Changes In Small Bowel Research Articles

Sprue-like Intestinal Disease Induced by Checkpoint Inhibitor Immunotherapy

In recent years, immune checkpoint inhibitors have been increasingly used in cancer treatment with significant improvements in overall survival. A downside of these agents has been the emergence of novel intestinal diseases as reflected by development of diarrhea, sometimes severe, in at least 10%. In some, an immune-mediated enterocolitis may often develop. This may be severe, difficult to manage and result in a fatal outcome. Less well appreciated, however, are other less commonly detected forms of colitis, such as collagenous colitis, along with small bowel changes, specifically, sprue-like intestinal disease, apparently occurring as an independent inflammatory process. Taken together, these are likely to represent different pathological phenotypic expressions of treatment toxicity in the intestinal tract following management of cancer with checkpoint inhibitors.

Small-bowel mucosal changes in Egyptian cirrhotic patients with portal hypertension using capsule endoscopy versus single-balloon enteroscopy

BackgroundSmall-bowel mucosal abnormalities that may occur secondary to portal hypertension in patients with liver cirrhosis have an impact on health and quality of life. In spite of the importance of these changes, little is known about the frequency and features of small-bowel changes in cirrhotic patients with portal hypertension. Eighty cirrhotic patients with or without esophageal or gastric varices were recruited in this study as well as 60 age- and sex-matched controls. All study participants underwent capsule endoscopy. In addition, half of the patients and controls were randomized to receive single-balloon enteroscopy.ResultsThe prevalence of small-bowel mucosal changes was statistically significantly higher in cirrhotic patients than in controls; 57% versus 6.7%, respectively (p < 0.05). Cirrhotic patients with portal hypertensive gastropathy showed a significant increase in the small-bowel changes (p < 0.001). Small-bowel changes were significantly higher in patients with higher MELD and Child-Pugh scores (p < 0.001). Moreover, capsule endoscopy was more effective in the detection of small-bowel changes than single-balloon enteroscopy.ConclusionsMucosal changes associated with portal hypertensive enteropathy are more prevalent in cirrhotic patients, regardless of the presence or absence of gastric varices. Small-bowel mucosal changes in patients with portal hypertensive enteropathy were more common in patients who suffered from portal hypertensive gastropathy and were positively correlated with advanced chronic liver disease.

Assessment of portal hypertensive enteropathy in patients with liver cirrhosis

Background Portal hypertensive enteropathy remains difficult to diagnose in patients with cirrhosis and portal hypertension (PHT). Limited test choices exist for the inspection of the small bowel in these patients. Small-bowel endoscopy like double-balloon enteroscopy (DBE) is ideal in this situation but rarely performed. We aimed to determine the prevalence of portal hypertensive enteropathy using DBE in the patient population with PHT and correlate its presence with clinical, radiological, and histological findings. Patients and methods Thirty-two patients with PHT were included along with 10 controls without the criteria of PHT. All patients and control groups underwent blood tests, ultrasonography, gastroscopy, and enteroscopy. The small-bowel findings by DBE were categorized as inflammatory-like and vascular lesions. The small-bowel changes either endoscopically or histologically were analyzed to find out any association with various demographic, clinical, ultrasonographic, and endoscopic variables. Results The frequency of portal enteropathy in our study was 65.6% (21 patients out of 32) and it had positive correlation with the presence of esophageal varices, PHG, and Child-Pugh score. We found that there is statistically significant difference between the results of histology among patients and control groups not only in the jejunal specimen but also in the gastric and duodenal ones. The correlation with the endoscopic picture was statistically not significant. Conclusion Small-bowel mucosal and vascular changes related to PHT were seen in a significantly higher number of patients with cirrhosis and PHT.

The Correlation between Endoscopy Manifestations and Pathology Outcome for Diagnosis of Celiac Disease

Background: Celiac disease (CD) is one of the most common genetically based disease. Histological confirmation of the characteristic small bowel changes is currently considered the gold standard to establish diagnosis of CD in patients with positive antibody testing. The aim of this study is to determine the correlation between endoscopy manifestations and pathology outcome for diagnosis of CD. Materials & Methods: A total of 295 consecutive patients who were referred to our endoscopy section from March 2015 through March 2016 were enrolled into the study. All patients were underwent endoscopy, 4 biopsies were taken and their results were compared with pathology features. The relationship between age, sex, and pathology features and endoscopy manifestations were evaluated. Results: The mean age of the subjects was 46.7±15.5 years of which 147(49.8%) were female, and 148(50.2%) were male. No statistically significant correlation was showed between the age and gender with pathology features and endoscopy manifestations (pConclusions: Our data showed that endoscopy results are not specific for CD diagnosis, and biopsy should be collected in patients with suggested symptoms associated with the disease and regardless to endoscopic features.

Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology

Bleeding from small intestinal ectopic varices and persistent anemia caused by portal hypertensive enteropathy (PHE) can be very challenging. Capsule endoscopy (CE) is one of the best noninvasive modalities in identifying such lesions. The aims of this study are to study the prevalence of small-bowel changes related to portal hypertension (PHT) and to correlate them with the observations related to the effects of portal hypertension in the esophagus, stomach, and colon. Thirty-two patients with various etiologies of PHT with either anemia or gastrointestinal bleed were included along with age- and sex-matched controls without PHT. All patients underwent blood tests, gastroscopy, colonoscopy, and CE. The small-bowel findings by CE were categorized as inflammatory-like and vascular lesions. The small-bowel changes were analyzed to find out any association with various demographic, clinical, and endoscopic variables. Thirty-one out of 32 patients with PHT (96.8%) had PHE identified by CE. Of them, 31 (96.8%) had inflammatory-like appearance, 11 (34.4%) had vascular lesions, and 2 (6.2%) had small-bowel varices. Inflammatory-like appearance was noted in eight (25%) and angiodysplastic lesions in two (6.2%) controls. Findings compatible with PHE were detected in 96.8% of the patients and 25% of the controls (X 2 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables. Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.

Alcohol and Alzheimer's Disease-Does Alcohol Dependence Contribute to Beta-Amyloid Deposition, Neuroinflammation and Neurodegeneration in Alzheimer's Disease?

To investigate the underlying neurobiology between alcohol use, misuse and dependence and cognitive impairment, particularly Alzheimer's disease (AD). Review of the literature using searches of Medline, Pubmed, EMBASE, PsycInfo, and meeting abstracts and presentations. The role of alcohol as a risk factor and contributor for cognitive decline associated withAD has received little attention. This is despite the high prevalence of alcohol use, the potential reversibility of a degree of cognitive impairment and the global burden of AD. Until now the focus has largely been on the toxic effects of alcohol, neuronal loss and the role of thiamine. We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation. We describe the common underlying neurobiology in alcohol and AD, and examine ways alcohol likely contributes to neuroinflammation directly via stimulation of Toll-like receptors and indirectly from small bowel changes, hepatic changes, withdrawal and traumatic brain injury to the pathogenesis of AD. Alcohol use, misuse and dependence cause cognitive impairment. We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance ofAD pathology via neuroinflammation.

Now You See Me, Now You Donʼt: A Case of the Recurring Liver Lesions in Crohnʼs Disease

A 41 year old woman with history of stable colonic Crohn's disease on mesalamine, psoriasis, and celiac disease, presented with subacute substernal pleuritic chest pain. MRI abdomen showed greater than 20 left liver lobe lesions with ill-defined borders. Liver biopsies demonstrated focal fibrosis and cholangiolar proliferation suggestive of focal nodular hyperplasia. Three months later, she presented for a Crohn's flare confirmed with colonoscopy and initiated on prednisone with a slow taper with relief of her symptoms. Surveillance MRI 6 months after presentation revealed complete resolution of previously seen liver lesions. She remained asymptomatic for another 6 months, until she returned with subacute symptoms of fever/chills, abdominal pain, bloody diarrhea and associated leukocytosis with elevated ESR. She was initiated on prednisone taper given concern for Crohn's flare however her symptoms did not improve, prompting CT enterography which revealed abnormal liver lesions without obvious small bowel changes. Imaging showed at least 10 hypodense lesions (largest 6 x 4 cm) throughout the liver resulting in multiple CT guided drainages along with liver biopsies. Pathology demonstrated multiple areas of necrotic tissue with fibrotic walls with reactive spindled cells and occasional multi-nucleated giant cells suggestive of pyogenic liver abscesses. Microbial cultures on these specimens including bacterial, fungal, and acid-fast were all repeatedly negative. She was discharged with an antibiotic course and maintained on prednisone indefinitely (patient refused escalation of maintenance therapy) in addition to mesalamine. Surveillance MRI 6 months after discharge shows complete resolution of previously seen liver lesions. This case exemplifies a rare extraintestinal complication of inflammatory bowel disease presenting as recurrent liver lesions in Crohn's disease. Although prevalence of this entity is unknown, about 60 cases have been reported, the majority of which were found in active Crohn's disease. Abscess cultures are positive in most cases, however for our patient her infectious workup proved negative. It was only after aggressive management of her Crohn's disease with the addition of steroid therapy did her lesions dramatically resolve.

