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[Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease: an initial experience from 25 examinations].

UNLABELLED: Until recently, only the proximal small bowel was accessible for diagnostic and therapeutic endoscopy. Endoscopic evaluation of this organ has often required open laparotomy with surgically assisted passage of the endoscope through the intestine. Recently, Yamamoto et al have developed a new method, double-balloon endoscopy (DBE) that allows high-resolution visualization and therapeutic interventions in all segments of the GI tract. Our aim was to report our early experience with the Fujinon EN-450 T5 therapeutic double-balloon endoscope. PATIENTS AND METHODS: Between August 2005 and March 2006, 25 DBE was conducted in 23 consecutive patients (M/F: 13/10, age: 51.8 +/- 16.5 years) presenting at our tertiary referral hospitals (17 and 4 patients from the oral or the anal route, respectively; 2 patients from both). All procedures were done by i.v. anesthesia, at our outpatient clinic. After the procedure, the patients were monitored in a recovery room for at least 4h before discharge. RESULTS: The main indication for DBE was suspected small-bowel GI bleeding (11), diagnosis or complications of IBD (7), polyposis syndrome (3), stenosis (1) and insertion of jejunal catheter in one case. Twelve out of 22 patients (54.5%) had a small-bowel finding, with 16 of 22 (72.7%) of the patients having a more accurate diagnostic input. The average insertion length was app. 165 cm (range 50-350 cm, SD 97). Patients' tolerance of the procedure was excellent. No severe complications were recognized. CONCLUSIONS: Based on our limited experience double-balloon enteroscopy is a safe and useful method to evaluate and treating small bowel disease in selected patients, including patients with suspected small-bowel strictures, in whom capsule endoscopy is contraindicated.

Adult↗

[Immunologic aspects of chronic diarrhea in relation to inflammatory intestinal disease].

In a group of patients with chronic diarrhea of unknown origin, a study of cellular and humoral immunity was carried out with in vitro tests and the results are compared to those obtained in a group of patients with ulcerative colitis or Crohn's disease, and to normal controls. In the chronic diarrhea group there was evidence of an immunological deficiency affecting the B and T lymphocytes that had specific characters in relation to IgG, although the IgG deficit was not as important as in intestinal inflammatory disease.

Antibody Formation↗

[Pathogenesis of hyperoxalurias and calcium oxalate calculi in intestinal diseases].

Hyperoxaluria and calcium oxalate lithiasis have a multifactorial genesis in bowel diseases. The augmented synthesis of oxalic acid in the liver is of minor importance. A diminished bacterial degradation is to asses up to day only hardly. The increasing absorption is of highest importance by deficient production of calcium oxalate in the intestinal tract and by increasing permeability of colonic mucosa above all in steatorrhoea or in patients with augmented calcium absorption. The crystallization of calcium oxalate in the urine is promoted by shortage of vitamin A, citrate, zinc or magnesium.

Calcium Oxalate↗

Inulin and oligofructose: impact on intestinal diseases and disorders.

A large and diverse variety of bacteria have evolved and adapted to live in the human intestinal habitat in a symbiotic arrangement that influences both physiology and pathology in the host. Symbiosis between host and flora can be optimised by prebiotics. Inulin-type fructans have been shown to improve the metabolic functions of the commensal flora. Clinical and experimental data suggest that they also improve the gut mucosal barrier. Furthermore, modulation of the trophic functions of the flora by these prebiotics could help in the prevention of inflammatory bowel diseases. The anti-inflammatory effects of inulin or oligofructose have been assessed in the rat model of distal colitis induced by dextran sodium sulphate, which histologically resembles human ulcerative colitis, and in the trinitrobenzene sulphonic acid model that resembles human Crohn's disease. Both inulin and oligofructose stimulate colonic production of SCFA and favour the growth of indigenous lactobacilli and/or bifidobacteria. These effects are associated with reduced mucosal inflammation and decreased mucosal lesion scores. Inulin has also been tested in a placebo-controlled clinical trial in patients with relapsing pouchitis. Treatment reduced endoscopic and histological parameters of inflammation of the pouch mucosa. Inulin and oligofructose may offer an opportunity to prevent chronic inflammatory intestinal disorders, and this potential should be tested in further clinical studies.

Animals↗

Treatment with albendazole for intestinal disease due to Enterocytozoon bieneusi in patients with AIDS.

