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JNMA; Journal of the Nepal Medical... Apr 2023Adhesion is a leading cause of small bowel obstruction. Adhesive small bowel obstruction has significant challenges in diagnosis, treatment and prevention with... (Review)
Review
UNLABELLED
Adhesion is a leading cause of small bowel obstruction. Adhesive small bowel obstruction has significant challenges in diagnosis, treatment and prevention with considerable impact on morbidity and socioeconomic burden. Small bowel obstruction caused by adhesion or any other aetiology is clinically indistinguishable due to similar clinical presentation. Computed Tomography scans and water-soluble contrast studies are more specific in diagnosis and possess value in predicting the need for surgery. Surgical management is indicated only in complicated cases or failed conservative treatments with the majority resolving with non-operative management. However, there is no clear-cut consensus about the timing of operative intervention. Meticulous surgical practice is the keystone in preventing adhesion formation despite the availability of numerous pharmacological and surgical strategies. This review aims to update the current knowledge of the pathophysiology of adhesion formation, treatment options and various prevention modalities of adhesive small bowel obstruction.
KEYWORDS
diagnosis; laparotomy; prevention; surgery.
Topics: Humans; Intestinal Obstruction; Tissue Adhesions; Contrast Media; Intestine, Small; Conservative Treatment
PubMed: 37208871
DOI: 10.31729/jnma.8134 -
International Journal of Molecular... Oct 2021Intestinal epithelial cells (IECs) are crucial for the digestive process and nutrient absorption. The intestinal epithelium is composed of the different cell types of... (Review)
Review
Intestinal epithelial cells (IECs) are crucial for the digestive process and nutrient absorption. The intestinal epithelium is composed of the different cell types of the small intestine (mainly, enterocytes, goblet cells, Paneth cells, enteroendocrine cells, and tuft cells). The small intestine is characterized by the presence of crypt-villus units that are in a state of homeostatic cell turnover. Organoid technology enables an efficient expansion of intestinal epithelial tissue in vitro. Thus, organoids hold great promise for use in medical research and in the development of new treatments. At present, the cholinergic system involved in IECs and intestinal stem cells (ISCs) are attracting a great deal of attention. Thus, understanding the biological processes triggered by epithelial cholinergic activation by acetylcholine (ACh), which is produced and released from neuronal and/or non-neuronal tissue, is of key importance. Cholinergic signaling via ACh receptors plays a pivotal role in IEC growth and differentiation. Here, we discuss current views on neuronal innervation and non-neuronal control of the small intestinal crypts and their impact on ISC proliferation, differentiation, and maintenance. Since technology using intestinal organoid culture systems is advancing, we also outline an organoid-based organ replacement approach for intestinal diseases.
Topics: Acetylcholine; Animals; Cell Culture Techniques; Cell Differentiation; Cell Proliferation; Intestinal Mucosa; Intestine, Small; Models, Biological; Organoids; Receptors, Cholinergic; Stem Cells
PubMed: 34681571
DOI: 10.3390/ijms222010912 -
Cell Host & Microbe Apr 2018The gut microbiota play important roles in lipid metabolism and absorption. However, the contribution of the small bowel microbiota of mammals to these diet-microbe...
The gut microbiota play important roles in lipid metabolism and absorption. However, the contribution of the small bowel microbiota of mammals to these diet-microbe interactions remains unclear. We determine that germ-free (GF) mice are resistant to diet-induced obesity and malabsorb fat with specifically impaired lipid digestion and absorption within the small intestine. Small bowel microbes are essential for host adaptation to dietary lipid changes by regulating gut epithelial processes involved in their digestion and absorption. In addition, GF mice conventionalized with high-fat diet-induced jejunal microbiota exhibit increased lipid absorption even when fed a low-fat diet. Conditioned media from specific bacterial strains directly upregulate lipid absorption genes in murine proximal small intestinal epithelial organoids. These findings indicate that proximal gut microbiota play key roles in host adaptability to dietary lipid variations through mechanisms involving both the digestive and absorptive phases and that these functions may contribute to conditions of over- and undernutrition.
