Distal Ileum Research Articles

A Rare Case of ACE Inhibitor-Induced Intestinal Angioedema Presenting as a Delayed Complication in a Heart Transplant Recipient

<h3>Introduction</h3> ACE inhibitor-induced intestinal angioedema is a rare side effect of ACEi that presents with nonspecific signs and symptoms. Although the risk of occurrence is greater early in therapy, angioedema can present at any time and thus a high index of suspicion is needed to avoid delays in diagnosis, unnecessary testing, and considerable morbidity. <h3>Case Report</h3> Our patient is a 54-year-old male with past medical history of orthotopic heart transplantation 3 years prior for history of end-stage ischemic cardiomyopathy, heparin-induced thrombocytopenia, and hypertension who presented with 3 days of crampy abdominal pain rated 4 out of 10. He also had bloating and watery diarrhea. He had no fever, nausea or vomiting. The patient had rebound tenderness on physical examination. Labs were unremarkable. GI pathogen panel was negative including C. difficile. CT showed a moderate segment of distal ileum which demonstrated acute inflammatory changes including mucosal hyperemia and mural edema on a background of moderate ascites. GI were consulted and performed colonoscopy that revealed no significant abnormalities. The patient had been on lisinopril for 3 years to treat hypertension. This was subsequently stopped due to suspicion of intestinal angioedema. His symptoms resolved within 72 hours of discontinuation. <h3>Summary</h3> Isolated intestinal angioedema secondary to ACEi is a diagnosis of exclusion that necessitates awareness among physicians, particularly in vulnerable subgroups such as heart transplant patients. Symptoms classically subside within 24 to 48 hours after discontinuation of the ACEi.

Appendiceal knotting causing small bowel obstruction: A rare case report

Introduction and importanceAppendicitis causing intestinal obstruction by forming a knot around a small bowel is uncommon. Preoperative diagnosis is challenging as the typical presentations of appendicitis are not usually seen. The diagnosis of appendicular knotting is usually an intraoperative surprise.Case presentationA 34-year-old male patient (BMI-20.86 kg/m2) presented to the surgical emergency unit with colicky central abdominal pain of 2-days duration, which later involved the whole abdomen. In association with this, he had a history of frequent vomiting of ingested matter which later became bilious. The abdominal examination revealed diffuse abdominal tenderness with guarding and rigidity. On midline exploratory laparotomy, the inflamed appendix which was adherent to the distal part of the ileum was observed. The appendix and the encircled segment of the distal ileum were both gangrenous, and the patient underwent resection of the bowel segment in addition to appendectomy.Clinical discussionWhenever an appendix wraps around an intestine or its tip adheres with small bowel, cecum, or posterior peritoneum forming a ring-like structure, and a segment of a bowel herniates through an opening can cause a closed-loop obstruction with or without strangulation. The management for ileo-appendicular knotting associated with gangrenous bowel could be appendectomy and resection of the bowel segment. Postoperatively, the patient had developed diarrhea caused by ileocecal resection, which later subsided by medication.ConclusionIleo-appendicular knotting is a rare cause of small intestinal obstruction, and it's challenging to diagnose during the preoperative period. As surgeons dealing with acute abdomen in routine clinical practice, knowledge of this unusual case is helpful for clinical suspicion and evidence-based management.

Epidemiological, clinical, and histological presentation of celiac disease in Northwest China.

