Role of rat large intestine in reducing diarrhea after 50% or 80% distal small bowel resection

The effects of intestinal resection on several intestinal parameters have been studied in the large intestine of rats one month after the surgical operation. The results show that both 50% and 80% distal small bowel resection increased net fluid absorption and mucosal permeability and caused expansion of the intercellular spaces of the large intestine. The increase in net fluid absorption was dependent upon the extent of the intestine removed. The cAMP and cGMP content of cecal and colonic mucosa were significantly reduced after jejunoilectomy. Changes in nucleotide levels were dependent on the length of the intestine resected. On the other hand, mucosa Na,K-ATPase specific activity was only increased in the cecum after 80% intestinal resection. The results are discussed in terms of adaptation to prevent diarrhea.     

Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders in developed countries. Its etiology remains unknown; however, a common finding, regardless of IBS subtype, is the presence of altered intestinal barrier. In fact, signaling and location of cell‐to‐cell adhesion proteins, in connection with increased immune activity, seem abnormal in the intestinal epithelium of IBS patients. Despite that most research is performed on distal segments of the intestine, altered permeability has been reported in both, the small and the large bowel of all IBS subtypes. The small intestine carries out digestion and nutrient absorption and is also the site where the majority of immune responses to luminal antigens takes place. In fact, the upper intestine is more exposed to environmental antigens than the colon and is also a site of symptom generation. Recent studies have revealed small intestinal structural alterations of the epithelial barrier and mucosal immune activation in association with intestinal dysfunction, suggesting the commitment of the intestine as a whole in the pathogenesis of IBS. This review summarizes the most recent findings on mucosal barrier alterations and its relationship to symptoms arising from the small intestine in IBS, including epithelial structural abnormalities, mucosal immune activation, and microbial dysbiosis, further supporting the hypothesis of an organic origin of IBS.     

REVIEW: Small Bowel Review: Diseases of the Small Intestine

In the past year there have been many advances in the area of small bowel physiology and pathology and therapy. In preparation for this review, over 1500 papers were assessed. The focus is on presenting clinically useful information for the practicing gastroenterologist. Selected important clinical learning points include the following: (1) glutamine may restore the AIDs-associated increased intestinal permeability to normal; (2) substance P is a major mediator of diarrhea caused by Costridium difficile toxin A, acting by binding to a G-protein-coupled receptor, and represents a possible 2therapeutic target; (3) the serological diagnosis of celiac disease has been greatly enhanced with the use of anti-endomysial antibody testing, and the recent antitransglutaminase; (4) a quarter of patients with celiac disease may have secondary pancreatic insufficiency and require enzyme replacement therapy; (5) in the patient with unexplained elevation in the serum transaminase concentration, consider celiac disease as an obscure possibility; (6) bosentan and endothelin receptor agonist may prove to be useful in reducing gut ischemia in patients with septic shock; and (7) the administration of recombinant human fibroblast growth factor-2 may prove to be useful to prevent radiation damage to the gastrointestinal tract.     

体表小肠电检测方法的探讨

目的探讨体表检测小肠电的方法和肠易激综合征（ＩＢＳ）患者体表小肠电的主频有无变化。方法应用自适应滤波方法通过自行设计的生物电检测分析系统检测正常对照组２４例及ＩＢＳ组２６例受检者的小肠体表电活动。结果体表检测小肠电活动波形清晰；经功率谱计算对照组和ＩＢＳ组小肠体表电的主频分别为１０．８８±０．７０周次／分（ｃｐｍ）和１１．０３±０．８４ｃｐｍ，范围均为９－１２ｃｐｍ，两组比较ｐ＝０．１０６。结论本实验方法可在体表清晰地记录小肠电活动，ＩＢＳ患者空腹状态下体表小肠电主频可能与正常人一致。     

Neuromuscular and vascular hamartoma of the small bowel

Summary Neurovascular and muscular hamartoma is an unusual benign neoplasm of the small intestine. The clinical and pathological features of this lesion, which we recently encountered in a 91-year-old male, are the subject of this report and are discussed in the context of previously described cases.     

Amyloidosis of the small intestine secondary to rheumatoid arthritis or juvenile rheumatoid arthritis: report of two cases

We report two cases of gastrointestinal amyloidosis, complicated with juvenile rheumatoid arthritis (JRA) in one and rheumatoid arthritis (RA) in the other. A 21-year-old woman, who had been suffering from JRA for the past 12 years, was transferred to our hospital due to intense pain in the epigastrium and back, diarrhea, high fever, and paralytic ileus. Treatment by corticosteroid, antibiotics protease inhibitor and total parenteral nutrition was not effective. Laparoscopic surgery was performed because of repeated melena followed by an episode of hypovolemic shock. The resected specimen of the ileum showed histologically marked amyloid deposition in the arteriolar walls. A 83-year-old man with RA for 14 years was admitted to our hospital with complaints of abdominal pain, nausea and diarrhea. He underwent an emergency operation for perforation of the ileum. The resected specimen revealed amyloid deposition and non-caseating granulomas. The fragility and impaired blood supply caused by amyloid deposition in the vascular walls may have terminated in the severe intestinal lesion. Further clinicopathological studies along this line are keenly desired in order to establish therapeutic modalities for gastrointestinal amyloidosis.     

