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PubMed1987

Exocrine pancreatic function in dyspepsia.

The prevalence of pancreatic diseases as the cause for dyspepsia differs in clinical materials between 0 and 25-30%. In parallel, the incidence rate of chronic pancreatitis varies between 0.7 and 10 per 100,000 inhabitants per year. The correct figures are unsettled. The main reason for the great variability in figures for frequency of chronic pancreatitis is probably the different clinical awareness and variable practice for performing morphological and functional studies of the pancreas in patients with dyspepsia. Epidemiologic data indicate, but do not prove, an increasing frequency of chronic pancreatitis at least valid for the alcoholic chronic pancreatitis. Pancreatic function and pancreatic disease are probably connected to different gastro-intestinal diseases (duodenal ulcer, inflammatory bowel diseases, malabsorption syndromes, subtotal and total gastrectomy and to some extent in patients with hepatobiliary diseases). The prevalence of chronic pancreatitis can be calculated to around 70 per 100,000 inhabitants in the Western world. Around one-third of these present with exocrine pancreatic insufficiency. The demand for enzyme substitution based on marked exocrine pancreatic insufficiency in patients with chronic pancreatitis, pancreatic cancer and mucoviscidosis can be calculated to approximately 150 patients per 1 million inhabitants. The question concerning the analgetic effect of pancreatic enzyme substitution is still unsettled.

Chronic Disease↗
PubMed1991

Plasma postheparin diamine oxidase in patients with small intestinal lymphoma.

Diamine oxidase (DAO) is an enzyme located almost exclusively in villus tip enterocytes. Its plasma activity is enhanced by intravenous heparin which releases the enzymes from small bowel enterocytes into the blood. Plasma postheparin DAO (PHD) values have been shown to be significantly lower in patients with malabsorption and villous atrophy, thus suggesting that PHD reflects the mature enterocytic mass. In this study we have assayed PHD in five patients with small bowel lymphoma (two with immunoproliferative small intestinal disease [IPSID] and three with non-IPSID lymphoma) associated with malabsorption syndrome and small bowel mucosa atrophy. The PHD test was performed at diagnosis, after partial or complete remission induced by chemotherapy, and during the follow-up. The PHD values, very low at diagnosis (0.66 +/- 0.12 U/ml), increased during chemotherapy and reached the normal range (greater than 3.7 U/ml) when complete remission occurred. The PHD values rapidly and consistently decreased whenever the disease relapsed. Our data indicate that in patients with small bowel lymphoma PHD test is a sensitive marker of small bowel mucosa damage and suggest that it could be useful in monitoring the recovery of mucosal lesions induced by chemotherapy.

Adolescent↗
PubMed2001

Campylobacter reporting at its peak year of 1998: don't count your chickens yet.

Infections due to Campylobacter spp. are the most commonly reported bacterial cause of human gastrointestinal illness, and reports of campylobacteriosis in the UK and other temperate countries have been increasing. An all-time peak of 58,059 cases of campylobacter infectious intestinal disease (IID) were reported to the Communicable Disease Surveillance Centre in 1998. An analysis of the age, gender and seasonal and geographical distribution of cases reported in 1998 is presented here, together with population-based estimates of reported incidence. The frequency of reports was highest in late Spring. Reported incidence was highest in males under 1 year of age (214/100,000 population), with a secondary peak in adults aged 25 to 34 years (140/100,000 population). Reported incidence was higher in males than females for all age groups. The highest reported incidence occurred in the South West region (140/100,000 population), while the lowest was observed in London (54/100,000 population). Campylobacter is a major cause of human gastrointestinal illness. Work towards its control must be a priority if the burden of human infectious intestinal disease is to be reduced.

Adult↗
PubMed2006

Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases.

Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied. This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There were 16 consecutive children and adolescents (12 boys, 4 girls) and 15 adults (9 men, 6 women) referred to us for suspected small bowel diseases from August 2002 to September 2005. Among the pediatrics, six patients were less than 10 years old. Technique for capsule placement, gastric transit time, small bowel transit time, excretion time of capsule endoscopy, capsule findings, and complications were recorded. All 16 pediatric patients described that the capsule was easy to swallow except for three children. Finally we delivered the capsule under gastroscopy with overtube for these three children. No capsule retention occurred during our study. Median recording time was 7 h 44 min (range 6 h 51 min-9 h 11 min). Median gastric transit time was 83.5 min (range 4-296 min). Median small bowel transit time was 270 min (range 142-484 min). Median excretion time of capsule was 33.9 h (range 12-96 h). There was no significant difference in excretion time of capsule, gastric transit time and small bowel transit time between pediatric patients and adult patients (P > 0.05). CE was positive in 12 patients, including Crohn's disease (4), hemangioma (2), angiodysplasia (2), Meckel diverticulum (1), polyp (1), aphthous ulcer in ascending colon (1), and cobblestone appearance of ileal mucosa. CE has been performed safely in a small series of pediatric patients after ingestion or endoscopic placement of the capsule. The high yield of abnormal findings was comparable to those of adult patients.

Adolescent↗
PubMed2000

Equine lymphocytic-plasmacytic enterocolitis: a retrospective study of 14 cases.

Lymphocytic-plasmacytic enteritis (LPE) is a morphological diagnosis given to a type of infiltrative intestinal disease classified within the complex of idiopathic inflammatory bowel disease (IBD). The purpose of this retrospective study was to describe the details of breed, age and sex, clinical and clinicopathological findings and outcome of horses diagnosed with LPE. Data were reported from 14 horses that had a histopathological diagnosis of LPE; the median age was 12 years, and there was no breed or sex predilection. Common clinical signs were weight loss (100%), diarrhoea (50%) and lethargy (50%). Hypoproteinaemia and hypoalbuminaemia were present in 6/13 (46%) and 9/12 (75%) horses, respectively. Results of the oral glucose tolerance tests or D-xylose absorption tests were abnormal in 9/12 (75%) horses and rectal mucosal biopsies were abnormal in 3/7 (43%) horses. Corticosteroid treatment was used unsuccessfully in 4 horses. All horses were subjected to euthanasia and LPE was diagnosed at necropsy. Diffuse thickening of the small intestine was apparent grossly in 10/13 (77%) horses examined. LPE is an uncommon equine intestinal disease that is difficult to diagnose antemortem and has a poor prognosis.

Adrenal Cortex Hormones↗
PubMed2003

Natural history of intestinal failure, investigated through a national network-based approach.

OBJECTIVES: Intestinal failure (IF) is a condition whose treatment requires advanced knowledge and techniques and a multidisciplinary approach. Intestinal failure is the endpoint of many intestinal diseases and may result in full recovery, in life-long parenteral nutrition, or in the death of the child. The aim of this study was to evaluate the natural history of IF in children using a national network of resources. METHODS: Italian centers of pediatric gastroenterology merged in a national network, developing a collaborative management approach for children with IF. A consensus definition of IF was achieved. A database was set up to investigate the cause, epidemiologic factors, and natural history of IF. RESULTS: One hundred nine children were enrolled in 5 years. The cause of IF was: short bowel syndrome (n = 48), disorders of motility (n = 16), structural enterocyte defects (n = 14), multiple food intolerance (n = 10), autoimmune enteropathy (n = 7), and others or unknown (n = 14). The eventual outcome was closely related to the primary cause, ranging from full and permanent intestinal sufficiency in children with multiple food intolerance to high death rate or total dependance upon parenteral nutrition in those with structural enterocyte defects. Intermediate outcomes were observed for the other causes. Four children received intestinal transplantation. CONCLUSIONS: The network approach for IF provides an effective model to optimize resources and to investigate prospectively the natural history of IF. Based on the work on this series, a European network for IF could be an effective model for fulfilling the diagnostic and management needs, including intestinal transplantation.

Adolescent↗
PubMed1984

[Amebic liver abscess--diagnostic and therapeutic advances].

