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Background: Chronic idiopathic constipation (CIC) is a disorder of gut–brain interaction characterized by a variety of bowel movement‐related and abdominal symptoms. A greater understanding of medication use and satisfaction with symptom control may provide insights to optimize patient care. Therefore, we explored these aspects of the disorder in adults with CIC. Methods: This study assessed data collected from a large nationwide survey of adult participants in the United States, querying demographics, clinical characteristics, and comorbid conditions, as well as medication use, care‐seeking behaviors, and satisfaction with symptom control. Participants were grouped into the CIC cohort if they met Rome IV criteria, with controls matched 1:1 according to age, sex, race, region, and Charlson Comorbidity Index score. All data were self‐reported. Key Results: Two thousand five hundred and thirty‐three participants with CIC were matched 1:1 to controls. In the CIC cohort, abdominal pain was the most reported symptom leading to medication use: 15.9% of respondents were receiving a prescription medication in addition to an over‐the‐counter medication, while 26.3% were taking neither. In addition, only one‐third were satisfied with the control of their symptoms; however, satisfaction was significantly higher in respondents taking a prescription medication (p < 0.001). The proportion of reported comorbidities was significantly higher in the CIC cohort versus the control cohort, with chronic pain, anxiety, and depression among the highest (p < 0.001 for all). Conclusions and Inferences: This study emphasizes the need for better communication regarding prescription medications and their benefits, with the goal of further improving CIC patients' overall symptoms. [ABSTRACT FROM AUTHOR]

Background: Video capsule endoscopy is a noninvasive technique for evaluation of the gastrointestinal tract. Objective: To investigate the safety of using the video capsule ALICAM in dogs with chronic enteropathy (CE) >10 kg, and to compare macroscopic gastrointestinal morphology between CE dogs and healthy controls (HC). Animals: Fifteen CE dogs and 15 similarly breed, age and body weight matched HC. Methods: All dogs underwent a clinical work up including blood analyses, fecal samples, abdominal ultrasonographic examination, and blood pressure measurement. The dogs were withheld from food for 16 hours before and 8 hours after they PO received an ALICAM. All recordings were quality assessed, and blindly evaluated by 2 trained observers. Results: The median age of CE dogs and HC was 3.3 (interquartile range [IQR] 2.5‐5.9) years and 4.7 (IQR 3.3‐5.6) years, respectively. The median body weight in the CE dogs and HC was 25.9 (IQR 20.6‐30.9) kg, and 29 (IQR 16.2‐30.5) kg, respectively. Complete recordings of the gastrointestinal tract were obtained from all dogs without complications. No significant differences were found between groups regarding number of abnormalities such as irregular mucosa, erythema, nonbleeding erosions, bleeding erosions, and dilated lacteals, as well as severity and extent of the abnormalities. Conclusions and Clinical Importance: The use of ALICAM for evaluation of the gastrointestinal tract in CE dogs and HC seems safe and feasible regarding gastrointestinal transit and macroscopic morphology assessment in dogs >10 kg. Abnormalities were found in similar proportions in CE dogs and HC. [ABSTRACT FROM AUTHOR]

The small intestine represents a complex and understudied gut niche with significant implications for human health. Indeed, many infectious and non‐infectious diseases center within the small intestine and present similar clinical manifestations to large intestinal disease, complicating non‐invasive diagnosis and treatment. One major neglected aspect of small intestinal diseases is the feedback relationship with the resident collection of commensal organisms, the gut microbiota. Studies focused on microbiota–host interactions in the small intestine in the context of infectious and non‐infectious diseases are required to identify potential therapeutic targets dissimilar from those used for large bowel diseases. While sparsely populated, the small intestine represents a stringent commensal bacterial microenvironment the host relies upon for nutrient acquisition and protection against invading pathogens (colonization resistance). Indeed, recent evidence suggests that disruptions to host–microbiota interactions in the small intestine impact enteric bacterial pathogenesis and susceptibility to non‐infectious enteric diseases. In this review, we focus on the microbiota's impact on small intestine function and the pathogenesis of infectious and non‐infectious diseases of the gastrointestinal (GI) tract. We also discuss gaps in knowledge on the role of commensal microorganisms in proximal GI tract function during health and disease. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of infiltrative small intestinal (SI) disease in cats is challenging, and debate continues regarding optimal biopsy techniques. Ultrasonography may facilitate selection of biopsy type and location. Hypothesis/Objectives: Assess ability of ultrasonography to predict histologic lesions by SI segment and tissue layer. Animals: One‐hundred sixty‐nine cats that had abdominal ultrasonography and full‐thickness SI biopsies performed. Methods: Ultrasonographic images and full‐thickness biopsy samples were retrospectively reviewed, and each SI wall layer evaluated for lesions according to published standards. Results: Ultrasonographic SI lesions were present in 132 cats (63 duodenum; 115 jejunum; 71 ileum). Samples were obtained at laparotomy (60) or necropsy (109). Ultrasonographic abnormalities had high positive predictive value (PPV) for histologic lesions (duodenum, 82.0%; 95% confidence interval [CI], 68.6‐91.4; jejunum, 91.0%; 95% CI, 81.5‐96.6; ileum, 88.1%; 95% CI, 74.4‐96.0), but poor negative predictive value (duodenum, 27.1%; 95% CI, 17.2‐39.1; jejunum, 27.3%; 95% CI, 10.7‐50.2; ileum, 40.4%; 95% CI, 26.4‐55.7). The ability of ultrasonography to predict histologic lesions in this population, which had high disease prevalence (SI histologic lesions in 78.1% of cats) was high for mucosal lesions (PPV, 72.7%‐100%) but low for submucosal or muscularis lesions (PPV, 18.9%‐57.1%). Conclusions and Clinical Importance: In a population with high disease prevalence, most cats with SI mucosal ultrasonographic lesions will have mucosal histologic lesions. Small intestinal submucosal and muscularis ultrasonographic lesions are not predictive of histologic disease in those layers, suggesting that full‐thickness biopsy may not be essential in these cats. Ultrasonography may help guide decisions about biopsy type in individual cats. [ABSTRACT FROM AUTHOR]

Fasciolopsis buski is the largest fluke parasitizing the human small intestine. F. buski infections are not uncommon in Southeast Asia. The risk factors of F. buski infection mainly include eating of raw aquatic crops and infected snails. Most infections are asymptomatic. Heavy infection can be fatal as the flukes cause extensive intestinal inflammation, intestinal perforation, small bowel stricture, ulceration, hemorrhage, and abscess formation. Endoscopic diagnosis of this parasite has been described in a few case reports. Here, we describe and illustrate the endoscopic removal of F. buski from the stomach and duodenum. [ABSTRACT FROM AUTHOR]

