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PubMed2001

Necrotizing ileitis caused by cytomegalovirus in patient with systemic lupus erythematosus: case report.

We report a systemic lupus erythematosus (SLE) patient with necrotizing ileitis diagnosed at a tertially care centre in Thailand. The patient was surgically explored because peritonitis was suspected and segmental gangrenous and perforation of the terminal iliem were found. The pathological finding was necrotizing ileitis with appearance of cytomegalic intranuclear inclusion body. The presence of cytomegalovirus (CMV) infection in tissue was confirmed by CMV-DNA detection using polymerase chain reaction and ELISA probe hybridization method. The hemoculture and peritoneal fluid culture results revealed no pathogenic organisms. Postoperatively, the clinical course of the patient deteriorated and she developed hypotension. Vasopressive drugs were administered without clinical improvement. She expired on day 5 postoperation. Regarding CMV infection, the organism involves the small bowel in only 4.3 per cent of all CMV infections of the gastrointestinal tract. Isolated cases of ileal perforation due to CMV infection have never been reported in a SLE patient. Thus, chronic right lower abdominal pain, fever with or without diarrhea in immunocompromised patients should cause clinicians to consider CMV ileitis in the differential diagnosis. Immediate surgical resection and prompt antiviral therapy lead to successful treatment.

Cytomegalovirus↗
PubMed2005

The influence of experimental ileitis on the neuropeptide coding of enteric neurons in the pig.

In the present study, both the ELISA test and immunohistochemical staining were used to investigate the influence of artificially induced ileitis on the chemical coding of enteric neurons in the pig. The ileum wall in experimental (E) pigs was injected in multiple sites with 4% paraformaldehyde to induce inflammation, while in the control (C) animals, the organ was injected with 0.1M phosphate buffer (pH 7.4). Three days after ileitis induction, samples of ileum wall from all the animals were evaluated for VIP, SP, CGRP, NPY, GAL and SOM concentration (ELISA test) and the expression of these biologically active substances by the enteric neurons (immunohistochemical staining). Quantitative results showed that ileitis decreased tissue concentration of VIP, CGRP and SOM but increased tissue concentration of SP, NPY and GAL. Immunochemistry revealed that in both the experimental and control pigs, VIP-positive (VIP+) nerve fibers supplied mainly ileal blood vessels, and the labeled pericarya were located in the inner (ISP) and outer submucous plexus (OSP). SP+ and CGRP+ nerve terminals were found in both the mucous and muscular membrane, while the labeled pericarya were found in ISP, OSP and myenteric plexus (MP). In both C and E pigs, the very few nerve terminals containing NPY and SOM were located mainly in the mucous membrane. NPY- or/and SOM-immunopositive nerve cell bodies were found in ISP, OSP and MP. GAL+ nerve fibers supplied all layers of the ileum and were most numerous in the muscular membrane, while the labeled pericarya were present in all the enteric plexuses. The present results suggest that enteric neurons are highly plastic in their response to inflammation.

Animals↗
PubMed2005

[Terminal ileitis due to Yersinia enterocolitica in infants].

Yersinia enterocolitica infection presents a wide clinical spectrum; in infants and young children it usually presents as uncomplicated acute diarrhea, while in older children and adolescents it more frequently presents as terminal ileitis and/or mesenteric adenitis. We describe two infants who developed terminal ileitis complicating Y. enterocolitica infection, which is exceptionally rare. The clinical, laboratory and radiologic findings are described and ultrasound study is emphasized as a simple and reliable tool for investigation of terminal ileitis.

Crohn Disease↗
PubMed1991

Yersinia terminal ileitis: sonographic findings in eight patients.

To determine the sonographic features of Yersinia terminal ileitis, we analyzed the sonograms of eight patients with acute terminal ileitis. Bacteriologic or serologic confirmation of Yersinia enterocolitica infection was available in six patients. In the other two, the clinical course and radiologic findings were compatible with the diagnosis. Radiographs and endoscopy showed edematous mucosa with small elevations in the terminal ileum in all the patients. Sonograms showed thickening of the wall of the ileum in all eight patients and enlarged mesenteric lymph nodes in six patients. Although the number of the patients is small, our experience suggests that sonography can be useful for the detection of acute terminal ileitis caused by Yersinia.

Adolescent↗
PubMed1989

Ileitis and pouchitis after colectomy for ulcerative colitis.

