Distal Jejunum Research Articles

Effect of method of delivery of sodium butyrate on maturation of the small intestine in newborn calves

The effect of sodium butyrate (SB) supplementation in milk replacer (MR), starter mixture (SM), or both on small intestine maturation in newborn calves was investigated. Twenty-eight male calves with a mean age of 5 (±1) d were randomly allocated into 1 of 4 groups (7 animals per group) and fed (1) MR and SM, without SB (MR− and SM−, respectively; MR−/SM−); (2) MR− and SM supplemented with SB encapsulated within triglyceride matrix (SM+, 0.6% as fed; MR−/SM+); (3) MR supplemented with crystalline SB (MR+, 0.3% as fed) and SM− (MR+/SM−); or (4) MR+ and SM+ (MR+/SM+). The MR was offered in amounts equal to 10% of initial body weight of the calf. The SM was blended with whole corn grain (50/50; wt/wt) and offered ad libitum as a starter diet. Calves were slaughtered at 26d (±1) of age and small intestine development was investigated. Treatment with MR+ decreased villus height in the proximal jejunum and decreased villus height, crypt depth, and tunica mucosa thickness in the middle jejunum, whereas treatment with SM+ tended to increase small intestine weight and crypt depth in the proximal jejunum, and increased villus height in the distal jejunum. In the duodenum, crypt depth and tunica mucosa thickness were greater for the MR−/SM+ group compared with MR−/SM−, MR+/SM−, and MR+/SM+ groups. In the ileum, crypt depth was less for MR−/SM+ compared with MR−/SM−. Supplementation with SB in both MR and SM enhanced cell proliferation and decreased apoptosis in the middle jejunum mucosa. Regarding brush border enzyme activities, addition of SB to MR increased lactase activity in the middle jejunum and maltase activity in the distal jejunum, and tended to increase lactase activity in the distal jejunum, aminopeptidase A activity in the middle jejunum and ileum, and aminopeptidase N activity in the ileum. In contrast, SM+ increased dipeptidylpeptidase IV activity in the distal jejunum and tended to increase aminopeptidase N in the distal jejunum. In conclusion, both MR+ and SM+ affected small intestine development in newborn calves. This effect depended on the method of SB delivery but MR+ generally had a more pronounced effect. No synergistic effect of SB supplementation into MR and SM was found.

Small Bowel Hemangioblastoma Presenting as Acute GI Bleed

Introduction: A hemangioblastoma is an uncommon central nervous system (CNS) tumor. It is typically slow-growing and sporadic in occurrence, but up to 25% of cases are associated with von Hippel-Lindau disease. Generally found in the cerebellum, brainstem, or in the spinal cord, there are only a few reported cases of hemangiomablastomas outside the CNS, and these appear to be limited to the kidney, colon, and the retroperitoneum. Hemangiomablastomas are highly vascular lesions and in this presentation we summarize a unique case of acute GI bleeding secondary to hemangiomablastoma in the small bowel. Case Report: A 35-year-old Caucasian male with an unremarkable past medical history presented with syncopal episodes that began after having multiple bowel movements with black stools and subsequent hematochezia. He denied previous episodes of GI bleeding or anemia. He had no complaints of abdominal pain, heartburn, dysphasia, or weight loss. He had recently taken amoxicillin for a URI, and he had taken ibuprofen for several days leading up to his hospitalization. He denied sick contacts or recent travel. The family history was unremarkable. The patient's physical exam was essentially benign. Specifically, he had no abdominal tenderness. His laboratory tests included a hemoglobin level of 11.0 g/DL, and a BUN/creatinine of 25/1.2 mg/DL. The CT scan of the abdomen/pelvis found no abnormalities. The patient subsequently underwent an EGD and colonoscopy, which were both unremarkable. A Meckel's scan was negative, with no evidence for focal abnormal radiotracer activity. A video capsule endoscopy was then performed, and an ulcerated lesion was noted in the distal jejunum. The patient was referred to surgery and underwent an uneventful laparoscopic small bowel resection of the lesion. The surgical pathology results identified an extracerebellar hemangioblastoma. This diagnosis was supported by immunohistochemistry that showed that the stromal cells between the capillaries were negative for CD34, yet clearly positive for inhibin. The neooplastic cells also showed cytoplastic brachyuric expression consistent with hemangioblastoma. The patient has since done well, without recurrence of GI bleeding or other negative sequelae. Conclusion: To our knowledge, this appears to be the first reported case of a hemangioblastoma presenting in the small bowel. While extraordinarily rare, a hemangioblastoma should be considered in the differential for small bowel pathology associated with GI bleeding.