Objective. To investigate gastric and small intestinal mucosal injury in asymptomatic patients taking enteric-coated aspirin using magnetically controlled capsule endoscopy. Methods. Patients taking enteric-coated aspirin (aspirin group) and healthy controls (control group) were recruited from Beijing Anzhen Hospital, Capital Medical University, between September 2017 and May 2018, and undertook magnetically controlled capsule endoscopy. Results. Twenty-six subjects were recruited to the aspirin group and twenty-six to the control group; the median Gastrointestinal Symptom Rating Scale scores were 3.50 and 3.00 (P=0.200), the median gastric Lanza scores were 2.50 and 1.00 (P<0.001), the small intestinal Lanza scores were 1.00 and 0.00 (P<0.001), the gastric controlled examination times were 50.0 and 51.0 min (P=0.171), the small intestinal transit times were 240.0 and 238.0 min (P=0.654), and the capsule excretion times were 24.0 and 24.0 hours (P=0.956), respectively. Conclusions. Rates of gastric and small intestinal mucosal injuries were significantly higher in patients without obvious gastrointestinal symptoms taking enteric-coated aspirin compared to healthy controls. Magnetically controlled capsule endoscopy constitutes a safe, real-time screening modality for gastric and small intestinal mucosal injury in patients taking enteric-coated aspirin. [ABSTRACT FROM AUTHOR]

Primary small intestinal volvulus is defined as torsion in the absence of congenital malrotation, band, or postoperative adhesions. Its occurrence as an early postoperative complication is rare. A 40‐year‐old woman presented with rectal prolapse, and laparoscopic rectopexy was uneventfully performed. She could not have food on the day after surgery. She started oral intake on postoperative day 3 but developed abdominal pain after the meal. Contrast‐enhanced CT revealed torsion of the small intestinal mesentery. An emergent laparotomy showed small intestinal volvulus, without congenital malformation or intestinal adhesions. We diagnosed it as primary small intestinal volvulus. The strangulated intestine was resected, and reconstruction was performed. The patient recovered uneventfully after the second surgery. To the best of our knowledge, this is the first report of primary small intestinal volvulus occurring after rectopexy for rectal prolapse. Primary small intestinal volvulus could be a postoperative complication after laparoscopy. [ABSTRACT FROM AUTHOR]

Background: Overall survival for patients with small intestinal neuroendocrine tumours (siNETs) is long, even with metastatic disease, making quality of life issues relevant. The impact of surgery on quality of life is not known. We investigated determinants of health-related quality of life in patients who had undergone surgery for a siNET.Methods: Patients operated for a siNET between 1998 and 2016 at Skåne University Hospital (Lund, Sweden), who were alive in February 2017, were sent two questionnaires constructed by the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30, EORTC QLQ-GINET21). Global quality of life, physical function, disease-related worries, diarrhoea and endocrine symptoms were evaluated with linear and logistic regression in relation to patient-, tumour- and treatment-related factors. Statistical analysis was performed using STATA 11®.Results: One hundred patients (84%) completed the questionnaires. Women had worse global quality of life (p = 0.019), more disease-related worries (p < 0.001) and endocrine symptoms (p = 0.017) than men. Older age was associated with more disease-related worries (p = 0.007), but fewer endocrine symptoms (p = 0.034). Non-symptomatic tumour versus symptomatic tumour (p = 0.002), and treatment with somatostatin analogues versus no treatment (p = 0.040) were associated with less diarrhoea. Small versus large bowel resection was associated with better global quality of life (p = 0.036) and physical function (p = 0.035).Conclusions: Male gender, younger age, treatment with somatostatin analogues, non-symptomatic tumour, and small intestinal surgery rather than large bowel surgery were associated with better quality of life. [ABSTRACT FROM AUTHOR]

Objective. Familial Mediterranean fever (FMF) is an autosomal recessive disease due to a MEFV gene mutation. Since Helicobacter pylori infection has been described to increase the severity and frequency of FMF attacks, we evaluate if overgrowth of small intestinal bacterial (SIBO), associated with a release of bacterial products, can affect the response to colchicine in FMF patients poorly responsive to colchicine. Methods. We revised our Periodic Fever Centre database to detect FMF patients who were poorly responsive to colchicine, without a well-defined cause of drug resistance. They were evaluated for SIBO presence, then treated with decontamination therapy. Results. Among 223 FMF patients, 49 subjects show colchicine resistance, and no other known causes of colchicine unresponsiveness has been found in 25 patients. All 25 patients underwent glucose breath test; 20 (80%) of them were positive, thus affected by SIBO. After a successful decontamination treatment, 11 patients (55%) did not show FMF attacks during the following three months (p<0.01), while 9 of them revealed a significant reduction of the number of attacks compared to three months before (p<0.01). Conclusion. The SIBO eradication improves laboratory and clinical features of FMF patients. Thus, patients with unresponsiveness to colchicine treatment should be investigated for SIBO. [ABSTRACT FROM AUTHOR]

Purpose. Squamous cell carcinoma (SCC) developing within fistulae and chronic wounds in patients with Crohn’s disease is a rare phenomenon with few reported studies in the literature. Clinical suspicion for SCC in Crohn’s disease patients with chronic painful fistulae is low, leading to delayed diagnosis and treatment. We present a patient with long-standing Crohn’s disease complicated by malignant degeneration of an enterocutaneous fistula tract. Methods. Workup with MRI, CT, and fistulogram revealed a 7 × 3 cm fistulous connection between a loop of small intestine and the patient’s perineum. Biopsies of the fistula tract confirmed the diagnosis of SCC. Results. The patient underwent an abdominoperineal resection with positive margins and is currently awaiting radiation therapy. Conclusions. This is the second case reported within the English literature of SCC arising from an enterocutaneous fistula in the setting of Crohn’s disease. Based on the findings in this case report and others presented in the literature, a high degree of suspicion of malignancy should be present in patients with chronic painful, poor-healing fistulae, especially in the absence of infection. [ABSTRACT FROM AUTHOR]

HIV infection is reportedly associated with an increased permeability of the intestinal epithelium and can cause HIV enteropathy, which occurs independently of opportunistic infections. However, the characteristics of small bowel abnormalities attributable to HIV infection are rarely investigated. In the present study, we assessed the intestinal mucosal changes found in HIV-infected patients and compared them with the mucosa of healthy control subjects using capsule endoscopy (CE). Three of the 27 HIV-infected patients harbored gastrointestinal opportunistic infections and were thus excluded from subsequent analyses. The endoscopic findings of CE in HIV-infected patients were significantly higher than those in control subjects (55% versus 10%, P=0.002); however, most lesions, such as red spots or tiny erosions, were unlikely to cause abdominal symptoms. After validating the efficacy of CE for the diagnosis of villous atrophy, we found that the prevalence of villous atrophy was 54% (13/24) among HIV-infected patients. Interestingly, villous atrophy persisted in patients receiving long-term antiretroviral therapy, though most of them exhibited reconstituted peripheral blood CD4+ T cells. Although we could not draw any conclusions regarding the development of small bowel abnormalities in HIV-infected patients, our results may provide some insight regarding the pathogenesis of HIV enteropathy. [ABSTRACT FROM AUTHOR]

