Distal Jejunum Research Articles

2009 Bleeding Intestinal Lymphangiectasia Diagnosed and Treated by Using Double Balloon Enteroscopy in a 41-Year-Old Female: Case Report and Review of Literature

INTRODUCTION: Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessels in the intestinal wall and small bowel mesentery, which induce loss of protein and lymphocytes into the bowel lumen. Gastrointestinal bleeding (GIB) rarely has been described as the only symptom of IL. We describe a case of obscure GIB in a young female caused by lymphangiectasia localized to the distal jejunum by antegrade double balloon enteroscopy. CASE DESCRIPTION/METHODS: A 41-year-old African American female who initially presented to her PCP with chronic fatigue and intermittent episodes of melena. The patient was subsequently placed on iron supplementation and referred to gastroenterology for further work up. Physical examination finding were largely unremarkable. On laboratory tests, her hemoglobin declined to 5.8 g/dL (from a baseline of 10 g/dL). Initial Esophagogastroduodenoscopy (EGD) showed 2 cm hiatal hernia but was otherwise unremarkable. A subsequent colonoscopy showed mild internal hemorrhoids and a 3 mm solitary ulcer in the distal rectum but no other obvious sources of GI bleeding. Magnetic resonance enterography (MRE) was unremarkable. Next, a video capsule endoscopy was done which showed a site of active bleeding from the mid-small bowel and was associated with nodular mucosa and prominent lacteals. A subsequent double balloon enteroscopy (DBE) showed an oozing fold in the distal jejunum with white speckled appearance consistent with a bleeding lymphangiectasia. A total of seven clips were placed on the lesion and during application of clips, a white milky substance was noted coming from the lesion suggesting the diagnosis of lymphangiectasia. DISCUSSION: IL is most commonly found in the small bowel, making its diagnosis difficult by EGD or colonoscopy. DBE and video capsule endoscopy (VCE) are the two most important diagnostic modalities available to evaluate the entire small intestine.The noninvasive nature of VCE and its capability to visualize the entire small bowel has made it a first-line tool in many centers. However, DBE is preferred over video capsule endoscopy because of higher sensitivity from better endoscopic visualization and ability to perform biopsies for pathologic diagnosis. In this report, we present an extremely rare case of primary intestinal lymphangiectasia in causing obscure GIB and successful intervention using DBE. We believe this is the second case to report small bowel bleeding from jejunal lymphangiectasia, which was successfully treated using DBE.

3089 Orifice to Orifice Evaluation, in a Single Exam

INTRODUCTION: We present a case of a middle age Caucasian male with Peutz-Jeghers syndrome who underwent an antegrade double balloon enteroscopy (DBE) for surveillance of a known small bowel polyps. He has a history of right hemicolectomy for a large polyp and subsequent partial small bowel resection for intussusception of a jejunal polyp. He had a DBE a year ago which revealed several small bowel polyps, the larger ones requiring therapeutic intervention. We show a video demonstrating feasibility of complete entero-colonoscopy dictated by necessity. CASE DESCRIPTION/METHODS: A 55-year-old Caucasian male with Peutz-Jeghers syndrome presented for his surveillance antegrade DBE. He has history of right hemicolectomy & partial jejunal resection due to intussusception deemed secondary to a large hamartomatous polyp. He has been getting EGD, Colonoscopy and antegrade DBE every 2 years given his history of multiple large hamartomatous polyps. His vital signs, physical examination and lab work were unremarkable. DISCUSSION: This patient underwent antegrade DBE with a therapeutic double-balloon enteroscope (Fujinon EN-450 T5) using push and pull maneuver, under general anesthesia and utilizing CO2 for insufflation. A stiffening device (Zutron medical) was used during portions of the procedure to help prevent loop formation. Around the distal jejunum, the stiffening device snapped within the biopsy channel at the boot of the insertion tube of the enteroscope. Given that a significant amount of time has been already invested in the procedure an attempt at reaching the anus was pursued with success. The stiffening device was pushed out of the channel using a biopsy forceps and the procedure was resumed. Multiple polyps (atleast 30) were observed in the small bowel ranging in size from 4-25 mm, some of which were oozing. The oozing polyps and those larger than 10 mm (total 6) were resected. The procedure was completed with no adverse events. The patient's oral cavity was cleaned using hydrogen peroxide swab before he was extubated and sent to recovery. The patient experienced no infection related complication, bleeding, perforation or pancreatitis. CONCLUSION: 1. It is feasible and safe to perform through and through entero-colonoscopy in specific scenarios. 2. Panendoscopy in one encounter may not always be achievable in patients without a history of bowel resection. 3. Advancing the enteroscopy outside the anus may be considered to clear an obstructed biopsy channel as an option to salvage a long procedure. Watch the video: http://bit.ly/2XTDKhY

