Diagnosis Of Small Intestinal Diseases Research Articles

A Single Center Study Using CT Enterography to Evaluate Small Bowel Disorders

Background: A research was done on the efficiency of identifying small intestinal problems using computed tomography (CT) enterography. The findings showed that 93% of patients had appropriate diagnoses, while the remaining [07%] were still pending. These results indicate that CT enterography is a highly accurate, safe, and cost-effective imaging method for the diagnosis of small intestinal diseases. Aim: By using CT enterography as an imaging method, small intestinal problems may be precisely identified. Its cost-efficiency in comparison to other imaging modalities, as well as its safety and effectiveness in identifying small bowel illnesses, have been assessed. Additionally, various imaging modalities have been compared to CT enterography's accuracy, and its effect on patient outcomes has also been taken into account. Method: The Radiology Department of KTH Peshawar conducted a comprehensive research with hundred patients between Jan 2017 and jan 2018. Each patient performed a CT enterography, and based on precise data gathered from their medical records, their clinical findings were compared with the results, which were then assessed using SPSS Version 27. A descriptive statistical analysis was then performed on the data. Results: In our investigation, CT enterography had a good 93% diagnostic success rate in the diagnosis of small intestinal diseases. Unfortunately, for certain individuals, notably the remaining 7%, the findings were not conclusive. We found it interesting that CT enterography had a greater accuracy rate than other imaging methods like MRI and ultrasound. Conclusion: This research established CT enterography as a cost-efficient, secure, and accurate imaging method for the diagnosis of small intestinal illnesses. This non-invasive method also has high accuracy and safety. Keywords: imaging modalities, accuracy, cost-effectiveness, safety, and CT enterography.

CARE Dose 4D combined with sinogram-affirmed iterative reconstruction improved the image quality and reduced the radiation dose in low dose CT of the small intestine.

ObjectiveMultislice computed tomography (MSCT) has been used for diagnosis of small intestinal diseases. However, the radiation dose is a big problem. This study was to investigate whether CARE Dose 4D combined with sinogram‐affirmed iterative reconstruction (SAFIRE) can provide better image quality at a lower dose for imaging small intestinal diseases compared to MSCT.MethodsThe noise reduction ability of SAFIRE was assessed by scanning the plain water mold using SOMATOM Definition Flash double‐source spiral CT. CT images at each stage of radiography for 239 patients were obtained. The patients were divided into groups A and B were based on different tube voltage and current or the image recombination methods. The images were restructured using with filtered back projection (FBP) and SAFIRE (S1–S5). The contrast noise ratio (CNR), CT Dose index (CTDI), subjective scoring, and objective scoring were compared to obtain the best image and reformation parameters at different stages of CT.ResultsTwenty‐six restructuring patterns of tube voltage and current were obtained by FBP and SAFIRE. The average radiation dose using CARE Dose 4D combined with SAFIRE (S4–S5) reduced approximately 74.85% compared to conditions where the tube voltage of 100 kV and tube current of 131 mAs for patients with MSCT small intestinal CT enterography at plain CT scan, arterial stage, small intestine, and portal venous phase. The objective and subjective scoring were all significantly different among groups A and B at each stage.ConclusionsCombination of CARE Dose 4D and SAFIRE is shown to decrease the radiation dose while maintaining image quality.

Application of magnetic resonance enterography for diagnosis of small intestinal diseases in children

To explore the value of magnetic resonance enterography (MRE) for diagnosis of small intestinal diseases in children. A total of 92 children who received MRE from July 2009 to January 2014 were included into this study. The clinical value of MRE in children was evaluated by describing the image presentation of MRE based on clinical diagnosis. All the 92 cases (average age was nine year and one month, among whom 61 were boys, and 31 were girls) received MRE examination with good tolerance and had no complications. Eleven cases (12%) did not show good distension of small bowel loop during MRE and could not evaluate the bowel wall pathologies correctly. A total of 66 cases (72%) showed pathological MRE images. All patients with Crohn's disease showed pathological gut and 53% (16/30) showed extramural changes with MRE, 97% (29/30) showed colon lesions with colonoscopy, 73% (20/22) showed small intestine lesions with capsule endoscopy. All patients with intestinal obstruction (7 cases) showed abnormal gut distension, 4 of whom showed obstruction point. Five patients with small intestinal neoplasms showed the mass with MRE. One of the patients with intestinal tuberculosis showed enlarged lymph nodes with ring strengthening. Nine cases with eosinophilic gastroenteritis (75%) and 1 case of gastrointestinal bleeding showed increased contrast enhancement for small bowel. The main finding of MRE were abnormal wall thickening and enhancement, gut stricture, bowel expansion, etc. MRE for children was safe and reliable. It can be a suitable method for determining the location and extent of gut for small intestinal diseases, especially suitable for Crohn's disease in children.

