Enteropathy Research Articles

The diagnostic value of capsule endoscopy for asymptomatic NSAID–induced enteropathy

Objective To study the diagnostic value of capsule endoscopy for asymptomatic non–steroid antiinflammatory drugs(NSAID)–induced enteropathy. Methods A total of 110 health exam cases(38 cases taking NSAID orally)were recruited to the study and underwent capsule endoscopy. The incidence of small intestine lesion of NSAID takers and non–NSAID takers, that of those whose medication time longer than 3 months and less than 3 months, and who took low dose asprin and who took non–asprin NSAID were compared. The location of mucosal lesions and recovery status were followed up. Results The incidence of small intestine lesions was significantly different between NSAID group(55.3%, 21/38) and non–NSAID group(5.6%, 4/72)(P<0.01). The incidence of small intestine lesion was significantly higher in the over–three–month–medication group than in the less–than–three–month group(7/24 VS 4/14, P=0.01). The incidence of small intestine lesions was also significantly higher in the non–asprin group than asprin group(11/14 VS 10/24, P<0.05). The ulcerative lesions were predominantly located in the ileum(10/11), while the erosive lesions were predominantly found in the jejunum(8/10). Eight ulceration cases recovered after stopping taking NSAID or the use of rebamipide. Four erosion cases recovered after the use of rebamipide. Conclusion Capsule endoscopy is of favourable diagnostic and therapeutic value for asymptomatic NSAID–induced enteropathy. Key words: Small intestine; Non–steroid antiinflammatory drugs; Aspirin; Capsule endoscopy; Endoscopy

The relevance of the colon to zinc nutrition.

Globally, zinc deficiency is widespread, despite decades of research highlighting its negative effects on health, and in particular upon child health in low-income countries. Apart from inadequate dietary intake of bioavailable zinc, other significant contributors to zinc deficiency include the excessive intestinal loss of endogenously secreted zinc and impairment in small intestinal absorptive function. Such changes are likely to occur in children suffering from environmental (or tropical) enteropathy (EE)—an almost universal condition among inhabitants of developing countries characterized by morphologic and functional changes in the small intestine. Changes to the proximal gut in environmental enteropathy will likely influence the nature and amount of zinc delivered into the large intestine. Consequently, we reviewed the current literature to determine if colonic absorption of endogenous or exogenous (dietary) zinc could contribute to overall zinc nutriture. Whilst we found evidence that significant zinc absorption occurs in the rodent colon, and is favoured when microbially-fermentable carbohydrates (specifically resistant starch) are consumed, it is unclear whether this process occur in humans and/or to what degree. Constraints in study design in the few available studies may well have masked a possible colonic contribution to zinc nutrition. Furthermore these few available human studies have failed to include the actual target population that would benefit, namely infants affected by EE where zinc delivery to the colon may be increased and who are also at risk of zinc deficiency. In conducting this review we have not been able to confirm a colonic contribution to zinc absorption in humans. However, given the observations in rodents and that feeding resistant starch to children is feasible, definitive studies utilising the dual stable isotope method in children with EE should be undertaken.

Adult-onset generalized autoimmune enteropathy involving small intestine and colon: report of a case and review of literature

To investigate the clinicopathologic features of adult-onset autoimmune enteropathy (AIE). A case of adult-onset AIE was described along with a literature review. A 41-year-old male patient was admitted for intractable diarrhea for more than three months despite of any dietary restriction or anti-inflammatory therapy. Fat globule was observed by stool examination and Sudan III staining of the stool was positive. Enteroclysis showed weak movement and few plica of small intestine, while colonoscopy appeared normal. Small bowel biopsies revealed villus atrophy and increased crypt apoptotic bodies and lymphocytic infiltration in deep crypt. Although without significant surface intro-epithelial lymphocytosis, there were a large number of monocytes, lymphocytes, plasmacytes and neutrophilic granulocytes infiltrating in the lamina propria. Morphologically, the colonic mucous was similar to the small intestine although cryptitis and crypt abscess were significant in the former. Serum IgG anti-goblet cell antibody was demonstrated by indirect immunofluorescence. Other causes of diarrhea were excluded on the base of medical history, histopathology and other accessory examinations before the diagnosis of AIE was made. The patient had a complete remission after steroid treatment without recurrence for eight months during the follow-up even after steroid withdrawal for five months. AIE is exceedingly rare and timely diagnosis is important for successful therapy. Histological differential diagnoses should include ulcerative colitis, celiac disease, lymphocytic colitis, etc. The final diagnosis should be based on histological examination combined with the patient history, clinical manifestation, endoscopy finding and serological testing.