Background Small intestinal bacterial overgrowth ( SIBO) is a heterogeneous syndrome, characterised by an increased number and/or abnormal type of bacteria in the small bowel. Over the past decades, rifaximin has gained popularity for this indication despite its use is not evidence based. Aim To perform a systematic review and meta-analysis to summarise evidence about the efficacy and safety of rifaximin to eradicate SIBO in adult patients. Methods MEDLINE, EMBASE, CCRCT, Scopus and Web of Science were searched from inception to March 16, 2015 for RCTs and observational studies. Furthermore, abstract books of major European, American and Asian gastroenterological meetings were also examined. Results Thirty-two studies involving 1331 patients were included. The overall eradication rate according to intention-to-treat analysis was 70.8% (95% CI: 61.4-78.2; I2 = 89.4%) and to per protocol analysis 72.9% (95% CI: 65.5-79.8; I2 = 87.5%). Meta-regression identified three covariates (drug dose, study design and co-therapy) independently associated with an increased eradication rate. The overall rate of adverse events was 4.6% (95% CI: 2.3-7.5; I2 = 63.6%). In the subset of studies (n= 10) allowing the analysis, improvement or resolution of symptoms in patients with eradicated SIBO was found to be 67.7% (95% CI: 44.7-86.9; I2 = 91.3%). Conclusions Rifaximin treatment seems to be effective and safe for the treatment of SIBO. However, the quality of the available studies is generally poor. Well-designed RCTs are needed to substantiate these findings and to establish the optimal regimen. [ABSTRACT FROM AUTHOR]

Background and Aims Angioectasias are the most common sources of bleeding in the small bowel. They can be treated using balloon-assisted enteroscopy (BAE). This study aimed to identify the rebleeding rate and associated factors after BAE in patients with small bowel angioectasia bleeding. Methods We retrospectively analyzed the records of patients with bleeding due to small bowel vascular lesion in a multicenter enteroscopy database including 1108 BAEs. Finally, in rebleeding analysis, we analyzed 66 patients with angioectasia on the basis of the Yano-Yamamoto classification. Patients who had undergone endotherapy (ET) were divided into ET ( n = 45) and non-ET ( n = 21) groups. Rebleeding was defined as evidence of bleeding at least 30 days after BAE. Results Fifty-three patients (80.4%) underwent only one-side enteroscopy. The most common ET was argon plasma coagulation (87.2%). During a mean follow-up duration of 24.5 months, ET and non-ET groups had rebleeding rates of 15.6% and 38.1% ( P = 0.059), respectively. Median rebleeding time of ET and non-ET groups was 32.5 and 62 months, respectively. Liver cirrhosis (LC), low platelet count (< 105/μL), and transfusions were the rebleeding-associated factors in the univariate analysis. In the multivariate analysis, the presence of LC (HR 4.064, 95% CI 1.098-15.045; P = 0.036) was the only independent rebleeding-associated risk factor. Conclusions ET using BAE did not significantly affect the rebleeding rate in patients with small bowel angioectasia bleeding. An independent rebleeding risk factor was the presence of LC. Regardless of ET, careful long-term follow-up may be needed, especially in LC patients with small bowel angioectasia bleeding. [ABSTRACT FROM AUTHOR]

Today, several strategies are being used to decrease the serious effects of antibiotics abuse on broilers industry and public health, among which synbiotics are one of the most promising antibiotic alternative. This study was undertaken to assess the effects of synbiotics, which composed of probiotics ( Bacillus subtilis) and prebiotics (xylooligosaccharide and mannanoligosaccharide), on growth performance, intestinal morphology, sIgA content and antioxidant parameters of broilers. Four hundred and fifty one-day-old commercial Cobb48 broilers were assigned to five treatments consisting of six replicates of 15 birds each pen. Five dietary treatments include basal diets (control), basal diets plus antibiotics (4 mg/kg Xanthomycin), basal diets plus 1 g of probiotics B. subtilis product/kg of diets (4 × 108 cfu/kg), basal diets plus 150 mg/kg xylooligosaccharide (35%) and 1 g/kg mannanoligosaccharide (75%), and basal diets plus synbiotics (1 g of probiotics B. subtilis product/kg of diets (4 × 108 cfu/kg), 150 mg/kg xylooligosaccharide (35%) and 1 g/kg mannanoligosaccharide (75%). The results demonstrated that on 21 and 42 days, dietary supplementation of the synbiotics significantly increased daily weight gain (p < 0.05), feed efficiency (p < 0.05), the villus height and villus:crypt ratio in the duodenum, jejunum and ileum (p < 0.05), as well as intestinal mucosa sIgA content (p < 0.05), serum T- SOD activity (p < 0.05) and lysozyme content (p < 0.05), comparing with control group. In conclusion, synbiotics ( B. subtilis and xylooligosaccharide and mannanoligosaccharide) is one of the safe and ideal dietary supplementations to increase broilers' growth performance by improving small intestinal morphology, sIgA content and antioxidant capabilities. [ABSTRACT FROM AUTHOR]

Neuroendocrine tumour of the small intestine (SI-NET), formerly known as midgut carcinoid tumour, is the most common small intestinal malignancy. The incidence is rising, with recent reports of 0.67 per 100 000 in the USA and 1.12 per 100 000 in Sweden. SI-NETs often present a challenge in terms of diagnosis and treatment, as patients often have widespread disease and are beyond cure by surgery. Somatostatin analogues provide the mainstay of medical treatment to control hormonal excess and increase the time to progression. Despite overall favourable prognosis (5-year overall survival of 65%), there is a need to find markers to identify both patients with worse outcome and new targets for therapy. Loss on chromosome 18 has been reported in 60-90% of SI-NETs, but mutated genes on this chromosome have failed detection. Recently, a putative tumour suppressor role has been suggested for TCEB3C occurring at 18q21 (encoding elongin A3), which may undergo epigenetic repression. CDKN1B has recently been revealed as the only recurrently mutated gene in SI-NETs but, with a frequency as low as 8%, its role as a driver in SI-NET development may be questioned. Integrated genomewide analysis including exome and whole-genome sequencing, gene expression, DNA methylation and copy number analysis has identified three novel molecular subtypes of SI-NET with differing clinical outcome. DNA methylation analysis has demonstrated that SI-NETs have significant epigenetic dysregulation in 70-80% of tumours. In this review, we focus on understanding of the genetic, epigenetic and molecular events that lead to development and progression of SI-NETs. [ABSTRACT FROM AUTHOR]

