Involvement Of Small Intestine Research Articles

Patterns and Outcomes in Pediatric Abdominal Tuberculosis: A Single Centre Cohort Study

IntroductionAbdominal tuberculosis presents in a variety of ways. Different testing modalities must be applied in addition to having a high clinical suspicion to diagnose and initiate therapy. Medications have a good response; however, morbidity has been seen following surgical management of complicated presentations like intestinal obstruction and perforation. There is a paucity of studies in the pediatric age group which evaluate response to the different treatment regimen and identify factors associated with poorer outcomes in children with abdominal tuberculosis. MethodsPatient records of 75 children with abdominal tuberculosis at a single center were evaluated using a questionnaire, covering a 14-year period from 2007 to 2021. Demographic features, presenting signs and symptoms, investigations and treatment details were studied. In- person or telephonic follow-up was conducted to identify treatment outcomes. ResultsIncidence of abdominal TB was 7%, of all TB children with a mean age of 10.1 years. Mesenteric lymph nodes were involved in 67% and small intestine in 33% cases. Surgery was required in 22 children. 85% children completed treatment. Small intestine involvement had higher probability of undergoing surgery. Of the 70 children with complete follow up, 64 were well and 6 children succumbed to the disease. Older age, small intestine involvement and surgery were independently associated with higher mortality. ConclusionIntestinal involvement is associated with greater need for surgical intervention and greater mortality. Adolescents have poorer outcomes. Further studies are required focusing on these individual subgroups to understand the patterns of presentation, causes for mortality and prevention. Level of EvidenceLevel 5.

P1176 The Influence of positive family history on the phenotype and clinical course of inflammatory bowel disease: A Systematic review and meta-Analysis

Abstract Background The phenotypes and clinical course of familial and sporadic inflammatory bowel disease (IBD) are not yet well-established. We sought to perform a systematic review and meta-analysis to assess the pooled influences of positive family history on disease characteristics and clinical outcomes in IBD. Methods We searched MEDLINE, EMBASE, and the COCHRANE library to identify full text articles analyzing disease phenotypes and clinical courses in IBD based on the presence or absence of a family history of IBD. A meta-analysis was performed using a random-effects model to pool estimates and report odds ratios [ORs]. Results A total of 14 studies were identified as eligible for the meta-analysis. A positive family history (of any degree) of IBD was associated with a lower prevalence of extensive colitis in ulcerative colitis (OR 0.83, 95% confidence interval [CI] 0.72-0.94) but was not associated with most phenotype features including male gender (OR 0.89, 95% CI 0.74-1.07), small intestine involvement (OR 1.11, 95% CI 0.81-1.52), and stricturing or penetrating disease behavior (OR 0.99, 95% CI 0.76-1.29) in Crohn's disease, extraintestinal manifestations (OR 1.26, 95% CI 0.89-1.78), or perianal fistula (OR 1.02, 95% CI 0.84-1.23). Additionally, various clinical outcomes of IBD including IBD-related hospitalization (OR 1.52, 95% CI 0.93-2.47), corticosteroid use (OR 0.91, 95% CI 0.58-1.44), immunomodulator use (OR 1.07, 95% CI 0.98-1.17), biologics use (OR 1.13, 95% CI 0.91-1.42), and intestinal resection surgery (OR 1.01, 95% CI 0.83-1.23) were not associated with family history. In the subgroup analysis of studies analyzing first-degree family history alone, family history was also not associated with small intestine involvement, stricturing or penetrating behavior, perianal fistula, corticosteroid use, immunomodulator use, biologics use, or intestinal resection surgery. Conclusion Familial cases with IBD exhibited a lower prevalence of extensive colitis compared to sporadic cases, but the overall disease phenotype and clinical course were similar in both types of IBD.

Assessment of QRS duration and presence of fragmented QRS in patients with celiac disease.

