Inflammatory Small Bowel Disease Research Articles

Small bowel adenocarcinoma arising in longstanding fibrostenotic Crohn’s disease

Empirical evidence suggesting a link between neoplasia and chronic inflammation was first noted by Virchow more than a century ago, but the intricacies of the involved pathological processes have not yet been entirely elucidated. With a growing number of Crohn’s disease (CD) cases worldwide, it is only logical to consider that the complications of this entity would become proportionally more prevalent. We report a case of small bowel adenocarcinoma arising in a patient with longstanding CD and discuss the current differences in paradigms related to surgical decisions in patients with inflammatory small bowel disease. A 56-years-old male patient known with CD was admitted in emergency to our clinic for intense diffuse abdominal pain spontaneously and on palpation, Blumberg +, with signs of peritoneal irritation, episode apparently much more severe compared to the previous ones. Laboratory investigations confirmed the diagnosis of acute abdomen and immediate surgery was performed. Intraoperative findings were peritonitis due to ileal perforation and ileal adenocarcinoma with “signet ring” cells, moderately differentiated (G2), on the background of active inflammatory bowel disease (CD). Segmental enterectomy and ileostomy were performed. The postoperative outcome was relatively favorable, with resumption of digestive tolerance and of intestinal transit at ileostomy level. As increased evidence suggest causality between chronic inflammation and malignant transformation one should contemplate whether the old treatment paradigms applied for other conditions such as fistulae in anal and leg ulcers should not be translated to inflammatory bowel disease (IBD) patients. Are we doing too much or not enough surgery for IBD? Could we diagnose small bowel adenocarcinomas in CD in early stages or there is too much risk for the patients and very few to benefit from a more aggressive surveillance?

Enteritis unravelled with ‘target sign’ of lupus

A 31-year-old woman presented with anasarca developed in the past 2 weeks accompanied by chronic diarrhoea of small bowel, secretory type for 40 days, associated with intermittent, colicky abdominal pain...

Inflammatory bowel disease and risk of gastric, small bowel and colorectal cancer: a meta-analysis of 26 observational studies.

The purpose of this meta-analysis was to assess the associations between inflammatory bowel disease (IBD) and risk of the gastric, small bowel and colorectal cancer. We searched the PubMed and Web of Science for observational studies published before June 2020, and the quality of each included study was evaluated according to the Newcastle-Ottawa-Scale. Twenty-six studies comprising 531 449 IBD patients and more than 65 million reference individuals were included. Although IBD was significantly associated with 67% increased risk of the total gastric, small bowel and colorectal cancer. After stratifying by cancer location, IBD mainly increased the risk of intestinal cancer instead of gastric cancer. Furthermore, Crohn's disease (CD) significantly increased the risk of both small bowel cancer and colorectal cancer, while ulcerative colitis (UC) only increased the risk of colorectal cancer. In subgroup analysis, associations between IBD and risk of total gastric, small bowel and colorectal cancer were similar between male and female, except for that male IBD patients but not female had a significantly higher risk of small bowel cancer. Additionally, IBD patients in different geographical areas had different associations with risk of various gastrointestinal tract cancers. IBD is mainly associated with increased risk of cancers in the lower gastrointestinal tract, including small bowel cancer and colorectal cancer. Because studies about the association between IBD and risk of gastric cancer and the populations in Asia are limited, more observational studies are required in the future.

