowel syndrome (IBS) is a matter of debate. The prevalence of psychiatric disorders is high in IBS patients. Positive response to antidepressant therapy and presence of family history of depression in IBS patients have led speculations whether this syndrome might be regarded as an affective spectrum disorder. In this study we tried to examine the possible association of IBS with affective spectrum disorders. Forty IBS patients from gastroenterology outpatient clinics of a university hospital and state hospital, 32 controls with inflammatory bowel disease and 34 healthy hospital workers were included in the study. Psychiatric interviews were done using SCID-NP (Structured Clinical Interview for DSM-Non-patients) and psychological factors were assessed by the SCL-90-R (Symptom Checklist-90-Revised), the Beck Depression Inventory, the Beck Anxiety Scale and the Hamilton Rating Scale for Depression. Family histories were obtained by FH-RDC (Family History Research Diagnostic Criteria). All groups were matched for sociodemographic variables. The prevalence of psychiatric disorders and mood disorders was higher in the IBS group than the control groups. Also IBS group rated higher on anxiety and depression scales than the other groups, where the differences were statistically significant. Presence of positive family history for mood disorders was higher in the IBS group. These results support the hypothesis that IBS might be linked to affective spectrum disorder. Psychiatric assessment and therapy might be useful in the course of irritable bowel syndrome.

  7. The radiolesions of the small bowel

    International Nuclear Information System (INIS)

    Bories-Azeau, A.; Dayan, L.

    1980-01-01

    The irradiation of the pelvic abdominal cancers extends beyond the centre of the tumour and may induce actinic digestive lesions. The bowel and more rarely the small bowel -which is the subject-matter of our study- are concerned by those radiolesions that are favoured by therapeutic overdose, post-operative adhesions fastening the bows, radio-surgical or chemicostatic associations, and lastly by vascular or nutritive deficiencies. One may distinguish between two kinds of lesions, depending on the lapse of time before their coming out and on the symptoms. The early or acute types are characterized by a radio-mucitis and give an exsudative enteropathy with anorexia, vomiting, diarrhoea and loss of weight, of which the diagnosis is easy because it occurs during the irradiation and lessens at the end of the treatment. The late radiolesions of the small bowel are characterized by sclerosis and chronic endarteritis and, after a longlasting period of latency, give varied symptoms: disordered intestinal transit which sometimes is irreversible, perforation, fistula, syndrome of malabsorption, giving often rise to be mistaken for a recurrence of the cancer. The treatment varies whether the lesion is segmental or diffuse. In the first case, the failure of the medical means accounts for the surgical cutting away or the internal derivation; in the second case, the digestive mutilation which would result from an enlargement of the lesion commands to be more cautious and to call for the methods of parenteral feeding and digestive setting to rest [fr

  8. Review of Irritable Bowel Syndrome Treatment

    Directory of Open Access Journals (Sweden)

    M.R Ghadir

    2012-05-01

    Full Text Available

    Background and Objectives: Irritable bowel syndrome is one of the most common functional gastrointestinal disorders striking 10-20% of the world population. Although most patients do not take medical assistance, this disease enforces significant cost on the patient and health systems and has negative effects on quality of life of the individual. After diagnosis ,treatment of this disease is the next step. Many pathways of treatment has been introduced and the efficacy of each other has been established in one way or another. The first step in the path of treatment is education and confidence of patients that might also be the most important step. Fiber diet, probiotic, anti-cholinergic and anti antispasmodics, laxatives, anti-diarrhea, the drugs affecting serotonin receptors, antidepressants and anti-anxiety, the chloride channel activator and non-drug methods such as cognitive-behavior therapy, hypnotherapy, acupuncture and herbal medicine each of which has been tested on irritable bowel syndrome and efficacy of each one has been indicated in one way or another. This paper tried to outline new treatments available in addition to categorization and discussion of various treatments for irritable bowel syndrome.

  9. Surgical management of tuberculous small bowel obstruction

    International Nuclear Information System (INIS)

    Akbar, M.; Naveed, D.; Akbar, I.; Khattak, I.; Zafar, A.; Haider, I.Z.; Akbar, K.

    2010-01-01

    Background: Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored. Methods: Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months. Results: Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%. Conclusion: Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery. (author)

  10. Neurological Manifestations In Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    youssef HNACH

    2015-06-01

    Full Text Available IntroductionThe purpose of this retrospective study was to report neurological manifestations noted in patients who were monitored for inflammatory bowel disease, in order to document the pathophysiological, clinical, progressive, and therapeutic characteristics of this entity.Material and methodsWe conducted a retrospective study on patients monitored -in the gastroenterology service in Ibn Sina Hospital in Rabat, Morocco- for inflammatory bowel disease from 1992 till 2013 and who developed neurological manifestations during its course. Patients with iatrogenic complications were excluded, as well as patients with cerebrovascular risk factors.ResultsThere were 6 patients, 4 of whom have developed peripheral manifestations. Electromyography enabled the diagnosis to be made and the outcome was favorable with disappearance of clinical manifestations and normalization of the electromyography.The other 2 patients, monitored for Crohn’s disease, developed ischemic stroke. Cerebral computed tomography angiography provided positive and topographic diagnosis. Two patients were admitted to specialized facilities.ConclusionNeurological manifestations in inflammatory bowel disease are rarely reported.  Peripheral neuropathies and stroke remain the most common manifestations. The mechanisms of these manifestations are not clearly defined yet. Currently, we hypothesize the interaction of immune mediators.

  11. The epidemiology of irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Canavan C

    2014-02-01

    Full Text Available Caroline Canavan, Joe West, Timothy Card Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK Abstract: Irritable bowel syndrome (IBS is a functional condition of the bowel that is diagnosed using clinical criteria. This paper discusses the nature of the diagnostic process for IBS and how this impacts epidemiological measurements. Depending on the diagnostic criteria employed, IBS affects around 11% of the population globally. Around 30% of people who experience the symptoms of IBS will consult physicians for their IBS symptoms. These people do not have significantly different abdominal symptoms to those who do not consult, but they do have greater levels of anxiety and lower quality of life. Internationally, there is a female predominance in the prevalence of IBS. There is 25% less IBS diagnosed in those over 50 years and there is no association with socioeconomic status. IBS aggregates within families and the genetic and sociological factors potentially underlying this are reviewed. Patients diagnosed with IBS are highly likely to have other functional disease and have more surgery than the general population. There is no evidence that IBS is associated with an increased mortality risk. The epidemiological evidence surrounding these aspects of the natural history is discussed. Keywords: irritable bowel syndrome, epidemiology, prevalence, mortality, natural history

  12. Placental complications after a previous cesarean section

    OpenAIRE

    Milošević Jelena; Lilić Vekoslav; Tasić Marija; Radović-Janošević Dragana; Stefanović Milan; Antić Vladimir

    2009-01-01

    Introduction The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complic...

  13. CT of complicated inflammatory bowel disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Riddlesberger, M.M. Jr.

    1985-09-01

    Most children with inflammatory bowel disease do not need a CT scan. However, when the course becomes complicated if often is necessary to evaluate what is happening outside the bowel lumen. CT is the examination of choice for that evaluation. With CT, the presence and extent of an abscess can be diagnosed and followed; fistulae can be detected; bowel wall and mesenteric thickening can generally be differentiated from an abscess.

  14. Pathophysiology of acute small bowel disease with CT correlation

    Energy Technology Data Exchange (ETDEWEB)

    Sarwani, N., E-mail: nsarwani@hmc.psu.ed [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States); Tappouni, R.; Tice, J. [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States)

    2011-01-15

    The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

  15. MicroRNAs in inflammatory bowel disease--pathogenesis, diagnostics and therapeutics

    DEFF Research Database (Denmark)

    Coskun, Mehmet; Bjerrum, Jacob Tveiten; Seidelin, Jakob Benedict

    2012-01-01

    The pathogenesis of inflammatory bowel disease (IBD) is complex and largely unknown. Until recently, research has focused on the study of protein regulators in inflammation to reveal the cellular and molecular networks in the pathogenesis of IBD. However, in the last few years, new and promising...... diagnosis of IBD, and in the development of personalized therapies. Here, we provide a short review of the current state-of-the-art of miRNAs in IBD pathogenesis, diagnostics and therapeutics....

  16. Inflammatory bowel disease among Bedouin Arabs in southern Israel: urbanization and increasing prevalence rates.

    Science.gov (United States)

    Abu Freha, Naim; Schwartz, Doron; Elkrinawi, Jaber; Ben Yakov, Gil; Abu Tailakh, Muhammad; Munteanu, Daniela; Abu Ganim, Abdelrhman; Fich, Alexander

    2015-03-01

    Inflammatory bowel disease (IBD) has been associated with genetic and environmental factors, including urban living. IBD was rare in the Israeli Bedouin community 30 years ago. Over recent decades, a large proportion of this community has undergone a transition from a nomadic to a western lifestyle. Our aim was to carry out an updated evaluation of the clinical and epidemiological features of IBD in the Bedouin sector of southern Israel. All Bedouin patients with a known diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were included in the retrospective study. The cohort included 31 CD patients and 31 UC patients. The mean age of the patients at diagnosis was 29±10.9 and 35±17.5 years for CD and UC, respectively. The prevalence rate for CD was 15.5/100,000 and the incidence rate was 0.8-3.55/100,000. Fourteen of the CD patients (45%) had ileal disease and 64.5% had inflammatory disease behavior according to the Montreal classification. Eleven of the CD patients (35%) were treated with anti-TNF-α and 26% had undergone surgery. Over the previous decade, the prevalence of UC was 14/100,000 and the incidence was 0.5-2.39/100,000. Eighteen UC patients (58%) had left-sided colitis. Three (9.7%) had undergone total colectomy for severe disease. We found an increased prevalence of IBD in the Bedouin population, associated with their change in lifestyle over previous decades. However, the prevalence is still markedly lower than that in other population groups. A high percentage of patients were treated with anti-TNF-α and/or surgery.

  17. Bowel preparation in CT colonography. Is diet restriction necessary? A randomised trial (DIETSAN)

    International Nuclear Information System (INIS)

    Bellini, Davide; De Santis, Domenico; Caruso, Damiano; Rengo, Marco; Biondi, Tommaso; Laghi, Andrea; Ferrari, Riccardo

    2018-01-01

    To investigate whether diet restriction affects quality of colon cleansing and patient tolerance during reduced bowel preparation for CT colonography (CTC). Asymptomatic and symptomatic patients were enrolled in this pragmatic, single-centre, randomised trial. All patients were randomly assigned (1:1 ratio, blocks of ten) to receive a reduced bowel preparation and faecal tagging with (Diet-Restriction-Group [DR]) or without (No-Diet-Restriction-Group [NDR]) dietary restriction. Five readers performed a blinded subjective image analysis, by means of 4-point Likert-scales from 0 (highest score) to 3 (worst score). Endpoints were the quality of large bowel cleansing and tolerance to the assigned bowel preparation regimen. The trial is registered at ClinicalTrial.gov (URomLSDBAL1). Ninety-five patients were randomly allocated to treatments (48 in NDR-group, 47 in DR-group). Both groups resulted in optimal colon cleansing. The mean residual stool (0.22, 95%CI 0.00-0.44) and fluid burden (0.39, 95%CI 0.25-0.53) scores for patients in DR-group were similar to those in patients in NDR-group (0.25, 95%CI 0.03-0.47 [p = 0.82] and 0.49, 95%CI 0.30-0.67 [p = 0.38], respectively). Tolerance was significantly better in NDR-group. A reduced bowel preparation in association with faecal tagging and without any dietary restriction demonstrated optimal colon cleansing effectiveness for CTC, providing better patient compliance compared with dietary restriction. (orig.)

  18. Cytomegalovirus infection in inflammatory bowel disease is not associated with worsening of intestinal inflammatory activity.

    Directory of Open Access Journals (Sweden)

    Alexandre Medeiros do Carmo

    Full Text Available Cytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. Because this, there are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus.Evaluate the frequency of cytomegalovirus in patients with inflammatory bowel disease and identify correlations.Patients with inflammatory bowel disease underwent an interview, review of records and collection of blood and fecal samples. The search for cytomegalovirus was performed by IgG and IgM blood serology, by real-time PCR in the blood and by qualitative PCR in feces. Results were correlated with red blood cell levels, C-reactive protein levels, erythrocyte sedimentation rates and fecal calprotectin levels for each patient.Among the 400 eligible patients, 249 had Crohn's disease, and 151 had ulcerative colitis. In the group of Crohn's disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin. In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin. A large majority of patients had positive CMV IgG. Overall, 10 patients had positive CMV IgM, and 9 patients had a positive qualitative detection of CMV DNA by PCR in the feces. All 400 patients returned negative results after the quantitative detection of CMV DNA in blood by real-time PCR. Analyzing the 19 patients with active infections, we only found that such an association occurred with the use of combined therapy (anti-TNF-alpha + azathioprine.The findings show that latent cytomegalovirus infections are frequent and active cytomegalovirus infection is rare. We did not find any association between an active infection of CMV and inflammatory bowel

  19. Bowel preparation in CT colonography. Is diet restriction necessary? A randomised trial (DIETSAN)

    Energy Technology Data Exchange (ETDEWEB)

    Bellini, Davide; De Santis, Domenico; Caruso, Damiano; Rengo, Marco; Biondi, Tommaso; Laghi, Andrea [Rome Univ. ' ' Sapienza' ' (Italy). Dept. of Radiological Sciences, Oncology and Pathology; I.C.O.T. Hospital, Latina (Italy); Ferrari, Riccardo [San Camillo Forlanini Hospital, Rome (Italy). Dept. of Emergency Radiology

    2018-01-15

    To investigate whether diet restriction affects quality of colon cleansing and patient tolerance during reduced bowel preparation for CT colonography (CTC). Asymptomatic and symptomatic patients were enrolled in this pragmatic, single-centre, randomised trial. All patients were randomly assigned (1:1 ratio, blocks of ten) to receive a reduced bowel preparation and faecal tagging with (Diet-Restriction-Group [DR]) or without (No-Diet-Restriction-Group [NDR]) dietary restriction. Five readers performed a blinded subjective image analysis, by means of 4-point Likert-scales from 0 (highest score) to 3 (worst score). Endpoints were the quality of large bowel cleansing and tolerance to the assigned bowel preparation regimen. The trial is registered at ClinicalTrial.gov (URomLSDBAL1). Ninety-five patients were randomly allocated to treatments (48 in NDR-group, 47 in DR-group). Both groups resulted in optimal colon cleansing. The mean residual stool (0.22, 95%CI 0.00-0.44) and fluid burden (0.39, 95%CI 0.25-0.53) scores for patients in DR-group were similar to those in patients in NDR-group (0.25, 95%CI 0.03-0.47 [p = 0.82] and 0.49, 95%CI 0.30-0.67 [p = 0.38], respectively). Tolerance was significantly better in NDR-group. A reduced bowel preparation in association with faecal tagging and without any dietary restriction demonstrated optimal colon cleansing effectiveness for CTC, providing better patient compliance compared with dietary restriction. (orig.)

  20. Magnetic resonance enterography/enteroclysis in acquired small bowel diverticulitis and small bowel diverticulosis.

    Science.gov (United States)

    Mansoori, Bahar; Delaney, Conor P; Willis, Joseph E; Paspulati, Raj M; Ros, Pablo R; Schmid-Tannwald, Christine; Herrmann, Karin A

    2016-09-01

    Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE. This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. • Small bowel diverticulosis and diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula.

  1. General practitioners' perceptions of population based bowel screening and their influence on practice: a qualitative study.

    Science.gov (United States)

    Dawson, Greer; Crane, Melanie; Lyons, Claudine; Burnham, Anna; Bowman, Tara; Perez, Donna; Travaglia, Joanne

    2017-03-15

    Although largely preventable, Australia has one of the highest rates of bowel cancer in the world. General Practitioners (GPs) have an important role to play in prevention and early detection of bowel cancer, however in Australia this is yet to be optimised and participation remains low. This study sought to understand how GPs' perceptions of bowel screening influence their attitudes to, and promotion of the faecal occult blood test (FOBT), to identify opportunities to enhance their role. Interviews were conducted with 31 GPs from metropolitan and regional New South Wales (NSW), Australia. Discussions canvassed GPs' perceptions of their role in bowel screening and the national screening program; perceptions of screening tests; practices regarding discussing screening with patients; and views on opportunities to enhance their role. Transcripts were coded using Nvivo and thematically analysed. The study revealed GPs' perceptions of screening did not always align with broader public health definitions of 'population screening'. While many GPs reportedly understood the purpose of population screening, notions of the role of asymptomatic screening for bowel cancer prevention were more limited. Descriptions of screening centred on two major uses: the use of a screening 'process' to identify individual patients at higher risk; and the use of screening 'tools', including the FOBT, to aid diagnosis. While the FOBT was perceived as useful for identifying patients requiring follow up, GPs expressed concerns about its reliability. Colonoscopy by comparison, was considered by many as the gold standard for both screening and diagnosis. This perception reflects a conceptualisation of the screening process and associated tools as an individualised method for risk assessment and diagnosis, rather than a public health strategy for prevention of bowel cancer. The results show that GPs' perceptions of screening do not always align with broader public health definitions of 'population

  2. Pediatric Crohn's disease presenting with a large calcified pelvic mass

    Directory of Open Access Journals (Sweden)

    Dominic C. Grimberg, BS

    2017-07-01

    Full Text Available Small bowel Crohn's disease classically presents with symptoms of abdominal pain, diarrhea, and weight loss in the pediatric population. However, there is no published literature on its presentation associated with a dystrophically calcified pelvic mass. We present a case of a 15-year-old female presenting with four weeks of inflammatory bowel disease (IBD symptoms as well as a large calcified pelvic mass suggestive of chronic, organized inflammatory process versus a calcifying fibrous tumor.

