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Small-bowel tumors, both benign and malignant, are rare lesions that clinicians often do not encounter, accounting for less than 2% of gastrointestinal malignancies. Usually, benign small-bowel tumors, including polyps, are asymptomatic. The diagnosis of small-bowel tumors is difficult because of an often-delayed presentation and nonspecific signs and symptoms. We report an incidentally detected case of a long, pedunculated, large polyp of the terminal ileum, which protruded through the ileocecal valve into the cecum that was removed by colonoscopy in a 41-year-old male with intermittent right-sided lower-abdominal pain. The polyp was resected through snare polypectomy without complications. The histopathology of the resected polyp was confirmed as an ileal hyperplastic polyp. Two years later, there was no recurrence observed via postpolypectomy surveillance colonoscopy.

Objective The utility of capsule endoscopy (CE) findings in the route selection for double balloon endoscopy (DBE) has not been adequately discussed. The PillCam Progress Indicator in the RAPID 6.5 software program graphically demonstrates the progress of the capsule endoscope through the small-bowel. This study aimed to clarify the usefulness of the PillCam Progress Indicator in choosing the initial DBE route. Methods We retrospectively examined 50 consecutive patients with 50 target lesions detected on both CE and DBE at Hiroshima University Hospital from January 2011 to February 2018. In this study, we selected antegrade DBE on the basis of % Capsule Progress

Gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs) are heterogeneous regarding site of origin, biological behavior, and malignant potential. There has been a rapid increase in data publication during the last 10 years, mainly driven by high-throughput studies on pancreatic and small intestinal neuroendocrine tumors (NETs). This review summarizes the present knowledge on genetic and epigenetic alterations. We integrated the available information from each compartment to give a pathway-based overview. This provided a summary of the critical alterations sustaining neoplastic cells. It also highlighted similarities and differences across anatomical locations and points that need further investigation. GEP-NENs include well-differentiated NETs and poorly differentiated neuroendocrine carcinomas (NECs). NENs are graded as G1, G2, or G3 based on mitotic count and/or Ki-67 labeling index, NECs are G3 by definition. The distinction between NETs and NECs is also linked to their genetic background, as TP53 and RB1 inactivation in NECs set them apart from NETs. A large number of genetic and epigenetic alterations have been reported. Recurrent changes have been traced back to a reduced number of core pathways, including DNA damage repair, cell cycle regulation, and phosphatidylinositol 3-kinase/mammalian target of rapamycin signaling. In pancreatic tumors, chromatin remodeling/histone methylation and telomere alteration are also affected. However, also owing to the paucity of disease models, further research is necessary to fully integrate and functionalize data on deregulated pathways to recapitulate the large heterogeneity of behaviors displayed by these tumors. This is expected to impact diagnostics, prognostic stratification, and planning of personalized therapy.

Contains fulltext : 177302.pdf (Publisher’s version ) (Open Access) Gastrointestinal mucositis is a complex inflammatory reaction of the mucous membranes, a side effect of both chemotherapy and radiotherapy. Currently, assessment scales are used to diagnose mucositis. However, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. This will give the opportunity to evaluate studies, to determine risk factors and incidence, and it will make it possible to compare studies. Moreover, this biomarker might improve clinical management for patients. In this paper, we reviewed studies concerning potential biomarkers in blood samples and fecal samples, and potential tests in breath samples and urine samples. We include biomarkers and tests studied in animal models and/or in clinical trials, and discuss the validity, diagnostic accuracy, and applicability.

Objective The aim of the present study is to assess the difference in the detection rates of small-bowel lesions in chronic abdominal pain (CAP) patients with irritable bowel syndrome (IBS) and non-IBS. Patients Ninety-nine CAP patients who were scheduled to undergo capsule endoscopy (CE) to investigate their abdominal symptoms were included in this study. Among the subjects, 34 patients fulfilled the Rome III criteria for IBS (IBS group); the remaining 65 patients were categorized as the non-IBS group. CE was performed in both groups and the total enteroscopy achievement rate, small-bowel lesion detection rate, and the presence of small-bowel lesions were evaluated. We also evaluated the patients' blood test results and the rate at which abdominal symptoms improved following internal medication. Results Total enteroscopy was achieved in 62% (21/34) and 86% (56/65) of the IBS and non-IBS patients, respectively. The total enteroscopy achievement rate was significantly higher in non-IBS patients. The small-bowel lesion detection rates were 3% (1/34) and 19% (12/65), respectively, and the detection rate was significantly higher in the non-IBS patients. In the non-IBS patients, mean C-reactive protein (CRP) was significantly higher in the patients with small-bowel lesions. The abdominal symptoms of 12 (92%) of the CAP patients with small-bowel lesions were improved by internal medication. Conclusion CE may be considered for non-IBS CAP patients with high levels of CRP.