BACKGROUNDResearch on celiac disease (CD) in northwest China is still in its infancy. At present, large-sample data on the epidemiological, clinical, and pathological characteristics of CD are limited.AIMTo investigate the epidemiological, clinical, and pathological characteristics of CD in northwest China.METHODSThe clinical data of 2884 patients with gastrointestinal (GI) symptoms were retrospectively analyzed. Total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) IgA levels were examined in all patients. Gastroscopy and colonoscopy were performed in patients with positive anti-tTG IgA and deficient total IgA levels. Atrophy of the duodenal and ileal villi was examined and histopathological examinations were performed. The modified Marsh–Oberhuber classification system was used to grade villous atrophy in the duodenum or distal ileum. The patients’ Helicobacter pylori (H. pylori) infection status was compared in terms of clinical presentation and Marsh grade. Statistical analyses were performed using the t-test or chi-square test.RESULTSAmong the 2884 patients, 73 were positive for serum anti-tTG IgA, and 50 were diagnosed with CD. The CD detection rate was significantly higher in Kazakhs (4.39%) than in Uyghurs (2.19%), Huis (0.71%), and Hans (0.55%). The main symptoms of CD were chronic diarrhea, anorexia, anemia, fatigue, weight loss, sleep disorders, osteopenia, and osteoporosis. The body mass index of patients with CD was significantly lower than that of patients without CD. A total of 69 patients with positive serum anti-tTG IgA and two patients with deficient total IgA levels underwent GI endoscopy. Endoscopy revealed crypt hyperplasia and/or duodenal villous atrophy, mainly manifested as nodular mucosal atrophy, grooves, and fissures. The difference in H. pylori infection rates was not statistically significant between CD and non-CD patients but was significantly different among CD patients with different Marsh grades.CONCLUSIONAmong the patients with GI symptoms in northwestern China, the prevalence of CD was more in the Uyghur and Kazakh populations. H. pylori infection may be associated with CD severity.

The expression of the gastrin/cholecystokinin (GAST/CCK) family and their receptors (CCKAR/CCKBR) in the chicken changes in response to quantitative restriction and reveals a functional role of CCK in the crop

Gastrin and cholecystokinin peptides bind a common G-protein coupled receptor, cholecystokinin receptor B (CCKBR) whilst cholecystokinin receptor A (CCKAR) is preferentially bound by CCK. Gastrin and cholecystokinin mediate signalling from the gastrointestinal tract to regulate appetite and digestive function. In this study, expression of the cholecystokinin/gastrin family and distribution of their receptors expression was measured to understand the target organs for the peptides and how expression responds to changes in food intake. We confirmed the restricted expression of gastrin in the antrum and the abundant expression of cholecystokinin in the hypothalamus. The expression of gastrin in the antrum was significantly elevated in broiler breeders when released from feed restriction. CCKBR was most abundant in the hypothalamus and proventriculus. CCKAR was most abundant in the pancreas and crop, more than tenfold greater than the gastrointestinal tract. Cholecystokinin expression in the pancreas increased after removal of food restriction. CCKAR in the gastrointestinal tract peaks around the distal ileum, distal to the peak of cholecystokinin expression. There was virtually no cholecystokinin expression in the caecum but CCKAR expression was high. The CCKAR expression in the crop was unexpected, supporting a role of cholecystokinin in mediating crop emptying which was supported by the observation of in-vitro contraction after cholecystokinin administration. The response to changes in food intake and the expression pattern of the cholecystokinin/gastrin family and their receptors will stimulate and inform new hypotheses on their role in growth in poultry.

Identification of sleep fragmentation-induced gut microbiota alteration and prediction of functional impact in Sprague Dawley rats harboring microbiome derived from multiple human donors.

ObjectivesPoor quality sleep, including sleep fragmentation (SF), can result in severe health consequences. Gut microbiota symbiotically coexist with the host, making essential contributions to overall well-being. In this study, the effects of both acute (6-day) and chronic (6-week) SF in a humanized rat model were examined to evaluate the impact of SF on this symbiotic relationship.Material and MethodsHuman fecal material was transplanted into antibiotic-treated, microbially depleted, Sprague Dawley rats. Animals were subjected to either acute or chronic SF and shifts to gut microbiota were investigated using 16S rRNA sequencing and predictive functional profiles were constructed with PICRUSt. We also investigated SF-induced intestinal microbial adhesion and penetration or increased microbial invasion of selected tissues and organs; as well as changes in crypt/villi architecture.ResultsMicrobiota profiling indicated that chronic, but not acute, SF significantly decreased the richness of alpha-diversity of distal ileum microbiota, and altered cecum and distal ileum beta-diversity; although both acute and chronic SF significantly changed select populations of microbiota in all three regions. Neither acute nor chronic SF induced changes to microbial adhesion, penetration, or invasion into intestinal tissues or nearby organs. Additionally, we found that chronic SF caused a reduction in villus height in the proximal colon.DiscussionOur study suggests that acute SF alters the gut microbiota in this humanized rat model, while chronic SF produces more pronounced changes to microbiota populations. This study identified potential microbiota targets for the prevention and/or intervention of the adverse effects of S F.