  3. Small bowel diverticulitis: an imaging review of an uncommon entity.

    Science.gov (United States)

    Transue, Darren L; Hanna, Tarek N; Shekhani, Haris; Rohatgi, Saurabh; Khosa, Faisal; Johnson, Jamlik-Omari

    2017-04-01

    In this review, we discuss the clinical and radiologic findings of small bowel diverticulosis, which is infrequently encountered during practice and far less common than colonic diverticulosis. Small bowel diverticulosis can present with a range of emergent symptomatic complications including diverticulitis, perforation, or hemorrhage. Here, we focus on the clinical features, pathogenesis, radiologic findings, and treatment of small bowel diverticulitis. Although not routinely considered in the differential diagnosis of an acute abdomen, prospective radiologic diagnosis of small bowel diverticulitis is important and can lead to conservative treatment thus preventing unnecessary exploratory laparotomy.

  4. Multislice CT enteroclysis in the diagnosis of bowel endometriosis

    International Nuclear Information System (INIS)

    Biscaldi, Ennio; Rollandi, Gian A.; Ferrero, Simone; Ragni, Nicola; Remorgida, Valentino; Fulcheri, Ezio

    2007-01-01

    This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions. (orig.)

  5. Multislice CT enteroclysis in the diagnosis of bowel endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Biscaldi, Ennio; Rollandi, Gian A. [' ' Duchesse of Galliera' ' -Hospital, Genoa (Italy). Dept. of Radiology; Ferrero, Simone; Ragni, Nicola; Remorgida, Valentino [San Martino Hospital and Genoa Univ. (Italy). Dept. of Obstretics and Gynaecology; Fulcheri, Ezio [San Martino Hospital and Genoa Univ. (Italy). Unit of Anatomy and Histopathology

    2007-01-15

    This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions. (orig.)

  6. CT diagnosis of acute mesenteric vein thrombosis with bowel infarction

    International Nuclear Information System (INIS)

    Sommer, A.; Jaschke, W.; Georgi, M.

    1994-01-01

    Imaging methods provide an important diagnostic basis to clarify mesenteric ischemia. Angiography is the definitive method of investigation in such cases. Other noninvasive methods such as ultrasonography, computed tomography, and magnetic resonance imaging must still prove their importance. We describe three cases of unspezific abdominal pain where the CT shows a mesenteric venous thrombosis with an infarcted bowel. The venous infarcted bowel is clearly demonstrated by CT when other signs for MTV such as ascites, bowel wall thickening, bowel dilatation, and pneumatosis intestinalis are present. CT seems to be a good procedure in order to identify unspecific abdominal pain as being caused by a vascular insufficiency. (orig.) [de

  7. Effectiveness of anti-tumour necrosis factor-α therapy in Danish patients with inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bank, Steffen; Andersen, Paal Skytt; Burisch, Johan

    2015-01-01

    INTRODUCTION: The objective of this study was to evaluate the outcome of anti-tumour necrosis factor-α (anti-TNF) treatment in a large cohort of patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) in clinical practice and to establish a coho...

  8. An immunoglobulin G-4 related sclerosing disease of the small bowel: CT and small bowel series findings

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Young Hwan; Hwang, Dae Hyun; Min, Seon Jeong [Dept. of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong (Korea, Republic of); Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul [Hallym University Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of)

    2013-10-15

    Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

  9. Could stool collection devices help increase uptake in bowel cancer screening programmes?

    Science.gov (United States)

    Morling, J R; Barke, A N; Chapman, C J; Logan, R F

    2018-01-01

    Objective To understand the usage and acceptability of a faecal collection device amongst participants in the National Health Service Bowel Cancer Screening Programme, with the aim of influencing future uptake. Setting Participants completing faecal occult blood test retests as part of the routine Bowel Cancer Screening Programme in Eastern England. Methods A faecal collection device and questionnaire were sent to all potential retest participants during a one-month period to collect information on prior stool collection methods and ease of use and usefulness of the enclosed faecal collection device. Results Out of 1087 participants invited, 679 (62.5%) returned their questionnaire. Of these, 429 (63.2%) trialled the faecal collection device at least once, 163 (38.4%) found the device made collecting their sample easier than previously, 189 (44.6%) found it made collection more difficult and 72 (17.0%) said it made no difference. Similar numbers reported finding that the faecal collection device made collecting the sample more pleasant (130, 31.5%), less pleasant (103, 25.0%) and no different (179, 43.4%) compared with previous collection without a faecal collection device. Conclusion Although a small proportion of participants found the faecal collection device helpful, a considerable majority did not or did not use it at all. Offering faecal collection devices is unlikely to produce a substantial increase in bowel cancer screening uptake.

  10. Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

    Directory of Open Access Journals (Sweden)

    Mohamed Moftah

    2012-08-01

    Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

  11. Preoperative screening: value of previous tests.

    Science.gov (United States)

    Macpherson, D S; Snow, R; Lofgren, R P

    1990-12-15

    To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). Urban tertiary care Veterans Affairs Hospital. Consecutive sample of 1109 patients who had elective surgery in 1988. At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.

  12. Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Jesuratnam-Nielsen, Kayalvily; Løgager, Vibeke B; Rezanavaz-Gheshlagh, Bijan

    2015-01-01

    -52%, 83-94% and 76-92% for DWI, respectively. The κ values for bowel wall thickening, DWI, and mural hyperenhancement were detected with fair agreement (κ = 0.26-0.39) at both MRI examinations, whereas only bowel wall thickening in MRFT were detected with moderate agreement (κ = 0.47) Conclusion. Plain......), and other inflammatory changes in each bowel segments. Further, hyperenhancement of the bowel was also evaluated in MRFT. RESULTS: A total of 100 patients (40 males and 60 females; median age: 38.5; range: 19-90) were enrolled; 44 with Crohn's disease (CD), 25 with ulcerative colitis (UC), 24 with IBD...

  13. Automatic electromagnetic valve for previous vacuum

    International Nuclear Information System (INIS)

    Granados, C. E.; Martin, F.

    1959-01-01

    A valve which permits the maintenance of an installation vacuum when electric current fails is described. It also lets the air in the previous vacuum bomb to prevent the oil ascending in the vacuum tubes. (Author)

  14. CT evaluation of target-like bowel wall thickening

    International Nuclear Information System (INIS)

    Bae, In Young; Kim, Mi Young; Suh, Chang Hea; Kim, Jin Hee; Chung, Won Kyun; Cho, Soon Gu

    1997-01-01

    The purpose of this study was to evaluate the CT features of target-like bowel wall thickenings and to correlate target layers with histopathologic layers. We retrospectively analyzed 37 target-like bowel wall thickenings with inner high-, middle low- and outer high attenuated layers on CT scan. Bowel lesions included 15 cases of ischemic lesion, 12 of inflammation, four of carcinomatosis, four of trauma, and two of radiation enteritis. Target-like bowel wall thickenings were classified into three types : with inner most thickened high-attenuated layer(type 1); with middle most thickened low-attenuated layer(type 2), and with outer most thickened high-attenuated layer(type 3). We analyzed the characteristic CT features of these bowel lesions and correlated target and histopathologic layers in resected bowel specimens. Target-like bowel wall thickening was type 1 in 18 cases(49%), type 2 in 13 cases(35%), and type 3 in 6 cases(16%). Type 1 ischemic bowel lesions and inflammations were most common, and were found in 60% and 67% of cases, retrospectively. All cases of trauma were type 2 and radiation colitis was type 3. Histopathologic findings showed that each layer of target lesions did not exactly correlated with histopathologic layers. However, the inner high attenuated layer correlated with mucosa and some submucosa, the middle low-attenuated layer correlated with most submucosa and some muscularis, and the outer high-attenuated layer correlated with muscularis, serosa, and periserosal mesentery. CT features of target-like bowel wall thickenings showed type characteristics according to bowel lesions. Histopathologic comparison and analysis were considered helpful for the differential diagnosis of bowel lesions

  15. Bowel Dysfunction Related to Spina Bifida: Keep It Simple.

    Science.gov (United States)

    Brochard, Charlène; Peyronnet, Benoît; Dariel, Anne; Ménard, Hélène; Manunta, Andréa; Ropert, Alain; Neunlist, Michel; Bouguen, Guillaume; Siproudhis, Laurent

    2017-11-01

    Although care of urological disorders in spina bifida is well established, there is yet no agreement on a standardized approach to bowel dysfunction in this population. The purpose of this study was to assess bowel dysfunction using validated instruments and the risk factors in adults with spina bifida. A multidisciplinary team prospectively collected patient data, focusing on anorectal and urological symptoms. The study was conducted with data from a French referral center for spina bifida. A total of 228 adults with spina bifida (sex ratio men:women, 92 (40%):136 (60%)) with a median age of 34.7 years (range, 26.8-44.7 y) were assessed. Factors associated with severe fecal incontinence (Cleveland Clinic Incontinence Score ≥9) and severe bowel dysfunction (Neurogenic Bowel Dysfunction score ≥14) were assessed in a multivariate analysis model. The prevalence rates of severe fecal incontinence and severe bowel dysfunction were 60% (130/217) and 42% (71/168). Bowel dysfunction was the second most common major concern of patients after lower urinary tract dysfunction. Male sex, obesity, urinary incontinence, and a Knowles-Eccersley-Scott symptom constipation score ≥10 were independently associated with severe fecal incontinence. Patients with soft stools had significantly less severe bowel dysfunction. Neither neurologic level nor other neurologic features of spina bifida were associated with severe fecal incontinence or severe bowel dysfunction. The recruitment of patients with spina bifida through a national referral center might have resulted in selection bias, and some data were missing especially regarding BMI and Neurogenic Bowel Dysfunction score (21% and 26% of missing data). The prevalence rates of severe fecal incontinence and severe bowel dysfunction in adults with spina bifida were high and were adequately perceived by the patients. The present study emphasized the association of bowel dysfunction and fecal incontinence with obesity, urologic

  16. Midkine is up-regulated in both cancerous and inflamed bowel, reflecting lymph node metastasis in colorectal cancer and clinical activity of ulcerative colitis.

    Science.gov (United States)

    Krzystek-Korpacka, Malgorzata; Gorska, Sabina; Diakowska, Dorota; Kapturkiewicz, Bartosz; Podkowik, Magdalena; Gamian, Andrzej; Bednarz-Misa, Iwona

    2017-01-01

    Midkine is a multifunctional cytokine and growth factor displaying proinflammatory and pro-tumorigenic activity. Its association with bowel diseases has not been fully elucidated. Our purpose was to delineate midkine expression pattern by RT-qPCR in inflamed/cancerous bowel (n=208) and whole blood (n=150) in colorectal cancer (CRC), Crohn's disease (CD), and ulcerative colitis (UC) and to evaluate midkine dynamics in early postoperative period following colorectal surgery. The expression of midkine was significantly up-regulated in stage III CRC and independently associated with lymph node metastasis. The expression of midkine in whole blood was up-regulated solely in N1 CRC. Midkine expression in cancer-free tissue (CRC) was also elevated and dependent on CRC advancement. In IBD, inflammation increased the bowel expression of midkine solely in UC, in a manner proportional to the disease clinical activity. Large and small bowel differed with respect to the expression of midkine in quiescent tissue (higher in small bowel) and to its correlation pattern with chemokines (in a large bowel) and angiogenic factors and cell cycle regulators (in a small bowel). Circulating midkine and its expression in whole blood dropped directly following colorectal surgery; however, the concentration of midkine in serum was restored on postoperative day three. Midkine is involved in bowel inflammation in UC and lymph node metastasis in CRC, rendering midkine an attractive target for their treatment. Owing to midkine elevation in early postoperative period and its overexpression in tumor-adjacent tissue, targeting midkine might be considered also as a prevention of CRC recurrence following curative tumor resection. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. The "Pavia model" of experimental small bowel transplantation in pigs: technical variations for ischemia reperfusion injury studies.

    Science.gov (United States)

    Alessiani, M; Cobianchi, L; Viganò, J; Dominioni, T; Bottazzi, A; Zonta, S; Dionigi, P

    2014-01-01

    Ischemia reperfusion injury (IRI) is a major field of study in small bowel transplantation because of its implications regarding intestinal immunity. In this study, we have introduced some variations to the described models of IRI in pigs to make possible a complete isolation of the small bowel for IRI studies. In swine, two anatomical barriers make impossible a complete isolation of the small bowel at the origin of superior mesenteric artery (SMA) and vein (SMV): the main colic vessels, which originate distally to form SMA and SMV, and the blood supply of the distal portion of the duodenum and the cephalic part of the pancreas. In a group of Large White pigs (n = 5), we have performed a complete isolation of the small bowel, including sub-total colectomy and pancreaticoduodenectomy. Both SMA and SMV were isolated at the origin from the aorta and at the junction of the splenic vein, respectively. Intestinal continuity was restored with duodenojejunal anastomosis and with ileotransverse colon anastomosis. One pig died on postoperative day 5 from intestinal occlusion due to adhesions. The remaining four pigs were killed on postoperative day 7 after an uneventful postoperative course. No complications were found at autopsy. In swine, resection of part of the pancreas and duodenum and removal of the large bowel does not affect short-term survival, allowing a full isolation of the entire small bowel mimicking the transplantation procedure. Thus, this model appears to be attractive for IRI studies in the field of intestinal transplantation. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Concomitant and previous osteoporotic vertebral fractures.

    Science.gov (United States)

    Lenski, Markus; Büser, Natalie; Scherer, Michael

    2017-04-01

    Background and purpose - Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs. Patients and methods - This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures. Results - More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003). Interpretation - Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment.

  19. [Pain therapy in irritable bowel syndrome].

    Science.gov (United States)

    de Greck, M; Layer, P; Andresen, V

    2014-06-01

    Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. It is characterized by chronic abdominal pain, typically associated with altered bowel habits that cannot be explained by structural abnormalities in routine diagnostic workup. Based on the predominant symptom, IBS can be divided into different subtypes: IBS with predominant constipation, diarrhea, bloating, or pain. Knowledge about the complex and multifactorial IBS pathophysiology has increased tremendously in recent years, e.g., IBS may be related to alterations in gastrointestinal motility, visceral sensitivity, and the mucosal immune system. It is important, both for the patient and the physician, that IBS diagnosis is made quickly and thoroughly based on the typical symptom complex and exclusion of relevant differential diagnoses and to reassure the patient that IBS is a chronic, but benign disease. These components are the fundamental basis for a good patient-physician relationship and for a successful long-term management of this potentially very compromising disorder. IBS therapy is based on general measures as well as symptom-oriented medical therapy, where improvement of abdominal pain is one of the main goals in treating IBS patients. Several pain treatment options are available, which may be used long-term or on demand and which may be combined with other therapies. General medical approaches include antispasmodics, improvement of bowel function, phytotherapy, and probiotics. Especially in patients with psychological comorbidities, antidepressants may be used. Modern drug treatments include the GC-C agonist linaclotide in IBS with predominant constipation, the locally acting antibiotic rifaximin in IBS with bloating, and 5-HT3 antagonists in IBS with predominant diarrhea. Psychotherapy should be included in an interdisciplinary approach in refractory cases or in psychological comorbidity.

  20. An Uncommon Cause of Acute Bowel Obstruction: The Left Para ...

    African Journals Online (AJOL)

    Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year- old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography ...

  1. Indications and outcome of childhood preventable bowel resections ...

    African Journals Online (AJOL)

    injury (2), gangrenous umbilical hernia (2), blunt abdominal trauma (1), midgut volvulus (1), necrotizing enterocolitis (1), strangulated inguinal hernia (1), postoperative band intestinal obstructions (1). There were 16 right hemicolectomies, 4 small bowel resections and 2 massive bowel resections. Average duration of ...