Background: Celiac Disease (CD) is characterized by small intestine involvement. However, cardiac manifestations may also be seen in the clinical course. The significance of the QRS prolongation and the presence of QRS fragmentation (fQRS) has been previously studied in many chronic inflammatory disorders as an independent predictor of cardiac manifestations. The study aimed to evaluate the QRS duration and presence of fQRS in patients with CD. Methods: 164 patients with CD and 162 healthy controls were included in the present study. QRS duration and presence of fQRS were calculated from the 12-lead electrocardiogram and compared between groups. The association between these parameters and disease duration was also evaluated. Results: QRS duration was found to be higher in the CD group compared to the control group (83 (76.8-93) vs. 91 (84-94), p<0.001). The presence of fQRS was demonstrated to be higher in the CD group (n=68 (41.5%) vs n=42 (25.9%), p=0.003). Notably, QRS duration was positively correlated with disease duration (Spearman's Rho= 0.47, p<0.001). In addition, disease duration was significantly higher in the fQRS (+) group (60 (23,5-144) vs. 28,5 (15-71,5), p=0.002). Conclusion: This study revealed that QRS prolongation and the presence of fQRS were higher in patients with CD. The presence of these findings may be an indicator of early subclinical cardiac involvement, especially in those with long disease duration. Thus, patients with these ECG findings can be considered for further cardiac evaluation.

Duodenal plasmablastic lymphoma in an human immunodeficency virus-negative patient: a case report

BackgroundPlasmablastic lymphoma is a rare type of non-Hodgkin lymphoma that generally presents an aggressive clinical course. It is strongly associated with human immunodeficency virus (HIV) infection, and the most common site of involvement is the oral cavity. Although extraoral PBL has been reported in several places, small intestine involvement is extremely rare.Case presentationHere, we describe an exceptionally rare case of a 24-year-old immunocompetent Asian Male patient with newly diagnosed plasmablastic lymphoma of the duodenum. The patient was admitted to our oncology facility due to the patient's clinical course, which included persistent vomiting, hematemesis, weight loss, and generalized weakness. Computed tomography of the abdomen (triphasic) of the patient showed thickness at the 2nd part of the duodenum measuring 2.6 cm in width and 16 cm in length blocking the pancreatic and common bile ducts by entering the second section of the duodenum. The biopsy specimen's pathological investigation indicated abnormal cells with plasmacytoid characteristics and a high proliferation index. The diagnosis of PBL was confirmed by immunohistochemical profiling. Supportive therapies like blood transfusions, antacids, and antiemetics were started to manage the patient's symptoms. Palliative radiation was also anticipated for the lesion site.ConclusionsDuodenal involvement to the extent seen in our patient is exceptionally rare and, to the best of our knowledge, has hardly been described. The main goal of the article is to review the literature and report a case.

Outcomes by disease onset, sex, and intervention in neonates with SIP and surgical NEC.

Outcomes of infants following surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) categorized by the age of onset, interventions, and sex are not well defined. Retrospective comparison of infants categorized by age of onset (NEC at <10, 10-20, and >20 days) and SIP at <7 versus ≥7 days), sex, and intervention [Penrose Drain (PD) vs. laparotomy]. A total of 114 infants had NEC and 37 had SIP. On multinomial logistic regression, infants with NEC/SIP onset >20 days had significantly lower odds of small bowel involvement (aOR = 0.07, 95% CI: 0.01-0.33, p = 0.001), higher necrosis (aOR = 3.59, 95% CI: 1.34-9.65, p = 0.012) and higher CRP (p = 0.004) than onset <10 days. Initial laparotomy was associated with more bowel loss (24.1 cm [12.3; 40.6] vs.12.1 [8.00; 23.2]; p = 0.001), small and large intestine involvement (47.1% vs 17.2%; p = 0.01), and ileocecal valve resection (42% vs. 19.4%; p = 0.036) than initial PD therapy. Females underwent fewer small bowel resections (52.3% vs 73.6%; p = 0.025) but had higher surgical morbidity (53.7% vs. 24.7%.; p = 0.001) than males. Clinical, radiological, and histopathological presentation and outcomes in preterm infants with surgical NEC/SIP are associated with age of disease onset, sex, and initial intervention. Neonates with surgical NEC onset >20 days had more severe necrosis, inflammation, kidney injury, and bowel loss than those with <10 days. Initial laparotomy was associated with later age onset, more bowel loss, and ileocecal valve resection compared to initial PD treatment, but not with differences in mortality or length of stay. Female sex was associated with lower maturity, more placental malperfusion, less often small bowel involvement, lower pre-NEC hematocrit as well as higher surgical morbidity than males. Whether the management of surgical NEC and SIP should differ by the age of onset requires further investigation.

