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Nutrition and Cancer 2015Chemotherapy-induced mucositis is characterized by inflammation and ulceration of the intestinal mucosa, compromising intestinal function. Exogenous nucleotides have...
Chemotherapy-induced mucositis is characterized by inflammation and ulceration of the intestinal mucosa, compromising intestinal function. Exogenous nucleotides have been reported to repair the mucosa. The nucleotide preparation, Nucleoforce F0328 (Nucleoforce), was investigated for its potential to ameliorate intestinal mucositis in rats. Female Dark Agouti rats (n = 8/group) were gavaged once daily with Nucleoforce (175 mg/kg) or water from Days 0 to 8 and injected (i.p.) with 5-fluorouracil (5-FU; 150 mg/kg) or saline on Day 5. Histological parameters (disease severity, crypt depth, and villus height measurements) and myeloperoxidase activity were quantified. P < 0.05 was considered significant. Jejunal and ileal histological disease severity scores were significantly increased by 5-FU, compared to normal controls (P < 0.05). Nucleoforce treatment in 5-FU-injected rats significantly reduced jejunal and ileal disease severity compared to 5-FU controls (P < 0.05). In 5-FU-injected rats, jejunal and ileal villus heights and crypt depths were significantly decreased compared to 5-FU controls, with no additional Nucleoforce effect (P > 0.05). Intestinal myeloperoxidase activity was significantly elevated by 5-FU (8.8-fold), compared to normal controls (P < 0.05), which was not normalized by Nucleoforce treatment (P > 0.05). Nucleoforce only partially improved parameters associated with experimentally-induced mucositis. Future studies could investigate increased concentrations, more frequent administration, or protective microencapsulation delivery methods, to increase bioavailability.
Topics: Animals; Female; Fluorouracil; Intestinal Mucosa; Intestine, Small; Mucositis; Nucleotides; Organ Size; Rats
PubMed: 26284427
DOI: 10.1080/01635581.2015.1062118 -
Arquivos de Gastroenterologia 2022Behçet's disease is a rare immune-mediated disorder that can affect the gastrointestinal tract. The prevalence and extension of small bowel involvement is largely...
BACKGROUND
Behçet's disease is a rare immune-mediated disorder that can affect the gastrointestinal tract. The prevalence and extension of small bowel involvement is largely unknown.
OBJECTIVE
The aim of this study was to describe the small bowel lesions diagnosed by double-balloon enteroscopy (DBE) and to verify if these findings were associated to the presence of gastrointestinal symptoms and disease activity after long-term follow-up.
METHODS
This study included 19 Behçet's disease patients who underwent DBE. After a mean follow-up of 15 years the endoscopic findings were associated to the presence of gastrointestinal symptoms, disease activity and current therapy through collection of electronic medical records.
RESULTS
A total of 63.2% patients were female and the mean age was 37 years at the time of DBE. Mean disease duration at baseline was 24 years. 11 patients had no gastrointestinal symptoms and eight patients presented either abdominal pain, gastrointestinal bleeding or diarrhea. The average procedure time was 1 hour and 30 minutes and the ileum was achieved in all patients but one. Small bowel ulcers were diagnosed in 78.9%, with 63.1% of jejunal involvement. Two patients presented only small bowel edema and two were normal by DBE. Eight patients had concomitant gastric ulcers. Gastrointestinal symptoms prior to DBE were present in 36.8% of the patients and, after follow-up, all of them persisted with some of the symptoms. Bleeding was reported by three patients at baseline and persisted in only one patient. The frequency of treatment with steroids and immunomodulators was 31.6% and 57.9% at baseline, respectively, and 21% in both at the end of the follow-up. No patient was treated with biologics at the time of the DBE procedure and the current rate of biologic use is 21%.
CONCLUSION
Small bowel involvement in Behçet's disease was frequently demonstrated by DBE even in asymptomatic patients. Understanding clinical evolution of the disease over the years and the impact of such diagnosis still represents a challenge, possibly with the need for novel treatment.
Topics: Adult; Behcet Syndrome; Double-Balloon Enteroscopy; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Male; Retrospective Studies
PubMed: 35442321
DOI: 10.1590/S0004-2803.202200001-20 -
World Journal of Gastroenterology Nov 2015To report the outcome of surgery in patients with (pre)malignant conditions of celiac disease (CD) and the impact on survival. (Comparative Study)
Comparative Study
AIM
To report the outcome of surgery in patients with (pre)malignant conditions of celiac disease (CD) and the impact on survival.