Ileitis can occur after surgical treatment of ulcerative colitis. Following continent ileostomy or restorative proctocolectomy ileitis can become a serious clinical problem and is then known as pouchitis although this condition is yet to be clearly defined. It is likely that pouchitis is the result of an abnormal host response to a change in bacterial flora and that the nature of this host response is related to the underlying pathogenesis of ulcerative colitis. Continued study of the immunological basis of ulcerative colitis is therefore required to solve the problem of pouchitis.

Colectomy↗
PubMed2001

Role of intercellular adhesion molecule 1 in indomethacin-induced ileitis.

Adhesion molecules have been implicated in the pathogenesis of inflammatory bowel diseases. We investigated their expression and contribution to leukocyte recruitment in experimental intestinal inflammation. Ileitis was induced in Sprague-Dawley rats by two injections of indomethacin (7.5 mg/kg), given 24 h apart. Endothelial intercellular adhesion molecule-1 (ICAM-1) expression was quantified using the dual radiolabeled monoclonal antibody technique and Mac-1 (CD11b/CD18) expression on leukocytes by flow cytometry. Leukocyte infiltration was monitored by tissue myeloperoxidase (MPO) activity. The first indomethacin injection induced a time- and site-dependent increase of ICAM-1 expression in ileal mucosa and muscularis. The second injection resulted in a reduction of ICAM-1 expression below constitutive levels whereas Mac-1 was upregulated. MPO changes paralleled lesion development over 48 h. ICAM-1 and MPO values were correlated for the first 24 h. Immunoneutralization of either ICAM-1 or Mac-1 attenuated mucosal injury. We conclude that (i) indomethacin-induced ileitis is associated with a temporally disassociated upregulation of ICAM-1 and (ii) despite a reduction in ICAM-1 after 24 h, ICAM-1, in concert with Mac-1, contributes to mucosal injury and leukocyte infiltration elicited by indomethacin.

Animals↗
PubMed1993

Experimental ileitis in dogs and colitis in rats with trinitrobenzene sulfonic acid--colonoscopic and histopathologic studies.

Using a novel experimental model of chronic enterocolitis described by Morris et al., we observed sequential changes of mucosal lesions endoscopically and performed histopathological studies. Fisher rats were rectally administered 25 mg of trinitrobenzene sulfonic acid (TNBS) dissolved in 0.5 ml of 50% ethanol (ET). The combination treatment of TNBS and ET produced colitis in rats for over 3 weeks. TNBS itself did not induce any lesions. ET alone induced mucosal lesions, but their severity was much smaller than that induced by TNBS/ET. As an animal model much closer to human inflammatory bowel disease, we have newly developed a canine model of chronic ileitis. Adult mongrel dogs were administered 10 ml of 100% ethanol and 1 g of TNBS dissolved in 10 ml of distilled water (i.e., 100 mg/ml solution) through a 4-lumen double balloon tube which was inserted into the ileum. The TNBS/ET-induced ileitis in dogs persisted for 8 weeks. The mucosal lesions induced by TNBS/ET were characterized as annular or longitudinal ulcers accompanied by extensive lymphocyte infiltration and granulomas, which were similar to macro- and microscopic findings observed in human Crohn's disease. Endoscopic examinations were a valuable tool to obtain sequential information on the development of inflammatory changes in each individual animal. Our canine model would provide various advantages for the study of functional impairment in chronic enterocolitis as well as for the detection of potential therapeutic agents in the human counterpart.

Animals↗
PubMedDate not supplied

Sonographic assessment of the normal and abnormal bowel wall in nondiverticular ileitis and colitis.

BACKGROUND: To assess the value of high resolution sonography (HRS) in identifying normal and inflammatory bowel wall in nondiverticular ileitis and colitis by using a segment-by-segment analysis. METHODS: Thirty-five HRS were performed in patients with nondiverticular inflammatory bowel disease, without knowledge of clinical, endoscopic, and radiologic data. HRS evaluated separately five intestinal segments (terminal ileum, cecum/ascending colon, transverse, descending colon, and sigmoid colon) and was considered positive for inflammation when wall thickness during compression exceeded 3 mm. We compared HRS findings with results of endoscopy or enteroclysis performed within 8 days of HRS; endoscopic and radiologic results were classified into two subgroups: mild inflammatory lesions and frank inflammatory lesions. RESULTS: Segment-by-segment analysis resulted in an accuracy of 81%, a sensitivity of 70%, and a specificity of 93%. Sensitivity was significantly lower for mild lesions (52%) than for frank lesions (87%, p < .001). Of the 32 patients having an inflammatory bowel condition, 29 (91%) had at least one segment correctly identified as inflammatory by HRS. CONCLUSION: Even if relatively insensitive for minor lesions, HRS is a promising, minimally invasive method for assessing normal and inflammatory bowel wall in nondiverticular ileitis and colitis.