Mechanisms of Small Intestine Involvement in Obesity-Induced Atherosclerosis.

Studies have shown that atherosclerotic plaques are associated with changes in the microbial composition of the intestinal flora and obesity, and that the small intestine plays an irreplaceable role in regulating intestinal flora homeostasis, but the role of the small intestine in the development of obesity-related atherosclerosis remains understudied. Therefore, this study explores the role of the small intestine in obesity-induced atherosclerosis and its molecular mechanisms. In the GSE59054 data, small intestine tissue samples from 3 normal and 3 obese mice were analyzed using bioinformatics methods. Screening for differentially expressed genes (DEGs) using the GEO2R tool. The DEGs were next processed for bioinformatics analysis. We constructed an obese mouse model and measured aortic arch pulse wave velocity (PWV). Aortic and small intestine tissues were stained with hematoxylin-eosin (HE) to observe pathological changes. Finally, immunohistochemistry was performed to verify the expression of small intestinal proteins. We identified a total of 122 DEGs. Pathway analysis revealed that BMP4, CDH5, IL1A, NQO1, GSTM1, GSTA3, CAV1 and MGST2 were mainly enriched in the Fluid shear stress and atherosclerosis pathway. In addition, BMP4, NQO1 and GSTM1 are closely related to atherosclerosis. Ultrasound and pathological findings suggest the presence of obesity atherosclerosis. Immunohistochemistry verified high expression of BMP4 and low expression of NQO1 and GSTM1 in obese small intestine tissues. The altered expression of BMP4, NQO1 and GSTM1 in small intestine tissues during obesity may be related to atherosclerosis, and Fluid shear stress and atherosclerosis pathway may be the molecular mechanism of their role.

Latent course of Crohn’s disease: the role of tomographic imaging in diagnosis

Crohns disease with localization in the upper gastrointestinal tract, terminal ileum, or colon is diagnosed based on visualization of the lesion area using endoscopic methods and histological examination. In cases of damage to the small intestine, when endoscopy methods are not informative enough and the use of videocapsular endoscopy has a number of contraindications, it is advised to use radiation diagnostic methods, such as multispiral computed tomography and/or magnetic resonance enterography, to make a diagnosis.&#x0D; We present a clinical case of ambiguous clinical manifestations of Crohns disease with small intestine and rectal involvement. Tomographic imaging was used to confirm the diagnosis. A 44-year-old patient presented with complaints of non-pronounced abdominal pain, dyspepsia. The lab panel showed indirect signs of malabsorption, an increase in fecal calprotectin. An endoscopic examination with histological verification revealed a picture of proctitis. After performing computed tomography and/or magnetic resonance enterography multiple lesions of the small intestine were revealed. This clinical case demonstrates an atypical clinical picture of Crohns disease with jejunal, iliac, and rectal lesions.&#x0D; The patient had no characteristic complaints; the results of endoscopic and morphological studies were not informative. Imaging by means of computed and magnetic resonance tomography has played a crucial role in the diagnosis and successful treatment.

Microscopic Polyangiitis Presenting with Acute Abdominal Pain Due to Rare Small Intestine Involvement

Microscopic Polyangiitis Presenting with Acute Abdominal Pain Due to Rare Small Intestine Involvement

Capsule endoscopy successfully diagnosed Henoch-Schönlein Purpura in a patient with small intestine involvement.

Capsule endoscopy successfully diagnosed Henoch-Schönlein Purpura in a patient with small intestine involvement.

Pneumatosis Intestinalis and Anorexia Nervosa.