Ca2+-Permeable Channels/Ca2+ Signaling in the Regulation of Ileal Na+/Gln Co-Transport in Mice.

Oral glutamine (Gln) has been widely used in gastrointestinal (GI) clinical practice, but it is unclear if Ca2+ regulates intestinal Gln transport, although both of them are essential nutrients for mammals. Chambers were used to determine Gln (25 mM)-induced I sc through Na+/Gln co-transporters in the small intestine in the absence or the presence of selective activators or blockers of ion channels and transporters. Luminal but not serosal application of Gln induced marked intestinal I sc , especially in the distal ileum. Lowering luminal Na+ almost abolished the Gln-induced ileal I sc , in which the calcium-sensitive receptor (CaSR) activation were not involved. Ca2+ removal from both luminal and serosal sides of the ileum significantly reduced Gln- I sc . Blocking either luminal Ca2+ entry via the voltage-gated calcium channels (VGCC) or endoplasmic reticulum (ER) release via inositol 1,4,5-triphosphate receptor (IP3R) and ryanodine receptor (RyR) attenuated the Gln-induced ileal I sc , Likewise, blocking serosal Ca2+ entry via the store-operated Ca2+ entry (SOCE), TRPV1/2 channels, and Na+/Ca2+ exchangers (NCX) attenuated the Gln-induced ileal I sc . In contrast, activating TRPV1/2 channels enhanced the Gln-induced ileal I sc . We concluded that Ca2+ signaling is critical for intestinal Gln transport, and multiple plasma membrane Ca2+-permeable channels and transporters play roles in this process. The Ca2+ regulation of ileal Na+/Gln transport expands our understanding of intestinal nutrient uptake and may be significant in GI health and disease.

Nutritional support in a patient with Cytomegalovirus (CMV) enterocolitis in the acquired immunodeficiency syndrome (AIDS)

Introduction: Several diseases of the gastrointestinal tract should be taken into account in patients with the human immunodeficiency virus (HIV) since diarrhea negatively affects the patient's quality of life. Given this condition, Cytomegalovirus (CMV) enterocolitis may present with fever, weight loss, intermittent diarrhea, and hematochezia. Objective: This study aimed to report the effect of enteral supplementation with L-glutamine and oligomeric enteral nutritional therapy (ENT) formula in patients with cytomegalovirus, and with refractory diarrhea associated with wasting HIV syndrome. Methods: The information contained in this report was obtained through a review of the medical record and a review of the literature. Results: This is the report of S. S. A, a female, 27 years old, who was admitted to Hospital Ernesto Dornelles, in Porto Alegre, from 11/15/2020 to 12/30/2020, diagnosed with HIV for a month, without undergoing treatment. The patient was hospitalized due to worsening abdominal pain starting 2 days ago, with diarrhea and mental confusion. On physical examination, she presented pain in the lower abdominal region. From anthropometry, the measured weight of 67kg, the self-reported height of 1.67m, and BMI of 24kg/m2. On 11/17, she presented PCR-CMV positive for CMV and underwent laparotomy for pneumoperitoneum with endarterectomy due to perforation of the distal ileum. In use of ganciclovir for CMV. On December 2, the upper digestive endoscopy with biopsy showed an esophagus with the Z-line located close to the diaphragmatic clamping, with esophageal mucosa with extensive, friable, serpiginous ulcers, being a valuable diagnosis in CMV enterocolitis. From 12/04 to 12/08, she used exclusive enteral L-glutamine 20g/day. On 12/09, she started an oligomeric formula via the low-flow enteral route with progression to the caloric and protein targets. On 12/30, the patient had improved diarrhea, with a depressible and painless abdomen, and had been discharged. Final Considerations: In the present report, it was obtained a beneficial effect with the nutritional intervention using L-glutamine and enteral oligomeric formula in the treatment of diarrhea. Thus, the improvement in the condition in just 5 days can be explained by the rhythm of the enterocyte cell cycle, which occurs in an average period of 3 days, and it is possible that the 4 day period of nutritional intervention is sufficient to increase endogenous levels of L-glutamine.

Angiographic Diagnosis of a Meckel's Diverticulum in a 26-month-old Boy.

