Necrotizing Enterocolitis: Using Regulatory Science and Drug Development to Improve Outcomes
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Clinical Cases of Crohn's Disease in Pediatric Hirschprung's Patients
Open Access Austin Journal of Gastroenterology Case Report Clinical Cases of Crohn‘s Disease in Pediatric Hirschprung‘s Patients Cerniauskaite R1, Statkuviene J2, Labanauskas L2, Urbonas V3, Bagdzevicius S4, Adamonis K5, Abstract Rokaite R2, Janciauskas D6 and Kucinskiene R2* Crohn’s and Hirschsprung’s diseases are two different conditions of 1Department of Radiology, Vilnius University Hospital intestinal tract though both of them are genetically predisposed. Each disease Santariskiu Clinics, Lithuania have genetic mutations in some genes, however there are no evidence that 2Department of Pediatric gastroenterology, Hospital of there are mutations common to both conditions. Lithuanian University of Health Sciences, Lithuania 3Department of Pediatric gastroenterology, Vilnius We present 3 clinical cases of patients who underwent surgery in infancy University Hospital Santariskiu Clinics, Lithuania for Hirschsprung’s disease. Later in early childhood all the patients developed 4Department of Pediatric surgery, Hospital of Lithuanian clinical symptoms of inflammatory bowel disease and Crohn’s disease was University of Health Sciences, Lithuania diagnosed. Both conditions were confirmed histologically. After introducing the 5Department of Gastroenterology, Hospital of Lithuanian treatment for Crohn’s disease positive effect was shown. These cases raise University of Health Sciences, Lithuania the hypothesis that the two conditions may have similarities in etiology and 6Department of Pathology, Hospital of Lithuanian pathogenesis and may -
Intestinal Obstruction
Intestinal obstruction Prof. Marek Jackowski Definition • Any condition interferes with normal propulsion and passage of intestinal contents. • Can involve the small bowel, colon or both small and colon as in generalized ileus. Definitions 5% of all acute surgical admissions Patients are often extremely ill requiring prompt assessment, resuscitation and intensive monitoring Obstruction a mechanical blockage arising from a structural abnormality that presents a physical barrier to the progression of gut contents. Ileus a paralytic or functional variety of obstruction Obstruction: Partial or complete Simple or strangulated Epidemiology 1 % of all hospitalization 3-5 % of emergency surgical admissions More frequent in female patients - gynecological and pelvic surgical operations are important etiologies for postop. adhesions Adhesion is the most common cause of intestinal obstruction 80% of bowel obstruction due to small bowel obstruction - the most common causes are: - Adhesion - Hernia - Neoplasm 20% due to colon obstruction - the most common cause: - CR-cancer 60-70%, - diverticular disease and volvulus - 30% Mortality rate range between 3% for simple bowel obstruction to 30% when there is strangulation or perforation Recurrent rate vary according to method of treatment ; - conservative 12% - surgical treatment 8-32% Classification • Cause of obstruction: mechanical or functional. • Duration of obstruction: acute or chronic. • Extent of obstruction: partial or complete • Type of obstruction: simple or complex (closed loop and strangulation). CLASSIFICATION DYNAMIC ADYNAMIC (MECHANICAL) (FUNCTIONAL) Peristalsis is Result from atony of working against a the intestine with loss mechanical of normal peristalsis, obstruction in the absence of a mechanical cause. or it may be present in a non-propulsive form (e.g. mesenteric vascular occlusion or pseudo-obstruction) Etiology Mechanical bowel obstruction: A. -
Necrotizing Enterocolitis: Intraluminal Biochemistry in Human Neonates and a Rabbit Model