Background: Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a condition historically associated with many diagnoses and can be life-threatening. The purpose of this article is to understand PI better in the setting of malnutrition secondary to anorexia nervosa (AN), a condition not historically affiliated with PI. Patients and Methods: In this retrospective study, the clinical findings of seven patients with AN are reported. Results: The patients were all found to have PI involving the right colon, with only a single patient also found to have PI involving additional colonic areas. No patients had small intestine involvement, and most of the patients were also diagnosed with the binge-purge subtype of AN, were receiving tube feeds, and had tenderness on abdominal examination. All seven patients were managed non-operatively. Conclusions: The authors propose that there may be an association between AN and PI. Given the surgical risks associated with malnutrition, the decision to pursue surgery, in the absence of the discussed pathologic risk factors, should be made in a very thoughtful manner. Future studies are warranted to better understand this potential association between PI and AN.

Cronkhite-Canada syndrome: a retrospective analysis of four cases at a single medical center

Objective Cronkhite-Canada syndrome (CCS) is a rare disease that is characterized by multiple gastrointestinal polyps and ectodermal abnormalities. This study aimed to improve the understanding of CCS by presenting our patient data. Methods Clinical features, treatment, and outcomes of four CCS patients at a single medical center were retrospectively analyzed. Results The age of the patients ranged from 32 to 61 years (mean: 49.5 years), including three men and one woman. All the patients presented with gastrointestinal symptoms, ectodermal abnormalities, and multiple gastrointestinal polyps. Two patients showed abnormal immune indices. Three patients underwent magnetic resonance enterography, and the typical manifestations of small intestine involvement were diffuse wall thickening, high signal intensity on diffusion-weighted imaging, obvious enhancement, and multiple small nodular enhancements of the small intestine. The main histological manifestations were chronic inflammation and hyperplastic, adenomatoid, and hamartomatoid polyps. Eosinophilic infiltration was observed in two patients. One patient had rectal adenocarcinoma at the time of diagnosis. All the four patients received prednisone at a dose of 0.75–1 mg/kg/day, and had their gastrointestinal symptoms gradually resolved (including two with ectodermal abnormality and endoscopic remission). Two patients are currently receiving low-dose prednisone (2.5–5 mg/day) with no recurrence after a 1.5- and 6-year follow-up periods, respectively. Conclusion Magnetic resonance enterography has the potential to evaluate small-intestinal lesions in CCSs. Long-term therapy with low doses of prednisone may be beneficial in maintaining remission.

Clinicopathological findings in patients with COVID-19-associated ischaemic enterocolitis.

AimsCoronavirus disease 2019 (COVID‐19) has been recognised as a predominantly respiratory tract infection, but some patients manifest severe systemic symptoms/coagulation abnormalities. The aim of this study was to evaluate the impact of severe COVID‐19 infection on the gastrointestinal tract.Methods and resultsWe examined clinicopathological findings in 28 resected ischaemic bowels from 22 patients with severe COVID‐19. Most patients required intubation preoperatively and presented with acute decompensation shortly before surgery. D‐dimer levels were markedly elevated in all measured cases (mean, 5394 ng/ml). Histologically, 25 cases (19 patients) showed evidence of acute ischaemia with necrosis. In this group, the most characteristic finding was the presence of small vessel fibrin thrombi (24 of 25 cases, 96%), which were numerous in 64% of cases. Patients with COVID‐19 were significantly more likely than a control cohort of 35 non‐COVID‐19‐associated acute ischaemic bowels to show isolated small intestine involvement (32% versus 6%, P < 0.001), small vessel fibrin thrombi (100% versus 43%, P < 0.001), submucosal vessels with fibrinous degeneration and perivascular neutrophils (90% versus 54%, P < 0.001), fibrin strands within submucosal vessels (58% versus 20%, P = 0.007), and histological evidence of pneumatosis (74% versus 34%, P = 0.010). Three cases in this cohort had histopathological findings normally seen in the setting of chronic ischaemia, notably prominent fibroblastic proliferation affecting the outer layer of the muscularis propria.ConclusionsHerein, we describe the histopathological findings in COVID‐19‐associated ischaemic bowels and postulate a relationship with the hypercoagulable state seen in patients with severe COVID‐19 infection. Additional experience with these cases may further elucidate specific features or mechanisms of COVID‐19‐associated ischaemic enterocolitis.