2183 Endoscopic Management of Efferent Loop Syndrome Using Axios Lumen-Apposing Metal Stent

INTRODUCTION: Efferent loop syndrome (ELS) is a rare post gastrectomy syndrome that can occur following Billroth-II or Roux-en-Y reconstruction. The most common loop syndrome after gastric surgery is afferent loop syndrome (ALS), however efferent loop syndrome has been reported. ELS may occur due to a mechanical obstruction of the efferent limb due to an anastomotic stricture, malignancy, volvulus, intussusception, internal hernia or abdominal adhesion after surgery. Presentations include abdominal distension and vomiting and rarely pancreatitis or cholangitis. We present a case of efferent loop syndrome managed with an Axios lumen apposing metal stent (LAMS). CASE DESCRIPTION/METHODS: 79 year-old male with a history of gastric adenocarcinoma status post distal gastrectomy with Billroth-II reconstruction one month prior to admission presented with abdominal pain and nausea. Computed tomography of the abdomen revealed distended stomach with contrast, dilated biliary limb with collapsed distal jejunum and no passage of contrast distal to the anastomosis (Image 1). Upper endoscopy (EGD) revealed a friable gastrojejunostomy anastomosis with a patent afferent limb and a nearly obstructed stenosis at the efferent limb suture line. A 20 × 10 mm A-LAMS was deployed across the stenosed efferent limb under direct visualization and fluoroscopic guidance (Images 2 and 3). Follow up upper gastrointestinal series confirmed brisk passage of contrast into the efferent limb. The patient clinically improved and a repeat EGD revealed a patent efferent limb and a dislodged Axios LAMS which was endoscopically removed. DISCUSSION: ELS and ALS can be managed surgically or endoscopically. Endoscopic options include dilation and enteral stenting. Dilation may require multiple sessions and stenting utilizing self-expanding metallic stents (SEMS) may be limited by tumor in-growth in the setting of malignant obstruction. LAMS creates a de-novo fistulous tract to bypass an obstruction while its saddle shape provides anti-migratory properties and allows apposition of two gastrointestinal lumens. While LAMS has been reported in ALS, there are only rare reports in the management of ELS. Our case highlights a case of successful management of ELS with Axio LAMS.

2612 Gastrointestinal Stromal Tumor Causing Obscure Gastrointestinal Bleeding: An Uncommon Way of Diagnosing an Uncommon Disease

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are neoplasms which arise from the tissue of the gastrointestinal tract or, rarely, from other intra-abdominal tissues. CT angiography can be utilized as an alternative imaging study when endoscopic and colonoscopy results are non-diagnostic. We report a case of a 59 year-old-female who presented with recurrent episodes of obscure overt gastrointestinal bleeding and was found to have a GIST. CASE DESCRIPTION/METHODS: A 59-year old woman with history of gastro-esophageal reflux disease presented to the emergency room with bright red blood per rectum and lower abdominal pain for one month. She reported one episode of melenic stool. Physical examination was unremarkable. Laboratory findings revealed a hemoglobin of 9.4 g/dL and a positive fecal occult blood test. Esophagogastroduodenoscopy (EGD) was non-diagnostic. Colonoscopy revealed fresh blood with clots at the terminal ileum, but no evident source of bleeding was identified. As the source of bleeding could not be accurately diagnosed with routine colonoscopy and EGD, an abdominal computed tomography angiography (CTA) was obtained. Abdominal CTA revealed a large exophytic, necrotic mass with hypervascularity to the right of the uterine fundus along with extensive vessels within the bowel wall. The mass, distal portion of the distal jejunum, portion of the terminal ileum were resected. Postoperative pathological examination revealed gastrointestinal stromal tumor (high grade, spindle cell variant). The patient is doing well at a four-month follow-up. DISCUSSION: Patients with GISTs can often be asymptomatic leading to a missed initial diagnosis. When symptomatic, patients often present with bleeding, anemia, mucosal ulceration or mass effect, depending on location. Occasionally they are discovered as incidental findings in radiologic imaging or as incidental findings during surgery or autopsy. Bleeding is the most common presenting symptom and is attributed to the erosion of the gastrointestinal tract lumen with tumor invasion, resulting in hematemesis, melena or anemia. This case offers a unique perspective of GIST diagnosis. In cases where a colonoscopy and EGD along with abdominal series is undiagnostic and capsule endoscopy/balloon enteroscopy are not available - CT angiography can be considered an alternative imaging procedure for the management of GIST tumors. In our case, CT angiography provided exact tumor location preoperatively allowing for appropriate surgical resection.

