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Les troubles fonctionnels digestifs sont parmi les motifs de consultation médicale les plus fréquents et une source importante d'errance médicale. Une étude de la fondation de Rome a retrouvé une prévalence de 40 % de troubles fonctionnels digestifs dans la population générale. La prise en charge thérapeutique de ces patients est difficile notamment du fait de l'absence de traitement spécifique en lien avec une compréhension incomplète des mécanismes physiopathologiques. Chez un certain nombre de ces patients, la symptomatologie est accompagnée d'une pullulation bactérienne au niveau de l'intestin grêle (SIBO). Cette entité historiquement identifiée dans des situations postchirurgicales précises, semble finalement très fréquente et associée à des pathologies très diverses. Le diagnostic du SIBO est actuellement rendu plus accessible grâce au développement de tests respiratoires. La prise en charge thérapeutique, reposant principalement sur une antibiothérapie et un régime alimentaire, reste à ce jour largement empirique car basée sur peu d'études mais l'intérêt croissant pour le SIBO devrait permettre d'identifier des traitements efficaces lors d'essais cliniques robustes. Digestive functional disorders are among the most frequent reasons for medical consultation and a significant source of medical wandering. Therapeutic management of these patients is difficult, particularly due to the absence of specific treatment linked to an incomplete understanding of the pathophysiological mechanisms. In a certain number of these patients, the symptoms are accompanied by a small intestinal bacterial overgrowth (SIBO). This entity, historically identified in specific post-surgical situations, seems finally very common and associated with very diverse pathologies. The diagnosis of SIBO is currently being made more accessible through the development of breathing tests. Therapeutic management, based mainly on antibiotic therapy and diet, remains to date largely empirical because it is based on few studies but the growing interest in SIBO should make it possible to identify effective treatments during robust clinical trials. [ABSTRACT FROM AUTHOR]

Non-traumatic small intestine perforations (NTSIP) constitute a rare cause of acute surgical pathologies and have a high mortality and morbidity if not treated in time. Since the clinical presentation of the disease is non-specific, there may be delays in its diagnosis. Despite medical improvements, the mortality of NTSIP is still high today. This study aimed to investigate non-traumatic small intestine perforation, an entity that continues to pose diagnostic and therapeutic challenges for clinicians, through a retrospective analysis of patients who underwent surgery for this condition. Patients, who were operated due to NTSIP in our general surgery clinic between June 2017 and June 2024, were retrospectively examined. Patients under the age of 18 were not included in the study. In addition, cases with colon and/or stomach perforation were excluded from the study. Fifty-nine patients with NTSIP were included in the study. The mean age of the patients was determined as 61.9 ± 18.4 (19-86 years). Male/female ratio was 1.1. The most common causes of perforation were found as non-specific causes (35.6%), tumor (27.1%) and herniation (16.9%), respectively. Mortality rates were 20% in perforations due to herniation, 50% mesenteric ischemia and 62.5% tumors. NTSIP is a condition whose preoperative final diagnosis is difficult, whose surgical treatment selection is still discussed and which is an acute abdomen cause with high mortality and morbidity in case of delayed diagnosis and treatment. It is an important cause of acute abdomen, which should be evaluated with the selection of patient-specific surgical technique and multidisciplinary approach when necessary. As more homogeneous and larger-population studies on the subject are added to the literature, the questions in the minds of clinicians will be answered. [ABSTRACT FROM AUTHOR]

The article discusses a study on the risk of small intestine cancer in patients with inflammatory bowel disease (IBD) in the United States. The study found an increasing trend of diagnosed small bowel cancer in patients with IBD, with Crohn's disease (CD) patients having a higher risk compared to the general population. Interestingly, patients with ulcerative colitis (UC) also had an elevated risk of developing small bowel cancer. The study highlights the importance of early detection and the impact of advancements in diagnostic modalities on improving outcomes for patients with IBD and small intestine cancer. [Extracted from the article]

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]

Aim. To improve the results of surgical treatment for patients with severe non-cancerous diseases of the colon by developing and implementing the new type of pelvic small intestine reservoirs. Materials and methods. A new type of pelvic small intestine reservoirs has been developed and introduced into clinical practice to improve processes of intestinal digestion, absorption, anal retention after radical surgery for ulcerative colitis, Crohn's disease with total colon involvement, familial adenomatous polyposis. Each of the reservoirs has been adapted to anatomical relationships between the small intestine and the debuccalized surgical anal canal depending on a radical surgery extent and a functional state of the small intestine. Pelvic small intestine reservoirs of a new type were used in 39 patients of the main study group, 21 (53.8 %) men and 18 (46.2 %) women. The patients' age ranged from 21 to 43 years. The comparison group consisted of 42 patients. The patient groups were identical in terms of sex, age, diagnosis and complications of the underlying disease. Patients in the comparison group differed in that they underwent the well-known "J"-shaped pelvic small intestine reservoir procedures. Results. The number of postoperative complications was statistically significantly higher in patients of the comparison group due to acute and chronic complications, 33.2 % and 10.4 %, respectively. Indicators of intestinal digestion, absorption and anal retention were statistically significantly better in the majority of patients of the study group. The number of patients with I (mild) degree of pathological post-colectomy syndrome was significantly higher in the study group, and the number of patients with diarrheal syndrome and secondary anal incontinence syndrome was significantly lower. Positive results after the introduction of a new type of pelvic small intestine reservoirs were obtained by applying the following basic principles of their formation: the use of only known factors of physiological delay in the passage of contents through the small intestine, preservation of the small intestine wall anatomical integrity, location of the small intestine reservoir at a certain distance from the upper border of the rectal sphincters, as well as the reasonable expediency of choosing a method of forming the pelvic small intestine reservoir depending on the patient's anatomy. Conclusions. The use of physiological factors of delayed passage of the contents in the small intestine, small intestine wall anatomical integrity preservation in the formation of pelvic small intestine reservoirs of the new type, the reservoir location at a certain distance from the upper border of the rectal sphincters has resulted in significant improvements in the functions of intestinal digestion, absorption, and anal retention. Practical application of the new type of pelvic small intestine reservoirs has helped to significantly decrease the incidence of postoperative complications from 33.2 % to 10.4 %, increase the number of patients with post-colectomy syndrome of the I (mild) degree from 47.4 % to 86.4 %, reduce the number of patients with diarrheal syndrome from 55.3 % to 8.1 %, and secondary anal incontinence syndrome from 36.8 % to 5.4 %. [ABSTRACT FROM AUTHOR]