Highlights • Pre-operative diagnosis of fish bone perforation of the bowel is difficult. • It usually mimics common abdominal pathology. • A low threshold must be maintained to perform a diagnostic laparoscopy., Introduction The diagnosis of abdominal complications due to fish bone ingestion is particularly difficult as the presentation may mimic common abdominal pathologies. Presentation of case 65 year-old male presented with a two day history of right iliac fossa pain. He denied any nausea and vomiting. He had no systemic systems including fever, change in bowel habit. He had tenderness and guarding localized to the right iliac fossa. He had raised inflammatory markers. A CT scan of the abdomen was performed which showed fat standing in proximity to the terminal ileum, with the appearance of Crohn’s disease. The clinical picture did not match the imaging and so the patient underwent a diagnostic laparoscopy. Findings included an acutely inflamed terminal ileum. A foreign body was identified piercing through at the small bowel wall at the terminal ileum. The foreign body was removed and revealed a fish bone. Intracorporeal sutures were inserted at the site of the microperforation. The patient was discharged well two days post operatively. Discussion Fish bone perforation is not a common cause of gastrointestinal perforation. Unfortunately the history is often non-specific and these people can be misdiagnosed with acute appendicitis & other pathologies. CT scans can be useful to aid diagnostics. It is not however fully sensitive in detecting complications arising from fishbone ingestion. Conclusion Management therefore, should be based taking into account primarily the clinical picture & may necessitate diagnostic laparoscopy.

Fijlstra M, Rings EH, Verkade HJ, van Dijk TH, Kamps WA, Tissing WJ. Lactose maldigestion during methotrexate-induced gastrointestinal mucositis in a rat model. Am J Physiol Gastrointest Liver Physiol 300: G283-G291, 2011. First published November 18, 2010; doi:10.1152/ajpgi.00462.2010.-Patients with chemotherapy-induced gastrointestinal mucositis suffer from anorexia, diarrhea, and stomach pain, often causing weight loss and malnutrition. When the intestinal function during mucositis would be known, a rational feeding strategy might improve the nutritional state, accelerate recuperation, and increase survival of mucositis patients. We developed a methotrexate (MTX)-induced mucositis rat model to study nutrient digestion and absorption. To determine lactose digestion and absorption of its derivative glucose during mucositis, we injected Wistar rats intravenously with MTX (60 mg/kg) or 0.9% NaCl (controls). Four days later, we orally administered trace amounts of [1-C-13] lactose and [U-C-13] glucose and quantified the appearance of labeled glucose in the blood for 3 h. Finally, we determined plasma citrulline level and harvested the small intestine to assess histology, myeloperoxidase level, glycohydrolase activity, immunohistochemical protein, and mRNA expression. MTX-treated rats showed profound villus atrophy and epithelial damage. During the experimental period, the absorption of lactose-derived [1-C-13] glucose was 4.2-fold decreased in MTX-treated rats compared with controls (P

Bayramoglu Z, Yilmaz R, Demir AA, Ataizi-Celikel C, Kombak FE, Ikinci A, Yekeler E. Multimodality imaging findings of visceral myopathy in a child presenting with palpable abdominal mass. Turk J Pediatr 2019; 61: 120-125. Visceral myopathy is a rare cause of intestinal obstruction characterized by intestinal dysmotility and constipation. Patients often present with recurrent abdominal pain, vomiting and abdominal distension. We report a rare case of visceral myopathy in a child presenting with intraabdominal mass. We aimed to describe ultrasound, computed tomography and magnetic resonance enterography findings of this rare disease that has not been demonstrated before. Differential diagnosis of mural thickening with distinguishable layers in addition to intestinal dilatation in the absence of mesenteric inflammation includes visceral myopathy.

Contains fulltext : 69805.pdf (Publisher’s version ) (Closed access) Most Gram-positive bacteria inhabiting the gastrointestinal tract are capable of hydrolysing bile salts. Bile salt hydrolysis is thought to play an important role in various biological processes in the host. Therefore, correct annotation of bacterial bile salt hydrolases (Bsh) in public databases (EC 3.5.1.24) is of importance, especially for lactobacilli, which are considered to play a major role in bile salt hydrolysis in vivo. In the present study, all enzymes listed in public databases that belong to the Bsh family and the closely related penicillin V acylase (Pva; EC 3.5.1.11) family were compared with the sequences annotated as Bsh in Lactobacillus plantarum WCFS1, as an example. In Gram-positive bacteria, a clear distinction was made between the two families using sequence alignment, phylogenetic clustering, and protein homology modelling. Biochemical and structural data on experimentally verified Bsh and Pva enzymes were used for validation of function prediction. Hidden Markov models were constructed from the sequence alignments to enable a more accurate prediction of Bsh-encoding genes, and their distinction from those encoding members of the Pva family. Many Pva-related sequences appeared to be annotated incorrectly as Bsh in public databases. This refinement in the annotation of Bsh family members influences the prediction of the function of bsh-like genes in species of the genus Lactobacillus, and it is discussed in detail.

