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

Small bowel enteroscopy in 1991 is now feasible in two clinical situations: in the case of malabsorption or diffuse intestinal disease, it is easier to visualise the small bowel with the "push enteroscopy methods". The most proximal and distal ends of the small intestine can be viewed through standard instruments or better with videocoloscope beyond the ligament of Treitz. The ileocecal valve can be intubated after total colonoscopy for the evaluation of Crohn's disease, tuberculosis and small bowel lymphoma. In the case of occult gastrointestinal hemorrhage small bowel enteroscopy now permits visualization of large amounts of small intestinal. When the gastrointestinal bleeding is severe, we recommend intraoperative enteroscopy. When the bleeding is not severe and chronic, it is possible to perform a non surgical total small bowel enteroscopy with an enteroscope or videoenteroscopoe. Prototypes are under development. The procedure is safe an can be performed on an outpatient basis. The limitations of the procedure are the impossibility of intervention and inability to inspect the total mucosal surface. It is not a "first line" or "second line" investigation in these situations. It should be considered after previous investigations have been negative. Push enteroscopy should be performed by general endoscopists, non surgical and total enteroscopy should be reserved, for instance for skills and motivated team endoscopists.
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PMID:[Endoscopy of the small intestine in 1991: is it the end of the tunnel?]. 141 52

Diamine oxidase (DAO) is an enzyme located almost exclusively in villus tip enterocytes. Its plasma activity is enhanced by intravenous heparin which releases the enzymes from small bowel enterocytes into the blood. Plasma postheparin DAO (PHD) values have been shown to be significantly lower in patients with malabsorption and villous atrophy, thus suggesting that PHD reflects the mature enterocytic mass. In this study we have assayed PHD in five patients with small bowel lymphoma (two with immunoproliferative small intestinal disease [IPSID] and three with non-IPSID lymphoma) associated with malabsorption syndrome and small bowel mucosa atrophy. The PHD test was performed at diagnosis, after partial or complete remission induced by chemotherapy, and during the follow-up. The PHD values, very low at diagnosis (0.66 +/- 0.12 U/ml), increased during chemotherapy and reached the normal range (greater than 3.7 U/ml) when complete remission occurred. The PHD values rapidly and consistently decreased whenever the disease relapsed. Our data indicate that in patients with small bowel lymphoma PHD test is a sensitive marker of small bowel mucosa damage and suggest that it could be useful in monitoring the recovery of mucosal lesions induced by chemotherapy.
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PMID:Plasma postheparin diamine oxidase in patients with small intestinal lymphoma. 189 7

At the present, immunoproliferative small intestinal disease (IPSID) is considered a fairly homogeneous entity. Isolated heavy chain production is so closely related with IPSID that has been considered as a natural biologic marker for it. By contrast, we report here the case of a 63-year-old female that developed a multinodular small bowel lymphoma without clinical malabsorption symptoms. The main tumour mass was located in proximal jejunum and the neighbour intestinal mucosa did not show neoplastic cell infiltrates. Immunohistochemical methods demonstrated restrictive presence of IgA1 subclass in the neoplastic cells without presence of light chains. Cases as present are extremely infrequent and their potential relationship with IPSID has not been completely outlined, being useful in trying to understand the spectrum of gut lymphomas.
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PMID:[Non-Mediterranean lymphoma producing heavy alpha chains]. 251 85

Diamine oxidase (DAO) is an enzyme whose low plasma values are enhanced by an intravenous injection of heparin, which releases the enzyme from the enterocytes of the villous tips. In 20 normal controls and 15 untreated subjects affected with an overt malabsorption syndrome and subtotal atrophy shown by Crosby jejunal mucosa biopsy (12 suspected celiac disease and three small bowel lymphoma), plasma diamine oxidase was assayed, over 2 hr following an intravenous bolus of 15,000 IU heparin. Plasma postheparin DAO concentrations and the corresponding values of the area under curve, expressed as units/ml X min (mean +/- SD), were significantly lower in the patients (celiac sprue: 138 +/- 62; lymphoma: 83 +/- 42) compared to normals (481 +/- 104). DAO area values were well correlated (r = 0.81; P less than 0.001) with 24-hr fecal fat excretion but not with xylosuria. Our data suggest that postheparin plasma DAO assay may be useful to detect and quantitate small bowel mucosal atrophy in patients with malabsorption syndromes.
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PMID:Postheparin plasma diamine oxidase in subjects with small bowel mucosal atrophy. 310 90