Celiac disease (CeD) is a chronic inflammatory disease of the small intestine, produced by ingesting dietary gluten products in susceptible people. Gluten causes an impairment of the mucosal surface and, consequently, an abnormal absorption of nutrients. Although malabsorption of essential nutrients is a major risk factor for various CeD-associated morbidities, genetic, immunological, and environmental factors also play an important role. The clinical presentation of CeD widely varies and can range from asymptomatic to full-blown symptoms due to the multi-system nature of CeD. The typical gastrointestinal (GI) manifestations of CeD include abdominal pain, diarrhea, bloating, and weight loss, but several hepatobiliary manifestations and a poor nutritional status have also been described. Currently, a gluten-free diet (GFD) is the only current evidence-based treatment that leads to the complete recovery of mucosal damage and the reversibility of its progression. Conversely, undiagnosed CeD might have severe consequences in children as well as in adult patients. This narrative overview aims to characterize the GI and hepatobiliary manifestations, nutritional deficiencies, and delayed pediatric development associated with unrecognized CeD in order to identify it promptly. Moreover, the role of GFD and how it could prevent long-term complications of CeD are described. [ABSTRACT FROM AUTHOR]

This document is an editorial titled "Insights in infectious agents and disease: 2022" that provides an overview of recent developments in the field of bacterial, viral, and parasitic infectious diseases. It discusses major pandemics and epidemics caused by bacterial and viral diseases, including zoonotic pathogens transmitted from animals to humans. The editorial highlights various topics covered in research articles published in the journal, such as pathogenesis, antimicrobial resistance, epidemiology, diagnosis, and vaccine development. The document focuses on bats as reservoirs of zoonotic pathogens, diagnostic methods for identifying pathogens, vaccine development, and viral and parasitic infections. It emphasizes the importance of understanding microorganisms hosted by bats and the need for effective diagnostic strategies. The document also explores vaccine development for diseases like bubonic plague and COVID-19, as well as the pathogenesis of viral infections in reservoir hosts and specific infections caused by parasites. It concludes by highlighting ongoing research and advancements in the field of infectious diseases. [Extracted from the article]

Celiac disease (CD) is an autoimmune disease of the small intestine triggered by the consumption of gluten-containing foods in individuals with a genetic predisposition. CD was a rare disease until 20 years ago, when the prevalence increased. Currently, there is no data on the prevalence of CD in high-risk adult populations in Indonesia, even though there is a trend of increasing gluten consumption. Therefore, basic research is needed to determine the magnitude of CD in high-risk adult patients in Indonesia while identifying clinical signs/symptoms, illness history, and lifestyle to determine factors associated with CD in Indonesia. This study is an observational study with a cross-sectional method.Two hundred eighty-three patients who fulfilled the selection and signed the informed consent were recruited from the gastroenterology clinic of Dr. Cipto Mangunkusumo General Hospital. Patients were asked to fill out a celiac disease-related questionnaire and then given anthropometry measurement and blood test for serologic examination with ELISA, consisting of IgA anti-tissue transglutaminase (anti-TTG) and IgG anti-deaminated gliadin peptide (anti-DGP). Statistical analysis was performed using Chi-square and Multivariate logistic regression tests with SPSS software ver. 26. Statistical test differences were considered significant if the p-values were < 0.05. Eight of 283 patients are serologically confirmed with CD (2,83%). On bivariate analysis, the significant variables are age (p < 0,05), constipation (p < 0,05) and history of autoimmune disease (p < 0,05). On multivariate analysis, the only significant variable is the history of autoimmune disease (p < 0,05). This study concluded that the prevalence of CD in high-risk patients with functional gastrointestinal disorder at Dr. Cipto Mangunkusumo Hospital is relatively high (2.83%). CD-associated factors are age, constipation, and history of autoimmune disease in patients. On simultaneous interaction between these factors, autoimmune is the only significant variable associated with CD. [ABSTRACT FROM AUTHOR]

Peptide receptor radionucleotide therapy (PRRT) with 177Lu-dotatate is widely used for the treatment of patients with neuroendocrine tumors (NETs). We analyzed data from 104 patients with NETs treated with 177Lu -dotatate at a US academic center between December 2017 and October 2020 to better understand patterns of long-term efficacy, safety, and toxicity in the real-world setting. 177Lu-dotatate (200 mCi) was administered every eight weeks for four doses. The most common sites of primary disease were small intestine NETs (n = 49, 47%), pancreatic NETs (n = 32, 31%), and lung NETs (n = 7, 7%). Twenty-seven percent had Ki-67 <3%, 49% had Ki-67 between 3–20%, and 13.5% had Ki-67 >20%. The cohort had been pretreated with a median of two prior lines of treatment. Forty percent had received prior liver-directed treatment. Seventy-four percent of patients completed all four doses of treatment. The objective response rate was 18%. The median time-to-treatment failure/death was significantly longer for small-bowel NETs when compared to pancreatic NETs (37.3 months vs. 13.2 months, p = 0.001). In a multivariate model, Ki-67, primary site, and liver tumor burden ≥50% were found to independently predict time-to-treatment failure/death. Around 40% of patients experienced adverse events of ≥grade 3 severity. Treatment-related adverse events leading to discontinuation of therapy happened in 10% of patients. Preexisting mesenteric/peritoneal disease was present in 33 patients; seven of these patients developed bowel-related toxicities including two grade 5 events. We also report two cases of delayed-onset minimal change nephrotic syndrome, which occurred 14 and 27 months after the last dose of PRRT. Lastly, we describe six patients who developed rapid tumor progression in the liver leading to terminal liver failure within 7.3 months from the start of PRRT, and identify potential risk factors associated with this occurrence, which will need further study. [ABSTRACT FROM AUTHOR]