003 1-3998/85/ 1909-09 19$02.00/0 PEDIATRIC RESEARCH Vol. 19, No. 9, 1985 Copyright O 1985 International Ped~atncResearch Foundation, Inc. Prinrc~din U.S/1 Necrotizing Enterocolitis: Intraluminal Biochemistry in Human Neonates and a Rabbit Model DAVID A. CLARK. JEFFREY E. THOMPSON. LEONARD B. WEINER, JULIA A. McMILLAN, ALBERT J. SCHNEIDER, AND JOHN E. ROKAHR Dcy~crriincnio/'Pcdiarric.s. SU/L'Y, Ill,.siutc Meclrcul Cmtcr, Syrucir.cc, NPW York ABSTRACT. The intestinal contents of 17 neonates with amined the intestinal contents of preterm infants with severe necrotizing enterocolitis were analyzed for pH, carbohy- necrotizing enterocolitis. The low intraluminal pH and high drate, protein, and bacteria. The intraluminal pH was 4.0 protein content in the intestines of these neonates led us to (16117). Sufficient carbohydrate and bacteria capable of examine the variables of pH and protein in a rabbit intestinal fermenting the carbohydrate to organic acids were found. loop model. The intraluminal protein content was >S g/dl. The varia- bles of acid and protein were then examined in a rabbit intestinal loop model. The hemorrhagic response in indi- MATERIALS AND METHODS vidual loops was measured using Cr5' tagged red blood Nronute.~.We obtained the intestinal contents at or adjacent cells such that the microliters of blood per centimeter to the site of perforation or necrosis in 17 infants requiring intestine could be determined. Loops with organic acid and surgical removal of the intestine for advanced necrotizing enter- protein had significantly (p < 0.01) more intramural blood ocolitis. The intestinal contents were analyzed for blood, pH, than control loops. -
Acute Gastroenteritis
Article gastrointestinal disorders Acute Gastroenteritis Deise Granado-Villar, MD, Educational Gap MPH,* Beatriz Cunill-De Sautu, MD,† Andrea In managing acute diarrhea in children, clinicians need to be aware that management Granados, MDx based on “bowel rest” is outdated, and instead reinstitution of an appropriate diet has been associated with decreased stool volume and duration of diarrhea. In general, drug therapy is not indicated in managing diarrhea in children, although zinc supplementation Author Disclosure and probiotic use show promise. Drs Granado-Villar, Cunill-De Sautu, and Objectives After reading this article, readers should be able to: Granados have disclosed no financial 1. Recognize the electrolyte changes associated with isotonic dehydration. relationships relevant 2. Effectively manage a child who has isotonic dehydration. to this article. This 3. Understand the importance of early feedings on the nutritional status of a child who commentary does has gastroenteritis. contain a discussion of 4. Fully understand that antidiarrheal agents are not indicated nor recommended in the an unapproved/ treatment of acute gastroenteritis in children. investigative use of 5. Recognize the role of vomiting in the clinical presentation of acute gastroenteritis. a commercial product/ device. Introduction Acute gastroenteritis is an extremely common illness among infants and children world- wide. According to the Centers for Disease Control and Prevention (CDC), acute diarrhea among children in the United States accounts for more than 1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths per year. In developing countries, diarrhea is a common cause of mortality among children younger than age 5 years, with an estimated 2 million deaths each year. -
Diagnostic Imaging Features of Necrotizing Enterocolitis: a Narrative Review
Review Article Diagnostic imaging features of necrotizing enterocolitis: a narrative review Francesco Esposito1, Rosanna Mamone1, Marco Di Serafino2, Carmela Mercogliano3, Valerio Vitale4, Gianfranco Vallone5, Patrizia Oresta1 1Department of Radiology, Santobono-Pausilipon Children Hospital, Naples; Italy; 2Department of Emergency Radiology, 3Department of Neonatology, San Carlo Hospital, Potenza; Italy; 4Department of Imaging and Radiation therapy, Azienda Socio-Sanitaria Territoriale di Lecco, A. Manzoni Hospital, Lecco, Italy; 5Department of Radiology, Section of Pediatric Diagnostics, University Hospital “Federico II”, Naples, Italy Correspondence to: Dr. Francesco Esposito. Santobono Hospital, Via M. Fiore, 6, 80100 Napoli, Naples, Italy. Email: [email protected]. Abstract: Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation -
Gallstone Ileus As an Unexpected Complication of Cholelithiasis: Diagnostic Difficulties and Treatment
Turkish Journal of Trauma & Emergency Surgery Ulus Travma Acil Cerrahi Derg 2010;16 (4):344-348 Original Article Klinik Çalışma Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment Kolelitiazisin beklenmedik komplikasyonu, safra taşı ileusu: Tanı zorlukları ve tedavi Savaş YAKAN,1 Ömer ENGİN,1 Tahsin TEKELİ,1 Bülent ÇALIK,2 Ali Galip DENEÇLİ,1 Ahmet ÇOKER,3 Mustafa HARMAN4 BACKGROUND AMAÇ Gallstone ileus is a rare complication of cholelithiasis, Safra taşı ileusu safra taşı hastalığının nadir ve genelde mostly in the elderly. The aim of this study was to evaluate yaşlılarda görülen bir komplikasyonudur. Çalışmamızın our experience with 12 gallstone ileus cases and discuss amacı safra taşı ileusu tanısı alan 12 hastayla ilgili dene- current opinion as reported in the literature. yimimizi değerlendirmek ve güncel literatür eşliğinde tar- tışmaktır. METHODS Data of 12 patients operated between January 1998 and GEREÇ VE YÖNTEM January 2008 with gallstone ileus were retrospectively Kliniğimizde Ocak 1998-2008 yılları arasında safra taşı ile- studied. usu nedeniyle ameliyat edilen 12 olgunun dosyaları retros- pektif olarak incelendi. RESULTS There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age BULGULAR of 63.6 (50-80) years. Median duration of symptoms before Hastaların 9’u (%75) kadın, 3’ü (%25) erkek olup orta- admission to the hospital was 4.1 (1-15) days. Preoperative lama yaş 63,6 idi (dağılım, 50-80). Semptomların başla- diagnosis was made in only five cases (41.6%). Enteroli- masından hastaneye başvurmaya kadar geçen süre ortala- thotomy was done in nine cases (75%). Enterolithotomy and ma 4,1 (dağılım, 1-15) gün bulundu. -
Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms
nutrients Review Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms Annamaria Altomare 1,2 , Claudia Di Rosa 2,*, Elena Imperia 2, Sara Emerenziani 1, Michele Cicala 1 and Michele Pier Luca Guarino 1 1 Gastroenterology Unit, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; [email protected] (A.A.); [email protected] (S.E.); [email protected] (M.C.); [email protected] (M.P.L.G.) 2 Unit of Food Science and Human Nutrition, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy; [email protected] * Correspondence: [email protected] Abstract: Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder charac- terized by abdominal pain associated with defecation or a change in bowel habits. Gut microbiota, which acts as a real organ with well-defined functions, is in a mutualistic relationship with the host, harvesting additional energy and nutrients from the diet and protecting the host from pathogens; specific alterations in its composition seem to play a crucial role in IBS pathophysiology. It is well known that diet can significantly modulate the intestinal microbiota profile but it is less known how different nutritional approach effective in IBS patients, such as the low-FODMAP diet, could be Citation: Altomare, A.; Di Rosa, C.; responsible of intestinal microbiota changes, thus influencing the presence of gastrointestinal (GI) Imperia, E.; Emerenziani, S.; Cicala, symptoms. The aim of this review was to explore the effects of different nutritional protocols (e.g., M.; Guarino, M.P.L. -
Mastocytic Enterocolitis