  2. Biofilms associated with bowel necrosis: A newly recognised ...

    African Journals Online (AJOL)

    Background. A biofilm is defined as a collection of organisms attached to a surface and surrounded by a matrix. Objective. To present three cases in which bowel necrosis coexisted with biofilm. Methods. The medical records, bacteriological findings and tissue biopsies from three infants with bowel necrosis who ...

  3. Infantile Short Bowel Syndrome: short and long term evaluation

    NARCIS (Netherlands)

    J.F. Olieman (Joanne)

    2009-01-01

    textabstractInfantile short bowel syndrome is a condition which is characterized by malabsorption of nutrients, as a result of congenital intestinal shortening or massive small bowel resection. Survival rates have improved over the years, but morbidity remains high and clinical management of these

  4. Small bowel intussusception in 2 adults caused by inflammatory polyps

    Directory of Open Access Journals (Sweden)

    André Carvalho, MD

    2017-12-01

    Full Text Available Inflammatory fibroid polyps are rare, benign pseudotumors of the gastrointestinal tract of unknown etiology, which may rarely present as bowel intussusception and obstruction. The authors describe the clinical, radiologic, and pathologic features of 2 patients with ileal inflammatory fibroid polyps presenting as small bowel intussusception.

  5. The research progress of acute small bowel perforation

    Directory of Open Access Journals (Sweden)

    Rudolf Schiessel

    2015-08-01

    Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

  6. Rapunzel Syndrome: a rare cause of acute small bowel obstruction ...

    African Journals Online (AJOL)

    The Rapunzel syndrome is a very rare condition where trichobezoar has extended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was ...

  7. Evaluation Of Irritable Bowel Syndrome Symptoms Amongst Warsaw University Students

    OpenAIRE

    Niemyjska Sylwia; Ukleja Anna; Ławiński Michał

    2015-01-01

    Irritable bowel syndrome (IBS) belongs to functional gastrointestinal disorders and is characterized by abdominal pain and change in stool consistency and/or bowel habits. Etiological factors include gastrointestinal peristalsis disturbances, visceral hypersensitivity, chronic inflammation of the mucous membrane, dysbacteremia, intestinal infections, psychosomatic and nutritional factors. Gastrointestinal motility disturbances in case of IBS are manifested by the inhibition of the intestinal ...

  8. Solar radiation is inversely associated with inflammatory bowel disease admissions.

    Science.gov (United States)

    Jaime, Francisca; Riutort, Maria C; Alvarez-Lobos, Manuel; Hoyos-Bachiloglu, Rodrigo; Camargo, Carlos A; Borzutzky, Arturo

    To explore the associations between latitude and solar radiation with inflammatory bowel disease admission rates in Chile, the country with the largest variation in solar radiation in the world. This is an ecological study, which included data on all hospital-admitted population for inflammatory bowel disease between 2001 and 2012, according to different latitudes and solar radiation exposures in Chile. The data were acquired from the national hospital discharge database from the Department of Health Statistics and Information of the Chilean Ministry of Health. Between 2001 and 2012 there were 12,869 admissions due to inflammatory bowel disease (69% ulcerative colitis, 31% Crohn's disease). Median age was 36 years (IQR: 25-51); 57% were female. The national inflammatory bowel disease admission rate was 6.52 (95% CI: 6.40-6.63) per 100,000 inhabitants with increasing rates over the 12-year period. In terms of latitude, the highest admission rates for pediatric ulcerative colitis and Crohn's disease, as well as adult ulcerative colitis, were observed in the southernmost region with lowest annual solar radiation. Linear regression analysis showed that regional solar radiation was inversely associated with inflammatory bowel disease admissions in Chile (β: -.44, p = .03). Regional solar radiation was inversely associated with inflammatory bowel disease admission rates in Chile; inflammatory bowel disease admissions were highest in the southernmost region with lowest solar radiation. Our results support the potential role of vitamin D deficiency on inflammatory bowel disease flares.

  9. Childhood Sexual Abuse and Psychosomatic Symptoms in Irritable Bowel Syndrome

    Science.gov (United States)

    Ross, Colin A.

    2005-01-01

    Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. To investigate this possibility, the Dissociative Disorders Interview Schedule (DDIS), the…

  10. Biofilms associated with bowel necrosis: A newly recognised ...

    African Journals Online (AJOL)

    He has a keen interest in neonatal surgery. Associate ... The medical records, bacteriological findings and tissue biopsies from three infants with bowel necrosis who subsequently died from sepsis were ... needed to evaluate all resected necrotic bowel for biofilms and the clinical implications of this finding. S Afr Med J 2016 ...

  11. CT enteroclysis in the diagnostics of small bowel diseases

    International Nuclear Information System (INIS)

    Kolodziej, M.; Annabhani, A.; Sasiadek, M.

    2010-01-01

    Background: The role of CT enteroclysis is gaining on importance in the diagnostics of small bowel diseases. The aim of the study was to present own experiences in CT enteroclysis application, with the use of a 64-detector CT unit. Material/Methods: CT enteroclyses were performed in 60 patients: 53 with the suspicion of the Crohns disease, 2 suspected for carcinoid, 1 with suspicion of the fistula between the small bowel and the bladder, 2 suspected for the tumor of the ileo-caecal region, and in 1 case, the aim of examination was to carry out an evaluation of the postsurgical state of the bowel-bowel anastomosis. We used own endoscopic technique of catheter insertion into the bowel, which shortens the examination time and improves patients comfort. Results: The catheter was correctly introduced into the small bowel in 58 patients (endoscopy had to be repeated in 4 cases). Only 2 examinations failed, because patients refused repeated endoscopy. Radiological signs of the Crohns disease were found in 50 out of 53 patients. In the 3 remaining patients, the appearance of the small bowel was normal. In 5 non-Crohns disease patients, CT enteroclysis enabled a good visualization of the pathology (tumors, fistula). Conclusions: CT enteroclysis with the use of the 64-detector CT unit is a valuable method in the diagnostics of small bowel diseases. It could supplement or precede capsule endoscopy. (authors)

  12. Dysplasia and Cancer in Inflammatory Bowel Disease.

    Science.gov (United States)

    Huang, Lyen C; Merchea, Amit

    2017-06-01

    Inflammatory bowel disease is associated with an increased risk of dysplasia and cancer. Improvements in medical management and endoscopic surveillance have reduced these risks. Patients can develop cancer even in the absence of dysplasia or with indefinite or low-grade dysplasia. Most guidelines recommend starting surveillance colonoscopy 6 to 10 years after initial diagnosis with interval surveillance afterward every 1 to 5 years depending on risk and/or individual characteristics. Most patients should undergo total proctocolectomy with end ileostomy or reconstruction with ileal pouch anal anastomosis because segmental and subtotal resections carry a higher risk of metachronous cancers. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Spectrum of short bowel syndrome in adults

    DEFF Research Database (Denmark)

    Jeppesen, Palle B

    2014-01-01

    to diminished health-related quality of life because of its many physical and psychological effects on patients. SBS is associated with decreased survival; risk factors for SBS-related mortality include very short remnant small bowel, end-jejunal remnant anatomy, and arterial mesenteric infarction as primary...... severity and resection type; thus, each patient should be individually managed. This review discusses the spectrum of disease in patients with SBS and presents common complications encountered by these patients to highlight the importance of individualized management and treatment....

  14. Is bowel preparation for excretory urography necessary?

    International Nuclear Information System (INIS)

    Bilal, R.; Qureshi, M.N.; Hayat, A.

    2013-01-01

    Objective: The objective of this study was to compare the three methods of preparation for excretory urography with regards to image clarity: bowel preparation, together with dietary restriction, dietary restriction alone and no preparation at all. Study Design: Randomized control trail. Place and Duration of Study: Department of Radiology, Military Hospital, Rawalpindi, which is a tertiary care hospital. The duration of study was 6 months from Aug 2009 to Feb 2010. Material and Methods: This was a randomized control trial of 588 patients undergoing excretory urography at a tertiary care hospital. Both male and female consecutive ambulatory patients older than 15 years referred for excretory urography were included in the study. The 588 patients were randomly distributed into three separate groups. Group 1 received standard bowel preparation consisting of tablet bisacodyl in a dose of 30 mg. The patients were instructed to fast for 4 hours before starting the laxative and do drink the laxative drug in the afternoon the day before the examination. Group 2 was instructed to only fast for 12 hours before the examination and the group 3 received no preparation at all. All the three groups were advised not to take breakfast and underwent the same examination procedure and then image clarity was assessed. The images were shown to a single consultant who was blind about the group of the patient and bowel preparatory technique which he or she underwent. Images were regarded clear when pelvicalyceal system, ureters and urinary bladder were demonstrated beyond any doubt. Same contrast agent (urografin) was used in all the three groups in a dose according to body weight (1 mg/kg) to exclude its effects on image clarity. Results: Assessment of image clarity was done between group 1 and 2, group 1 and 3 and group 2 and 3. The image clarity in patients of group 1 patients was found to be 94.3% and images were unclear in 5.7%. The image clarity in patients of group 2 was found to

  15. SU-C-BRA-01: Interactive Auto-Segmentation for Bowel in Online Adaptive MRI-Guided Radiation Therapy by Using a Multi-Region Labeling Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Y; Chen, I; Kashani, R; Wan, H; Maughan, N; Muccigrosso, D; Parikh, P [Washington University School of Medicine, Saint Louis, MO (United States)

    2016-06-15

    Purpose: In MRI-guided online adaptive radiation therapy, re-contouring of bowel is time-consuming and can impact the overall time of patients on table. The study aims to auto-segment bowel on volumetric MR images by using an interactive multi-region labeling algorithm. Methods: 5 Patients with locally advanced pancreatic cancer underwent fractionated radiotherapy (18–25 fractions each, total 118 fractions) on an MRI-guided radiation therapy system with a 0.35 Tesla magnet and three Co-60 sources. At each fraction, a volumetric MR image of the patient was acquired when the patient was in the treatment position. An interactive two-dimensional multi-region labeling technique based on graph cut solver was applied on several typical MRI images to segment the large bowel and small bowel, followed by a shape based contour interpolation for generating entire bowel contours along all image slices. The resulted contours were compared with the physician’s manual contouring by using metrics of Dice coefficient and Hausdorff distance. Results: Image data sets from the first 5 fractions of each patient were selected (total of 25 image data sets) for the segmentation test. The algorithm segmented the large and small bowel effectively and efficiently. All bowel segments were successfully identified, auto-contoured and matched with manual contours. The time cost by the algorithm for each image slice was within 30 seconds. For large bowel, the calculated Dice coefficients and Hausdorff distances (mean±std) were 0.77±0.07 and 13.13±5.01mm, respectively; for small bowel, the corresponding metrics were 0.73±0.08and 14.15±4.72mm, respectively. Conclusion: The preliminary results demonstrated the potential of the proposed algorithm in auto-segmenting large and small bowel on low field MRI images in MRI-guided adaptive radiation therapy. Further work will be focused on improving its segmentation accuracy and lessening human interaction.

  16. Unraveling the ties between irritable bowel syndrome and intestinal microbiota.

    Science.gov (United States)

    Hong, Sung Noh; Rhee, Poong-Lyul

    2014-03-14

    Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder. It is a multifactorial disorder. Intestinal microbiota may cause the pathogenesis of IBS by contributing to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Previous attempts to identify the intestinal microbiota composition in IBS patients have yielded inconsistent and occasionally contradictory results. This inconsistency may be due to the differences in the molecular techniques employed, the sample collection and handling methods, use of single samples that are not linked to fluctuating symptoms, or other factors such as patients' diets and phenotypic characterizations. Despite these difficulties, previous studies found that the intestinal microbiota in some IBS patients was completely different from that in healthy controls, and there does appear to be a consistent theme of Firmicutes enrichment and reduced abundance of Bacteroides. Based on the differences in intestinal microbiota composition, many studies have addressed the roles of microbiota-targeted treatments, such as antibiotics and probiotics, in alleviating certain symptoms of IBS. This review summarizes the current knowledge of the associations between intestinal microbiota and IBS as well as the possible modes of action of intestinal microbiota in the pathogenesis of IBS. Improving the current level of understanding of host-microbiota interactions in IBS is important not only for determining the role of intestinal microbiota in IBS pathogenesis but also for therapeutic modulation of the microbiota.

  17. Irritable bowel syndrome and chronic constipation: Fact and fiction.

    Science.gov (United States)

    Bellini, Massimo; Gambaccini, Dario; Usai-Satta, Paolo; De Bortoli, Nicola; Bertani, Lorenzo; Marchi, Santino; Stasi, Cristina

    2015-10-28

    Irritable bowel syndrome (IBS) and functional constipation (FC) are the most common functional gastrointestinal disorders. According to the Rome III Criteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation (typical of IBS) and they should be mutually exclusive. However, many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC, often associated with many other functional digestive and non digestive disorders, are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive, often suggesting a distorted view of pathophysiology, diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients, often producing odd, useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC, helping physicians to understand where they should focus their attention when communicating with patients, detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.

  18. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

    International Nuclear Information System (INIS)

    Grassi, Roberto; Romano, Stefania; D'Amario, Fenesia; Giorgio Rossi, Antonio; Romano, Luigia; Pinto, Fabio; Di Mizio, Roberto

    2004-01-01

    ; abdominal plain film showed an increased dilatation of small bowel loops with moderate thickened wall and air-fluid levels. In 34 other patients US examination revealed the presence of thick-walled loops, hypoperistalsis and a larger amount of free extraluminal fluid. Radiographic findings in these patients were: horizontal featured and markedly dilated small bowel loops presenting parietal thickness, presence of intraluminal fluid stasis and evidence of thickened, sparse and incomplete valvulae conniventes. At surgery etiology of small bowel obstructions was various, but most of cases related to adhesions (70 cases). The presence of extraluminal fluid were confirmed at surgery in 104 patients. Conclusions: Our experience using sonography in suspicion of SBO (small bowel obstruction) suggests the usefulness of this imaging modality to differentiate a functional or obstructive ileus, demonstrating the evidence of intestinal peristalsis. Furthermore, the presence of a large amount of fluid between dilated small bowel loops suggests worsening mechanical small bowel obstruction, that requires not a medical therapy but immediate surgery

  19. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

    Energy Technology Data Exchange (ETDEWEB)

    Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; D' Amario, Fenesia; Giorgio Rossi, Antonio; Romano, Luigia; Pinto, Fabio; Di Mizio, Roberto

    2004-04-01

    ; abdominal plain film showed an increased dilatation of small bowel loops with moderate thickened wall and air-fluid levels. In 34 other patients US examination revealed the presence of thick-walled loops, hypoperistalsis and a larger amount of free extraluminal fluid. Radiographic findings in these patients were: horizontal featured and markedly dilated small bowel loops presenting parietal thickness, presence of intraluminal fluid stasis and evidence of thickened, sparse and incomplete valvulae conniventes. At surgery etiology of small bowel obstructions was various, but most of cases related to adhesions (70 cases). The presence of extraluminal fluid were confirmed at surgery in 104 patients. Conclusions: Our experience using sonography in suspicion of SBO (small bowel obstruction) suggests the usefulness of this imaging modality to differentiate a functional or obstructive ileus, demonstrating the evidence of intestinal peristalsis. Furthermore, the presence of a large amount of fluid between dilated small bowel loops suggests worsening mechanical small bowel obstruction, that requires not a medical therapy but immediate surgery.

  20. Diffusion-weighted MR enterography for evaluating Crohn's disease: Effect of anti-peristaltic agent on the diagnosis of bowel inflammation

    Energy Technology Data Exchange (ETDEWEB)

    Park, So Hyun [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Songpa-gu, Seoul (Korea, Republic of); Gachon University, Department of Radiology, Gil Medical Center, Incheon (Korea, Republic of); Huh, Jimi; Park, Seong Ho; Lee, Seung Soo; Kim, Ah Young [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Songpa-gu, Seoul (Korea, Republic of); Yang, Suk-Kyun [University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology, Songpa-gu, Seoul (Korea, Republic of)

    2017-06-15

    To prospectively investigate how Buscopan affects the diagnosis of bowel inflammation by diffusion-weighted imaging MR enterography (DWI-MRE) in Crohn's disease (CD). Thirty CD patients without previous bowel surgery underwent DWI-MRE (b = 900 sec/mm{sup 2}) before and after intravenous Buscopan. The 30 patients were randomly divided into two groups; using a crossover design, interpretations were made regarding the presence of restricted mural diffusion (i.e., bowel inflammation) in nine bowel segments in two separate reading sessions by two readers. The readers also judged restricted mural diffusion extent in each bowel segment on two side-by-side DWI-MRE images with a random right-to-left order. Ileocolonoscopy and conventional MRE interpreted by an expert panel were reference standards. We analyzed 262 bowel segments. DWI-MRE without Buscopan significantly decreased sensitivity for both readers (58.8 % vs. 72.9 %, P = 0.046; 57.6 % vs. 85.9 %, P = 0.001) and did not significantly increase specificity (P = 0.085 and 0.396). Two readers noted that 28.6 % and 23.3 % of 262 bowel segments had greater diffusion restriction extent on DWI-MRE with Buscopan compared with DWI-MRE without Buscopan (P < 0.001) and 68.7 % and 74 %, respectively, had similar extent between them. Omitting Buscopan caused a greater loss in sensitivity of DWI-MRE than false-positive reduction for diagnosing bowel inflammation in CD. (orig.)