PTU-036 Environmental Enteropathy: Imaging The Cellular Basis Of Disrupted Barrier Function

IntroductionEnvironmental enteropathy (EE), originally termed tropical enteropathy, is very common in overcrowded living conditions in developing countries. It predisposes to growth failure in the young, and probably to poor performance...

High dose multiple micronutrient supplementation improves villous morphology in environmental enteropathy without HIV enteropathy: results from a double-blind randomised placebo controlled trial in Zambian adults.

BackgroundEnvironmental enteropathy (EE) is an asymptomatic abnormality of small bowel structure and function, which may underlie vaccine inefficacy in the developing world. HIV infection co-exists in many of these populations. There is currently no effective treatment. We conducted a secondary analysis of a randomised controlled trial of high dose multiple micronutrient (MM) supplementation on small bowel architecture in EE in participants with or without HIV infection.MethodsIn a double-blind parallel-group trial of the effect of MM on innate immune responses to oral vaccines, consenting Zambian adults were randomised to receive 6 weeks of 24 micronutrients as a daily capsule or placebo. HIV status was established after randomisation. Proximal jejunal biopsies were obtained after the supplementation period. Villous height, crypt depth, villous width, villous perimeter per 100 μm muscularis mucosa (a measure of epithelial surface area), and villous cross sectional area per 100 μm muscularis mucosa (a measure of villous compartment volume) were measured in orientated biopsy sections using semi-automated image analysis. Analysis was by intention to treat.Results18 patients received MM and 20 placebo. 6/18 MM and 9/20 placebo patients had HIV. In HIV negative patients given MM compared to placebo, mean villous height was 24.0% greater (293.3 v. 236.6 μm; 95% CI of difference 17.7–95.9 μm; P = 0.006), mean villous area was 27.6% greater (27623 v. 21650 μm2/100 μm; 95% CI of difference 818–11130 μm2/100 μm; P = 0.03), and median villous perimeter was 29.7% greater (355.0 v. 273.7 μm/100 μm; 95% CI of difference 16.3–146.2 μm/100 μm; P = 0.003). There was no significant effect on crypt depth or villous width. No effect was observed in HIV positive patients. There were no adverse events attributable to MM.ConclusionsMM improved small bowel villous height and absorptive area, but not crypt depth, in adults with EE without HIV. Nutritional intervention may therefore selectively influence villous compartment remodelling. In this small study, there was a clear difference in response depending on HIV status, suggesting that EE with superimposed HIV enteropathy may be a distinct pathophysiological condition.

Balloon-assisted enteroscopy in portal hypertensive enteropathy.

Balloon-assisted enteroscopy (BAE) provides higher-resolution of imaging and allows both diagnosis and treatment in the small intestine. However, the role of BAE in portal hypertensive enteropathy (PHE) is not clear. The purpose of this study is to define BAE findings and its utility in patients with PHE. This study included 20 cirrhotic patients with PHE and 20 control patients, matched by age and gender, who underwent BAE. The indications were to investigate the cause of obscure gastrointestinal bleeding and to achieve a diagnosis in patients with abnormal video capsule endoscopy and/ or abnormal radiological imaging. We evaluated the diagnostic yield and safety of BAE in PHE. BAE revealed significantly abnormal small bowel mucosa including angiodysplasia-like lesions, friability, edema, erythema, and punctate hemorrhage in PHE. There was a significantly higher prevalence of small bowel angiodysplasia- like lesions (65%) in the cirrhotic patients as compared with that (10%) in the controls (p = 0.01). Among the patients with small bowel angiodysplasialike lesions (65%), seven patients (35%) exhibited a diffuse pattern, which was not found in the control group (p = 0.008). Our study has shown that small bowel angiodysplasia-like lesion, particularly, the diffuse form of the lesion, is the dominant mucosal abnormality in PHE.