Zebras Do Exist: Churg-Strauss with GI Involvement

Purpose: A 57-year-old woman with recent diagnosis of asthma was admitted with progressive, diffuse abdominal pain for several weeks. The patient also reported non-bloody diarrhea, nausea without emesis, and early satiety. She denied fevers, recent travel, and family history of inflammatory bowel disease (IBD). On physical examination, vital signs were normal and abdominal exam was notable for mild diffuse tenderness to palpation. Admission labs revealed a white blood cell count of 20K with 56% eosinophils. Given diarrhea, abdominal pain, and eosinophilia, diagnosis of IBD was felt to be most likely with other considerations being parasitic infection, allergic reaction, connective tissue disease, neoplasm, and hypereosinophilic syndrome. Stool studies were negative for parasites. ESR and CRP were significantly elevated. CT abdomen showed wall thickening of the distal duodenum and jejunum again suggesting possible small bowel IBD. EGD was performed and was endoscopically normal to the duodenum with random biopsies showing no significant pathology. While admitted, the patient developed dyspnea with intermittent hypoxia; chest x-ray was performed and showed new pulmonary infiltrates. The patient continued to have persistent abdominal symptoms therefore endoscopy was repeated and this time revealed scattered duodenal and jejunal erosions/small ulcers and gastric erythema. Biopsies obtained from the stomach revealed eosinophilic vasculitis with thrombosis involving the small lamina propria blood vessels. The diagnosis of Churg-Strauss was confirmed with additional testing and the patient was treated with high-dose corticosteroids with resolution of all abdominal symptoms. This case illustrates several learning points including the importance of evaluating a broad differential diagnosis. IBD is a much more common cause of abdominal pain and diarrhea than gastrointestinal vasculitis, however, based on the clinical setting, even “zebras” must be considered. Our patient had a diagnosis of asthma in lateadulthood, significant peripheral eosinophilia, varying pulmonary complaints, and transient pulmonary infiltrates, all of which are consistent with Churg-Strauss. The case also emphasizes the need for repeat endoscopy with biopsy in cases that remain enigmatic as initial biopsies can be non-diagnostic due to sampling variation or inadequate depth. In our case, only after repeat biopsies could a final diagnosis be made and appropriate treatment initiated.

Severe Iron Deficiency: Rare Etiology, Easy Treatment

A 23-year-old male with an over 10-year history of chronic iron-deficiency anemia and gastroschisis at birth was initially evaluated at an outpatient Gastroenterology clinic with complaints of generalized malaise and fatigue lasting for several days. Although he denied abdominal pain, he had experienced intermittent bloating and epigastric discomfort for several years. He also reported chronic diarrhea, which he described as foul smelling, loose stools that occurred three to six times per day for several years. He denied fevers, chills, nausea, vomiting, hematemesis, or rectal bleeding. Additionally, he denied dyspnea on exertion or chest discomfort. On examination, tachycardia and normotension were noted. A hemoglobin of 4.4 g/dL prompted admission for further evaluation. His past medical history included asthma. The patient had been hospitalized for 3 months after birth (at 36 weeks gestation), largely due to an inability to tolerate oral intake, having received total parenteral nutrition prior to being discharged tolerating oral feeds. Charts from that time noted that he ‘‘...had gastroschisis with intestine, spleen and stomach outside of the abdomen.’’ A few days after birth, he underwent non-resective surgical repair. Intraoperatively, there was no evidence of intestinal atresia. At the age of five, he had one episode of a small bowel obstruction that resolved with medical management. An upper gastrointestinal series (UGIS) with small bowel follow through (SBFT) at that time showed slightly dilated small bowel segments with normal transit time throughout. In 1994, at the age of six, his hemoglobin and mean corpuscular volume (MCV) were within normal limits. Nevertheless, even in 2001, the patient had a history of heme-positive stool, along with bloating, diarrhea, and anemia (hemoglobin 9.1 g/dL and MCV 60). His anemia was evaluated at that time with panendoscopy without abnormal findings. The duodenum was reported as being ‘‘patulous.’’ Biopsies revealed mild chronic active gastritis (antral biopsies were negative for Helicobacter pylori), mild reflux esophagitis, and a normal duodenum. Biopsies throughout the right and left colon were normal. Overall, his endoscopic evaluation did not reveal any abnormalities that explained his anemia. He was prescribed oral iron replacement therapy, which, however, was not tolerated and thus not taken regularly. Given his history of asthma and poor growth as a child, he was evaluated for cystic fibrosis (CF) with sweat chloride and genetic testing which were normal. In 2001 another UGIS with SBFT showed a somewhat dilated distal jejunum. Pancreatic enzyme supplements were prescribed for unclear reasons, which, however, initially improved his bloating and diarrhea. By 2004, the diarrhea recurred with non-bloody, loose stools reported two to three times a week. There was no clear explanation for the patient’s diarrhea, anemia, or hemepositive stools; he was lost to follow-up until being seen at our institution. The patient’s social history was unremarkable in that he denied any drug, alcohol, or tobacco use. He also denied foreign travel or unusual environmental exposures. He did not have any pertinent family history; his three siblings S. R. Sinha (&) G. Triadafilopoulos N. Shah Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 300 Pasteur Dr., Always Bldg. M211, Stanford, CA 94305-5187, USA e-mail: sidsinha@stanford.edu