Background The laparoscopic approach for complex Crohn's disease (CD), which involves abscess formation, fistula formation, and recurrent CD, is controversial. The aim of this study was to investigate the feasibility and safety of the laparoscopic approach for complex CD. Methods Fifty-six patients who had undergone surgery for CD of the small bowel from January 2007 to August 2014 were divided into two groups: the laparoscopic approach for complex CD group (LC group, n = 31) and the laparoscopic approach for simple CD group (LS group, n = 25). The preoperative data and surgical outcomes of the LC group were compared with those of the LS groups. Results There were no significant differences in preoperative data and operating time between the two groups. Blood loss was not significantly different between the LC and LS groups. The incision length was longer in the LC group than the LS group ( P = 0.004). The incidence of severe postoperative complications in the LC group was higher than in the LS group ( P = 0.026). The length of postoperative stay was similar in the LC and LS groups. Conclusions The laparoscopic approach for complex CD is feasible and provides good cosmesis that is comparable to that offered by simple CD. [ABSTRACT FROM AUTHOR]

Background and Aim Diagnostic yield of video capsule endoscopy may be hampered by intestinal content or air bubbles. A major limitation in video capsule-related study is the lack of a validated objective score for bowel preparation quality. We aimed to design and validate a computed small bowel preparation score for research and clinical use. Methods Two experienced physicians reached a consensus regarding bowel preparation quality based on known criteria used in previous studies and their confidence of an accurate medical interpretation of the procedure. A computed algorithm based on the pixels in the color bar was created and validated. Concordance between the gastroenterologists' agreement (gold standard) and the computed analysis was assessed. Results Of 85 videos studied, 44 (52%), 13 (15%) and 28 (33%) had adequate, borderline and inadequate bowel preparation, respectively, according to the gastroenterologists' agreement. Computer analysis restricted to adequate and inadequate cases yielded accurate classification of bowel preparation in 65/72 cases (90% agreement, sensitivity 95%, specificity 82%, total accuracy 90%, Kappa 0.79). When adding the borderline definition, the computer analysis correctly classified 71/85 of the cases, yielding an overall agreement of 84% (Kappa 0.72). Minute-by-minute analysis of 10 cases also yielded an agreement of 91.4%. Conclusion The present study introduces a user-friendly computer analysis-based small bowel preparation score, which demonstrated excellent concordance with the physician 's assessment. This score holds promise as a standardization tool in research and clinical practice of video capsule endoscopy. Further validation is warranted. [ABSTRACT FROM AUTHOR]

The article describes the case of a 72-year-old lady with several hours of bilious vomiting and abdominal pain following dinner and was diagnosed with internal hernia causing a small bowel obstruction. Topics discussed include her surgical history, most common types of internal hernias, and reason for the increasing incidence of internal hernias.

There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy. We present the case of a 4-year-old boy who was placed on LMWH for a catheter-related deep venous thrombosis in the setting of intractable seizures and subsequently developed a small bowel obstruction secondary to a suspected intussusception. He underwent exploratory laparotomy and was found to have an intramural bowel hematoma. Prior to this bleed, the patient had been monitored daily, and his anti-Xa levels were found to be in the therapeutic range. This case highlights the need for a high index of suspicion for spontaneous bleeding even in the setting of therapeutic anti-Xa levels. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients’ lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas. [ABSTRACT FROM AUTHOR]

Enterotoxigenic E scherichia coli ( ETEC) is a water and food-borne pathogen that infects the small intestine of the human gut and causes diarrhoea. Enterotoxigenic E. coli adheres to the epithelium by means of colonization factors and secretes two enterotoxins, the heat labile toxin and/or the heat stable toxin that both deregulate ion channels and cause secretory diarrhoea. Enterotoxigenic E. coli as all E. coli, is a versatile organism able to survive and grow in different environments. During transmission and infection, ETEC is exposed to various environmental cues that have an impact on survivability and virulence. The ability to cope with exposure to different stressful habitats is probably shaping the pool of virulent ETEC strains that cause both endemic and epidemic infections. This review will focus on the ecology of ETEC in its different habitats and interactions with other organisms as well as abiotic factors. [ABSTRACT FROM AUTHOR]

A 45-year-old male was admitted to our hospital with a small bowel obstruction due to torsion and was immediately scheduled for surgical intervention. At anesthesia induction, the patient aspirated and subsequently developed a severe SIRS with ARDS and multiple organ failure requiring the use of ECMO, CRRT, antibiotics, and low dose steroids. Due to a rapid deterioration in clinical status and a concurrent surge in inflammatory biomarkers, an extracorporeal cytokine adsorber (CytoSorb) was added to the CRRT blood circuit. The combined treatment resulted in a rapid and significant reduction in the levels of circulating inflammatory mediators. This decrease was paralleled by marked clinical stabilization of the patient including a significant improvement in hemodynamic stability and a reduced need for norepinephrine and improved respiratory function as measured by PaO2/FIO2, ventilator parameters, lung mechanics, and indirect measures of capillary leak syndrome. The patient could be discharged to a respiratory weaning unit where successful respiratory weaning could be achieved later on. We attribute the clinical improvement to the rapid control of the hyperinflammatory response and the reduction of inflammatory mediators using a combination of CytoSorb and these other therapies. CytoSorb treatment was safe and well tolerated, with no device-related adverse effects observed. [ABSTRACT FROM AUTHOR]

Ileitis is defined as inflammation of the ileum. This condition includes ulcers, aphthous ulcers, erosions, and nodular or erythematous mucosa. Various etiologies are associated with ileitis. Crohn’s disease, ulcerative colitis, medications such as nonsteroidal anti-inflammatory drugs, infectious conditions, neoplasms, infiltrative disorders, vasculitides, spondyloarthritis, endometriosis, and radiation therapy-related conditions involve the ileum. However, the differential diagnosis of terminal ileitis can be difficult in many cases. Video capsule endoscopy (VCE) has become a useful tool for the diagnosis of a variety of small bowel lesions. This review describes each of the various conditions associated with ileitis and the diagnostic value of VCE for ileitis, which may help identify and evaluate these conditions in clinical practice. Based on the information provided by VCE, a definitive diagnosis could be made using the patients’ medical history, clinical course, laboratory and ileocolonoscopic findings, radiologic imaging findings, and histologic findings. [ABSTRACT FROM AUTHOR]