Patient Counseling Report MASTOCYTIC ENTEROCOLITIS WHAT IS MASTOCYTIC ENTEROCOLITIS? Mastocytic enterocolitis is a disease of the colon, or large intestine that is caused by an increased number of mast cells in the lining of the colon. It is believed that this increased number of mast cells is caused by a form of immune response by the gastrointestinal tract. This allergic response then causes a physical response by the body which results in diarrhea and abdominal pain. Previously, Mastocytic Enterocolitis was classifed as diarrhea-predominant irritable bowel syndrome (IBS) due to the fact that there was not a more specific diagnosis. With this diagnosis, a more specific treatment regimen can be offered with the hope of relieving symptoms. Mastocytic Enterocolitis affects patients as young as 16 and has been documented in patients as old as 85. Mastocytic Enterocolitis is not associated with an increased risk for cancer and patients diagnosed with this disease usually have a normal endoscopy and normal endoscopic findings. HOW IS MASTOCYTIC ENTEROCOLITIS DIAGNOSED? The goal of treatment is to try and reduce the number of mast cells During your endoscopy procedure, tissue biopsies were taken and sent to in the colon and relieve symptoms like abdominal pain, diarrhea, a specialized gastrointestinal pathology laboratory. At the laboratory, and weight loss. Most individuals respond well to treatment and see a special stain was utilized to highlight the mast cells in your tissue. a relatively dramatic reduction in their symptoms. Unfortunately, The special stain revealed that the number of mast cells in your tissue was treatment may not always work for patients and you and your doctor abnormally high and therefore you were diagnosed with Mastocytic may need to find another treatment regimen that can be successful for Enterocolitis. -
Ileus with Hypothyroidism
Ileus With Hypothyroidism Mason Thompson, MD, and Paul M. Fischer, MD Augusta, G eorgia he symptoms of constipation and gaseous disten vealed no signs of hypothyroidism except for a flat T sion are often seen in patients with hypothy affect. These studies showed a free thyroxine (T4) level roidism and are evidence of diminished bowel motility. of 4.7 /xg/mL and a thyroid-stimulating hormone (TSH) In its extreme this problem can result in an acute ileus level of 41.1 /uU/mL. or “pseudo-obstruction.” 1 This dramatic presentation She was placed on L-thyroxine and had no further may be the first indication to the clinician that the difficulty with ileus. Her L-thyroxine was unfortu patient is hypothyroid. This report describes two cases nately omitted approximately one year later for a of myxedema ileus with unusual presentations and re period of 19 days during an admission to the psychiat views the literature on this condition. ric floor. During this period she developed symptoms of acute hypothyroidism manifested by massive edema, shortness of breath, and lethargy. A TSH read CASE R E P O R TS ing was later reported to be greater than 50 /uU/mL during this acute withdrawal period prior to restarting CASE 1 the L-thyroxine. These symptoms promptly abated A previously healthy 48-year-old woman was admitted after restarting her thyroid medication. for lower abdominal pain. An ultrasound examination revealed a cystic mass in the left pelvis, which was felt CASE 2 to be an ovarian remnant resulting from a previous abdominal hysterectomy and a bilateral salpingo- A 48-year-old woman presented with a 36-hour history oophorectomy. -
The Entire Intestinal Tract Surveillance Using Capsule Endoscopy After Immune Checkpoint Inhibitor Administration: a Prospective Observational Study
diagnostics Article The Entire Intestinal Tract Surveillance Using Capsule Endoscopy after Immune Checkpoint Inhibitor Administration: A Prospective Observational Study Keitaro Shimozaki 1 , Kenro Hirata 1,* , Sara Horie 1, Akihiko Chida 1, Kai Tsugaru 1, Yukie Hayashi 1, Kenta Kawasaki 1, Ryoichi Miyanaga 1, Hideyuki Hayashi 2 , Ryuichi Mizuno 3, Takeru Funakoshi 4, Naoki Hosoe 5, Yasuo Hamamoto 2 and Takanori Kanai 1 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] (K.S.); [email protected] (S.H.); [email protected] (A.C.); [email protected] (K.T.); [email protected] (Y.H.); [email protected] (K.K.); [email protected] (R.M.); [email protected] (T.K.) 2 Keio Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] (H.H.); [email protected] (Y.H.) 3 Department of Urology, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] 4 Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] 5 Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo 160-8582, Japan; [email protected] * Correspondence: [email protected]; Tel.: +81-3-3353-1211 Citation: Shimozaki, K.; Hirata, K.; Abstract: Background: Despite the proven efficacy of immune checkpoint inhibitors (ICIs) against Horie, S.; Chida, A.; Tsugaru, K.; various types of malignancies, they have been found to induce immune-related adverse events, such Hayashi, Y.; Kawasaki, K.; Miyanaga, as enterocolitis; however, the clinical features of ICI-induced enterocolitis remain to be sufficiently R.; Hayashi, H.; Mizuno, R.; et al. -