Preliminary assessment of including a reducing agent (sodium metabisulphite) in ‘all-sorghum’ diets for broiler chickens

The preliminary assessment was designed to determine appropriate inclusion levels of the reducing agent, sodium metabisulphite (SMBS), in ‘all-sorghum’ broiler diets. Dietary SMBS inclusion levels of 0, 1.25, 2.5, 5.0, 7.5, 10.0, 12.5 and 15.0gkg−1 were investigated with corresponding reductions (923–908gkg−1) in dietary sorghum concentrations. In vitro evaluations included the determination of concentrations of free sulphydryl groups and disulphide bonds in all-sorghum diets. In vivo parameters included growth performance (14–21 days post-hatch), nutrient utilisation and apparent nitrogen (N) digestibility coefficients in four small intestinal sites in broilers at 21 days post-hatch. In addition, the effect of 5.0gkg−1 SMBS on starch digestibility coefficients and sites of starch disappearance along the small intestine were determined. The reducing agent significantly increased free sulphydryl group and decreased disulphide bond concentrations. SMBS significantly depressed feed intakes at 5.0gkg−1 and at higher inclusion levels and there was a linear reduction in feed intakes (r=−0.783; P<0.001). SMBS had cubic effects on weight gain (r=0.588; P<0.001) and feed conversion ratios (r=0.500; P<0.01). It may be deduced from the relevant regression equations that the optimum SMBS inclusions are 2.47gkg−1 for weight gains and 2.14gkg−1 for feed conversion ratios. SMBS significantly increased apparent metabolisable energy (AME) at inclusions of 1.25, 5.0, 10.0 and 12.5gkg−1. At the lowest inclusion of 1.25gkg−1 SMBS increased AME by 0.39MJ (14.80 versus 14.41MJkg−1; P<0.001) and the most profound response of 0.56MJ (14.97 versus 14.41MJkg−1; P<0.001) was observed at 10.0gkg−1. SMBS linearly increased N retention (r=0.592; P<0.001). In the distal jejunum, SMBS significantly depressed N digestibility coefficients at inclusions of 1.25, 2.5, 10.0, and 15.0gkg−1 and in the distal ileum with SMBS inclusions of 1.25, 10.0 and 15.0gkg−1. SMBS did not influence N digestibility in the proximal jejunum (P>0.60) and proximal ileum (P>0.55). At 5.0gkg−1, SMBS increased starch digestibility coefficients by 3.76% in the proximal ileum (0.966 versus 0.931; P<0.01) and 3.27% in the distal ileum (0.980 versus 0.949; P<0.001). Also, SMBS significantly decreased the quantity of starch disappearance in the proximal jejunum, or abruptly digestible starch, by 16.3% (245.6 versus 293.4gbird−1; P<0.01). It is concluded that birds are able to tolerate dietary inclusions of SMBS approaching 5.0gkg−1 and that SMBS has the capacity to enhance energy utilisation of sorghum-based diets by broiler chickens. Consideration is given to the mechanisms whereby SMBS might enhance energy utilisation.

Distribution of glycinin in the gastrointestinal tissue of pigs at different growth stages

The gastrointestinal distribution of glycinin in pigs at different growth stages was investigated in this study. Fifteen healthy General No. 1 barrows weaned on the 28th day were randomly assigned to three groups with five replicates: five weanling, five growing and five finishing. All pigs received diets with non-soya bean ingredients in non-experimental periods, while the pigs received diets containing 4% purified glycinin in experimental periods. Binding of anti-glycinin antibody was detected using a labelled streptavidin–peroxidase complex method to determine the gastrointestinal distribution of glycinin. The results indicated that there was a significant difference on the gastrointestinal mucosal distribution of glycinin between pigs of different ages. Glycinin in growers was higher than piglets and lower than finishers (P<0.001). The highest content of glycinin was in the distal jejunum and ileum for piglets, and in distal jejunum for growers and finishers (P<0.05).