  1. Uterine rupture without previous caesarean delivery

    DEFF Research Database (Denmark)

    Thisted, Dorthe L. A.; H. Mortensen, Laust; Krebs, Lone

    2015-01-01

    OBJECTIVE: To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery. STUDY DESIGN: Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned...... vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine...... rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery. RESULTS: We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3...

  2. Small bowel volvulus with jejunal diverticulum: Primary or secondary?

    Science.gov (United States)

    Shen, Xiao-Fei; Guan, Wen-Xian; Cao, Ke; Wang, Hao; Du, Jun-Feng

    2015-09-28

    Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.

  3. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease.

    Science.gov (United States)

    Cantorna, Margherita T; McDaniel, Kaitlin; Bora, Stephanie; Chen, Jing; James, Jamaal

    2014-11-01

    The inflammatory bowel diseases are complex diseases caused by environmental, immunological, and genetic factors. Vitamin D status is low in patients with inflammatory bowel diseases, and experimental inflammatory bowel diseases are more severe in vitamin D-deficient or vitamin D receptor knockout animals. Vitamin D is beneficial in inflammatory bowel diseases because it regulates multiple checkpoints and processes essential for homeostasis in the gut. Vitamin D inhibits IFN-γ and IL-17 production while inducing regulatory T cells. In addition, vitamin D regulates epithelial cell integrity, innate immune responses, and the composition of the gut microbiota. Overall, vitamin D regulates multiple pathways that maintain gastrointestinal homeostasis. The data support improving vitamin D status in patients with inflammatory bowel diseases. © 2014 by the Society for Experimental Biology and Medicine.

  4. Perceived Threat and Internet Use Predict Intentions to Get Bowel Cancer Screening (Colonoscopy): Longitudinal Questionnaire Study.

    Science.gov (United States)

    Becker, Daniela; Grapendorf, Johannes; Greving, Hannah; Sassenberg, Kai

    2018-02-07

    Many people use the Internet for health-related information search, which is known to help regulate their emotional state. However, not much is known yet about how Web-based information search together with negative emotional states (ie, threat of cancer diagnosis) relate to preventive medical treatment decisions (ie, colonoscopy intentions). The aim of this study was to investigate how frequency of health-related Internet use together with perceived threat of a possible (bowel) cancer diagnosis influences intentions to get a colonoscopy. Previous research has shown that people who experience threat preferentially process positive information in an attempt to downregulate the aversive emotional state. The Internet can facilitate this regulatory strategy through allowing self-directed, unrestricted, and thus biased information search. In the context of threat regarding a possible bowel cancer diagnosis, feelings of threat can still be effectively reduced through cancer screening (ie, colonoscopy). We, therefore, predict that in that particular context, feelings of threat should be related to stronger colonoscopy intentions, and that this relationship should be enhanced for people who use the Internet often. A longitudinal questionnaire study was conducted among healthy participants who were approaching or just entering the bowel cancer risk group (aged 45-55 years). Perceived threat of a possible (bowel) cancer diagnosis, frequency of health-related Internet use, and intentions to have a colonoscopy were assessed at 2 time points (6-month time lag between the 2 measurement points T1 and T2). Multiple regression analyses were conducted to test whether threat and Internet use at T1 together predicted colonoscopy intentions at T2. In line with our predictions, we found that the threat of a possible (bowel) cancer diagnosis interacted with the frequency of Internet use (both T1) to predict colonoscopy intentions (T2; B=.23, standard error [SE]=0.09, P=.01). For people

  5. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

    International Nuclear Information System (INIS)

    Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung; Wang, Hong-Hau; Fan, Hsiu-Lung; Chen, Ran-Chou; Chang, Wei-Chou

    2015-01-01

    The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

  6. INTRODUCTION Previous reports have documented a high ...

    African Journals Online (AJOL)

    pregnancy if they were married, educated, had dental insurance, previously used dental services when not pregnant, or had knowledge about the possible connection between oral health and pregnancy outcome8. The purpose of this study was to explore the factors determining good oral hygiene among pregnant women ...

  7. Empowerment perceptions of educational managers from previously ...

    African Journals Online (AJOL)

    The perceptions of educational manag ers from previously disadvantaged primary and high schools in the Nelson Mandela Metropole regarding the issue of empowerment are outlined and the perceptions of educational managers in terms of various aspects of empowerment at different levels reflected. A literature study ...

  8. Management of choledocholithiasis after previous gastrectomy.

    Science.gov (United States)

    Anwer, S; Egan, R; Cross, N; Guru Naidu, S; Somasekar, K

    2017-09-01

    Common bile duct stones in patients with a previous gastrectomy can be a technical challenge because of the altered anatomy. This paper presents the successful management of two such patients using non-traditional techniques as conventional endoscopic retrograde cholangiopancreatography was not possible.

  9. Laboratory Grouping Based on Previous Courses.

    Science.gov (United States)

    Doemling, Donald B.; Bowman, Douglas C.

    1981-01-01

    In a five-year study, second-year human physiology students were grouped for laboratory according to previous physiology and laboratory experience. No significant differences in course or board examination performance were found, though correlations were found between predental grade-point averages and grouping. (MSE)

  10. Zinc absorption in inflammatory bowel disease

    International Nuclear Information System (INIS)

    Valberg, L.S.; Flanagan, P.R.; Kertesz, A.; Bondy, D.C.

    1986-01-01

    Zinc absorption was measured in 29 patients with inflammatory bowel disease and a wide spectrum of disease activity to determine its relationship to disease activity, general nutritional state, and zinc status. Patients with severe disease requiring either supplementary oral or parenteral nutrition were excluded. The mean 65ZnCl2 absorption, in the patients, determined using a 65Zn and 51Cr stool-counting test, 45 +/- 17% (SD), was significantly lower than the values, 54 +/- 16%, in 30 healthy controls, P less than 0.05. Low 65ZnCl2 absorption was related to undernutrition, but not to disease activity in the absence of undernutrition or to zinc status estimated by leukocyte zinc measurements. Mean plasma zinc or leukocyte zinc concentrations in patients did not differ significantly from controls, and only two patients with moderate disease had leukocyte zinc values below the 5th percentile of normal. In another group of nine patients with inflammatory bowel disease of mild-to-moderate severity and minimal nutritional impairment, 65Zn absorption from an extrinsically labeled turkey test meal was 31 +/- 10% compared to 33 +/- 7% in 17 healthy controls, P greater than 0.1. Thus, impairment in 65ZnCl2 absorption in the patients selected for this study was only evident in undernourished persons with moderate or severe disease activity, but biochemical evidence of zinc deficiency was uncommon, and clinical features of zinc depletion were not encountered

  11. Sensory dysfunction and the irritable bowel syndrome.

    Science.gov (United States)

    Houghton, L A

    1999-10-01

    Dysfunction of the sensory system of the gut is now generally believed to be important in the pathophysiology of irritable bowel syndrome (IBS). This disturbance may well account for some of the symptoms of the disorder, such as abdominal pain, by virtue of the fact that intra-lumenal events (e.g. contractions) may be 'sensed' more easily. It can be assessed in the laboratory by a variety of techniques, but usually involves measuring the patient's response to distension of any site of the gut, most commonly the rectum. Hypersensitivity is the most frequent finding, but hyposensitivity can also occur--hypersensitivity does not appear to be specific to any particular pattern of bowel habit, but hyposensitivity does tend to be generally only seen in patients with constipation, especially those with the 'no urge' type. Although there is some evidence to support hypersensitivity being related to enhanced vigilance in some patients, other data suggest that there may be a true alteration in sensory processing. The mechanisms underlying this sensory dysfunction remain to be elucidated, but could involve changes in either the enteric, spinal and/or central nervous systems. Finally, factors such as gender, stress, emotion and infection can all influence the sensitivity of the gut and may therefore play a role in IBS.

  12. Rheumatic manifestations of inflammatory bowel disease.

    Science.gov (United States)

    Rodríguez-Reyna, Tatiana Sofía; Martínez-Reyes, Cynthia; Yamamoto-Furusho, Jesús Kazúo

    2009-11-28

    This article reviews the literature concerning rheumatic manifestations of inflammatory bowel disease (IBD), including common immune-mediated pathways, frequency, clinical course and therapy. Musculoskeletal complications are frequent and well-recognized manifestations in IBD, and affect up to 33% of patients with IBD. The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations, notably in HLA-B27 transgenic rats. The autoimmune pathogenic mechanisms shared by IBD and spondyloarthropathies include genetic susceptibility to abnormal antigen presentation, aberrant recognition of self, the presence of autoantibodies against specific antigens shared by the colon and other extra-colonic tissues, and increased intestinal permeability. The response against microorganisms may have an important role through molecular mimicry and other mechanisms. Rheumatic manifestations of IBD have been divided into peripheral arthritis, and axial involvement, including sacroiliitis, with or without spondylitis, similar to idiopathic ankylosing spondylitis. Other periarticular features can occur, including enthesopathy, tendonitis, clubbing, periostitis, and granulomatous lesions of joints and bones. Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur. The management of the rheumatic manifestations of IBD consists of physical therapy in combination with local injection of corticosteroids and nonsteroidal anti-inflammatory drugs; caution is in order however, because of their possible harmful effects on intestinal integrity, permeability, and even on gut inflammation. Sulfasalazine, methotrexate, azathioprine, cyclosporine and leflunomide should be used for selected indications. In some cases, tumor necrosis factor-alpha blocking agents should be considered as first-line therapy.

  13. INVASIVE AMOEBIASIS COMPLICATING IFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    Ziglam H

    2007-01-01

    Full Text Available INTRODUCTIONAmoebiasis, which is caused by the intestinal protozoan Entamoeba histolytica, is a ubiquitous parasitic infection affecting approximately 10% of the world’s population and causing more deaths every year (100,000 deaths than any other parasitic infection, with the exception of malaria and schistosomiasis [1–3]. Most individuals with an E. histolytica infection are asymptomatic, but some develop severe invasive disease, such as amoebic colitis. Other manifestations, such as pulmonary, cardiac or brain involvement, are rare. Intestinal amoebiasis can probably also present as a chronic, non-dysenteric syndrome of diarrhoea, weight loss, and abdominal pain that can last for years and mimic inflammatory bowel disease. Fulminant colitis with bowel necrosis leading to perforation and peritonitis occurs in only about 0.5% of cases, but it is associated with a mortality rate of more than 40%. Patients with invasive amoebiasis living in the United Kingdom and other developed countries generally acquire the infection in another country in which the pathogenic species is endemic. Areas that have high rates of amoebic infection include India, Africa, Mexico and parts of Central and South America. Infection with pathogenic E. histolytica is not a common cause of travelers’ diarrhoea, and gastrointestinal infection is uncommon in travelers who have spent less than one month in endemic areas.

  14. Functional Bowel Disorders Gastroenterology's 75thanniversary.

    Science.gov (United States)

    Wiley, John W; Chang, Lin

    2018-02-15

    Articles appearing in Gastroenterology have played an integral role in the evolution of our understanding of Functional Bowel Disorders (FBD), including Irritable Bowel Syndrome (IBS), beginning with the prescient contributions of Almy and Tulin in 1947 and 1949 that highlighted the role of stress to enhance perception of abdominal pain and promote colon contractions. Subsequent publications have codified diagnostic criteria and stratified subpopulations of FBD (Manning and ROME I-IV), which resulted in improved symptom-based therapeutic interventions. Advances in our understanding of the pathophysiology of FBD, particularly IBS, published in Gastroenterology has led to our current appreciation that FBD represent dysfunction in the bidirectional brain-gut axis, intestinal barrier dysfunction and interactions with the microbiota and dietary factors. Team science and the application of next-generation -omics methods are leading the way to improved diagnostic criteria and targeted therapeutic interventions. As the field evolves, publications appearing in Gastroenterology will continue to be at the forefront of these advances. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  15. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

    Anshu Rajnish Sharma; Charan, S.; Silva, I.

    2004-01-01

    Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

  16. Is irritable bowel syndrome an infectious disease?

    Science.gov (United States)

    Thompson, John Richard

    2016-01-28

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms.

  17. Irritable bowel syndrome: Diagnosis and pathogenesis

    Science.gov (United States)

    El-Salhy, Magdy

    2012-01-01

    Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome III criteria. A combination of the Rome III criteria, a physical examination, blood tests, gastroscopy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS: heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following: genetic factors, dietary intake, intestinal flora, or low-grade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI- and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut. PMID:23066308

  18. Bowel obstruction in obturator hernia: A challenging diagnosis.

    Science.gov (United States)

    Conti, L; Baldini, E; Capelli, P; Capelli, C

    2018-01-01

    The obturator hernia is a rare pelvic hernia that often comes in the shape of bowel obstruction caused by the presence of an intestinal segment, more often ileum, passing trough the obturator foramen of the pelvic wall (Fig. 1). This type of hernia accounts for 0.5-1.4% of all hernias. We report the clinical case of a 84-year-old woman with no previous surgical interventions, who went to the emergency room complaining of vomit and nausea, bowels closed to gas and stool, which she had experienced for three previous days. Routine blood test showed impaired renal function and hydrohelectrolyte imbalance. A CT scan revealed a right ileal, strangulated obturator hernia. The patient underwent an emergency surgical intervention with laparoscopic trans-abdominal peritoneal approach (TAP): after the reduction of the herniated segment, a primary suturing of the parietal defect was performed without ileal resection. Because of the non-specific symptoms the diagnosis of this kind of hernia is often unclear; female are 6-9 times more likely than men to be subject to the aforementioned pathology, mostly occurring in multiparous, emaciated, elderly woman so it is also called "the little old lady's hernia". Risk factors are loss of weight, chronic pulmonary disease and ascites which increase the abdominal pressure. An unfrequent presenting sign is a palpable mass, or the Howship-Romberg sign- a pain radiating from the inner tigh and knee - but it could be misleading when confused with symptoms of gonarthrosis or lumbar vertebral disc pathology. CT scan has superior sensitivity and accuracy with respect to other radiological exams to assess the presence of an obturator hernia. Obturator hernia is a rare type of hernia due to his diagnosis, which is often unclear; a prompt suspect based for the non-specific symptoms is crucial for the diagnosis. Surgical management depends on early diagnosis and it is the only possible treatment for this pathology. Copyright © 2017 The Authors

  19. Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI

    International Nuclear Information System (INIS)

    Neubauer, Henning; Evangelista, Laura; Wirth, Clemens; Beer, Meinrad; Pabst, Thomas; Machann, Wolfram; Koestler, Herbert; Hahn, Dietbert; Dick, Anke

    2013-01-01

    Small-bowel MRI based on contrast-enhanced T1-weighted sequences has been challenged by diffusion-weighted imaging (DWI) for detection of inflammatory bowel lesions and complications in patients with Crohn disease. To evaluate free-breathing DWI, as compared to contrast-enhanced MRI, in children, adolescents and young adults with Crohn disease. This retrospective study included 33 children and young adults with Crohn disease ages 17 ± 3 years (mean ± standard deviation) and 27 matched controls who underwent small-bowel MRI with contrast-enhanced T1-weighted sequences and DWI at 1.5 T. The detectability of Crohn manifestations was determined. Concurrent colonoscopy as reference was available in two-thirds of the children with Crohn disease. DWI and contrast-enhanced MRI correctly identified 32 and 31 patients, respectively. All 22 small-bowel lesions and all Crohn complications were detected. False-positive findings (two on DWI, one on contrast-enhanced MRI), compared to colonoscopy, were a result of large-bowel lumen collapse. Inflammatory wall thickening was comparable on DWI and contrast-enhanced MRI. DWI was superior to contrast-enhanced MRI for detection of lesions in 27% of the assessed bowel segments and equal to contrast-enhanced MRI in 71% of segments. DWI facilitates fast, accurate and comprehensive workup in Crohn disease without the need for intravenous administration of contrast medium. Contrast-enhanced MRI is superior in terms of spatial resolution and multiplanar acquisition. (orig.)

  20. Split-dose Bowel Preparation for Colonoscopy: 2 Liters Polyethylene Glycol with Ascorbic Acid versus Sodium Picosulfate versus Oral Sodium Phosphate Tablets.

