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PubMed1981

[Esophageal ulcers induced by doxycycline. Evaluation of 4 cases].

In this study we present four cases, three of them with endoscopic demonstration and the other one with clinical diagnose of esophageal ulcer induced by Doxicicline. None of the patients had previous reports of esophageal pathology. The symptoms of retroesternal pain and dysphagia appeared after the taking of capsules without any liquid. In three patients we effectuated Esophagoscopy; it showed the presence of esophagitis and ulceration and the biopsy taken from case ner. 2 showed necrotic epithelium with inflammatory exudate with predominance of linphositoes and eosinophilos. In all the cases the symptoms disappeared after a short period of time when the medication was suspended and they were treated with bland diet and hour alcalines. We conclude that this kind of medication, as if it is possible, haven't to be administered to patients with esophageal pathologies. On the other hand it must be recommended to administer this medication with an important quantity of liquid and a considerable period before bedtime; besides we suggest not to ingest the medication in decubitus position.

Adult↗
PubMed2006

Video capsule endoscopy in peutz-jeghers syndrome: a blinded comparison with barium follow-through for detection of small-bowel polyps.

BACKGROUND AND STUDY AIMS: Video capsule endoscopy has shown promise for the surveillance of significant small-bowel polyps in patients with Peutz-Jeghers syndrome. In this study the yield of significant small-bowel polyps by capsule endoscopy was compared to the yield of these polyps by barium follow-through in adults with Peutz-Jeghers syndrome. PATIENTS AND METHODS: A total of 19 adults with Peutz-Jeghers syndrome who were undergoing surveillance underwent both capsule endoscopy and barium follow-through examinations, and the number of small-bowel polyps of at least 1 cm in diameter that were detected was recorded for each method. The two methods were assessed in terms of comfort and convenience for the patients and their preferred future surveillance method, using a questionnaire. RESULTS: Capsule endoscopy detected a median of four significant small-bowel polyps while barium follow-through detected a median of one (P = 0.008). There was a trend towards more participants having at least one significant small-bowel polyp detected by capsule endoscopy than was the case with barium follow-through, though capsule endoscopy seemed to be less reliable for accurate sizing of polyps that were at the limit of clinical significance. Most participants expressed a preference for capsule endoscopy for future surveillance. CONCLUSIONS: Capsule endoscopy should replace barium follow-through for the surveillance of small-bowel polyps in adults with Peutz-Jeghers syndrome, but the findings of this study should be interpreted with caution until a more reliable means of sizing polyps by capsule endoscopy is available.

Administration, Oral↗
PubMed1987

Enprostil and ranitidine: comparative efficacy and safety in patients with duodenal ulcer.

This randomised, double-blind, double-dummy, multiclinic study of duodenal ulcer healing compared the efficacy and safety of enprostil with ranitidine. The six week trial admitted 164 patients with endoscopically demonstrated duodenal ulcer. Ratings of symptoms and adverse events were collated from patients' daily diaries, and endoscopy was repeated to verify healing after four weeks and, if appropriate, after six weeks. Medication used was enprostil (35 micrograms capsule) or ranitidine hydrochloride (150 mg tablet) with matching placebos twice daily. After six weeks, 81% of patients treated with enprostil and 95% of those treated with ranitidine had healed ulcers, a statistically significant difference (p = 0.007). There were no differences between treatment groups for the number of days until the daytime ulcer pain completely ceased. Night-time ulcer pain ceased significantly earlier in the group receiving ranitidine (p = 0.019) and was less severe during the week before the last visit (p = 0.001); daytime pain for ranitidine users was also less severe (p = 0.020) during this week. Mild to moderate adverse experiences were reported by 44% of enprostil and 35% of ranitidine patients. There were no severe adverse events. In conclusion, both enprostil and ranitidine were found to be safe and effective in the treatment of duodenal ulcer. However, the ranitidine regimen used in this trial produced better results than the enprostil regimen.

Clinical Trials as Topic↗
PubMed2006

Small bowel tumors.

WCE is a noninvasive diagnostic technique that visualizes the entire small intestine and identifies lesions in parts of the small bowel not reached by traditional endoscopy. Although further studies are needed to define the exact role of WCE for diagnosing and managing small bowel tumors, its sensitivity has been shown to be superior to PE and small bowel follow-through in regard to diagnosing patients who have obscure GI bleeding, the most common indication for capsule endoscopy in the authors' series of patients with documented small bowel tumors. As more material is published, capsule endoscopy likely will be confirmed to be the diagnostic procedure of choice in patients with suspected small bowel tumors.

Endoscopes, Gastrointestinal↗
PubMed1995

Suppurative pleuropneumonia and a pulmonary abscess in a ram: ultrasonographic and radiographic findings.