Influence of white- and red-sorghum varieties and hydrothermal component of steam-pelleting on digestibility coefficients of amino acids and kinetics of amino acids, nitrogen and starch digestion in diets for broiler chickens

Two experiments were conducted to examine the influence of sorghum variety and the hydrothermal component of steam-pelleting diets on apparent amino acid digestibility coefficients and digestion kinetics of amino acids, nitrogen and starch in broiler chickens. In experiment one, 84 male Ross 308 chicks were offered steam-pelleted diets based on white (Liberty) and red (Buster) sorghum from 7 to 28 days post-hatch. In experiment two, the same red sorghum-based diets were offered to chicks from 7 to 28 days post-hatch as either unprocessed raw mash or reground mash following steam-pelleting at 95°C. In both experiments, digesta samples from proximal jejunum, distal jejunum, proximal ileum and distal ileum were collected in their entirety at day 28. The samples were then freeze-dried and weighed for determination of mean retention time in each small intestinal segment. The digestion kinetics of amino acids, nitrogen and starch were determined using an exponential mathematical model to relate apparent digestibility coefficients with mean retention times in each small intestinal segment. In experiment one, white sorghum-based diets had significantly higher average amino acid digestibility coefficients than red sorghum in the proximal ileum and distal ileum (P<0.05). Nine from sixteen amino acids in white sorghum-based diets had significantly higher apparent digestibility coefficients in the proximal ileum and distal ileum. The potential digestible fraction of starch and rate of starch digestion in white sorghum-based diet were significantly higher than red sorghum (P<0.05). However, there were no significant differences in digestion rates of nitrogen and amino acids. However, pre-determined feed conversion ratios were strongly correlated with potential digestible starch (r=−0.840, P<0.001). The differences in white and red sorghum-based diets were more pronounced in starch digestion than nitrogen digestion and further research is required to identify the precise causes of deficient starch digestion in red sorghum. In experiment two, the hydrothermal component of the steam-pelleting process had a negligible impact on digestion of amino acids as there were no significant differences in the extent or rate of amino acid digestion in raw mash and reground mash diets. Therefore, the linear increases of amino acid digestibilities with increased conditioning temperatures observed in a previous study may be attributed to the feed form effect of intact pellets generating heavier relative gizzard weights; thereby enhancing the overall protein digestive process.

Influence of conditioning temperatures on amino acid digestibility coefficients at four small intestinal sites and their dynamics with starch and nitrogen digestion in sorghum-based broiler diets

The influence of conditioning temperatures on apparent digestibility coefficients of amino acids at proximal jejunum, distal jejunum, proximal ileum and distal ileum were investigated in this study. Broilers were fed sorghum-based diets steam-pelleted at three conditioning temperatures (65, 80, 95°C) from 7 to 28days post-hatch. Digesta samples were collected at day 28 and freeze-dried and weighed for determination of amino acid digestibilities and mean retention time in each small intestinal segment. The digestion kinetics of amino acids were determined using an exponential mathematical model to relate digestion coefficients with mean retention times in each small intestinal segment. Increasing conditioning temperatures from 65 to 95°C significantly increased apparent digestibility coefficients of phenylalanine at proximal jejunum, apparent digestibility coefficients of aspartic acid and proline at proximal ileum and apparent digestibility coefficients of arginine, lysine, aspartic acid and glycine at distal ileum. Conditioning temperatures linearly increased retention times in the distal ileum (P<0.05). There were no significant differences in digestion rates of amino acids, starch and nitrogen between treatments. Nitrogen retention was positively correlated (P<0.05) with amino acid digestibility coefficients at the proximal jejunum, but not at the other three small intestinal sites. Interestingly, relative gizzard weights were positively correlated with amino acid digestibility coefficients at the proximal ileum (P<0.05) and distal ileum (P<0.05). Starch digestion rate was positively correlated with digestion rates of 8 amino acids (P<0.05). Percentage responses of amino acid digestibilities to increased conditioning temperatures were negatively correlated with their initial digestibility at 65°C (P<0.001). Increasing conditioning temperatures from 65 to 95°C improved the average digestibility coefficients of amino acid by 29.8% at the proximal jejunum, 4.8% at the proximal ileum and 4.0% at the distal ileum. These results indicate that increasing conditioning temperatures generally enhanced amino acid digestibilities. These increases may have been generated by reversible protein denaturation that facilitated proteolysis, by heavier and more functional gizzards promoting protein digestion and, to a lesser extent, by inactivation of protease inhibitors inherent in the diet