Texas consistently accounts for approximately 10% of annual national births, the second highest of all US states. This temporal study aimed to evaluate incidences of neonatal surgical conditions across Texas and to delineate regional pediatric surgeon accessibility. The Texas Birth Defects Registry was queried from 1999 to 2018, based on 11 well-established regions. Nine disorders (30,476 patients) were identified as being within the operative scope of pediatric surgeons: biliary atresia (BA), pyloric stenosis (PS), Hirschsprung's disease, stenosis/atresia of large intestine/rectum/anus, stenosis/atresia of small intestine, tracheoesophageal fistula/esophageal atresia, gastroschisis, omphalocele, and congenital diaphragmatic hernia. Annual and regional incidences were compared (/10,000 births). Statewide pediatric surgeons were identified through the American Pediatric Surgical Association directory. Regional incidences of neonatal disorder per surgeon were evaluated from 2010 to 2018 as a surrogate for provider disparity. PS demonstrated the highest incidence (14.405/10,000), while BA had the lowest (0.707/10,000). Overall, incidences of PS and BA decreased significantly, while incidences of Hirschsprung's disease and small intestine increased. Other diagnoses remained stable. Regions 2 (48.24/10,000) and 11 (47.79/10,000) had the highest incidence of neonatal conditions; Region 6 had the lowest (34.68/10,000). Three rural regions (#2, 4, 9) lacked pediatric surgeons from 2010 to 2018. Of regions with at least one surgeon, historically underserved regions (#10, 11) along the Texas–Mexico border consistently had the highest defect per surgeon rates. There are temporal and regional differences in incidences of neonatal conditions treated by pediatric surgeons across Texas. Improving access to neonatal care is a complex issue that necessitates collaborative efforts between state legislatures, health systems, and providers. • With its vast size and regional diversity, Texas may face unique challenges in access to care. • There have been significant temporal and regional differences in statewide incidences of neonatal conditions. • Regional disparities in access to pediatric surgeons and intensive care centers exist. • Disparities are most concerning along underserved, rural regions. • Collaborative efforts informed by geographic and epidemiological analyses must be leveraged. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine serum levels of liver and intestinal fatty acid-binding proteins (L-FABP and I-FABP), fecal numbers of Bacteroidetes (B) and Firmicutes (F) in patients with metabolic-associated fatty liver disease (MAFLD) in combination with type 2 diabetes mellitus (T2DM) and small intestinal bacterial overgrowth (SIBO) syndrome. Materials and methods. The prospective, interventional, randomized study included 51 patients with MAFLD in combination with T2DM, who were examined and divided into 2 groups. Group 1 consisted of 24 patients with MAFLD and T2DM without SIBO. Group 2 was comprised of 27 patients with MAFLD in combination with T2DM and SIBO. The control group included 20 apparently healthy individuals. Serum levels of L-FABP and I-FABP were measured by ELISA method using the Human L-FABP and I-FABP ELISA Kit test systems, respectively (Elabscience, USA). Fecal numbers of B and F were determined by real-time PCR. Bacterial DNA was detected in a thermal cycler Rotor-Gene 6000 (QIAGEN, Germany) using DNA 16S rRNA primers and NanoDrop ND-8000 reagents (Thermo Scientific, USA). Results. To assess the state of intestinal permeability, serum levels of L-FABP and I-FABP were examined and numbers of phylum F and B as well as their ratio were calculated. Patients of both groups have been found to have increased serum levels of L-FABP, I-FABP, numbers of B in fecal samples and decreased numbers of F and F/B ratio. Conclusions. The study results obtained have revealed increased intestinal permeability and demonstrated an important diagnostic value of serum L-FABP and I-FABP as a biomarker of intestinal permeability in diabetic MAFLD patients with or without SIBO. Increased fecal numbers of Bacteroidetes, decreased numbers of Firmicutes and F/B ratio have been detected in diabetic MAFLD patients with or without SIBO. [ABSTRACT FROM AUTHOR]

Giardia duodenalis, an important flagellated noninvasive protozoan parasite, infects the upper small intestine and causes a disease termed giardiasis globally. Few members of the heat shock protein (HSP) family have been shown to function as potential defenders against microbial pathogens, while such information is lacking for Giardia. Here we initially screened and indicated that in vitro Giardia challenge induced a marked early upregulation of HSP70 in intestinal epithelial cells (IECs). As noted previously, apoptotic resistance, nitric oxide (NO)-dependent cytostatic effect and parasite clearance, and epithelial barrier integrity represent effective anti-Giardia host defense mechanisms. We then explored the function of HSP70 in modulating apoptosis, NO release, and tight junction (TJ) protein levels in Giardia-IEC interactions. HSP70 inhibition by quercetin promoted Giardia-induced IEC apoptosis, viability decrease, NO release reduction, and ZO-1 and occludin downregulation, while the agonist celastrol could reverse these Giardia-evoked effects. The results demonstrated that HSP70 played a previously unrecognized and important role in regulating anti-Giardia host defense via attenuating apoptosis, promoting cell survival, and maintaining NO and TJ levels. Owing to the significance of apoptotic resistance among those defense-related factors mentioned earlier, we then elucidated the anti-apoptotic mechanism of HSP70. It was evident that HSP70 could negatively regulate apoptosis in an intrinsic way via direct inhibition of Apaf-1 or ROS-Bax/Bcl-2-Apaf-1 axis, and in an extrinsic way via cIAP2-mediated inhibition of RIP1 activity. Most importantly, it was confirmed that HSP70 exerted its host defense function by downregulating apoptosis via Toll-like receptor 4 (TLR4) activation, upregulating NO release via TLR4/TLR2 activation, and upregulating TJ protein expression via TLR2 activation. HSP70 represented a checkpoint regulator providing the crucial link between specific TLR activation and anti-Giardia host defense responses. Strikingly, independent of the checkpoint role of HSP70, TLR4 activation was proven to downregulate TJ protein expression, and TLR2 activation to accelerate apoptosis. Altogether, this study identified HSP70 as a potentially vital defender against Giardia, and revealed its correlation with specific TLR activation. The clinical importance of HSP70 has been extensively demonstrated, while its role as an effective therapeutic target in human giardiasis remains elusive and thus needs to be further clarified. [ABSTRACT FROM AUTHOR]

Background: Small intestinal bacterial overgrowth (SIBO), although associated with potentially serious complications, has not been adequately studied in critically ill patients. The primary objective of this study was to assess the prevalence of SIBO in critically ill patients. Secondary outcomes included the assessment of its effect on ventilator-associated pneumonia (VAP), intensive care unit (ICU) length of stay (LOS), and all-cause in-hospital mortality rate. Methods: This prospective observational study was conducted in a mixed medical-surgical ICU. In 52 consecutive ICU patients, a noninvasive modified hydrogen breath test (HBT) with lactulose was employed for SIBO diagnosis. The HBT was conducted at predetermined time intervals (first day of admission; third, fifth, and seventh day of ICU stay). Patients with an abnormal HBT suggesting SIBO on the day of ICU admission were excluded from the study. Participants were classified as either positive or negative based on their HBT on the third, fifth, and/or seventh day. A comparative assessment of demographic data, APACHE II score, incidence of VAP, duration of ICU stay, and all-cause in-hospital mortality was conducted. Multivariate logistic regression analysis was performed to identify the predictive factors for SIBO. Results: The groups were homogeneous in terms of their baseline characteristics. The prevalence of SIBO was 36.5%. The all-cause in-hospital mortality was 34.6%. The presence of SIBO was associated with an increased incidence of VAP (P <.001) and a prolonged ICU length of stay (P <.033). All-cause in-hospital mortality was similar between the groups. Regarding the results of the multivariate logistic regression model, only age was identified as a statistically significant independent predictor of SIBO (OR 1.08, P =.018). Conclusions: The prevalence of SIBO in ICU patients appears to be increased. Both early diagnosis and effective treatment are of utmost importance, especially for critically ill patients since it appears to be associated with VAP and prolonged hospitalization. [ABSTRACT FROM AUTHOR]

