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PubMed2002

Stenting of the gastrointestinal tract.

Self-expandable metal stents are being increasingly used to palliate malignant stenoses of the gastrointestinal tract. These prostheses have made it possible to reestablish luminal continuity in patients with malignant obstruction of esophagus, gastric outlet, small bowel, or colon who are at high risk of surgical intervention. Despite technologic refinements in the stents and their delivery systems, and an increasing number of studies related to self-expandable metal stents, data regarding their long-term efficacy, side effect profile, and true cost efficacy in comparison with other treatment modalities remain incomplete. This article reviews the available technology, placement techniques, indications, and outcomes relating to the use of self-expandable metal stents in esophagus, stomach, small bowel, and colon.

Colonic Diseases↗
PubMed1978

[Acute ulcers of the gastrointestinal tract complicated by hemorrhage and perforation].

The data on 130 patients with acute ulcers of the gastrointestinal tract complicated hemorrhage and perforation are reported. Acute ulcers developed in patients with cardiovascular diseases (47%), intoxication (17.7%), postoperative paresis of the stomach and intestine (10%), other pathology (15.3%), and in medication (10%). The former manifested in acute hemorrhage in 108 patients, perforation--in 8, hemorrhage and perforation--in 14. In 86% of cases ulcers were located in the stomach, and in 63%--these were multiple. Conservative therapy was employed in 97 patients and 33 patients were operated upon. The mortality after early operations was 2.5 times as low as in the expectation policy and conservative therapy.

Acute Disease↗
PubMed1995

Localized vasculitis of the gastrointestinal tract.

We studied the clinical and pathologic findings of 63 patients with localized vasculitis of the gastrointestinal tract, including 35 partial bowel resections, 14 cholecystectomies, five partial pancreatectomies, six appendectomies, one omentectomy, one gastrectomy, and one esophagectomy. Vasculitis was classified histologically as polyarteritis (n = 33), phlebitis (n = 12), Churg-Strauss angiitis (n = 8), small-vessel vasculitis (n = 6), Buerger's disease (n = 2), and giant-cell arteritis (n = 1). Nineteen of 33 cases of polyarteritis affected the small bowel or gallbladder, and nine patients with polyarteritis had elevated serum antinuclear antibodies or rheumatoid factor. Eight of 12 cases of phlebitis affected the right colon; there were giant cells in four of these 12 cases, a history of medication use in seven of eight cases, and no evidence of serum autoantibodies. Short-term follow-up (mean, 5 years) demonstrated that systemic disease developed in six of 23 patients with polyarteritis (four of whom had elevated serum rheumatoid factor or antinuclear antibodies), the patient with giant-cell arteritis, and one of two patients with Buerger's disease. Systemic vasculitis did not develop in patients with other types of vasculitis. We conclude that patients with gastrointestinal phlebitis, polyarteritis without serum autoantibodies, and small-vessel vasculitis have a low short-term risk for the development of systemic disease.

Adult↗
PubMedDate not supplied

Extensive papillomatosis of the bovine upper gastrointestinal tract.

Extensive papillomatosis was identified in a heifer born and raised in Scotland and a steer born and raised in England. In both cases, the papillomas extended from the mouth and tongue to the reticulum. Although cases of florid papillomatosis of the upper gastrointestinal tract occur relatively frequently in cattle grazing on bracken fern in the Scottish Highlands, no such cases have been reported previously in English cattle. Histopathological examination of the papillomas showed that the lesions were wholly epithelial, with acanthosis, hyperkeratosis and the pathognomonic koilocytes characteristic of papillomavirus infection. Bovine papillomavirus type 4 (BPV-4) was identified by molecular amplification and sequencing of the viral genome.

Animals↗
PubMed1981

Changes of adenosinetriphosphatase (ATPase) activities in lymphocytes from patients with carcinomas of the gastrointestinal tract.

The activities of both total and Oligomycin-sensitive ATPase in lymphocytes from patients with gastrointestinal tract (GI) carcinomas in different Karnofsky performance status (KPS) were determined to investigate whether or not the changes of these enzyme activities were correlated to those of the immune responsiveness of the patients. In the patients whose KPS indicated more than 50%, the mean value of the total ATPase activity in lymphocytes tended to increase slightly as compared with that determined in the control subjects, but the mean value of the Oligomycin-sensitive ATPase activity in lymphocytes tended to decrease slightly as compared with that determined in the control subjects. In the patients whose KPS indicated less than 30%, the mean values of the activities of both total and Oligomycin-sensitive ATPase in lymphocytes tended to decrease remarkably as compared with those determined in the control subjects. The ATPase activities in lymphocytes were suggested to be useful measures to the immune responsiveness of the patients with GI carcinomas.