Giant Mesenteric Hemangioma without Small Intestinal Involvement Report of a Case and Review of Literature

there were approximately twenty cases reported in the English literature, of which five cases were designated as giant hemangioma. We reported another giant mesenteric hemangioma, measuring 35x20x11 cm. with a weight of 5,5 Kilograms. The etiology of mesenteric hemangioma was still debatable. In our case, the patient only experienced mild abdominal pain, without gastrointestinal hemorrhage. Therefore, we were in favor of mesenteric origin as opposed to gastrointestinal origin. The symptoms were non-specific, ranging from abdominal pain, nausea, vomiting, and gastrointestinal bleeding if Gastrointestinal tract was involved. Preoperative diagnosis was very challenging despite the modern images’ technics have become available, such as computed tomography magnetic resonance and ultrasonography. The final diagnoses of mesenteric hemangioma have been exclusively established by histological examination after surgical removal of the tumor. Surgical resection with clear margin is the treatment of choice.

Pilot case-control study to explore the value of intestinal ultrasound in the differentiation of two common diseases involving the ileocecal region: intestinal Behçet's disease and Crohn's disease.

Intestinal Behçet's disease (BD) and Crohn's disease (CD) are two diseases that commonly involve the ileocecal region and are difficult to differentiate. We aimed to investigate the value of intestinal ultrasound (IUS) in differentiating between these diseases. In this case-control study, patients diagnosed with intestinal BD or CD in the ileocecal region involved were recruited. The IUS characteristics of the two disease groups in terms of disease location, ileocecal region characteristics, and complications were compared. The differences were analyzed using univariate and multivariate analyses. We consecutively enrolled 22 intestinal BD and 44 age- and sex-matched CD patients. On univariate analysis, focal lesion, ileocecal region involvement only, presence of ulcers on ultrasound (US), large ulcers (>2 cm) on US, and fistulas were significantly more common in intestinal BD than in CD, whereas small intestine involvement was significantly more common in CD. On multivariate analysis, focal lesion [odds ratio (OR) 0.156, 95% confidence interval (CI): 0.043-0.564], and large ulcers (OR 0.056, 95% CI: 0.006-0.550) were independent predictors of intestinal BD over CD. The area under the curve for the receiver-operating characteristic was 0.808 (95% CI: 0.706-0.929), and the sensitivity and specificity with a cutoff value of 0.7 were 75.0% and 77.3%, respectively. IUS can provide useful information for the differential diagnosis of intestinal BD and CD.

Improved Prognosis of Extranodal NK/T-Cell Lymphoma, Nasal Type (ENKL) of Nasal Origin but Not Extranasal Origin: An Analysis of NKEA Study

Improved Prognosis of Extranodal NK/T-Cell Lymphoma, Nasal Type (ENKL) of Nasal Origin but Not Extranasal Origin: An Analysis of NKEA Study

Resveratrol enhances trans-intestinal cholesterol excretion through selective activation of intestinal liver X receptor alpha

Resveratrol (RSV) is a dietary polyphenol with well-documented cardio-protective activity, but its effects on blood cholesterol levels remain to be established. Due to its poor bioavailability, tissue accumulation of RSV is extremely low except for that in the small intestine. In the present study, we aimed to investigate the dose-dependent effects of RSV on blood cholesterol levels and the involvement of small intestine in the cholesterol-lowering impacts of RSV. Mice were administrated with RSV at various doses with high-fat diet (HFD) or high-fat and high-cholesterol diet (HCD) for 12 weeks. The fecal neutral sterol contents were analyzed, and intestinal perfusion test was performed. An enteric barrier model using Caco-2 cells was established. We observed that RSV reduced blood cholesterol levels in a dose-dependent manner in mice fed with HFD or HCD. Further investigation revealed that RSV administration increased the bile acid pool size but did not affect cholesterol consumption or de novo cholesterol synthesis. Interestingly, RSV promoted trans-intestinal cholesterol excretion (TICE) by 2-fold in the intestinal perfusion test. In addition, RSV upregulated the expressions of ATP-binding cassette sub-family G member 5 or 8 (Abcg5/8) and ATP-binding cassette sub-family B member 1a or 1b (Abcb1a/b) by up to 8 times in the duodenum mucosa but not in the liver. RSV also significantly downregulated the expression of intestinal Niemann-Pick C1-Like 1 (Npc1l1). Knock-down of liver X receptor alpha (LXRα) but not Sirt1 by siRNA significantly blocked RSV-induced cholesterol excretion in Caco-2 cells. In conclusion, RSV could decrease circulating cholesterol levels through enhancing TICE and limiting cholesterol absorption via selective activation of intestinal LXRα.

