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PubMed1996

Infantile chronic idiopathic intestinal pseudo-obstruction: the role of small intestinal manometry as a diagnostic tool and prognostic indicator.

BACKGROUND: Chronic idiopathic intestinal pseudo-obstruction (CIIP) presenting in infancy is a rare but serious condition of heterogeneous aetiology often with an uncertain outcome. AIM: To assess whether intestinal manometry in the first two years of life can help define a neuropathic or myopathic aetiology or clinical outcome, or both, in cases of infantile CIIP. SUBJECTS AND METHODS: 14 consecutive children who presented in the first year of life with CIIP were studied histologically and by small intestinal manometry. RESULTS: Five had a myopathic disorder, four were neuropathic, and five unclassified following histological investigation of full thickness intestinal biopsy specimens. Analysis of fasting phase III activity showed four patterns: (1) (n = 4) no detectable motor activity, (2) (n = 5) low amplitude phase III activity, (3) (n = 3) poorly formed phase III complexes of short duration, (4) (n = 2) well formed cyclical phase III activity with abnormal propagation. The seven children with low amplitude phase III: motility index (MI) < 10 KPa/min, all had a poor outcome (death or dependence on parenteral nutrition) after 1-10 years follow up, compared with two of seven of those with a MI > 10 KPa/min. Of the five with myopathic histology, four had a MI < 10 KPa/min. CONCLUSION: These results show that small intestinal manometry is useful not only as an aid in diagnosing the aetiology of CIIP presenting in infancy, but also in predicting outcome.

Chronic Disease↗
PubMed2005

Effects of psychological stress on small intestinal motility and bacteria and mucosa in mice.

AIM: To investigate the effects of psychological stress on small intestinal motility and bacteria and mucosa in mice, and to explore the relationship between small intestinal dysfunction and small intestinal motility and bacteria and mucosa under psychological stress. METHODS: Sixty mice were randomly divided into psychological stress group and control group. Each group were subdivided into small intestinal motility group (n = 10), bacteria group (n = 10), and D-xylose administered to stomach group (n = 10). An animal model with psychological stress was established housing the mice with a hungry cat in separate layers of a two-layer cage. A semi-solid colored marker (carbon-ink) was used for monitoring small intestinal transit. The proximal small intestine was harvested under sterile condition and processed for quantitation for aerobes (Escherichia coli) and anaerobes (Lactobacilli). The quantitation of bacteria was expressed as log10(colony forming units/g). D-xylose levels in plasma were measured for estimating the damage of small intestinal mucosa. RESULTS: Small intestinal transit was inhibited (39.80+/-9.50% vs 58.79+/-11.47%, P<0.01) in mice after psychological stress, compared with the controls. Psychological stress resulted in quantitative alterations in the aerobes (E. coli). There was an increase in the number of E. coli in the proximal small intestinal flora (1.78+/-0.30 log10 (CFU/g) vs 1.37+/-0.21 log10 (CFU/g), P<0.01), and there was decrease in relative proportion of Lactobacilli and E. coli of stressed mice (0.53+/-0.63 vs 1.14+/-1.07, P<0.05), while there was no significant difference in the anaerobes (Lactobacilli) between the two groups (2.31+/-0.70 log10 (CFU/g) vs 2.44+/-0.37 log10 (CFU/g), P>0.05). D-xylose concentrations in plasma in psychological stress mice were significantly higher than those in the control group (2.90+/-0.89 mmol/L vs 0.97+/-0.33 mmol/L, P<0.01). CONCLUSION: Small intestinal dysfunction under psychological stress may be related to the small intestinal motility disorder and dysbacteriosis and the damage of mucosa probably caused by psychological stress.

Animals↗
PubMed1999

Protective effect of aged garlic extract on the small intestinal damage of rats induced by methotrexate administration.

The methotrexate (MTX) administration to rats causes the damage of small intestine. The small intestinal damage was evaluated by measuring the intestinal permeability of the poorly absorbable compound, fluorescein isothiocyanate (FITC)-labeled dextran (average molecular weight, 4,400) (FD-4) using the in vitro everted intestine technique and by determining the FD-4 that appeared in plasma using the in situ closed loop intestine technique. The MTX administration to rats fed with the standard laboratory diet increased the small intestinal permeability of FD-4 due to the damage of the small intestine. Interestingly, the permeability of FD-4, when MTX was administered to rats fed with the aged garlic extract containing diet, was depressed almost to the level of control rats without the MTX treatment. The present study showed that the aged garlic extract protected the small intestine from the damage induced by the action of MTX on the crypt cells.