Adenosine Triphosphatases↗
PubMed1997

Recovery of gastrointestinal tract motility and myoelectric activity change after abdominal surgery.

OBJECTIVE: To investigate the relationship between fedstate gastrointestinal tract (GI) function and upper GI myoelectric changes seen after abdominal surgery. DESIGN: Twenty-one adult female mongrel dogs underwent either an open cholecystectomy, a laparoscopic cholecystectomy alone, or a laparoscopic cholecystectomy with peritoneal injury (n = 7 for each group). Bipolar recording electrodes were placed on the antrum and 3 sites of the proximal small intestine to record fasting myoelectric data each morning postoperatively. Solid-phase, technetium Tc 99m gastric emptying studies were performed on postoperative days 1 and 2. Radiopaque markers were ingested just before operation, and the excreted markers were counted using x-ray films of the feces. MAIN OUTCOME MEASURES: Postoperative fasting GI myoelectric activity, gastric emptying, and intestinal transit time. RESULTS: Migrating motor complexes (MMCs) in the small intestine were observed in 33.3% and 75.0% of the dogs on postoperative days 1 and 2, respectively. Gastric dysrhythmias were observed in 23.8% and 45.0% of the dogs on postoperative days 1 and 2, respectively. No relationship between type of surgery and the presence of MMCs or gastric dysrhythmias was noted. Gastric emptying was delayed on postoperative day 1 and was unrelated to the presence of MMCs. Transit time was not significantly delayed in dogs without MMCs on postoperative day 1 compared with that in dogs with MMCs on that day. The presence of gastric dysrhythmias did not affect transit time studies. CONCLUSION: Fasting GI myoelectric activity, including the return of MMCs and the presence of gastric dysrhythmias, does not accurately predict fed-state gastrointestinal GI function following abdominal surgery.

Abdomen↗
PubMed2003

Laboratory procedures for the diagnosis of gastrointestinal tract diseases of dogs and cats.

An increasing number of laboratory tests are available for diagnosis of gastrointestinal tract diseases in dogs and cats. Use of these tests can lead to more accurate and rapid diagnoses. This review discusses laboratory tests, both new and old, and the role they currently play in the evaluation of animals presented with gastrointestinal problems. A minimum database helps assess the severity of the disorder, detect extra-gastrointestinal causes of problems and assists in formulating diagnostic and therapeutic plans. Faecal examination remains one of the most important diagnostic procedures in the investigation of gastrointestinal problems. Zinc sulphate faecal flotation is an excellent routine screening technique for helminth and protozoal infections, including giardiasis. Rectal cytology can assist in the diagnosis of large bowel disorders. Interpretation of faecal immunodiagnostic tests is hampered by insufficient knowledge of test sensitivities and specificities. Routine faecal cultures are not warranted and faecal occult blood tests are rarely indicated. Serum tests for gastric inflammation are now under development. The serum trypsin-like immunoreactivity test remains the gold standard technique for the diagnosis of exocrine pancreatic insufficiency. Breath hydrogen tests can be helpful in assessing the functional relevance of mild abnormalities in small-bowel biopsy specimens. Subnormal concentrations of serum cobalamin appear to be more specific indicators of gastrointestinal disease in cats than in dogs. Tests for small intestinal bacterial overgrowth remain controversial and assessment of gastrointestinal permeability has yet to prove its value in the diagnostic assessment of companion animals with gastrointestinal problems. Faecal alpha1-protease inhibitor shows promise for the diagnosis of protein-losing enteropathy.

Journal Article↗
PubMed1981

Gastrointestinal tract complications following radiotherapy of uterine cervical cancer: past and present.

A retrospective analysis of the gastrointestinal tract complications in 298 patients with cervical cancer treated with radiotherapy at the State University of New York at Buffalo and Albert Einstein College of Medicine affiliated hospitals was carried out. Fifty-two patients had pretreatment surgical staging (39 transperitoneal and 13 extraperitoneal). Twenty-four percent had varying degrees of radiation sickness. They all responded to conservative therapy. Seven percent developed Stage I radiation proctitis. In the clinical staging group late complications consisted of: Three small bowel injuries, 4% persistent Stage I, 3% Stage III, and one patient with Stage II radiation proctitis. Among 39 patients who had transperitoneal surgical staging, two small bowel injuries, one case of gastric ulcer, and three cases of radiation proctitis were encountered. Only one of 13 patients who had extraperitoneal surgical staging developed intestino-vesico-vaginal fistula. A literature search was conducted, and prophylactic and therapeutic measures are discussed. The importance of careful selection of patients for radiotherapy and recognition of high risk clinical factors is reemphasized.