The Role of Hyperbaric Oxygen Therapy in Pneumatosis Cystoides Intestinalis-A Scoping Review.

Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts within gastrointestinal tract wall from esophagus to rectum, with preferential involvement of large and small intestine. PCI is rare with an estimated incidence of 0.03 to 0–2% in general population. PCI can be distinguished into idiopathic (15%) or secondary (85%) and the clinical picture ranges from completely asymptomatic to life-threatening intraabdominal complications. Although etiology of PCI appears to be multifactorial, the exact pathophysiology is poorly understood and two main theories have been proposed (mechanical and bacterial). Over the last decades, an enormous therapeutic armamentarium was considered in PCI's management, including hyperbaric oxygen therapy (HBOT). Treatment comprises conservative treatment in mild cases to surgery in highly symptomatic and complicated PCI. In the late 70s, HBOT started to be used in selected cases of PCI not responding to conservative measures. Since then, several case reports, case series, and reviews have been published in the literature with variable outcomes. The overall response rate and complete response were 92.1% (n = 82/89) and 65.2% (n = 58/89), respectively, with a median follow-up of 7 months. Furthermore, HBOT is extremely safe, with few reported complications in the literature when used for PCI. Nevertheless, a randomized, controlled, and double-blind clinical trial is unlikely to occur given the rarity of PCI, logistical issues of HBOT, and methodological considerations related to adequate blinding with a sham-controlled group. HBOT in combination with personalized diet and antibiotics may be beneficial for moderate to severe PCI in patients with no indication for emergency exploratory laparotomy. The purpose of this article is to synthesize the existing data, analyse results of previous studies, identify gaps in knowledge, and discuss PCI' management, including the proposal of an algorithm, with a special focus on HBOT.

FOLLOW-UP AND TREATMENT OF INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE STUDY

OBJECTIVE: The aim of this retrospective study was to investigate the socio-demographic and clinical characteristics as well as the diagnosis and treatment of patients with Inflammatory Bowel Disease between 1990 and 2009.MATERIAL AND METHODS: Between 1990 and 2009, the records of 237 patients diagnosed with Inflammatory Bowel Disease in the Gastroenterology Clinic of Faculty of Medicine were examined. The age, sex, smoking history, endoscopy and histopathology findings of the patients, local and systemic complications developed in the patients, types of treatment applied and reasons for surgical treatment were examined.RESULTS: Between 1990 and 2009, 144 Ulcerative Colit, 73 Crohn Disease and 20 Indeterminate Colit patients were followed. The mean age of diagnosis, at the time of diagnosis of Ulcerative Colit patients was 37 years. 28.7% patients had left colon involvement, 25.2% patients had pancolitis, and 21% patients had proctitis (p&amp;lt;0.01). Erythema nodosum in one patient, sacroiliitis in 3 patients, primary sclerosing cholangitis in 3 patients, and malign transformation in one patient were determined as systemic complications. The mean age was 35 years in patients with Crohn Disease. Involvement of colon and small intestine was determined in %34 and %64,2 patients, respectively. Uveitis in 4 patients, sacroiliitis in 5 patients were determined as systemic complications. 222 patients were treated with 5-ASA. Immunosuppressive treatment was given to 6 patients. 159 patients were given mono treatment (5-ASA) while 19 patients were given combine treatment.CONCLUSIONS: Understanding of the prognosis and clinical course are important for determining medical and surgical treatment and follow up strategies for different subgroups of the patient.