An Episode of Proliferative Hemorrhagic Enteropathy Associated with Lawsonia Intracellularis in a Pig Farm from Romania

Introduction: In swine, Lawsonia intracellularis is known to be responsible for porcine proliferative enteropathy. The syndrome can be divided in an acute intestinal hemorrhage (proliferative hemorrhagic enteropathy) affecting naive adult pigs and a wasting disease (porcine intestinal adenomatosis) in growing pigs. As new diagnostic techniques develop, there is increased number of pig farms where L. intracellularis is being identified worldwide. Aims: There are few reports of L. intracellularis outbreaks in Romania. We aimed to describe the clinical signs, treatment, outcome, gross necropsy and histopathological lesions from an episode of proliferative hemorrhagic enteropathy associated with L. intracellularis in a farm from Transylvania. Materials and methods: A farm of 4000 pigs (TOPIGS line) from Bistrita-Nasaud County. The microscopical examination was composed of Hematoxilin and Eosin exam, Warthin-Starry silver stain and immunohistochemistry for Multi-Cytokeratin. Results: Over a period of 6 days, a total number of 10 pigs dyed (from 2000 animals in the age group 90-120 days), and 1 pig dyed (from 1000 animals in the age group 60-90 days) with pallor, anorexia or with no clinical signs. Gross lesions were represented by pallor of the carcass and were restricted to the ileum. The intestinal wall was thicker (cerebriform aspect) and turgid. A mixture of blood and fibrin was present in the ileum, impregnating the faeces in the large intestine. Histologically the mucosa was thicker due to epithelial proliferation (Multi-Cytokeratin positive), with few Goblet cells, with severe erosion, necrosis and haemorrhage. Curved rod-shaped bacteria with morphology consistent with L. intracellularis were observed in the apical cytoplasm of epithelial cells using the Warthin-Starry silver stain. The food was medicated with chlortetracycline (20 - 40 mg a.s./kg b.w./day) and the pigs remained healthy, with no further mortality. Conclusion: We report here an outbreak of proliferative hemorrhagic enteropathy associated with L. intracellularis in a pig farm from Romania, emphasizing the importance of early diagnostic and control measures for this disease.

Celiac Disease and Risk for Lymphoma

Celiac disease (CD) is a gluten-sensitive autoimmune enteropathy that leads to intestinal villous atrophy. Although an elevated risk for intestinal

Protein losing enteropathy in children

Protein kaybettiren enteropati altinda farki hastaliklari barindiran bagirsaktan protein vitamin ve eser elementlerin kaybi ile giden bir klinik durumdur Hastalik sindirim sistemine ozgu hastaliklardan kaynaklanabildigi gibi sindirim sistemi disi bazi sistemik hastaliklardan da kaynaklanabilir Klinik bulgularin temelini bagirsaktan protein kaybi sonucu gelisen hipoalbuminemi olusturur Hastaligin tedavisi ve seyri altta yatan hastalikla yakin iliskilidir Bu derlemede protein kaybettiren enteropatilerin nedenleri klinik bulgulari ve tedavi yaklasimlari guncel bilgiler isiginda anlatilmistir Turk Ped Ars 2013; 48: 7 12

