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Query: UMLS:C0021831 (enteropathy)
 4,403 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Omphalomesenteric duct remnants (ODR) including Meckel diverticula often present with symptoms of bowel obstruction. Their histologic features are varied and include heterotopic gastrointestinal mucosa and/or pancreatic tissue within the wall. Abnormalities of the submucosal plexus of Meissner, however, have not been documented in the literature. Thus, we have examined a number of ODR for evidence of ganglion abnormalities. Fifty-three cases of ODR were retrieved from our archives, along with 25 nonduodenal small bowel control specimens obtained from autopsies of patients without clinical or pathologic evidence of enteropathy. Histologic criteria for the diagnosis of abnormal hypercellular/heterotopic ganglia (HHG) in ODR were defined as a single submucosal ganglion/plexus containing > 10 neurons, or > 5 submucosal ganglions per high-power (x 40) field, or heterotopic ganglion cells within the muscularis mucosa or the lamina propria. HHG, histologically indistinguishable from intestinal neuronal dysplasia type B, were found in more than half of the ODR (ODR: 51.9%, n = 50 vs. control: 4%, n = 25, P = 3.6 x 10(-6), particularly those excised for obstructive complications (ODR with acute abdomen: 65.7%, n = 35, vs. ODR without acute abdomen: 33.3%, n = 15, P = 0.035). HHG were present in equal numbers of inflamed and noninflamed ODR (inflamed: 53.6%, n = 28, vs. noninflamed: 59.1%, n = 22, P = 0.70). A similar incidence was found in ODR with heterotopia and without (with heterotopia: 61.1%, n = 18, vs. without: 53.1%, n = 32, P = 0.59). ODR frequently contained HHG histomorphologically similar to those found in intestinal neuronal dysplasia, type B (IND-B). The overrepresentation of HHG in symptomatic ODR patients suggests an association with bowel obstruction. The data did not demonstrate a relationship with either inflammation or heterotopia.
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PMID:Hypercellular/heterotopic ganglia in omphalomesenteric duct remnants. 1137 Feb 62

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.
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PMID:Multiplanar spiral CT enterography in patients with Crohn's disease using a negative oral contrast material: initial results of a noninvasive imaging approach. 1219 78

Radiologists have played an important role in evaluation of patients with small bowel pathology. The small bowel series and, later, enteroclysis were the mainstays in radiologic diagnosis of many small bowel diseases, because the resolution and speed of CT was limited. Continued improvements in CT technology over the last 2 decades have resulted in a expanding role of CT for evaluation of the gastrointestinal tract, including the small intestine. Many conditions, such as small bowel obstruction and ischemia, that would traditionally be imaged with other modalities (small bowel series or angiography) are now routinely imaged with CT. The development of MDCT and improvements in 3D imaging systems have greatly improved the ability to examine the small bowel and mesenteric vasculature. With the introduction of new CT oral contrast agents and faster 32-detector row CT scanners, the diagnosis and evaluation of patients with small bowel disease will continue to improve.
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PMID:The current status of multidetector row CT and three-dimensional imaging of the small bowel. 1265 34

Currently, CT-E is not recommended as the first-line examination in patients when mucosal detail is required. Double-contrast barium air enteroclysis has advantages in demonstrating small mucosal abnormalities. The authors find CT-E of value in the work-up of patients with symptoms of intermittent small bowel obstruction, particularly those with a history of prior abdominal surgery; in the further work-up of selected patients with high-grade obstruction in whom general surgeons prefer initial conservative management (immediate postoperative small bowel obstruction, patients with history of prior abdominal surgery for malignant tumor, history of radiation treatment, and possible internal extraintestinal fistulae); in looking for complications of small bowel Crohn's disease; and in the patient with unexplained anemia or gastrointestinal bleeding. In a series of patients who had both abdominal CT and barium enteroclysis done, each examination provided unique and complimentary diagnostic information. Because CT-E combines the advantages of both methods of examination, is it the optimum imaging work-up in the investigation of small bowel disease? Further research and clinical experience will define the precise role of CT-E in the investigation of small bowel disease. Experience with this method of examination is limited to a few institutions, performed by investigators with interest in small bowel diseases. The addition of cross-sectional display and multiplanar reformatting made possible by multidetector-row helical CT to enteral volume change and the use of multifunctional nasointestinal catheters make CT-E an important tool in the investigation of small bowel disease. Experience has shown the increased reliability of any method of examining the small bowel that challenges intestinal wall distensibility by fluid enteral volume infusion.
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PMID:Multidetector-row helical CT enteroclysis. 1265 37

The study of small bowel disease is hampered by the organ length and shape. Malabsorption syndromes, small bowel bleeding, intestinal obstruction are analyzed with reference to the clinical characteristics and present laboratory and instrumental tests used in diagnosis. The introduction of sophisticated diagnostic imaging procedures, both endoscopic and radiologic have contributed to a better understanding of the symptomatic patterns.
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PMID:Small bowel diseases. 1269 70

