Chronic Small Bowel Research Articles

Association of Intra-Abdominal Adhesions with Ultrasonographic Sliding Sign in Third Trimester Women Prior to a Repeated Cesarean Section

Abstract Background Adhesions are the most frequent complication following abdominal and pelvic surgery, developing after more than 90% of interventions concerning the abdominal cavity. Consequences include infertility, chronic pelvic pain and small bowel obstruction. Adhesions increase the complexity of future surgery by increasing the risk of urinary tract and intestinal injury, and by increasing the operative duration and thus the risk of blood loss. Objective To evaluate the efficiency of preoperative transabdominal ultrasonographic features in prediction of intra-abdominal adhesions in pregnant women during third-trimester with history of previous cesarean section surgery scheduled for a planned repeated elective C.S. delivery. Methods After ethical committee approval and informed consent from the patients, this prospective study was performed on total 200 third-trimesteric pregnant women with history of previous cesarean section who admitted for elective caesarian section and willing to participate in the study to investigate the value of the sonographic evaluation in predicting the intra-abdominal adhesions at tertiary care hospital at Ain Shams University Maternity Hospital from January 2023 till October 2023 and performed on total 200 patients who underwent elective caesarean delivery. Results The findings of our study demonstrated a good capability of a simple third-trimester transabdominal sonographic sign, the absence of sliding of the uterus, to predict the presence of intra-abdominal adhesions in women undergoing repeat CS. Conclusion We concluded that the real-time dynamic transabdominal ultrasound sliding sign is a non-invasive, well-tolerated technique. Its preoperative analysis in patients who have had previous abdominopelvic surgery may help to evaluate the risk of bowel or bladder injury and the complexity of the planned intervention, improving the safety of surgery, and may help to inform the anesthesiologist regarding the expected duration of the intervention and any potential complications during the procedure.

The primary nutritional approach in pediatric celiac disease: a mini-review

Background: Celiac disease (CD) is chronic small bowel inflammation with villous atrophy, consequently, an immune-mediated disorder triggered by ingesting Gluten in wheat, barley, and rye in genetically susceptible individuals. Aims: Summarize the fundamental principles for managing the diet of patients with CD. This Mini-Review using relevant articles in PubMed's online databases followed the medical keywords Celiac Disease, Gluten, gluten-free diet, nutritional approach, and diet adherence. The institution's Ethics Committee has waived the need to review the ethical aspects of this text. The cornerstone of the treatment is the lifelong adherence to a Gluten-Free Diet (GFD). This dietary regimen, which forms the basis of the patient's treatment, requires eliminating all food components containing Gluten and its derivatives from the diet. However, the treatment approach has changed from focusing on food avoidance to a wide-ranging evaluation of the various factors influencing the dietary choices in the patient's life. The Global Approach to the Follow-up of Celiac Disease is based on 1) control of symptomatology and dietary adherence; 2) improving emotional and social wellness in treating CD patients, with the active involvement of a psychologist; and 3) ensuring successful education of both the child and the family about its management. Indeed, the impact of CD extends beyond the patient and affects the well-being of caregivers and 4) evaluate socioeconomic burden, considering that Gluten-free food products remain significantly more expensive than gluten-containing equivalents with variable availability. So, the GFD is the primary treatment for CD, and difficulties in managing the Disease can lead to impaired Quality of Life. In conclusion, strict adherence to the GFD is imperative, requiring a multidisciplinary team involving physicians, dietitians, and psychologists on a regular visit schedule to assess dietary adherence and avoid long-term complications.

Efficacy of Lanreotide for management of patients with chronic small bowel obstruction receiving palliative home Parenteral Nutrition and patients with non-malignant chronic small bowel obstruction receiving home parenteral nutrition

Efficacy of Lanreotide for management of patients with chronic small bowel obstruction receiving palliative home Parenteral Nutrition and patients with non-malignant chronic small bowel obstruction receiving home parenteral nutrition

An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review.

Postoperative intraabdominal adhesions can occur after more than 90% of gynecologic surgeries. They not only cause chronic pelvic pain and small bowel obstruction, but are also one of the main reasons for infertility. Adhesions are not only a burden for the affected patients, but are also a burden for the healthcare system, since the treatment of adhesion-associated complications costs a considerable amount of money. The gold standard for the diagnosis of adhesions is by laparoscopy, although other methods, such as transvaginal hydro-laparoscopy, are being discussed as better alternatives. Ideally, adhesions are avoided inherently, by operating carefully and by using microsurgical principles. If this is not possible, gel barriers have been shown to be successful in reducing postoperative adhesions.