    Science.gov (United States)

    Lee, Seok Won; Bang, Chang Seok; Park, Tae Young; Suk, Ki Tae; Baik, Gwang Ho; Kim, Dong Joon

    2017-08-25

    Adequate bowel preparation is an essential factor affecting the visibility of colonic mucosa and safety of related therapeutic interventions. The aim of this study was to assess the efficacy, tolerability, and safety of three bowel preparation agents -2 L polyethylene glycol with ascorbic acid (PEGA), sodium picosulfate magnesium citrate (SPMC), and oral sodium phosphate tablet (NaP)- for morning colonoscopy. Here, we analyzed the medical records of patients who had taken bowel preparation agents using the split-dose method and undergone colonoscopy in a single hospital. The efficacy of bowel preparation agents was evaluated using the Ottawa bowel preparation assessment tool. The safety and tolerability of the agents were assessed by measuring the renal function and electrolytes prior to and after the procedure as well as by assessing the self-reported questionnaire. Of the 365 patients (PEGA:163, SPMC: 93, NaP: 109), 98.6% ingested more than 90% of the agents. NaP showed an inferior cleansing efficacy, and serum phosphate elevation was significantly higher in the NaP group. However, the satisfaction score was lowest in the PEGA group. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.92-0.99, p=0.04) and preparation agents (OR of PEGA versus NaP 5.0, 95% CI 2.28-10.97, p2.73, 95% CI 1.22-6.08, p=0.01) were independently associated with bowel preparation success. According to our analysis, NaP showed an inferior cleansing efficacy compared with PEGA and SPMC, which may be attributed to the complex administration method and lower water intake. However, large-volume ingestion remains unsatisfactory for patients. Detailed bowel preparation instructions could enhance bowel cleansing efficacy.

  1. Detection of unsuspected colonic abnormalities using the pneumocolon technique during small bowel meal examination

    Energy Technology Data Exchange (ETDEWEB)

    Chou, S.; Skehan, S.J.; Brown, A.L.; Rawlinson, J.; Somers, S

    2000-06-01

    AIMS: The pneumocolon technique in small bowel meal examination is used to obtain double-contrast views of the distal ileum. The purpose of this study was to determine the proportion of cases in which an overhead pneumocolon radiograph demonstrated clinically relevant findings in the colon. METHODS: The overhead pneumocolon radiographs in 151 patients who underwent small bowel meals were evaluated retrospectively. A chart review was performed on those patients with positive colonic findings to determine if the suspected abnormalities affected patient management. RESULTS: Colonic abnormalities were identified in 34 of the 151 patients. One patient had a previously undiagnosed ascending colonic cancer; 17 had evidence of acute or chronic colitis; 13 had diverticulosis; one had a caecal polyp; one had an ileosigmoid fistula; one had a filling defect in the ascending colon. In 25 cases the colonic abnormality was visible only on the pneumocolon radiograph and not on the preceding single-contrast images. Management was altered by the colonic findings in seven cases. False-positive findings occurred in two cases. CONCLUSIONS: A routine overhead radiograph following use of the pneumocolon technique is a useful adjunct to small bowel meal examination as it can yield unsuspected and clinically significant colonic findings. Chou, S. (2000)

  2. Detection of unsuspected colonic abnormalities using the pneumocolon technique during small bowel meal examination

    International Nuclear Information System (INIS)

    Chou, S.; Skehan, S.J.; Brown, A.L.; Rawlinson, J.; Somers, S.

    2000-01-01

    AIMS: The pneumocolon technique in small bowel meal examination is used to obtain double-contrast views of the distal ileum. The purpose of this study was to determine the proportion of cases in which an overhead pneumocolon radiograph demonstrated clinically relevant findings in the colon. METHODS: The overhead pneumocolon radiographs in 151 patients who underwent small bowel meals were evaluated retrospectively. A chart review was performed on those patients with positive colonic findings to determine if the suspected abnormalities affected patient management. RESULTS: Colonic abnormalities were identified in 34 of the 151 patients. One patient had a previously undiagnosed ascending colonic cancer; 17 had evidence of acute or chronic colitis; 13 had diverticulosis; one had a caecal polyp; one had an ileosigmoid fistula; one had a filling defect in the ascending colon. In 25 cases the colonic abnormality was visible only on the pneumocolon radiograph and not on the preceding single-contrast images. Management was altered by the colonic findings in seven cases. False-positive findings occurred in two cases. CONCLUSIONS: A routine overhead radiograph following use of the pneumocolon technique is a useful adjunct to small bowel meal examination as it can yield unsuspected and clinically significant colonic findings. Chou, S. (2000)

  3. Exploring the Potential of Anticipated Regret as an Emotional Cue to Improve Bowel Cancer Screening Uptake

    Directory of Open Access Journals (Sweden)

    Ian T. Zajac

    2017-01-01

    Full Text Available Objective. Bowel cancer is currently the second leading cause of cancer-related death in Australia and screening participation is suboptimal. This study examined the role of emotion in the form of anticipated regret (AR and its relationship to screening intentions. Methods. N=173 persons aged 45 to 80 years completed a survey measuring demographic variables, readiness to screen, relative importance of health by comparison to other life priorities, satisfaction with current health, and AR if not participating in future bowel cancer screening. Results. AR was a significant predictor of future screening intentions. Those with higher levels of AR were seven times more likely (OR = 7.18 to intend to screen in the future compared to those with lower AR. This relationship was not compromised when controlling for other variables including gender and satisfaction with one’s health. AR levels were significantly lower in people who had been screened previously and in those with full health insurance. Conclusions. These results demonstrate that AR is uniquely related to future bowel cancer screening intentions. Future studies should continue to consider this as a useful target for behavioural interventions and identify new ways of delivering these interventions to improve their reach.

  4. Microscopic colitis and small intestinal bacterial overgrowth--diagnosis behind the irritable bowel syndrome?

    Science.gov (United States)

    Stoicescu, Adriana; Andrei, M; Becheanu, G; Stoicescu, M; Nicolaie, T; Diculescu, M

    2012-01-01

    Some patients previously diagnosed with irritable bowel syndrome (IBS) may develop microscopic colitis or small intestinal bacterial overgrowth (SIBO). To estimate the prevalence of microscopic colitis and SIBO in patients with IBS, to evaluate the symptoms and the efficacy of treatment. We examined patients with IBS admitted in our clinic during a three-year period. We identified patients with microscopic colitis by performing total colonoscopy with multiple biopsies from normal intestinal mucosa and those with SIBO by performing a H2-breath test with glucose. We compared the symptoms and the effectiveness of the treatment. Out of the 132 patients initially diagnosed with IBS 3% (n=4) had microscopic colitis and 43.9% (n=58) had SIBO. Diarrhea was the main symptom in patients with microscopic colitis and SIBO (p=0.041), while abdominal pain, abdominal bloating and flatulence were prominent in IBS patients (p=0.042; p=0.039; p=0.048). Specific treatment with rifaximin in SIBO patients negativated H2-breath test in 70.9% cases. Patients suspected to have irritable bowel syndrome should be evaluated for microscopic colitis and SIBO. The proper diagnosis and the specific treatment may cure some difficult cases of the so called "irritable bowel syndrome".

  5. Geographic associations between lactase phenotype, multiple sclerosis, and inflammatory bowel diseases; Does obesity trump geography?

    Science.gov (United States)

    Szilagyi, Andew; Xue, Xiaoqing

    2016-11-01

    Geographic patterns with diminishing rates from north to south toward the equator have been described for a number of diseases, putatively related largely to "western" lifestyle. Among these the inflammatory bowel diseases; Crohn's (CD) and Ulcerative colitis (UC) have been prominent in sharing distributions with a number of autoimmune diseases. One of the interesting associations is the epidemiologic similarity with multiple sclerosis (MS). However, in addition, at least some of these diseases also correlated inversely with lactase non persistent population (LNP) distributions. It is hypothesized that MS should also have an inverse relationship with LNP. We provide support for this by comparing published MS, CD, UC and LNP national rates to the beginning of the new millennium. Possible links among these diseases may be an evolutionary signature of new genes which may have accompanied emergence of lactase persistence millennia ago. The emergent phenotypic dichotomy also forced different assimilation responses to lactose digestion. While intestinal retention of lactase results in direct host enzymatic digestion, in LNP persons intestinal bacterial metabolism of lactose impacts on the host micro-flora. These microbial changes may play some role in altering rates of diseases including IBD and MS. However, since the late 20th century previously observed patterns are changing. Although industrialization is considered to play an important modifying role, the rising rates of obesity with an emphasis on diet, and microfloral pathogenesis, but with an independent geographic pattern may also facilitate altering rates and geographic distributions of both of these and other diseases. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. The morphological profile of small bowel tumors - our experience.

    Science.gov (United States)

    Mărgăritescu, Nicolae Dragoş; Ciobanu, Mircea Ovidiu; Nemeş, Răducu Nicolae; Ghelase, Ştefan Mugurel; Pleşea, Răzvan Mihail; Georgescu, Ion; Voinea, Bogdan; Pleşea, Iancu Emil; ChiuŢu, LuminiŢa Cristina

    2016-01-01

    The authors assessed the morphological profile of tumor masses belonging to the small bowel discovered in their daily practice. 31 tumor masses located in different segments of small intestine operated between 2002 and 2013 in the 1st Surgical Department, Emergency County Hospital of Craiova, Romania, were analyzed. The investigated parameters were: tumor location and number, tumor dimensions, gross assessment, tumor extension and histological assessment. Tumor masses belonging to small intestine were rare. They usually expressed by their complications. In many cases, they were placed at the extremities of the small intestine. They were usually small but sometimes large and developing outwards intestinal wall. Commonly they had a fungating and ulcerated appearance. They were rather of mesenchymal origin than epithelial. However, some of them were inflammatory pseudotumors. Almost all neoplastic proliferations had a malignant phenotype, most often with regional extension. Our series of tumors had a morphological profile somehow similar with the profile described in the literature but with some particularities: the polarization to the extremities of the intestinal segment, a significant number of large tumors, clinical expression through different complications, the balance inclined in favor of mesenchymal origin of tumors and the clear predominance of malignant aggressive phenotype.

  7. Previously unknown organomagnesium compounds in astrochemical context

    OpenAIRE

    Ruf, Alexander

    2018-01-01

    We describe the detection of dihydroxymagnesium carboxylates (CHOMg) in astrochemical context. CHOMg was detected in meteorites via ultrahigh-resolving chemical analytics and represents a novel, previously unreported chemical class. Thus, chemical stability was probed via quantum chemical computations, in combination with experimental fragmentation techniques. Results propose the putative formation of green-chemical OH-Grignard-type molecules and triggered fundamental questions within chemica...

  8. [Placental complications after a previous cesarean section].

    Science.gov (United States)

    Milosević, Jelena; Lilić, Vekoslav; Tasić, Marija; Radović-Janosević, Dragana; Stefanović, Milan; Antić, Vladimir

    2009-01-01

    The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development. The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history. The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (pcesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (pcesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (pcesarean section is an important risk factor for the development of placental complications.

  9. Wegener’s granulomatosis mimicking inflammatory bowel disease and presenting with chronic enteritis

    Directory of Open Access Journals (Sweden)

    Shahedi K

    2013-10-01

    Full Text Available Kamyar Shahedi,1,2 Ramy Magdy Hanna,1,2 Oleg Melamed,1,2 James Wilson2,31Department of Medicine Olive-View UCLA Medical Center, Sylmar, CA, 2David Geffen School of Medicine at UCLA, Los Angeles, CA, 3UCLA Medical Center-UCLA Stone Center, Los Angeles, CA, USAAbstract: Wegener’s granulomatosis, also known as anti-neutrophil cytoplasmic antibody (ANCA-associated vasculitis, is a small vessel vasculitis with primarily pulmonary, renal, and sinus disease manifestations. The prevalence of Wegener’s granulomatosis is three cases per 100,000 patients. Cardiovascular, neurologic, cutaneous, and joint manifestations have been reported in many case reports and case series. Gastrointestinal manifestations are less noted in Wegener’s granulomatosis, although they have been previously reported in the form of intestinal perforation and intestinal ischemia. Additionally, there are characteristic findings of vasculitis that are noted with active Wegener’s granulomatosis of the small bowel. We report a case of an elderly patient who presented with weight loss, diarrhea, and hematochezia. His symptoms were chronic and had lasted for more than 1 year before diagnosis. Inflammatory bowel disease or chronic enteritis due to Salmonella arizonae because of reptile exposure originally were suspected as etiologies of his presentation. The findings of proteinuria, renal failure, and pauci-immune glomerulonephritis on renal biopsy, in conjunction with an elevated c-ANCA titer, confirmed the diagnosis of Wegener’s granulomatosis with associated intestinal vasculitis. This case demonstrates an atypical presentation of chronic duodenitis and jejunitis secondary to Wegener’s granulomatosis, which mimicked inflammatory bowel disease.Keywords: ANCA-associated vasculitis, Wegener’s syndrome, pauci-immune glomerulonephritis, Salmonella arizonae, inflammatory bowel disease

  10. Transient small-bowel intussusception in children on CT

    International Nuclear Information System (INIS)

    Strouse, Peter J.; DiPietro, Michael A.; Saez, Fermin

    2003-01-01

    To determine the frequency and significance of small-bowel intussusception identified in children on CT. All abdomen CT reports between July 1995 and April 2002 were reviewed to identify patients with small-bowel intussusception. Intussusceptions were identified as an intraluminal mass with a characteristic layered appearance and/or continuity with adjacent mesenteric fat. Ileocolic intussusceptions and intussusceptions related to feeding tubes were excluded. Imaging studies and medical records were reviewed. Twenty-five pediatric patients (16 boys, 9 girls; mean age 11.2 years) were identified with small-bowel intussusception on CT. No patient had a persistent intussusception requiring surgery. Fourteen had limited immediate repeat CT images as part of the same examination, ten of which demonstrated resolution of the CT abnormality. Follow-up CT [n=13 (6 within 24 h)], ultrasound (n=3), small-bowel follow-through (n=4) and surgery (n=3) showed no intussusception. In four patients with persistent symptoms, underlying pathology was identified requiring treatment (giardiasis, 2; small-bowel inflammation/strictures, 1; abscess and partial small-bowel obstruction after perforated appendicitis, 1). In 21 other patients, direct correlation of symptoms to CT abnormality was absent or questionable, no treatment was required, and there was no clinical or imaging evidence of persistence or recurrence. Most small-bowel intussusceptions identified in children by CT are transient and of no clinical significance. (orig.)

  11. Surgical aspects of radiation enteritis of the small bowel

    Energy Technology Data Exchange (ETDEWEB)

    Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

    1984-02-01

    Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

  12. Surgical aspects of radiation enteritis of the small bowel

    International Nuclear Information System (INIS)

    Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

    1984-01-01

    Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation

  13. Integrated real time bowel sound detector for artificial pancreas systems

    Directory of Open Access Journals (Sweden)

    Khandaker A. Al Mamun

    2016-03-01

    Full Text Available This paper reports an ultra-low power real time bowel sound detector with integrated feature extractor for physiologic measure of meal instances in artificial pancreas devices. The system can aid in improving long term diabetic patient care and consists of a front end detector and signal processing unit. The front end detector transduces the initial bowel sound recorded from a piezoelectric sensor into a voltage signal. The signal processor uses a feature extractor to determine whether a bowel sound is detected. The feature extractor consists of a low noise, low power signal front-end, peak and trough locator, signal slope and width detector, digitizer, and bowel pulse locator. The system was fabricated in a standard 0.18 μm CMOS process, and the bowel sound detection system was characterized and verified with experimentally recorded bowel sounds. The integrated instrument consumes 53 μW of power from a 1 V supply in a 0.96 mm2 area, and is suitable for integration with portable devices. Keywords: Bowel sound, Artificial pancreas, Glucose monitoring, Feature extractor, Charge amplifier, Piezoelectric sensor

  14. Inflammatory Bowel Disease and Small Bowel Cancer Risk, Clinical Characteristics, and Histopathology

    DEFF Research Database (Denmark)

    Bojesen, Rasmus Dahlin; Riis, Lene Buhl; Høgdall, Estrid

    2017-01-01

    BACKGROUND & AIMS: Inflammatory bowel disease (IBD) may increase risk of small bowel cancer (SBC). However, little is known of the characteristics and features of IBD-SBC, due to a low number of cases worldwide. We performed a population-based study of IBD and SBC to calculate risk and increase our...... understanding of clinical characteristics and histopathological and molecular features. METHODS: The study population consisted of all individuals aged 16 years or older living in Denmark during 1978-2010. Through linkage between national registers and subsequent scrutiny of medical records and pathology...... descriptions, we identified 40 cases of IBD-SBC. Risk was calculated by standardized incidence ratio (SIR) (observed/expected); patient characteristics were derived from medical files, and surgery specimens were obtained from hospitals nationwide for histopathological and molecular analyses. RESULTS: During...