Are Bile Acids the New Gut Hormones? Lessons From Weight Loss Surgery Models

Bileacidsareincreasinglyrecognizedasmoleculeswith endocrine functions (1), but their effect on gut hormones, energy expenditure, and insulin sensitivity has not been fully elucidated. Bile acids do represent an attractive target for obesity and type 2 diabetes from a therapeutic pointofviewbecauseoftheendogenouschangesobserved after gastric bypass (2). The anatomical changes with alteredbileflowaftergastricbypasssurgerymakestudieson animal models such as the one by Kohli et al (2) extremely relevant.Gastricbypasssurgeryhasbeenshowntobesafe and effective for inducing weight loss and ameliorating hyperglycemia, but understanding the mechanism of action and dissecting the role of bile acid manipulation in particular, not only offers important insight into glucose metabolism, but also may open the door for even more effectivetreatmentoptionsfortype2diabetesandobesity. These therapies could be medical, surgical, endoscopic, and perhaps more importantly combinational therapy. ThestudybyKohlietal(2)demonstratesthemetabolic effect of diverting bile to the distal gut. The authors used aninnovativeapproachbyplacingacatheterintothecommon bile duct of male obese rats to drain bile to the more distal jejunum. Bile diversion was associated with increased serum bile acids, enhanced postprandial glucagon-like peptide-1 response, improved glucose tolerance, and reduced hepatic steatosis. None of these effects were observed in the appropriate sham group. By isolating the effect of the altered bile flow without changing the length of the gut and the size of the stomach, this work suggests that the metabolic effects of gastric bypass cannot be explained by weight loss alone. Consistent with the work of Kohlietal(2)inanotherratmodel,itwasalsoshownthat drainage of endogenous bile into the terminal ileum was associated with an enhanced satiety gut hormone response, reduced food intake, and lower body weight (3). Kohli et al advanced our current knowledge by demonstrating that manipulating bile flow without altering the anatomy of the small bowel leads to improved glucose tolerance. During the last decade, the role of gut hormones after gastric bypass surgery has featured prominently (4), but it hasalsobecomeevidentthatguthormonesdonotexplain alltheeffectsseenafterweightlosssurgery.Forone,when gut hormones are blocked with a somatostatin analog, a substantial increase in ad libitum food intake is observed, but food intake does not return to presurgical levels (5). Second,manyofthebeneficialchangesinglycemiccontrol occur even after open gastric bypass surgery (6), which is associated with increased inflammation and should have

Structural Sampling of Glycan Interaction Profiles Reveals Mucosal Receptors for Fimbrial Adhesins of Enterotoxigenic Escherichia coli.

Fimbriae are long, proteinaceous adhesion organelles expressed on the bacterial envelope, evolutionarily adapted by Escherichia coli strains for the colonization of epithelial linings. Using glycan arrays of the Consortium for Functional Glycomics (CFG), the lectin domains were screened of the fimbrial adhesins F17G and FedF from enterotoxigenic E. coli (ETEC) and of the FimH adhesin from uropathogenic E. coli. This has led to the discovery of a more specific receptor for F17G, GlcNAcβ1,3Gal. No significant differences emerged from the glycan binding profiles of the F17G lectin domains from five different E. coli strains. However, strain-dependent amino acid variations, predominantly towards the positively charged arginine, were indicated by sulfate binding in FedF and F17G crystal structures. For FedF, no significant binders could be observed on the CFG glycan array. Hence, a shotgun array was generated from microvilli scrapings of the distal jejunum of a 3-week old piglet about to be weaned. On this array, the blood group A type 1 hexasaccharide emerged as a receptor for the FedF lectin domain and remarkably also for F18-fimbriated E. coli. F17G was found to selectively recognize glycan species with a terminal GlcNAc, typifying intestinal mucins. In conclusion, F17G and FedF recognize long glycan sequences that could only be identified using the shotgun approach. Interestingly, ETEC strains display a large capacity to adapt their fimbrial adhesins to ecological niches via charge-driven interactions, congruent with binding to thick mucosal surfaces displaying an acidic gradient along the intestinal tract.

Characterization of anal double balloon endoscopy in the dog

Retrograde (anal) exploration of the canine small intestine by conventional endoscopy is restricted to the ileum, but double balloon endoscopy (DBE) has recently been validated using the oral approach. In this study, anal DBE was performed on nine healthy dogs to characterize the efficiency, exploration dynamics and safety of the technique. DBE was successful in all dogs; the average estimated insertion depth of the endoscope was about 2m and took approximately 1h to achieve. No complications or related adverse clinical effects were observed, and pancreatitis did not occur following the procedure. Anal DBE is viable and safe in the dog within the limits of the study, and has the potential to facilitate the diagnosis and treatment of gastrointestinal diseases, not only in portions of the colon and ileum, but also in portions of the distal jejunum.