ABSTRACT Acute mesenteric ischemia (AMI) is caused by considerable intestinal injury, which is associated with intestinal ischemia followed by reperfusion. To elucidate the mechanisms of ischemia/reperfusion injuries, a C5a inhibitory peptide termed AcPepA was used to examine the role of C5a anaphylatoxin, induction of inflammatory cells, and cell proliferation of the intestinal epithelial cells in an experimental AMI model. In this rat model, the superior mesenteric artery was occluded and subsequently reperfused (Induce-I/R). Other groups were treated with AcPepA before ischemia or reperfusion. Induce-I/R induced injuries in the intestine and AcPepA significantly decreased the proportion of severely injured villi. Induce-I/R induced secondary receptor for C5a-positive polymorphonuclear leukocytes in the vessels and CD204-positive macrophages near the injured site; this was correlated with hypoxia-induced factor 1-alpha-positive cells. Induction of these inflammatory cells was attenuated by AcPepA. In addition, AcPepA increased proliferation of epithelial cells in the villi, possibly preventing further damage. Therefore, Induce-I/R activates C5a followed by the accumulation of polymorphonuclear leukocyte and hypoxia-induced factor 1-alpha-producing macrophages, leading to villus injury. AcPepA, a C5a inhibitory peptide, blocks the deleterious effects of C5a, indicating it has a therapeutic effect on the inflammatory consequences of experimental AMI. [ABSTRACT FROM AUTHOR]

Aim. To compare the diagnostic value of multidetector CT enterography (MDCTE) and double-balloon enteroscopy (DBE) for patients with suspected small bowel diseases. Methods. From January 2009 to January 2014, 190 patients with suspected small bowel diseases were examined with MDCTE and DBE. The characteristics of the patients, detection rates, diagnostic yields, sensitivity, specificity, positive predictive value, and negative predictive value were described and analyzed. Results. The overall detection rates of DBE and MDCTE were 92.6% and 55.8%, respectively (P<0.05), while the overall diagnostic yields were 83.2% and 33.7%, respectively (P<0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of DBE were all higher than those of MDCTE. DBE had a higher diagnostic yield for OGIB (87.3% versus 20.9%, P<0.05). The diagnostic yields of DBE were higher than those of MDCTE for inflammatory diseases, angioma/angiodysplasia, and diverticulums, while being not for gastrointestinal tumors/polyps. Conclusions. The diagnostic value of DBE for small bowel diseases is better than that of MDCTE as a whole, but if gastrointestinal tumors are suspected, MDCTE is also needed to gain a comprehensive and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Physicians are educated with the classical teaching that symptomatic patients with Meckel’s diverticulum (MD) most often present with painless rectal bleeding. However, a review of the literature reveals that young patients with MD will most commonly present with signs of intestinal obstruction, an etiology not frequency considered in patients presenting to the emergency department with obstruction. We present two cases of intestinal obstruction diagnosed in our emergency department, with Meckel’s diverticulum being the etiology. [ABSTRACT FROM AUTHOR]

Aims: Histological features of chronic active ileitis in the small intestine neighbouring a Meckel's diverticulum raise the possibility of concurrent Crohn's disease. Several studies have reported a significant association between Meckel's diverticulum and Crohn's disease, whereas some case reports have proposed that the ileitis is attributable to acidsecreting gastric heterotopia. The aim of this study was to evaluate the incidence, histomorphology and clinical follow-up of Meckel's diverticulum-associated ileitis. Methods and results: Medical records and slides from 48 consecutive surgical resections performed for Meckel's diverticulum were reviewed. Nine of 48 adults had significant inflammatory changes in the small intestine neighbouring the diverticulum. Two were transmural ulcers attributable to ingestion of a sharp object. Two patients had established Crohn's disease, both with long segments (>95 mm) of transmural inflammation located >100 mm from the diverticulum. The remaining five patients had inflammatory changes (ulceration, pseudopyloric metaplasia, submucosal fibrosis, and muscularis mucosa hyperplasia) confined to a short segment (<20 mm) of mucosa/ submucosa within 50-60 mm of the diverticulum. Two had gastric heterotopia in the diverticulum. None of these five patients used non-steroidal antiinflammatory drugs (NSAIDs). On follow-up, none had symptoms, imaging or pathology suggestive of Crohn's disease. Conclusions: Ileitis affecting a short segment of mucosa and submucosa in the small intestine near a Meckel's diverticulum is relatively common, and is not necessarily related to Crohn's disease. [ABSTRACT FROM AUTHOR]

Background. There has been a growing use of both capsule endoscopy (CE) and double balloon enteroscopy (DBE) to diagnose and treat patients with obscure gastrointestinal blood loss and suspected small bowel pathology. Aim. To compare and correlate sequential CE and DBE findings in a large series of patients at two tertiary level hospitals in Wisconsin. Methods. An IRB approved retrospective study of patients who underwent sequential CE and DBE, at two separate tertiary care academic centers from May 2007 to December 2011, was performed. Results. 116 patients were included in the study. The mean age ± SD was 66.6 ± 13.2 years. There were 56% males and 43.9% females. Measure of agreement between prior capsule and DBE findings was performed using kappa statistics, which gave kappa value of 0.396 with P<0.001. Also contingency coefficient was calculated and was found to be 0.732 (P<0.001). Conclusions. Our study showed good overall agreement between DBE and CE. Findings of angioectasia had maximum agreement of 69%. [ABSTRACT FROM AUTHOR]

We observed a cluster of 4 pediatric liver recipients who developed diarrhea in a liver transplant unit within 5 days. Feces from these 4 patients were rotavirus positive when tested with Colloidal Gold Diagnostic Kit. Nucleic acid from 3 fecal specimens was extracted and reverse transcribed. Two were amplified positively. The complementary DNAs were sequenced. Alignment and phylogenetic analysis were performed with MEGA 6.06. Although involving only 4 pediatric liver recipients, this cluster was caused by at least 2 distinct G9P[8] rotavirus strains and included community infection and nosocomial infection. [ABSTRACT FROM AUTHOR]

Synthetic or biological materials can be used for the surgical repair of pelvic organ prolapse ( POP) or stress urinary incontinence ( SUI). While non-degradable synthetic mesh has a low failure rate, it is prone to complications such as infection and erosion, particularly in the urological/gynecological setting when subject to chronic influences of gravity and intermittent, repetitive strain. Biological materials have lower complication rates, although allografts and xenografts have a high risk of failure and the theoretical risk of infection. Autografts are used successfully for the treatment of SUI and are not associated with erosion; however, can lead to morbidity at the donor site. Tissue engineering has thus become the focus of interest in recent years as researchers seek an ideal tissue remodeling material for urogynecological repair. Herein, we review the directions of current and future research in this exciting field. Electrospun poly- L-lactic acid ( PLA) and porcine small intestine submucosa ( SIS) are two promising scaffold material candidates. Adipose-derived stem cells ( ADSCs) appear to be a suitable cell type for scaffold seeding, and cells grown on scaffolds when subjected to repetitive biaxial strain show more appropriate biomechanical properties for clinical implantation. After implantation, an appropriate level of acute inflammation is important to precipitate moderate fibrosis and encourage tissue strength. New research directions include the use of bioactive materials containing compounds that may help facilitate integration of the new tissue. More research with longer follow-up is needed to ascertain the most successful and safe methods and materials for pelvic organ repair and SUI treatment. [ABSTRACT FROM AUTHOR]