  15. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Pedersen, Natalia; Ankersen, Dorit Vedel; Felding, Maria

    2017-01-01

    AIM: To investigate the effect of a low-FODMAP diet on irritable bowel syndrome (IBS)-like symptoms in patients with inflammatory bowel disease (IBD). METHODS: This was a randomised controlled open-label trial of patients with IBD in remission or with mild-to-moderate disease and coexisting IBS......-like symptoms (Rome III) randomly assigned to a Low-FODMAP diet (LFD) or a normal diet (ND) for 6 wk between June 2012 and December 2013. Patients completed the IBS symptom severity system (IBS-SSS) and short IBD quality of life questionnaire (SIBDQ) at weeks 0 and 6. The primary end-point was response rates......; inter-quartile range [IQR] 33-169) than ND group (median 170, IQR 91-288), P = 0.02. Furthermore, the LFD group had a significantly greater increase in SIBDQ (median 60, IQR 51-65) than the ND group (median 50, IQR 39-60), P diet reduced IBS...

  16. Incidence of Bowel Surgery and Associated Risk Factors in Pediatric-Onset Crohn's Disease.

    Science.gov (United States)

    Rinawi, Firas; Assa, Amit; Hartman, Corina; Mozer Glassberg, Yael; Friedler, Vered Nachmias; Rosenbach, Yoram; Silbermintz, Ari; Zevit, Noam; Shamir, Raanan

    2016-12-01

    Data describing the incidence and the risk factors for surgical interventions in pediatric Crohn's disease (CD) is inconsistent. Our aim was to describe the rates of intestinal surgery and to identify associated risk factors in a large cohort of children with CD. Medical charts of 482 children with CD from the Schneider Pediatric Inflammatory Bowel Disease cohort who were diagnosed between 1981 and 2013 were carefully reviewed retrospectively. Of 482 patients, 143 (29.7%) underwent intestinal surgery with a median follow-up time of 8.6 years (range, 1-30.5). Kaplan-Meier survival estimates of the cumulative probability of CD-related intestinal surgery were 14.2% at 5 years and 24.5% at 10 years from diagnosis. Of these, 14% needed more than one operation. Multivariate Cox models showed that isolated ileal disease (hazard ratio [HR] 2.39, P = 0.008), complicated behavior (penetrating or stricturing) (HR 2.44, P Crohn's Disease Activity Index (HR 1.02, P = 0.001) were associated with increased risk for intestinal surgery. Age, gender, family history of CD, early introduction of immunomodulators, treatment with anti-tumor necrosis factor α, or diagnosis before the year 2000 did not affect the risk of bowel surgery. Ileal location, complicated behavior, and higher disease activity indices at diagnosis are independent risk factors for bowel surgery, whereas anti-tumor necrosis factor α treatment and diagnosis during the "biological era" are not associated with diminished long-term surgical risk.

  17. Effects of a proprietary Bacillus coagulans preparation on symptoms of diarrhea-predominant irritable bowel syndrome.

    Science.gov (United States)

    Dolin, B J

    2009-12-01

    Symptoms of irritable bowel syndrome (IBS) have a profound impact on quality of life for many patients and current treatments are sometimes unsatisfactory. This controlled pilot study was conducted to evaluate effects of the proprietary GanedenBC(30) (Bacillus coagulans GBI-30, 6086) probiotic on IBS symptoms, in a randomized, double-blind, placebo-controlled clinical trial including patients with diarrhea-predominant IBS (IBS-D). Patients were randomized to receive either B. coagulans GBI-30, 6086 or placebo once a day for 8 weeks. Patients filled out a quality-of-life questionnaire, and self-assessment diaries were provided to record stool count and consistency, symptom severity, and medication consumption. Of the 61 patients enrolled, six did not meet the inclusion criteria and three were lost to follow-up. Of the remaining 52 patients with IBS-D, the average number of bowel movements per day was significantly reduced for patients treated with B. coagulans GBI-30, 6086 when compared to placebo (P = 0.042). Large variability in baseline scores prevented the assessment of severity scores and quality of life. This small pilot study provides evidence that the proprietary B. coagulans GBI-30, 6086 probiotic is safe and effective for reducing daily bowel movements in patients with IBS-D. Copyright 2009 Prous Science, S.A.U. or its licensors. All rights reserved.

  18. Clinical trials using mesenchymal stem cells in liver diseases and inflammatory bowel diseases.

    Science.gov (United States)

    Tsuchiya, Atsunori; Kojima, Yuichi; Ikarashi, Shunzo; Seino, Satoshi; Watanabe, Yusuke; Kawata, Yuzo; Terai, Shuji

    2017-01-01

    Mesenchymal stem cell (MSC) therapies have been used in clinical trials in various fields. These cells are easily expanded, show low immunogenicity, can be acquired from medical waste, and have multiple functions, suggesting their potential applications in a variety of diseases, including liver disease and inflammatory bowel disease. MSCs help prepare the microenvironment, in response to inflammatory cytokines, by producing immunoregulatory factors that modulate the progression of inflammation by affecting dendritic cells, B cells, T cells, and macrophages. MSCs also produce a large amount of cytokines, chemokines, and growth factors, including exosomes that stimulate angiogenesis, prevent apoptosis, block oxidation reactions, promote remodeling of the extracellular matrix, and induce differentiation of tissue stem cells. According to ClinicalTrials.gov, more than 680 clinical trials using MSCs are registered for cell therapy of many fields including liver diseases (more than 40 trials) and inflammatory bowel diseases (more than 20 trials). In this report, we introduce background and clinical studies of MSCs in liver disease and inflammatory bowel diseases.

  19. Colonic inflammation in pediatric inflammatory bowel disease: detection with magnetic resonance enterography

    Energy Technology Data Exchange (ETDEWEB)

    Campari, Alessandro [E. Bassini Hospital - ASST Nord Milano, Radiology Department, Milan (Italy); V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Radiology Department, Milan (Italy); Napolitano, Marcello [V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Radiology Department, Milan (Italy); Zuin, Giovanna [V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Department, Milan (Italy); Maestri, Luciano [V. Buzzi Children' s Hospital - ASST Fatebenefratelli-Sacco, Pediatric Surgery Department, Milan (Italy); Di Leo, Giovanni [IRCCS Policlinico San Donato, Radiology Unit, Milan (Italy); Sardanelli, Francesco [IRCCS Policlinico San Donato, Radiology Unit, Milan (Italy); Universita degli Studi di Milano, Department of Biomedical Sciences for Health, Milan (Italy)

    2017-06-15

    Colonic involvement in pediatric inflammatory bowel disease is common. Magnetic resonance (MR) enterography is considered the best imaging modality for pediatric inflammatory bowel disease evaluation. It is unclear whether the lack of a dedicated large bowel preparation prevents a reliable colonic assessment. To determine the diagnostic performance of standard MR enterography in detecting and grading colonic inflammatory activity. We retrospectively evaluated children who underwent both MR enterography and ileocolonoscopy with biopsies <4 weeks apart. Two radiologists independently reviewed MR examinations and quantified inflammation in each of the five colonic segments using a standardized MR score system. Findings were compared with histological examination of the corresponding segment. Mann-Whitney, Kruskal-Wallis, Jonckheere-Terpstra and Bland-Altman statistics were used. One hundred seventy-five segments from 37 examinations were included. MR enterography diagnostic performance for inflammation was as follows: sensitivity 94% (95% confidence interval [CI]: 90-97%), specificity: 64% (95% CI: 57-71%). A significant positive correlation was found between MR score and inflammatory activity histologically graded (P<0.001, Jonckheere-Terpstra test). The interobserver agreement was good (mean difference between MR enterography scores was -0.03; limits of agreement -2.8 to 2.7). Standard MR enterography is sensitive for the detection of actively inflamed colonic segments. MR enterography might provide useful information for guiding biopsies and its role as an alternative to ileocolonoscopy in monitoring colonic disease activity in children should be further investigated. (orig.)

  20. Fine-mapping inflammatory bowel disease loci to single-variant resolution.

    Science.gov (United States)

    Huang, Hailiang; Fang, Ming; Jostins, Luke; Umićević Mirkov, Maša; Boucher, Gabrielle; Anderson, Carl A; Andersen, Vibeke; Cleynen, Isabelle; Cortes, Adrian; Crins, François; D'Amato, Mauro; Deffontaine, Valérie; Dmitrieva, Julia; Docampo, Elisa; Elansary, Mahmoud; Farh, Kyle Kai-How; Franke, Andre; Gori, Ann-Stephan; Goyette, Philippe; Halfvarson, Jonas; Haritunians, Talin; Knight, Jo; Lawrance, Ian C; Lees, Charlie W; Louis, Edouard; Mariman, Rob; Meuwissen, Theo; Mni, Myriam; Momozawa, Yukihide; Parkes, Miles; Spain, Sarah L; Théâtre, Emilie; Trynka, Gosia; Satsangi, Jack; van Sommeren, Suzanne; Vermeire, Severine; Xavier, Ramnik J; Weersma, Rinse K; Duerr, Richard H; Mathew, Christopher G; Rioux, John D; McGovern, Dermot P B; Cho, Judy H; Georges, Michel; Daly, Mark J; Barrett, Jeffrey C

    2017-07-13

    Inflammatory bowel diseases are chronic gastrointestinal inflammatory disorders that affect millions of people worldwide. Genome-wide association studies have identified 200 inflammatory bowel disease-associated loci, but few have been conclusively resolved to specific functional variants. Here we report fine-mapping of 94 inflammatory bowel disease loci using high-density genotyping in 67,852 individuals. We pinpoint 18 associations to a single causal variant with greater than 95% certainty, and an additional 27 associations to a single variant with greater than 50% certainty. These 45 variants are significantly enriched for protein-coding changes (n = 13), direct disruption of transcription-factor binding sites (n = 3), and tissue-specific epigenetic marks (n = 10), with the last category showing enrichment in specific immune cells among associations stronger in Crohn's disease and in gut mucosa among associations stronger in ulcerative colitis. The results of this study suggest that high-resolution fine-mapping in large samples can convert many discoveries from genome-wide association studies into statistically convincing causal variants, providing a powerful substrate for experimental elucidation of disease mechanisms.

  1. User perspectives, preferences and priorities relating to products for managing bladder and bowel dysfunctions.

    Science.gov (United States)

    Buckley, Brian S

    2017-12-01

    A great many people of all ages around the world cannot fully control their bladder or bowel, or both. Either in the short or long term, they rely upon products and devices to manage the emptying of their bladders and bowels and to collect, absorb and contain leaked urine or faeces. The incontinence product market is large and growing, and ongoing developments in materials and technologies should lead to improvements in these products and devices. Engineers and designers who work in this field - or who plan to do so - need to recognise the breadth of factors that affects the effectiveness and acceptability of products. The primary functions of products for managing bladder and bowel dysfunctions are the collection and containment of urine or faeces - and the associated engineering and design challenges may be considered in terms of flow rates and volumes and methods of acquisition and containment. But products will fail if they do not take into account other factors, some of which relate less directly to these primary functions and some not at all. This article aims to highlight the product characteristics that are most important to the people who use them, and areas where user-centred innovation and development may lead to improvements.

  2. Colonic inflammation in pediatric inflammatory bowel disease: detection with magnetic resonance enterography

    International Nuclear Information System (INIS)

    Campari, Alessandro; Napolitano, Marcello; Zuin, Giovanna; Maestri, Luciano; Di Leo, Giovanni; Sardanelli, Francesco

    2017-01-01

    Colonic involvement in pediatric inflammatory bowel disease is common. Magnetic resonance (MR) enterography is considered the best imaging modality for pediatric inflammatory bowel disease evaluation. It is unclear whether the lack of a dedicated large bowel preparation prevents a reliable colonic assessment. To determine the diagnostic performance of standard MR enterography in detecting and grading colonic inflammatory activity. We retrospectively evaluated children who underwent both MR enterography and ileocolonoscopy with biopsies <4 weeks apart. Two radiologists independently reviewed MR examinations and quantified inflammation in each of the five colonic segments using a standardized MR score system. Findings were compared with histological examination of the corresponding segment. Mann-Whitney, Kruskal-Wallis, Jonckheere-Terpstra and Bland-Altman statistics were used. One hundred seventy-five segments from 37 examinations were included. MR enterography diagnostic performance for inflammation was as follows: sensitivity 94% (95% confidence interval [CI]: 90-97%), specificity: 64% (95% CI: 57-71%). A significant positive correlation was found between MR score and inflammatory activity histologically graded (P<0.001, Jonckheere-Terpstra test). The interobserver agreement was good (mean difference between MR enterography scores was -0.03; limits of agreement -2.8 to 2.7). Standard MR enterography is sensitive for the detection of actively inflamed colonic segments. MR enterography might provide useful information for guiding biopsies and its role as an alternative to ileocolonoscopy in monitoring colonic disease activity in children should be further investigated. (orig.)

  3. FEATURES OF BOWEL CYTOPROTECTION IN INFANTS WITH FUNCTIONAL AND CHRONIC INFLAMMATORY BOWEL DISEASES

    Directory of Open Access Journals (Sweden)

    Marushko RV

    2013-08-01

    Full Text Available Summary. Over past years, considerable attention is paid to the role of fatty acids, especially polyunsaturated, in the development of various gastrointestinal diseases, among which the most common are functional and inflammatory bowel diseases. The need for studies of fatty acid disorders is to clarify the pathogenetic mechanisms in which fatty acids participate in the development intestinal pathology. The aim of this study to elaborate the optimal preventive and therapeutic measures to reduce the incidence of these diseases and provide the effective treatment, especially in early childhood . Objective: To study the profile features of fatty acids in infants with functional and inflammatory bowel diseases. Patients and methods: Were examined 149 children aged from 6 months to 3 years, divided into 3 groups: 52 children with chronic nonulcerative nonspecific colitis, 49 children with functional constipation and 47 children with functional diarrhea. Verification of diagnoses was provided in accordance with the «Standardised clinical protocols of medical care for children with digestive diseases.»Analysis of fatty acid's profile was evaluated by the method blood gas chromatography. Results: All the examined children had fatty acid disorders. The level of saturated fatty acids was decreased and the concentration of polyunsaturated fatty acids was increased in the expence of omega6 polyunsaturated fatty acids (PUFA, in partiular, linoleic and arachidonic acids. The greatest changes were observed in patients with chronic nonulcerative nonspecific colitis which can be considered as important links in the pathogenesis of chronic inflammation. In functional bowel disorders imbalance of fatty acids is likely to be a risk factor in development significant lesions in the intestinal mucosa. Conclusions: Given the presence of lipid imbalance in inflammatory bowel disease as well as in intestinal functional disorders, which is characterized by a significant

  4. Acupuncture for treatment of irritable bowel syndrome

    Science.gov (United States)

    Manheimer, Eric; Cheng, Ke; Wieland, L. Susan; Min, Li Shih; Shen, Xueyong; Berman, Brian M; Lao, Lixing

    2013-01-01

    Background Irritable bowel syndrome (IBS) is a common, costly, and difficult to treat disorder that impairs health-related quality of life and work productivity. Evidence-based treatment guidelines have been unable to provide guidance on the effects of acupuncture for IBS because the only previous systematic review included only small, heterogeneous and methodologically unsound trials. Objectives The primary objectives were to assess the efficacy and safety of acupuncture for treating IBS. Search methods MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Selection criteria Randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and RCTs that evaluated acupuncture as an adjuvant to another treatment, in adults with IBS were included. Data collection and analysis Two authors independently assessed the risk of bias and extracted data. We extracted data for the outcomes overall IBS symptom severity and health-related quality of life. For dichotomous data (e.g. the IBS Adequate Relief Question), we calculated a pooled relative risk (RR) and 95% confidence interval (CI) for substantial improvement in symptom severity after treatment. For continuous data (e.g. the IBS Severity Scoring System), we calculated the standardized mean difference (SMD) and 95% CI in post-treatment scores between groups. Main results Seventeen RCTs (1806 participants) were included. Five RCTs compared acupuncture versus sham acupuncture. The risk of bias in these studies was low.We found no evidence of an improvement with acupuncture relative to sham (placebo) acupuncture for symptom severity (SMD-0.11, 95%CI −0.35 to 0.13; 4 RCTs; 281 patients) or quality of life (SMD = −0.03, 95%CI −0.27 to 0.22; 3 RCTs; 253 patients). Sensitivity analyses based on study

  5. Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.

    Science.gov (United States)

    James, Laura J; Wong, Germaine; Craig, Jonathan C; Ju, Angela; Williams, Narelle; Lim, Wai H; Cross, Nicholas; Tong, Allison

    2017-04-03

    Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts. Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity). Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD. Copyright © 2017 by the American Society of Nephrology.