To determine the efficacy and safety of albendazole for treatment of intestinal microsporidosis due to Enterocytozoon bieneusi, 29 patients with AIDS were studied. All had chronic diarrhea, weight loss, and evidence of malabsorption. After 1 month of treatment with albendazole (400 mg orally twice a day), the mean number of bowel movements decreased from 7.0 to 3.8 stools/day (P < .0001) and the mean weight gain was 0.56 kg (P = .259). Albendazole at this dose did not clear E. bieneusi on follow-up small-bowel biopsies, but ultrastructural studies revealed an apparent decrease in parasite burden in 2 patients and an increased proportion of dividing plasmodia in 5 patients. There were no significant adverse events associated with this dose of albendazole. A formal double-blind placebo-controlled study using higher doses has recently been approved and will soon be underway (AIDS Clinical Trial Group protocol 207).

AIDS-Related Opportunistic Infections↗

Comparative absorption of vitamin D3 and 25-hydroxyvitamin D3 in intestinal disease.

The absorption of simultaneously administered equimolar doses of 14C vitamin D3 and 3H 25 hydroxyvitamin D3 (25-OH-D3) has been studied in controls and patients with a variety of gastrointestinal disorders. As assessed from peak radioactivity in the serum and from faecal excretion of radioactivity, malabsorption of both vitamin D3 and 25-OH-D3 occurred in patients with steatorrhoea. Malabsorption of vitamin D3 was greater than 25-OH-D3. The magnitude of malabsorption of these compounds was related to the severity of the steatorrhoea but was moderate enough to suggest that replacement therapy in patients with intestinal malabsorption should be accomplished with relatively small doses of vitamin D. The more potent vitamin D metabolites are probably unnecessary in this situation.

Adult↗

Jejunal transport of electrolytes and water in intestinal diseases.

The role of decreased absorption of electrolytes and water by the jejunum in the pathogenesis of diarrhoea was examined in patients with intestinal scleroderma, ileocolitis, gastric hypersecretion, or extensive ileal resection. Absorption of electrolytes and water from a 20-cm segment of jejunum was compared in 10 patients and six healthy volunteers. Malabsorption of electrolytes and water by the jejunum may contribute to diarrhoea in scleroderma, regional enteritis, and gastric hypersecretion. After ileal resection, jejunal absorption was normal.

Adult↗

Chicken egg antibodies for prophylaxis and therapy of infectious intestinal diseases. III. In vivo tenacity test in piglets with artificial jejunal fistula.

Large quantities of specific egg antibodies can be produced with little effort by immunization of laying hens. Several antibody containing egg preparations were subjected to a tenacity test against digestive activity taking piglets with artificial jejunum fistulas as a model. Even with high doses of orally administered yolk lyophilisate no antibody activity could be found in the distal jejunum. The additional feeding of egg white, however, showed a significant protective effect on the yolks antibodies during the digestive act. No difference between egg white of immunized hens and egg white of unimmunized hens could be detected. Buffering the acidic gastric environment with sodium bicarbonate increased the antibody activity in the intestine by an average of 40%. Eggs administered in hot (70 degrees C) beef stock had higher antibody titers than eggs that were boiled for 4 minutes. Tenacity in antibodies fed in pellets was significantly lower than in powdered feed.

Animals↗

[Enterotoxigenic capacity of strains of Klebsiella and Enterobacter genera isolated in acute intestinal diseases in children].

234 strains, including 104 K. pneumoniae strains, 28 K. oxytoxica strains, 64 E. cloacae strains and 40 E. aerogenes strains, have been isolated from the intestine of 266 children with diarrhea, aged up to 1 year, and studied for enterotoxigenicity. By the coagglutination test, made with G. Kronvall's staphylococcal reagent prepared with the use of antiserum to Escherichia coli LT-enterotoxin, and the biological assay on suckling mice enterotoxigenic activity has been revealed in 119 strains, including 48 K. pneumoniae strains (12.6%), 33 E. cloacae strains (27.4%) and 23 E. aerogenes strains (19.7%). The strains producing only LT-enterotoxins, only ST-enterotoxins, and both LT- and ST-enterotoxins have been found. The determination of the enterotoxigenic activity of the clinical isolates of opportunistic enterobacteria makes it possible to improve the etiological interpretation of acute intestinal infections.

Acute Disease↗