Type II enteropathy-associated T-cell lymphoma: a clinicopathologic study

To study the clinicopathologic features, immunohistochemical findings, differential diagnosis and prognosis of type II enteropathy-associated T-cell lymphoma (EATL). Fourteen cases of type II EATL encountered in Department of Pathology, Nanjing General Hospital were retrospectively reviewed. The clinical data, histologic features, immunohistochemical findings and follow-up information were analyzed, with literature review. There were altogether 12 males and 2 females. The median age of patient was 49 years. The sites of involvement included jejunum (10 cases) and ileum/colon (4 cases). The patients often presented with an abdominal mass, abdominal pain, diarrhea and constitutional symptoms such as fever, night sweating and cachexia. There was no clinical evidence of gluten-sensitive enteropathy. Histologically, the lymphoma cells showed full-thickness infiltration of the intestinal wall. They contained round hyperchromatic nuclei and pale cytoplasm. The stroma was minimally inflamed, with or without associated coagulative necrosis. A remarkable finding was the presence of villous atrophy, cryptal hyperplasia and intraepithelial lymphocytosis. Immunohistochemical study showed that the tumor cells expressed CD3, CD43 and CD8 (14/14). Some of them were also positive for CD56 (11/14) and CD30 (2/14). The staining for CD4, CD20, CD79a and myeloperoxidase was negative. A high proliferation index was demonstrated by Ki-67 immunostain. In-situ hybridization for EBER was negative. Follow-up data were available in 9 cases. The duration of follow-up ranged from 6 months to 36 months. Seven patients died within 14 months. EATL is a rare type of lymphoma with intestinal involvement. Associated enteropathy is not demonstrated, in contrast to cases encountered in Nordic countries. A correct diagnosis requires evaluation of clinical manifestations, pathologic features and ancillary study results.

A fatal case of intestinal capillariasis due to misleading investigations

Background: Intestinal capillariasis is an important agent in the differential diagnosis of chronic diarrhea and protein-losing enteropathy. The disease is uncommon and possibly under-diagnosed in Thailand and neighboring countries. Objective: Report a fatal case of intestinal capillariasis that underwent misleading diagnostic efforts for six months. We also reviewed previous cases of intestinal capillariasis from our hospital. Patient and Method: A descriptive study of a fatal case of intestinal capillariasis, and review of patients admitted for capillariasis during the past 10 years. Conclusion: This case highlights the importance of adequate and repeated microscopic stool examinations before proceeding to other sophisticated investigations that may cause delay in diagnosis and confusing results that result in inappropriate therapy. Keywords: Diagnosis, fatal, intestinal capillariasis

A case of gluten sensitive enteropathy, who presented with difficulty in walking

Abstract Osteomalacia is a metabolic bone disease, which occurs due to impaired bone mineralization resulted from insufficient activity of vitamin D. Main reasons for vitamin D deficiency include malabsorptive states, diet with poor vitamin D and calcium content, insufficient sunlight exposure and higher numbers of birth. Gluten sensitive enteropathy is one of the most common causes of malabsorption. Gluten sensitive enteropathy is classically manifested with diarrhea, flatulence, weight loss and malabsorption. However, it can also present with non-gastrointestinal symptoms and signs, as it can be recognized by non-specific gastrointestinal symptoms. We presented a case that referred with gait abnormality and hip pain due to osteomalacia and was diagnosed as gluten-sensitive enteropathy. Keywords: Osteomalacia, gluten-sensitive enteropathy, gait abnormality Ozet Osteomalazi, D vitamini aktivitesindeki yetersizlik sonucu kemik mineralizasyonunun bozulmasi ile ortaya cikan metabolik bir kemik hastaligidir. Malabsorbsiyon durumlari, vitamin D ve kalsiyumdan fakir diyetle beslenme, gunes isigina yetersiz maruziyet ve dogum sayisinin fazla olmasi vitamin D eksikliginin baslica nedenlerindendir. Gluten enteropatisi malabsorbsiyonun sik sebeplerinden birisidir.Gluten enteropatisi klasik olarak diyare, siskinlik, kilo kaybi ve malasorbsiyon ile karsimiza cikar. Bununla birlikte nonspesifik gastrointestinal semptomlarla da karsimiza cikabilecegi gibi nongastrointestinal semptom ve bulgularlada karsimiza cikar. Biz burada osteomalaziye bagli yurume bozuklugu ve kalca agrisi ile gelen ve Gluten enteropatisi tanisi alan olguyu sunduk. Anahtar sozcukler: Osteomalazi, gluten enteropatisi, yurume guclugu

Underestimation of clinical importance of non-steroidal anti-inflammatory drug induced enteropathy and its exacerbation by proton pump inhibitors

DOI: http://dx.doi.org/10.3126/jaim.v1i2.6502 Journal of Advances in Internal Medicine 2012;01(02):50-2