Protease supplementation of sorghum-based broiler diets enhances amino acid digestibility coefficients in four small intestinal sites and accelerates their rates of digestion

Apparent amino acid digestibility coefficients in the proximal jejunum, distal jejunum, proximal ileum and distal ileum of broilers fed sorghum-based diets without or with exogenous protease were determined at 28 days post-hatch. The digestion kinetics of amino acids were determined using an exponential mathematical model to relate digestion coefficients at four intestinal sites with mean retention times in each small intestinal segment. Protease increased average digestibility coefficients in the distal jejunum by 12.6% (0.681 vs. 0.605; P<0.05), in the proximal ileum by 5.0% (0.783 vs. 0.746; P=0.055) and in the distal ileum by 4.7% (0.822 vs. 0.785; P<0.05). In distal ileum, protease significantly increased the digestibility of thirteen amino acids, which ranged from a 4.5% increase in histidine (0.820 vs. 0.785, P<0.05) to a 7.9% increase in proline (0.779 vs. 0.722, P<0.01). Protease supplementation significantly increased digestion rates of twelve amino acids from 34.2% for histidine (2.57 vs. 3.45×10−2min−1, P<0.05) to 55.7% for proline (2.28 vs. 3.55×10−2min−1, P<0.01). Protease did not significantly influence retention times in each intestinal site. Protease significantly increased predicted glycaemic response by 18.8% (P<0.05). There were no significant correlations between digestion rates of starch and amino acids. The present study indicates that the Bacillus lichenformis-derived protease has the capacity to improve amino acid digestibility coefficients in sorghum-based diets and accelerate the digestion rate of protein and amino acid absorption.

PTH-092 Interval Scanning with Magnetic Resonance Enterography Demonstrates Response to Anti-Tnf Therapy and has Utility in Reassessment of Crohn’S Disease

IntroductionNICE guidelines mandate yearly reassessment of disease activity for those treated with anti-TNF therapy (ATT). Magnetic resonance enterography (MRE) is established in the assessment of small bowel Crohn’s disease, however,...

Steam-pelleting temperatures and grain variety of finely ground, sorghum-based broiler diets. 1. Influence on growth performance, relative gizzard weights, nutrient utilisation, starch and nitrogen digestibility

Sorghum-based diets were offered to male Ross 308 chicks from 7 to 28 days post-hatch as a 2 × 3 factorial array of treatments. The diets were based on either a white (Liberty) or red (Venture) sorghum that were finely ground through a 2.0-mm hammer-mill screen before incorporation into diets that were steam-pelleted at conditioning temperatures of 70°C, 80°C and 90°C. Protein solubilities and concentrations of disulfide bonds and free sulfydryl groups in sorghums and sorghum-based diets were determined. Concentrations of phenolic compounds and antioxidant activities in both sorghums were analysed and the presence or absence of a pigmented testa was detected. In vivo parameters assessed included growth performance, relative gizzard weights, nutrient utilisation and apparent starch and nitrogen (N) digestibility coefficients were determined at four small-intestinal sites. Increasing conditioning temperatures depressed dietary protein solubilities and induced changes in concentrations of disulfide bonds and free sulfydryl groups that were more pronounced in red sorghum-based diets. The red sorghum contained a higher concentration of phenolic compounds and had a higher antioxidant activity than did white sorghum. A pigmented testa was not present in both sorghums, which indicates that they do not contain condensed tannin. There was a significant interaction between sorghum type and conditioning temperature for weight gain; however, diets based on white or red sorghums did not generate any significant differences in weight gains, feed intakes or feed conversion ratios as main effects. It was anticipated that birds would perform better on white sorghum-based diets but the likelihood is that the fine 2.0-mm grind disadvantaged the softer-textured white sorghum. As main effects, red sorghum-based diets had significantly higher densities of N-corrected apparent metabolisable energy, a higher starch digestibility coefficient in the distal jejunum and higher N digestibility coefficients in the distal jejunum, proximal ileum and distal ileum than did white sorghum-based diets. Red sorghum-based diets generated significantly heavier relative gizzard weights, which appeared to enhance N digestibility coefficients relative to the white sorghum diets. Increasing conditioning temperatures linearly increased starch digestibility coefficients in the proximal jejunum and distal ileum and N digestibility coefficients in the proximal jejunum, distal jejunum and distal ileum to significant extents. Conditioning temperatures did not significantly influence gizzard weights or parameters of growth performance and nutrient utilisation. Several significant interactions between the main effects were observed, which suggests that the two sorghums responded somewhat differently to increasing conditioning temperatures.

Long-term survival after multidisciplinary treatment of small-bowel neuroendocrine tumors with synchronous liver metastases: A single-institute experience.