Animals↗
PubMed2005

[Sarcomas of the small intestine].

Sarcomas of the small intestine are rare, clearly differentiated, malignant, mesenchymatous tumours that can be of smooth muscle, Schwann cell or fibroblastic origin. From a clinical point of view, the pain and abdominal mass are the 2 types of symptoms that frequently reveal the disease. In rare cases, sarcomas of the small intestine are manifested by an acute complication. No imaging method can clearly confirm the diagnosis. Before immunohistochemistry, differential diagnosis was made on undifferentiated mesenchymatous "stromal" tumours, which are also rare. Exeresis must be complete and without perforation of the tumour because of the risk of locoregional relapse. The benefits provided by chemotherapy and radiotherapy are limited because of the low mitotic activity of the tumour cells and its weak vascularisation. Long-term survival is limited by poor prognosis criteria: high grade malignancy, size greater than 5 cm, tumour extension, perforation of the tumour, quality of surgical resection and histological type.

Diagnostic Imaging↗
PubMed2003

Immunohistochemical analysis of adenocarcinoma of the small intestine: a tissue microarray study.

BACKGROUND: Primary adenocarcinomas of the small intestine are rare, and the genetic mechanisms involved in their carcinogenesis remain unclear. AIM: To examine the expression of candidate proteins in small intestinal adenocarcinomas by immunohistochemistry performed on tissue microarrays (TMAs). METHODS: Twenty seven primary sporadic small intestinal adenocarcinomas were analysed. The TMA technique was validated by comparing immunohistochemical labelling of hMLH1 and hMSH2 on TMAs and the tissue sections they derived from. The expression of Smad4, hMSH6, beta catenin, and p53 was investigated and results compared with those obtained in 14 malignant ampullary tumours. RESULTS: TMA technology with threefold redundancy adequately represented the immunohistochemical pattern of small intestinal adenocarcinomas. Loss of hMLH1 expression, but not hMSH2 or hMSH6, was seen in two of 27 small intestinal adenocarcinomas. All ampullary tumours showed nuclear staining for hMSH2 and hMSH6. One case showed lack of immunostaining for hMLH1. Smad4 expression was absent in five small intestinal adenocarcinomas and two ampullary tumours. Overexpression of p53 was detected in the nuclei of 14 of the 27 small intestinal adenocarcinomas, and five of the 14 ampullary tumours. Nuclear or cytoplasmic expression of beta catenin was present in all specimens. CONCLUSION: Inactivation of the SMAD4/DPC4 gene seems to be involved in small intestinal adenocarcinoma tumorigenesis. Overexpression of p53 and abnormal expression of beta catenin are two common events, unlike the loss of expression of the DNA mismatch repair proteins (hMLH1, hMSH2, and hMSH6). The carcinogenetic process appears to be similar in small intestinal adenocarcinomas and malignant ampullary tumours.

Adenocarcinoma↗
PubMed1991

[An experimental model of ischemic lesions of the small intestine].

Ischemic (necrotic) lesions of the small intestine are caused by the influence of elevated environment temperature on the rat. The initial change which was gained was a subnuclear vacuolization of the absorptive cells on the tips of the intestinal villi. Later on, the vacuoles blend into the subnuclear space which contains a serous exudate in some places. With the expansion of the subnuclear space the epithelium separates from the stroma, and after it's desquamation there comes to an autolysis of the denuded stroma of the intestinal villi. The lesions are comparable with lesions of the small intestine caused by hypothermia, shock, mesenterial blood vessel ligation in experimental models of other authors, and with ischemic lesions of the small intestine in humans as well. These changes can be considered as a nonspecific consequence of mesenterial ischemia in the appearance of which vascular factors play a key role.

Animals↗
PubMed1985

Effect of experimental vascular occlusion on small intestinal motility in ponies.