A 26-month-old boy presented with recurrent hematochezia. Abdominal examination was normal. Laboratory findings showed hemoglobin of 7.5 g/dL. Abdominal ultrasound (US) for intussusception revealed a short (0.3 cm) segment of wall thickening in the distal ileum and Meckel’s scan was negative. The patient underwent two additional Meckel’s scans, tagged red blood cell scan, CT-angiography, upper endoscopy and colonoscopy, and video capsule endoscopy, but had normal results. Superior mesenteric angiography was performed revealing an area of abnormal vasculature in the terminal ileum (Fig. 1). Subsequently, exploratory laparotomy showed an obvious Meckel’s diverticulum (MD), and Meckel’s diverticulectomy was performed (Fig. 2).FIGURE 1.: Meckel's Diverticulectomy.FIGURE 2.: Meckel’s Diverticulectomy. A) Gross specimen of MD removed from patient and (B) histological examination of MD with the presence of ectopic gastric mucosa.MD is the most common congenital malformation of the gastrointestinal tract, occurring in approximately 2% of the population (1). The gold standard in diagnosing a MD is a Meckel’s scan which detects the accumulation of a radioisotope, Technetium-99m. However, false negatives do occur and this is likely due to insufficient gastric mucosa in the MD (2). The literature on typical angiographic findings for diagnosis of MD are limited to a few individual cases (3–6). Our patient exhibited multiple abnormal corkscrew-like arteries of the ileocolic artery. Angiography can detect MD in the absence of acute bleeding through visualization of the vitelline artery (7). ACKNOWLEDGMENTS A.P. was involved in conception and design, acquisition of data, drafting the work, final approval of the version to be published. M.R.A., P.M., T.R.B., and C.M.S. were involved in conception and design, critical revision of work, final approval of version to be published. L.A. was involved in conception and design, acquisition of data, critical revision of work, final approval of version to be published.

Comprehensive Evaluation and Unique Morphologic Features of Nonsteroidal Anti-Inflammatory Drug (NSAID) Enteropathy in the Terminal Ileum.

Differentiating NSAID enteropathy from Crohn disease can be challenging on terminal ileum biopsy. It is important to distinguish these two entities for management. In this study, clinical, radiographic, endoscopic, and histologic features of 30 patients diagnosed with NSAID enteropathy and 30 patients diagnosed with Crohn disease on terminal ileal biopsy were compared. None of the patients in the NSAID cohort demonstrated significant changes on imaging performed prior to biopsy. Depending on disease severity, patients with Crohn disease showed imaging findings ranging from minimal changes to significant bowel wall and/or luminal changes. Endoscopically, erythema, erosions, and/or ulcers in the terminal ileum were observed in a majority of NSAID cases. Patients with active Crohn disease were noted to have erythema, ulcers, strictures, and/or visible inflammation throughout the distal ileum and colon. Histologically, at least 80% of cases in each cohort showed ulceration/erosion and cryptitis/crypt abscesses. The Crohn disease cohort had significantly higher degree of lymphoplasmacytic inflammation in the lamina propria compared to the NSAID cohort. In contrast, a significantly higher percentage of the NSAID cohort had gland/crypt atrophy. A decrease in number of Paneth cells was found in the NSAID cohort. Decreased lamina propria lymphoplasmacytic inflammation was the most specific and the presence of gland atrophy the most sensitive feature favoring NSAID enteropathy. In summary, the combination of gland/crypt/Paneth cell atrophy with decreased lamina propria lymphoplasmacytic inflammation can aid in differentiating NSAID enteropathy from Crohn disease in terminal ileal biopsies; however, correlation with clinical, radiographic, and endoscopic findings is still required.

Digestibility of amino acids in fish meal and blood-derived protein sources fed to pigs.