Abdominal Cocoon as a Rare Cause of Intestinal Obstruction: A Case Report

Abdominal cocoon is referred as a complete or partial small bowel encapsulation caused by dense fibrocollagen membranes leading to acute or chronic small bowel obstruction. It was first termed as peritonitis chronic fibrosain capsulata by Owtschinnikow in 1907 and finally abdominal cocoon by Foo in 1978 [1]. It is most commonly seen in adolescent girls of tropical and subtropical region though few cases of male have also been reported in literature [1,2].

Abdominal Cocoon Syndrome (ACS) or Idiopathic Sclerosing Peritonitis: An Extremely Rare Cause of Intestinal Obstruction

Introduction: Abdominal cocoon syndrome is an extremely rare cause of intestinal obstruction in which loops of small bowel are encapsulated by a fibro-collagenous membrane. This condition is also known in the literature as sclerosing peritonitis, and in the majority of cases, it has no known cause. The majority of patients exhibit long-standing signs and symptoms of partial intestinal obstruction. Presentation of case: A 15-year-old female patient presented with complete intestinal obstruction with no known co-morbidity and no history of prior laparotomy. Intraoperatively, the entire small bowel was found to be encapsulated by a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions with appendicectomy done at the same time. Discussion: Most patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops. Conclusions: Abdominal cocoon is a rare condition causing intestinal obstruction, and diagnosis requires a high index of suspicion because of the non-specific clinical picture. Contrast-enhanced CT-scan (CT) of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment, and the outcome is usually satisfactory.

Nutritional considerations in severe primary chronic small intestinal dysmotility.

To provide an update on the recent evidence underpinning the approach to nutritional care in patients with severe primary chronic small bowel dysmotility. Patients with severe chronic small intestinal dysmotility suffer nutritional and nonnutritional morbidity, both as a result of their underlying polysymptomatic, poorly understood condition and the interventions required. A proportion require artificial nutrition support; however, this is associated with impaired quality of life and associated complications. The approach to nutritional support must therefore engage a multidisciplinary team (MDT) to ensure that decisions to escalate beyond oral nutrition reflect individualised risk-benefit discussions while adopting a holistic approach to symptom management. Since nutritional outcomes are worse in those with the chronic intestinal pseudo-obstruction (CIPO) phenotype, differentiation into CIPO and non-CIPO subgroups, using a pragmatic diagnostic approach rather than invasive/poorly tolerated investigations, can be an important step in achieving nutritional care tailored to the individual. Malnutrition in patients with severe chronic small intestinal dysmotility is multifactorial. Early engagement of a broad team that includes dietitians, psychologists and pain management experts is crucial to achieving the most beneficial and least harmful patient-centred nutritional care outcomes.

Usefulness of laparoscopic surgery and preoperative examinations for chronic recurrent small bowel obstruction.

The aim of this study was to investigate the usefulness of laparoscopic surgery for patients with postoperative abdominal symptoms, including chronic recurrent small-bowel obstruction (SBO), and preoperative examinations of barium follow-through and computed tomography (CT) to predict the postoperative outcomes of laparoscopic surgery. Between 2016 and 2018, 49 patients with postoperative symptoms were treated by laparoscopic surgery at our institute. The data from two preoperative examinations were available for 42 patients. The patients were divided into 4 groups: CT-positive (CP, n = 18), barium follow-through-positive (BP, n = 1), both positive (AP [all positive] n = 13), and both negative (AN [all negative], n = 10). Among the 49 patients, 41 received pure laparoscopic surgery, 7 received laparoscopic-assisted surgery with mini-laparotomy, and 1 required conversion. Intra- and postoperative complications occurred in two and seven patients, respectively. Improvement of abdominal symptoms was observed in 40 patients. In terms of the medium-term outcomes, the rate of improvement of symptoms was poorer in the AN group than in the other three groups, but not to a significant degree. Laparoscopic surgery was safe and feasible for patients with chronic recurrent abdominal symptoms, including SBO. Furthermore, in patients with negative results on both preoperative examinations, laparoscopic surgery may yield only poor improvement of symptoms.