Pretreatment with endothelium-derived nitric oxide synthesis modulators on gastrointestinal microcirculation during NOTES: an experimental study.

On-demand endoscopic insufflation during natural orifice transluminal endoscopic surgery (NOTES) adversely affects microcirculatory blood flow (MBF), even with low mean intra-abdominal pressure, suggesting that shear stress caused by time-varying flow fluctuations has a great impact on microcirculation. As shear stress is inversely related to vascular diameter, nitric oxide (NO) production acts as a brake to vasoconstriction. To assess whether pretreatment by NO synthesis modulators protects gastrointestinal MBF during transgastric peritoneoscopy. Fourteen pigs submitted to cholecystectomy by endoscope CO2 insufflation for 60min were randomized into 2 groups: (1) 150mg/kg of N-acetyl cysteine (NAC, n=7) and (2) 4ml/kg of hypertonic saline 7.5% (HS, n=7), and compared to a non-treated NOTES group (n=7). Five animals made up a sham group. Colored microspheres were used to assess changes in MBF. The average level of intra-abdominal pressure was similar in all groups (9mmHg). In NOTES group microcirculation decrease compared with baseline was greater in renal cortex, mesocolon, and mesentery (41, 42, 44%, respectively, p<0.01) than in renal medulla, colon, and small bowel (29, 32, 34, respectively, p<0.05). NAC avoided the peritoneoscopy effect on renal medulla and cortex (4 and 14% decrease, respectively) and reduced the impact on colon and small bowel (20% decrease). HS eliminated MBF changes in colon and small bowel (14% decrease) and modulated MBF in renal medulla and cortex (19% decrease). Neither treatment influenced mesentery MBF decrease. Both pretreatments can effectively attenuate peritoneoscopy-induced deleterious effects on gastrointestinal MBF.

Endoscopically Evident Celiac Disease With Negative Pathology: A Case Report

Introduction: Two criteria must be fulfilled for the diagnosis of celiac disease: Evidence of typical pathological changes of untreated disease in biopsies from the proximal small bowel and sufficient evidence that clinical and/or pathological changes are gluten-dependent. Pathological abnormalities of celiac disease include small bowel mucosal architectural abnormalities with both epithelial cell and lymphoid cell changes, including intraepithelial lymphocytosis. Although these findings are the characteristic of celiac disease, they are not specific due to other conditions may present with similar changes, thereby making celiac disease more difficult to diagnosis. We report a rare case of celiac disease with endoscopic and serology evidence but negative pathology. Case: 26 year-old female with past medical history of proctosigmoid ulcerative colitis treated with mesalamine who presented with diarrhea. Her mesalamine was changed to delayed-release mesalamine and scheduled for endoscopy. The endoscopy showed scalloping and patchy erythema in the second part of the duodenum. Biopsies were obtained with cold biopsy forceps in the 1st and 2nd duodenum. Pathology revealed fragments of benign small intestinal mucosa with no villous atrophy or intraepithelial lymphocytosis. Given the endoscopic findings, a celiac serology was obtained and showed a high titer of endomysial antibody IgA and tissue transglutaminase antibody IgA. Therefore, the patient was diagnosed with endoscopic and serologic celiac disease with negative pathology. She was started on a gluten-free diet with improvement in her symptoms. Discussion: Celiac disease has common and uncommon presentations. Physicians should be aware many important aspects of celiac disease including presentations, endoscopic changes, biopsy preparation and handling, classical celiac disease on pathology, occult and latent celiac disease, other causes of small bowel changes that may mimic celiac disease. This case represents a rare pathology negative celiac disease.

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography.

Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population.

Resveratrol attenuates both small bowel and liver changes in obstructive jaundice.