Small intestinal ischaemia is a cause of pain in man and horses. Occlusion of the vascular supply to Thiry loops in experimental ponies caused severe discomfort and loss of motility within a few minutes but these effects could not be reproduced by a similar procedure in intact gut preparations. However, embolisation of the mural vascular network produced ischaemia of the small intestine of anaesthetised ponies which led to a cessation of motility in the affected segments, though unaffected segments became hypermotile with a characteristic motility pattern. These results suggest the need for reappraisal of the classical theory of parasite-induced damage to the cranial mesenteric artery as the cause of ischaemic bowel disease.

Animals↗
PubMed1996

Characterization of glutaminase in the developing rat small intestine.

As a primary substrate in the small intestine, glutamine is a very important source of energy. Glutaminase (GA) is the enzyme involved in the deamination of glutamine to glutamate, which is utilized for energy production via the TCA cycle. Although the enzymatic activity of GA in the small intestine is known to undergo maturational changes, the tissue localization of the protein and its mRNA, the intracellular processing of this enzyme and levels of its mRNA in the small intestine at different maturational stages have not yet been described. In this study, using immuno-histochemical staining, we confirm previous studies using other techniques that suggested GA is localized in the epithelial layer of the rat small intestine. Some GA is also found in cells of the lamina propria and crypt epithelium. Using in situ hybridization studies, we have corroborated the presence of the protein in the epithelial cells of the villi by localizing the mRNA of this protein to the same layer and its precursor layer in the crypt region. An ontogenic analysis of GA mRNA and protein from rat small intestines, using RNA dot blots, gel blots and protein immunoblotting revealed differences in immunoreactive GA protein and mRNA during maturation. Immunoreactive GA and steady-state levels of GA mRNA increased around the 3rd wk of life, coincident with weaning and the endogenous glucocorticoid surge. Whether these findings have nutritional or pathophysiological implications remains speculative.

Age Factors↗
PubMed2000

The small intestine.

Clinical investigation of the small bowel at The Mount Sinai Hospital began with David Adlersberg's arrival in 1931. His research interests were in bile acids, cholesterol, carotene, and vitamin A. In 1952, he was given a Nutrition Laboratory and later, a Nutrition Clinic. His vitamin A tolerance test and interest in malabsorption led him to a comprehensive study of sprue, the separation of the tropical and non-tropical forms, and their different etiologies and treatments. Adlersberg's work was complemented by (a) Marshak and Wolf's radiologic examination of the small bowel (especially in sprue and other malabsorption disorders); (b) Gerson s perfusion experiments; and (c) Friedman, Waye and Wolf's motility studies. Lieber and his colleagues explored the deleterious effects of alcohol on the function and structure of the small intestine. Gerson explored the nutrition of patients with Crohn's disease of the small intestine, especially after extensive resection or bypass leading to ascorbic and folic acid deficiencies and hypergastrinemia.

History, 20th Century↗
PubMed1975

[Participation of the small intestine in carbohydrate metabolism].

Participation of the small intestine in the intermediate carbohydrate metabolism was pointed out by appearing of glucose in the small intestine secret within 2-3 hrs after carbohydrate uptake in the concentration comparable or even exceeding that in the blood. The glucose concentration in the blood drops just when it increases in the intestinal juice, while increase in the blood sugar coincided with reducing of the glucose concentration in the small intestine secret. This suggests that the small intestine lumen can serve as one of the depots for carbohydrates: a kind of temporary depot for monomeres.

Animals↗
PubMed1992

Small intestinal volvulus in adults of Gonder Region, northwestern Ethiopia.

A review of intestinal obstruction in Gonder revealed that small intestinal volvulus in adults is the most common cause of small intestinal obstruction, and it ranked only second to sigmoid volvulus as the most common cause of all intestinal obstruction. Out of 25 patients 23 had primary and the remaining 2 secondary small intestinal volvulus. The secondary small intestinal volvulus occurred in patients both of whom had previous gangrenous sigmoid volvulus that was resected. The disease was predominantly seen in young, adult, male farmers. Though early diagnosis is one of the most important factors in the final outcome of the treatment, the diagnostic accuracy preoperatively is said to be low. In this study diagnosis by exclusion of the common causes of small intestinal obstruction in the region improved the preoperative diagnostic accuracy.

Adolescent↗
PubMed2001

Small Intestinal Bacterial Overgrowth Syndrome.