Liver abscess is the most frequent complication of intestinal disease caused by entamoeba histolytica. Noninvasive procedures are nowaday most important in establishing the diagnosis: sonography, scintigraphy and computer tomography (CT). Sonography is rather precise and should be used in the first place. Recently it became possible to demonstrate specific antigens to amoeba in the pus of the abscess or in liver biopsy material; this procedure has been proven to be dependable and fast in establishing a diagnosis. Serological methods like indirect hemagglutination tests usually show positive results in high titers. The clinical picture, serological and immunological diagnostic procedures as well as demonstration of intrahepatic defects by sonography and/or scintigraphy usually help to establish a diagnosis fastly; only in a few cases will it be necessary to do computer tomography additionally. Metronidazole, tinidazole and other nitroimidazoles have led to a considerable decrease of lethality, which used to be rather high before. Treatment of the intestinal disease caused by amoebae should not be forgotten. Cortisone is contraindicated.

Humans↗
PubMed2000

Serum unconjugated bile acids as a test for intestinal bacterial overgrowth in dogs.

Small intestinal bacterial overgrowth (SIBO) has a high incidence in dogs and, as in humans, is difficult to diagnose. The aim of this study was to determine the diagnostic significance of serum unconjugated bile acid concentrations in dogs with bacterial overgrowth. Fasting sera were obtained from 23 dogs: 10 with culture-proven SIBO, 8 with indirectly diagnosed SIBO (normal pancreatic function but small intestinal disease associated with subnormal serum cobalamin and supranormal folate concentrations), and 5 healthy controls. Unconjugated bile acids were determined using gas chromatography-mass spectrometry after isolation by liquid-solid extraction and anion-exchange chromatography. Mean serum unconjugated bile acid concentrations were significantly elevated in dogs with SIBO (mean +/- SD: 0.91 +/- 1.03 micromol/liter), and in dogs with indirectly diagnosed SIBO (2.11 +/- 2.20 micromol/liter) compared to clinically healthy dogs (0.015 +/- 0.015 micromol/liter, P < 0.005). Cholic acid was the predominant unconjugated bile acid in the serum of dogs with SIBO. In conclusion serum unconjugated bile acid concentrations of healthy dogs are significantly lower than reported values for humans, and this fraction represents a relatively small proportion (0-2.3%; mean 0.8%) of the total bile acids in dogs. Unconjugated bile acids increased 10- to 20-fold in dogs with SIBO indicating the clinical utility of serum unconjugated bile acids for diagnosis of intestinal bacterial overgrowth in dogs.

Animals↗
PubMed1984

Radiologic examination of the small intestine: review of 402 cases and discussion of indications and methods.

An analysis of the records of 300 patients who had had 370 small-bowel radiologic examinations and a subsequent 102 patients examined by fluoroscopy and enteroclysis suggests that enteroclysis (small-bowel enema) is extremely valuable in the radiologic evaluation of small intestinal disease. Our results suggest that best results are obtained if the radiologist spends adequate time to participate in and observe the studies carefully. We believe that the fluoroscopic observation of low-density barium passing through distended small bowel gives a much clearer picture of its status than routine follow-through examinations. Disagreement exists concerning the choice of Sellink's method, using dilute barium, and Herlinger's technique, using a somewhat denser barium followed by methylcellulose. We prefer the latter. Enteroclysis probably should not be done in the presence of a high small-bowel obstruction because of the danger of reflux and aspiration. If intubation is unsuccessful, an oral study should be postponed until the effects of the topical anesthesia disappear. A controlled prospective study of the accuracy of fluoroscopic enteroclysis versus a good detailed independent follow-through examination is needed.

Barium Sulfate↗
PubMed1998

Increased cell proliferation characterizes Crohn's disease.