Two Cases of Plexiform Angiomyxoid Myofibroblastic Tumor (PAMT) of Gastrointestinal (GI) Tract: One With 8-Year Follow-up, One in Distal Jejunum

Abstract Objectives PAMT is an exceedingly rare mesenchymal tumor of the gastric antrum that was first described in 2007. Although likely benign, long-term follow-up is limited due to its recent description and rarity. In small bowel, only four cases of PAMT have been reported, two in duodenum and two in proximal jejunum. Methods (A) A 16-year-old female presented with GI bleeding and gastric outlet obstruction. Imaging studies suggested a gastrointestinal stromal tumor (GIST) arising in duodenum. An open biopsy revealed a bland spindle cell neoplasm. Resection of the tumor was performed. (B) A 68-year-old male presented with an incidental mesenteric mass on imaging during hematuria workup. He underwent surgical resection of the mass to exclude a GIST. Results Case A was a 15.0-cm mass arising in gastric antrum, and case B was an 8.0-cm mass arising in antimesenteric side of distal jejunum. Both tumors showed multinodular plexiform growth pattern and foci of cystic changes, with a proliferation of bland spindle cells in a prominent myxoid matrix. Numerous vascular structures were noted without tumor necrosis, nuclear atypia, or mitotic activity. The lesional cells were positive for actin and negative for desmin. The lesional cells were negative for other markers including cytokeratin, CD34, CD117, DOG-1, S-100, and PDGFRA (case B). Both masses were based in the subserosa with focal extension to the muscularis propria in case A. Patient A was followed up for 8 years with no evidence of disease. Patient B was lost to follow-up. Conclusion While clinical presentation and imaging finding of PAMT overlap with GIST, PAMT appears to be more indolent. PAMT of distal jejunum has not been previously reported. Small bowel PAMT is much less common than gastric PAMT but can involve variable segments. PAMT may be underdiagnosed.

Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Attenuate Pro-inflammatory Small Intestinal Cytokine Signatures.

Bariatric surgery rapidly induces improvements in type 2 diabetes (T2D) in concert with reduction in systemic markers of inflammation. The impact of bariatric surgery on local intestinal immunity is not known. We hypothesize that sleeve gastrectomy (SG) and gastric bypass (RYGB) surgeries resolve obesity-induced intestinal inflammation, thereby promotingT2D resolution. SG and RYGB, or control surgery was performed in SD rats (n = 4-6/group). Key cytokines involved in insulin resistance (TNF-α, IFN-γ), inflammasome activation (IL-1β, IL-18), inflammation resolution (IL-10, IL-33), and Th17 cell responses (IL-17, IL-23) were measured by qPCR in mucosal scrapings of jejunum at 4weeks post-surgery. Intestinal cytokine expressions were correlated with weight change, systemic and portal glucose, and insulin levels in response to an enteral glucose load. SG downregulated IL-17 and IL-23 in both proximal and distal jejunum, and IFN-γ was reduced only in distal jejunum (p < 0.05). Jejunal IL-17 and IL-23 expression correlated positively with weight changes after SG (0.93 and 0.98, respectively; p < 0.05). Changes in IFN-γ correlated strongly with insulin levels in portal and systemic circulation (0.99 and 0.95, respectively, p < 0.05). As with SG, IFN-γ, IL-17, and IL-23 were significantly reduced by RYGB. RYGB also reduced TNF-α and IL-18 and increased IL-33 levels (p < 0.05). RYGB and SG reduce expression of pro-inflammatory cytokines IL-17, IL-23, and IFN-γ in the jejunum. RYGB showed attenuation of additional pro-inflammatory cytokines and enhanced expression of IL-33. Post-surgical changes in intestinal IL-17, IL-23, and IFN-γ correlate strongly with changes in weight and glucose-triggered insulin responses.