METHODS
A total of 40 patients with (pre)malignant conditions of CD, ulcerative jejunitis (n = 5) and enteropathy associated T-cell lymphoma (EATL) (n = 35), who underwent surgery between 2002 and 2013 were retrospectively evaluated. Data on indications, operative procedure, post-operative morbidity and mortality, adjuvant therapy and overall survival (OS) were collected. Eleven patients with EATL who underwent chemotherapy without resection were included as a control group for survival analysis. Patients were followed-up every three months during the first year and at 6-mo intervals thereafter.
RESULTS
Mean age at resection was 62 years. The majority of patients (63%) underwent elective laparotomy. Functional stenosis (n = 13) and perforation (n = 12) were the major indications for surgery. In 70% of patients radical resection was performed. Early postoperative complications, mainly due to leakage or sepsis, occurred in 14/40 (35%) of patients. Eight patients required reoperation. More patients who underwent resection in the acute setting (n = 3, 20%) died compared to patients treated in the elective setting. With a median follow-up of 20 mo, seven patients (18%) required reoperation due to long-term complications. Significantly more patients who underwent acute surgery could not be treated with adjuvant chemotherapy. Patients who first underwent surgical resection showed significantly better OS than patients who received chemotherapy without resection.
CONCLUSION
Although the complication rate is high, the preferred first step of treatment in (pre)malignant CD consists of local resection as early as possible to improve survival.
Topics: Aged; Antineoplastic Agents; Celiac Disease; Chemotherapy, Adjuvant; Digestive System Surgical Procedures; Elective Surgical Procedures; Enteropathy-Associated T-Cell Lymphoma; Female; Humans; Intestinal Neoplasms; Kaplan-Meier Estimate; Male; Middle Aged; Netherlands; Postoperative Complications; Precancerous Conditions; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26604647
DOI: 10.3748/wjg.v21.i43.12403 -
BMC Surgery Apr 2020Perforation of a marginal peptic ulcer after pancreaticoduodenectomy (PD) can lead to severe conditions, although its clinical features have not been well reported. In...
BACKGROUND
Perforation of a marginal peptic ulcer after pancreaticoduodenectomy (PD) can lead to severe conditions, although its clinical features have not been well reported. In this article, we present three cases of marginal peptic ulcer perforation after PD that we experienced in our institute and attempt to clarify its appropriate treatment and prevention.
CASE PRESENTATION
Marginal ulcer perforation confirmed with computed tomography and/or surgical exploration occurred in 3 (1.8%) of 163 consecutive patients who underwent PD (including 160 patients who underwent a total or subtotal stomach-preserving procedure) at our institution. The three patients (one man and two women) had a median age of 77 (65-79) years. Two of these patients had a medical history of duodenal peptic ulcer. All three patients had biliary neoplasms. Two of the patients underwent subtotal stomach-preserving PD with antro-jejunal anastomosis, and the other patient underwent pylorus-preserving PD with duodenal jejunostomy. The perforation occurred with a sudden and severe onset of abdominal pain 34, 94, and 1204 days, respectively, after the PDs. At the time of the perforation, all of the patients had been withdrawn from postoperative prophylactic antipeptic ulcer agents, with the cessation periods ranging from 12 to 1008 days. In addition, all the patients were in fasting conditions for 1 to 13 days just before the perforation. Surgical treatment with direct suturing of the perforated ulcer was performed for two patients, while conservative therapy was performed for one patient. Their primary treatment courses were satisfactory. Chronic antisecretory agent therapy was prescribed for 562, 271, and 2370 days, respectively, from marginal ulcer perforation, and no ulcer recurrence was noted in any of the patients.
CONCLUSIONS
Lack of antisecretory therapy and fasting were considered an essential cause of marginal peptic ulcer perforation after PD. In addition, unlike the native duodenum, the jejunal limb used for reconstruction to a preserved stomach may be at increased risk of ulceration. Chronic permanent administration of antisecretory agents and fasting avoidance are desirable for patients who have undergone stomach-preserving PD to prevent marginal ulcer perforation.
Topics: Aged; Anastomosis, Surgical; Duodenal Ulcer; Female; Humans; Male; Pancreaticoduodenectomy; Peptic Ulcer; Peptic Ulcer Perforation; Postoperative Period
PubMed: 32306934
DOI: 10.1186/s12893-020-00743-6 -
BioMed Research International 2019This study aims to delineate the effects of Linn. (Sapodilla) fruit chloroform (Mz.CHCl) and aqueous (Mz.Aq) extracts tested through different techniques. Antidiarrheal...