SURGICAL AND MEDICAL MANAGEMENT OF SEVER PID WITH PERITUBAL ADHESOLYSIS AND UTERINE LAPAROSCOPIC MYOMECTOMY AS SUCCESSFUL MANAGEMENT OF SECONDARY INFERTILITY

Adhesions are abnormal peritoneal fibrotic bands with varying degrees of stiffness that connect two surfaces that are normally separated in the peritoneal cavity. They are responsible for locating the inflammatory reaction when there is an infection or foreign body carrying oxygen to ischemic tissue [1]. Many serious complications may be associated to adhesions such as chronic pelvic pain and small bowel obstruction and are associated to dyspareunia and secondary infertility [2]. Adhesion formation occurs in 90% of abdominal and pelvic surgeries, with a lower incidence when the surgery is performed laparoscopically Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits.

Long-term Consequences of Pelvic Irradiation: Toxicities, Challenges, and Therapeutic Opportunities with Pharmacologic Mitigators.

A percentage of long-term cancer survivors who receive pelvic irradiation will develop treatment-related late effects, collectively termed pelvic radiation disease. Thus, there is a need to prevent or ameliorate treatment-related late effects in these patients. Modern radiotherapy methods can preferentially protect normal tissues from radiation toxicities to permit higher doses to targets. However, concerns about chronic small bowel toxicity, for example, still constrain the prescription dose. This provides strong rationale for considering adding pharmacologic mitigators. Implementation of modern targeted radiotherapy methods enables delivery of focused radiation to target volumes, while minimizing dose to normal tissues. In prostate cancer, these technical advances enabled safe radiation dose escalation and better local tumor control without increasing normal tissue complications. In other pelvic diseases, these new radiotherapy methods have not resulted in the low probability of normal tissue damage achieved with prostate radiotherapy. The persistence of toxicity provides rationale for pharmacologic mitigators. Several new agents could be readily tested in clinical trials because they are being or have been studied in human patients already. Although there are promising preclinical data supporting mitigators, no clinically proven options to treat or prevent pelvic radiation disease currently exist. This review highlights therapeutic options for prevention and/or treatment of pelvic radiation disease, using pharmacologic mitigators. Successful development of mitigators would reduce the number of survivors who suffer from these devastating consequences of pelvic radiotherapy. It is important to note that pharmacologic mitigators to ameliorate pelvic radiation disease may be applicable to other irradiated sites in which chronic toxicity impairs quality of life.

A Huge Retroperitoneal Large B-Cell Lymphoma Presenting as Chronic Small Bowel Obstruction: A Case Report

A Huge Retroperitoneal Large B-Cell Lymphoma Presenting as Chronic Small Bowel Obstruction: A Case Report

P155 THERAPEUTIC EFFECT OF OPS-2071 ON HEALING OF T CELL-MEDIATED COLITIS, A MURINE MODEL OF CROHN’S DISEASE, WITH ANTI-INFLAMMATORY AND ANTIBACTERIAL ACTIVITY