Recovery of the small intestine in coeliac disease on a gluten-free diet: Changes in intestinal permeability, small bowel morphology and T-cell activity

Intestinal permeability was assessed before and 1, 2, 4, 8 and 12 weeks after commencing a gluten-free diet (GFD) in eight coeliac subjects. Intestinal morphology was quantified in six coeliac subjects on a normal diet, six coeliac subjects on a GFD, and 21 normal subjects. T-cell activity was measured in the eight coeliac subjects by soluble interleukin-2 receptor (sIL-2R) concentration (normal less than 477 U/mL). Intestinal permeability was increased 10-fold with a geometric mean value of 0.72 on a normal diet, and decreased to 0.17 at 4 weeks (P = 0.04), to 0.07 at 8 weeks (P = 0.010), and to 0.20 at 12 weeks (P = 0.015) of a GFD. Two of the eight subjects showed a poor response to gluten withdrawal. Quantitative intestinal morphology showed no significant improvement after 3 to 6 months of a GFD. Mean +/- s.d. sIL-2R concentrations in the eight subjects were increased 5-fold higher than control values at 1400 +/- 530 U/mL on a normal diet and decreased to 750 +/- 200 U/mL after 12 weeks of a GFD (P = 0.004). We conclude that intestinal permeability improves rapidly in the majority of coeliac subjects after commencing a GFD, although some abnormal permeability and increased T-cell activity persists. This may be due to varying degrees of gluten ingestion resulting in continued immune activation.     

Assessment of blood flow in the small intestine by laser Doppler flowmetry: Comparison of healthy small intestine and small intestine in Crohn's disease

Blood flow and blood distribution were investigated in 40 patients with normal small intestine and the relation between blood flow and the morphological features of Crohn's disease was examined in 11 patients with Crohn's disease by laser Doppler flowmetry from the serosal side during surgery. In normal small intestine, blood flow was measured at six points: upper, middle, and lower small intestine, each of the mesenteric borders, and the antimesenteric surface. In Crohn's disease, macroscopically normal tissue and affected lesions were observed in detail by intraoperative endoscopy after blood flow measurement. The blood flow values in the normal small intestine gradually decreased from the upper to the lower small intestine. As the level of inflammation progressed in Crohn's disease the blood flow values gradually decreased; the exudative stage of Crohn's disease (aphthoid ulcer) showed blood flow values that were slightly below those in macroscopically normal tissue. These results are the first to demonstrate decreased blood flow in affected lesions in Crohn's disease and changes in blood flow according to the degree of inflammation in vivo.     

人小肠移植术后的营养支持

目的探讨肠内外营养在移植肠功能恢复中的意义．方法研究对象为１例小肠移植患者，分别于术后２ｄ和４ｄ开始肠外及肠内营养，术后１００ｄ停止静脉营养，口服饮食维持营养．观察术后营养支持的全过程，通过Ｄ＿木糖吸收试验，氮平衡计算以及钡餐检查监测移植肠功能；通过测定体重及血清白蛋白水平监测营养状况．结果该患者营养维持良好，移植肠结构与功能恢复正常．受体体重及血清白蛋白维持于正常水平．结论合理的肠内外营养支持有利于移植肠功能的恢复．     

Warfarin-induced haemorrhagic infarction of the small bowel

Haemorrhagic infarction of the small bowel is a rare complication of warfarin therapy. We take this opportunity to report a case that needed a resection of the small bowel.     

胶囊内镜在小肠疾病诊断中的作用

目的:小肠疾病很难诊断,现有的诊断技术又不尽如人意,而胶囊内镜能发现整个小肠内的微小病变。为此,我们对胶囊内镜在小肠疾病诊断中的价值进行评估。方法:自2002年5月至2003年9月,我们对经结肠镜、胃镜、X线钡餐造影、小肠钡灌造影、血管造影或核素扫描等检查未发现异常的79例疑患小肠疾病、尤其是不明原因消化道出血的患者,进行胶囊内镜检查,其中不明原因的消化道出血患者56例。结果:75例完成最终研究。75例患者中经胶囊内镜检查共发现异常63例,检出率为84％;其中能明确解释临床病因者50例,诊断率为66.6％,包括消化道血管病变21例、小肠炎症性肠病16例、小肠息肉5例、小肠恶性间质肿瘤2例、小肠类癌1例(该患者同时伴升结肠脂肪瘤)、淋巴瘤1例、粘膜下肿瘤3例及憩室1例。所获取的图像质量良好。结论:胶囊内镜对小肠疾病尤其是不明原因消化道出血具有良好的诊断价值。     