Vitrification of in vivo recovered equine embryos in France

It has been suggested that gluten may play a role in equine inflammatory small bowel disease (ISBD). Previous work showed an association between equine gluten-sensitive enteropathy and IgA antibodies to tissue transglutaminase (TGA) in serum. The purpose of this study is to investigate the prevalence of IgA antibodies to TGA in a group of healthy non–gluten-free sport ponies and to present a case of tentative gluten-sensitive enteropathy and dermatitis in a horse. Blood samples were obtained from 40 healthy jumping ponies. The ponies comprised 12 mares, 8 stallions, and 20 geldings with an average age of 9.0 ± 3.8 years (±SD; range 3–19 years). Sera were tested for IgA antibodies against human recombinant TGA. Significance (P < .05) of the correlation between TGA titer and age in these ponies was assessed using Pearson test (two tailed). In addition, to further illustrate tentative equine gluten-sensitive enteropathy and dermatitis, the clinical course in an 11-year-old Dutch Warmblood sport horse gelding has been described. The average TGA titer was 21.4 ± 13.6 AU/mL (range 2–65 AU/mL). There was a significant (P = .013) correlation (r = 0.389) between age and TGA titer in ponies. One of the 40 ponies (2.5%) showed an elevated TGA titer. An elevated TGA titer decreased after a gluten-free ration for 3 months in an 11-year-old Warmblood gelding with a tentative diagnosis of ISBD associated with full remission of the generalized skin reaction. To our best knowledge, this is the first study assessing TGA antibodies in sera from healthy non–gluten-free ponies and showing a correlation with age. The presented case could be the first one of a horse with a tentative diagnosis of gluten-sensitive enteropathy combined with dermatitis. Given the reported findings, this study warrants further investigations into gluten-sensitive enteropathy and dermatitis in individual horses affected with ISBD.

Preliminary Notes on Equine Tissue Transglutaminase Serology and A Case of Equine Gluten-Sensitive Enteropathy and Dermatitis in an 11-Year-Old Dutch Warmblood Horse

It has been suggested that gluten may play a role in equine inflammatory small bowel disease (ISBD). Previous work showed an association between equine gluten-sensitive enteropathy and IgA antibodies to tissue transglutaminase (TGA) in serum. The purpose of this study is to investigate the prevalence of IgA antibodies to TGA in a group of healthy non–gluten-free sport ponies and to present a case of tentative gluten-sensitive enteropathy and dermatitis in a horse. Blood samples were obtained from 40 healthy jumping ponies. The ponies comprised 12 mares, 8 stallions, and 20 geldings with an average age of 9.0 ± 3.8 years (±SD; range 3–19 years). Sera were tested for IgA antibodies against human recombinant TGA. Significance (P < .05) of the correlation between TGA titer and age in these ponies was assessed using Pearson test (two tailed). In addition, to further illustrate tentative equine gluten-sensitive enteropathy and dermatitis, the clinical course in an 11-year-old Dutch Warmblood sport horse gelding has been described. The average TGA titer was 21.4 ± 13.6 AU/mL (range 2–65 AU/mL). There was a significant (P = .013) correlation (r = 0.389) between age and TGA titer in ponies. One of the 40 ponies (2.5%) showed an elevated TGA titer. An elevated TGA titer decreased after a gluten-free ration for 3 months in an 11-year-old Warmblood gelding with a tentative diagnosis of ISBD associated with full remission of the generalized skin reaction. To our best knowledge, this is the first study assessing TGA antibodies in sera from healthy non–gluten-free ponies and showing a correlation with age. The presented case could be the first one of a horse with a tentative diagnosis of gluten-sensitive enteropathy combined with dermatitis. Given the reported findings, this study warrants further investigations into gluten-sensitive enteropathy and dermatitis in individual horses affected with ISBD.

Magnetic resonance enterography in inflammatory small bowel disease. image analysis criteria

Today magnetic resonance enterography is one of the most informative and safe methods of identification of the manifistations and complications of Crohn’s disease among children and adults. Receipt of the high-informaitive MR-enterograms directly depends on the right preparation of the patient and the competent research. The article deals with semiotics of the small bowel lesions in Crohn’s disease. The qualitative and quantitative analysis of the images are also represented.

