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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five patients with non-specific small intestinal ulceration and malabsorption are presented. Four of these patients had subtotal villous atrophy of jejunal mucosa but none showed a morphological improvement after gluten withdrawal from the diet. Intestinal ulceration caused the complications of melaena, intestinal obstruction and perforation which resulted in the death of three patients. A review of the English literature reveals twenty-seven similar cases for which the term idiopathic chronic ulcerative enteritis is recommended. The condition is of unknown aetiology, diagnosis only being firmly established by laparotomy and histological examination of resected bowel. The relationship of this syndrome to coeliac disease, intestinal lymphoma and Crohn's disease is discussed. Management is extremely difficult and the long-term prognosis poor. Gluten withdrawal should be tried in the presence of villous atrophy but the value of steroid therapy in unresponsive cases is unproven. Surgical excision of the worst affected segments of small bowel has so far proved to be the most effective course of action.
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PMID:Idiopathic chronic ulcerative enteritis. Report of five cases and review of the literature. 743 32

Five adults had inflammatory rheumatic disorders 6 to 20 years before the diagnosis of coeliac disease. It is known that joint inflammation occurs in certain patients with adult coeliac sprue who develop either a specific inflammatory rheumatic disease or an atypical progressive polyarthropathy, sometimes as the first manifestation of the intestinal disorder. The diagnosis of adult coeliac sprue should be entertained in these cases even in absence of major digestive disorders or malabsorption. IgA anti-reticulin antibodies and atrophy of the duodenojejunal villosities are the best indicators for diagnosis. There are two important reasons for making the diagnosis of "asymptomatic adult coeliac sprue". First a gluten-free diet can improve or even cure the inflammatory joint disease, a rare situation which emphasizes the causal relationship between these two diseases. Second, the risk of developing lymphoma (especially in the small bowel) is apparently lower in patients on gluten-free diet. Pathogenesis is unclear. Frequently the two autoimmune disorders simply appear to coincide in the same patient; more rarely, arthritis is a symptom of coeliac disease. The immunological mechanisms probably begin when antigens cross an excessively permeable intestinal mucosa.
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PMID:[Inflammatory rheumatism and celiac disease in adults. Coincidence or pathogenic relationship?]. 776 62

Celiac disease is a fascinating illness, from both a clinical and research perspective. Most clinicians consider a diagnosis of celiac disease when a young patient has classic signs and symptoms of steatorrhea and severe malabsorption. However, the typical gastrointestinal symptoms often are absent. The patient may only have subtle signs of chronic malnutrition or nonspecific gastrointestinal complaints. Celiac disease is not diagnosed commonly in the United States, at least in part because of a low clinical index of suspicion. A diagnosis of celiac disease is confirmed by a small bowel mucosa biopsy. A dramatic clinical response to a gluten-free diet verifies the diagnosis, and provides a cost-effective treatment free of significant side effects. Strict adherence to the prescribed diet usually results in a complete resolution of the symptoms and mucosal histopathologic changes. The serious, long-term complication of intestinal lymphoma also may be prevented. To the clinical investigator, celiac disease is an important model of the HLA-associated immune-mediated illnesses. A specific HLA-DQ heterodimer is found in 95% of patients, representing perhaps the strongest association of any illness with a specific class II HLA molecule. In addition, an important environmental trigger (gluten) has been identified, providing a unique opportunity to study the interaction of gene products and environmental factors in the pathogenesis of an immune-mediated disease.
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PMID:Celiac disease: clinical features and pathogenesis. 816 Jul 11

Abdominal infections or tumors in the immunocompromised host are both common in AIDS but uncommon in transplant recipients. The role of diagnostic imaging modalities differs in the patients with specific symptoms such as dysphagia, diarrhea, malabsorption and jaundice and in the patients with aspecific clinical findings such as fever, weight loss, superficial lymphadenopathies and abdominal pain. In the former patients, the symptoms suggest a disease of one or more alimentary tracts, in which case radiology is ancillary to clinics and endoscopy plays the leading role to make the diagnosis. However, X-ray barium studies yield valuable information on different types of infections--e.g., Candida, Cytomegalovirus, mycobacterium avium intracellulare and Cryptococcus infections--in Kaposi's sarcoma and in gastrointestinal lymphoma. In these cases CT findings may suggest the diagnosis. In the patients with aspecific findings, US, as an easy immediate examination, and CT, as a panoramic means, can demonstrate deep lymphadenopathies and focal parenchymal lesions which are sometimes suspected to be abscesses or tumors. Moreover, both methods can provide indications and guide to percutaneous needle biopsies. Especially CT findings can distinguish mycobacterial infections from neoplastic lesions on the basis of the involved anatomical sites and of densitometric features. US and CT are useful means to monitor HIV+ subjects, to manage AIDS patients and to follow-up transplant recipients.
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PMID:[Abdominal manifestations in immunocompromised patients]. 820 25

The clinico-pathological characteristics of a 22 years old mestizo mexican patient with immunoproliferative small intestinal disease (IPSID) are described. The patient coursed with chronic diarrhea, malabsorption, and a 30 kg weight loss. The laboratory tests revealed hypokalemia, hypocalcemia, hypoalbuminemia and decreased levels of immunoglobulins. The histological changes in the endoscopic biopsies included a dense lymphoplasmacytic infiltrate in the lamina propria that produced vellosity blunting and distortion of the crypts. The immunohistochemical analysis disclosed that almost every cell was positive to heavy chains and negative to light chains. The radiological studies showed thickening of the intestinal folds and mesenteric adenomegalies. In the full thickness biopsy of the yeyunum, in addition to the lymphoplasmacytic infiltrate, a high grade malignant lymphoma infiltrating the regional lymph nodes was documented. An ultrastructural study revealed viruses that resembled the morphology described for the Epstein-Barr virus. The main clinico-pathological findings of other eight mexican patients with IPSID previously reported are commented. It is concluded that the IPSID is a rare disease in our country but it can be found sporadically.
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PMID:[Immunoproliferative small intestinal disease. Report of a case with immunohistochemical and ultrastructural study]. 821 Jul 70