Mantle Cell Lymphoma: Incidence of Gastrointestinal Involvement and Correlation with Overall Response- Retrospective Review of Multiple Multicenter Trials

Background:Mantle cell lymphoma (MCL) is a rare kind of Non-Hodgkin Lymphoma. The incidence of Gastrointestinal (GI) involvement is an important factor in assessing patients and determining the disease burden, although it has not been studied extensively. It is relatively difficult to detect GI involvement by endoscopy especially for the small bowel however more frequent use of Positron Emission Tomography- Computed Tomography (PET-CT) has improved detection rates. GI involvement has an important role in staging and overall assessment. With this background we hypothesized that the patients with GI involvement will have a poorer Overall Response Rate (ORR) and sustained response as compared to patients without GI involvement. Methods:A total of 120 patients were included in this retrospective analysis of multiple, phase II, clinical trials with MCL. These patients were independently reviewed using Lugano criteria. Patients with GI involvement at baseline and their subsequent response at Follow up were assessed. The Overall response rate (patients who achieved at least a CR or PR) and the sustained responses (of at least 6 months) of patients with GI involvement were compared with patients without GI involvement in this analysis. The subset of anatomical location of GI involvement was also assessed. Results: Out of a total of 120 patients, 34 had GI involvement noted on imaging. Correlative endoscopy findings were noted in 14 patients whereas in 20 patients endoscopy was not performed. The anatomical distribution of the gastrointestinal involvement on imaging was noted as follows: 17 Colon, 11 Small intestine (2 in Duodenum, 9 ileum), 11 Gastric, 1 Esophagus. Some patients had multifocal GI involvement. In patients with GI involvement (n=34), CR was noted in 13 patients (sustained response in 11) while PR was documented in 11 patients (sustained response in 5). In patients without the GI involvement (n=86) CR was noted in 39 patients (sustained response in 31) while PR was documented in 27 patients (sustained response in 16). Conclusion: Based on the results above it was observed that GI involvement was noted in approximately 28.3% of patients. Colon was the most common site involved, in 50% patients. Small Intestine and Gastric involvement were the next most common, 32% each. The incidence of GI involvement highlights the importance of predefining the imaging guidelines with the use of oral contrast to improve the detection of GI involvement. Any MCL patient with GI symptoms and suspected bowel involvement on imaging should always be followed up via endoscopy and biopsy when feasible to confirm the lymphomatous bowel involvement. The ORR in cases with GI involvement was 70.5% (24/34) and out of these only 47% (16/34) patients showed sustained response. Patients without GI involvement was 76.7% (66/86) and out of these only 54% (47/86) patients showed sustained response. Our analysis suggests that the GI involvement in MCL patients have slightly less ORR as well as sustained response. Further prospective studies with larger number of patients may be needed to substantiate this claim, if GI involvement has poorer prognosis. Disclosures No relevant conflicts of interest to declare.

Nutritional status and predictors of weight loss in patients with systemic sclerosis

Systemic sclerosis (SSc) commonly affects the gastrointestinal (GI) tract and predisposes to malnutrition. Few studies assessed body composition in outpatients with SSc or used more than one method for comparison over time. The aim of this study was to describe markers of nutrition and body composition in patients with SSc and to identify predictors of unintentional weight loss. We consecutively included outpatients with SSc and performed a one-year follow-up. Gastrointestinal (GI) involvement was evaluated from clinical investigations. Patients completed questionnaires for organ involvement and functional status. Clinical assessment included body mass index (BMI), the malnutrition universal screening tool (MUST), inter-incisor distance, anthropometry, and bio-electrical impedance analysis (BIA). In total, 168 consecutive patients with SSc were included, and 127 (76%) completed one-year follow-up. Thirteen (8%) died before follow-up. Based on MUST scores, 12% of patients were at high and 14% at medium risk of malnutrition. A low BMI was associated with small intestinal involvement (p<0.0001). Percentage body fat correlated with BMI, both when using four-site anthropometry (r=0.65, p<0.01) and BIA (r=0.49, p<0.01). Nine (7%) patients had >5% unintentional weight loss at follow-up. Independent baseline predictors of unintentional weight loss included upper GI involvement and disease severity estimated by Health Assessment Questionnaire Disability Index score. Nutritional risk and GI involvement are frequent and closely correlated in patients with SSc. BIA and four-site anthropometry are comparable in the clinical assessment of patients with SSc. Unintentional weight loss is discrete and related to disease-specific characteristics.