1198 Temporal Trends of Acute Myocardial Infarction-Related Hospitalizations in Celiac Disease Patients

INTRODUCTION: Celiac disease (CD) is a chronic autoimmune inflammatory disease of small bowel. There is availability of mixed data about influence of CD on the incidence of Acute Myocardial Infarction (AMI). Some studies have suggested that patients with CD have a worse atherosclerotic profile due to the underlying inflammatory state and restriction of whole grains in their diet. We aimed to evaluate temporal trends of incidence and mortality of CD + AMI hospitalizations in the largest nationally representative sample. METHODS: We reviewed Nationwide Inpatient Sample from 2005-2014 for adult AMI hospitalizations (includes ST elevation and Non ST elevation MI) as a principal diagnosis with CD as the secondary diagnosis by using validated ICD9-CM codes. We examined the annual trends in the number of cases and hospitalization charges yearly and used survey regression to calculate adjusted odds ratios (aOR) for hospital mortality and other outcomes. RESULTS: We identified a total of 61,80,485 AMI hospitalizations from 2005-2014 of which 3169 had a diagnosis for CD. The proportion of patients with CD in AMI hospitalizations increased from 0.015% in 2005 to % 0.076% in 2014 (Figure 1). CD + AMI hospitalizations were significant (P &lt; 0.02) for being older (70.3 vs. 67.4 years), more female (51.9% vs. 39.5%); higher proportion of whites (93.8% vs. 76.6%; P &lt; 0.01) and more prevalent in the Northeast (28.7% vs 19.5%) and West (21.0% vs 17.5%) United States. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, CD + AMI hospitalizations had lower odds-ratio for hospital mortality (aOR = 0.39; 95% CI = 0.23-0.67; P &lt; 0.01). Length of stay in the CD + AMI patients was shorter (4.53 vs 4.84 days, P &lt; 0.01) but the mean hospitalization charges was higher ($64058 vs $60223, P &lt; 0.01), as compared to non-CD AMI patients. CONCLUSION: The results of our study provide valuable epidemiological data about the occurrence of AMI in CD patients. We found that the number of AMIs in the CD patients has risen more than five-fold from 2005-2014. However, the odds of in-hospital mortality in these patients is lower than the patients without CD for unknown reasons. The results of our study add to the current literature that though the CD-related systemic inflammation is associated with an increasing number of AMI hospitalization but these patients have comparably favorable outcomes than controls.

Renal disease in patients with celiac disease.

Celiac disease, an inflammatory disease of small bowel caused by sensitivity to dietary gluten and related protein, affects approximately 0.5-1% of the population in the Western world. Extra-intestinal symptoms and associated diseases are increasingly recognized including diabetes mellitus type 1, thyroid disease, dermatitis herpetiformis and ataxia. There have also been a number of reports of various types of renal involvement in patients with celiac disease including diabetes nephropathy, IgA nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis, nephrotic syndrome related to malabsorption, oxalate nephropathy, and associations of celiac disease with chronic kidney disease and end-stage kidney disease. This review aims to present the current literature on possible pathologic mechanisms underlying renal disease in patients with celiac disease.

All IBD is Not Necessarily Sporadic IBD; A Case of Primary Immunodeficiency Mimicking Small Bowel Crohnʼs Disease

The gastrointestinal (GI) tract is the largest immunological organ in the body. The GI tract contains majority of the lymphocytes and produces large amounts of immunoglobulin, protecting us from exposure to pathogens. There are over 150 heterogeneous primary immunodeficiencies and most of them are inherited. Immune defects can occur in the T cell line (cellular), B cell line (humoral), or both T and B cell lines. Dysfunction in immunity can lead to mucosal inflammation and GI distress. Thus, it is not uncommon for immunocompromised patients to present with GI symptoms. Immunocompetent and immunocompromised patients with gastrointestinal diseases can present with similar symptoms. However, immunocompromised patients have distinct histologic features and do not respond to conventional therapies. Therefore, it is critical for gastroenterologists to correctly diagnose and treat patients with immunodeficiency. Therapy for primary immunodeficiency: antibiotics, immunoglobulins, and rarely bone marrow transplantation. Herein, we report a 63-year-old male who was transferred from an outside hospital (OSH) for evaluation of Crohn Disease refractory to steroids and anti-TNF therapy. OSH work up revealed that this patient had recent exposure to Giardia. On admission, the patient was severely malnourished (albumin 0.9) with diffuse anasarca. He had multiple vitamin deficiencies due to malabsorption. MRE revealed active inflammatory small bowel disease. His hospital course was complicated by multiple infections, requiring intubation and broad spectrum antibiotics. Labs further revealed CD4 count 235, decreased absolute B cells, decreased immunoglobulins, decreased T regulatory cells, and absent NK function, suggestive of late onset combined immunodeficiency. His jejunal biopsies appeared similar to graft-versus-host disease. His biopsies were not consistent with Crohn Disease, lymphoma, or autoimmune enteropathy. He was started on monthly IVIG and sirolimus with partial recovery of his NK function. His infections resolved and he was discharged with TPN to rehab. Whole genomic sequencing was sent to determine a possible genetic link to his disease and is currently pending. This case demonstrates the importance of incorporating basic immunological work up in the assessment of patients with gut inflammation. It also suggests that individuals who present with an infection followed by gut inflammation may be more likely to have an immunodeficiency as opposed to sporadic IBD.