Effects of ad libitum milk replacer feeding and butyrate supplementation on the epithelial growth and development of the gastrointestinal tract in Holstein calves

Intensive milk feeding and butyrate supplementation in calves stimulate body growth and affect gastrointestinal development. The aim of the present study was to investigate the synergistic effects of ad libitum milk replacer (MR) feeding and butyrate supplementation of MR on rumen and small intestinal growth and on gene expression in the small intestine related to growth and energy metabolism at weaning. Male Holstein calves (n = 32) received colostrum from birth to d 3 of age and MR either ad libitum (Adl) or restrictively (Res; 6 L of MR/d; 12.5% solids) with (AdlB+, ResB+) or without (AdlB-, ResB-) 0.24% butyrate from d 4 until wk 8 of age. From wk 9 to 10, all calves were weaned and were fed 2 L/d until the end of the trial. Concentrate, hay, and water were freely available. At d 80, calves were slaughtered, volatile fatty acids were measured in rumen fluid, and rumen and small intestine samples were taken for histomorphometric measurements. The expression of mRNA associated with the local insulin-like growth factor (IGF) system and glucose metabolism as well as lactase and maltase activities were measured in the intestinal mucosa. The small intestine was 3 m longer in Adl than in Res. In the atrium ruminis, papilla width was greater in Res than in Adl. Villus circumference, cut surface, and height in the duodenum, proximal jejunum, and ileum were greater in Adl than in Res and in the proximal, mid, and distal jejunum and ileum were greater in calves treated with butyrate. Crypt depth in the duodenum and proximal jejunum was greater in Adl than in Res and in the ileum was smaller in calves treated with butyrate. The villus height:crypt depth ratio was greatest in AdlB+ calves. In the proximal and mid jejunum, IGF1 mRNA abundance was lower in calves treated with butyrate. In the proximal jejunum, INSR mRNA abundance was greater in Res than in Adl. The abundance of PCK2 mRNA was greater in Res than in Adl in the duodenum and was greatest in ResB- in the mid jejunum. Lactase activity tended to be greater in Res than in Adl and after butyrate treatment in the proximal jejunum. The results indicated an elevated growth of the small intestinal mucosa at weaning due to intensive milk feeding and butyrate supplementation, and the local IGF system was involved in intestinal growth regulation. Rumen development was not affected by butyrate supplementation of MR and was slightly delayed due to ad libitum MR feeding.

Massive obscure GI bleeding from Idiopathic Jejunal varices identified using single balloon enteroscopy

Background: Obscure gastrointestinal bleeding from idiopathic small bowel varices is both a diagnostic and management challenge for physicians. There are very few cases reported in the literature and there is no consensus on management recommendations.&#x0D; Aims: To present the case of a 34-year-old male patient with bleeding from idiopathic jejunal varices and to review similar cases in the literature. &#x0D; Methods: A case of idiopathic jejunal varices is reported. A literature review was conducted and a total of 24 articles describing idiopathic small bowel varices were identified.&#x0D; Results: Case Report: A 34-year-old gentleman was referred for worsening obscure gastrointestinal bleeding and anemia. Anterograde single balloon enteroscopy revealed several petechial like lesions that were not classic for angiodysplasia. These lesions were initially treated with argon plasma coagulation and clipped, which did not resolve the patient’s persistent anemia. No venous abnormalities were identified on computed tomography of the abdomen and pelvis with contrast. The patient underwent an endoscopically assisted exploratory laparoscopy that was converted to a laparotomy upon finding of grossly abnormal distal jejunum. Dilated and tortuous varicosities were identified involving approximately 150 cm of small bowel. It was decided to resect the 40 cm segment of jejunum in which varices were visible endoscopically. There was no evidence of thrombosis in the resected specimen. The patient suffered a pulmonary embolism post-operatively, believed to be provoked by the surgery. The patient has had no re-bleeding 12 months post-resection.&#x0D; Literature Review: Both familial and non-familial accounts of small bowel varices in the absence of a primary cause have been reported in the literature. When supportive therapy is insufficient, the most common treatment modality chosen is surgical resection. Select cases have also demonstrated that sclerotherapy and varix dissection can be used for to treat these lesions.&#x0D; Conclusions: Idiopathic small bowel varices pose both diagnostic and therapeutic challenges for physicians. In the literature, several treatment modalities have been shown to be successful; these include surgical resection, varix dissection and sclerotherapy. There is no consensus on the preferred treatment strategy. This report demonstrates endoscopically assisted surgical resection as a viable management strategy for bleeding of idiopathic small bowel varices, an uncommon cause of occult GI bleeding.