This report describes a two-year-old White Alpine ram with suppurative pleuropneumonia and a lung abscess. Prior to admission, the ram had been unsuccessfully treated with antibiotics and levamisole. Clinical examination revealed that the general behaviour and condition of the ram were severely disturbed. The rectal temperature and respiratory rate were increased. Auscultation of the lungs revealed increased vesicular sounds. Based on clinical findings, a tentative diagnosis of bronchopneumonia was made. To confirm the diagnosis, blood was taken for serological testing for Maedi-Visna, and endoscopic examination of the respiratory tract and ultrasonographic and radiographic examination of the thorax were performed. Cytologic and bacteriologic examination of tracheal secretions revealed large numbers of neutrophils and Actinomyces pyogenes organisms. A pocket of gas, surrounded by a capsule of soft tissue density, overlying the base of the heart, and a horizontal fluid line were observed on radiographs. Ultrasonographic examination revealed an effusion between the pleura and the lung on the left side of the thorax; an encapsulated abscess was seen on the right side of the thorax. Centesis and aspiration of this accumulation of fluid yielded foul-smelling pus. Post mortem examination confirmed the clinical, radiographic and ultrasonographic findings. The ram had severe chronic suppurative pleuropneumonia with abscess formation between the pleura and lung on the right side.

Actinomyces↗
PubMed1993

Mesalamine capsules for treatment of active ulcerative colitis: results of a controlled trial. Pentasa Study Group.

The efficacy of a capsule formulation of mesalamine was assessed in 374 patients with mild to moderately active ulcerative colitis. Patients, stratified to pancolitis or left-sided disease, received either placebo or mesalamine at 1, 2, or 4 g daily for 8 wk. Efficacy was assessed using clinical improvement--physician global assessment, sigmoidoscopic index, biopsy score, trips to the toilet, and clinical symptoms (abdominal pain, urgency, stool consistency, and rectal bleeding)--and induction of remission (more stringent criteria for physician global assessment, sigmoidoscopic index, and biopsy score). For physician global assessment of treatment benefit, 79% and 84% of patients on the 2-g and 4-g doses of mesalamine, respectively, received treatment benefit, compared with 54% on placebo (p < or = 0.0002). For the physician global assessment of treatment success, both the 2-g and 4-g doses of mesalamine were superior to placebo (57% and 59% of patients, p = 0.0021 and 0.0012, respectively), compared with 36% on placebo. Both the 2-g and 4-g doses produced statistically significant macroscopic (endoscopic) improvement compared with placebo (p < 0.004). The 4-g dose also produced a statistically significant microscopic (histologic) improvement compared to placebo (p < 0.002). Significant improvement compared to placebo was also observed at 2 g and 4 g for the four clinical symptoms and trips to the toilet (p < or = 0.003). Oral mesalamine capsules were significantly superior to placebo for inducing remission, with 29% of patients at 2 g and 29% at 4 g achieving remission by physician global assessment, compared with 12% on placebo. Forty-four percent and 48% of patients receiving 2 g and 4 g of mesalamine, respectively, achieved remission by sigmoidoscopic index (p < 0.05), compared with 31% on placebo. Thirty-nine percent of patients at 4 g daily achieved microscopic remission, compared with 23% on placebo (p < 0.03). Treatment response was not affected by extent of disease or prior steroid or sulfasalazine therapy. These data suggest that controlled-release mesalamine capsules are a safe and effective monotherapy in doses of 2-4 g daily for treating mild to moderately active ulcerative colitis, as well as for inducing remission, regardless of prior oral steroid or sulfasalazine therapy or extent of disease.

Adult↗
PubMed1999

Endoscopic nasobiliary drain placement facilitates subsequent percutaneous transhepatic cholangiography.

BACKGROUND: Percutaneous biliary drainage is an established alternative to ERCP for managing bile duct obstruction. Although generally safe and effective, percutaneous drainage has its risks and is technically more difficult in patients with nondilated bile ducts. We report the use of nasobiliary drains and subsequent nasobiliary drain cholangiography to facilitate percutaneous biliary drainage by providing a target for accessing intrahepatic bile ducts. METHODS/RESULTS: Nine patients who were identified as requiring percutaneous biliary drainage underwent nasobiliary tube placement at completion of ERCP. Five of 9 patients had generalized intrahepatic ductal dilatation; in 4 patients, dilatation was focal or absent. Following nasobiliary drain cholangiography, percutaneous needle puncture of a bile duct was successful in all patients, in most cases with only a single puncture of the liver capsule. No procedural complications were encountered. CONCLUSION: Nasobiliary drain placement with subsequent nasobiliary drain cholangiography facilitates percutaneous biliary drainage and may be especially helpful in patients with nondilated intrahepatic bile ducts.

Catheterization↗
PubMed2004

Diagnostic yield and clinical outcomes of capsule endoscopy.