Abstract Background Crohn’s disease (CD) is a form of chronic inflammatory bowel disease (IBD). Although CD is an immune-mediated condition of unknown etiology, many studies suggested that abnormal immune responses against certain intestinal bacteria may trigger development of chronic inflammation. The T cell-mediated colitis model is a well characterized adaptive transfer murine model of chronic small bowel and colonic inflammation that resembles human CD (e.g., diarrhea, a heavily inflamed colon, loss of mucus from goblet cells, Th1/Th17 dominated cytokine profile). OPS-2071, a novel agent synthesized by Otsuka Pharmaceutical Co., Ltd, has broad and strong antibacterial activity with low systemic absorption. In this study, we have evaluated the therapeutic effect of OPS-2071 on murine T cell-mediated colitis and in vitro activity on T cell activation, cytokine production and antibacterial activity. Methods T cell-mediated colitis was induced via naive T cell (CD4+CD62L+CD44-) injection into T and B cell deficient recipient mice. Two weeks following T cell transfer, OPS-2071 or vehicle solution was administered orally for 3 weeks, followed by harvesting of colon tissue and assessment of efficacy evaluation by histological score and inflammatory index (colon weight/ length). In vitro inhibitory action for TNF-α production was assayed by ELISA using LPS-stimulated human peripheral blood cells. The effect on T cell activation and cytokine production (TNF-α, IFN-γ), was examined using human peripheral blood mononuclear cells and, mouse spleen which were stimulated by anti-CD2/CD3/CD28 antibody-loaded beads. In vitro activity against bacteria considered to be the cause of IBD was also tested. Results In the murine T cell transfer model, OPS-2071 significantly reduced both histological score (control: 9.2, OPS: 2.7, p<0.001) and inflammatory index (control: 54.7±2.2 mg/cm, OPS: 27.8±1.7 mg/cm, p<0.001) at a dose of 10 mg/kg. In the in vitro experiments, OPS-2071 suppressed TNF-a production produced by LPS in human whole blood dose-dependently. OPS-2071 also suppressed human and mouse T cell activation and cytokine production and suppressed T cell proliferation. At high OPS-2071 concentrations, these effects were comparable to prednisolone. The Minimum Inhibitory Concentration against IBD related bacteria for OPS-2071, ciprofloxacin, and metronidazole were 0.015 - 0.5, 0.25 - 8, and 0.03 - >128 mg/mL, respectively. Conclusion OPS-2071 demonstrated significant therapeutic effects on colon inflammation in the murine T cell-medicated colitis model, suppressed TNF-a production in vitro and showed in vitro activity against bacteria related to CD. The dual effect of anti-inflammatory effects and antibacterial activity of the novel agent OPS-2071 demonstrated in this study, provide rationale for exploring the impact of this compound on human CD in clinical trials.

Prevalence of Celiac Disease Autoimmunity in Ethiopian Pregnant Women: A Cross Sectional Study from the Oromia region

Celiac disease is a chronic small bowel disease induced by ingestion of gluten in genetically susceptible individuals affecting 1% among Caucasians in the Western world. The prevalence of celiac disease is still unknown in most developing countries, especially in Africa which suffer from lack of resources to perform screening of the general population. The aim of this study was to determine the prevalence of celiac disease autoimmunity in women undergoing antenatal care in selected Ethiopian health institutes. A total of 1942 pregnant women were included at median 25 (range 15-45) years of age who were attending antenatal care at 14 health centers of Central and South-East Oromia regional state of Ethiopia. Serum samples were analyzed for both IgA and IgG autoantibodies against tissue transglutaminase (tTG) using radioligand binding assays. Celiac disease autoimmunity defined as testing positive for both of IgA-tTG and IgG-tTG. In all, 4 of 1942 (0.2%) were positive for IgG-tTG of whom one participant (0.05%) was positive for both IgA-tTG and IgG-tTG and defined as having celiac disease autoimmunity. Based on these results, it was concluded that celiac disease autoimmunity is expected to be less common among the female adult Ethiopian population compared with the expected prevalence in Caucasians.

Outcome of laparoscopic intervention in acute and chronic small bowel obstruction

Introduction Major abdominal operations result in severe unpredictable scar tissue formation that may contribute to adhesions and then recurrent attacks of acute bowel obstruction, chronic abdominal pain, or both problems. Laparoscopic adhesiolysis provides good relief of symptoms in patients with chronic abdominal pain and/or acute bowel obstruction but without major previous abdominal surgery or severe peritonitis (necrosis or perforation). Early laparoscopic intervention for acute or chronic bowel obstruction has been tried many times worldwide but without complete data about the safety and outcome for both conditions. Patients and methods Between February 2017 and January 2019, a prospective randomized controlled study was done on 32 patients admitted for small bowel obstruction (14 patients with acute bowel obstruction and 18 patients with chronic small bowel obstruction). Patients selected for early laparoscopic adhesiolysis were those who had no preoperative finding of perforation, torsion, strangulation, or any clinical signs or radiological evidences of peritonitis. The outcome of the study was evaluated depending on length of postoperative hospital stay, enteral nutrition, 30-day mortality, positive bowel movement and stool passage, the length of sick leave (return to work), and recurrence of bowel obstruction during the 2-year follow-up. Results A total of 32 patients with a diagnosis of small bowel obstruction were identified and divided into two groups. Group A included 18 patients with chronic bowel obstruction who were treated with laparoscopic adhesiolysis, and group B included 14 patients having acute intestinal obstruction who were treated with laparoscopic adhesiolysis. The follow-up period was ∼24 months. Conclusion Laparoscopic adhesiolysis is a safe and effective management option for patients with prior abdominal surgery with acute or chronic abdominal pain or recurrent bowel obstruction.

