Distal Jejunum Research Articles

Vulnerable Sites and Changes in Mucin in the Rat Small Intestine After Non-steroidal Anti-inflammatory Drugs Administration

The location of mucosal damage and changes in mucin content in the rat small intestine following administration of non-steroidal anti-inflammatory drugs (NSAIDs) have not been well elucidated. After subcutaneous administration of loxoprofen sodium (10-40 mg/kg), the small intestinal mucosa of male Wistar rats was evaluated macroscopically, histologically, and immunohistochemically by measuring the total mucin content and immunoreactivity for anti-mucin monoclonal antibody, HCM31, 1, 3, 7, and 14 days later. Changes in the number of enterobacteria invading the mucosa around the lesions were also determined. Loxoprofen sodium induced erosions and ulcers along the mesenteric margin of the distal jejunum. Early (≤6 h) mucosal lesions were small and round, located between the branches of the mesenteric arteries. In the jejunum, there was a transient increase in the total mucin content, and HCM31-positive mucin in the mucosa around the ulcers increased significantly on days 3 and 7, but in the ileum there were no marked changes and few ulcers. Bacterial translocation following loxoprofen sodium administration significantly increased, according to the site of the intestinal lesions. Vascularly compromised sites along the jejunal mesenteric margin are vulnerable to NSAIDs-induced damage and show increased numbers of enterobacteria in the NSAIDs-treated mucosa. Increased sialomucin content in the mucus around the lesions may play an important role in the healing of NSAIDs-induced intestinal lesions.

Papillary adenocarcinoma arising in a tubular duplication of the jejunum

Alimentary tract duplications are uncommon congenital anomalies containing a normal gastrointestinal mucosa and smooth muscle layer. Intestinal duplication in the jejunum is rare, and any malignancy arising in the jejunal duplication is extremely rare. In this report, we present the first case of papillary adenocarcinoma arising in a tubular duplication of the jejunum. Coronal reformatted images from contrast-enhanced CT revealed a well-enhanced tubular mass in the distal jejunum with small bowel obstruction. There were multiple enlarged lymph nodes in the small bowel mesentery around the superior mesenteric artery. The typical macroscopic and histological findings were present.

Circumferential mural bands in the small intestine causing simple obstructive colic: a case series

Circumferential mural band (CMB) in the small intestine is an emerging condition in Ireland. The clinical presentation is a simple obstruction of the small intestine of unknown aetiology. Horses affected with CMB in the small intestine have a good prognosis following surgical decompression into the caecum. A retrospective study was carried out and 28 cases identified from 559 colic surgeries performed over a 5.5 year period. An exploratory celiotomy was performed in every case. A simple obstruction at the mid or distal jejunum was identified caused by a CMB, which was multiple in some cases. All of the horses except 2 had undergone a regular anthelmintic programme. Manual decompression of the small intestine into the caecum resulted in resolution of the simple jejunal obstruction. A constricted segment of small intestine was resected in one case, as the degree of constriction was severe. A full thickness biopsy was taken from another case. Histopathology was performed on both samples. All horses recovered from surgery and were discharged from the hospital 7-32 days post operatively. Short-term complications were observed. Survival rate was 100% at long-term follow-up. Histopathology showed inflammatory infiltration in the submucosa, muscularis and serosa with eosinophils predominating. Parasites were not detected. Small intestine circumferential mural bands have a good prognosis after surgical decompression of the small intestine into the caecum.