Background: Apple peel atresia is the rarest type of small bowel atresia. Because of its rare occurrence and high mortality rate, little is known about the long-term outcome of these children.Methods: The patient charts, operative reports, and office notes of 15 children with apple peel atresia from 6 pediatric surgical centers in the Netherlands were reviewed. Longterm follow-up was assessed through review of office notes and through questionnaires.Results: The median age at the time of operation was 1.5 days. Postoperatively, 53% suffered from cholestasis, and 40% were septic. Three patients died (20%). At follow-up at a median age of 24 months, 1 child showed growth retardation and 2 children suffered from short bowel syndrome. At the time of the questionnaire, all children showed normal growth and development.Conclusions: Even though children with apple peel atresia often suffer serious morbidity like short bowel syndrome and sepsis during the postoperative course, late morbidity turned out to be low. If the patients survive the operative and direct postoperative period, and survive the morbidity associated with malnutrition and the long-term use of total parenteral nutrition, they have a good chance of having normal bowel function with normal growth and development. J Pediatr Surg 37:61-65. Copyright (C) 2002 by W.B. Saunders Company.

Background Lewis Score (LS) is an inflammatory score in small-bowel capsule endoscopy (SBCE). Fecal calprotectin (FC) is considered the non-invasive, ‘gold standard’ marker of gastrointestinal (GI) inflammation. Recently, we reported that LS shows only a moderate correlation with FC. In this study, we aim to evaluate which LS parameters have greater correlation with FC. Methods A retrospective, two-center study; 74 patients who underwent SBCE within 7 (median 1.5) days from a FC measurement. LS was calculated; univariate and multivariate analyses were performed, investigating LS correlation with FC, and which LS parameters had stronger correlation coefficient (rs) with FC. Results 74 patients had an FC measurement within 7 days of their SBCE examination (median 22 time-interval: 1.5 days; IQR: 5). Coefficient rs between LS and FC was moderate (0.454). In univariate analysis, the variables that gave the strongest association with FC were: the higher tertile subscore for ulcer, the summative ulcer subscore, the higher tertile ulcer score (only with descriptors of ulcer size and number), the summative ulcer score (only with descriptors of ulcer size and number), and subscores including various combinations of the stenosis descriptors. In multivariate analysis, the only positive predictor for FC was the higher tertile ulcer subscore (only with descriptors of ulcer size and number). Conclusion LS shows only moderate correlation to FC. This is due to a) an inherent limitation of LS, and b) the notion of correlating the 2 parameters, and consideration should be given to development of a new, simplified (or composite) inflammation score/index for SBCE.

INTRODUCTIONSmall-bowel myeloid sarcoma is rare. Acute bowel obstruction is its usual clinical presentation.PRESENTATION OF CASEWe report a case of small-bowel myeloid sarcoma that occurred in a 64-year-old woman who presented chronic secretory diarrhoea, hypokalaemia, and weight loss. Immature white blood cells in a peripheral smear and small-bowel capsule endoscopic features were the main diagnostic clues. The patient experienced capsule retention and developed acute bowel obstruction. Urgent laparotomy showed a stricturing ileal mass and pathology of the resected bowel specimen unveiled a CD34+, CD117+, and myeloperoxidase-positive myeloid sarcoma. The diarrhoea promptly resolved after surgery, and the patient is now undergoing chemotherapy.DISCUSSIONSecretory diarrhoea can be the first manifestation of small-bowel myeloid sarcoma. Capsule endoscopy may provide a diagnostic clue, but it can trigger an acute bowel obstruction. Differential diagnosis of the pathologic specimen may be difficult and a high suspicion index of is mandatory to perform immunophenotyping to determine the correct management.CONCLUSIONChronic diarrhoea with alarm features can be the first manifestation of small-bowel myeloid sarcoma.