Active transport of glucose across the jejunal epithelium decreases with age in broiler chickens

Intestinal glucose absorption varies with growth; however, the dynamics of these variations has not been yet fully elucidated in broiler chickens. The present study aimed to compare jejunal glucose uptake and maltose digestion in broilers of 2 different ages, i.e., 1- vs. 5 wk old. Oral D-maltose gavage, everted sac, and Ussing chamber experiments were carried out to investigate intestinal glucose absorption and mRNA expression of glucose-transport-related genes as well as jejunal maltase activity. Upon gavage, glucose concentrations peaked at 10min post-administration in 1-wk-old chicks, while they peaked at 40min in 5-wk-old chickens. Glucose concentrations at 10min were significantly higher in the 1-wk-old chicks (P = 0.010). Using the everted sacs experimental setup, 5 intestinal regions i.e., duodenum, proximal jejunum, distal jejunum, proximal ileum, and distal ileum, were targeted to examine D-maltose digestion and glucose transport across the intestinal mucosa. In the distal and proximal ileum, glucose concentrations were found to be significantly higher in the serosal compartment of the 1-wk-old chicks upon incubation with D-maltose (25mM) (P < 0.05), while in the mucosal compartment the levels were significantly higher in the 5-wk-old chickens (P < 0.05). An Ussing chamber setup was employed to measure glucose-induced short-circuit current (ΔIsc) in the mucosal epithelium of the jejunum. In response to the addition of D-maltose (10mM) into the mucosal compartment, ΔIsc was significantly higher in the 1-wk-old chicks (P = 0.018). Furthermore, no variations in jejunal maltase activity were observed between the 2 age groups. While jejunal glucose absorption was lower in the 5-wk-old chickens, the mRNA expression levels of jejunal SGLT1, GLUT2, and Na+/K+-ATPase did not show any significant differences between the 2 age groups. Our results suggest that the active transport of glucose across the jejunal epithelium decreases upon growth in broiler chickens but is not accompanied by any variations in maltase activity or in the expression of glucose-absorption-related genes.

Hemi-double stapling technique performed with a transorally inserted anvil for esophagojejunostomy in the surgical treatment of gastric cancer.

A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into place during laparoscopic total gastrectomy (LTG). We describe a hemi-double stapling technique and application of a transorally inserted anvil for esophagojejunostomy during LTG, and we report the results of a retrospective study in which we examined the feasibility and safety of this method. We also describe the key technical details of the method. Our anastomotic method has four chief features: (a) the esophagus is cut at a slant, and its left cut end is cut and punched for the hemi-double stapling technique; (b) the anvil and circular stapler are connected, placing the distal jejunum in cranial traction; (c) a single layer of sutures is used to correct dog-earing and overlapping, and these points are completely closed with Lembert sutures; and (d) the jejunal limb is fixed to the duodenal stump to prevent kinking of the jejunal limb and to decrease tension on the anastomosis. This method has been used in 53 patients thus far. LTG with Roux-en-Y reconstruction was successful in all patients, and there was no need for conversion to open surgery. The mean operative time was 313 minutes, and the mean blood loss was 106 mL. The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis. Hemi-double stapling technique with a transorally inserted anvil for LTG can be performed safely and easily and safely. It can also product good outcomes.

The occlusion balloon reduction technique for de novo placement and salvage of malpositioned enteric tubes.

Nasoenteric, gastrojejunostomy, and jejunostomy tubes are methods of enteral nutrition in patients with functioning gastrointestinal tracts who cannot maintain adequate oral intake. Current placements; however, may be complicated by redundant wire and catheter loops within the stomach preventing operators from optimal feeding tube placement and predisposing patients to feeding tube prolapse. This report describes the occlusion balloon reduction technique for salvage of malpositioned tubes and placement of new enteric tubes in the setting of redundant loops. Five patients underwent the occlusion balloon reduction technique for jejunostomy (n = 3), gastrojejunostomy (n = 1), or nasojejunal tube placement (n = 1). All patients (n = 5) had redundant wires coiled within the stomach. In all patients (n = 5), a 9-French × 32mm × 120cm Coda balloon was inserted over the wire and passed into the small bowel. The balloon was inflated after which reduction of redundancy in the upper gastrointestinal tract was performed. Feeding tubes were then placed with tips in the distal jejunum. Technical success of the occlusion balloon reduction technique, successful placement of enteric tube, complications, and follow-up were recorded. The occlusion balloon reduction was technically successful in all patients (n = 5). Feeding tube placement was successful in all patients (n = 5). No minor or major complication occurred. Mean follow-up was 56days. The occlusion balloon reduction technique provides a method for reduction of redundant wire and catheter loops within the stomach during enteric tube placement or repositioning.