Development of techniques for gastrojejunal bypass surgery in obese mice

We have previously described a duodenojejunal bypass (DJB) surgical model in healthy C57BL/6 mice. However, our pilot study showed that the same surgical technique caused a high mortality rate in obese mice. In this study, to significantly improve animal survival rate following bariatric surgery and thereby providing a stable surgical model for the study of glucose homeostasis in obese mice, we have used modified techniques and developed the end-to-side gastrojejunal bypass (GJB) surgery in obese C57BL/6 with impaired glucose tolerance. The modification consisted of using the distal part of the jejunum for biliopancreatic diversion including: 1) ligation of the distal stomach at the level of the pylorus; 2) connection the jejunum to the anterior wall of stomach in an end-to-side fashion; and 3) diverting the biliopancreatic secretions through the blind limb into the distal jejunum through an end-to-side anastomosis. We found that by modifying the proximal end-to-end duodenojejunal anastomosis, described in our original model, to an end-to-side gastrojejunal anastomosis in these obese mice, we were able to significantly improve the postoperative mortality in this study. We have also demonstrated that performing the GJB surgery in obese mice resulted in significant weight loss, normalized blood glucose levels, and prevented acute pancreatitis. This newly developed GJB surgery in the obese mice offers a unique advantage to study the mechanisms of gastrointestinal surgery as treatment for type 2 diabetes.

Intestinal Adaptation Following Massive Ileocecal Resection in 20‐day‐old Weanling Rats

Few infant animal models have been used to study infantile short bowel syndrome (SBS). Most SBS models involve removal of the proximal small bowel followed by jejunoileal anastomosis, which has unclear clinical relevance to human infantile SBS that often results from surgical treatment for necrotizing enterocolitis and involves removal of the ileum, ileocecal valve, and part of or the entire colon. Our objective was to develop a more appropriate SBS model in developing rats. Twenty-day-old weanling rats were divided into 2 surgery groups, ileocecal resection (ICR) and sham groups, and a control group that did not undergo surgery. All were fed a liquid diet ad libitum for 7 days after surgery or for 7 days in the controls, and body weight, food intake, and stool changes were recorded daily. The rats were then euthanized and intestinal lengths and weights were recorded. Samples of intestine from the distal jejunum and proximal colon were collected for histology. Mucosal samples from the middle, distal jejunum, and colon were collected for measurements of mucosal weights, DNA, RNA, and protein levels. Maltase activity was determined in the small intestine. Eighty-five percent of rats survived the ICR with subsequent development of diarrhea, hyperphagia, and poor growth. Adaptive responses to ICR, as compared with sham, were evidenced by increased intestinal and mucosal weights, DNA, RNA, and protein levels, increased maltase activity and villous thickness in distal jejunum, and increased mucosal thickness in the colon. This ICR model in weanling rats is appropriate for studying human infantile SBS.

Deciphering the porcine intestinal microRNA transcriptome

BackgroundWhile more than 700 microRNAs (miRNAs) are known in human, a comparably low number has been identified in swine. Because of the close phylogenetic distance to humans, pigs serve as a suitable model for studying e.g. intestinal development or disease. Recent studies indicate that miRNAs are key regulators of intestinal development and their aberrant expression leads to intestinal malignancy.ResultsHere, we present the identification of hundreds of apparently novel miRNAs in the porcine intestine. MiRNAs were first identified by means of deep sequencing followed by miRNA precursor prediction using the miRDeep algorithm as well as searching for conserved miRNAs. Second, the porcine miRNAome along the entire intestine (duodenum, proximal and distal jejunum, ileum, ascending and transverse colon) was unraveled using customized miRNA microarrays based on the identified sequences as well as known porcine and human ones. In total, the expression of 332 intestinal miRNAs was discovered, of which 201 represented assumed novel porcine miRNAs. The identified hairpin forming precursors were in part organized in genomic clusters, and most of the precursors were located on chromosomes 3 and 1, respectively. Hierarchical clustering of the expression data revealed subsets of miRNAs that are specific to distinct parts of the intestine pointing to their impact on cellular signaling networks.ConclusionsIn this study, we have applied a straight forward approach to decipher the porcine intestinal miRNAome for the first time in mammals using a piglet model. The high number of identified novel miRNAs in the porcine intestine points out their crucial role in intestinal function as shown by pathway analysis. On the other hand, the reported miRNAs may share orthologs in other mammals such as human still to be discovered.

Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis

Anisakiasis usually occurs in the stomach and can easily be diagnosed by digestive tract endoscopy as opposed to enteric anisakiasis which is very rare and difficult to be diagnosed definitively. The most important and useful tool in diagnosing enteric anisakiasis is obtaining an accurate patient history of having eaten raw fish before the onset of symptoms. We report a case of small bowel obstruction caused by acute invasive enteric anisakiasis. A 60-year-old woman visited the emergency room suffering from sudden abdominal pain. She had eaten raw fish 1 day before the onset of symptom. Radiologic studies showed small bowel obstruction. However, no definitive cause could be found. An emergency laparotomy revealed edematous and dilated proximal jejunum and a focal stenosis of the distal jejunum. Segmental resection of the jejunum was performed, and histopathological examination revealed enteric anisakiasis. The patient was discharged on the 7th day after surgery following an uneventful course of recovery.

A rare cause of small bowel obstruction

Suprapubic catheter insertion is uncommonly associated with complications. This article reports an 83-year-old man admitted with small bowel obstruction, 4 years after insertion of a suprapubic catheter.

Recent Developments in Acute Pancreatitis

The incidence of acute pancreatitis (AP) has been increasing worldwide, but the major etiologies remain gallstones and alcohol. Several studies have reported that smoking is an independent risk factor for developing AP. Classification of AP has traditionally used the categories of mild and severe disease. However, a new intermediate category of moderately severe AP has been described with intermediate characteristics including a high incidence of local complications but a low mortality. Assessment criteria that can serve as early predictors of AP severity are often complex and not sufficiently accurate. However, several recently described criteria that rely on criteria such as the body mass index, physical findings, and simple laboratory measurements could prove useful if validated in large prospective studies. Many issues related to the therapy of AP are still unresolved. Although preliminary studies support the importance of early volume expansion for the treatment of acute pancreatitis, optimization of the amount and type of fluids will require further studies. Similarly, preliminary studies suggest that enteral nutrition might benefit patients with AP and could even be useful early in the course of disease. However, the timing and type of fluids as well as the intestinal infusion site require further study. Finally, issues related to the prophylactic use of antibiotics in patients with severe AP have not been resolved. While the process of clinical investigation moves slowly, progress has been made in clinical studies of AP.

Heat shock protein 70 is upregulated in the intestine of intrauterine growth retardation piglets

The objective of this study is to investigate the expression and distribution of heat shock protein 70 (Hsp70) in the intestine of intrauterine growth retardation (IUGR) piglets. Samples from the duodenum, prejejunum, distal jejunum, ileum, and colon of IUGR and normal-body-weight (NBW) piglets were collected at birth. The results indicated that the body and intestine weight of IUGR piglets were significantly lower than NBW piglets. The villus height and villus/crypt ratio in jejunum and ileum of IUGR piglets were significantly reduced compared to NBW piglets. These results indicated that IUGR causes abnormal gastrointestinal morphologies and gastrointestinal dysfunction. The mRNA of hsp70 was increased in prejejunum (P < 0.05), distal jejunum (P < 0.05), and colon in IUGR piglets. However, the hsp70 mRNA in ileum of piglets with IUGR was decreased. Similar to hsp70 mRNA, the protein levels of Hsp70 in prejejunum (P < 0.05), distal jejunum, and colon (P < 0.05) in IUGR piglets were higher than those in NBW piglets. These results indicated that the expression of Hsp70 in the intestinal piglets was upregulated by IUGR, and different intestinal sites had different responses to stress. Meanwhile, the localization of Hsp70 in the epithelial cells of the whole villi and intestinal gland rather than in the lamina propria and myenteron suggested that Hsp70 has a cytoprotective role in epithelial cell function and structure.