Usually, the massive elimination of cells under steady-state conditions occurs by apoptosis, which is also acknowledged to explain the loss of enterocytes in the small intestine of celiac disease (CD) patients. However, little is known about the role of proinflammatory cell death pathways in CD. Here, we have used confocal microscopy, western blot, and RT-qPCR analysis to assess the presence of regulated cell death pathways in the duodenum of CD patients. We found an increased number of dead (TUNEL+) cells in the lamina propria of small intestine of CD patients, most of them are plasma cells (CD138+). Many dying cells expressed FAS and were in close contact with CD3+ T cells. Caspase-8 and caspase-3 expression was increased in CD, confirming the activation of apoptosis. In parallel, caspase-1, IL-1β, and GSDMD were increased in CD samples indicating the presence of inflammasome-dependent pyroptosis. Necroptosis was also present, as shown by the increase of RIPK3 and phosphorylate MLKL. Analysis of published databases confirmed that CD has an increased expression of regulated cell death -related genes. Together, these results reveal that CD is characterized by cell death of different kinds. In particular, the presence of proinflammatory cell death pathways may contribute to mucosal damage. Graphical Abstract [ABSTRACT FROM AUTHOR]

Leukotriene B 4 (LTB 4) is a lipid mediator rapidly generated from arachidonic acid in response to various stimuli. This lipid mediator exerts its biological activities by binding to cognate receptors. Two LTB 4 receptors have been cloned; BLT1 and BLT2 as a high- and a low-affinity receptors, respectively. In numerous analyses, physiological and pathophysiological importance of LTB 4 and cognate receptors in various diseases has been clarified. For example, disruption of the BLT1 gene or treatment with blockers for this receptor reduced various diseases such as rheumatoid arthritis and bronchial asthma in mice, in contrast BLT2 deficiency facilitated several diseases in the small intestine and the skin. These data support the idea that BLT1 blockers and BLT2 agonists could be useful for the cure of these diseases. Thus, various drugs targeting each receptor are being developed by many pharmaceutical companies. In this review, we focus on our current knowledge of the biosynthesis and physiological roles of LTB 4 through cognate receptors. We further describe the effects of these receptor deficiencies on several pathophysiological conditions, including the potential of LTB 4 receptors as therapeutic targets for the cure of the diseases. Moreover, current information on the structure and post-translational modification of BLT1 and BLT2 is discussed. [Display omitted] • Leukotriene B 4 (LTB 4) is a lipid mediator generated from arachidonic acid. • BLT1 and BLT2 are a high- and a low-affinity LTB 4 receptor, respectively. • Importance of LTB 4 and cognate receptors in various diseases has been clarified. • We describe the potential of LTB 4 receptors as therapeutic targets. [ABSTRACT FROM AUTHOR]

Background: Intestinal epithelial cell (IEC) mitochondrial dysfunction involvement in inflammatory bowel diseases (IBD), including Crohn's disease affecting the small intestine, is emerging in recent studies. As the interface between the self and the gut microbiota, IECs serve as hubs of bidirectional cross-talk between host and luminal microbiota. However, the role of mitochondrial-microbiota interaction in the ileum is largely unexplored. Prohibitin 1 (PHB1), a chaperone protein of the inner mitochondrial membrane required for optimal electron transport chain function, is decreased during IBD. We previously demonstrated that mice deficient in PHB1 specifically in IECs (Phb1i∆IEC) exhibited mitochondrial impairment, Paneth cell defects, gut microbiota dysbiosis, and spontaneous inflammation in the ileum (ileitis). Mice deficient in PHB1 in Paneth cells (epithelial secretory cells of the small intestine; Phb1∆PC) also exhibited mitochondrial impairment, Paneth cell defects, and spontaneous ileitis. Here, we determined whether this phenotype is driven by Phb1 deficiency-associated ileal microbiota alterations or direct effects of loss of PHB1 in host IECs. Results: Depletion of gut microbiota by broad-spectrum antibiotic treatment in Phb1∆PC or Phb1i∆IEC mice revealed a necessary role of microbiota to cause ileitis. Using germ-free mice colonized with ileal microbiota from Phb1-deficient mice, we show that this microbiota could not independently induce ileitis without host mitochondrial dysfunction. The luminal microbiota phenotype of Phb1i∆IEC mice included a loss of the short-chain fatty acid butyrate. Supplementation of butyrate in Phb1-deficient mice ameliorated Paneth cell abnormalities and ileitis. Phb1-deficient ileal enteroid models suggest deleterious epithelial-intrinsic responses to ileal microbiota that were protected by butyrate. Conclusions: These results suggest a mutual and essential reinforcing interplay of gut microbiota and host IEC, including Paneth cell, mitochondrial health in influencing ileitis. Restoration of butyrate is a potential therapeutic option in Crohn's disease patients harboring epithelial cell mitochondrial dysfunction. BykqUrdWkjvtZT9W9KFZmH Video Abstract [ABSTRACT FROM AUTHOR]

Amyloidosis is a rare condition where fibrillar proteins and abnormal, soluble peptides accumulate throughout the body's organs. Gastrointestinal symptoms secondary to amyloid deposition vary widely and may be confused with other common small intestine diseases, making the diagnosis challenging. Our case is a 63-year-old male with a past medical history of smoking who showed up in the ED with 5 months of diffuse abdominal pain referred to the back. Pelvis-abdominal ultrasound showed bilateral acute pyelonephritis. A colonoscopy revealed large multiple ileal ulcers about 10 cm from the ileocecal valve with a wide base. Pathology biopsies revealed ileal amyloidosis and chronic ileitis with superficial erosions. The patient has been diagnosed with primary localized ileal AL amyloidosis. The patient has finally been referred for surgical resection. We want to raise awareness of ileal amyloidosis and emphasize the importance of considering uncommon etiologies of small intestine pathology in patients presenting with chronic diarrhea, malabsorption, abdominal pain, and weight loss. Finally, patients with small intestine amyloid disease progressing rapidly and failing to respond to non-surgical treatment should be considered for surgical resection. [ABSTRACT FROM AUTHOR]

Background: Hepatic portal venous gas (HPVG) has rarely been described in the presence of benign, non-life-threatening conditions such as gastric emphysema and gastric dilatation. In such cases, management and patient prognosis have evolved to become highly dependent on the etiology. Nevertheless, although such conditions can be benign and conservative management can be applied, close monitoring of the patient's status is necessary to avoid any complication like gastric necrosis. Case Presentation: We report a case of acute gastric dilatation with HPVG in the presence of gastric emphysema and closed loop small bowel obstruction, complicated by gastric necrosis, in a patient with adjustable gastric band. Conclusion: HPVG can have benign etiologies which influence its mortality rate, management, and prognosis. These should be detected, and patients should be monitored closely, especially if managed conservatively, to avoid complications. [ABSTRACT FROM AUTHOR]