Ultrasonographic and histopathological features in 8 cats with fibrotic small intestinal stricture.

Benign stricture is an uncommon cause of chronic small intestinal obstruction in the cat. The purpose of this retrospective case series was to describe the ultrasonographic features, histopathological findings, and clinical presentation in a group of cats with benign small intestinal stricture. Inclusion criteria were cats presenting during the period 2010-2017, and that had ultrasonography and small intestinal stricture confirmed at surgery. For each cat, clinical data and ultrasonographic findings were retrieved from the medical record, and histopathology, where available, was reviewed. Eight cats met the inclusion criteria. The location of strictures was duodenum (1/8), mid- to distal jejunum (4/8), and ileum (3/8). Ultrasonographic findings included gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction. Ingesta did not propagate beyond the strictured segment. Wall thickening was mild to moderate (3-6mm). Normal wall layering was disrupted in all cats. Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri-intestinal mesentery (6/8). Annular strictures (5/8) were less than 15mm in length whereas long-segment strictures (3/8) were greater than 15mm in length. Histopathology showed transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery. The mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation. Clinical presentation reflected delayed diagnosis of chronic bowel obstruction with debilitation (8/8), marked weight loss (8/8), and prerenal azotemia (5/8). Benign fibrostenotic stricture should be considered a differential diagnosis in debilitated young cats presenting with chronic bowel disease and ultrasonographic features of intestinal obstruction.

Chestnut-phytobezoar causing small bowel obstruction in a child with Dravet syndrome

Abstract An 11-year old girl with Dravet syndrome presented with recurrent vomiting and abdominal tenderness and distension. Subsequent investigations including ultrasound and gastrointestinal fluoroscopy series showed signs of small bowel obstruction within the right hypogastric abdominal region. Laparotomy revealed three chestnut-phytobezoars in the distal jejunum as cause of intestinal obstruction. This is the first reported case about a mechanical ileus related to a chestnut-phytobezoars in a pediatric patient.

Characterization of Microbiota Associated with Digesta and Mucosa in Different Regions of Gastrointestinal Tract of Nursery Pigs.

Weaning is a crucial period when piglets have to cope with sudden dietary, social, and environmental stressors that often lead to serious intestinal dysbiosis and mortality. In this study, five mucosal and five digesta samples from each proximate jejunum, distal jejunum, and mid-colon were collected from 7- and 27-day post-weaned pigs and subjected to microbiota analysis using 16S rRNA gene profiling. Taxonomic analysis at phylum level revealed that Proteobacteria was significantly higher at 7 days (13.54%), while Bacteriodetes was higher at 27 days (30.72%) post weaning. Genera such as Campylobacter, Veillonella, Helicobacter, and Blautia that were previously reported in intestinal dysbiosis were significantly enriched in seven-day post-weaned pigs. However, microbial communities shifted as post weaning age increased with a significant increase in alpha diversity, and genera such as Moryella, Dialister, Clostridium, Streptococcus, Prevotella, and Bacteroides become significantly abundant in 27-day post-weaned pigs. Interestingly, the genus Campylobacter was significantly abundant on seven-day post-weaning in two piglets with diarrhea, implicating its role in post-weaning diarrhea. The results of this study suggest that gut microbiota in pigs with dysbiosis on 7-day post weaning undergoes significant changes toward a more normal state as the post-weaning age reaches 27 days.

Impact of Sensitization and Inflammation on the Interaction of Mast Cells With the Intestinal Epithelium in Rats.

The density of intestinal mast cells has been reported to increase during inflammatory bowel disease (IBD). As mast cell mediators are known to increase the permeability of epithelial tight junctions, we hypothesized that antigen responses in sensitized animals might be enhanced under inflammatory conditions. This would contribute to a vicious circle by further enhancing the entry of luminal antigens into the colonic wall and thereby continuing the inadequate immune response during IBD. Therefore, one group of rats was sensitized against ovalbumin. In a second group of animals additionally a colitis was induced by rectal administration of 2,4,6-trinitrobenzenesulfonic acid (TNBS) dissolved in ethanol. Specimens from distal colon and jejunum (as intestinal segment located distantly from the inflamed area) were mounted in Ussing chambers to measure tissue conductance, short-circuit current (Isc) induced by antigen exposure and paracellular permeability (fluorescein flux). This was paralleled by determination of mast cell markers and tight junction proteins with immunofluorescence and qPCR. In contrast to the initial hypothesis, antigen-induced Isc was not upregulated, but tended to be downregulated in the tissues from the colitis animals, both in colon and in jejunum. Only in the jejunum mast cell degranulation evoked an increase in fluorescein flux. Mast cell density was not altered significantly in the colon of the colitis animals. In the jejunum, sensitization induced a strong increase in mast cell density, which was unaffected by additional induction of colitis. Expression of sealing tight junction components claudin-3 and -4 were increased on the protein level in the sensitized animals in comparison to non-sensitized animals. Additional induction of colitis evoked a downregulation of claudin-3 in both intestinal segments and an upregulation of claudin-4 in the jejunum. Consequently, these data indicate segment differences in mast cell – epithelium interaction, but no enhancement of ion secretion in the TNBS/ethanol model of acute colitis after prior sensitization.