Small Bowel Tumor Presenting as Chronic Overt, Obscure Gastrointestinal Bleeding Missed on Capsule Enteroscopy

Purpose: Overt, obscure gastrointestinal bleeding (GIB) leads to increased morbidity and mortality and can require large volume transfusions and multiple diagnostic procedures before identifying the bleeding source. In 5% cases of GIB, no source is identified, and surgical resection must be considered to control life threatening episodes of bleeding. After negative EGD and colonoscopy, capsule enteroscopy (CE) is indicated to evaluate the small bowel (SB) for a bleeding source. Here we report a case of ongoing transfusion dependent, overt, obscure lower GIB from an ileal carcinoid tumor that was missed on initial capsule study. Case: 66 y/o male with chronic intermittent alternating melena and hematochezia with blood loss anemia over one year was referred for evaluation. He underwent multiple diagnostic endoscopies and radiographic imaging without a definitive source for overt bleeding. Colonoscopy revealed blood clots in the cecum and terminal ileum, diverticulosis, and a small 2 mm adenoma in the left colon. Capsule finds an AVM in mid/distal jejunum. Tagged RBC scan lit up in the LUQ. UGI/SBFT was normal. Push enteroscopy was negative for bleeding. Mesenteric angiogram is unrevealing. Then, double balloon enteroscopy (DBE) finds a 1 cm clean based ulcer at 250 cm and India inked. In the proximal jejunum an AVM was cauterized. Follow up CE finds mucosal erosions in the distal jejunum or proximal ileum, but no active bleeding. Finally, retrograde DBE finds a 2-3 cm ulcerated mass proximal to the India ink marking, likely the source of bleeding. He underwent surgical resection of a palpable SB nodule. Pathology diagnosed a 1.6 × 0.9 × 0.6 cm carcinoid tumor in the proximal ileum. Discussion: The management of ongoing, obscure GIB in the SB may require multiple endoscopic and imaging modalities before identification and resolution. CE is often the initial study of choice for SB evaluation. However, up to 20% SB tumors can be missed by CE alone. Repeat CE and/or DBE should be done in the case of ongoing obscure GIB after an initial negative capsule study. Both CE and DBE are comparable in diagnostic efficacy and cost effectiveness. A vigilant approach to finding the source of occult GIB should be maintained to avoid delaying the diagnosis of small bowel tumors.

Obscure Gastrointestinal Bleeding with Elusive Meckelʼs Diverticulum

Purpose: Obscure gastrointestinal tract bleeding can be particularly worrisome, as even after judicious testing, the etiology is not always certain. Meckel's diverticulum is a remnant of the viteline duct affecting about 2% of the population, making it the most prevalent congenital abnormality of the GI tract. It contains ectopic tissue of gastric and pancreatic predominance whose respective acidic and alkaline secretions can ulcerate tissue and cause hemorrhage. Around 90% of the diverticuli are within 90cm of the ileocecal valve. Results: 20-year-old healthy male with no past medical history was admitted for 4 episodes of painless rectal bleeding for one day. Slight nausea was present, but no emesis, fevers, abdominal pain or constitutional symptoms. No family history of colorectal cancer or IBD. Hemoglobin was 12.8. Colonoscopy showed blood throughout the entire colon and distal ileum, with ileal biopsy normal. EGD was unremarkable. Capsule endoscopy revealed small patches of hematin in distal intestine but no active bleeding source identified. There was no clear etiology of the bleeding and a presumed diagnosis of Dieulafoy's lesion was made. He was discharged and two days later, re-presented with continued rectal bleeding but was also severely anemic—hemoglobin 5.4. Colonoscopy and EGD was repeated showing blood throughout the colon and at the terminal ileum. Mesenteric angiogram showed no evidence of bleeding. Meckel's nuclear scan was performed showing no ectopic gastric mucosa. As the source of the rectal bleeding was not identified, exploratory laparotomy with push enteroscopy was performed, revealing an actively bleeding Meckel's diverticulum in the distal ileum along with suspected arteriovenous malformation in the distal jejunum. Diverticulectomy along with segmental small bowel resection was performed and afterwards bleeding resolved. Pathology confirmed Meckel's diverticulum with an ulceration extending into a submucosal artery. The acute anemia was treated with 10 units of RBC. Conclusion: Meckel's diverticulum is difficult to diagnose with nonspecific symptoms and can mimic a number of common conditions such as gastroenteritis, biliary colic, PUD, milk allergy, colonic diverticulitis. Complications include SBO, bleeding, intussusception and diverticulitis. CT scans are often nonspecific and arteriography is not always diagnostic because the arterial supply may not show any abnormalities. Technetium-99m scanning is the most useful test as it accumulates in gastric mucosa but sensitivity is only 62.5%, specificity 9%, in adults. This case illustrates the diagnostic importance of persistence in making a diagnosis of Meckel's diverticulum because of the insensitivity of current diagnostic modalities.