Topics: Animals; Diet; Gastrointestinal Microbiome; Intestine, Small; Lipid Metabolism; Mice
PubMed: 29649441
DOI: 10.1016/j.chom.2018.03.011 -
International Journal of Molecular... May 2020Small intestinal bacterial overgrowth (SIBO) is a condition hallmarked by an increase in the concentration of colonic-type bacteria in the small bowel. Watery diarrhea,... (Review)
Review
Small intestinal bacterial overgrowth (SIBO) is a condition hallmarked by an increase in the concentration of colonic-type bacteria in the small bowel. Watery diarrhea, bloating, abdominal pain and distension are the most common clinical manifestations. Additionally, malnutrition and vitamin (B12, D, A, and E) as well as minerals (iron and calcium) deficiency may be present. SIBO may mask or worsen the history of some diseases (celiac disease, irritable bowel disease), may be more common in some extra-intestinal disorders (scleroderma, obesity), or could even represent a pathogenetic link with some diseases, in which a perturbation of intestinal microbiota may be involved. On these bases, we performed a review to explore the multiple links between SIBO and digestive and extra-intestinal diseases.
Topics: Animals; Blind Loop Syndrome; Disease; Humans; Intestine, Small
PubMed: 32429454
DOI: 10.3390/ijms21103531 -
Gut Microbes 2021Mucin-degrading bacteria are densely populated in the intestinal epithelium; however, their interaction with intestinal stem cells (ISCs) and their progeny have not been...
Mucin-degrading bacteria are densely populated in the intestinal epithelium; however, their interaction with intestinal stem cells (ISCs) and their progeny have not been elucidated. To determine whether mucin-degrading bacteria play a role in gut homeostasis, mice were treated with , a specialized species that degrades mucin. Administration of for 4 weeks accelerated the proliferation of Lgr5 ISCs and promoted the differentiation of Paneth cells and goblet cells in the small intestine (SI). We found similar effects of in the colon. The levels of acetic and propionic acids were higher in the cecal contents of -treated mice than in PBS-treated mice. SI organoids treated with cecal contents obtained from -treated mice were larger and could be diminished by treatment with G protein-coupled receptor (Gpr) 41/43 antagonists. Pre-treatment of mice with reduced gut damage caused by radiation and methotrexate. Further, a novel isotype of the strain was isolated from heathy human feces that showed enhanced function in intestinal epithelial regeneration. These findings suggest that mucin-degrading bacteria (e.g., ) may play a crucial role in promoting ISC-mediated epithelial development and contribute to intestinal homeostasis maintenance.
Topics: Akkermansia; Animals; Cell Differentiation; Cell Proliferation; Epithelial Cells; Fatty Acids, Volatile; Feces; Female; Gastrointestinal Microbiome; Homeostasis; Humans; Intestinal Mucosa; Intestine, Small; Methotrexate; Mice; Mice, Inbred C57BL; Mucins; Stem Cells; Wnt Signaling Pathway
PubMed: 33678130
DOI: 10.1080/19490976.2021.1892441 -
Annals of the Royal College of Surgeons... Oct 2020Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful... (Review)
Review
INTRODUCTION
Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting.
METHODS
A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review.
FINDINGS
A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment.
CONCLUSION
Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.
Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Female; Gangrene; Humans; Infant; Intestinal Obstruction; Intestinal Volvulus; Intestine, Small; Intussusception; Male; Middle Aged; Vomiting; Young Adult
PubMed: 32538120
DOI: 10.1308/rcsann.2020.0122 -
Current Gastroenterology Reports Jul 2017The term 'tropical enteropathy' originated in observations in the 1960s that small intestinal morphology and function differed in the tropics from the norms found in... (Review)
Review
PURPOSE OF REVIEW
The term 'tropical enteropathy' originated in observations in the 1960s that small intestinal morphology and function differed in the tropics from the norms found in temperate climates. It was subsequently shown that this enteropathy is more closely related to environmental conditions than latitude, and it was re-labelled 'environmental enteropathy'. It is now recognised that environmental enteropathy (also now called environmental enteric dysfunction) has implications for the health and linear growth of children in low- and middle-income countries, and it may underlie poor responses to oral vaccination in these countries. The purpose of this review is to define and clarify this enteropathy despite the confusing terminology it has attracted and to contrast it with other enteropathic states.