Rare Case of Chronic Diarrhoea in an Immunocompetent Host

Chronic diarrhoea is one of the common presenting symptoms of patients attending gastroenterology clinics. Cyclosporacayetanensis is a protozoan parasite causing intestinal infections. Most of these infections are self-limiting in immunocompetent individuals. However prolonged course of infection is often observed in immunocompromised individuals and rarely in normal individuals. In our case report, 50-year-old patient from west Bengal, India presented with chronic small bowel type of diarrhoea with significant weight loss. Serology for HIV was negative. Endoscopic biopsy from duodenum showed villous atrophy and crypt hyperplasia mimicking sprue with presence of oval round structures within parasitophorous vacuoles located in the supra nuclear cytoplasm of enterocytes, consistent with cyclospora infestation. Same biopsy also showed CMV inclusion bodies in the background. He was managed with oral Trimethoprim/sulfamethoxazole for cyclospora and valganciclovir for CMV. Conclusion: Mixed infection of cyclospora and cytomegalovirus presenting as chronic diarrhoea was rarely reported in an immunocompetent individual. Duodenal biopsy may help in differentiating parasitic infections from tropical sprue by demonstrating various forms of pathogens in histology.

Feasibility of laparoscopic surgery for chronic adhesive small bowel obstruction

To determine the feasibility and possible superiority of laparoscopic surgery for chronic adhesive small bowel obstruction(CASBO). Clinical data of 36 CASBO patients who underwent laparoscopic surgery in Jinling Hospital from March 2011 to August 2014 were retrospectively reviewed. In addition, 36 cases, matched by age, gender, previous abdominal surgery history, body mass index(BMI) and abdominal adhesion grade, who underwent open surgery from April 2007 to February 2011 were used as controls. General information, operative findings and short-term outcomes were compared between two groups. There were no statistically significant differences in baseline data between the two groups (all P>0.05). Among 36 cases in laparoscopic surgery group, 17 underwent complete laparoscopic surgery, 10 underwent laparoscopic assisted surgery and 9 were converted to open surgery, respectively. The conversion rate was 25%(9/36). Reason of laparoscopic assisted surgery in 3 cases was uncertainty of small bowel injury, in 5 cases was further dissection of intra-loop adhesion and in 2 cases was intestinal resection. Reasons for conversion were small bowel injury in 3 cases and severe adbesion at the abdominal wall in 6 cases. There were no differences between two groups in terms of adhesion score, intra-operative blood loss, operation time, need for small bowel resection, total hospital charge and intra- or post-operational complications. As compared to open surgery, laparoscopic surgery significantly shortened the incision length [median 2 (0 to 10) cm vs. 12(7 to 16) cm, P=0.000], and hospital stay [median 5 (2 to 28) days vs. 7 (4 to 26) days, P=0.001], and improved postoperative recovery of bowel movement [median 2(1 to 20) days vs. 3 (2 to 10) days, P=0.001]. Laparoscopic surgery can improve postoperative recovery of CASBO with similar morbidity as open surgery.

Chronic Small Bowel Disease in Cats

Chronic Small Bowel Disease in Cats

Spectrum of chronic small bowel diarrhea with malabsorption in Indian subcontinent: is the trend really changing?