This study aims to delineate the effects of Linn. (Sapodilla) fruit chloroform (Mz.CHCl) and aqueous (Mz.Aq) extracts tested through different techniques. Antidiarrheal activity and intestinal fluid accumulation were examined by using castor oil-induced diarrhea and castor oil fluid accumulation models. Isolated rabbit jejunum tissues were employed for in vitro experiments. Antimotility and antiulcer were performed through charcoal meal transient time and ethanol-induced ulcer assay, molecular studies were conducted through proteomic analysis, and virtual screening was performed by using a discovery studio visualizer (DSV). Mz.CHCl and Mz.Aq extracts attributed dose-dependent (50-300 mg/kg) protection (20-100%) against castor oil-induced diarrhea and dose-dependently (50-300 mg/kg) inhibited intestinal fluid secretions in mice. Mz.CHCl and Mz.Aq extracts produce relaxation of spontaneous and K (80 Mm) induced contractions in isolated tissue preparations and decreased the distance moved by charcoal in the gastrointestinal transit model in rats. It showed gastroprotective effect in ulcerative stomach of rats and decreased levels of IL-18 quantified by proteomic analysis. Histopathological results showed ethanol-induced significant gastric injury, leading to cloudy swelling, hydropic degeneration, apoptosis, and focal necrosis in all gastric zones using hematoxylin and eosin (H&E) staining. Moreover, ethanol increased the activation and the expression of tumor necrotic factor (TNF-), cyclooxygenase (COX-2), and nuclear factor kappa-light-chain-enhancer of activated B cells (p-NFB). In silico results were comparative to in vitro results evaluated through virtual screening. Moreover, ethanol increased the activation and expression of tumor necrotic factor, cyclooxygenase, and nuclear factor kappa-light-chain-enhancer of activated B cells. This study exhibits the gastroprotective effect of extracts in the peritoneal cavity using a proteomic and in silico approach which reveals different energy values against target proteins, which mediate the gastrointestinal functions.
Topics: Animals; Antidiarrheals; Castor Oil; Diarrhea; Gene Expression Regulation; Manilkara; Mice; Mice, Inbred BALB C; Plant Extracts; Proteome; Proteomics; Rabbits; Rats; Rats, Sprague-Dawley; Stomach Ulcer
PubMed: 31886219
DOI: 10.1155/2019/4921086 -
World Journal of Gastrointestinal... Jun 2023Small bowel diverticula are rare in clinics, and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early. The true incidence of these...
BACKGROUND
Small bowel diverticula are rare in clinics, and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early. The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes. It is common in the elderly, although it can occur at any age.
CASE SUMMARY
This is a case report of a 78-year-old man with epigastric pain for 5 d. Conservative treatment does not effectively relieve pain, inflammatory indicators are elevated, and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall. Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous, the jejunum mass at the near Flex ligament was palpable, the size was about 7 cm × 8 cm, the local movement was slight, and the diverticulum was seen 10 cm downward, and the local small intestine was dilated and edema. Segmentectomy was performed. After the short parenteral nutrition after surgery, the fluid and enteral nutrition solution were pumped through the jejunostomy tube, and the patient was discharged after the treatment was stable, and the jejunostomy tube was removed in an outpatient clinic one month after the operation. Postoperative pathology: Jejunectomy specimen: (1) Small intestinal diverticulum with chronic inflammation, ulcer with full-thickness activity, and necrosis of the intestinal wall in some areas; (2) also see that the hard object is consistent with stone changes; and (3) the incision margin on both sides shows chronic inflammation of mucosal tissue.
CONCLUSION
Clinically, the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception. Combined with the patient's condition, rule out other possibilities after a timely disease diagnosis. According to the patient's body tolerance adopt personalized surgical methods to achieve better recovery after surgery.
PubMed: 37405091
DOI: 10.4240/wjgs.v15.i6.1256 -
Clinical & Experimental Pharmacology 2016Breast feeding protects infants from many diseases, including necrotizing enterocolitis, peptic ulceration and infectious diarrhea. Conversely, maternal separation...
OBJECTIVES
Breast feeding protects infants from many diseases, including necrotizing enterocolitis, peptic ulceration and infectious diarrhea. Conversely, maternal separation stress and Non-Steroidal Anti-Inflammatory Drugs (NSAID's) can induce intestinal injury and bleeding. This study aimed to evaluate in suckling rats if maternal separation/formula feeding leads to increased intestinal sensitivity to indomethacin (indo)-induced intestinal injury and to look at potential mechanisms involved.
METHODS
Nine-day-old rats were dam-fed or separated/trained to formula-feed for 6 days prior to indo administration (5 mg/kg/day) or saline (control) for 3 days. Intestinal bleeding and injury were assessed by measuring luminal and Fecal Hemoglobin (Hob) and jejunal histology. Maturation of the intestine was assessed by measuring luminal bile acids, jejunal sucrase, serum corticosterone, and mRNA expression of ileal Apical Sodium-Dependent Bile Acid Transporter (ASBT).