We report a rare case of small bowel obstruction (SBO) caused by endometriosis in a postmenopausal woman. A 54-year-old postmenopausal woman presented with severe abdominal pain and vomiting. Before menopause, she sometimes had abdominal pain associated with menses. Axial multi-dimensional CT images revealed a SBO with small nodules near the terminal ileum. The obstruction was diagnosed as being caused by small bowel endometriosis. Curved planar reconstruction images showed a complicated obstruction of the small intestine 15 cm from the terminal ileum. Based on the stenotic lesion, a SILS procedure was performed. The patient's SBO diagnosis was histologically confirmed as being caused by small bowel endometriosis. SILS was deemed to be a safe, feasible procedure for treating this bowel obstruction. Curved planar reconstruction images were useful in preoperative imaging and diagnosis of SBO, especially as they were able to highlight the constricting legion. [ABSTRACT FROM AUTHOR]

Background The diagnosis of small intestinal bacterial overgrowth ( SIBO) remains challenging. Our aim was to examine the diagnostic yield of duodenal aspiration/culture and glucose breath test ( GBT), and effects of gender, race and demographics on prevalence of SIBO. Methods Patients with unexplained gas, bloating and diarrhea and negative endoscopy, imaging and blood tests were prospectively enrolled in two centers in USA. Randomly, within 1 week each patient underwent both duodenal aspiration/culture and GBT. The diagnostic yield of each test and relationship of symptoms, and effects of ethnicity, age, and gender on prevalence of SIBO were assessed and compared. Key Results Duodenal culture was positive in 62/139 (44.6%) subjects and GBT was positive in 38/139 (27.3%) subjects with an overall diagnostic agreement of 65.5%. The sensitivity, specificity, positive and negative predictive value of GBT was 42%, 84%, 68%, and 64%, respectively. Ethnicity or gender did not influence SIBO, but SIBO positive patients were older ( p = 0.0018). Symptom patterns were similar except bloating was more prevalent in GBT positive and gas in culture positive subjects. Conclusions & Inferences Duodenal aspiration/culture identifies 45% of patients with suspected SIBO. GBT has lower sensitivity but good specificity for detection of SIBO. There were no ethnic or gender differences in the prevalence of SIBO, but patients with SIBO were older. Because GBT is non-invasive, it should be considered first in patients with suspected SIBO. [ABSTRACT FROM AUTHOR]

Objective Few studies have been performed on the effect of intestinal electrical stimulation ( IES) on intestinal dysmotility. This study aimed to investigate the small intestine transit ( SIT) in a canine model of intestinal hypermotility when applying IES. Method Six hound bitches were surgically prepared with two chronic intestinal fistulas, intestinal serosal electrodes of which the proximal pair was used for serosal IES. Pacing wires were attached to a manometric catheter for mucosal IES. A nitrogen oxide synthase inhibitor, Nω-nitro- L-arginine ( LNNA) was used to induce intestinal motility. SIT was measured during IES. The study consisted of four randomized sessions: session 1 ( LNNA), session 2 ( LNNA plus serosal IES), session 3 ( LNNA plus mucosal IES) and session 4 (control). Results The intestine transit was slowed down from 31.7 ± 6.1 min in the control session to 49.0 ± 6.2 min after using LNNA ( P = 0.003). Both mucosal and serosal IES accelerated SIT compared with the LNNA session. The SIT time was reduced to 17.7 ± 3.4 min in the mucosal IES session ( P = 0.006 vs LNNA) and 27.5 ± 6.3 min in the serosal IES session ( P = 0.020 vs LNNA). No difference was noted in the SIT time between mucosal and serosal IES ( P = 0.128). Conclusion IES significantly accelerates delayed SIT in a hypermotility model and intraluminal stimulation is as effective as a serosal one for IES, suggesting that IES may have a therapeutic potential for improving intestinal motility. [ABSTRACT FROM AUTHOR]

Aims To investigate AT-rich interactive domain-containing protein 1A ( ARID1A) and p53 expression in small intestinal carcinoma ( SIC) and to determine its prognostic significance. Methods and results Immunohistochemical staining for ARID1A and p53 was performed in 178 SICs using a tissue microarray (TMA). Loss of or low ARID1A expression was observed in 36 (20.2%) and 60 (33.7%) of cases, respectively. Aberrant p53 expression was observed in 99 (55.6%) cases. Loss of or low ARID1A expression was found to be associated with signet ring cell carcinoma and undifferentiated carcinoma, a high-grade tumour, and a higher T stage. No relationship was found between aberrant p53 expression and clinicopathological factors or overall survival. Patients with loss of ARID1A expression, irrespective of p53 expressional status, showed significantly poorer overall survival than those expressing ARID1A. Multiple regression analysis revealed that grade and pT stage were associated significantly with ARID1A loss, and multivariate analysis showed that patients with high ARID1A expression had a lower risk of death than those with loss of ARID1A expression. Conclusions Low or loss of ARID1A expression is correlated significantly with a high-grade tumour, higher T stage, and poorer overall survival. These findings suggest that ARID1A expression could be used as a prognostic marker in SIC. [ABSTRACT FROM AUTHOR]

Background Hyperglycemia is known to induce dysrhythmias in the stomach; however, it is unknown whether they are also induced in the small intestine. Autonomic dysfunction is commonly noted in diabetes but the role it plays in hyperglycemia-induced dysrhythmias remains unknown. This study aimed to explore the effects of hyperglycemia on intestinal myoelectrical activity and the role of autonomic functions in hyperglycemia. Methods Small intestinal myoelectrical activity (slow wave and spike activity) and autonomic functions (assessed by the spectral analysis of heart rate variability) were measured in Goto-Kakizaki diabetic rats and control rats treated with acute glucagon. Blood glucose was measured and its correlation with intestinal slow waves was determined. Key Results (1) The diabetic rats showed reduced regularity in intestinal slow waves in fasting and fed states ( p < 0.001 for both), and increased sympathovagal balance ( p < 0.05) in comparison with the control rats. The regularity in intestinal slow waves was negatively correlated with the HbA1c level in all rats ( r = −0.663, p = 0.000). (2) Glucagon injection in the control rats induced transient hyperglycemia, intestinal slow wave dysrhythmias and impaired autonomic functions, similar to those observed in the diabetic rats. The increase in blood glucose was correlated with the decrease in the regularity of intestinal slow waves ( r = −0.739, p = 0.015). Conclusions & Inferences Both spontaneous and glucagon-induced hyperglycemia results in slow wave dysrhythmias in the small intestine. Impairment in autonomic functions (increased sympathovagal balance) may play a role in hyperglycemia-induced dysrhythmias. [ABSTRACT FROM AUTHOR]