Resveratrol Alleviates Acute Campylobacter Jejuni Induced Enterocolitis in a Preclinical Murine Intervention Study
microorganisms Article Resveratrol Alleviates Acute Campylobacter jejuni Induced Enterocolitis in a Preclinical Murine Intervention Study Markus M. Heimesaat 1,* , Soraya Mousavi 1, Ulrike Escher 1,Fábia Daniela Lobo de Sá 2 , Elisa Peh 3 , Jörg-Dieter Schulzke 2 , Sophie Kittler 3, Roland Bücker 2 and Stefan Bereswill 1 1 Institute of Microbiology, Infectious Diseases and Immunology, Charité—University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; [email protected] (S.M.); [email protected] (U.E.); [email protected] (S.B.) 2 Institute of Clinical Physiology, Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; [email protected] (F.D.L.d.S.); [email protected] (J.-D.S.); [email protected] (R.B.) 3 Institute for Food Quality and Food Safety, University of Veterinary Medicine Hannover, Foundation, 30559 Hannover, Germany; [email protected] (E.P.); [email protected] (S.K.) * Correspondence: [email protected]; Tel.: +49-30-450524318 Received: 7 October 2020; Accepted: 23 November 2020; Published: 25 November 2020 Abstract: The polyphenolic compound resveratrol has been shown to exert health-beneficial properties. Given globally emerging Campylobacter infections in humans, we addressed potential anti-pathogenic, immuno-modulatory and intestinal epithelial barrier preserving properties of synthetic resveratrol in the present preclinical intervention study applying a murine acute campylobacteriosis model. / Two days following peroral C. jejuni infection, secondary abiotic IL-10− − mice were either subjected to resveratrol or placebo via the drinking water. -
Pdf (30 November 2019, Date Last Accessed)
Gastroenterology Report, 8(1), 2020, 25–30 doi: 10.1093/gastro/goz065 Advance Access Publication Date: 17 December 2019 Review REVIEW Gastrointestinal adverse events associated with immune checkpoint inhibitor therapy Eva Rajha1, Patrick Chaftari1,*, Mona Kamal1, Julian Maamari2, Christopher Chaftari3, Sai-Ching Jim Yeung1 1Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Schoool of Medicine, Lebanese American University, Byblos, Lebanon; 3Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA *Corresponding author. Department of Emergency Medicine, Unit 1468, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: þ1-832-833-1702; Email: [email protected] Abstract Immunotherapy with checkpoint inhibitors has revolutionized cancer therapy and is now the standard treatment for several different types of cancer, supported by favorable outcomes and good tolerance. However, it is linked to multiple immune manifestations, referred to as immune-related adverse events (irAEs). These adverse events frequently affect the skin, colon, endocrine glands, lungs, and liver. The gastrointestinal system is one of the most commonly affected organ sys- tems and is responsible for the most frequent emergency visits resulting from irAEs. However, because immune checkpoint inhibitors are a recent addition to our arsenal of cancer drugs, many health-care providers remain unfamiliar with the management of irAEs. Gastroenterologists involved in the treatment of oncology patients who have received checkpoint inhibitors are currently encountering cases of abdominal pain, diarrhea, and other nonspecific symptoms that may be challenging to manage. This article reviews the gastrointestinal, hepatic, and pancreatic toxicities of checkpoint inhibitors and provides an approach to their diagnosis and recommended workup.