e15147 Background: Neuroendocrine tumors (NETs) that originate in the distal jejunum and ileum are commonly diagnosed in stage IV, with liver metastases in 50%-75% of cases. The aim of this study was to ascertain the impact of surgery in a consecutive series of patients with small bowel NET and synchronous liver metastases treated at a single institute. Methods: Ninety-one patients managed between 1995 and 2011 were extracted from the institutional tumor registry. All patients had diagnosis by histology of small bowel NET and synchronous liver metastases. Results: Among the 91 patients 28 (30.8%) underwent primary tumor removal and liver metastases resection or intraoperative termal ablation (Group 1), 54 (59.3%) underwent resection of only the primary tumor (Group 2), and the remaining 9 (9.9%) did not receive any surgery (Group 3). After a median follow-up of 64 months an overall survival (OS) of 93.1%, 81.8% and 76.2% at 3, 5 and 8 years was registered for the whole group. Cancer-specific survival (CSS) was 93.1%, 83.3% and 77.6% at 3, 5 and 8 years, respectively. Five-years OS differed significantly according to the surgical approach (96.0% for Group 1 vs 79.8% for Group 2 vs 48.6% for Group 3, p=0.02). During the course of the illness octreotide was administered in 78 patients (85.7%), peptide receptor radiotherapy in 61 (67.0%), systemic chemotherapy in 21 (23.1%), hepatic artery embolization in 17 (18.7%), interferon in 11 (12.1%), molecular targeted agents in 2 (2.2%). For patients who underwent any surgery (Group 1 and Group 2) the multidisciplinary approach was associated with a better OS (85.7% vs 77.2% 5-years OS, p=0.04). In the multivariate analysis only age was associated with OS, HR: 1.05 (C. I.: 1.01-1.10). The results of CSS were comparable to those of OS. Conclusions: In this metastatic setting of small bowel NETs the 5 year OS was as high as 82% with a maximum benefit achievable for patients who had primary tumor resection and liver disease amenable to surgical or thermal ablation. However, the potential impact of age in prognosis should be carefully considered when choosing the treatment to be delivered in such patients.

Four Thai Patients With Chronic Diarrhea, Malabsorption, and Weight Loss

Diagnosis: Capillariasis associated with tubular narrowing of multiple small-bowel loops with fold effacement. The clinical and radiographic presentations of these cases are representative of Capillaria philippinensis infection. Infection with C. philippinensis is primarily acquired by ingestion of raw, undercooked, small, fresh- or brackish-water fish [1]. Capillaria philippinensis, first discovered in the Philippines, has subsequently been detected in Thailand, Japan, Iran, Egypt, and Taiwan, with major outbreaks reported in Thailand and the Philippines [2]. Typically, patients present with signs and symptoms of malabsorption inclusive of chronic diarrhea, edema, muscle wasting, and abdominal pain; laboratory data reveal low serum albumin and potassium [3–4]. The diagnosis of C. philippinensis is usually based on the detection of eggs (Figure 1), larva, and/or adult worms with or without egg in stool specimens (Figure 1), although excretion can be sporadic, necessitating multiple repeated stool examinations, with small intestinal aspiration or biopsy to confirm the diagnosis in some cases [1–2]. Notably, mortality has been reported in patients with C. philippinensis who did not have capillaria eggs or larva recovered from stool specimens [2–3]. The detection of the parasite’s stichosome (the posterior glandular esophagus) and stichocytes (large glandular cells) by hematoxylin and eosin stain are not diagnostic, as these can also be identified in biopsies of patients with Trichinella spiralis and Trichuris trichiura infection. The clinical presentations and locations of lesions can readily help in the differentiation and case detection of these 3 parasitic infections [5]. Whereas patients with C. philippinensis typically present with clinical manifestations of chronic watery diarrhea and malabsorption, those with T. trichiura usually present with prolonged diarrhea, blood-streaked stool, anemia, colitis, proctitis, and rectal prolapse (in patients with heavy infestation). Cases with T. spiralis usually have biphasic presentations that begin with clinical manifestations of nausea, vomiting, and diarrhea (intestinal phase) followed by intense myalgias and periorbital edema (muscular phase) [5]. Additionally, C. philippinensis typically involves the distal jejunum and proximal ileum, T. trichiura tends to cause lesions limited to the large bowel, and T. spiralis is typically associated with encysted larva that migrated to specific organ tissues (eg, muscle, myocardium, and brain). In each of our 4 reported cases, the initial stool specimen was negative for C. philippinensis. Subsequent stool specimens were positive for C. philippinensis in 2 patients, and all 4 had small-bowel biopsies remarkable for severe villous blunting, inflammatory cell infiltration, and visualization of nematodes in longitudinal sections with the identification of stichocytes

PROPUESTA DE UN MODELO EXPERIMENTAL DE ENTERITIS AGUDA INDUCIDA POR INDOMETACINA EN RATAS ALBINAS

Fifteen Holtzman male rats weighing 250 to 275 g were distributed in four groups. Group 1 was subcutaneously injected with 5% NaHCO3 (n=20). Groups 2, 3 and 4 received 15 mg/kg of indomethacin subcutaneously (n=10 rats/group). Macroscopic and microscopic evaluation of small intestine (jejunum-ileum) were carried out at first, second and third day after drug administration. Intestinal injury were observed along the mesenteric side of the middle and distal jejunum. Macroscopic lesions consisted of bowel thickening and dilatation, absence of the mucosa, hyperemia and multiple longitudinal and round ulcers. These lesions were observed at 24 h after drug injection and were present by 72 h. There were no statistical differences (p>0.05) between groups 2, 3 and 4, relating to gross lesions. Microscopically, lesions were characterized by erosion of the mucosa, fibrinous and bacterial infiltration, neutrophilic and lymphocytic infiltration, necrosis of the mucosa and the muscularis, bowel perforations and fibroblastic proliferation. Lymphocytes were present at first day (primary cellular indicator of inflammation) and neutrophils were present at second day (cellular indicator of persistence and severity). Microscopic lesions were most evident by 24 h after drug injection.