RESULTS
At 17 days, formula-fed indo-treated pups had a 2-fold increase in luminal Hb compared to formula-fed control pups and had evidence of morphological injury to the small intestinal mucosa as observed at the light microscopic level, whereas indo had no effect on dam-fed littermates. In addition, formula-fed rats had significant increases in luminal bile acid, sucrase specific activity, serum corticosterone, and expression of ASBT mRNA compared to dam-fed rats.
CONCLUSION
Maternal separation stress may cause early intestinal maturational changes induced by corticosteroid release, including increased epithelial exposure to bile acids. These maturational changes may have a sensitizing rather than protective effect against indo-induced injury in the new-born.
PubMed: 31565540
DOI: 10.4172/2161-1459.1000222 -
Frontiers in Bioscience (Landmark... Jun 2018A useful animal model of intestinal injury is pivotal for studying its pathogenesis and developing nutritional interventions (e.g., amino acid supplementation). Here, we...
A useful animal model of intestinal injury is pivotal for studying its pathogenesis and developing nutritional interventions (e.g., amino acid supplementation). Here, we propose the use of indomethacin (IDMT) to induce intestinal inflammation in neonatal pigs. Fourteen-day-old piglets fed a milk replacer diet receive intraperitoneal administration of IDMT (5 mg/kg body weight) for 3 consecutive days. On day 4, blood and intestinal samples are obtained for physiological and biochemical analyses. IDMT increases blood DAO activity, I-FABP concentration, neutrophil and eosinophil numbers; intestinal MMP3 mRNA levels, MPO activity, and MDA concentration; but reduces the plasma concentration of citrulline (synthesized exclusively by enterocytes of the small intestine), intestinal GSH-Px activity, and mRNA levels for , , , , and . Moreover, extensive hemorrhagic spots, thinned intestinal wall, and ulcers in the distal jejunum and ileum are observed in IDMT-challenged piglets. Furthermore, IDMT decreases intestinal villus height and villus surface area in the piglet jejunum. Collectively, this work establishes a porcine model of intestinal injury for designing novel nutritional means to improve gut function in pigs and humans.
Topics: Animals; Animals, Newborn; Disease Models, Animal; Enterocytes; Fatty Acid-Binding Proteins; Gene Expression Regulation; Humans; Indomethacin; Intestinal Diseases; Intestine, Small; Malondialdehyde; Microfilament Proteins; Potassium Channels, Inwardly Rectifying; Swine; TRPV Cation Channels
PubMed: 29772553
DOI: 10.2741/4697 -
International Journal of Surgery Case... Dec 2021Adenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical...
INTRODUCTION AND IMPORTANCE
Adenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical symptoms. On the other hand, the Sister Mary Joseph's nodule is a rare clinical sign that refers to umbilical metastasis of an internal malignancy. We here report a rare case of jejunal adenocarcinoma revealed by a Sister Mary Joseph's nodule.
CASE PRESENTATION
A 55-year-old man presented with an ulcerated umbilical tumor, which was found to be a secondary lesion of an advanced jejunal adenocarcinoma invading the transverse colon. He underwent surgical resection of the umbilical tumor and the intestinal primitive.
CLINICAL DISCUSSION
The presence of umbilical metastasis usually represents advanced disease but can be its first manifestation. Gastro-intestinal tract tumors such as jejunal adenocarcinomas and gynecologic malignancies are the most common primary sites.
CONCLUSION
Practicians must be aware of clinical implication of Sister Mary Joseph nodule. Aggressive surgery when feasible can be beneficial for survival.
PubMed: 34861547
DOI: 10.1016/j.ijscr.2021.106620 -
Annals of the Royal College of Surgeons... Jan 2016We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the...
We report the case of an 18-year-old female patient with no past medical history who presented to the emergency department with acute abdominal pain and vomiting on the background of a long history of ingesting hair (trichophagia). Computed tomography revealed pneumoperitoneum and free fluid in keeping with visceral perforation. In addition, a large hair bolus was seen extending in contiguity from the stomach to the jejunum. A laparotomy was performed, revealing an anterior gastric perforation secondary to a 120cm long trichobezoar, which had formed a cast of the entire stomach, duodenum and proximal jejunum. The bezoar was removed and an omental patch repair to the anterior ulcer was performed. The patient made an excellent postoperative recovery and was discharged home with psychiatric follow-up review.
Topics: Adolescent; Bezoars; Diagnosis, Differential; Female; Hair; Humans; Laparotomy; Stomach; Stomach Rupture; Syndrome; Tomography, X-Ray Computed; Trichotillomania
PubMed: 26688419
DOI: 10.1308/rcsann.2016.0008