  6. Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial

    Directory of Open Access Journals (Sweden)

    MacPherson Hugh

    2012-10-01

    Full Text Available Abstract Background Acupuncture is used by patients as a treatment for irritable bowel syndrome (IBS but the evidence on effectiveness is limited. The purpose of the study was to evaluate the effectiveness of acupuncture for irritable bowel syndrome in primary care when provided as an adjunct to usual care. Methods Design: A two-arm pragmatic randomised controlled trial. Setting: Primary care in the United Kingdom. Patients: 233 patients had irritable bowel syndrome with average duration of 13 years and score of at least 100 on the IBS Symptom Severity Score (SSS. Interventions: 116 patients were offered 10 weekly individualised acupuncture sessions plus usual care, 117 patients continued with usual care alone. Measurements: Primary outcome was the IBS SSS at three months, with outcome data collected every three months to 12 months. Results There was a statistically significant difference between groups at three months favouring acupuncture with a reduction in IBS Symptom Severity Score of −27.43 (95% CI: –48.66 to −6.21, p = 0.012. The number needed to treat for successful treatment (≥50 point reduction in the IBS SSS was six (95% CI: 3 to 17, based on 49% success in the acupuncture group vs. 31% in the control group, a difference between groups of 18% (95% CI: 6% to 31%. This benefit largely persisted at 6, 9 and 12 months. Conclusions Acupuncture for irritable bowel syndrome provided an additional benefit over usual care alone. The magnitude of the effect was sustained over the longer term. Acupuncture should be considered as a treatment option to be offered in primary care alongside other evidenced based treatments. Trial Registration Current Controlled Trials ISRCTN08827905

  7. An experimental study on radiological examination of obstructed small bowel with various contrast media

    International Nuclear Information System (INIS)

    Lee, Yong; Kim, Sung Jin; Han, Moon Hee; Park, Jae Hyung

    1991-01-01

    For the evaluation of the level and cause of small bowel obstruction, an oral barium study is usually chosen. When perforation is whether barium or a water-soluble contrast agent should be used, because barium causes from foreign body reactions as well as adhesions in the extraluminal tissues. Water-soluble contrast agent, on the other hand, are less satisfactory but in general have no untoward effects in the extraluminal tissues. Because of hyperosomolarity, water-soluble contrast agents attract large amounts of fluid with subsequent dilution and loss of contrast and pose a risk of pulmonary edema if aspirated. The use of the newer non-ionic and low-osmolarity water-soluble contrast will likely avoid pulmonary complications due to aspiration. The author performed this experimental study to compare the radiological efficacy of different contrast media in enteric follow-through examinations of obstructed small bowel. Rate had a ligature applied to the distal ileum via laparotomy. Four contrast media were subjected to testing by instillation via oro-gastric tube immediately after laparotomy. Radiographs were exposed at 1, 4 and 8 hours and evaluated later. After 24 hours the animals were sacrificed and the stomach and small bowels, free from mesentery and omental tissue, were weighted with contrasts. The progression in the bowel was proportionate to the osmolarity of the contrast media. After 1 hour, the observations indicated sodium diatrizoate (Gastrografin, Schering) to be the least favorable medium with respect to sharpness of the mucosal border. After 8 hours, barium gave a poorer delineation compared to Ioxaglate (Hexabric, Guerbet) and Iopromide (Ultravist, Schering). Early deaths were noted in the sodium diatrizoate and ioxaglate groups. So we conclude that when using a rather high-volume bolus, low-osmolar non-ionic contrast media seem to have significant prospects for general diagnostic use in patients with suspected intestinal obstruction

  8. Primary Care of the Patient with Inflammatory Bowel Disease.

    Science.gov (United States)

    Park, Jean R; Pfeil, Sheryl A

    2015-09-01

    Inflammatory bowel disease involves 2 major disorders, ulcerative colitis and Crohn disease, both of which are due to inflammatory dysregulation in the gastrointestinal tract. Although these disorders have many overlapping features in pathophysiology and management, our current understanding of inflammatory bowel disease has illuminated several distinguishing features of the 2 diseases. This article highlights similarities and differences most applicable to a primary care physician's practice. Also detailed are disease-related and treatment-related complications, and routine health maintenance practices for the patient with inflammatory bowel disease. Published by Elsevier Inc.

  9. Increasing participation of people with learning disabilities in bowel screening.

    Science.gov (United States)

    Gray, Jonathan

    2018-03-08

    Learning disability nurses have a key role in addressing the health inequalities experienced by people with learning disabilities. People with learning disabilities are less likely to participate in bowel screening than other sectors of the population, despite there being evidence of this population being at an increased risk of developing bowel cancer. There are a range of barriers at individual and systemic levels that impact on participation in bowel screening by people with learning disabilities. Actions to address these barriers have been identified in the literature and learning disability nurses are a key agent of change in enabling people with learning disabilities to participate in the national screening programmes.

  10. Supra-transumbilical laparotomy (STL approach for small bowel atresia repair: Our experience and review of the literature

    Directory of Open Access Journals (Sweden)

    Ernesto Leva

    2013-01-01

    Full Text Available Background: Supra-Transumbilical Laparotomy (STL has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with small bowel atresia were treated via STL approach at our Institution over a 5-year period and their charts were retrospectively reviewed. Results: STL procedure was performed at mean age of 3.1 day. No malrotation disorders were detected with pre-operative contrast enema. Eight patients (54.1% presented jejunal atresia, five (35.7% ileal atresia, and one (7.1% multiple ileal and jejunal atresias. Standard repair with primary end-to-back anastomosis was performed in all but one patient. In the newborn with multiple atresia, STL incision was converted in supra-umbilical transverse incision due to difficulty of exposition. After surgery, one patient developed anastomotic stricture, and another developed occlusion due to adhesions: Both infants required second laparotomy. No infections of the umbilical site were recorded, and cosmetic results were excellent in all patients. Conclusions: Increasing evidence suggests that STL approach for small bowel atresia is feasible, safe and provides adequate exposure for small bowel atresia surgery. When malrotation and colonic/multiple atresia are pre-operatively ruled out, STL procedure can be choosen as first approach.

  11. Immunization history of children with inflammatory bowel disease.

    Science.gov (United States)

    Soon, Ing Shian; deBruyn, Jennifer C C; Wrobel, Iwona

    2013-04-01

    Protection against vaccine-preventable diseases is important in children with inflammatory bowel disease (IBD) due to frequent immunosuppressive therapy use. The chronic relapsing nature and treatment regimen of IBD may necessitate modified timing of immunizations. To evaluate the completeness of immunizations in children with IBD. Immunization records of all children with IBD followed at the Alberta Children's Hospital (Calgary, Alberta) were reviewed. For children with incomplete immunization according to the province of Alberta schedule, the reasons for such were clarified. Demographic data and age at diagnosis were also collected. Immunization records were obtained from 145 (79%) children with IBD. Fifteen children had incomplete routine childhood immunizations, including two with no previous immunizations. The most common incomplete immunizations included hepatitis B (n=9), diphtheria, tetanus, acellular pertussis at 14 to 16 years of age (n=7), and diphtheria, tetanus, acellular pertussis, inactivated polio at four to six years of age (n=6). The reasons for incomplete immunization included use of immunosuppressive therapy at time of scheduled immunization; IBD-related symptoms at time of scheduled immunization; parental refusal; recent move from elsewhere with different immunization schedule; unawareness of routine immunization; and needle phobia. Although the majority of children with IBD had complete childhood immunizations, suboptimal immunizations were present in 10%. With increasing use of immunosuppressive therapy in IBD, physicians caring for children with IBD must periodically evaluate immunization status and ensure the completeness of childhood immunizations.

  12. Self-schema in irritable bowel syndrome and depression.

    Science.gov (United States)

    Toner, B B; Garfinkel, P E; Jeejeebhoy, K N; Scher, H; Shulhan, D; Di Gasbarro, I

    1990-01-01

    Some investigators have suggested that irritable bowel syndrome (IBS) represents a physiologic expression of an affective disorder. This study investigated whether IBS patients differed in their self-schema from depressed patients. Self-schema refers to a cognitive framework of the individual's beliefs, attitudes, and self-perceptions which is stored in memory and which influences incoming information. The sample consisted of 21 IBS patients, 21 psychiatric outpatients with major depression (MD), and 19 normal controls. All groups were age matched. Subjects completed a structured psychiatric interview (Diagnostic Interview Schedule (DIS) and a Beck Depression Inventory (BDI), in addition to a test of self-schema, which involved rating and recall of a variety of "depressed" and "nondepressed" content adjectives. Consistent with previous work on self-schema, the MD group recalled significantly more depressed adjectives rated under the self-referent task than the Control group (p less than 0.05) and, also, the IBS group (p less than 0.05). Most striking was the finding that a subgroup of IBS patients who met criteria for MD (43% of the sample) recalled significantly more self-referent nondepressed words (and less self-referent depressed words) than the MD group (p less than 0.05). In other words, IBS patients with MD do not view themselves as depressed. These findings suggest that while some IBS and depressed psychiatric outpatients may share depressive symptoms, these groups can be differentiated by their self-schema.

  13. Irritable bowel syndrome: role of food in pathogenesis and management.

    LENUS (Irish Health Repository)

    Morcos, Ashraf

    2009-11-01

    Patients with the irritable bowel syndrome (IBS) commonly report the precipitation of symptoms on food ingestion. Though the role of dietary constituents in IBS has not been extensively studied, food could contribute to symptom onset or even the causation of IBS through a number of mechanisms. First, the physiological response of the intestine to food ingestion could precipitate symptoms in predisposed individuals; second, there is some evidence that allergy or intolerance to a particular food can produce IBS-like symptoms, third, certain foods may alter the composition of the luminal milieu, either directly or indirectly through effects on bacterial metabolism, and thus induce symptoms and, finally, IBS may develop following exposure to food-borne pathogens. Anticipatory, psychological factors generated by previous negative experiences with food ingestion or other factors may also contribute though their contribution has been scarcely quantified. Not surprisingly, there is considerable interest in the potential roles of diet and food supplements in the therapy of IBS; for the most part, the evidence base for such recommendations remains slim though certain probiotics show considerable promise.

  14. Role of Incretin Axis in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Lihua Duan

    2017-12-01

    Full Text Available The inflammatory bowel diseases (IBDs, including Crohn’s disease (CD and ulcerative colitis (UC, are chronic inflammatory conditions of the gastrointestinal tract and involve a complicated reciprocity of environmental, genetic, and immunologic factors. Despite substantial advances in the foundational understanding of the immunological pathogenesis of IBD, the detailed mechanism of the pathological progression in IBD remains unknown. In addition to Th1/Th2 cells, whose role in IBD has been previously well defined, recent evidence indicates that Th17 cells and Tregs also play a crucial role in the development of IBD. Diets which contain excess sugars, salt, and fat may also be important actors in the pathogenesis of IBD, which may be the cause of high IBD incidence in western developed and industrialized countries. Up until now, the reason for the variance in prevalence of IBD between developed and developing countries has been unknown. This is partly due to the increasing popularity of western diets in developing countries, which makes the data harder to interpret. The enterocrinins glucagon-like peptides (GLPs, including GLP-1 and GLP-2, exhibit notable benefits on lipid metabolism, atherosclerosis formation, plasma glucose levels, and maintenance of gastric mucosa integrity. In addition to the regulation of nutrient metabolism, the emerging role of GLPs and their degrading enzyme dipeptidyl peptidase-4 (DPP-4 in gastrointestinal diseases has gained increasing attention. Therefore, here we review the function of the DPP-4/GLP axis in IBD.

  15. Previous climatic alterations are caused by the sun

    International Nuclear Information System (INIS)

    Groenaas, Sigbjoern

    2003-01-01

    The article surveys the scientific results of previous research into the contribution of the sun to climatic alterations. The author concludes that there is evidence of eight cold periods after the last ice age and that the alterations largely were due to climate effects from the sun. However, these effects are only causing a fraction of the registered global warming. It is assumed that the human activities are contributing to the rest of the greenhouse effect

  16. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Trier Møller, Frederik; Andersen, Vibeke; Wohlfarht, Jan

    2015-01-01

    OBJECTIVES: Estimates of familial risk of inflammatory bowel diseases (IBDs), Crohn's disease (CD), and ulcerative colitis (UC) are needed for counseling of patients and could be used to target future prevention. We aimed to provide comprehensive population-based estimates of familial risk of IBD....... METHODS: The study encompassed the entire Danish population during 1977-2011 (N=8,295,773; 200 million person-years). From national registries, we obtained information on diagnosis date of IBD (N=45,780) and family ties. Using Poisson regression, we estimated incidence rate ratios (IRRs) of IBD...... pronounced in relatives of CD cases. IRRs increased with two or more IBD-affected relatives and were modified by age, with the highest family-related IRR observed in early life. CONCLUSIONS: The risk of IBD is significantly increased in first -, second-, and third-degree relatives of IBD-affected cases...

  17. Environment and the inflammatory bowel diseases.

    Science.gov (United States)

    Frolkis, Alexandra; Dieleman, Levinus A; Barkema, Herman W; Panaccione, Remo; Ghosh, Subrata; Fedorak, Richard N; Madsen, Karen; Kaplan, Gilaad G

    2013-03-01

    Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gastrointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breastfeeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology.

  18. Intestinal epithelium in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Mehmet eCoskun

    2014-08-01

    Full Text Available The intestinal epithelium has a strategic position as a protective physical barrier to luminal microbiota and actively contributes to the mucosal immune system. This barrier is mainly formed by a monolayer of specialized intestinal epithelial cells (IECs that are crucial in maintaining intestinal homeostasis. Therefore, dysregulation within the epithelial layer can increase intestinal permeability, lead to abnormalities in interactions between IECs and immune cells in underlying lamina propria, and disturb the intestinal immune homeostasis, all of which are linked to the clinical disease course of inflammatory bowel disease (IBD. Understanding the role of the intestinal epithelium in IBD pathogenesis might contribute to an improved knowledge of the inflammatory processes and the identification of potential therapeutic targets.

  19. Flavonoids in Inflammatory Bowel Disease: A Review

    Science.gov (United States)

    Vezza, Teresa; Rodríguez-Nogales, Alba; Algieri, Francesca; Utrilla, Maria Pilar; Rodriguez-Cabezas, Maria Elena; Galvez, Julio

    2016-01-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the intestine that compromises the patients’ life quality and requires sustained pharmacological and surgical treatments. Since their etiology is not completely understood, non-fully-efficient drugs have been developed and those that have shown effectiveness are not devoid of quite important adverse effects that impair their long-term use. In this regard, a growing body of evidence confirms the health benefits of flavonoids. Flavonoids are compounds with low molecular weight that are widely distributed throughout the vegetable kingdom, including in edible plants. They may be of great utility in conditions of acute or chronic intestinal inflammation through different mechanisms including protection against oxidative stress, and preservation of epithelial barrier function and immunomodulatory properties in the gut. In this review we have revised the main flavonoid classes that have been assessed in different experimental models of colitis as well as the proposed mechanisms that support their beneficial effects. PMID:27070642

  20. Ocular Complications of Inflammatory Bowel Disease

    Science.gov (United States)

    Mady, Rana; Grover, Will; Butrus, Salim

    2015-01-01

    Though inflammatory bowel disease (IBD) has a specific predilection for the intestinal tract, it is a systemic inflammatory disorder affecting multiple organs, including the eye. Ocular complications directly related to IBD are categorized as primary and secondary. Primary complications are usually temporally associated with IBD exacerbations and tend to resolve with systemic treatment of the intestinal inflammation. These include keratopathy, episcleritis, and scleritis. Secondary complications arise from primary complications. Examples include cataract formation due to treatment with corticosteroids, scleromalacia due to scleritis, and dry eye due to hypovitaminosis A following gut resection. Some ocular manifestations of IBD can lead to significant visual morbidity and temporally associated complications can also be a herald of disease control. Furthermore, ocular manifestations of IBD can occasionally manifest before the usual intestinal manifestations, leading to an earlier diagnosis. Thus, it is important to understand the clinical presentation of possible ocular manifestations in order to initiate appropriate treatment and to help prevent significant visual morbidity. PMID:25879056

  1. Microbiome, Metabolome and Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Ishfaq Ahmed

    2016-06-01

    Full Text Available Inflammatory Bowel Disease (IBD is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn’s Disease (CD or Ulcerative Colitis (UC, two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis.

  2. The Immunological Basis of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Francesca A. R. Silva

    2016-01-01

    Full Text Available Inflammatory bowel diseases (IBDs are chronic ailments, Crohn’s disease and ulcerative colitis being the most important. These diseases present an inflammatory profile and they differ according to pathophysiology, the affected area in the gastrointestinal tract, and the depth of the inflammation in the intestinal wall. The immune characteristics of IBD arise from abnormal responses of the innate and adaptive immune system. The number of Th17 cells increases in the peripheral blood of IBD patients, while Treg cells decrease, suggesting that the Th17/Treg proportion plays an important role in the development and maintenance of inflammation. The purpose of this review was to determine the current state of knowledge on the immunological basis of IBD. Many studies have shown the need for further explanation of the development and maintenance of the inflammatory process.