Investigation of drug metabolism in various segments of small intestine in the rat

In the extrahepatic drug metabolism the intestinal tract can play an important role. These experiments were designed to study the biotransformation of p-nitrophenol (PNP) in the small intestine in the rat. Various segments of the small intestine (proximal and distal jejunum, terminal ileum) were perfused with isotonic solution in vivo containing different concentrations of PNP (20-100-500-1000 μM) and the concentrations of metabolites (PNP-G: p-nitrophenol glucuronide, PNP-S: p-nitrophenol sulfate) were determined in the perfusion medium. It was found a decreasing tendency in the glucuronidation from the proximal to distal segment of the small intestine: e.g. 430 nmol, 240 nmol, and 100 nmol PNP-G appeared in the perfusion medium in the proximal, distal jejunum and in the terminal ileum, respectively, when 500 μM PNP was luminally perfused for 90 minutes. Similar ratio was found at the luminal perfusion of other PNP-concentrations, too. Luminal appearance of sulfoconjugate of PNP was considerably lower and no clear gradient tendency in the formation of PNP-S could be detected in the small intestine from the proximal to distal segment. Our results show that there are considerable differences in drug metabolism in various segments of the small intestine. We have found a gradient conjugating activity from proximal to distal segment of small intestine in the glucuronidation of PNP.

An endoscopic technique for treating symptomatic distal jejunum obstruction by leaving the overtube in place

Double balloon enteroscopy has a limitation for positioning an enteral stent in the distal jejunum through its long, narrow biopsy channel. When the distal end of its overtube is left in place close to the neoplasia with the enteroscope removed, if we push an enteral stent introduction system, it tends to form loops so the techniquecannot be performed with this instrument. However, the double balloon colonoscope has a shorter overtube length and using the same push-and-pull technique we can reach the distal jejunum with this instrument by inserting the delivery stent system without loops through its overtube. We present a patient with neoplastic obstruction in the distal jejunum with resolution of his symptoms after positioning an enteral stent.

Long-term survival after multidisciplinary treatment of small-bowel neuroendocrine tumors with synchronous liver metastases. A single-institute experience.

299 Background: Neuroendocrine tumors (NETs) that originate in the distal jejunum and ileum are commonly diagnosed in stage IV, with liver metastases in 50-75% of cases. The aim of this study was to ascertain the impact of surgery in a consecutive series of patients with small bowel NET and synchronous liver metastases treated at a single institute. Methods: Ninety-one patients managed between 1995 and 2011 were extracted from the institutional tumor registry. All patients had diagnosis by histology of small bowel NET and synchronous liver metastases. Results: Among the 91 patients 28 (30.8%) underwent primary tumor removal and liver metastases resection or intraoperative termal ablation (Group 1), 54 (59.3%) underwent resection of only the primary tumor (Group 2), and the remaining 9 (9.9%) did not receive any surgery (Group 3). After a median follow-up of 64 months an overall survival (OS) of 93.1%, 81.8% and 76.2% at 3, 5 and 8 years was registered for the whole group. Cancer-specific survival (CSS) was 93.1%, 83.3% and 77.6% at 3, 5 and 8 years, respectively. Five-years OS differed significantly according to the surgical approach (96.0% for Group 1 vs 79.8% for Group 2 vs 48.6% for Group 3, p=0.02). During the course of the illness octreotide was administered in 78 patients (85.7%), peptide receptor radiotherapy in 61 (67.0%), systemic chemotherapy in 21 (23.1%), hepatic artery embolization in 17 (18.7%), interferon in 11 (12.1%), molecular targeted agents in 2 (2.2%). For patients who underwent any surgery (Group 1 and Group 2) the multidisciplinary approach was associated with a better OS (85.7% vs 77.2% 5-years OS, p=0.04). In the multivariate analysis only age was associated with OS, HR: 1.05 (C. I.: 1.01-1.10). The results of CSS were comparable to those of OS. Conclusions: In this metastatic setting of small bowel NETs the 5 year OS was as high as 82% with a maximum benefit achievable for patients who had primary tumor resection and liver disease amenable to surgical or thermal ablation. However, the potential impact of age in prognosis should be carefully considered when choosing the treatment to be delivered in such patients.