ObjectiveAn experiment was conducted to determine the standardized ileal digestibility (SID) of amino acids (AA) in fish meal (FM) and blood-derived protein sources including spray-dried porcine plasma (SDPP), porcine red blood cells (PRBC), and blood meal (BM) fed to growing pigs.MethodsTen barrows (mean initial body weight of 22.1±1.54 kg) surgically fitted with T-cannulas at the distal ileum were allotted to a duplicated 5×4 incomplete Latin square design with 5 experimental diets and 4 periods. Four experimental diets were prepared to contain FM, SDPP, PRBC, or BM as the sole source of nitrogen. A nitrogen-free diet was prepared and included to estimate the basal ileal endogenous losses of AA. For the 7-day experimental period, pigs were fed for 5 days as adaptation, and ileal digesta samples were collected for 9 hours on days 6 and 7.ResultsThe SID of crude protein in BM (48.0%) was less (p<0.05) than in FM, SDPP, and PRBC (83.4%, 83.9%, and 87.3%, respectively). Pigs fed the diet containing BM had less (p<0.05) SID of AA, except isoleucine and proline, than those fed the diet containing FM, SDPP, or PRBC. Among FM, SDPP, and PRBC, there was no difference in the SID of crude protein and all AA, except isoleucine. The SID of isoleucine in PRBC and BM (62.7% and 48.3%, respectively) was less (p<0.05) than in FM and SDPP (88.0% and 84.9%, respectively). The SID of lysine in FM, SDPP, PRBC, and BM was 85.4%, 84.9%, 89.7%, and 51.9%, respectively.ConclusionThe SID of most AA was not different among FM, SDPP, and PRBC, but BM had lower SID of most AA than FM, SDPP, and PRBC.

Pea starch increases the dry matter flow at the distal ileum and reduces the amino acids digestibility in ileal digesta collected after 4 hours postprandial of pigs fed low-protein diets.

ObjectiveThe study was aimed to investigate the rules of postprandial changes in intestine digesta dry matter (DM) flow and amino acid digestibility of growing pigs fed low-protein (LP) diets made of different starch.MethodsEight barrows (28.8±2.1 kg) with a T-cannula at the distal ileum were randomly allotted to an 8×3 Youden square design. Treatments included: waxy corn starch LP (WLP); corn starch LP (CLP) and pea starch LP (PLP). Diets were given at 08:00 and 20:00. Digesta samples were collected in six 2-h stages from 08:00 to 20:00.ResultsThe Cr concentrations of ileal digesta increased and then decreased in WLP and CLP, while increased continuously in PLP as time passed after postprandial (p<0.05). Higher average Cr concentrations (0.78% and 0.84% vs 0.70%; p<0.05) and lower average DM flow (181.1 g/kg and 166.3 g/kg vs 240.3 g/kg; p<0.001) were observed in WLP and CLP, compared with PLP. The apparent ileal digestibility coefficient of most amino acids in WLP and CLP increased compared with that in PLP. No difference in lysine or methionine digestibility was observed. When digesta were collected in 2-h periods, the apparent ileal digestibility coefficient of amino acids did not change over time. When digesta was collected in 4-h periods from 16:00 to 20:00 and 6-h periods from 14:00 to 20:00 (p<0.05), WLP and CLP showed markedly higher amino acid digestibility than PLPConclusionHigh-amylose slowly digested starch can increase the DM flow at the distal ileum and reduce the apparent ileal digestibility coefficient of amino acids of pigs fed LP diets. Compared with waxy corn starch and corn starch, pea starch reduced the digestibility of amino acids in digesta collected after 4 h postprandial.

Feasibility of Radio-Guided Surgery for Neuroendocrine Tumours Using 99mTc-HYNIC TOC

Introduction and aim: Intra-operative localization of small functioning pancreatic neuroendocrine tumours and liver metastases can be challenging. We here demonstrate the feasibility, technical protocol, utility and safety aspect of intra-operative tumour localization in using 99mTc-HYNIC-TOC. Materials and methods: 6 patients diagnosed with GEP-NET with or without liver secondaries were included in this study (5 males, 1 female). 3 patients had primary NET of the pancreas of which 2 patients had in additional liver metastases, 1 patient had distal ileal NET with loco-regional nodes and liver metastases, 1 patient had primary nodal gastrinoma with no evidence of any pre-operative lesions in duodenum/pancreas, 1 patient had bilobar liver secondaries from metastatic rectal NET. All patients were injected with 925-1110 MBq of 99mTc-HYNIC-TOC IV and surgery was done after 18-20 hours later on day 2. Intra-operative tumour localization was done using a hand-held high sensitivity gamma probe. Results: Total 23 lesions were localised intra-operatively and confirmed on histopathological as NET. Of these, were 10 in the liver, 3 in pancreas, 9 in nodes and 1 in the distal ileum. Of these 23 lesions, 19 were localized pre-operatively on imaging and by non-aided visualization by surgeon and 4 lesions (17%) were exclusively seen on intra-op localization using probe. These included 2 nodes and 2 liver lesions, all of which measured less than 1cm. Conclusion: Radio-guided surgery gastro-entero-pancreatic neuroendocrine tumours using indigenous 99mTc-HYNIC-TOC is safe and feasible in clinical setting and promises to improve precision of intra-operative localization of lesions in liver and pancreas.