Adolescent↗
PubMed1999

Effect of anti-CD11b (alphaM-MAC-1) and anti-CD54 (ICAM-1) monoclonal antibodies on indomethacin induced chronic ileitis in rats.

Leukocyte emigration from blood to sites of inflammation involves sequential interaction of specific adhesion molecules expressed by both leukocytes and endothelial cells. The central steps in leukocyte-endothelial adhesive interactions are leukocyte rolling, sticking, and transmigration. This study investigated the effect of monoclonal antibodies against CD54 (ICAM-1) and CD11b (alphaM-chain of MAC-1) on intestinal inflammation. Anti-CD54 and anti-CD11b were tested in rats with indomethacin-induced chronic ileitis. Macroscopic changes were assessed by a modified version of the Wallace et al. score. Leukocyte rolling and sticking were investigated by intravital microscopy. Results show that indomethacin administration led to a chronic inflammatory response characterized by significant increase (P<0.05) in rolling (from 5.41+/-2.87 to 32.41+/-15.03 100 microm(-1) s(-1)) and sticking (from 0.16+/-0.18 to 9.11+/-5.3 100 microm(-1) s(-1)) leukocytes. After antibody treatment only the anti-CD11b group showed significant (P<0.05) reduction in rolling (from 32.41+/-15.03 to 6.6+/-2.7 100 microm(-1) s-1) and sticking (from 9.11+/-5.3 to 0.07+/-0.09 100 microm(-1) s-1) leukocytes. This was also the case for macroscopic changes. Indomethacin led to a rise in the Wallace score from 0 to 4.29+/-0.76 points (P<0.05) and anti-CD11b to a reduction from 4.29+/-0.76 to 1.29+/-1.11 points (P<0.05). Anti-CD54 and combined anti-CD11b/CD54 administration was not followed by significant changes. Therefore we suggest that leukocyte-based CD11b but not endothelial-based CD54 contributes most to leukocyte adhesion in the setting of indomethacin-induced ileitis in rats.

Animals↗
PubMed2001

Acetyl-11-keto-beta-boswellic acid, a constituent of a herbal medicine from Boswellia serrata resin, attenuates experimental ileitis.

The gum resin extract from Boswellia serrata (H15), an herbal product, was recently shown to have positive therapeutic effects in inflammatory bowel disease (IBD). However, the mechanisms and constituents responsible for these effects are poorly understood. This study examined the effect of the Boswellia extract and its single constituent acetyl-11-keto-beta-boswellic acid (AKBA) on leukocyte-endothelial cell interactions in an experimental model of IBD. Ileitis was induced by two subcutaneous injections of indomethacin (7.5 mg/kg) in Sprague-Dawley rats 24 h apart. Rats also received oral treatment with the Boswellia extract (H15) or AKBA at two different doses (low and high) equivalent to recommendations in human disease over 2 days. Controls received only the carriers NaHCO3 (subcutaneously) and tylose (orally). Effects of treatment were assessed by intravital microscopy in ileal submucosal venules for changes in the number of rolling and adherent leukocytes and by macroscopic and histological scoring. Increased leukocyte-endothelial cell adhesive interactions and severe tissue injury accompanied indomethacin-induced ileitis. Treatment with the Boswellia extract or AKBA resulted in a dose-dependent decrease in rolling (up to 90%) and adherent (up to 98%) leukocytes. High-dose Boswellia extract as well as both low- and high-dose AKBA significantly attenuated tissue injury scores. Oral therapy with the Boswellia extract or AKBA significantly reduces macroscopic and microcirculatory inflammatory features normally associated with indomethacin administration, indicating that the anti-inflammatory actions of the Boswellia extract in IBD may be due in part to boswellic acids such as AKBA.