Lactobacillus reuteri KT260178 Supplementation Reduced Morbidity of Piglets Through Its Targeted Colonization, Improvement of Cecal Microbiota Profile, and Immune Functions.

Supplementing suckling piglets with Lactobacillus reuteri isolated from a homologous source improves L. reuteri colonization number in the gastrointestinal tract, which can have health benefits. This study investigated dietary L. reuteri supplementation on the growth and health-including immune status-of piglets, as well as its colonization. A total of 60 sows with similar parity and body weight were allocated into one of three groups after secretion (n = 20 each, with 10 neonatal piglets of each): untreated control, L. reuteri supplementation, and antibiotic treatment. The experimental duration was 28days, from birth of piglets to their group transferred. For the first 7days after birth, all neonatal piglets were fed by sows. Piglets in the L. reuteri supplementation group were administered with 1.0mlL. reuteri fermentation broth containing 5.0 × 107CFU. From 7 to 28days, piglets were given basal feed (control), basal feed supplemented with L. reuteri (1.0 × 107CFU/g), or aureomycin (150mg/kg). L. reuteri colonization in the distal jejunum and ileum was increased in piglets in the L. reuteri-supplemented as compared to the control group after 28days, as determined by fluorescence in situ hybridization and real-time PCR analysis. Total Lactobacillus and Bifidobacterium counts in the cecum were higher whereas total aerobic bacteria (Escherichia coli and Staphylococcus) counts were lower in the L. reuteri as compared to the control group. L. reuteri supplementation also improved body antioxidant status and immune function relative to control animals. Strain-specific L. reuteri administered to piglets colonizes the intestinal mucosa and improves cecal microbiota profile and whole-body antioxidant and immune status, leading to better growth and lower morbidity and mortality rates.

A Detailed Review on: Recent Advances, Pathophysiological Studies and Mechanism of Peptic Ulcer

A peptic ulcer is a chronic disease in which involve the complication of the gastrointestinal tract by identifying the mucosal damage secondary to gastric acid secretion and pepsin. It generally occurs the proximal duodenum and stomach and less occur in the distal duodenum, lower esophagus, jejunum, and ectopic gastric mucosa. The pathogenesis of peptic ulcer the binding to H2 receptor in paracrine fashion in parietal cells was activates by the release of histamine from HCL. In antral G cells primarily occur gastrin. The activation of central neural, chemical composition and local distension of gastric content having a gastrin release by their regulation. The influence of gastrin and vegal stimulation the histamine release from a mast cell and paracrine-ECL cells. Expend the level of intracellular Ca2+ through cyclic AMP, Ach/gastrin via histamine that causes acid secretion. H+/K+ ATPase stimulates the last step in acid secretion. which is also termed as a gastric proton pump. cAMP or Ca2+ ion-dependent pathways activation or H+/K+ ATPase activation from parietal cells the pathophysiology of peptic ulcer. ulcer disease are a disproportion between pepsin and acid and mucosa digestion inactivity of digestive. The three viable etiology group of peptic ulcer. 1) In Zollinger-Ellison Syndrome was occur the enormous hypersecreation of acid peptic. 2) by occurring nonsteroidal anti-inflammatory drugs (NSAIDs). 3) By the helicobacter pylori infections associate the ulcer. Modern technique which is used in treatment of peptic ulcer is Antacids, Pyroloplasty and SPV, Histamine H2 receptors, Pirenzepin, Proton pump inhibitors, H. Pylori infection more recent advancement are needed for peptic ulcer.