GASTRIC AND PANCREATIC HETEROTOPIA PRESENTING AS PATHOLOGICAL INTUSSUSCEPTION IN AN ADULT FEMALE

Gastric and pancreatic heterotopias are rare entities. They have been identified throughout the entire length of the gastrointestinal tract and in other structures, including Meckel’s diverticulum and the Ampulla of Vater. However, very few cases of combined gastric and pancreatic heterotopias in ileum have been reported till date. Also, intussusceptions in adults are uncommon. Here we report a novel case of combined gastric and pancreatic heterotopia in ileum in a 32-year-old female. The patient presented with complaints of pain in abdomen and bleeding per rectum. On computed tomography, ileo-ileal intussusception was seen in the distal ileum. Exploratory laparotomy revealed an ileal polyp. The ileal segment with the polyp was resected and sent for histpathological examination. It was diagnosed as heterotopic gastric and pancreatic tissue in ileum. It highlights the importance of histopathological examination for definitive diagnosis of this rare clinical entity.

Hangekobokuto, a traditional Japanese herbal medicine, ameliorates postoperative ileus through its anti-inflammatory action.

Background/Aims: Gastroprokinetic agents are used for patients with postoperative ileus (POI), and the Japanese traditional herbal medicine daikenchuto (DKT) is one such agent used in the clinical setting. POI is caused by inflammation. DKT and rikkunshito have anti-inflammatory abilities in addition to their gastroprokinetic effects. The efficacy of Kampo formulations, including hangekobokuto (HKT), in patients with POI has been reported recently. Several authors have described the efficacy of honokiol, the primary component of Magnoliae Cortex, in HKT in mouse models of POI. We therefore analyzed the effect of HKT on POI model mice to determine the similarities in the mechanism of action between HKT and DKT. Methods: HKT was administered orally to each mouse before and after intestinal manipulation was performed on the distal ileum. The gastrointestinal transit in vivo, leukocyte infiltration, and levels of inflammatory mediators, such as cytokines and chemokines, were analyzed. Results: HKT significantly inhibited the infiltration of neutrophils and macrophages and led to the recovery of delayed intestinal transit. In addition, it significantly decreased inducible nitric oxide synthase (iNOS) as well as honokiol levels, suggesting anti-inflammatory activity. However, it did not inhibit the increase in levels of interleukin (IL)-1beta and IL-6, which are related to iNOS induction. In contrast, HKT increased levels of nerve growth factor (NGF) and suppressed those of nuclear factor-κB (NFκB), which are related to iNOS induction, suggesting the possibility of a neuronal anti-inflammatory mechanism. Conclusions: HKT exerted a POI-relieving effect similar to DKT in a murine POI model, and findings suggest that it may exert its anti-inflammatory activity through NGF.

The Effect and Mechanism of Duodenal-Jejunal Bypass to Treat Type 2 Diabetes Mellitus in a Rat Model