Animals↗
PubMed2003

A comparison of the effects of medium- and long-chain triglycerides on neutrophil stimulation in experimental ileitis.

BACKGROUND: In ileitis, the chain length of dietary fats affects inflammation, and medium-chain triglycerides (MCTs), but not long-chain triglycerides (LCTs), reduce intestinal damage. The mechanism of this effect has not been fully elucidated. In this work, we studied the effects of MCTs and LCTs on polymorphonuclear neutrophil (PMN) action in trinitrobenzene sulfonic acid (TNB)-induced ileitis. METHODS: Twelve-week-old male Sprague-Dawley (SD) rats received TNB in the ileal lumen and were then fed MCTs or LCTs for 3 days. RESULTS: We detected no significant differences in the morphological damage between the MCT and the LCT groups. The content of interleukin (IL)-8, on the other hand, was significantly lower in the MCT group than in the LCT group, as was myeloperoxidase activity. The CD11b expression by PMNs was higher in the LCT group, but the difference was not of statistical significance. CONCLUSIONS: These findings suggested that proinflammatory activity was greater in the LCT group in comparison with the MCT group.

Animals↗
PubMed1979

Multiple adenocarcinomas and premalignant changes in "backwash" ileitis.

In a patient with long-staning ulcerative colitis and "backwash" ileitis, multiple carcinomas developed in the colon and ileum. In both locations premalignant mucosal changes of the basal cell proliferation type were seen adjacent to and remote from sites of carcinoma. Although the frequency of such premalignant and malignant changes in "backwash" ileitis is unknown, their concurrence in this case suggests that ulcerative colitis involving the terminal ileum increases the risk of small bowel carcinoma.

Adenocarcinoma↗
PubMed1989

The incidence of severe chronic ileitis after abdominal and/or pelvic external irradiation with high energy photon beams.

The authors report a 7.9% incidence of late severe ileal complications after abdominal and/or pelvic external radiation therapy in 188 consecutive patients. All treatments were performed using 25 MV photon beams, with AP-PA field technique, a daily dose of 1.8-2 Gy, 5 times a week. One hundred and two (54.3%) patients were given whole pelvic irradiation up to 45-55 Gy without a boost, 64 patients (34%) received boost doses on limited volumes up to 60-65 Gy. The analysis of factors which could be useful in predicting a high risk of severe ileal sequellae, has shown that the main factor was the past history of previous laparotomy. Thus, the incidence of chronic ileitis in patients who have never been laparotomized in the past and who were treated by radiotherapy alone, was 2.2% (2/97); in contrast patients with previous abdominal surgery whatever its purpose, showed in 13/91 cases (14.3%) severe ileal complications (p less than 0.05). In addition, the risk of chronic ileitis increases with the number of previous laparotomies irrespective of delay or purpose: 10.1% after one laparotomy, 22.2% after two and 50% after three or more laparotomies. The influence of these data on the planning of abdominal and/or pelvic external irradiation is discussed.

Adult↗
PubMed2003

Identification of a quantitative trait locus for ileitis in a spontaneous mouse model of Crohn's disease: SAMP1/YitFc.

BACKGROUND & AIMS: The SAMP1/Yit mouse strain develops spontaneous ileitis with histologic features of Crohn's disease. Disease expression in the SAMP1/YitFc subline (SAMP1/Fc) is partially inhibited by outcross to C57BL/6J (B6) mice, suggesting complex genetic control of disease susceptibility with both dominant and recessive determinants. We performed a genetic analysis of a (B6 x SAMP1/Fc)F(2) cross to localize the genes regulating intestinal inflammation in this model. METHODS: A genome-wide scan was performed using a panel of microsatellite loci determined to be informative for this cross. Quantitative trait loci were identified with Map Manager QT using a serial regression approach. Positional candidate genes were selectively sequenced at the genomic level to identify potential susceptibility genes for functional screening. RESULTS: A genome-wide scan of (B6 x SAMP1/Fc)F(2) mice identified a SAMP-derived quantitative trait loci with additive effects on chromosome 9 in a region likely to have been inherited from the AKR mouse strain. The candidate interval contains several genes of interest because of their potential role in either immune system function, intestinal epithelial function, or both. Suggestive evidence for additional loci was also observed on chromosomes 6 and X. CONCLUSIONS: The SAMP1/Fc allele for a locus, designated Ibdq1, promotes inflammation-associated epithelial damage in these mice. Consistent with persistent mild ileitis in (B6 x SAMP1/Fc)F(1) mice, this locus appears to function in an additive fashion. Two genes in this interval, encoding the interleukin 10 receptor alpha chain and interleukin 18, are excellent candidates for Ibdq1.