It is well known that mucosal changes and alterations in liver function occur in the experimental obstructive jaundice model. We aimed to evaluate the effect of resveratrol on obstructive jaundice-induced changes in the small bowel mucosa and liver using ischaemia-modified albumin as a marker of oxidative damage. Animal experimentation. The study used a rodent experimental model of obstructive jaundice, including a sham group (1), a control group (2), and a study group (3). Wistar albino rats were used. Jaundice was produced by ligation of the bile duct in Groups 2 and 3. In Group 3, resveratrol was administered intraperitoneally for 14 days. In terms of the structure and the size of the mucosal villi, significant thickening and blunting were detected in Group 2 compared with Group 1. These changes were significantly less noticeable in Group 3 compared with Group 2. Levels of ischaemia-modified albumin were significantly higher in Group 2 compared with those in Group 1, and they were significantly decreased in Group 3 compared with Group 2. Resveratrol administration to obstructive jaundiced rats reduced the organic effects of obstructive jaundice on small bowel mucosa and liver oxidative stress. We believe that this reduction might attenuate bacterial translocation and systemic effects of secreted cytokines.

Chronic abdominal pain with a difficult diagnosis

A 74-year-old man attended our gastroenterology outpatient clinic with hipogastric aching pain for the past 5 years associated with recent worsening of chronic constipation. Physical examination as well as abdomino-pelvic ultrasound and colonoscopy was unremarkable. Anti-antispasmodics and dietary measures did not improve the clinical condition. For this reason, we performed an abdomino-pelvic computed tomography (CT) scan which showed thickening of the terminal ileum. The patient repeated colonoscopy with ileoscopy and regular hogback in the terminal ileum was observed that could not be overcome, lined by normal mucosa. It was biopsed, but histologic examination was normal. The entero-resonance was suggestive of nonspecific mesenteritis, but did not reveal changes in small bowel. Serologies to Crohn’s disease and celiac disease were negative. A video capsule enteroscopy was performed which revealed diffuse pattern of linfagiectasia and segmental pseudopolypoid whitish areas in jejunum and ileum (Fig. 1). Through push enteroscopy (Fig. 2) with a pediatric colonoscope, biopsies of proximal jejunum were taken. Microscopic examination demonstrated neoplastic proliferation of lymphoid tissue with follicular pattern (Fig. 3). The tumor cells were positive for CD20, CD10, BCL2, BCL6 and negative for CD3, CD5, CD23, and 5 blasts per high power field were observed. Based on these findings, a diagnosis of follicular lymphoma grade 1 was established.

A Very Rare Case of Chylous Ascites

Purpose: Case Report: 62 y/o gentleman with obesity was referred to the hepatology clinic with 3-month history of diarrhea, new onset ascites and 75 lb weight loss. He denied alcohol abuse, chronic liver disease or family history of liver disease. Diarrhea was non-bloody, watery, occurred 20 X per day, awakened him at night and persisted despite fasting. Stool studies were negative. Paracentesis returned chylous ascites. Serum ascites albumin gradient was >1.1 with fluid protein of 3.3 g/dL and cholesterol >1000 g/dL. Labs showed AST 88 U/L, ALT 47 U/L and elevated alkaline phosphatase (AP) level of 155 U/L, INR 1.3. CT scan of abdomen/pelvis revealed hepatomegaly. Colonoscopy with random biopsies were unrevealing. Terminal ileum and appendix were grossly normal. CT scan guided liver biopsy confirmed suspicions of carcinoid. Octreotide scan located a primary small bowel neoplasm in the mid-abdomen with two liver metastatic lesions. Upon further review of the initial CT scan, jejunal non-specific narrowing was found with subtle small bowel dilation. Discussion: Carcinoids are rare neuroendocrine tumors arising from amine precursor uptake and decarboxylation (APUD) cells. Chylous ascites or leakage of lipid rich lymph is also rare with incidence of approximately 1 in 20,500. Majority of cases are due to inflammatory processes, trauma and congenital causes. The association between carcinoid tumors and chylous ascites is extremely rare and has only been reported in a few case studies. Carcinoid induced chylous ascites is thought to occur either from obstruction of lymph nodes by tumor or the intense mesenteric reaction blocking uptake of peritoneal fluid. Survival studies have demonstrated poor prognosis in patients whose carcinoid induced chylous ascites is a component of their symptoms compared to those patients who had metastatic carcinoid tumor without ascites. Carcinoid should be considered in the differential diagnosis in patients with diarrhea and chylous ascites. Subtle small bowel changes may be missed. Octreotide scan is still an important tool in diagnosing primary carcinoid tumor.Figure: Jejunal non-specific narrowing was found with subtle small bowel dilation.