Objectives: Bariatric surgery can treat obesity and T2DM, but the specific mechanism is unknown. This study investigated the effect and possible mechanism of duodenal-jejunal bypass (DJB) to treat T2DM. Methods: A T2DM rat model was established using a high-fat, high-sugar diet and a low dose of streptozotocin. DJB surgery and a sham operation (SO) were performed to analyze the effects on glucose homeostasis, lipid metabolism, and inflammation changes. Furthermore, the glucagon-like peptide-1 (GLP-1) in the ileum and the markers of endoplasmic reticulum stress (ERS) in the pancreas were examined after the surgery. The insulinoma cells (INS-1) were divided into three groups; group A was cultured with a normal sugar content (11.1 mmol/L), group B was cultured with fluctuating high glucose (11.1 mmol/L alternating with 33.3 mmol/L), and group C was cultured with fluctuating high glucose and exendin-4 (100 nmol/L). The cells were continuously cultured for 7 days in complete culture medium. The viability of the INS-1 cells was then investigated using the MTT method, apoptosis was detected by flow cytometry, and the ERS markers were detected by Western blot. Results: The blood glucose, lipids, insulin, and TNF-α were significantly elevated in the T2DM model. A gradual recovery was observed in the DJB group. GLP-1 expression in the distal ileum of the DJB group was significantly higher than that in the T2DM control group (DM) and the SO group (p < 0.05), and the markers of ERS expression in the pancreases of the DJB group decreased significantly more than those of groups DM and SO (p < 0.05). Compared with group A, the cell viability in group B was decreased, and the ERS and apoptosis were increased (p < 0.05). However, compared with group B, the cell viability in group C was improved, and the ERS and apoptosis declined (p < 0.05). Conclusions: DJB can be used to treat T2DM in T2DM rats. The mechanism may be that the DJB stimulates the increased expression of GLP-1 on the far side of the ileum, and then, GLP-1 inhibits ERS in the pancreas, reducing the apoptosis of β cells to create a treatment effect in the T2DM rats.

Effects of dibenzylbutyrolactone lignans arctigenin and trachelogenin on the motility of isolated rat ileum

Dibenzylbutyrolactone-type lignans are phenolic compounds of medical importance. The purpose of the study was to determine the effects of two such lignans, arctigenin and trachelogenin on the motility of isolated rat ileum and obtain indications on their mechanism of action. They were isolated from Arctium lappa and Cirsium arvense, respectively, which have been used traditionally to treat gastrointestinal disorders. 1–1.5 cm long segments of distal ileum were obtained from adult male Wistar rats. The intestinal segments were suspended vertically in a well-aerated organ-bath according to Magnus mounting method. The intestinal motility was monitored for 30 min before treatment to obtain the baseline, followed by treatment with 1 µM, 10 µM, 20 µM and 40 µM concentrations of arctigenin and 0.5 µM, 1 µM, 10 µM and 20 µM of trachelogenin concentrations. The amplitude, tone, and period of spontaneous contractions were measured after 15 and 30 min of treatment. To investigate their mechanism of action, cholinergic, glutamatergic, adrenergic antagonists and compounds inhibiting nitric oxide synthase and L-type calcium channels were also tested. Arctigenin and trachelogenin decreased the frequency of contractions in a dose-dependent manner. At the concentration of 20 µM and 40 µM of trachelogenin and arctigenin, respectively, there was a marked alteration in spontaneous contraction pattern with an observable increase in the period time. This activity was comparable to 0.5 µM nifedipine (L-type calcium channel blocker) treatment. Our results demonstrate relaxant effect of arctigenin and trachelogenin on the ileum motility that may be mediated by L-type calcium ion channel blockade.

Inflammatory Myofibroblastic Tumor in Adult: A Rare Case

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of intermediate biologic potential. Inflammatory myofibroblastic tumor (IMT) of the alimentary tract often occurs in children or young adults, but may occur at any age. The lung is the most commonly affected location. However, it may appear in small bowel mesentery especially the distal ileum, mesotransverse colon, or greater omentum. A 35 years old female presented to out-patient department with complaint of mass in right abdomen since 1 month associated with loss of weight. Computed tomography of abdomen revealed a solid intraperitoneal mass arising from bowel mesentery. Laparoscopic excision of the tumor was performed and the histopathological examination of the mass revealed it to be an inflammatory myofibroblastic tumor arising from the omentum and large bowel mesentery. The post- operative period was uneventful with no evidence of tumor recurrence at follow up at 2 years. Inflammatory myofibroblastic tumor is a rare soft tissue tumor usually arising from lungs but tumor arising from the omental-mesenteric origin has also been documented. The precise diagnosis is made only by the histopathological evidence. Surgical resection is the treatment of choice.

Dietary carbohydrate modifies the density of L cells in the chicken ileum.