Video capsule endoscopy is one more step towards improving the diagnosis of small intestinal diseases

To estimate the value of video capsule endoscopy (VCE) in the diagnosis of small intestine (SI) diseases.. A total of 134 patients, including 72 (53.7%) women and 62 (46.3%) men whose mean age was 41.48±9.33 years. Group 1 included 73 patients who were examined using an algorithm for the diagnosis of SI diseases, 61 patients underwent VCE by the referrals handed in other healthcare facilities. In the patients of Group 1, pathological SI changes were revealed by VCE by almost 4 times more frequently than in those of Group 2. VCE provides a possibility of establishing the sources of bleeding, Crohn's disease, and other inflammatory diseases, which are inaccessible to other diagnostic methods. SI arteriovenous malformations, polyps, and diverticula, parasitic infections, and nonsteroidal anti-inflammatory drug-associated enteropathy may be causes of obscure SI bleeding and anemia. In celiac disease, VCE may estimate the extent of SI mucosal atrophy and reveal its disintegration as erosions and ulcers, which are inherent in its refractory form. VCE is a highly informative method for examining the SI, but, in view of the specific features of its performance and the high cost of hardware, VCE is recommended to be performed in accordance with the proposed diagnostic algorithm.

Diagnosis of Small-Intestinal Disease with Capsule Endoscopy

Diagnosis of Small-Intestinal Disease with Capsule Endoscopy

Hydrogen Respiratory Test: Pilot Examinations for Evaluation of the Small Intestinal Colonization by Normal Microflora

Respiration hydrogen analyzer H2Rate has been used in pilot examinations of a group of students. This method for noninvasive diagnosis of small intestinal diseases promotes proper interpretation of the results. Free hydrogen level in the exhaled air increases as a result of lactulose (diagnostic agent) cleavage by enteric microflora within about 3 h. Based on the experimental data, the main groups with characteristic curves reflecting the time course of hydrogen concentrations have been distinguished. Excessive bacterial colonization of the intestine can correspond to emergence of characteristic peaks of hydrogen concentrations in the curve. Hydrogen concentrations in exhaled air can also be analyzed to evaluate the rate of the substrate propulsion in the middle compartment of the intestine.

Endoscopic diagnosis of small intestinal diseases.

The technological development in endoscopy is directed toward improved accuracy of the diagnoses of novel diseases. The capsule endoscope and balloon-assisted endoscope are examples of such technological development. By these novel technologies, the small intestine can be examined in more detail. Therefore, an increasing number of novel diseases have been discovered, requiring the establishment of diagnosis and treatment strategies for these unknown diseases. In particular, obscure gastrointestinal bleeding, Crohn's disease, and nonsteroidal anti-inflammatory drug-induced enteropathy are of great interest to endoscopists. The capsule endoscope is the best method for screening the small intestine; however, the development of supporting methods such as the patency capsule is eagerly desired.

Mo1548 Usefulness of Capsule Endoscopy With Selected White-Light LEDs (Contrast Capsule) for Small Intestinal Lesions

Capsule endoscopy (CE) is useful in patients with obscure gastrointestinal bleeding (OGIB). However, normal white-light CE images are often hard to assess compared to enteroscopy. The current technique and technology of image-enhanced endoscopy is available in conventional endoscopy, to augment the detection, diagnosis and treatment of lesions. Therefore, image-enhanced video capsule endoscopy is hopeful that it assists accurate diagnosis of small intestinal lesions. Recently Contrast Capsule is developed. That is equipped with selected white-light light emission diodes (LEDs) which have increased illumination intensity in blue light i.e. the main absorption range of hemoglobin. The normal white-light image is consisting of all colors (red, green and blue). The contrast image is generated out of green and blue. Here, we evaluated whether this contrast image improved the visibility of small intestinal lesions and was useful for diagnosis of small intestinal diseases in patients with OGIB. From October 2009 to October 2010, sixteen patients (8 males and 8 females) with OGIB were enrolled this study. The contrast capsule, Olympus EC Type 1 (Olympus Medical Systems, Tokyo, Japan) was used. The size of this capsule is 26 mm × 11 mm. Two blinded gastrointestinal physicians evaluated the contrast images. The visibility of small intestinal lesions was compared with the normal white-light image. It was also assessed whether the contrast image was useful for diagnosis of small intestinal diseases. Inter- and intra-observer agreement was calculated by using kappa statics. Twenty small intestinal lesions of 16 patients (13 lesions: erosion/ulceration, 4 lesions: inflammation, 3 lesions: angioectagia) were detected. Visibility of small intestinal lesions was improved in 75% (15/20), equivalent in 20% (4/20), and reduced in 5% (1/20). The mean (95% CI) inter- and intra-observer kappa values for visibility were 0.57 and 0.78. The contrast image was useful for diagnosis in 85% (17/20). The mean (95% CI) inter- and intra-observer kappa values for usefulness for diagnosis were 0.44 and 0.46. Contrast Capsule improved the visibility of small intestinal lesions. This new technology may be useful for diagnosis of small intestinal diseases.