Single-balloon enteroscopy efficacy and degree of concordance with noninvasive evaluation of small bowel.

Background and study aims Clinical impact of single-balloon enteroscopy (SBE) is fairly known, as well as its diagnostic yield comparing with other small bowel gastrointestinal investigations. This study represents a contribution to better understand it and is designed to evaluate SBE efficacy and degree of concordance with previous evaluation of small bowel. Patients and methods This is a single-center retrospective study of patients that underwent SBE with suspected small bowel disease based on non-invasive imaging. Demographic, clinical, procedural and outcome data were collected for analysis. Agreement beyond positive findings was evaluated using κ-coefficient. Results A total of 197 SBEs were performed in 168 patients; mainly men (64.3 %) with mean age 53.3±17.6 years. Most SBEs (86.3 %) performed were preceded by a noninvasive evaluation: in 61.4 % (n = 119) of cases, capsule enteroscopy (CE) was performed, in 18.8 % (n = 37), computed tomography was performed, and in 6.1 % (n = 12) magnetic resonance enterography was performed. Fourty-three patients (25.6 %) underwent endoscopic treatments, mainly: argon plasma coagulation in angioectasias (53.4 %) and polypectomy (34.9 %). The most common diagnoses made with SBE were findings consistent with inflammatory small bowel disease (21.8 %) and vascular lesions (14.2 %). The diagnostic yield of SBE was of 69 %, confirming the suspicion of small bowel disease. The degree of concordance between CE and SBE for positive findings was substantial, κ-coefficient = 0.635 (P < 0.001). However, the degree of concordance between imaging examinations (CT or MR) and SBE was only moderate, κ-coefficient = 0.410 (P < 0.001). SBE had an immediate effect in 20 % of patients, changing diagnostic approaches, medical and surgical treatments. Conclusions Our study supports the idea that for suspected small bowel disease, CE and SBE have an overall good degree of concordance for all the diagnostics included.

Diffuse intestinal ganglioneuromatosis of the ileum

Background: A 39-year-old man presented with nonspecific abdominal pain. He was known with neurofibromatosis type I, with history of cafe-au-lait spots, multiple cutaneous neurofibromas and osteoporosis. Findings on contrast-enhanced CT scan were rather nonspecific, but inflammatory small bowel disease was suspected.

Gluten-dependent antibodies in horses with inflammatory small bowel disease (ISBD)

Background: Equine inflammatory small bowel disease (ISBD) is an idiopathic pathologic condition seeming to increase in prevalence. Objective: To investigate the potential role of gluten in equine ISBD. Animals & Methods: Antibodies known to be important in the diagnosis of human coeliac disease (CD): IgA antibodies to human recombinant and guinea pig tissue-transglutaminase (TGA), native gliadin (AGA), deamidated-gliadin-peptides (DGPA), and primate and equine endomysium (EMA) were assessed in blood samples from three different groups of horses: ISBD affected (n = 12) on a gluten-rich diet and controls either on gluten-rich (n = 22) or gluten-poor (n = 25) diets. Significant differences (p < 0.05) between groups were assessed using the Wilcoxon test. Results: Both ISBD-affected horses and gluten-rich controls had significantly (p < 0.0004) higher hrTGA titers than gluten-poor controls. However, ISBD horses did not show significantly increased levels of any of the CD related antibodies when compared to gluten-rich controls. Nevertheless, markedly increased antibody levels (TGA, EMA and DGPA) were found in one of the ISBD horses. The introduction of a gluten-free ration in this 14-year-old warmblood stallion resulted after 6 months in the reduction of antibody levels and clinical recovery associated with improved duodenal histopathology. Conclusion: To the best of our knowledge, this is the first study assessing gluten-related antibodies in horses and results suggest a potential pathogenic role of gluten in at least some cases of equine ISBD. Clinical importance and impact for human medicine: Given serology and concurrent clinical findings, this study warrants further investigations into the immunologic basis of possible gluten-sensitive enteropathy in horses and analogy with human disease.