Non-lymphoid small intestinal neoplasia form a small but important part of the veterinary surgical caseload. These tumours/cancers provide particular challenges to clinicians due to the paucity, heterogeneity and retrospective nature of the research available in this field. In addition, many published studies were primarily intended as pathology rather than clinical publications. This article aims to review the literature and draw conclusions where appropriate relating to the biological behaviour, investigation and treatment of these tumours. [ABSTRACT FROM AUTHOR]

Background and Aims In evaluating small bowel Crohn's disease ( CD), small intestine contrast-enhanced ultrasonography ( SICUS) is emerging as an alternative to magnetic resonance enterography ( MRE). This retrospective study compared the diagnostic accuracy of SICUS and MRE with surgical findings, and their level of agreement. Methods We identified a cohort of CD patients investigated by either SICUS and/or MRE that subsequently required resective bowel surgery within 6 months. The accuracy and agreement of SICUS and MRE to detect small bowel complications were compared with intraoperative findings using kappa coefficient (κ). Agreement between SICUS and MRE in those undergoing both modalities was also assessed. Results A total of 67 patients were evaluated; 25 underwent SICUS and 17 underwent MRE prior to surgery. Another 25 patients underwent both SICUS and MRE. When compared with intraoperative findings, the sensitivity of SICUS and MRE was 87.5% and 100%, respectively, in detecting strictures, 87.7% and 66.7% for fistulae, 100% for both in identifying abscesses, 100% and 66.7% for bowel dilatation, and 94.7% and 81.8% in defining bowel wall thickening. When correlating SICUS and MRE with surgery, there was a high level of agreement in localizing strictures (κ = 0.75, 0.88, respectively), fistulae (κ = 0.82, 0.79) and abscesses (κ = 0.87, 0.77). Concordance between SICUS and MRE was substantial or almost complete in identifying stricturing disease (κ = 0.84), their number and location (κ = 0.85), fistulae (κ = 0.65), and mucosal thickening (κ = 0.61). Conclusion SICUS accurately identified small bowel complications and correlated well with MRE and intraoperative findings. SICUS offers an alternative in the preoperative assessment of CD. [ABSTRACT FROM AUTHOR]

Strangulating obstruction of the small intestine by anomalous mesenteric bands is an uncommon cause of colic in horses. The most commonly reported bands are mesodiverticular bands that are embryological remnants of the vitelline arteries. Despite the congenital nature of the anomaly, a wide age range of horses can be affected. This report describes a case of small intestinal strangulating obstruction caused by an unusual, anomalous congenital band attached to the ileocaecal fold in a yearling colt. Information including case background, history, clinical, laboratory, surgical and pathological findings is described. [ABSTRACT FROM AUTHOR]

Background Small intestinal bacterial overgrowth ( SIBO) may be a cause of irritable bowel syndrome ( IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose hydrogen breath test ( LHBT) alone and combined with scintigraphic measurement of oro-cecal transit ( SOCT). Methods Results of LHBT/ SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. Key Results Reproducibility of SIBO diagnosis by combined LHBT/ SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy ( p < 0.002 overall IBS symptom severity). This improvement was most marked in D- IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). Conclusions & Inferences Combined LHBT/ SOCT testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal test. [ABSTRACT FROM AUTHOR]

Gastroscopy is the most common technique used in veterinary medicine to evaluate the stomach in horses and to date, no complications have been described associated with the procedure. This paper reports 4 cases developing a nonstrangulating segmental volvulus of the small intestine after gastroscopy at 3 referral institutions over a 2 year period. After performing diagnostic gastroscopy, all horses developed acute and severe clinical signs of colic unresponsive to medical management. Time range between gastroscopy and onset of colic signs varied from 10 min to 3 h. An exploratory laparotomy revealed a nonstrangulating segmental volvulus of the small intestine that was manually corrected without need for resection in all horses. In all cases, affected small intestine was severely gas distended. Three of those horses survived to discharge and were alive at follow-up. One horse was subjected to euthanasia 2 days after surgery due to diffuse intestinal lymphoma. [ABSTRACT FROM AUTHOR]

The usefulness of flexible spectral imaging color enhancement ( FICE) has been reported for evaluating the esophagus, stomach, and small and large intestine. Higher contrast is shown between cancer and the surrounding mucosa in the esophagus and stomach and may facilitate the detection of gastric cancers missed by white light imaging alone. The surface patterns of gastric mucosa are clearly visualized in non-malignant areas but are irregular and blurred in malignant areas, leading to clear demarcation. Capsule endoscopy with FICE detects angiodysplasia and erosions of the small intestine. The surface and vascular pattern with FICE is useful for the differential diagnosis of colorectal polyps. However, FICE remains somewhat poor at visualizing mucosal microvasculature on a tumor surface. Narrow-band imaging ( NBI) is dark in observing whole gastric mucosa and poor at visualizing mucosal microstructure. Blue laser imaging ( BLI) has the potential to resolve these limitations. Narrow-band laserlight combined with white light shows irregular microvessels on both differentiated and undifferentiated gastric cancer similar to those using NBI. In addition, irregular surface patterns including minute white zones are clearly seen on the uneven surface of differentiated lesions, resulting in exclusion of undifferentiated lesions. Using both distant and close-up views, a high contrast between green intestinal metaplasia and brown gastric cancer may lead to early detection of gastric cancers and determination of a demarcation line. BLI produces high-contrast images in esophageal cancer with clear vision of intrapapillary capillary loops and also predicts the histopathological diagnosis and depth of invasion in colorectal neoplasms. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumor (GIST) is defined as a c-kit-positive gastrointestinal, mesenteric, or omental mesenchymal tumor that very rarely metastasizes to the brain. Metastasis to the cerebellum is particularly rare. An 80-year-old man presented with nausea and vomiting with disturbance of consciousness. Magnetic resonance imaging (MRI) revealed tumor in the cerebellar vermis causing obstructive hydrocephalus. The patient subsequently underwent midline suboccipital craniotomy, and the tumor was totally removed. Immunohistochemical analysis showed tumor cells positive for c-kit and CD34, and cerebellar metastasis of GIST was diagnosed. Postoperative radiotherapy was administered. Following surgery and radiotherapy, the patient developed ileus caused by tumor in the small intestine and underwent laparotomy for tumor removal. Following abdominal surgery, left hemiparesis and consciousness disturbance were noted. Computed tomography showed recurrent large tumor with perifocal edema in the right frontal lobe of the brain. The patient died 3 months after initial craniotomy. Intracranial metastasis of GIST is extremely rare. In cases such as the present, where the condition of the patient rapidly deteriorates and features such as rising intracranial pressure and ileus prevent the use of oral agents, molecular-targeted agents administered by intravenous infusion should be utilized. [ABSTRACT FROM AUTHOR]