Giardia duodenalis, an important flagellated noninvasive protozoan parasite, infects the upper small intestine and causes a disease termed giardiasis globally. Few members of the heat shock protein (HSP) family have been shown to function as potential defenders against microbial pathogens, while such information is lacking for Giardia. Here we initially screened and indicated that in vitro Giardia challenge induced a marked early upregulation of HSP70 in intestinal epithelial cells (IECs). As noted previously, apoptotic resistance, nitric oxide (NO)-dependent cytostatic effect and parasite clearance, and epithelial barrier integrity represent effective anti-Giardia host defense mechanisms. We then explored the function of HSP70 in modulating apoptosis, NO release, and tight junction (TJ) protein levels in Giardia-IEC interactions. HSP70 inhibition by quercetin promoted Giardia-induced IEC apoptosis, viability decrease, NO release reduction, and ZO-1 and occludin downregulation, while the agonist celastrol could reverse these Giardia-evoked effects. The results demonstrated that HSP70 played a previously unrecognized and important role in regulating anti-Giardia host defense via attenuating apoptosis, promoting cell survival, and maintaining NO and TJ levels. Owing to the significance of apoptotic resistance among those defense-related factors mentioned earlier, we then elucidated the anti-apoptotic mechanism of HSP70. It was evident that HSP70 could negatively regulate apoptosis in an intrinsic way via direct inhibition of Apaf-1 or ROS-Bax/Bcl-2-Apaf-1 axis, and in an extrinsic way via cIAP2-mediated inhibition of RIP1 activity. Most importantly, it was confirmed that HSP70 exerted its host defense function by downregulating apoptosis via Toll-like receptor 4 (TLR4) activation, upregulating NO release via TLR4/TLR2 activation, and upregulating TJ protein expression via TLR2 activation. HSP70 represented a checkpoint regulator providing the crucial link between specific TLR activation and anti-Giardia host defense responses. Strikingly, independent of the checkpoint role of HSP70, TLR4 activation was proven to downregulate TJ protein expression, and TLR2 activation to accelerate apoptosis. Altogether, this study identified HSP70 as a potentially vital defender against Giardia, and revealed its correlation with specific TLR activation. The clinical importance of HSP70 has been extensively demonstrated, while its role as an effective therapeutic target in human giardiasis remains elusive and thus needs to be further clarified. [ABSTRACT FROM AUTHOR]

Alloys based on TiNi are widely used in various fields of technology and medicine. In the present work, we report on the preparation of TiNi-alloy-based wire with the shape-memory effect, which was used for compression clips for surgery. The composition and structure of the wire and its martensitic and physical–chemical properties were studied using SEM, TEM, optic microscopy, profilometry, mechanical tests, etc. The TiNi alloy was found to consist of B2 and B19′ and secondary-phase particles of Ti2Ni, TiNi3 and Ti3Ni4. Its matrix was slightly enriched in Ni (50.3 at.% of Ni). A homogeneous grain structure was revealed (an average grain size of 19 ± 0.3 μm) with equal quantities of grain boundaries of special and general types. The surface oxide layer provides improved biocompatibility and promotes the adhesion of protein molecules. Overall, the obtained TiNi wire was concluded to exhibit martensitic, physical and mechanical properties suitable for its use as an implant material. The wire was then used for manufacturing compression clips with the shape-memory effect and applied in surgery. The medical experiment that involved 46 children demonstrated that the use of such clips in children with double-barreled enterostomies permitted improvement in the results of surgical treatment. [ABSTRACT FROM AUTHOR]

The use of computer-aided detection models to diagnose lesions in images from wireless capsule endoscopy (WCE) is a topical endoscopic diagnostic solution. We revised our artificial intelligence (AI) model, RetinaNet, to better diagnose multiple types of lesions, including erosions and ulcers, vascular lesions, and tumors. RetinaNet was trained using the data of 1234 patients, consisting of images of 6476 erosions and ulcers, 1916 vascular lesions, 7127 tumors, and 14,014,149 normal tissues. The mean area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for each lesion were evaluated using five-fold stratified cross-validation. Each cross-validation set consisted of between 6,647,148 and 7,267,813 images from 217 patients. The mean AUC values were 0.997 for erosions and ulcers, 0.998 for vascular lesions, and 0.998 for tumors. The mean sensitivities were 0.919, 0.878, and 0.876, respectively. The mean specificities were 0.936, 0.969, and 0.937, and the mean accuracies were 0.930, 0.962, and 0.924, respectively. We developed a new version of an AI-based diagnostic model for the multiclass identification of small bowel lesions in WCE images to help endoscopists appropriately diagnose small intestine diseases in daily clinical practice. [ABSTRACT FROM AUTHOR]

Foreign body in gastrointestinal tract is a common problem in small animal practice, especially in domestic cats. A case report of recurrent ingested thread as a linear foreign body with the thread held back by the tongue and stuck causing further complications is presented in this case report. Interestingly, the radiographic results did not indicate the paisley shaped gas pattern which is characteristic of a linear foreign body. The final diagnosis was made by exploratory laparotomy which confirmed the presence of several threads in the small intestine. Therefore, this complex case was diagnosed based on history, clinical signs and results of radiography and confirmed by exploratory laparotomy. This is the first ever published case report of successful clinical management of a linear foreign body in UAE according to the authors' knowledge. [ABSTRACT FROM AUTHOR]

Introduction: Bezoars are non-dissolved hard masses of undigested or partially digested food or foreign material trapped in the gastrointestinal tract, broadly classified into four groups: phytobezoars, trichobezoars, lactobezoars, and pharmacobezoars. In the Indian subcontinent, the persimmon fruit is called 'amlook'; hence, phytobezoars resulting from the ingestion of the unripe or excessive amlook are called 'amlookobezoars' in local medical vernacular or dialect. To describe the clinical profile and treatment outcome of a series of patients presenting with small bowel obstruction (SBO) due to amlookobezoars. Methods: Five patients were evaluated with a detailed history, physical examination, and radiological assessment to confirm the diagnosis. The radiological assessment included abdominal X-rays, ultrasonography, and contrast-enhanced computed tomography. Results: We had five cases of SBO caused by amlookobezoars. The age of these patients ranged from 8 to 22 years, with a male-female ratio of 4:1. All five patients presented in autumn. None had any other significant predisposing factor for bezoar formation except consuming considerable amounts of amlooks 3-10 days earlier. Four patients eventually required an exploratory laparotomy; all had soft to firm bezoars stuck in the distal or mid-ileum. For these four patients, we manually broke down the amlookobezoars and milked them down beyond the ileocaecal level without requiring any enterotomy, gut resection, or stoma creation, and the postoperative period was almost uneventful. Conclusion: Though uncommon, amlookobezoars should be considered a differential diagnosis in small bowel obstruction. Amlookobezoars commonly affect young adolescent males in the autumn months and often need a laparotomy with fragmentation and milking. [ABSTRACT FROM AUTHOR]

The article presents a case study of a proximal enteritis and secondary mesenteric venous thrombophlebitis in a 7-yearold Welsh pony gelding. It discusses that on physical examination the gelding was quiet with marked tachycardia (120 bpm) and tachypnoea (88 brpm); and Abdominocentesis was performed and the peritoneal fluid obtained was serosanguinous in colour with a lactate of 12.5mmol/L wehre the marked tachycardia persisted following gastric decompression.