Manifestations of small bowel disease in pediatric Crohnʼs disease on magnetic resonance enterography

We report the manifestations of Crohn's disease (CD) observed on magnetic resonance enterography (MRE) in a pediatric population at the time of CD diagnosis. MRE of 95 consecutive pediatric patients with inflammatory bowel disease (IBD) examined in 2006-2009 were retrospectively analyzed, with documentation of findings based on type and location of the small bowel (SB) disease. In all, 51 were boys and 44 girls. 54 had CD, 31 non-CD IBD, and 10 no IBD. The most common site of SB involvement in CD was the terminal ileum seen in 29 (53.7%) patients, followed by ileum in 10 (18.5%) and jejunum in 9 (16.7%) patients. Solitary jejunal inflammation (3.7%), SB stenoses (1.9%), fistula formation (0.95%), and abscess (0.95%) were much less common. Perienteric lymphadenopathy was seen in 30 (55.6%) patients and fatty proliferation in 9 (16.7%). The most common manifestation of SB inflammation was increased contrast enhancement of bowel wall (93.5%), thickening of the bowel wall (90.3%), and derangement of bowel shape with saccular formations (25.8%). MRE in the pediatric population often demonstrates increased contrast uptake, bowel wall thickening, and perienteral lymphadenopathy in CD. More chronic small bowel changes seen commonly in adults and solitary jejunal involvements are less commonly seen.

Influence of Dietary Habits on the Risk of Inflammatory Bowel Disease: A Case Control Study

Introduction: At the Los Angeles County University of Southern California Medical Center (LAC+USC) we service an inflammatory bowel disease (IBD) clinic for a low economic population. We evaluated the frequency of the types of IBD and identified risk factors associated with ulcerative colitis (UC) versus Crohns disease (CD). Methods: This is a retrospective, cross-sectional review of patients with the diagnosis of IBD including UC, CD or indeterminate colitis that were seen at the Roybal Comprehensive Health Clinic between 1/01/2004 through 12/31/2009. Ulcerative colitis was defined as a continuous inflammation of the colon involving the distal rectum and with architectural distortion on histology. Crohn's disease was defined by characteristic small and large bowel changes on imaging studies and/or segmental colitis in untreated patients on colonoscopy. Using an IBD database, ICD-9 diagnosis codes, electronic medical records, and the Clinical Outcomes Research Initiative (CORI) system, the type of colitis, extent of disease, and demographic information were obtained. Univariate and stepwise multivariate analysis were performed. Results: A total of 287 patients with IBD were identified. The frequency of UC in this population was 68% (196/287); (95% Confidence Interval (CI): 63%-74%); CD 24% (70/287); (95% CI; 19%-29%); and indeterminate colitis (IC) 7% (21/287); (95% CI: 4-10). In the 266 patients with UC or CD, 55% were male, 65% over 30 years of age, 69% Hispanic, 12% African American (AA), 9% Asian and 9% non-Hispanic American. Sixty-one percent were immigrants and 52% were from Latin America. We did not include in the analysis education, history of smoking and family history of IBD because of the high percentage of missing data 37, 30 and 47% respectively. Table 1 provides the association of each risk factor with UC vs CD. Stepwise logistic regression yielded two significant independent risk factors: AA ethnicity [adjusted OR: 0.34; 95% CI: 0.15, 0.77; p=0.01] and immigrant [adjusted OR: 2.16; 95% CI: 1.19, 3.94, p=0.01). The R-squared for AA was 7% and that for immigrant was 3%. These two factors explained 10% of the variation between UC and CD. Conclusion: In the LAC+USC IBD clinic which serves low socioeconomic patients, there is a 3 to 1 ratio of UC to CD. Immigrant and non-African American ethnicity are predictive of UC whereas non-immigrant and African American ethnicity are predictive of CD.