Tu1580 Efficacy of Flexible Spectral Imaging Color Enhancement on the Diagnosis of Small Intestinal Diseases by Capsule Endoscopy

Image enhanced endoscopy (IEE), such as flexible spectral imaging color enhancement (FICE) or narrow-band imaging (NBI), has been widely used for gastroscopy and colonoscopy. These techniques are based on narrowing the bandwidth of the conventional endoscopic image. It has been reported that FICE improves a visualization of both neoplastic and non-neoplastic lesions for gastroscopy and colonoscopy. However, efficacy of FICE on capsule endoscopy (CE) is not elucidated yet. In the present study, we aimed to estimate the efficacy of FICE on the diagnosis of small intestinal diseases by CE.Method;A total of 24 patients (Age 61.8 ± 11.2 years, 15 males) were chosen into the present study; all patients were followed up for 17 months.

4. Diagnosis of Small Intestinal Diseases Using CT and MRI.

4. Diagnosis of Small Intestinal Diseases Using CT and MRI.

Usefulness of computed tomography enteroclysis in the intestinal tract

The aim of this study was to evaluate computed tomography enteroclysis (CTE) of the small intestinal tract. A total of 36 patients underwent CTE for further examination of small intestinal disease. The indications were obscure gastrointestinal bleeding (OGIB) (n = 16), suspected Crohn's disease (n = 7), suspected and diagnosed by exclusion a small intestinal tumor (n = 5), and others (n = 8). Regarding OGIB, positive findings were observed in nine patients: angiodysplasia (n = 2), suspected ileac tumor (n = 2), colon cancer (n = 1), colon diverticulosis and diverticulitis (n = 2), Crohn's disease (n = 1), and enteritis (n = 1). As for Crohn's disease, hyperplasia of the small intestinal wall was shown in six patents. Positive findings of a small intestinal tumor were observed in two patients. In the "others" category, colon diverticulitis was found in three patients and isolated dissection of the superior mesenteric artery in one of four patients with abdominal pain. Primary carcinoid was identified in the pancreas in one patient, with liver carcinoid metastasis in the remaining four patients. CT enteroclysis is a noninvasive method and useful approach in the diagnosis of small intestinal diseases.

Clinical usefulness of a prototype ultrasound probe for single-balloon enteroscopy

Background and Objectives: Single-balloon enteroscopy (SBE) permits endoscopic examination of the entire small intestine and is being more widely used, along with conventional double-balloon enteroscopy. We had the opportunity to use a prototype ultrasound probe (XUM-S20-25X, Olympus Medical Systems, Tokyo, Japan) for SBE and evaluated the clinical usefulness of endoscopic ultrasonography (EUS) for the diagnosis of small intestinal diseases.

Diagnosis and Treatment of Obscure Gastrointestinal Bleeding (OGIB) At Double Balloon Endoscopy (DBE) In Comparison with Videocapsule Endoscopy (VCE)