She wonders if this could be a presentation of diagnostic momentum (i.e., once someone labels the patient with a diagnosis, we often assume that diagnosis without re-examination). i B He was discharged from the armed services 30 years prior to the current admission with a diagnosis of ulcerative colitis. An incorrect diagnosis can have two potentially negative implications: The patient will likely get treated for the wrong diagnosis, and the proper diagnosis will have a significant delay resulting in possible adverse impact for the patient. The patient had recurrent kidney stones and hypercalcemia, yet the hypercalcemia was not evaluated, and physicians continued to assign the kidney stone risk to the presumed Crohn's disease. Skepticism about listed diagnoses (or admission diagnoses) leads to reconsidering those diagnoses.[2] The process involves knowing the illness script for the chronic disease and comparing that to the patient's course. [Extracted from the article]

With the changing epidemiology of Crohn’s disease (CD) and intestinal tuberculosis (ITB), discriminating the two diseases has become increasingly challenging for physicians and delayed diagnosis or misdiagnosis resulted in higher morbidity and mortality. We describe the case of ITB in a 14-year-old boy who presented with chief complaints of lower abdominal pain, high swinging fever, and weight loss over the past 12 months. He had visited different clinics, diagnosed with ileal CD. He received 5‑aminosalicylic acid, prednisone, and azathioprine followed by three doses of infliximab, with no response. Abdominal computed tomography revealed terminal ileal stricture with no evidence of an intra-abdominal abscess. Colonoscopy with ileoscopy up to 25 cm from the ileocecal valve showed normal mucosa; retrograde single-balloon enteroscopy was used to delineate multiple transverse ulcers with mild stenosis at 40 cm of the terminal ileum from the ileocecal valve. Pathologic findings revealed mucosal granuloma. The patient was empirically started on four anti‑TB medications, and he responded very well within the 1st week of therapy. At the 6-month follow-up, he was still receiving anti-TB treatment, however became asymptomatic, gained weight and on the way to full recovery. [ABSTRACT FROM AUTHOR]

Background/Aim: To investigate the effect of polaprezinc (antioxidant) administration and hyperbaric oxygen therapy on radiation-induced intestinal injury. Materials and Methods: Forty-five C57BL/6J mice underwent total body radiation of 2 Gy. Polaprezinc was given in 12 mice, hyperbaric oxygen in 12 mice, and both in 12 mice. The other 9 mice did not undergo any treatment. Mice were sacrificed 2, 4, and 6 h after radiation, and 9 specimens (3 each from the duodenum, jejunum, and ileum) were harvested. Apoptotic intestinal crypt cells were histologically evaluated by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Results: Apoptotic cell number per 1,000 crypt cells was 31.0±6.7 at 2 h, 28.4±5.2 at 4 h, and 32.9±5.1 at 6 h in the mice group treated by radiation alone. Both polaprezinc administration and hyperbaric oxygen therapy significantly suppressed apoptosis. Although the effect of polaprezinc administration on suppressing apoptosis became less over time (4.9±5.7 and 19.4±13.2 at 2 and 6 h, respectively), that of hyperbaric oxygen therapy was stable regardless of time (23.6±4.8 and 25.8±4.1 at 2 and 6 h). Administration of both polaprezinc and hyperbaric oxygen showed a significant synergetic or additive effect on suppressing apoptosis at 6 h (11.4±10.5, p<0.0035 vs. polaprezinc, p<0.0001 vs. hyperbaric oxygen). Conclusion: Both polaprezinc administration and hyperbaric oxygen therapy are effective in relieving radiation-induced small intestinal damage, and a synergistic or additive effect is expected when using both. [ABSTRACT FROM AUTHOR]

Celiac disease is an autoimmune disorder in which ingestion of dietary gluten triggers an immune reaction in the small intestine leading to destruction of the lining epithelium. Current treatment focusses on lifelong adherence to a gluten-free diet. Gluten-specific CD4+ T cells and cytotoxic intraepithelial CD8+ T cells have been proposed to be central in disease pathogenesis. Here we use unbiased single-cell RNA-sequencing and explore the heterogeneity of CD45+ immune cells in the human small intestine. We show altered myeloid cell transcriptomes present in active celiac lesions. CD4+ and CD8+ T cells transcriptomes show extensive changes and we define a natural intraepithelial lymphocyte population that is reduced in celiac disease. We show that the immune landscape in Celiac patients on a gluten-free diet is only partially restored compared to control samples. Altogether, we provide a single cell transcriptomic resource that can inform the immune landscape of the small intestine during Celiac disease. Celiac disease is linked to responsiveness to dietary gluten, which manifests itself as immune cell activation and the immunopathology including destruction of the epithelium of the small intestine. Here the authors apply single cell transcriptomics to characterise the immune cell compartment of the human small intestine during active Celiac disease. [ABSTRACT FROM AUTHOR]

Cancer chemotherapy and radiotherapy may result in mucositis characterized by stem cell damage and inflammation in the gastrointestinal tract. The molecular mechanisms underlying this pathology remain unknown. Based on the assumption that mitochondrial CPG-DNA (mtDNA) released and sensed by TLR9 could underlie mucositis pathology, we analyzed the mtDNA levels in sera as well as inflammatory and disease parameters in the small intestine from wild-type (WT) and TLR9-deficient mice (TLR9−/−) in an experimental model of intestinal mucositis induced by irinotecan. Additionally, we verified the ability of WT and TLR9−/− macrophages to respond to CpG-DNA in vitro. WT mice injected with irinotecan presented a progressive increase in mtDNA in the serum along with increased hematocrit, shortening of small intestine length, reduction of intestinal villus:crypt ratio and increased influx of neutrophils, which were followed by higher expression of Nlrp3 and Casp1 mRNA and increased IL-1β levels in the ileum when compared to vehicle-injected mice. TLR9-deficient mice were protected in all these parameters when compared to WT mice. Furthermore, TLR9 was required for the production of IL-1β and NO after macrophage stimulation with CpG-DNA. Overall, our findings show that the amount of circulating free CpG-DNA is increased upon chemotherapy and that TLR9 activation is important for NLRP3 inflammasome transcription and further IL-1β release, playing a central role in the development of irinotecan-induced intestinal mucositis. We suggest that TLR9 antagonism may be a new therapeutic strategy for limiting irinotecan-induced intestinal inflammation. [ABSTRACT FROM AUTHOR]