Intracorporeal Laparoscopic Assisted Enteroscopy in a Patient with Obscure Overt GI Bleeding: A New Technique

Purpose: Case Report: An 83 y/o woman with no significant PMHx. 3 months prior to presentation, had GI bleeding with melena. Underwent EGD and colonoscopy after transfusion of 4 units of RBCs. Studies were negative. 4 more units were transfused over a period of 2 weeks. No bleeding seen by patient. 2 weeks later came to hospital with Hb of 5,transfusion given, EGD and colonoscopy repeated with negative findings. Capsule endoscopy, showed area of bleeding in the distal jejunum to proximal ileum. Referred to our center for single balloon enteroscopy (SBE), which saw angiodysplasias, none bleeding, cauterized with good effect. Distal most point of insertion tattooed. In the next 2 weeks, had 4 more units without overt bleeding. Underwent an anal approach SBE that failed to reveal bleeding and a spiral enteroscopy (SE) oral approach which passed the tattoo, but no new lesions were found. Same day of the SE, colonoscopy showed maroon stools, so capsule was repeated, showing bleeding in proximal ileum. Bleeding scan was positive in the RLQ and angiography showed a 1cm lesion in the area of the ileocecal artery which couldn't be cannulated. At surgery, a 15mm port was used to advance a sterilized upper scope after enterotomy was done distal to tattoo. Bowel was pleated onto scope until cecum was reached. The bowel was unpleated from the scope and vigorous washing applied in an area where bleeding stigmata was seen. A 1cm ulcerated lesion was found and as the surgeon palpated with the graspers, the lesion started actively bleeding. The segment of bowel was then resected and the bowel re-anastomosed laparoscopically. Scope was slowly withdrawn and did not show any other lesions. A small laparotomy to withdraw the specimen was done. Pathology showed ulcerated angiodysplasia. After 32 units of blood during this process, patient has not needed any other transfusions and has not experienced any other episodes of bleeding. Conclusion: Obscure overt GI bleeding is an entity that gastroenterologists and surgeons encounter frequently. Even though we used current technology, we were initially unsuccessful in diagnosing and treating this patient. A multidisciplinary approach using a new technique not described in the literature, was successful for the diagnosis and treatment. Most of the laparoscopic assisted enteroscopic studies have been described as extra-corporeal with extraction of the small intestine outside the peritoneal cavity and external endoscopic evaluation of the intra-luminal pathology. We showed that our intra-corporeal technique is safe and efficient in diagnosing and guiding treatment of obscure overt GI bleeding with prior unsuccessful studies. A prospective study to evaluate this new technique is being planned.

Wheat starch digestion rate affects broiler performance

Two experiments were conducted to determine the differences in starch digestion rate (KDS) among wheats from different cultivars and origins and to verify if chickens would benefit from a certain digestion rate of starch. In the first experiment, 192 chickens (21 d) were assigned to 4 diets containing 55% of each wheat sample (3 cultivars, one of them from 2 origins). Starch and protein digestion were calculated from the remaining starch and protein in 4 segments of the small intestine and in excreta, using chromic oxide as a marker. Mean retention time was measured in each segment, which enabled calculations of digestion rates. In the second experiment, 2,600 chickens were assigned to 5 isoenergetic and isonitrogenous diets (with KDS from 1.80 to 2.56 h−1) and growth performance was determined (1 to 34 d). In 3 treatments, dietary starch was provided each by the wheat cultivars (same origin), whereas in the other 2 treatments, 25 and 50% of the wheat starch with the highest KDS was substituted by pea starch. Clostridium perfringens and Lactobacillus in the cecal chyme and glucose in the blood (glycemic index) were measured in broilers at d 19 and 25, respectively. Starch was gradually digested along the small intestine, mainly in the jejunum (48.5 and 80.4% at proximal and distal jejunum) where the largest differences among wheat samples were found. Starch digestion rate varied with origin (from 1.96 to 2.56 h−1) and cultivar (from 2.17 to 2.56 h−1). Crude protein digestion rate (average 2.21 h−1) was not affected by either cultivar or origin. Broiler growth and feed conversion ratio improved in a quadratic way with KDS. The maximum broiler performance was observed with KDS around 2.2 h−1. Blood glucose response (glycemic index) was not affected by KDS; therefore, it cannot be used to predict broiler performance. In conclusion, the rate of starch digestion varies among wheats, depending on both genetic and environmental conditions of the grain, and affects broiler performance.