RECENT FINDINGS
Recent work has begun to demonstrate the nature of the mucosal lesion and the relationship with microbial translocation which is currently thought to link a failure of mucosal barrier function and the cascade of systemic inflammation which inhibits growth. The evidence is still correlative rather than definitive, but derives some additional support from animal models. There are some common features between environmental enteropathy and other enteropathies, but there are important differences also. The mechanism of the link between enteropathy and vaccine failure is not understood, and neither is it clear how the more severe form of enteropathy, which we refer to as malnutrition enteropathy, is driven by nutrient depletion and intestinal infection. Tropical enteropathies form a group of disorders which include environmental and nutritional enteropathies. The long-term health implications of these disorders for health in low-income countries are just being explored, but the scale of their effects is very large, with millions of people affected.
Topics: Animals; Bacterial Translocation; Child; Developing Countries; Environment; Humans; Intestinal Diseases; Intestine, Small; Terminology as Topic; Tropical Climate; Vaccination
PubMed: 28540669
DOI: 10.1007/s11894-017-0570-0 -
Cold Spring Harbor Perspectives in... Jan 2020The small intestine is the longest organ in the human body, spanning a length of ∼5 m and compartmentalized into three distinct regions with specific roles in... (Review)
Review
The small intestine is the longest organ in the human body, spanning a length of ∼5 m and compartmentalized into three distinct regions with specific roles in maintenance of comprehensive homeostasis. Along its length exists as a unique and independent system-called the enteric nervous system (ENS)-which coordinates the multitude of functions continuously around the clock. Yet, with so many vital roles played, the functions, relationships, and roles of the small intestine and ENS remain largely elusive. This fundamental hole in the physiology of the small intestine and ENS introduces a substantial number of challenges when attempting to create bioelectronic approaches for treatment of various disorders originating in the small intestine. Here, we review existing therapeutic options for modulating the small intestine, discuss fundamental gaps that must be addressed, and highlight novel methods and approaches to consider for development of bioelectronic approaches aiming to modulate the small intestine.
Topics: Animals; Enteric Nervous System; Gastrointestinal Microbiome; Homeostasis; Humans; Intestine, Small
PubMed: 30858329
DOI: 10.1101/cshperspect.a034355 -
Tidsskrift For Den Norske Laegeforening... May 2023Paraduodenal hernia is a rare form of congenital internal hernia and can lead to small bowel obstruction. This case report describes the case of a young boy who was...
Paraduodenal hernia is a rare form of congenital internal hernia and can lead to small bowel obstruction. This case report describes the case of a young boy who was admitted with acute exacerbation of chronic abdominal pain.
Topics: Male; Humans; Hernia; Paraduodenal Hernia; Duodenal Diseases; Intestine, Small; Intestinal Obstruction
PubMed: 37254989
DOI: 10.4045/tidsskr.22.0506 -
Journal of Visualized Experiments : JoVE Apr 2015Intestinal crypt-villus structures termed organoids, can be kept in sustained culture three dimensionally when supplemented with the appropriate growth factors. Since...
Intestinal crypt-villus structures termed organoids, can be kept in sustained culture three dimensionally when supplemented with the appropriate growth factors. Since organoids are highly similar to the original tissue in terms of homeostatic stem cell differentiation, cell polarity and presence of all terminally differentiated cell types known to the adult intestinal epithelium, they serve as an essential resource in experimental research on the epithelium. The possibility to express transgenes or interfering RNA using lentiviral or retroviral vectors in organoids has increased opportunities for functional analysis of the intestinal epithelium and intestinal stem cells, surpassing traditional mouse transgenics in speed and cost. In the current video protocol we show how to utilize transduction of small intestinal organoids with lentiviral vectors illustrated by use of doxycylin inducible transgenes, or IPTG inducible short hairpin RNA for overexpression or gene knockdown. Furthermore, considering organoid culture yields minute cell counts that may even be reduced by experimental treatment, we explain how to process organoids for downstream analysis aimed at quantitative RT-PCR, RNA-microarray and immunohistochemistry. Techniques that enable transgene expression and gene knock down in intestinal organoids contribute to the research potential that these intestinal epithelial structures hold, establishing organoid culture as a new standard in cell culture.
Topics: Animals; Cell Differentiation; Gene Knockdown Techniques; Genetic Vectors; Intestinal Mucosa; Intestine, Small; Lentivirus; Mice; Mice, Transgenic; Organ Culture Techniques; Organoids; RNA Interference; Stem Cells; Transduction, Genetic; Transgenes
PubMed: 25938265
DOI: 10.3791/52531