A morphological and immunohistochemical study of human intestinal fibrogenesis during Crohn’s disease

Background . Several enteropathies are characterized by an intestinal fibrosis that may lead to stenosis and obstruction (1). The most frequent and severe intestinal fibrosis occurs in Crohn’s disease (CD) that is related to the abnormal accumulation of extracellular matrix (ECM) proteins. In experimental model TGF-β1/Smad3 signalling plays a major role in tissue fibrogenesis as a potent stimulus of ECM accumulation (2). Aim . To evaluate the potential role of the TGF-β1/Smads pathway in the pathogenesis of intestinal fibrosis in patients affected by CD. Methods .Human samples from terminal ileum were processed for histological (H&E, Masson, Pas) morphometric and immunohistochemical (IHC) analyses. For IHC studies TGF-β1, CTGF, collagen types I-III, Smad3, Smad7, PDGF, C-kit, α-SMA, GFAP and a neuronal cocktail (S100, antineurofilament, NSE) antibodies were used. Smooth muscle cells (SMC) were cultured (3) for morphofunctional and cell cycle analysis. Results . Histological and morphometrical evaluation of stenotic fragments revealed a significantly high degree of intestinal fibrosis with an increase in mucosa, submucosa and muscle layer thickness. Transmural inflammation was also present in stenotic lesions compared to normal tracts. SMC isolated from inflamed fragments presented a 18.7% ±5.9% lenght shortening and a 44.5%±2.9% inhibition in contractile response to acetylcholine. Furthermore, under inflammatory burst a shift from the G0/G1 to the S cell cycle phase was observed. IHC analysis showed an increase in TGF-β1,CTGF, collagen I-III, Smad3, PDGF, C-kit and α-SMA staining in stenotic lesions compared to pre-post stenotic intestinal tracts, whereas Smad7 was positive only in pre-post stenotic samples. IHC evaluation of GFAP and neuronal cocktail showed a reduction of immunoreactivity in stenotic lesions. Conclusions . The data demonstrate that the TGF-β1/Smads pathway may play a central role in the development and differentiation of mesenchymal cells and in sustaining fibrosis of intestinal tissues in CD. The results confirm those obtained previously in our experimental mice model. 1) Burke JP et al. Am J Gastro, 2007 2) Latella G. et al. Eur J Clin Invest, 2008 3) Tattoli I et al. Dig Liv Dis, 2004.

Advances in pathogenesis research of hypoproteinemia in infectious diseases

Hypoproteinemia is a common clinical complication in many diseases, which could affect the disease prognosis, particularly in critical illness. Low serum albumin level often precludes dangerous conditions and poor prognosis. In the pediatric clinical practice, hypoalbuminemia is commonly seen in acute infection. Therefore, the mechanism of infection-induced hypoalbuminemia should be emphasized, which plays a crucial role in modifying clinical interventions and reducing the mortality rate. But the mechanism of hypoalbuminemia has not yet been fully clarified at present. In this article,the possible mechanism of infectioninduced hypoproteinemia is investigated from the albumin catabolism, synthesis, distribution of abnormalities,half-life, protein-losing enteropathy and so on. Key words: Hypoproteinemia; Infectious diseases; Pathogenesis

Probiotics to Reduce Nonsteroidal Anti-Inflammatory Enteropathy?

Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk for upper gastrointestinal bleeding. Reducing gastric acid by using proton-pump

Diarrhea in HIV Infection

During the last decade, there has been an increase of immunocompromized patients all around the world; that mostly due to pandemic of Human Immunodeficiency Virus (HIV) infection. Chronic diarrhea as one of common symptoms in patients with HIV infection has different etiology compared to immunocompetent patients. Initial approach of diarrhea in HIV infection may be conducted by evaluating the temporal relationship between the development of diarrhea and the administration of antiretroviral, especially the protease inhibitor agents; which is then followed by fecal analysis/examination for pathogenic bacteria and protozoa as well as endoscopy examination. Biopsy examination of intestinal mucosa is necessary for HIV enteropathy or diarrhea due to microsporidia, which is confirmed further by electron microscopy. The etiology of chronic diarrhea in HIV patients may also different, depend on the cluster of differentiation count value of all patients. Based on such differences, it is necessary to have adequate approach, recognition and understanding in the management of chronic diarrhea, especially for HIV patients. Keywords: diarrhea, infection, HI