Introduction: The Rapunzel syndrome occurs when the trichobezoar (hair ball) extends beyond the small intestine and sometimes even into the colon, producing long, tail-like hair extensions. Aim: To present cases of trichobezoars, an extremely rare human intestinal disease caused by the ingestion of hair (trichophagia). Material and methods: In this retrospective study, we assessed the medical records of 2 patients diagnosed with Rapunzel syndrome admitted to Academic Clinical Hospital No. 2 in Rzeszow, Poland. Results: The first patient was a 15-year-old girl. The abdominal ultrasound examination revealed an abnormal, non-compressible structure with the approximate dimensions of 12 × 11 cm in the epigastrium, with a strong shadow obscuring the view. Gastroscopy was performed and a tumour sample was taken for histopathological examination, which confirmed the diagnosis of a trichobezoar. The patient's mother did not agree to her daughter's psychiatric treatment. The second patient was a 15-year-old girl who reported to the Emergency Room in critical condition due to dehydration and long-term emesis with symptoms of cachexia. Ileotomy with the removal of two trichobezoars with a diameter of about 5 cm and 7 cm was performed. The patient was discharged for treatment at the Mental Health Clinic for trichotillomania. Conclusions: Trichobezoars give non-specific symptoms that may imitate other diseases for example tumours. Psychotherapy is the recommended treatment and follow-up visits are important in preventing relapses. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) diseases, including pathological dysplasia, inflammation, neoplasia and injury, suffer millions of patients globally per year. Organoids, three-dimensional cell mass structures supported by biomaterials in dishes, are currently used as a research model for diseases of the small intestine. However, the traditional enzy matic-digestion method for establishing small-intestinal o rganoid s (EnzyOs) is time consuming and often loses the bulk of crypts, a more efficient and reliable method needs to be developed. In this study, using mouse GI organoids as a model, we formulated a rapid mech anical isolation method that could efficiently isolate and culture villi-crypts into small intestinal o rganoids (MechOs). Primary duodenum organoids generated by MechOs displayed three types of morphology: spheroid, semi-budding and budding, while EnzyOs produced much less budding. Moreover, primary duodenum organoids from MechOs could be subcultured and presented similar gene expression profiles of small intestine specific markers as that from EnzyOs. Importantly, the MechOs method could also be used to generate other types of organoids derived from the stomach, jejunum–ileum, sigmoid–rectum and bile cysts. Taken together, the results show that MechOs could efficiently and economically generate digestive system organoids, providing a potential basis of epithelial organoids for the clinical treatment of gastroenterological diseases. • The MechOs method is applicable to generate organoids derived from digestive system including stomach, jejunum-ileum, sigmoid-rectum and bile cyst in vitro. • The MechOs provides an efficient and economical alternative for establishment of other epithelial organoids. • The MechOs provides potential base for drug screening of clinical gastroenterological disease treatments. [ABSTRACT FROM AUTHOR]

Hirschsprung disease occurs when children are born with no intrinsic nerve cells in varying lengths of the large intestine. In the most severe cases, neurons are also missing from the distal part of the small intestine. Nerve-mediated relaxation of the aganglionic bowel fails and fecal matter accumulates in the more proximal regions of the intestine. This is life threatening. Perforation of the bowel can ensue, causing sepsis and in some cases, death of the infant. Repopulation of the colon with neural stem cells is a potential therapy, but for this to be successful the patient or experimental animal needs to survive long enough for neural precursors to differentiate and make appropriate connections. We have developed a surgical procedure that can be applied to rats with Hirschsprung disease. A stoma was created to allow the normal bowel to empty and a second stoma leading to the aganglionic bowel was also created. This allowed homozygous mutants that would usually die at less than 3 weeks of age to survive into adulthood. During this time, the rats also required post-operative care of their stomas. The interventions we describe provide an animal model of Hirschsprung disease that is suited to assess the effectiveness of cell therapies in the treatment of this condition. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Esophageal varices are a well-characterized sequela of portal hypertension; however, less is known about varices arising in ectopic locations. We aimed to describe bleeding small intestine varices (SIV) in patients with cirrhosis and compare characteristics and outcomes to published case reports. METHODS: We performed an institutional chart review using billing codes and natural language processing between 2008 and 2019. Inclusion criteriawere adult patients with cirrhosis and SIV verified by endoscopy, video capsule, or imaging. Patientswith noncirrhotic portal hypertension and stomal varices were excluded. We examined demographic and clinical factors, characteristics of SIV, bleeding, intervention, and outcomes in our series and collated data from published cases identified during a literature review. RESULTS: We identified 71 patients with cirrhosis and SIV (18 bled). The literature search yielded 76 cases with bleeding SIV. Our series and published cases were matched for age, sex, liver disease etiology, and SIV location. Length of stay and transfusion requirementswere similar. Aggregate initial treatments (number, hemostasis rate) included medical (n = 7, 57%), endoscopic (n = 48, 56%), interventional radiology (n = 31, 77%), and surgery (n = 8, 87%). Hospital and overall mortality rates were higher in our series (22% and 38%) compared with the published cases (5.3% and 18.4%), respectively (P = 0.02 and P = 0.07). DISCUSSION: A quarter of patients with cirrhosis and SIV experience bleeding, with high transfusion requirements, frequent need for secondary interventions, and high mortality. These findings highlight the need for a multidisciplinary approach and second-line therapeutic modalities in the timely management of bleeding SIV in cirrhosis. [ABSTRACT FROM AUTHOR]

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. If diagnosed late maternal and foetal mortality is very high. The major cause of death in abdominal pregnancy is haemorrhage. The case report is about a 31-year-old gravida two with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring due to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, with celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed with crystalloids, colloids, blood products and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit. [ABSTRACT FROM AUTHOR]