Alleles↗
PubMed2003

Ileitis due to Yersinia pseudotuberculosis in Crohn's disease.

We present the case of a young woman with fulminating terminal ileitis due to Yersinia pseudotuberculosis, in whom Crohn's disease was subsequently diagnosed. Serological testing was prompted by radiological, macroscopic and histological changes which were atypical of Crohn's disease. We speculate that Y. pseudotuberculosis ileitis may occasionally produce an acute exacerbation of Crohn's disease, but that its occurrence may not be diagnosed if the atypical features are not recognised. In this case, the classical features of Y. pseudotuberculosis may have been modified by pre-existing Crohn's disease. We propose that, because of defects in mucosal barrier function and immunological function, patients with Crohn's may have increased susceptibility to infection by Yersinia sp.

Adult↗
PubMed2002

Porcine ileitis model induced by TNBS-ethanol instillation.

Nine young pigs were used to evaluate the ability of an trinitrobenzene sulfonic acid-ethanol (TNBS-EtOH) mixture, in varying combinations, to induce ileitis comparable to that caused by intraintestinal instillation in other species. The distal ileum was accessed via laparotomy in anesthetized animals and the TNBS-EtOH was instilled via hypodermic needle. In three pigs in which the instillate was not held within an ileal segment, there were no ileal lesions noted upon necropsy at two weeks after instillation. In all six pigs in which the instillate was confined to a 10-cm length of distal ileum for 10-15 min, there was definite gross and histologic evidence of severe ileitis upon necropsy at one week after instillation. The histopathology was more consistent with Th-1- than Th-2-mediated inflammation.

Animals↗
PubMed2002

The effect of josamycine on the control of ileitis in weaned piglets under field conditions.

The aim of this trial was to evaluate the effect of in-feed josamycine on the control of ileitis in weaned piglets. On a farm with a previous history of ileitis outbreaks, 288 piglets at weaning age (25 +/- 2 days old) were allocated into three experimental groups, each group comprising of four pens with 24 piglets in each pen. Group one (T1) served the trial as negative control group (unmedicated), group T2 was administered josamycine at 36 mg/kg of feed and group T3 was administered josamycine at 50 mg/kg of feed. Treatments lasted for 14 days followed by an observation period of 28 days. Administration of josamycine at both inclusion levels tested had a beneficial effect compared with the negative control group, by the reduction of prevalence of diarrhoea, the enhancement of growth performance and the reduction of prevalence of Lawsonia intracellularis in the intestine, as determined either by the PCR method or by specific histopathological examinations. The beneficial effect of josamycine was more pronounced at the inclusion level of 50 mg/kg of feed.

Animals↗
PubMed1999

Hyperthermia prevents functional, histological and biochemical abnormalities induced during ileitis.

Inflammatory bowel disease is associated with altered intestinal motility and epithelial damage. Hyperthermia induces heat shock protein expression, components of a basic cellular defence mechanism, and consequently prevents ischaemic damage. Here we investigate whether hyperthermia may prevent altered smooth muscle function as well as underlying inflammation in a model of inflammatory bowel disease. Ileal heat shock protein expression was induced in rats by hyperthermic shock (41.5 degrees C; 5 min). Two hours after heating or sham treatment, ileitis was evoked by TNBS. Ileal samples were taken 4 h later to determine the contractile response of circular muscle strips, and to measure heat shock protein expression, LTB4 generation and damage/inflammation. Ileitis was associated with an increase in the contractile response of circular muscle to substance P but not neurokinin A or nerve stimulation. Hyperthermia induced heat shock protein expression and also prevented this functional change as well as TNBS-induced LTB4 production, subsequent infiltration of neutrophils and epithelial damage. Thus, intestinal inflammation is associated with alterations in tachykinergic control of smooth muscle as well as inflammatory changes. Hyperthermia prevents these changes and induces heat shock protein expression. Pharmacological induction of these proteins may offer a novel clinical strategy in treating both of these aspects of disease.

Animals↗