Inflammatory Bowel Disease in a Low Socioeconomic Population

Introduction: At the Los Angeles County University of Southern California Medical Center (LAC+USC) we service an inflammatory bowel disease (IBD) clinic for a low economic population. We evaluated the frequency of the types of IBD and identified risk factors associated with ulcerative colitis (UC) versus Crohns disease (CD). Methods: This is a retrospective, cross-sectional review of patients with the diagnosis of IBD including UC, CD or indeterminate colitis that were seen at the Roybal Comprehensive Health Clinic between 1/01/2004 through 12/31/2009. Ulcerative colitis was defined as a continuous inflammation of the colon involving the distal rectum and with architectural distortion on histology. Crohn's disease was defined by characteristic small and large bowel changes on imaging studies and/or segmental colitis in untreated patients on colonoscopy. Using an IBD database, ICD-9 diagnosis codes, electronic medical records, and the Clinical Outcomes Research Initiative (CORI) system, the type of colitis, extent of disease, and demographic information were obtained. Univariate and stepwise multivariate analysis were performed. Results: A total of 287 patients with IBD were identified. The frequency of UC in this population was 68% (196/287); (95% Confidence Interval (CI): 63%-74%); CD 24% (70/287); (95% CI; 19%-29%); and indeterminate colitis (IC) 7% (21/287); (95% CI: 4-10). In the 266 patients with UC or CD, 55% were male, 65% over 30 years of age, 69% Hispanic, 12% African American (AA), 9% Asian and 9% non-Hispanic American. Sixty-one percent were immigrants and 52% were from Latin America. We did not include in the analysis education, history of smoking and family history of IBD because of the high percentage of missing data 37, 30 and 47% respectively. Table 1 provides the association of each risk factor with UC vs CD. Stepwise logistic regression yielded two significant independent risk factors: AA ethnicity [adjusted OR: 0.34; 95% CI: 0.15, 0.77; p=0.01] and immigrant [adjusted OR: 2.16; 95% CI: 1.19, 3.94, p=0.01). The R-squared for AA was 7% and that for immigrant was 3%. These two factors explained 10% of the variation between UC and CD. Conclusion: In the LAC+USC IBD clinic which serves low socioeconomic patients, there is a 3 to 1 ratio of UC to CD. Immigrant and non-African American ethnicity are predictive of UC whereas non-immigrant and African American ethnicity are predictive of CD.

Capsule endoscopy in patients with suspected Crohn's disease – is the PillCam worth the swallow?

IntroductionCapsule endoscopy (CE) has developed an important role in the investigation pathway of patients with suspected Crohn's disease. However there is paucity of data on the long term outcome in...

* Can we categorise patients with inflammatory bowel disease unclassified (IBDU) wirelessly?

IntroductionCapsule endoscopy (CE) has developed an established role in the investigation of patients with Crohn's disease. However, there remains a paucity of published literature on the use of CE in...

Impact of capsule endoscopy on management in patients with established crohn's disease-experience from a single tertiary centre

IntroductionCapsule endoscopy (CE) has developed a pertinent role in the management of patients with Crohn's disease, however there is a paucity of literature assessing the long term impact of CE....

Is portal hypertensive enteropathy an important additional cause of blood loss in portal hypertensive patients?

Objective. Recently, mucosal changes of small bowel were defined by developing new imaging techniques including capsule endoscopy (CE) in portal hypertensive patients. However, the clinical impact of these changes is unknown. In this study, we aimed to determine the additional cause of blood loss in portal hypertensive patients. Material and methods. A total of 444 portal hypertensive patients, hospitalized in our clinic between 2005 and 2007, were evaluated. Patients with obscure bleeding were enrolled to this prospective case–control study. CE was performed in 21 patients who met inclusion criteria. Gastroscopy, colonoscopy and computerized tomography/small bowel enema were performed in all patients. Results. Fourteen cirrhotic and seven noncirrhotic portal hypertensive patients were enrolled to this study. Mean age of patients was 47.9 ± 15.6 years, and 13 of 21 were male. Small bowel varices were found in 7 patients (1 active bleeding) and other mucosal abnormalities in 10 patients (vascular ectasia, erosion and edema, 1 active bleeding). Although two of them were normal, jejunal malignant mass was found in two patients (1 active bleeding). Of 21 patients, 19 (90.5%) patients had portal hypertensive abnormalities (including varices). However, ileal varices rate was 57.1% (4 patients) in noncirrhotic portal hypertensive patients and 21.4% (3 patients) in cirrhotics. Conclusion. Ninety percent of patients had portal hypertensive abnormalities in small bowel and one-third of them had small bowel varices. Small bowel varices and vascular ectasia were the main causes of obscure bleeding in portal hypertensive patients.