Feasibility of MRI in Experimentally Induced Inflammatory Small Bowel Disease: A Pilot Study in a Porcine Model

The purpose of this study was to compare the macroscopic and microscopic findings of experimentally induced inflammatory lesions in jejunum and ileum with magnetic resonance imaging (MRI) findings. Inflammatory small bowel lesions were experimentally induced in six pigs. Bowel segments in jejunum and ileum were isolated, and a solution with trinitrobenzenesulfonic acid and ethanol (TNBS-EtOH) was installed. MRI of the small bowel was performed 7 days after surgery. Before the MRI examination, a 6% mannitol solution was installed through a nasogastric tube. The MRI protocol consisted of single-shot turbo spin echo T2 sequences, steady state free precession (BFFE) sequences, and a 3D T1 gradient echo sequence with fat saturation and intravenous contrast. The following image findings were evaluated: increased bowel wall thickness (BWT), increased bowel wall enhancement (BWE), and bowel stenosis. After the MRI examination, the animals were sacrificed. The small bowel was removed and examined macroscopically and microscopically. Inflammatory lesions developed in jejunum and ileum in all animals. The lesions were visible macroscopically and microscopically. The microscopic findings consisted of variable degrees of inflammation, ulcer formation, and fibrosis. In jejunum the inflammatory lesions were not diagnosed with MRI, except in one pig with a bowel necrosis probably caused by an intramural injection or leakage of the TNBS-EtOH solution. In ileum the bowel wall thickness was increased and the inflammatory lesions were diagnosed with MRI. In conclusion, the inflammatory lesions were visible macroscopically and microscopically. Lesions in ileum had increased BWT and were possible to image with MRI. Lesions in jejunum had normal BWT and were not diagnosed with MRI, except in one pig with increased BWT probably caused by complications to the installation of TNBS-EtOH.

Usefulness and Limitation of Double Balloon Enteroscopy in Inflammatory Small Bowel Disease

Background and Aim: Diagnostic ability for inflammatory small bowel disease by double balloon enteroscopy (DBE) and conventional double contrast radiography (DCR) of the small intestine were compared. Subjects: From 2003 June to 2005 May we have examined 97 patients with various complaints by DBE. 44 patients with inflammatory small intestinal diseases underwent both DBE and DCR studies. The subjects of the present study were 26 patients with Crohn's disease (CD), 7 with intestinal tuberculosis, 8 with NSAIDs enteropathy and 3 with non-specific multiple ulcer of the small intestine (NMUSI, Matsumoto, J Clin Pathol 2004). Method: DCR (using per nasal tubing method, 70 percent barium, 250 ml) and DBE study (per anal approach, Fujinon-Toshiba EN-450T5 and EN-450P5/20 scope with Yamamoto's method) were made in all patients prospectively. Comparisons of diagnosability (range of insertion and/or observation, evaluation of lesion activity) of the two studies in the small intestinal lesions were made. Results: It was hard to observe intestinal lesions fully by DBE in CD and NMUSI (average insertion range from ileocecal valve was 111 cm in CD, and 50 cm in NMUSI) because these diseases had stenoses which made full insertion of DBE difficult. In contrast, it was possible to observe even subtle lesions (aphthoid or shallow ulcers) by DBE in intestinal tuberculosis and in NAIDS enteropathy because there were few stenosis in these diseases (average insertion range from ileocecal valve was 339 cm in NSAIDs enteropathy, and 269 cm in tuberculosis). Rate of cases with better diagnosability of DBE than DCR in cases with tuberculosis or NSAIDs enteropathy group was higher than that in CD or NMUSI group (p < 0.0001, Table). However, we have succeeded in dilating multiple stenoses of the small intestine in a patient with Crohn's disease. Conclusion: From theses observation, it was concluded that stenotic lesions and adhesions of the small intestine in CD or NMUSI were hazard to full study by DBE and that conventional radiography would be beneficial to study intestinal lesions in these cases. In contrast, DBE was very useful in NSAIDs enteropathy and in tuberculosis without stenosis. DBE might be useful to dilate stenotic lesion of the Crohn's ileitis.