Adult↗
PubMed2003

Interstitial cells in the musculature of the gastrointestinal tract: Cajal and beyond.

Expression of the receptor tyrosine kinase KIT on cells referred to as interstitial cells of Cajal (ICC) has been instrumental during the past decade in the tremendous interest in cells in the interstitium of the smooth muscle layers of the digestive tract. ICC generate the pacemaker component (electrical slow waves of depolarization) of the smooth musculature and are involved in neurotransmission. By integration of ICC functions, substantial progress has been made in our understanding of the neuromuscular control of gastrointestinal motility, opening novel therapeutic perspectives. In this article, the ultrastructure and light microscopic morphology, as well as the functions and the development of ICC and of neighboring fibroblast-like cells (FLC), are critically reviewed. Directions for future research are considered and a unifying concept of mesenchymal cells, either KIT positive (the "ICC") or KIT negative "non-Cajal" (including the FLC and possibly also other cell types) cell types in the interstitium of the smooth musculature of the gastrointestinal tract, is proposed. Furthermore, evidence is accumulating to suggest that, as postulated by Santiago Ramon y Cajal, the concept of interstitial cells is not likely to be restricted to the gastrointestinal musculature.

Animals↗
PubMed1993

Prolactin receptor expression in the gastrointestinal tract: characterization of the prolactin receptor of gastric mucosa.

There is evidence that prolactin (PRL) influences gastrointestinal function. However, the sites at which prolactin exerts these effects are not known. A monoclonal antibody was therefore generated against the rabbit mammary gland prolactin receptor (MAb 218) and used to study the distribution of the prolactin receptor in the rabbit gastrointestinal tract (GIT) by immunohistochemistry. MAb 218 is an IgG1 kappa-precipitating antibody which precipitates major affinity cross-linked mammary gland prolactin receptor subunits of molecular masses 45 and 80 kDa. It has an affinity of 0.8 x 10(9) mol/l for the prolactin receptor and does not react with GH or insulin receptors in precipitation assays. MAb 218 immunoreactivity was observed in classical prolactin target cells such as mammary gland epithelium, and this immunoreactivity was abolished by preincubation of MAb 218 with purified prolactin receptor but not by preincubation with purified GH receptor. In the GIT, the most intense immunoreactivity was associated with the oesophageal epithelium, chief (zymogenic) cells of the fundic mucosa, pancreatic islets of Langerhans and surface epithelial cells of the duodenum and jejunum. Other specific elements of the GIT were immunoreactive at lower levels or were immunonegative. No immunoreactivity was observed in these locations with a control monoclonal antibody (MAb 50.8) of identical isotype to 218. To support the immunohistochemical findings, rabbit gastric mucosal membranes were used to show the presence of lactogen-specific binding. Scatchard analysis of 125I-labelled human GH binding to the gastric mucosal membranes with rat prolactin as displacing ligand yielded an affinity constant (Ka) of 1.0 +/- 0.2 x 10(9) mol/l with a capacity of 3.5 +/- 0.4 fmol/mg protein. Affinity cross-linking and sodium dodecyl sulphate-polyacrylamide gel electrophoresis of the gastric receptor revealed lactogenic hormone-binding subunits of molecular masses 43, 68 and 83 kDa. The 68 kDa subunit was not seen in rabbit mammary gland or ovarian tissue, and may be unique to gastric mucosa. In conclusion, we have demonstrated the presence of a high affinity lactogenic receptor in specific epithelial cell subpopulations of the GIT. This localization of the prolactin receptor in the GIT will assist in further functional assignment of prolactin to gastrointestinal physiology.

Animals↗
PubMed1990

The effect of size and density on mean retention time of particles in the gastrointestinal tract of sheep.

The selective retention of particles in the reticulo-rumen and in the gastrointestinal tract distal to the reticulo-rumen was studied in fistulated sheep maintained on a roughage diet. Polyethylene glycol and plastic particles of different lengths (1 and 10 mm) and densities (0.92, 1.03, 1.22 and 1.44 g/ml) were either fed or were introduced into the omasum. The mean retention time in the reticulo-rumen (MRTRR) of 1 mm long particles with a density of approximately 1.0 g/ml was about 67 h, that is eight times longer than the MRTRR of fluid; the heavier particles were retained only three times longer than fluid. Particles with a length of 10 mm were retained in the reticulo-rumen 19-28 h longer than 1 mm long particles of the same density. Particles with a length of 10 mm were reduced to smaller particles (0.5-4 mm) due to rumination. Multiple regression analysis indicated that particle density and particle size accounted for 59 and 28% of the total variation of MRTRR respectively. The mean retention time distal to the reticulo-rumen (MRTGut) of 1 and 10 mm long particles with a density near 1.0 g/ml was 18-19 h, similar to that of fluid (16 h). The heavier particles were retained about 3-8 h longer.