Intestinal Handling of Glucose in &amp;lt;i&amp;gt;Buccholzia coriacea&amp;lt;/i&amp;gt; Treated Male Wistar Rats

Background: Different studies have unveiled the traditional usefulness and clinical potentials of Buchholzia coriacea, a medicinal plant known for its effectiveness in lowering blood glucose. Its role in intestinal glucose uptake was investigated. Materials and methods: Thirty male Wistar rats, weighing between 100 - 120 g were used and randomly assigned into three groups of 5 rats each per experiment. Group 1: control (not treated), groups 2 and 3, were treated with 100 mg/kg (BC100) and 200 mg/kg (BC200) of Buchholzia coriacea orally respectively for 2 weeks. Fasting blood glucose, luminal and in vitro glucose levels of rats were determined by glucose oxidase method using glucometer stripes plus glucose monitoring system (Fine test glucometer(R) ). Luminal electrolytes in the in vitro study were determined by Atomic Absorption Spectrophotometry method. Data were expressed as Mean ± SEM and statistical analysis was by one way ANOVA, and p-values in vivo experiments in both the ileum and jejunum of BC100 (23.08 ± 0.18; 19.68 ± 0.72) and BC200 (14.50 ± 1.02; 20.55 ± 0.45) compared with control (30.40 ± 1.01; 35.53 ± 1.45), respectively. The glucose uptake at the mucosa end of distal jejunum in the BC100 (292 ± 3.33) and BC200 (209.30 ± 2.67) decreased significantly compared with control (90.00 ± 1.50). There was a significant decrease in K+ concentration and increase in Na+ concentration at the mucosa end in the BC100 and BC200 compared with control. Conclusion: The study suggests glucose stowing in the intestinal cells in the in vivo study and inhibition of glucose transport from the in vitro study. The roles of alpha-amylase on the activity of this extract are suggested for future studies.

Gastrointestinal manifestations in patient with Common Variable Immunodeficiency Syndrome (CVID): A Case Report

A 57 yo male with a background history of common variable Immunodeficiency syndrome (CVID) on Immunoglobulin Infusion (Kiovig) 40mg three weekly was referred for investigation of diarrhoea and follow up from previous history of colonic polyps. Colonoscopy showed an irregular looking ileocaecal valve (ICV) with an adjacent flat polyp (Paris IIa). Biopsies showed low grade dysplasia. There was also a duodenal polyp noted on gastroscopy and biopsy again showed low grade dysplasia. In light of the findings of upper and lower gastrointestinal tract polyps, a small bowel capsule endoscopy (SBCE) was arranged. This showed an irregular area of mucosa in the proximal small bowel with significant ulceration and inflammation (Figure 1). There were also multiple scattered lymphagiectasias and lymphoid hyperplasia in the distal small bowel (Figure 2). Anterograde double ballon enteroscopy (ADBE) was subsequently performed to the distal jejunum about 8 weeks after the SBCE. The duodenal polyp seen at gastroscopy was visualised during ADBE (Figure 3). In addition, two diminutive (<3mm) jejunal sessile polyps were encountered and excised (Figure 4). There was no evidence of ulcerative enteritis as seen on SBCE. The enteritis features initially visualized on the SBCE was thought to be a transient phenomenon possibly related to his CVID background. However, for completion, the distal point of enteroscopy insertion was marked and a repeat SBCE performed immediately after recovery from the ADBE. This again showed the known duodenal polyp as well as 2 further diminutive small bowel polyps and minimal distal patchy enteritis only, with complete resolution of the previously observed ulcerative jejunitis. The jejunal polyps’ histology was reviewed at a histology multidisciplinary meeting, there were no adenomatous or hamartomatous features and biopsies were thought to have non-specific changes only. The patient was referred for polyp resection and further follow up and surveillance will be arranged based on histology.

Solitary Jejunal Tuberculosis with Intestinal Obstruction in an Immunocompetent Patient

Intestinal tuberculosis is an infection of the gastrointestinal tract by the Mycobacterium tuberculosis complex. To the best of our knowledge, solitary intestinal tuberculosis accompanied by intestinal obstruction, particularly in the middle of the small intestine, is extremely rare. We report a case of solitary jejunal tuberculosis in a 49-year-old man with no underlying disease. He was admitted a few days after the onset of diffuse abdominal discomfort. Upon evaluation, we initially considered a malignancy of the distal jejunum with ileus due to the presence of a mass. Therefore, he underwent laparoscopic resection of the small bowel. Unexpectedly, the histologic specimen showed a chronic caseating granulomatous lesion with acid-fast bacilli. Ultimately, he was diagnosed with solitary jejunal tuberculosis. He was successfully treated with anti-tuberculosis drugs without any complications. (Korean J Med 2018;93:556-559)