Occult inflammatory small-bowel disease: Not so occult anymore

Four cases are described in which reliance on small-bowel follow-through would have led to an incorrect diagnosis. In all cases, capsule endoscopy resulted in a diagnosis of inflammatory bowel disease, leading to successful treatment with mesalamine (PENTASA®; Ferring Pharmaceuticals, Copenhagen, Denmark) and corresponding reductions in aphthous lesions on repeated capsule endoscopy. Based on our experience and a review of the literature, it is concluded that relying on a negative small-bowel follow-through examination to rule out small-bowel disease would be unfair to patients with suspected small-bowel disease.

Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients.

To prospectively evaluate multi-detector row helical computed tomographic (CT) enteroclysis for the depiction of small-bowel diseases. The study group included 107 patients who were suspected of having small-bowel tumor (n = 8), active inflammatory small-bowel disease (n = 18), unexplained gastrointestinal bleeding (n = 36), refractory celiac sprue (n = 14), and low-grade small-bowel obstruction (n = 31). A nasoenteric tube was positioned into the duodenojejunal junction by using fluoroscopic guidance and water was infused with a pressure-controlled pump. After intravenous administration of 120 mL of iodinated contrast material, multi-detector row helical CT enteroclysis images were obtained with 4 x 2.5 mm collimation (four detector rows and 2.5-mm section thickness). Multi-detector row helical CT enteroclysis findings were analyzed by two readers working in consensus. Findings were compared with the results of endoscopy, enteroscopy, videocapsule endoscopy, histopathologic analysis, or clinical follow-up. Multi-detector row helical CT enteroclysis was well tolerated in 106 patients; one patient complained of abdominal pain after the examination. Multi-detector row helical CT enteroclysis allowed the diagnosis of small-bowel masses (n = 21), active Crohn disease (n = 9), small-bowel tuberculosis (n = 2), small-bowel lymphoma complicating celiac disease (n = 4), and confirmed low-grade small-bowel obstruction (n = 12). Multi-detector row helical CT enteroclysis demonstrated normal findings in 60 patients. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of multi-detector row helical CT enteroclysis were 100%, 95%, 97%, 94%, and 100%, respectively. Multi-detector row helical CT enteroclysis allows depiction of small-bowel diseases in patients suspected of having small-bowel conditions.

Diagnostic utility of capsule endoscopy in occult gastrointestinal bleeding

The video-capsule endoscopy (CE) of the small intestine is a novel innovative procedure for outpatient use that can detect even small lesions of the mucosa of the small intestine. Aim of this retrospective clinical study was to evaluate the diagnostic value of CE in a clinical routine setting. Between July 2001 and October 2002 we investigated 42 patients with suspected gastrointestinal bleeding by CE. In all patients, the previous upper and lower endoscopy work-up was normal. In some cases additional procedures such as bloodpool scintigraphy, angiography, small-bowel enteroclysis or push-enteroscopy were performed. CE detected relevant pathological findings in 23 out of 42 Patients (55 %). The majority of findings in the CE consisted of angiodysplasia (n = 16), ulcer and haemorrhagical erosions (n = 10), one Ulcus Dieulafoy and additional polyps of the small intestine (n = 2). In 4 cases an inflammatory small-bowel disease was detected. These findings could be confirmed by Re-endoscopy. The information provided was helpful to direct further diagnostic and treatment options. In 14 cases (33 %) CE-findings steered additional diagnostic and therapeutic steps. We conclude that CE is safe and has a high diagnostic yield. M2A video CE is likely to become an integral part of the algorithm of diagnostic of occult gastrointestinal bleeding after exclusion of other causes of anemia and negative upper and lower endoscopy work-up.