Background/AimsThis study aimed to document the recent etiological spectrum of chronic diarrhea with malabsorption and also to compare features that differentiate tropical sprue from parasitic infections, the two most common etiologies of malabsorption in the tropics.MethodsWe analyzed 203 consecutive patients with malabsorption. The etiological spectrum and factors that differentiated tropical sprue from parasitic infections were analyzed.ResultsThe most common etiology was tropical sprue (n=98, 48.3%) followed by parasitic infections (n=25, 12.3%) and tuberculosis (n=22, 10.8%). Other causes were immunodeficiency (n=15, 7.3%; 12 with human immunodeficiency virus and 3 with hypogammaglobulinemia), celiac disease (n=11, 5.4%), Crohn's disease (n=11, 5.4%), small intestinal bacterial overgrowth (n=11, 5.4%), hyperthyroidism (n=4, 1.9%), diabetic diarrhea (n=4, 1.9%), systemic lupus erythematosus (n=3, 1.4%), metastatic carcinoid (n=1, 0.5%) and Burkitt's lymphoma (n=1, 0.5%). On multivariate analysis, features that best differentiated tropical sprue from parasitic infections were larger stool volume (P=0.009), severe weight loss (P=0.02), knuckle hyperpigmentation (P=0.008), low serum B12 levels (P=0.05), high mean corpuscular volume (P=0.003), reduced height or scalloping of the duodenal folds on endoscopy (P=0.003) and villous atrophy on histology (P=0.04). Presence of upper gastrointestinal (GI) symptoms like bloating, nausea and vomiting predicted parasitic infections (P=0.01).ConclusionsTropical sprue and parasitic infections still dominate the spectrum of malabsorption in India. Severe symptoms and florid malabsorption indicate tropical sprue while the presence of upper GI symptoms indicates parasitic infections.

Intestinal Leiomyositis: A Cause of Chronic Intestinal Pseudo-Obstruction in 6 Dogs.

BackgroundIntestinal leiomyositis is a suspected autoimmune disorder affecting the muscularis propria layer of the gastrointestinal tract and is a cause of chronic intestinal pseudo‐obstruction in humans and animals.ObjectiveTo characterize the clinical presentation, histopathologic features, and outcome of dogs with intestinal leiomyositis in an effort to optimize treatment and prognosis.AnimalsSix client‐owned dogs.MethodsRetrospective case series. Medical records were reviewed to describe signalment, clinicopathologic and imaging findings, histopathologic diagnoses, treatment, and outcome. All biopsy specimens were reviewed by a board‐certified pathologist.ResultsMedian age of dogs was 5.4 years (range, 15 months–9 years). Consistent clinical signs included vomiting (6/6), regurgitation (2/6), and small bowel diarrhea (3/6). Median duration of clinical signs before presentation was 13 days (range, 5–150 days). Diagnostic imaging showed marked gastric distension with dilated small intestines in 4/6 dogs. Full‐thickness intestinal biopsies were obtained in all dogs by laparotomy. Histopathology of the stomach and intestines disclosed mononuclear inflammation, myofiber degeneration and necrosis, and fibrosis centered within the region of myofiber loss in the intestinal muscularis propria. All dogs received various combinations of immunomodulatory and prokinetic treatment, antimicrobial agents, antiemetics, and IV fluids, but none of the dogs showed a clinically relevant improvement with treatment. Median survival was 19 days after diagnosis (range, 3–270 days).Conclusions and Clinical ImportanceIntestinal leiomyositis is a cause of intestinal pseudo‐obstruction and must be diagnosed by full‐thickness intestinal biopsy. This disease should be considered in dogs with acute and chronic vomiting, regurgitation, and small bowel diarrhea.

Prevalence and underlying causes of histologic abnormalities in cats suspected to have chronic small bowel disease: 300 cases (2008-2013).

To determine prevalence of histologic abnormalities in cats suspected, on the basis of compatible clinical signs and ultrasonographic findings, to have chronic small bowel disease; identify the most common underlying causes in affected cats; and compare methods for differentiating among the various causes of chronic small bowel disease. Retrospective case series. 300 client-owned domestic cats suspected to have chronic small bowel disease. Medical records were reviewed to identify cats evaluated because of chronic vomiting, chronic small bowel diarrhea, or weight loss that also had ultrasonographic evidence of thickening of the small intestine. Cats were included in the study if full-thickness biopsy specimens had been obtained from ≥ 3 locations of the small intestine by means of laparotomy and biopsy specimens had been examined by means of histologic evaluation and, when necessary to obtain a diagnosis, immunohistochemical analysis and a PCR assay for antigen receptor rearrangement. Chronic small bowel disease was diagnosed in 288 of the 300 (96%) cats. The most common diagnoses were chronic enteritis (n = 150) and intestinal lymphoma (124). Results indicated that a high percentage of cats with clinical signs of chronic small bowel disease and ultrasonographic evidence of thickening of the small intestine had histologic abnormalities. Furthermore, full-thickness biopsy specimens were useful in differentiating between intestinal lymphoma and chronic enteritis, but such differentiation was not possible with ultrasonography or clinicopathologic testing alone.