Background: Recently DBE and VCE have enabled endoscopic diagnosis of small intestinal diseases, especially of OGIB. We evaluated the usefulness of DBE for diagnosis and treatment of OGIB, and clarified characteristics of small intestinal hemorrhagic diseases. Next, we compared diagnostic yields of OGIB between DBE and VCE. Methods: Of 280 patients who underwent DBE between June 2003 and October 2006, 146 (91 male, 55 female, mean age 59.9 years old, 92 oral approaches and 118 anal approaches) with OGIB were enrolled. We evaluated details of the findings and diagnostic yield of each technology, usage of anticoagulant, prevalence of underlying disease, therapeutic procedures and prognosis of OGIB after treatment. In 68 patients who had undergone VCE within one week before DBE, we compared positive findings rates between both examinations. Results: Diagnostic yield of DBE was 82/146(56.2%) in 146 patients with OGIB. Especially in 13 patients with on-going bleeding at DBE, diagnostic yield was highest in 11/13(84.6%). Endoscopic diagonoses were as follows; vascular diseases such as angiodysplasia, Dieulafoy's lesions, AVM, and varices (n = 30), chronic inflammatory diseases such as simple ulcers, drug-induced enteropathy, tuberculosis, and Crohn's disease (n = 28), small-bowel tumors (n = 16), and small-bowel diverticula (n = 8). In vascular diseases, the rate of use of anticoagulant and the prevalence of underlying disease such as cardiovascular disease, renal failure, and liver cirrhosis, were significantly higher than in non-vascular diseases. Indentified bleeding sources were treated in 51/82 (62.2%). Endoscopic therapies (electrocoagulation, clipping, and EMR) were performed in 27 cases. Surgical treatment was performed in 24 cases (including laparoscopic surgery with endoscopic tatooing in 14 cases). As for prognosis, the rate of rebleeding in vascular diseases was significantly higher than that in non-vascular diseases. (P = 0.028, logrank test). In 68 patients who had undergone both DBE and VCE, positive findings rate of DBE and VCE were 39/68(57.4%)and 37/68 (54.4%), respectively (not significant). Four cases detected by VCE were not reached by DBE because of difficulty of insertion, while 7 cases detected by DBE were overlooked by VCE (bleeding sources in 6 cases were detected in the proximal jejunum). Conclusions: DBE was useful for diagnosis of OGIB as well as VCE and treatment of OGIB. However, it is necessary to complementarily perform DBE and VCE in subgroups of OGIB.

小腸疾患の新たな診断法―診断と治療における小腸内視鏡の進歩と意義―Ｉ．小腸疾患診断の変遷と展望

小腸X線検査法は, 造影剤の投与方法によって経口法, 経ゾンデ法, 経肛門逆行性造影法の3種類に分類される. 現在, 本邦では経口法の1回投与法と, 経ゾンデ法の二重造影法が汎用されている. 一方, 小腸内視鏡検査法は1970年に開発された2種類のファイバースコープ (SIF, FIS) によって可能となった. 以後, プッシュ式, ロープウェイ式, ゾンデ式の3方式の挿入法が試みられたが, 広く臨床に普及するには至らなかった. 2000年にカプセル内視鏡, 2001年にダブルバルーン内視鏡が発表され, 小腸疾患の診断に大きな変革がもたらされた. すなわち, 2000年以前の小腸疾患診断の主役は小腸X線検査のみであったのに対し, 2001年以降はカプセル内視鏡, ダブルバルーン内視鏡, 小腸X線検査をうまく組み合わせて診断を進めていく時代となった. この大きな変革によって, 小腸疾患に対する臨床医の興味は著しく増し, 症例数の増加とともに小腸疾患についての知識の向上と臨床研究の進歩をもたらすことが期待される.

Dimensions and histologic characteristics of the small intestine of dogs during postnatal development.

To quantify dimensions of the small intestine of dogs and describe changes in histologic characteristics of the mucosa during postnatal development. Gastrointestinal tract tissues obtained from 110 Beagles (15 adult females and 95 puppies of both sexes). Several variables (length, total weight, mucosal weight, and nominal surface area) of the small intestine were measured in puppies at birth but before suckling; 1 day after birth and subsequent suckling, 21, 42, and 63 days after birth, and in the adult dams of the puppies. Tissue structure was examined and quantified at each time point by use of routine histologic examination and ocular micrometry of formalin-fixed specimens stained with H&E. Small intestinal dimensions increased throughout development with the greatest proportional changes during the first day after birth and onset of suckling. Villus height decreased during suckling but had consistent values from 42 days after birth to maturity, whereas crypt depth increased from birth to maturity. Vacuolated enterocytes were evident from birth to 21 days but not thereafter. Increases in intestinal dimensions provide growing dogs with a greater capacity for digestion and absorption. Changes in mucosal architecture and cell populations coincided with shifts in dietary inputs. These findings may assist in the diagnosis of small intestinal diseases and nutritional responses during growth and development of dogs.

Diagnosis and management of small intestinal diseases

Topics related to the diagnosis of small intestinal diseases that are covered in this review include a potential new serum marker for intestinal infarction; an improved diagnostic test for Whipple's disease; diagnostic enteroscopy; the use of marker studies to help diagnose and localize the site of partial small bowel obstruction; and the use of a color card to help localize the source of rectal bleeding. Treatment topics include the use of urokinase for acute superior mesenteric vein or portal vein thrombosis; the use of nasogastric versus long intestinal drainage tubes for acute adhesive small bowel obstruction; guidelines for the use of octreotide to treat secretory diarrhea; and the use of patient-controlled analgesia pumps after uncomplicated colonic surgery and postoperative ileus.

Oral sugar tests for diagnosis of small intestinal disease

Oral sugar tests for diagnosis of small intestinal disease