Small bowel ischemia is a disorder related to a variety of conditions resulting in interruption or reduction of the blood supply of the small intestine. It may present with various clinical and radiologic manifestations, and ranges pathologically from localized transient ischemia to catastrophic necrosis of the intestinal tract. The primary causes of insufficient blood flow to the small intestine are various and include thromboembolism (50% of cases), nonocclusive causes, bowel obstruction, neoplasms, vasculitis, abdominal inflammatory conditions, trauma, chemotherapy, radiation, and corrosive injury. Computed tomography (CT) can demonstrate changes because of ischemic bowel accurately, may be helpful in determining the primary cause of ischemia, and can demonstrate important coexistent findings or complications. However, common CT findings in acute small bowel ischemia are not specific and, therefore, it is often a combination of clinical, laboratory and radiologic signs that may lead to a correct diagnosis. Understanding the pathogenesis of various conditions leading to mesenteric ischemia and being familiar with the spectrum of diagnostic CT signs may help the radiologist recognize ischemic small bowel disease and avoid delayed diagnosis. The aim of this article is to provide a review of the pathogenesis and various causes of acute small bowel ischemia and to demonstrate the contribution of CT in the diagnosis of this complex disease.
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PMID:Acute small bowel ischemia: CT imaging findings. 1462 Jul 18

Enteropathy-associated T-cell lymphoma (EATL) ultimately develops in 7-10% of patients with long-standing coeliac disease. In patients without a prior diagnosis of coeliac disease this is a very rare disorder, and the diagnosis in such cases is often difficult and delayed due to the non-specific nature of the symptoms and a very low index of clinical suspicion. Standard anti-lymphoma therapies have minimal utility in patients with EATL, and their prognosis is poor. An added difficulty is the high risk of intestinal perforation especially with the commencement of treatment due to the multifocal nature of bowel disease and poor underlying nutrition and tissue integrity. To illustrate these problems and provide an example of how these issues may be addressed, we report the case of a patient with EATL who was completely asymptomatic from unsuspected underlying coeliac disease and presented initially with back pain followed by bowel obstruction. He was treated with gut rest with total parenteral nutrition before commencing an intensive chemotherapy regimen [hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone)] and is currently well in ongoing complete remission 34 months later.
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PMID:Enteropathy-associated T-cell lymphoma without a prior diagnosis of coeliac disease: diagnostic dilemmas and management options. 1545 69

Although uncommon, diffuse jejunoilietis is one of the most difficult areas in Crohn's disease (CD) to treat. Although the exact frequency is unknown, most gastroenterologists believe that its prevalence has been underestimated and that it may have an increased incidence among children and young adolescents. The clinical importance of this clinical disease phenotype is the impact diffuse small bowel disease is expected to have on a child's growth and development. Moreover, patients with jejunoileitis are more likely to experience complications, including fistulization, and most commonly, intestinal obstruction. The associated morbidity and frequent need for surgical intervention renders these patients at risk for intestinal insufficiency. Although stricturoplasty has reduced the incidence of short bowel syndrome, most patients with proximal small bowel CD still require repeated surgical intervention. Jejunoileitis represents a distinct clinical phenotype within the heterogenous family of disease phenotypes considered as CD. Whether a specific genotype will be found to associate with jejunoileitis remains to be determined. Through the development of novel diagnostic techniques, including gadolinium enhanced magnetic resonance imaging (GMRI), enteroscopy, and capsule endoscopy, the mean age at diagnosis is expected to decrease. Coupled with an increase in clinical suspicion, early diagnosis may allow physicians to consider implementing aggressive immunomodulatory therapy. Future studies are needed to determine if the early detection and use of immune modulators in patients with proximal small bowel disease will improve overall quality of life and decrease the risk of nutritional and surgical comorbidity.
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PMID:Crohn's jejunoileitis: the pediatrician's perspective on diagnosis and management. 1597 25

We are reporting our 9-year experience of cyclic parenteral nutrition with 200 in-patients (mean age 52 years) treated 64 +/- (SEM)3 days (range: 15-230) for Gl diseases. During the first period (A, n = 38), all-in-one nutritive bags with intralipid 10% were used; in a second period (B, n = 135), intralipid 10% was infused separately over the first 6 h of nutrition; in the final period (C, n = 27), Intralipid 20% was used in all-in-one nutritive bags. Indications for parenteral nutrition were non-malignant digestive diseases in 89.5% of the cases. The frequency of complications appearing during cyclic parenteral nutrition was the following: catheter-related sepsis 8%, catheter obstruction 8%, hypertriglyceridemia 33%, hypercholesterolemia 14.7%, liver function test abnormalities 28% and biliary sludge and/or lithiasis 31.6%. 5 patients, with chronic obstructive small bowel disease, developed jaundice with no identifiable cause other than parenteral nutrition. The prevalence of catheter obstruction significantly decreased (P < 0.01) during period B, as compared with periods A and C. The prevalence of liver function test abnormalities decreased significantly (P < 0.01) during periods B and C, as compared with period A. Mortality rate related to cyclic parenteral nutrition was 3%. These results suggest that a) the separate infusion of lipid emulsion reduces the prevalence of catheter obstruction; b) as compared with 10% intralipid in all-in-one nutritive bags, the separate infusion of 10% Intralipid or the 20% Intralipid given in all-in-one nutritive bags is associated with a decreased prevalence of liver function test abnormalities; c) chronic small intestine obstruction seems to play a key role in parenteral-associated jaundice.
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PMID:Cyclic parenteral nutrition in hospitalized adult patients: a 9-year experience. 1684 48

Radiation enteritis is a functional disorder of the intestine that occurs during or after a course of radiotherapy to the abdomen, pelvis or rectum. It presents in both an acute and chronic form and has sequelae that can be life threatening. As radiotherapy is now being used more than ever before in the treatment of solid organ malignancies in the abdomen and pelvis, the incidence of radiation enteropathy is likely to increase in the future. We present two patients with severe forms of this condition in order to clarify the salient issues regarding its diagnosis and, in particular, its distinction from mechanical bowel obstruction. We also review its pathophysiology, management and current preventative strategies.
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PMID:Radiation enteropathy. 1698 69


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