Literature and original data are reported on a case of alpha-chain disease associated with small intestine lymphoma in a male patient aged 20. The disease manifested clinically with chronic diarrhea, malabsorption, hypoproteinemia, hypocalcemia, cachexia, discretely detected alpha-chain monomer. Morphologically, there was lymphoplasmacyte infiltration of the intestinal mucosal layer; capsule collagenization, clustering immunoblasts among microlymphocytes, a pronounced macrophagal reaction, intercellular crystalloid and lymph masses, follicular pattern disappearance, sites of cellular polymorphism revealed in an axillary lymph node. The latter finding evidenced for developing immunoblastic sarcoma.
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PMID:[Morphologic changes of the small intestine and lymph nodes in alpha-chain disease]. 314 43

Diamine oxidase (DAO) is an enzyme located almost exclusively in the villus tip enterocytes of mammals. Its plasma activity, normally very low, is enhanced by intravenous heparin that releases the enzyme from the enterocytes into the blood. Postheparin plasma DAO (PHD) values have been shown to be significantly reduced in patients with malabsorption and villus atrophy and in patients with Crohn's disease, thus suggesting that this test explores the mucosal integrity. The execution of the PHD test requires 8 blood samples over a period of 120 min after an intravenous injection of 15,000 IU of heparin, and then the calculation of the area under the curve. The aim of this study was to simplify the test and make it more acceptable by choosing only one of the eight curve points required for the calculation of the area under the curve and then assessing its discriminant power in different small bowel diseases. To this end, a discriminant analysis was performed on PHD curves of 16 normal subjects, 25 patients with celiac disease, 14 patients with treated celiac disease, 5 patients with diffuse primary small bowel lymphoma, 4 patients with small bowel lymphoma during treatment, and 55 patients with small bowel Crohn's disease. Plasma DAO values assayed 1 h (T60) after the injection of 15,000 IU of heparin proved to be the best discriminator curve point and the use of the T60 point alone may be usefully employed instead of the area under the 120-min curve.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Postheparin plasma diamine oxidase in subjects with small bowel disease. Diagnostic efficiency of a simplified test. 314 70

Between 1974 and 1984 we saw 69 patients with lymphoma that involved the gastrointestinal tract. In ten patients the lymphoma compromised the small bowel and were associated to malabsorption. Seven patients fulfilled the criteria to be considered as primary small bowel lymphoma. We presumed the intestinal origin in the other 3 patients, but it was impossible to confirm it. The peroral small bowel biopsy showed histological findings compatible with celiac disease in 7 patients. Other particular histological signs were patchy alterations, inconstant epithelial pseudo-stratification and ulcerations. In 2 cases we found findings that suggested the diagnosis of lymphoma. In 50% of patients we found unspecific malabsorption signs in the small bowel radiology. We found giant ulcers and stenosis too. The gluten-free diet or the steroid therapies resulted in temporary or inconstant improvement. The laparotomy was the most effective diagnostic approach. It was performed electively in 6 patients and in 1 because of a small bowel perforation. The primary small bowel lymphoma is an entity of difficult diagnosis. The most important trouble is to differentiate it with celiac disease.
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PMID:[Primary lymphoma of the small bowel and malabsorption]. 322