BACKGROUND: Capsule endoscopy is proving to be superior to push enteroscopy and barium contrast radiography for evaluation of the small bowel. However, its impact on clinical outcome has not been thoroughly investigated. This study assessed changes in therapy based on capsule endoscopy findings and on the impact of such changes on patient outcomes. METHODS: Forty-four consecutive capsule endoscopies in 43 patients were reviewed. Data were collected by systematic review of patient records and included indication, results of prior diagnostic tests, and capsule endoscopy findings. Specific interventions after capsule endoscopy and clinical outcome were noted. RESULTS: The indication for capsule endoscopy was obscure GI bleeding in 40 patients, iron deficiency anemia in one, and right lower quadrant abdominal pain in two patients. Overall diagnostic yield was 42% (18/43 patients). Diagnostic findings included angiodysplasias (n = 13), intestinal ulcers (n = 2), Crohn's disease (n = 2), and mass lesion (n = 1). As a result of the capsule endoscopy findings, a specific intervention was implemented in 12 of 18 patients with positive findings. These included endoscopy with coagulation (n = 5), laparotomy (n = 2), pharmacotherapy (n = 4), and discontinuation of medication (n = 1). At a mean follow-up of 6.7 months, the clinical outcome was considered positive in 7 of 43 patients (16%). CONCLUSIONS: Although it has a high diagnostic yield, capsule endoscopy has a positive influence on clinical outcome in a relatively small proportion of patients. Larger studies are needed that assess the influence of capsule endoscopy on clinical outcomes.

Abdominal Pain↗
PubMed2006

The effect of erythromycin on video capsule endoscopy intestinal-transit time.

BACKGROUND: Video capsule endoscopy (VCE) will fail to reach the cecum in 20% of patients within the 8-hour battery life. The use of prokinetics to improve VCE completion rates to the cecum remains unclear. The objective of this study was to determine whether erythromycin increases the completion rate of VCE to the cecum without adversely affecting image quality. METHODS: This was a prospective, randomized, single-blinded control trial at St. Vincent's Hospital, Melbourne, Australia. A total of 86 consecutive patients referred for VCE were considered for entry; 45 patients met the entry criteria. These 45 patients were prospectively randomized to no erythromycin (controls, n = 23) or 250 mg erythromycin (n = 22). Two gastroenterologists, who were unaware of which group the patients were randomized into, reported all VCEs. The number of VCEs that reached the cecum within the 8-hour study period, gastric emptying time (GET), and small-bowel transit time (SBTT) were calculated for each group. RESULTS: There was no significant difference in the number of VCEs that reached the cecum (32% failed to reach the cecum in the erythromycin group compared with 22% in the control group), GET, or SBTT between the two groups. Image quality was not adversely affected by the use of erythromycin. The dose and the preparation of erythromycin used in this study may have possibly had an effect on GET and SBTT. CONCLUSIONS: The use of erythromycin did not significantly increase the likelihood of the capsule reaching the cecum or affect the degree of visible peristalsis or the interpretation of capsule findings.

Administration, Oral↗
PubMed2006

Use of capsule endoscopy for established Crohn's disease.

There remains significant uncertainty regarding the role of capsule endoscopy in the setting of known inflammatory bowel disease (IBD). Capsule endoscopy should be considered for patients who have indeterminate colitis, who are failing medical therapy or who may require colectomy, who have truly unexplained symptoms based on standard endoscopy and radiography, and who have IBD and obscure bleeding. Although capsule endoscopy clearly detects small bowel pathology with greater sensitivity than other methods, the implications of these lesions are not fully understood. At this time, use of capsule endoscopy as a tool for the evaluation of mucosal healing or for prognostication of post-operative recurrence remains investigational.

Crohn Disease↗
PubMedDate not supplied

Complications of endoscopic retrograde cholangiopancreatography: spectrum of abnormalities demonstrated with CT.

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that is performed to diagnose and treat pancreatic and biliary disease. In approximately 5%-10% of cases, the procedure itself causes adverse events. Diagnosis and management of ERCP-induced complications are performed with clinical, laboratory, and radiologic procedures. Evaluation of the type and severity of the complication is necessary and is successfully performed with computed tomography (CT). The most common causes of post-ERCP pain are acute pancreatitis and duodenal perforation. In severe pancreatitis, the pancreas is enlarged and enhances heterogeneously at CT. Pancreatic enhancement is diminished in areas of glandular necrosis. In duodenal perforation, CT may reveal extraluminal air or fluid. CT findings of acute duodenal hemorrhage are duodenal wall thickening and a high-attenuation mass in the duodenal wall. In infection, the bile ducts can be dilated and the attenuation of the bile can be increased at CT. Abscesses appear as hypoattenuating masses with enhancing capsules. CT findings of stent migration are an atypical location of the stent and bowel impaction. Other complications of ERCP are those related to endoscopy and include esophageal, liver, and splenic injury.

Cholangiopancreatography, Endoscopic Retrograde↗