Patients with long-standing Crohn's disease (CD), a chronic inflammatory intestinal disease, are at increased risk for intestinal cancer. The neoplasia likely results, in part, from deregulated cell proliferation, which allows mutations to become fixed in the crypt progenitor cells. We postulated that tissues derived from patients with CD would exhibit increased mucosal proliferation. Therefore, we examined specimens from 27 consecutive patients with chronic CD with a monoclonal antibody directed against the proliferation marker, Ki-67. The tissues were evaluated histologically, and the Ki-67 immunostaining patterns were recorded. The antibody to Ki-67 stained the bases of the crypts in both the small and large intestines. The mean number of Ki-67 immunoreactive cells in the normal crypt was 34.1 versus 95.1 in the regenerative mucosa and O in areas of pyloric metaplasia (P < .00001). Ki-67 staining of the mucosa of patients with CD confirmed that cell proliferation is markedly increased and that the replicating compartment of each crypt during regeneration is expanded. We concluded that the increased cell proliferation might predispose the mucosa to mutational events, thereby increasing the cancer risk in these patients. The lack of proliferation in areas of pyloric metaplasia might represent a mucosal adaptive response of the lower crypt that decreases the number of cycling cells vulnerable to genetic damage. Furthermore, growth factors produced by these cells might promote healing of the damaged mucosa.

Adult↗
PubMedDate not supplied

[Necrolytic migratory erythema in Waldmann's disease].

BACKGROUND: We report a case of necrolytic migratory erythema in a patient with Waldmann's disease. PATIENTS AND METHODS: A 55-year-old male patient with a history of Waldmann's disease was hospitalized for a rash on the trunk and limbs comprising annular polycyclic lesions with peripheral scaling evocative of necrolytic migratory erythema. High-protein and fatty-acid-supplemented parenteral feeding led to rapid improvement of the patient's cutaneous lesions. DISCUSSION: Waldmann's disease is characterized by intestinal lymphatic abnormalities leading to exudative intestinal disease causing protein loss in the bowel lumen and deficient fatty acid absorption. The pathogenesis of necrolytic migratory erythema is not fully understood. Increased serum glucagon does not appear to be the only mechanism involved. The occurrence of necrolytic migratory erythema in a patient with Waldmann's disease supports the current physiopathological hypothesis of the role of decreased plasma protein and amino acid levels in necrolytic migratory erythema.

Dietary Fats↗
PubMed1988

Enteritis in cattle due to Yersinia pseudotuberculosis infection.

A selective medium was used to isolate Yersinia sp from the intestinal tract of 222 scouring cattle in Gippsland during 1985 and 1986. Intestinal infection with Y. pseudotuberculosis, particularly of serotype III, was found to be especially prevalent in weaned calves, yearlings and young adult cattle. Clinically affected cattle had a profuse liquid diarrhoea and many were systemically ill. Haematological changes suggestive of infection were present in 38 of 49 of these cattle. At least 35 cattle died and characteristic microabscesses were demonstrated in the intestinal mucosa of 20 of 26 examined histologically. Y. pseudotuberculosis was sensitive to tetracyclines in vitro and this drug produced a rapid bacteriological cure. Yersiniosis occurred during the winter, spring and early summer. Challenge of adult cattle with Y. pseudotuberculosis serotype III did not result in intestinal colonisation or clinical disease. Intestinal infection was, however, established in 4 weaned calves and haematological changes and antibody production were demonstrated in them. Intestinal microabscesses were seen in three calves killed on days 8, 14 and 18 after challenge. The fourth calf eliminated infection by day 18 and no lesions were demonstrated when it was killed on day 72. There is a very high prevalence of antibodies reacting with Y. pseudotuberculosis serotype III in adult cattle. It is concluded that cattle are a common host for this bacterium, infection being frequent, with clinical and fatal disease occurring occasionally. The factors leading to clinical disease are unknown.

Animals↗
PubMed1989

[Stenosing and perforated ulcers of the small intestine related to potassium chloride in enteric-coated tablets. Apropos of 11 cases].