Small intestinal bacterial overgrowth is found in many conditions and may present with malabsorption, diarrhea, and malnutrition. Whereas dietary modifications and supplements might help, the primary treatment strategy is the judicious use of antibiotics. The most effective antibiotics, shown either empirically or by clinical trials, are the quinolones, tetracycline, amoxicillin with clavulanic acid, clindamycin, and metronidazole. In an unpredictable fashion, some patients fail to respond to one of these antibiotics, but often will respond to a second. These conditions are often chronic and require periodic or cyclical treatment. In some conditions seen in the elderly or in hypochlorhydric patients the small intestinal bacterial overgrowth is inconsequential and does not require therapy. Surgical management is reserved for the select situations in which there is a clear-cut structural defect.

Journal Article↗
PubMed1988

Prenatal and postnatal development of the small intestine in the insectivore Suncus murinus.

The development of the small intestine in the insectivore Suncus murinus was noted during the period from 21 days' gestation to 20 days after birth. At 21 days of gestation, the proximal small intestine exhibited the beginning of villus formation, whereas the distal small intestine preserved the stratified epithelium. Stratified epithelium in the distal small intestine changed into a single layer by 24 days' gestation. At 26 days' gestation, each epithelial cell was immature; but by 28 days mature-looking epithelial cells were found. The shape of the villi changed from cuboid to columnar during the same period. The connective-tissue cores of the villi began to develop at 7 days after birth in the proximal small intestine and at 15 days after birth in the distal small intestine. Crypts appeared at 15 days after birth. Endocytosis of epithelial cells took place at 28 days of gestation. In the proximal small intestine, supranuclear vesicle clusters were observed first at birth; they began to decrease both in number and size at 10 days' gestation and then disappeared completely by 20 days after birth. In the distal small intestine, large supranuclear vacuoles were observed first at 28 days of gestation. Although these vacuoles invariably were found up to 15 days after birth, they also disappeared completely by 20 days. Epithelial cells showed a structure similar to those of the adult after weaning.

Animals↗
PubMedDate not supplied

Overexpression of p53 protein and point mutation of K-ras genes in primary carcinoma of the small intestine.

Primary carcinoma of the small intestine is rare and represent about 0.5% of all gastrointestinal malignancies. The aim of this study was to examine the biological characteristics of primary carcinoma of the small intestine by immunohistochemical and nested polymerase chain reaction methods. Thirty-five primary carcinomas (12 in the duodenum and 23 in the jejunum or ileum) from 35 patients were studied clinicopathologically and examined for overexpression of p53 protein. In 22 of these 35 cases, point mutation at codon 12 of the K-ras gene was detected by the nested polymerase chain reaction and restriction fragment length polymorphism method. All the duodenal carcinomas were well-differentiated type and the rate of these carcinomas was significantly higher than that of jejunal or ileal carcinomas (100% vs. 65%). Fourteen cases showed overexpression of p53 (40%), and p53 tended to be expressed more frequently in poorly-differentiated type (71%) compared to well-differentiated type (30%). Only 2 out of 22 carcinoma cases showed K-ras gene mutation, and both were duodenal carcinomas. These findings suggest that p53 plays a major role in the progression of carcinoma of the small intestine, whereas the role of K-ras mutation is much less significant.

Adenocarcinoma↗
PubMed1975

[Histological findings following experimental implantation of an antiperistaltic segment into the small intestine].

Implantation of a small-intestine segment turned 180 degrees has proved good for improving utilization of remaining residues of small intestine. We studied the histological changes after rotation of such a segment in young dogs and young rats. We found an increase in the diameter of the gut in the region of the rotated segment. The height of villi, the number of villi per section and the thickness of the tunica muscularis were substantially increased. Overall, the absorptive surface in the area of the rotated segment had significantly increased at the front and the back.

Age Factors↗
PubMed1987

Crohn's disease of the small intestine.

The small bowel remains the most frequent site of inflammation in Crohn's disease, involving 75 to 85 per cent of all patients. In spite of the advent of newer imaging modalities and the increasing sophistication of endoscopy, barium studies remain the primary method of diagnosis and evaluation of small bowel Crohn's disease. It is important not only to detect the presence of disease, but also to give a correct anatomic distribution as well as identify possible complications.

Barium Sulfate↗