The gastrointestinal tract is the main site where the conversion and absorption of food components takes place. The host-derived physiological processes and the residing microorganisms, especially in the small intestine, contribute to this nutrient supply. To circumvent sampling problems of the small intestine, several model systems have been developed to study microbial diversity and functionality in the small intestine. In addition, metagenomics offers novel possibilities to gain insight into the genetic potential and functional properties of these microbial communities. Here, an overview is presented of the most recent insights into the diversity and functionality of the microorganisms in the human gastrointestinal tract, with a focus on the small intestine.

en-bloc resection, and an end-to-end anastomosis was performed. The patient had an uneventful recovery, except for a late wound infection. She was discharged after 5 days. A 50-year-old woman presented with a 24-hour history of increasing pain in the left lower quadrant of the abdomen with fever (38.2 ° C) and general discomfort. She had a medical history of obesity, an abdominoplasty and asthma for which she used combivent. Physical examination revealed tenderness of the lower left quadrant, guarding of the rectus and oblique muscles with rebound tenderness. Infection parameters in the blood showed a leukocyte count of 11,400 g/l and C-reactive protein of 141 mg/l. The computer tomography (CT) scan showed a process originating from the small bowel ( fig. 1 ). A median laparotomy was performed and 4 diverticula close to each other at the mesenterial side of the proximal jejunum were identified, varying from 1 to 5 cm. One of these diverticula was obviously inflamed and extended into the mesenterium ( fig. 2 ). The diverticula of the jejunum including the inflamed diverticulum were removed with an Published online: March 21, 2008

Background Recent work suggests that mixing in the small intestine takes place in central luminal and peripheral compartments. However, while movements of villi have been described, the mechanisms by which peripheral mixing are engendered remain unclear. Methods We examined the disposition and movement of mucosa and associated villi during contractions of the everted terminal ileum of the brushtail possum. We then simulated the effect of these movements on peripheral mixing. Key Results Compression of the intestinal mucosa by phasic longitudinal or radial contractions created short-lived microfolds, which were of similar scale to the attached villi. The packing density of the villous tips increased in the concavities and decreased on the crests of these microfolds. Simulations showed that these caused liquid digesta to be expelled from, or drawn into, intervillous spaces, significantly augmenting peripheral, but not bulk, luminal mixing. Conclusions & Inferences We describe a mechanism by which peripheral mixing may be engendered by mucosal microfolds without requiring the coordinated contraction of individual villi or groups of villi.

Malignant melanoma incidence is rapidly growing worldwide. The small bowel is well known to be a preferred site for melanoma metastases. In 60% of patients who died of disseminated melanoma, the gastrointestinal (GI) tract was affected, but only 1% to 4% of GI metastases were clinically diagnosed ante mortem.In this case we describe a report of a 71 years old male admitted to the hospital with a combination of two possible complications of GI metastatic melanoma: obstruction and GI bleeding. Past medical history reveals a malignant cutaneous melanoma excised 5 years before.Symptoms of small bowel involvement are frequently unspecific which leads to a late diagnosis often made only after complications, such as intestinal obstruction, massive gastrointestinal bleeding and perforation. In most cases, the diagnosis of melanoma metastasis was made only after surgery, which proved to be life-saving. We have searched literature for these complications and their relative treatment.Modern imaging techniques are recommended in order to obtain an early diagnosis. Surgical resection is the only treatment in patients with resectable metastatic intestinal melanoma.Acute abdomen, Metastatic melanoma, Small-bowel, Surgery.Il melanoma maligno è una patologia che sta conoscendo una rapida diffusione in tutto il mondo, caratterizzata da tassi di mortalità in aumento negli ultimi 10 anni. La distribuzione delle metastasi dovute a tale malattia non è casuale, anzi, il pattern di diffusione sembra essere correlato alla sua derivazione embriologica: molti studi hanno infatti dimostrato che l’apparato gastro-intestinale è il sito più frequentemente coinvolto dalle metastasi, che difficilmente sono diagnosticate in tempo. Ad oggi, infatti, solo l’1-4% dei casi di metastasi dell’apparato digerente da melanoma viene diagnosticato “ante mortem’’. I sintomi di tale localizzazione neoplastica sono spesso aspecifici ed è per questo motivo che la diagnosi viene effettuata soltanto dopo l’insorgere delle complicanze, quali l’ostruzione intestinale, il sanguinamento e la perforazione. In questa nota viene presentato il caso di un paziente di 71 anni, ricoverato con diagnosi di addome acuto da occlusione intestinale con importante enterorragia. Il paziente 5 anni prima era stato sottoposto ad asportazione di un melanoma cutaneo maligno. La laparotomia esplorativa ha evidenziato una diffusa disseminazione metastatica con interessamento sia del peritoneo parietale, che di diversi segmenti dell’intestino tenue. A causa della massiva diffusione della patologia neoplastica si è dovuto procedere esclusivamente al confezionamento di una derivazione intestinale a scopo palliativo. Il mancato riconoscimento dei sintomi legati alla presenza di una diffusione metastatica comporta il ritardo diagnostico nel trattamento delle metastasi dell’apparato digerente da melanoma cutaneo.