Animals↗
PubMed1995

Endocrine cells of the human gastrointestinal tract have no proliferative capacity.

There is compelling evidence that the epithelial cell lineage of the gastrointestinal tract are derived from a common stem cell precursor, but the details of the subsequent cellular hierarchies remain uncertain. In this context, it is important to know the arrangement of cell proliferation that gives rise to the final cell populations. In rodents, a number of studies have been performed examining the possible proliferative capacity of endocrine cells, but a wide range of technical problems makes interpretation of these data difficult. Continuous labelling studies suggest there is potential for proliferation in endocrine cells but flash labelling studies have not been conclusive. In man there are no data on this issue. We have taken advantage of the ability to perform double immunostaining for operational markers of proliferation (Ki67 antigen) and endocrine cell phenotype (chromogranin expression). We demonstrate that there are no double-labelled cells in the normal stomach, small intestine or colon of fetal, neonatal or adult humans. Moreover, no double-labelled cells are found in pathological states associated with endocrine cell hyperplasia (gastritis, ulcerative colitis). These data indicate that the normal endocrine cells of the human gut have no proliferative capacity and that, in this cell lineage, population expansion precedes differentiation.

Adult↗
PubMedDate not supplied

CT evaluation of gastrointestinal tract perforation.

The purpose of this study is to review the computed tomography (CT) appearance of gastrointestinal tract (GI) perforation. Forty-two patients with 10 cases of proximal GI perforation and 32 cases of distal GI perforation were evaluated based on the CT findings of extraluminal air (which was subdivided into the CT-falciform ligament sign crossing the midline and scattered pockets of air), bowel wall thickening (>8 mm in gastroduodenal wall, >3 mm in the small bowel wall, >6 mm in the caliber of the appendix and >5 mm in the colonic wall), associated abscess formation, ascites and adjacent fat stranding. The results were compared using Fisher's Exact Test. Detection of extraluminal air in the upright plain films and CT was analyzed by Z test. Our results showed that CT-falciform ligament sign was more frequent in the proximal GI perforation, while pockets of extraluminal air (excluding the cases accompanying CT-falciform ligament sign), bowel wall thickening and fat stranding were found in higher incidence in distal GI perforation (P<.05). CT detected extraluminal air in more cases than the upright plain films did (69% vs. 19%; Z=4.62>Z(0.01)=2.326). We concluded that CT is a good imaging tool to differentiate the various GI perforations.

Adolescent↗
PubMed1979

Lymphoreticular disorders of the gastrointestinal tract: roentgenographic features.

Recent advances have permitted close correlation of characteristic roentgen signs with the pathophysiologic alterations in lymphoreticular disorders of the gastrointestinal tract. The background of primary and secondary immunoglobin disorders with gastrointestinal manifestations is reviewed. The roentgenographic alterations in the small bowel of the enteropathic immunoglobulin deficiency syndromes and in lymphoma of the small bowel, stomach, and colon are discussed and illustrated in detail.

Agammaglobulinemia↗
PubMed1980

Endoscopic diagnosis and therapy of mucosal vascular abnormalities of the gastrointestinal tract occurring in elderly patients and associated with cardiac, vascular, and pulmonary disease.

Twenty-seven cases of mucosal vascular abnormalities of the gastrointestinal tract were demonstrated by endoscopy, usually during investigation for gastrointestinal bleeding. The lesions were flat, bright red, and seen clearly through the endoscope. All were successfully treated by endoscopic electrocoagulation without complication. The vascular abnormalities were situated in the colons of 24 patients and in the stomachs of 3 patients. The average age of the patients was 69 years. Twenty-two of the 27 patients had some type of associated cardiac, vascular, or pulmonary disease that apparently represents a syndrome. The author proposes a theory that the vascular lesions are acquired as a consequence of hypo-oxygenation of the colon mucosa.

Age Factors↗
PubMed2006

[Nonsteroidal anti-inflammatory agents--choice between disturbances of gastrointestinal tract and cardiovascular toxicity].