Adenomyoma of the small intestine in an adult: a rare cause of intussusception

Received: November 24, 2000 / Accepted: April 27, 2001     

Small bowel ischaemia in Fabry's disease

Abstract A patient with previously diagnosed Fabry's disease and a long history of post-prandial abdominal pain died following small bowel infarction. Post-mortem demonstrated Fabry's type deposits in the small vessels and nerves supplying the bowel but in addition, a localized atheromatous stenosis of the superior mesenteric artery. In retrospect, his terminal illness and possibly his chronic symptoms were related to the latter finding. Angioplasty to the superior mesenteric artery may have been of benefit. Mesenteric angiography should be considered in patients with chronic post-prandial pain because large vessel disease may coexist with other a priori pathologies and is imminently treatable.     

双气囊电子镜在小肠疾病诊断与治疗中的作用

目的探讨双气囊电子镜在小肠疾病诊断和治疗中的意义。方法对116例疑似小肠疾病患者采用双气囊电子镜，观察记录检查时间、检查阳性率、诊断结果等情况。结果116例患者共确诊111例，阳性率为95．6％，其中不明原因的小肠出血占49．1％（57／116），平均用时45min。5例进行了全胃肠检查，患者可以很好的耐受检查。5例因进镜困难而放弃检查。大多数器质性疾病（除了病变部位有活动性出血）患者均有病理诊断。1例胃大部切除患者发生肠扭转造成肠梗阻，在完成检查后，完全恢复。结论双气囊电子镜能够肉眼观察全小肠，并能够得到病理诊断，对病变进行大体定位。     

Retention of nondeflating balloon in small bowel

Summary Intubation of the upper gastrointestinal tract with balloon catheters has a role in the diagnosis, treatment, and research of many gastrointestinal conditions. A potential complication of this procedure, albeit rare, is failure of the balloon to deflate, thereby preventing removal of the intestinal tube. We describe a case where this problem arose and the series of maneuvers that were attempted to resolve it. Attempts at overdistending the balloon, reaching it via endoscopy, and ultrasound localization of the balloon all failed. The tube was successfully removed following CT-guided percutaneous needle puncture of the impacted balloon. The published experience with nondeflating catheter balloons in hollow viscera has been reviewed and the suggested methods for deflation or puncture are discussed.     

Metachronous small bowel adenocarcinoma after rectal adenocarcinoma: A case report

Rationale:Small bowel adenocarcinoma (SBA), an uncommon gastrointestinal malignant tumor, is difficult to diagnose at an early stage because of its non-specific disease presentation. Metachronous SBA is a special type of SBA that is rarely reported. We herein report a case of metachronous primary SBA following resection of rectal adenocarcinoma.Patient concerns:A 65-year-old man presented to our hospital after having experienced recurrent bowel obstruction for 6 months. He had undergone a Dixon operation 30 months previously followed by adjuvant chemotherapy with capecitabine plus oxaliplatin.Diagnosis:Abdominal computed tomography showed thickened bowel walls in the right lower abdomen, and the patient was initially misdiagnosed with intestinal adhesion. After the operation, he was diagnosed with primary SBA (T3N0M0, stage IIA).Interventions:Treatment with a transnasal ileus tube was ineffective. Therefore, we performed small intestinal segmental resection and side-to-side anastomosis through open surgery.Outcomes:The patient completed all postoperative adjuvant chemotherapy, and posttreatment surveillance revealed no further abnormalities.Lessons:This case suggests that patients with colorectal adenocarcinoma may have an increased risk of metachronous SBA. Corresponding symptoms in high-risk patients should raise clinicians’ suspicion for SBA, and further detailed examinations are imperative. Early screening for SBA may help to improve the patients’ prognosis.     

Jejunitis and brown bowel syndrome with multifocal carcinogenesis of the small bowel

This is the first report describing a case where prolonged,severe malabsorption from brown bowel syndrome progressed to multifocally spread small bowel adenocarcinoma. This case involves a female patient who was initially diagnosed with chronic jejunitis associated with primary diffuse lymphangiectasia at the age of 26 years. The course of the disease was clinically,endoscopically,and histologically followed for 21 years until her death at the age 47 due to multifocal,metastasizing adenocarcinoma of the small bowel. Multiple lipofuscin deposits(so-called brown bowel syndrome) and severe jejunitis were observed microscopically,and sections of the small bowel showed dense lymphoplasmacytic infiltration of the lamina propria as well as blocked lymphatic vessels. After several decades,multifocal nests of adenocarcinoma cells and extensive,flat,neoplastic mucosal proliferations were found only in the small bowel,along with a loss of the mismatch repair protein MLH1 as a long-term consequence of chronic jejunitis with malabsorption. No evidence was found for hereditary nonpolyposis colon carcinoma syndrome. This article demonstrates for the first time multifocal carcinogenesis in the small bowel in a malabsorption syndrome in an enteritis-dysplasia-carcinoma sequence.