Nematode challenge induces differential expression of oxidant, antioxidant and mucous genes down the longitudinal axis of the sheep gut

To characterize the role of a range of oxidant, antioxidant and mucous-related genes in the primary response to gastrointestinal nematodes, groups of genetically resistant sheep were challenged with either Haemonchus contortus or Trichostrongylus colubriformis and necropsied for retrieval of tissue at days 0, 3, 7, 14 and 21. To determine if the response was localized to the site of parasite infection, four different gut tissues were sampled: the abomasum, proximal and distal jejunum and ileum. Basal expression patterns of all candidate genes were determined using the day 0 (pre-challenge) samples. A conserved innate response involving elevated expression of dual oxidase, glutathione peroxidase and trefoil factor was initiated within 3 days of challenge and extended out to 21 days. An increase in host gene expression levels at the preferred site of infection (the abomasum for H. contortus and the proximal jejunum for T. colubriformis) was also common to both nematodes. However, these increases were concomitant with reduced expression in other areas of the gut suggesting a compartmentalized response. Other aspects of the response were parasite-specific, with T. colubriformis challenge inducing expression peaks at times corresponding to nematode life-stage transitions.

Inflammatory fibroid polyp (Vanek's tumour), an unusual large polyp of the jejunum: a case report

We report the case of a 46-year-old man who presented with recurrent episodes of severe upper abdominal pain over a period of three months. A computerized tomography scan of his abdomen demonstrated a large non-obstructing jejunal mass. He underwent laparotomy and resection of a 13.5 cm tumour from the distal jejunum. Histopathological examination confirmed a large inflammatory fibroid polyp of the jejunum. The clinical presentation and microscopic features are discussed.

Uptake and transport of foreign particles in Peyer’s patches of both distal ileum and jejunum of calves

To investigate the uptake and transport patterns of variously sized particles in Peyer's patches (PPs) of calves, intestinal loops were created in four newborn and two 2-month-old calves, and the loops were inoculated with various particles, including carbon black, fluorescein isothiocyanate (FITC)-labeled latex, FITC-labeled dextran, bovine serum, and recombinant mouse prion protein (rMPrP). The intestinal loops were recovered at 3, 6, 9, and 24 h in newborn calves and at 24 h in 2-month-old calves after inoculation, and the transport of the particles was examined by histological and immunohistochemical means. The uptake of the particles was quantified by estimation of signal intensities. A greater intensity was found in newborn calves compared with the 2-month-old calves. The peak uptake of carbon black, FITC-labeled latex, and rMPrP in the PPs of the distal ileum occurred at 6 h after inoculation in newborn calves and then progressively decreased with time. Uptake was also dependent on the site within the small intestine and the size of the particle studied. The transport of carbon black, FITC-labeled latex, and FITC-labeled dextran occurred via the bloodstream, the mesenteric lymph nodes, and the liver of newborn calves. rMPrP was found primarily in the interfollicular regions of the submucosa of the distal ileum of newborn calves. Thus, distal ileal PPs are probably more effective at particle absorption than the jejunal PPs, and the peak uptake of the PPs within the newborn calf occurs at 6 h after inoculation.