Nonsteroidal anti-inflammatory agents are used more than 100 years. Most of them can cause undesirable effects on gastrointestinal tract: ulceration, bleeding and perforation of stomach and duodenum. Gastrointestinal toxicity is diminished when selective cyclooxygenase-2 inhibitors are used. However, recent clinical trials have showed that the use of cyclooxygenase-2 inhibitors increases the risk of cardiovascular event and cerebrovascular accident. According to the data such risk may be high using also nonselective nonsteroidal anti-inflammatory agents, however, it is lesser. Incidence rates of the cardiovascular events and cerebrovascular accidents increase due to activated thrombotic activity. Nonsteroidal anti-inflammatory agents are very useful in the management of rheumatic diseases and as pain relievers. Choosing appropriate nonsteroidal anti-inflammatory agent it is essential to consider the risk of gastrointestinal as well cardiovascular damage.

Adolescent↗
PubMed1995

Gastrointestinal tract complications after acute spine injury.

OBJECTIVES: To determine the incidence, risk factors, and mortality rate of gastrointestinal complications in patients with acute spine injury and to derive methods by which mortality can be reduced. DESIGN: Case series. SETTING: Regional tertiary care center. PATIENTS: Consecutive sample of 1952 patients with acute spine injury with complete medical records who were admitted from 1981 through 1990. MAIN OUTCOME MEASURES: Gastrointestinal tract complications, age, sex, time from injury to admission, cause of injury, level of spine injury, neurologic deficit, head injury, injury to other organ systems, incidence of surgical intervention for spine injury, length of hospital stay, and mortality rate. RESULTS: The incidence of gastrointestinal complications was 1.9%. Gastrointestinal hemorrhage was the most frequent complication. Risk factors for gastrointestinal complications were increasing age (P < .02), male sex (P < .01), injury to other organ systems (P < .02), head injury (P < .02), cervical spine injury (P < .02), and neurologic deficit (P < .005). The mortality rate was 19% in patients with gastrointestinal complications, significantly greater (P < .005) than the 2.9% rate in patients without gastrointestinal complications. CONCLUSIONS: Gastrointestinal complications after acute spine injury are uncommon but frequently lethal. Prophylaxis against hemorrhage and earlier diagnosis and surgical intervention are recommended.

Adolescent↗
PubMed2002

Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi.

BACKGROUND: Human immunodeficiency virus (HIV) seropositive patients frequently experience upper gastrointestinal tract (GIT) symptoms that cause considerable morbidity and are due to multiple aetiologies. The role of Helicobacter pylori gastric mucosal infection in HIV related upper GIT morbidity is unclear. No data exist on the prevalence of H. pylori gastric mucosal infection and upper gastrointestinal endoscopic findings in HIV seropositive patients at the Kenyatta National Hospital. OBJECTIVES: The aim of the study was to determine the prevalence of H. pylori gastric mucosal infection and the pattern of upper gastrointestinal endoscopic findings in HIV seropositive patients. DESIGN: A hospital-based prospective case-control study. SETTING: Kenyatta National Hospital, Endoscopy Unit. SUBJECTS: Fifty two HIV seropositive patients with upper GIT symptoms were recruited (as well as 52 HIV seronegative age and gender matched controls). INTERVENTION: Both cases and control subjects underwent upper GIT endoscopy and biopsies were taken according to a standard protocol. H. pylori detection was done by the rapid urease test and histology, and H. pylori gastric mucosal infection was considered to be present in the presence of a positive detection by both tests; biopsies were also taken for tissue diagnosis and CD4+ peripheral lymphocyte counts were determined using flow cytometry. RESULTS: H. pylori prevalence was 73.1% [95% CI 59.9-83.8] in HIV positive subjects and 84.6% [95% CI 72.9-92.6] in HIV negative controls (p=0.230). Prevalence of H. pylori decreased with decreasing peripheral CD4+ lymphocyte counts. Median CD4+ lymphocyte count was 67 cells per cubic millimetre in HIV positive patients. On endoscopy, the most common lesion in HIV positive patients was oesophageal candidiasis (occurring in 51.9%), which was often associated with presence of oral candidiasis and, together with erosions, ulcers and nodules in the oesophagus, occurred exclusively in these patients. A few cases of cytomegalovirus and herpes simplex oesophagitis were seen, as were cases of upper GIT Kaposi's sarcoma, and one gastric lymphoma. CONCLUSIONS: H. pylori prevalence was not significantly different between HIV positive and HIV negative subjects, and decreased in HIV positive subjects with decreasing CD4+ cell counts. Oesophageal candidiasis was the most important endoscopic finding in HIV positive patients and was often associated with oral thrush.

AIDS-Related Opportunistic Infections↗