  3. [Importance of diet in irritable bowel syndrome].

    Science.gov (United States)

    Mearin, Fermín; Peña, Enrique; Balboa, Agustín

    2014-05-01

    About two-thirds of irritable bowel syndrome (IBS) patients associate their symptoms with certain foods. We reviewed food-related factors putatively associated with manifestations of IBS. Soluble fiber may improve constipation but frequently increases bloating and abdominal pain. Carbohydrate malabsorption seems to be more frequent in IBS. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet significantly reduces IBS symptoms and has been suggested as a therapeutic option. Serological screening for celiac disease should be done in patients without constipation. Moreover, non-celiac disease gluten sensitivity, defined as gluten intolerance once celiac disease and wheat allergy have been ruled out, should be considered in these patients. There is no specific diet for IBS patients but small and frequent meals, avoiding greasy foods, dairy products, many carbohydrates, caffeine and alcohol, is recommended. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  4. Environment and the Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Alexandra Frolkis

    2013-01-01

    Full Text Available Inflammatory bowel diseases (IBD, which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gas-trointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breast-feeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology.

  5. Bowel Perforation complicating an incarcerated inguinal hernia

    Directory of Open Access Journals (Sweden)

    Adam Sigal

    2017-04-01

    Full Text Available History of present illness: A 51-year-old male presents complaining of increasing right groin pain and an enlarging bulge. Symptoms started as a “bubble” 6 weeks prior to presentation. One week prior to presentation, thinking the bulge was an abscess, the patient attempted to “pop” the bulge with a sewing needle, the needle became lodged in the site and he attempted retrieval with a second sewing needle, which also became lodged. No purulent material was obtained. The patient denied any nausea, vomiting or constipation as well as any fevers or urinary symptoms. His abdomen was soft, non-tender, non-distended with active bowel sounds. The groin exam demonstrated an incarcerated right inguinal hernia and cellulitis of the right hemiscrotum with associated induration and tenderness. Significant findings: The AP and lateral pelvis x-rays revealed two sewing needles, 60 mm in length, within the soft tissue over the anterior right lower hemipelvis. In addition, the AP view showed emphysema involving the right hemiscrotum (arrow, concerning for perforated bowel. Discussion: Groin hernias have a lifetime risk of 27% for men and 3% for women and the incidence increases with age.1 Groin hernias can be either direct or indirect, and inguinal or femoral. The distinction is made during surgery. Femoral hernias make up only 5% of groin hernias but are more common in women.1 Concerning complications include incarceration, in which a hernia cannot be reduced, and strangulation in which vascular compromise occurs.1 Incarcerated hernias often present with a painful, tender mass and are difficult to distinguish from strangulation. Patients with strangulation may present with fevers and peritonitis. The overlying skin may also be red.2 The percentage of patients presenting with strangulation varies by region. Western developed countries report only 1%-3% of patients presenting as surgical emergencies whereas in Africa the percentage can be as high as 26

  6. Irritable Bowel Syndrome: Yoga as Remedial Therapy

    Directory of Open Access Journals (Sweden)

    Vijaya Kavuri

    2015-01-01

    Full Text Available Irritable bowel syndrome (IBS is a group of symptoms manifesting as a functional gastrointestinal (GI disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation. IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. In this review, we examined the basic principles of Pancha Kosha (five sheaths of human existence concept from an Indian scripture Taittiriya Upanishad and the pathophysiology of a disease from the Yoga approach, Yoga Vasistha’s Adhi (originated from mind and Vyadhi (ailment/disease concept. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS.

  7. Management of inflammatory bowel disease in pregnancy.

    Science.gov (United States)

    Smith, M A; Sanderson, J D

    2010-06-01

    Inflammatory bowel disease (IBD) affects body image, relationships, family planning, fertility and pregnancy outcomes. However, the common misconception that IBD is a contraindication, or serious concern, in pregnancy is essentially a myth. Most patients with IBD can expect to have uneventful pregnancies. We present an overview of the management of IBD during pregnancy, including management in those planning pregnancy, the suitability of relevant medication during pregnancy and breast feeding, investigation and monitoring of IBD during pregnancy, surgical management and considerations relating to delivery. While there are some definite alterations required in the management of IBD during pregnancy, management is essentially unchanged. With close attention to aspects such as nutrition and smoking cessation, and optimal disease control in the run-up to and during pregnancy, we have an opportunity to help our patients with IBD achieve good pregnancy outcomes.

  8. Inflammatory bowel disease with primary sclerosing cholangitis

    DEFF Research Database (Denmark)

    Sørensen, Jakob Ørskov; Nielsen, Ole Haagen; Andersson, Mikael

    2018-01-01

    . Among patients with PSC and Crohn's disease (CD) 91% had colonic involvement. The PSC-IBD patients had a significantly higher probability of receiving resective surgery (HR; 2.13, 95% CI: 1.50-3.03); of developing colorectal cancer (CRC) (HR; 21.4, 95% CI: 9.6-47.6), of cholangiocarcinoma (HR; 190, 95......BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) may be complicated by primary sclerosing cholangitis (PSC). We aimed to assess the characteristics of Danish PSC-IBD patients and to compare their prognosis with IBD patients without PSC. METHODS: A retrospective nationwide population......-based cohort of 257 PSC-IBD patients was assessed through Danish national registries and manual scrutiny of patient files. RESULTS: For all PSC-IBD patients diagnosed after 1976 (n = 222) and 8231 IBD controls (ie, without PSC), the cumulative probability of resective surgery, liver transplantation, cancer...

  9. Inflammatory bowel disease in children. Current trends

    International Nuclear Information System (INIS)

    Shikhare, G.; Kugathasan, S.

    2010-01-01

    Once considered rare in the East, inflammatory bowel disease (IBD) is now recognized to be an emerging entity in that region. East or West, the clinical features of and treatment options for IBD are the same, but it is possible that the exact pathogeneses or the initiating events differ. In this review, existing knowledge of IBD and new discoveries in the epidemiology, genetics and treatment of IBD are discussed in detail. The diagnosis and management of IBD in children has changed dramatically over the last decade, mainly due to increased awareness, the availability of newer diagnostic modalities such as MRI and video capsule endoscopy, and newer, more powerful treatments such as biologics. It is hoped that the combination of innovative research and advances in drug discoveries will change the natural history of IBD and make a major difference in children who are suffering from this unfortunate lifelong chronic inflammatory disorder. (author)

  10. Surgical treatment of inflammatory bowel diseases

    International Nuclear Information System (INIS)

    Fuerst, H.; Schildberg, F.W.

    1998-01-01

    Purpose: To summarize current knowledge on surgical therapy in patients with inflammatory bowel disease (Crohn's disease, ulcerative colitis and diverticulitis). Material and methods: To discuss surgical indications and strategies, we reviewed major peer review publications of the last 10 years, and we also analysed data from patients with Crohn's disease who were treated in our institution between 1978 and 1994. Results: With Crohn's disease (305 patients), emergency surgery should be avoided as much as possible, since morbidity (50% vs 8.8%) and mortality (11% vs 0.6%) rise significantly in comparison to elective procedures. With ulcerative colitis, operative therapy is indicated in patients with secondary malignoma, and urgent surgery is requested in cases with associated perforation, toxic megacolon or massive bleeding. With diverticulitis, the first episode should be managed conservatively. Surgery is indicated in patients with recurrent episodes or with secondary complications. (orig.) [de

  11. PREVALENCE AND PREDICTORS OF CHANGES IN BOWEL HABITS AFTER LAPAROSCOPIC CHOLECYSTECTOMY.

    Science.gov (United States)

    Del Grande, Leonardo de Mello; Leme, Luis Fernando Paes; Marques, Francisco Pimenta; Ramos, Andressa Teruya; Ramos, Paula Teruya; Souza, Felipe Araújo de

    2017-01-01

    The incidence of cholecystolithiasis is approximately 15% of the population. It is believed that between 30-40% of cholecystectomy patients have symptoms after surgery, being changes in bowel habits the most common among them. 1) Defining the prevalence, and 2) identifying predictors of changes in bowel habits after laparoscopic cholecystectomy. This is a retrospective cross-sectional study with an initial sample of 150 patients diagnosed with cholecystolithiasis operated between July and September 2014. Patients were submitted to a questionnaire about the presence of gastrointestinal symptoms and changes in stools consistency before and after the surgical procedure. They were divided into two groups (with or without changes in bowel habits) being combined with the following variables: high blood pressure, body mass index, hypothyroidism, adherence to postoperative dietary orientations, previous abdominal and bariatric surgery. The prevalence of changes in bowel habits in the study population was 35.1%. The association between it and gastrointestinal symptoms was demonstrated to be statistically significant (‰2=7.981; p=0.005), and people who did not have gastrointestinal symptoms had 2.34 times the odds of not presenting changes in bowel habits. None of the other investigated factors had shown to be a predictor of risk for post-cholecystectomy changes in bowel habits. 1) There was a high prevalence of changes in bowel habits, and 2) there was association between changes in bowel habits and the presence of gastrointestinal symptoms. A incidência da colecistopatia calculosa é de aproximadamente 15% da população brasileira. Acredita-se que entre 30-40% dos pacientes colecistectomizados apresentem sintomas pós-operatório, sendo a alteração do hábito intestinal o mais comum. 1) Determinar a prevalência, e 2) identificar preditores de mudanças do hábito intestinal pós-colecistectomia videolaparoscópica. Estudo transversal retrospectivo com amostra

  12. Multiphasic MDCT in small bowel volvulus

    International Nuclear Information System (INIS)

    Feng Shiting; Chan Tao; Sun Canhui; Li Ziping; Guo Huanyi; Yang Guangqi; Peng Zhenpeng; Meng Quanfei

    2010-01-01

    Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

  13. Multiphasic MDCT in small bowel volvulus

    Energy Technology Data Exchange (ETDEWEB)

    Feng Shiting, E-mail: fst1977@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Chan Tao, E-mail: taochan@hku.hk [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Sun Canhui, E-mail: canhuisun@sina.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Li Ziping, E-mail: liziping163@tom.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Guo Huanyi, E-mail: guohuanyi@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Yang Guangqi, E-mail: shwy03@126.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Peng Zhenpeng, E-mail: ppzhen@21cn.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Meng Quanfei, E-mail: mzycoco@gmail.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China)

    2010-11-15

    Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

  14. Low Risk of Unemployment, Sick Leave, and Work Disability Among Patients with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Vester-Andersen, Marianne K; Prosberg, Michelle V; Vind, Ida

    2015-01-01

    BACKGROUND: To assess the occurrence and risk of unemployment (UE), sick leave (SL), and work disability (WD) in incident patients with inflammatory bowel disease (IBD) after 7 years of follow-up compared with the background population and to determine outcome predictors. METHODS: The study...... than 55 years. The rate of WD in CD (5.8%) was markedly lowered compared with previous studies. Within the IBD population, sex, educational level, disease behavior, smoking status, and surgery were predictors of UE, SL, and WD. CONCLUSIONS: The observed increased risk of SL and WD in patients with IBD...

  15. Paediatric inflammatory bowel disease during a 44-year period in Copenhagen County: occurrence, course and prognosis--a population-based study from the Danish Crohn Colitis Database

    DEFF Research Database (Denmark)

    Jakobsen, Christian; Paerregaard, Anders; Munkholm, Pia

    2009-01-01

    patients below 15 years of age were included. Disease localization was classified according to the Montreal classification for ulcerative colitis (UC) patients and into small bowel, large bowel and small and large bowel combined for Crohn's disease (CD) patients. Disease activity and surgery in the first 2...... years after diagnosis were assessed. Standardized cancer incidence rates and standardized mortality rates were calculated. RESULTS: One hundred and nineteen IBD patients (77 UC and 42 CD) were included. Comparing periods II and I, the incidence rate ratios were 0.81 [95% confidence interval (CI): 0.......5-1.4] and 15.6 (95% CI: 7.5-32.7) in UC and CD, respectively. The number of UC patients with extensive disease (E3) increased from period I to II (46.7 vs. 94.1%, PUC patients in period II compared with nine in period I (P = 0.13) within the first 2 years after...

  16. Books average previous decade of economic misery.

    Science.gov (United States)

    Bentley, R Alexander; Acerbi, Alberto; Ormerod, Paul; Lampos, Vasileios

    2014-01-01

    For the 20(th) century since the Depression, we find a strong correlation between a 'literary misery index' derived from English language books and a moving average of the previous decade of the annual U.S. economic misery index, which is the sum of inflation and unemployment rates. We find a peak in the goodness of fit at 11 years for the moving average. The fit between the two misery indices holds when using different techniques to measure the literary misery index, and this fit is significantly better than other possible correlations with different emotion indices. To check the robustness of the results, we also analysed books written in German language and obtained very similar correlations with the German economic misery index. The results suggest that millions of books published every year average the authors' shared economic experiences over the past decade.

  17. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  18. Anxiety in close relationships is higher and self-esteem lower in patients with irritable bowel syndrome compared to patients with inflammatory bowel disease.

    Science.gov (United States)

    Bengtsson, Mariette; Sjöberg, Klas; Candamio, Martina; Lerman, Annie; Ohlsson, Bodil

    2013-04-01

    Previous research has suggested an interaction between personality factors and inflammatory bowel disease (IBD) as well as irritable bowel syndrome (IBS). We therefore aimed to elucidate differences in psychological and coping functioning between patients with IBD and IBS, and to assess the relationship of disease activity with these functions. Seventy-four patients with IBD (mean age 43±17 years, range 18-82 years) and 81 patients with IBS (mean age 37±12 years, range 21-66 years) completed the questionnaires; Rosenberg Self-Esteem Scale, Toronto Alexithymia, Experiences in Close Relationships, and Sense of Coherence. Disease activity was evaluated either by the Harvey-Bradshaw index, the Simple Clinical Colitis Activity Index, or the Visual Analogue Scale for Irritable Bowel Syndrome. The study revealed that patients with IBS had higher degree of anxiety in close relationships than patients with IBD (p=0.003), and lower self-esteem (p=0.001). No other statistical differences between the whole groups IBS and IBD or between subgroups were seen. The fact that patients with IBS seem to have higher levels of anxiety in relationships and lower self-esteem could influence the way the patient deal with the disease and how the communication with health care professionals works out. A higher awareness of the importance of past negative life events should be taken into consideration. Whether the disease or the personal traits are the primary event should be addressed in future research. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  19. Inflammatory bowel diseases influence major histocompatibility complex class I (MHC I) and II compartments in intestinal epithelial cells.

    Science.gov (United States)

    Bär, F; Sina, C; Hundorfean, G; Pagel, R; Lehnert, H; Fellermann, K; Büning, J

    2013-05-01

    Antigen presentation by intestinal epithelial cells (IEC) is crucial for intestinal homeostasis. Disturbances of major histocompatibility complex class I (MHC I)- and II-related presentation pathways in IEC appear to be involved in an altered activation of CD4(+) and CD8(+) T cells in inflammatory bowel disease. However, a comprehensive analysis of MHC I- and II-enriched compartments in IEC of the small and large bowel in the healthy state as opposed to inflammatory bowel diseases is lacking. The aim of this study was to characterize the subcellular expression of MHC I and II in the endocytic pathway of IEC throughout all parts of the intestinal tract, and to identify differences between the healthy state and inflammatory bowel diseases. Biopsies were taken by endoscopy from the duodenum, jejunum, ileum and colon in healthy individuals (n = 20). In Crohn's disease (CD), biopsies were obtained from the ileum and colon and within the colon from ulcerative colitis (UC) patients (n = 15). Analysis of IEC was performed by immunoelectron microscopy. MHC I and II were identified in early endosomes and multi-vesicular, multi-lamellar, electrondense and vacuolar late endosomes. Both molecules were enriched in multi-vesicular bodies. No differences were found between the distinct parts of the gut axis. In CD and UC the expression of MHC I and II showed a shift from multi-vesicular bodies towards the basolateral membranes. Within the multi-vesicular bodies, MHC I and II moved from internal vesicles to the limiting membranes upon inflammation in CD and UC. MHC I- and II-enriched compartments in IEC were identical in all parts of the small and large bowel. CD and UC appear to modulate the MHC I- and II-related presentation pathways of exogenous antigens in IEC. © 2012 British Society for Immunology.

  20. Super obese 33-week parturient undergoing an urgent laparoscopic bowel resection: A case report and review of anesthetic implications

    Directory of Open Access Journals (Sweden)

    Yury Khelemsky

    2011-01-01

    Full Text Available Approximately two percent of women undergo non-obstetric surgery during their pregnancies. The following case report describes the anesthetic management of a super obese parturient in her third trimester of pregnancy undergoing urgent laparoscopic (converted to open bowel resection. Such a case, which has not been previously reported, has multiple clinical implications for both mother and fetus and was further complicated by super obesity (BMI>50 and laparoscopy. The anesthetic implications for this patient population are reviewed.