Gastrointestinal lymphoma, uncommon in the West, is far more prevalent in developing countries where it falls into two groups: 'Western'-type lymphomas, similar to those seen in developed countries, and the so-called Mediterranean-type lymphoma. It is now accepted that Mediterranean lymphoma represents, in the majority if not in all cases, the late stage of alpha heavy chain disease (alpha-HCD). This disease is characterized by abnormal secretion of an immunoglobulin fragment; alpha-HCD and Mediterranean lymphoma constitute two ends of a spectrum of pathology now classified as immunoproliferative small intestinal disease (IPSID). IPSID is associated predominantly with poor socioeconomic conditions; patients present with progressive malabsorption in the second and third decades of life. Diagnosis is established by small bowel biopsy, with or without high serum levels of the alpha heavy chain protein. Treatment consists of an initial staging laparotomy, with debulking of lymphomatous deposits if appropriate, followed by chemotherapy or radiotherapy. Overall prognosis is poor but the recent use of doxorubicin-based chemotherapy offers some hope for the future.
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PMID:Immunoproliferative small intestinal disease: Mediterranean lymphoma and alpha heavy chain disease. 831 11

Celiac sprue, also called nontropical sprue, is a malabsorption syndrome with symptoms that are triggered mainly by gluten ingestion. Non-Hodgkin's lymphoma of the gastrointestinal tract has been reported in patients with a long history of celiac sprue. This case report describes the occurrence of primary oral lymphoma in such a patient. This case is unusual because lymphomas associated with celiac sprue usually develop in the small intestine or in the stomach, and primary lymphoma in the mouth is itself uncommon.
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PMID:Oral T-cell lymphoma associated with celiac sprue. A case report. 835 Nov 22

Hydrogen breath tests (H2 BT) have been used extensively to investigate intestinal disaccharidase deficiencies. A potentially useful test for assessing intestinal absorptive function, the H2 BT with D-xylose (H2 BT-D-xylose), has received scant attention. We report here the results of our investigation of this test in 45 patients. Fifteen patients had proved malabsorption that was due to nontropical sprue in nine, and to lymphoma, Whipple's disease, or giardiasis in the remainder. Nine patients had small-bowel bacterial overgrowth secondary to either postsurgical sequelae or intestinal dysmotility. Twenty-one patients with irritable bowel syndrome and 21 healthy individuals served as control groups. All participants ingested 25 g of D-xylose, and alveolar breath samples were obtained thereafter at 30 min intervals for 5 hr. Breath H2 was measured by chromatography. Basal H2 production, peak change (delta) and area under the curve (AUC) were calculated. Simultaneously, 5-hr urinary excretion of D-xylose was measured by colorimetry and served as the reference test. In healthy individuals, D-xylose ingestion increased H2 production (delta = 5.8 +/- 1.4 ppm, P < 0.001). Changes were similar in patients with the irritable bowel syndrome. In contrast, the increase was of a much greater magnitude in the malabsorption group (delta = 49.9 +/- 7.2 ppm, P < 0.001 vs healthy controls). AUC analysis yielded comparable results. Test performance analysis showed that, in malabsorption the H2 BT-D-xylose had a sensitivity index of 0.86, which was identical to that of the urinary D-xylose test. Specificity was 1 and 0.95, respectively; and predictability 1 and 0.93, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Potential usefulness of hydrogen breath test with D-xylose in clinical management of intestinal malabsorption. 842 44

We present a patient with celiac sprue in whom intestinal lymphoma was suspected. At laparotomy, a brown discolouration of small bowel loops was observed, and a transmural biopsy confirmed a brown bowel syndrome, an entity that is found in long-standing malabsorption conditions. We believe that the intestinal disorder caused by deposition of lipofuscin in the bowel non-striated muscle may cause radiologic changes similar to those seen in intestinal lymphoma.
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PMID:[The brown bowel syndrome. A case report]. 849 59

Heavy chain diseases (HCD) are immunoproliferative disorders characterized by the production of monoclonal immunoglobulin molecules composed of deleted heavy chains devoid of light chains. The diagnosis is established by immunoelectrophoresis (possibly combined to immunoselection) or immunofixation. The clinicopathologic features of gamma HCD are heterogenous, often somewhat similar to macroglobulinemia. Some patients show no evidence of underlying malignant lymphoproliferation. Autoimmune disorders are frequent. mu HCD is rare and often presents as chronic lymphocytic leukemia with hepatosplenomegaly and vacuolated plasma cells on bone marrow smears. Alpha chain disease is the most frequent. In its usual digestive form, the clinicopathologic pattern is uniform. The main clinical features are chronic diarrhea and severe malabsorption syndrome. At the initial stage, there is a diffuse lymphoplasmocytic infiltration of the small intestine and mesenteric nodes, sometimes reversible after treatment by antibiotics alone. At the terminal stage, a malignant lymphoma, often of immunoblastic type, occurs. The natural history and epidemiology of alpha HCD should provide insights into the pathogenesis of malignant lymphoid proliferations.
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PMID:[Heavy chain diseases]. 850 62


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