Glucagon-like peptides (GLPs) are secreted from intestinal L cells and stimulate various physiological functions in the gastrointestinal tract. The secretion of GLPs is influenced by macronutrient ingestion. This study aims to clarify the effects of dietary carbohydrate (CHO) on L cells in the chicken ileum. Six-week-old, male White Leghorn chickens were divided into three groups: control, low-CHO and CHO-free, with five chickens in each group. Paraffin sections were made from the proximal and distal ileum of each animal and subjected to immunohistochemistry for GLP-1 and GLP-2 peptides and in situ hybridization for proglucagon (PG) mRNA. A significant reduction of GLP-1- and GLP-2-immunoreactive cells was observed in the two experimental groups compared with that in the control. A reduction of cells expressing PG mRNA was observed in the proximal and distal ileum of the CHO-free group compared with that in the control. The ratio of GLP-1-immunoreactive cells showing Ki-67 immunoreactivity was significantly lower in the distal ileum of the CHO-free group than that in the control group. These data suggest that dietary CHO is an effective stimulator for modifying L cell density in the chicken ileum.

Long-Term Follow-up and Predictors of Complicated Disease Behavior in Pediatric Crohn's Disease Patients.

Identifying predictors of inflammatory bowel disease (IBD) outcome in order to optimize individual patient management in has become an important goal. We aimed to describe the long-term outcome of pediatric Crohn disease (CD) patients and identify risk factors for complicated behavior. Pediatric CD patients diagnosed between 1998 and 2014, with long-term follow-up were included. Baseline data; age, gender, weight/height/BMI percentiles, and family history of IBD. Disease characteristics (Paris classification), laboratory testing, imaging and treatment were documented. Outcome data; evidence of stricturing or penetrating disease, hospitalizations, surgical intervention, malignancies, and mortality. Of 93 patients included, mean age at diagnosis 13.5 (±3.2), 51 (55%) male, median follow-up 10.3 years (±4 SD(. Disease location at diagnosis: 29 (31.2%) distal ileum, 17 (18.3%) colonic, 40 (43.0%) ileo-colonic. Seven (7.5%) had upper gastrointestinal and 36 (38.7%) perianal involvement. Behavior at diagnosis, 68 (73.1%) inflammatory (B1), and 25 (26.9%) complicated [(B2 (stricturing) and/or B3 (penetrating)]. Twenty (23.2%) of B1 evolved to B2 and/or B3, thus by the end of follow-up 45 (48.4%) had complicated behavior. Sixty-seven (72%) were hospitalized, 20 (21.5%) underwent surgery, two developed malignancy with no mortalities. In a logistic regression model, growth delay (hazard ratio [HR], 5.02 [1.10-22.85], P = 0.037) and low albumin levels (HR, 3.97 [1.32-11.97], P = 0.014) at diagnosis were predictors of complicated disease in adulthood. Over a quarter of pediatric Crohn disease patients present with complicated behavior. During follow-up another quarter progress to complicated disease behavior. Delayed growth and low albumin at diagnosis predict progression.

Colonic Delivery of α-Linolenic Acid by an Advanced Nutrient Delivery System Prolongs Glucagon-Like Peptide-1 Secretion and Inhibits Food Intake in Mice.

ScopeNutrients stimulate the secretion of glucagon‐like peptide‐1 (GLP‐1), an incretin hormone, secreted from enteroendocrine L‐cells which decreases food intake. Thus, GLP‐1 analogs are approved for the treatment of obesity, yet cost and side effects limit their use. L‐cells are mainly localized in the distal ileum and colon, which hinders the utilization of nutrients targeting GLP‐1 secretion. This study proposes a controlled delivery system for nutrients, inducing a prolonged endogenous GLP‐1 release which results in a decrease food intake.Methods and Resultsα‐Linolenic acid (αLA) was loaded into thermally hydrocarbonized porous silicon (THCPSi) particles. In vitro characterization and in vivo effects of αLA loaded particles on GLP‐1 secretion and food intake were studied in mice. A total of 40.4 ± 3.2% of loaded αLA is released from particles into biorelevant buffer over 24 h, and αLA loaded THCPSi significantly increased in vitro GLP‐1 secretion. Single‐dose orally given αLA loaded mesoporous particles increased plasma active GLP‐1 levels at 3 and 4 h and significantly reduced the area under the curve of 24 h food intake in mice.ConclusionsαLA loaded THCPSi particles could be used to endogenously stimulate sustain gastrointestinal hormone release and reduce food intake.