Treatment Experience of Subsequent Complications after Roux-en-Y Biliojejunostomy

Purpose: Roux-en-Y biliojejunostomy has been frequently used in the management of benign biliary disease. The aim of this study was to summarize one institute’s experiences in prevention and management of subsequent complications of Roux-en-Y biliojejunostomy. Methods: A retrospective analysis was carried out for patients who underwent reoperation after Roux-en-Y biliojejunostomy from February 1990 through June 2004. Operation history, laboratory test data before the last operation, and images were collected. Results: Sixty-one patients, aged 36–60 years and with a 3.5-year average operation interval, were involved in the study. Anastomotic stricture (47, 80.3%), recurrent calculi (36, 60.7%), and biliary tract infection (all) were the most common complications after Roux-en-Y biliojejunostomy. Other complications (such as calculi of the intrahepatic duct or intrahepatic duct stricture, malformed or twisted jejunum loop, too long or too short proximal jejunum, disappearance of the normal form of anastomosis, and adhesion of the intestinal loop) were also detected by laparotomy. Conclusion: Calculus, stricture, and infection arise as a result of each other. Lessening of the anastomotic stricture, fluent drainage of the distal jejunum below the anastomosis, and relieving pressure of gastrointestinal tract are pivotal in decreasing subsequent complications after Roux-en-Y biliojejunostomy.

Wheat starch digestion rate in broiler chickens is affected by cultivar but not by wheat crop nitrogen fertilisation

1. A study was set up to investigate the influence of wheat cultivar and wheat crop nitrogen (N) fertilisation on starch (ST) digestion rate in broiler chickens. A total of 288 broiler chickens were used in a 3 × 2 factorial design with diets based on three varieties of wheat (Apache, Caphorn and Charger), each grown at two N application rates (40 and 170 kg of N/ha). 2. Starch digestion rate was determined by measuring the remaining starch and the mean retention time (MRT) in 4 segments of the small intestine (proximal and distal jejunum and proximal and distal ileum) and in excreta, using chromic oxide as a marker. 3. Varietal differences in starch content (714–746 g starch/kg DM) were smaller than differences caused by crop N fertilisation (705–755 g starch/kg DM). Nitrogen application increased wheat crude protein (CP) content from 94 to 130 g/kg DM. 4. The majority of the ST in all diets was digested by the time the digesta reached the distal ileum (average 0·84 in the distal jejunum and 0·96 in the proximal ileum). 5. Starch digestion differed among wheat cultivars in the proximal jejunum (from 0·43 to 0·57, P < 0·001). Afterwards no differences due to wheat cultivar or N fertilisation were found. 6. Starch digestion rate varied among wheat cultivars (from 2·45 to 3·28 h−1, P < 0·001), but did not vary with N fertilisation, whereas dietary CP digestion rate was not affected by wheat cultivar or N fertilisation level. The digestion rate of ST was faster than that of CP (average 2·78 vs. 1·53 h−1). 7. The current study suggests that wheat cultivars can be classified on their rate of ST digestion independently of the N fertilisation applied to the crop during growth.

Assessment of the Diagnostic Value of Duodenal Bulb Histology in Patients With Celiac Disease, Using Multiple Biopsy Sites

Multiple endoscopic biopsies from the descending duodenum are usually recognized as the standardized method for the evaluation of mucosal changes in celiac disease (CD). Generally, the duodenal bulb is not considered a useful site for biopsies, owing to some difficulties in histologic evaluation. We wanted to verify if duodenal bulb histology establish a correct diagnosis of CD. Fifty-two consecutive children with suspicion of CD and positive antitissue transglutaminase antibodies were enrolled in a prospective fashion. During upper gastrointestinal endoscopy, 2 to 4 biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histologic lesions were classified according to the modified Oberhuber classification by single pathologist who was blinded to the site of biopsy. A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anemia 40/52 (76.9%), and failure to thrive 32/52 (61.5%). All had type 3 lesion-(a) mild, (b) moderate, or (c) severe-in at least 1 site. There was 45/52 (86.5%) CD patients with lesions of identical type (type 2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared with duodenal bulb. The biopsies from the duodenal bulb and second part of the duodenum in CD can be equally representative of the underlying disease. The diagnosis of CD can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.