Dilatation and curettage (D&C) sometimes causes uterine perforation, which usually does not cause a serious problem. Here, we report uterine perforation caused by D&C, in which the small intestine prolapsed from the uterus, requiring intestinal resection. D&C was performed for missed abortion at 9 weeks. After dilating the cervix, forceps grasped tissue that, upon being pulled, resulted in the intestine being prolapsed into the vagina. Laparotomy revealed a perforation at the low anterior uterine wall, through which the ileum had prolapsed. The mesentery of the prolapsed ileum was completely detached and the ileum was necrotic, which was resected. The uterus and the intestine were reconstructed. Although intestinal prolapse is considered to be caused by "unsafe" D&C performed by inexperienced persons or even by nonphysicians in developing countries, this occurred in a tertiary center of a developed country. We must be aware that adverse events such as uterine perforation with intestinal prolapse can occur even during routine D&C. [ABSTRACT FROM AUTHOR]

Background Intestinal stricturing and aberrant small bowel motility are common complications in patients with Crohn's disease ( CD) leading to significant morbidity. A retrospective study was performed quantifying small bowel motility within and upstream of strictures in CD patients using magnetic resonance enterography ( MRE). Methods A total of 91 subjects with stricturing CD (mean age 36 range 18-88) and undergoing MRE with dynamic motility imaging were identified. Of this cohort, 84 subjects were scanned at 1.5 T field strength with the remainder at 3 T. Linear regions of interest ( ROI) were placed at the stricture, immediately upstream of the stricture, and in a proximal normal segment of bowel. Maximum bowel calibre (mm) and motility (Arbitrary units) at each ROI were calculated using previously validated software. Diameters and motility were compared using repeat measures anova and diameter correlated with motility score. In 21 subjects with follow-up MRE, ROIs were duplicated and percentage diameter and motility change across the two time points correlated. Key Results Mean diameter within the normal, prestricture and strictured bowel was 20, 30, and 15 mm (p < 0.001) with motility score 0.43, 0.28, and 0.15 AU, respectively (p < 0.001). There was a negative correlation between prestricture bowel diameter and motility (Pearson's R = −0.47, p < 0.001). For patients with follow-up MRE, there was a negative correlation between percentage change in prestricture diameter and motility, Spearman's Rho −0.6 p = 0.007. Conclusions & Inferences Quantified small bowel motility during MRE differs significantly between normal, prestricture, and strictured bowel. As prestricture bowel dilates, motility decreases, although this appears reversible in some. [ABSTRACT FROM AUTHOR]

Background Small intestinal bacterial overgrowth (SIBO) is an under-recognised diagnosis with important clinical implications when untreated. However, the optimal treatment regimen remains unclear. Aim To perform a systematic review and meta-analysis comparing the clinical effectiveness of antibiotic therapies in the treatment of symptomatic patients with documented SIBO. Methods Four databases were searched to identify clinical trials comparing effectiveness of: (i) different antibiotics, (ii) different doses of the same antibiotic and (iii) antibiotics compared with placebo. Data were independently extracted according to predetermined inclusion and exclusion criteria. Study quality was independently assessed. The primary outcome was normalisation of post-treatment breath testing. The secondary outcome was post-treatment clinical response. Results Of 1356 articles identified, 10 met inclusion criteria. Rifaximin was the most commonly studied antibiotic (eight studies) with overall breath test normalisation rate of 49.5% (95% confidence interval, CI 44.0-55.1) (44.0%-55.1%) then (46.7%-55.5%), then (4.6%-17.8%). Antibiotic efficacy varied by antibiotic regimen and dose. Antibiotics were more effective than placebo, with a combined breath test normalisation rate of 51.1% (95% CI 46.7-55.5) for antibiotics compared with 9.8% (95% CI 4.6-17.8) for placebo. Meta-analysis of four studies favoured antibiotics over placebo for breath test normalisation with an odds ratio of 2.55 (95% CI 1.29-5.04). Clinical response was heterogeneously evaluated among six studies, but tended to correlate with breath test normalisation. Conclusions Antibiotics appear to be more effective than placebo for breath test normalisation in patients with symptoms attributable to SIBO, and breath test normalisation may correlate with clinical response. Studies were limited by modest quality, small sample size and heterogeneous design. Additional higher quality clinical trials of SIBO therapy are warranted. [ABSTRACT FROM AUTHOR]

The article presents a study which explores whether the use of Push enteroscopy is a viable option in treating patients with small intestinal bleeding. The study was done through analysis of data for patients referred for wireless capsule endoscopy (WCE) to have further investigation on iron deficiency anaemia after undergoing gastroscopy and colonoscopy. The study reveals that 6.1% patients have peptic ulcer disease, based on endoscopy, and 9% have low complete Rockall score.

Objective We aimed to determine the characteristics of patients with celiac disease and differences between those who presented during adolescence or adulthood. Methods We retrospectively reviewed the case records of 233 consecutive patients with celiac disease who were diagnosed at 12-18 years or >18 years of age. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition criteria. Results The diagnosis of celiac disease was made after 18 years of age in 153 (65.7%) patients. Median duration of symptoms at the diagnosis was 54 months (range 1 month to 29 years). In all, 103 (44.2%) patients with atypical manifestations were referred by other departments for evaluation. Chronic diarrhea (48.5%), short stature (27.0%) and chronic anemia (9.0%) were the common modes of presentation. Elevated level of aminotransaminase were present in 50 (24.3%) patients. Chronic diarrhea, hypocalcemia and hypoalbuminemia were present in significantly higher number of adult than adolescent patients. In all, 227 (97.4%) patients responded to a 6-month gluten-free diet and six non-responders were non-compliant. Conclusions More than 40% of the patients with celiac disease present to clinicians other than gastroenterologists or internists with atypical manifestations. A high index of suspicion is required for diagnosing its variant forms. [ABSTRACT FROM AUTHOR]

Colic is a major cause of veterinary attendance in general practice and although most colic episodes remain isolated, recurrence may occur and definitive diagnosis can be difficult to obtain. This report describes an unusual presentation of a lipoma in a middle-aged horse presented for recurrent colic. A massive lipoma causing a nonstrangulating space occupying obstruction of the small intestine was found during an exploratory celiotomy and was considered to be the most likely cause of the recurrent episodes of abdominal discomfort. [ABSTRACT FROM AUTHOR]