The enteric coated KCl tablet formulation generates complications that affect selectively the small intestine. A novel 1 g KCl tablet preparation proved to be accountable for the development of a specific type of intestinal disease. 11 cases of stenotic ulcers of the proximal ileum have been treated at the Clinique chirurgicale "C" (CHRU, Nancy) since January 1986, 9 of them presenting with perforations. These 11 patients required potassium replacement, which was being supplied by the same tablet formula. A study of these 11 cases focusing on the patients history and clinical characteristics was carried out, that included both macroscopic and microscopic examinations of the lesions. Arterial and venous networks were visualized by X-ray in two surgical tissue specimens, respectively, following injection of contrast material. The authors were thus able to bring forth evidence of the clinical uniqueness (prodromal pain reminiscent of König's syndrome and peritonitis characterized by asthenia); to identify the main risk factor (i.e., reduced bowel movement); as well as describe the basic lesion (pylorus-like stenosis), and propound a novel theory concerning the etiology and the pathology of this condition. The observation of the aforementioned cases initiated a nation-wide, post-marketing pharmacological survey, which resulted, as did a similar investigation which had been carried out in the States, in the discontinuation of any treatment by this type of galenic form of the product.

Adult↗
PubMed2005

The role of video capsule endoscopy for evaluating obscure gastrointestinal bleeding: usefulness of early use.

BACKGROUND: We report our preliminary experience with the use of video capsule endoscopy (VCE) in 64 patients with obscure gastrointestinal bleeding (OGIB) and suspected small intestine disease. METHODS: To be eligible for VCE, patients had to have undergone upper endoscopy, small bowel series, and colonscopy without discovering any source of bleeding. To find the best timing to perform VCE, the patients were retrospectively divided in two groups of 32 cases each: group 1 with patients who had been submitted to VCE within 15 days from OGIB diagnosis, and group 2 with patients who had been submitted to VCE at least 15 days after OGIB diagnosis. RESULTS: Lesions were found by VCE in 29 (91%) in group 1: angioectasia-like lesions of the small bowel in 12, some erosions of the ileum without signs of bleeding in 14, a polyp with erosions in 1, and a bleeding site where the surgery showed a tumor of the ileum in 2 patients. In 2 cases, VCE missed showing two small tumors that were revealed by laparoscopy in 1 case and by push enteroscopy in the other. In group 2, lesions were found by VCE in 11 (34%): angioectasia-like lesions of the small bowel in 6, some erosions in 3, a short segmental stenosis in 1, and two polyps in 1. In 1 case, VCE missed showing a small polyp in the jejunum that was revealed by push enteroscopy. In none of these cases was a bleeding site identified. VCE was well tolerated and able to acquire good images in patients with OGIB. It showed lesions in 91% of the patients in group 1 and 34% of cases in group 2. CONCLUSIONS: Our data suggest that the optimal timing to perform VCE is within a few days after the occurrence of bleeding, possibly within 2 weeks.

Adult↗
PubMedDate not supplied

[Perianal manifestations in Crohn's disease].

UNLABELLED: A total of 114 of 195 patients with Crohn's disease had perianal involvement. The average age at the beginning of symptomatology was 30.3 years. The interval between symptoms and diagnosis was 3.1 years. PAC was associated with colonic disease and in these patients, was multiple. PAC preceded intestinal disease in 11 percent, was coincident in 66 percent and appeared later in 23 percent. Sixty one patients (53.5%) were operated on 104 times (1.7 operations per patient). None of these patients developed faecal incontinence. Two patients were treated with hyperbaric oxygenation. The association of perianal disease and extra-intestinal manifestation occurred in 76 patients. There was no association in 38 patients. Forty patients had extra-intestinal manifestation without perianal disease. Twenty two patients had panproctocolectomy because of perianal disease. Twenty one had a stoma, with or without intestinal resection. The stoma improved perianal symptoms, but all remain defunctioned. After mean follow-up of 8.8 years, 45 patients present some kind of perianal complication. CONCLUSION: the surgical treatment of perianal disease well indicated and performed don't result in incontinence; PAC combined with colonic or rectal disease is associated with higher need of performing a proctocolectomy or a defunctioning stoma. Only 22.8 percent presented resolution of perianal disease maintaining anal sphincter function.

Adolescent↗