Background/Aim: Crohn's Disease (CD) and Ulcerative Colitis (UC) are grouped as Inflammatory Bowel Diseases (IBD). There are many similarities between these two diseases, and CD and UC cases cannot be separated at a rate varying between 5% and 10%. Reelin is an extracellular matrix protein first known for its vital role in neuronal migration. Studies in rodent small intestine suggested that reelin protects the organism from intestinal pathologies. In a 5-year retrospective case-control study, we aimed to detect the effectiveness of serum reelin level in patients with IBD in determining the severity and activation of the disease and compare healthy volunteers with patients in terms of inactivation and remission. Methods: The data of all 194 IBD patients diagnosed at Beyazit Training and Research Hospital between 2011-2015 were retrospectively reviewed. The patients were matched with 30 healthy volunteers. Risk factors were assessed by multivariate logistic regression analysis. Results: The serum reelin levels were similar between UC and CD patients, the control group, UC and CD groups (P=0.067), and those with active disease or disease in remission, and did not differ according to disease behavior or location of involvement. Conclusions: Our study shows that Reelin cannot be used as an activation/remission marker in IBD. In addition, it does not differentiate between UC and CD. [ABSTRACT FROM AUTHOR]

Enteroscopy has become an indispensable technique for the exploration and, in particular, the treatment of small intestine lesions. It is usually performed following video capsule endoscopy of the small intestine. Three equivalent techniques exist: double balloon enteroscopy, single balloon enteroscopy and spiral enteroscopy. The purpose of this study is to describe the technical feasibility of single balloon enteroscopy as well as its tolerance, indications and the results obtained in our context. We conducted a retrospective and descriptive analysis of the records of patients undergoing single balloon enteroscopy in the Department of Gastroenterology at the Mohammed V Training Military Hospital in Rabat over an 8-year period. Inclusion criteria were: small intestine disease or the suspicion of small intestine disease on imaging tests or video-capsule endoscopy and having undergone single balloon enteroscopy. The variables studied were the technical feasibility of single balloon enteroscopy, its indications, results and complications. Fifty-one (51) patients, including 30 men and 21 women with an average age of 48 years (18 years-91 years), were included in the study. The technique used in all patients was single balloon enteroscopy under general anesthesia with intubation. The mean duration of single balloon enteroscopy via the upper gastrointestinal (GI) tract (antegrade) was 45 min and 60 min via the lower GI tract (retrograde). The small intestine was explored up to the proximal ileum via the upper gastrointestinal (GI) tract and through more than 120cm from IAD via the lower GI tract. The indications included: unexplained digestive bleeding (72%), small intestine wall thickening (17%), the suspicion of small intestine tumor (6%), evaluation of Crohn's disease (4%) and endoscopic video capsule (ECV) reduction (2%). Diagnosis was made or confirmed in 29 patients, reflecting a diagnostic efficiency of 57%. Angiodysplasia accounted for 70% of the lesions, ulcerations 10%, stenoses 7%, tumors 7%, diverticula 3% and spontaneous ECV reduction 3%. Endoscopic treatment was performed in 20 patients, with a therapeutic efficiency of 39%; it was based on argon plasma coagulation of gastroenteric angiodysplasia lesions. No complications were observed in our case series. Single balloon enteroscopy is a well-tolerated examination which allows for the exploration of a long portion of the small intestine. Multiple and various indications were provided in our study and the diagnostic and therapeutic benefits were satisfactory. [ABSTRACT FROM AUTHOR]

A 7-month-old neutered male poodle dog presented with general deterioration and gastrointestinal symptoms after two separate operations: a jejunotomy for small-intestinal foreign body removal and an exploratory laparotomy for diagnosis and treatment of the gastrointestinal symptoms that occurred 1 month after the first surgery. The dog was diagnosed as having small-bowel obstruction (SBO) due to intra-abdominal adhesions and small-bowel fecal material (SBFM) by using abdominal radiography, ultrasonography, computed tomography, and laparotomy. We removed the obstructive adhesive lesion and SBFM through enterotomies and applied an autologous peritoneal graft to the released jejunum to prevent re-adhesion. After the surgical intervention, the dog recovered quickly and was healthy at 1 year after the surgery without gastrointestinal signs. To our knowledge, this study is the first report of a successful treatment of SBO induced by postoperative intra-abdominal adhesions and SBFM after laparotomies in a dog. [ABSTRACT FROM AUTHOR]

Chronic inflammation of the small intestine in celiac disease is driven by activation of CD4+ T cells that recognize gluten peptides presented by disease-associated HLA-DQ molecules. We have performed direct cell cloning of duodenal biopsies from five untreated and one refractory celiac disease patients, and three non-celiac disease control subjects in order to assess, in an unbiased fashion, the frequency of gluten-reactive T cells in the disease-affected tissue as well as the antigen fine specificity of the responding T cells. From the biopsies of active disease lesions of five patients, 19 T-cell clones were found to be gluten-reactive out of total 1,379 clones tested. This gave an average of 1.4% (range 0.7% - 1.9%) of gluten-reactive T cells in lamina propria of active celiac lesions. Interestingly, also the patient with refractory celiac disease had gluten-reactive T cell clones in the lamina propria (5/273; 1.8%). In comparison, we found no gluten-reactive T cells in any of the total 984 T-cell clones screened from biopsies from three disease control donors. Around two thirds of the gluten-reactive clones were reactive to a panel of peptides representing known gluten T-cell epitopes, of which two thirds were reactive to the immunodominant DQ2.5-glia-α1/DQ2.5-glia-α2 and DQ2.5-glia-ω1/DQ2.5-glia-ω2 epitopes. This study shows that gluten-reactive T cells in the inflamed duodenal tissue are prevalent in the active disease lesion, and that many of these T cells are reactive to T-cell epitopes that are not yet characterized. Knowledge of the prevalence and epitope specificity of gluten-specific T cells is a prerequisite for therapeutic efforts that target disease-specific T cells in celiac disease. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) originate from mesenchymal cells throughout the gastrointestinal tract. A common symptom is gastrointestinal hemorrhage; intra-abdominal hemorrhage is relatively rare. There are few reports of GIST presenting with both types of hemorrhage concurrently. A 77-year-old man was admitted to our hospital because of melena and anemia (Hb: 4.7 g/dL). Computed tomography revealed a small bowel tumor and high-density fluid in both the small intestine and the pelvic floor. We diagnosed a small intestinal tumor with concurrent gastrointestinal and intra-abdominal hemorrhage, and performed emergency surgery. The tumor arose from the small intestine and was ruptured. We found hemorrhage in the pelvic cavity and performed partial small intestine resection. Pathological findings revealed that the tumor was positive for c-Kit protein and was diagnosed as GIST. The patient was discharged from the hospital on postoperative day 9 and received imatinib 1 month postoperatively. We experienced a very rare case of ruptured GIST originating from the small intestine associated with both gastrointestinal and intra-abdominal hemorrhage. We also reviewed the relevant literature. [ABSTRACT FROM AUTHOR]

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