SEROLOGICAL PROFILES FOR LAWSONIA INTRACELLULARIS IN SWINE FARMS

Farm prevalence studies in several countries in Europe, Asia and Northern America indicated that 24 to 47% of pig farms had a serious incidence with PPE in the past years. Herd prevalence for finishing pigs in other EU countries has been estimated to range between 88 and 100% (1, 2, 3). Porcine proliferative enteropathy (PPE) known as porcine proliferative ileitis is produced by Lawsonia intracellularis. PPE affects animals from 6 weeks of age and produce important damage, diarrhoea and poor performance in growing pigs. PPE are observed most commonly in the postweaned pig between 6 and 20 weeks of age. The purpose of this study was to determine the prevalence of L. intracellularis from 12 swine farms by enzyme-linked immunosorbent assay. Materials and method There were taken in study 12 pig farms from west side of Romania with young pigs (35-70 days of age) and fattening (100-150 days of age). In total 61 blood samples from 12 farms were analyzed by using a blocking ELISA by kit Bioscreen Ileitis antibody ELISA (Synbiotics Europe SAS, France). Results and discussions In 10 from 12 studied farms we found one or more positive samples. Our results show that the most affected categories were fattening (100-150 days). From 61 tested samples 31 samples were positive (49,1%), 11 samples had value of percentage of inhibition (PI) between 20 and 30 (18%), and 19 samples were negative (31,1%). The shift of seropositivity to higher age categories (fattening) may be principally connected with the very early antibiotic therapy of swine dysentery in the post-weaning period. In relation to the infection dynamic in the herd demonstrated an increase in the antibodies prevalence in animals from nursery to fattening. Usually seroconversion can be detected between 16 and 24 weeks of age by an increasing percentage of inhibition (PI). A positive test result reflects the exposure of pigs to infection L. intracellularis at least 2 to 3 weeks before (2). The low prevalence in the antibodies detection in weaning pigs suggests a low passive immunity.

Cytokine mRNA quantification in gastro-intestinal biopsies of dogs with idiopathic chronic enteropathies by Real Time RT-PCR: preliminary results

Cytokine mRNA quantification in gastro-intestinal biopsies of dogs with idiopathic chronic enteropathies by Real Time RT-PCR: preliminary results M. De Majo & M. Pugliese & S. Galia & G. Mazzullo & E. La Camera & M. T. Fera # Springer Science + Business Media B.V. 2008

Investigation on morbility status of functional dyspepsia and functional enteropathy Of nurses in emergency department

Objective To investigate the morbility status of functional dyspepsia and functional enteropathy of the nurse in emergency department and to find the regularity.Methods The nurses in emergency department of the First Hospital Affiliated to China Medical University and Shengjing Hospital were investigated with digestive symptoms questionnaire and other relative mental scales (nurse's working stressor scale, working burn-out scale, Pittsburg sleep quality index, clinical mental health symptom checklist).Results The morbility and frequency of digestive symptoms of the nurse in emergency department were higher than that of the nurse in outpatient department (P＜0.05 ).In the nurses in emergency department, 72 cases were troubled by functional dyspepsia and functional enteropathy (47.37%), while in the nurses in outpatient department the morbility was 34.65%(P＜0.001 ).The subtypes of functional dyspepsia and enteropathy in two groups were different: FD, functional constipation and IBS were common in the nurses in emergency department; FD, FD with entero-symptom and functional abdominal distention were common in the nurses in outpatient department.The scores of nurse's working stressor scale, working burn-out scale, Pittsburg sleep quality index, clinical mental health symptom checklist in the nurses in emergency department were higher than that of the nurses in outpatient department (P＜0.05).Conclusions There is tendency of functional dyspepsia and enteropathy in the nurses in emergency department, which is possibly related with the nurse's negative emotion, dormancy disorder, tired work, and tension. Key words: Nurse; Emergency department; Functional dyspepsia; Functional enteropathy