Primary small intestinal lymphoma (PSIL) represents a heterogenous group of disorders with variable clinical and pathologic features and a characteristic age, socioeconomic, and geographic distribution. In developed countries, PSIL usually occurs as a localized ileal tumor, shows a bimodal age distribution, and most frequently presents with abdominal pain and obstructive symptoms. Histologically, most of these tumors are diffuse histiocytic, lymphocytic, or undifferentiated lymphomas. Other variants of PSIL, collectively referred to as immunoproliferative small intestinal disease, occur most often among young patients of poor socioeconomic status in Third World countries, mostly in the Middle East and Mediterranean area. They are characterized by involvement of long loops of the upper small intestine and commonly present with abdominal pain, diarrhea, malabsorption, and clubbing of the fingers. A subgroup of these patients shows a serological abnormality with the appearance of part of the alpha heavy chain of IgA in the serum. Histologically, the lesion appears as a dense diffuse lymphoplasmacytic infiltrate of the mucosa of the upper jejenum or duodenum. A form of malignant lymphoma of true histiocytic origin complicates long-standing celiac disease. The contrasting clinical, epidemiological, histopathological, and immunological features of these variants of PSIL raise interesting questions about the pathogenesis of small bowel lymphoma.
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PMID:Primary lymphomas of the small intestine: east-west contrast. 395 68

Review of the medical records of 43 patients with common variable immunodeficiency (CVID) and 23 patients with X-linked agammaglobulinemia (XLAG) revealed a high incidence of chronic gastrointestinal complaints, most commonly diarrhea. Thirty-eight biopsies, four small-bowel resection specimens, and one autopsy from 10 patients with CVID and one patient with XLAG showed a wide range of abnormalities. A pattern resembling acute graft-versus-host disease, with apoptotic bodies and lymphocytes in crypts, was seen in the stomach (four patients), small bowel (three patients), and colon (three patients). Small-bowel specimens from three CVID patients with malabsorption showed mild to severe villous atrophy. Three CVID patients had Giardia in biopsies. Two cases of small bowel lymphoma associated with nodular lymphoid hyperplasia were identified in CVID patients. One patient's small bowel contained foamy histiocytes in the lamina propria, resembling Whipple's disease or chronic granulomatous disease, with numerous apoptotic bodies in crypts. Ultrastructurally, the histiocytes contained cellular debris. The patient with XLAG had recurrent fissuring necrosis of small bowel resembling Crohn's disease; a patient with CVID had colitis with features similar to ulcerative colitis. Poorly formed granulomas were seen in the stomach (one CVID patient) and the colon (two CVID patients). Lymphocyte populations were dominated by T cells; B cells were scarce except in lymphoid follicles in CVID patients with nodular lymphoid hyperplasia. Patients with CVID and XLAG manifest a spectrum of abnormalities in the gastrointestinal tract, with patterns superficially resembling graft-versus-host disease, inflammatory bowel disease, and Whipple's disease, but often lacking some of the diagnostic features of the diseases. Many of the CVID patients with chronic gastrointestinal complaints (62%) also had evidence of autoimmune phenomena, suggesting that in some patients the inflammatory process in the gastrointestinal tract has an autoimmune component.
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PMID:Gastrointestinal pathology in patients with common variable immunodeficiency and X-linked agammaglobulinemia. 882 31

We report a case of enteropathy-associated T-cell lymphoma (EATL) of the jejunum in a 56-year-old man. The patient suffered for several years from nonspecific abdominal complaints, with no clinical evidence of malabsorption. The patient underwent extensive imaging procedures including barium meal and computed tomography. Computed tomography of the abdomen showed small mesenteric lymph nodes and an area of intestinal wall thickening. Barium meal demonstrated a short jejunal stricture. Histology revealed lymphoma of the jejunum, with microscopic changes distant from the lesion consistent with celiac disease. The spectrum of EATL ranges from patients with frank celiac disease, to patients with only immunohistochemical evidence of celiac disease, who develop small bowel lymphoma.
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PMID:Enteropathy-associated T-cell lymphoma: a case report with radiographic and computed tomography appearance. 917 68


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