MRI of the abdomen with positive oral contrast agents for the diagnosis of inflammatory small bowel disease.

Magnetic resonance imaging (MRI) is being used more often in the evaluation of inflammatory bowel diseases. A prerequisite for adequate image quality is the oral application of contrast medium, which can be administered with different modalities. Positive and negative oral contrast media can be used; in terms of diagnostic efficacy, there appears to be no relevant differences between them. Sequences usually are acquired using breath-hold or respiration-triggered protocols. The underlying principle is visualization of circumscribed thickening of the intestinal wall, which shows a pathologic pattern of contrast medium uptake. The available data suggest that MRI is equally as effective as enteroclysis in the primary diagnosis of Crohn's disease and actually more sensitive in the detection of extraintestinal manifestations such as fistulae or abscesses. Supporters of the method predict that MRI will replace enteroclysis in the long term.

Multiplanar spiral CT enterography in patients with Crohn's disease using a negative oral contrast material: initial results of a noninvasive imaging approach.

The aim of this study was to prospectively define the role of multiplanar spiral CT enterography with a new negative oral contrast material for noninvasive assessment of the small bowel in patients with Crohn's disease. Thirty patients with established Crohn's disease prospectively underwent spiral CT enterography at 45-60 min after distension of the small bowel with 1400 ml of a negative oral contrast material (Mucofalk water enema). Spiral CT scans were obtained 50 s after administration of intravenous contrast material with the following parameters: 5-mm collimation; 7.5-mm/s table feed; and 3-mm reconstruction interval. The adequacy of bowel opacification, luminal distension, and the contribution of two-dimensional multiplanar reformatted imaging were assessed by two observers. Spiral CT imaging findings were compared with results of enteroclysis as well as endoscopic and histological findings in all patients. Spiral CT enterography with Mucofalk water enema was well tolerated in 29 of 30 patients. Findings on spiral CT enterography were comparable with those of barium studies in 25 of 30 patients, superior to those on barium studies in 4 patients, and inferior in 1 patient ( p<0.05). The addition of multiplanar reformatted images to axial spiral CT scans significantly improved observers' confidence in image interpretation ( p<0.05) but did not reveal additional abnormalities. Multiplanar spiral CT enterography with Mucofalk excellently provides information in patients with Crohn's disease. This technique accurately depicts the level of small bowel obstruction and the extent of inflammatory small bowel disease and its extraluminal complications.

MRI of the abdomen combined with enteroclysis in Crohn disease using oral and intravenous Gd-DTPA

In spite of the improved MR-diagnosis of the abdomen, MRI is not used as a routine method for the diagnosis of inflammatory small bowel disease. The aim of this study was--after optimazation of the bowel opacification--the correlation of the findings obtained with enteroclysis and MRI in patients with known Crohns' disease. 60 patients between 17 and 72 years of age were investigated. First, an enteroclysis was performed in typical manner. The applicated methylcellulosis was blended with positive oral MR contrast media (Magnevist oral, Schering). After enteroclysis, MRI of the abdomen was performed using T1- and T2-weighted breathhold sequences (Flash 2D pre- and postcontrast and TSE) in axial and coronal planes. The length of the affected bowel and the stenosis seen with enteroclysis correlated well with the visible thickening of the small bowel wall and the stenosis seen in MRI. Using MRI, additional findings could be obtained in 28 patients, such as fistulas, abscesses or a hydronephrosis, or a better assessment of the stenosis was possible with MRI, because of the avoidance of overshadowing of the affected bowel loop with MRI. A brilliant MR-tomographic imaging of the small bowel is possible under the condition, that the small bowel contrast is optimal. The main prerequisite is a large filling volume of the small bowel to reach a homogeneous contrast and a good distension of the small bowel lumen.