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Dolu S, Arayici ME, Onem S, Dongelli H, Akarsu M. Diagnostic and Clinical Impact of Double-Balloon Enteroscopy in Small-Bowel Inflammatory Lesions: A Retrospective Cohort Study in a Turkish Population. Diagnostics (Basel) 2025; 15:661. [PMID: 40150004 PMCID: PMC11941567 DOI: 10.3390/diagnostics15060661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/06/2025] [Accepted: 03/07/2025] [Indexed: 03/29/2025] Open
Abstract
Background/Objectives: Small-bowel inflammatory lesions are challenging to diagnose thanks to their anatomical complexity and the limitations of conventional imaging. Double-balloon enteroscopy (DBE) allows for direct visualization, biopsy, and therapeutic intervention. This study evaluated the diagnostic yield and clinical impact of DBE in small-bowel inflammatory lesions, particularly in differentiating Crohn's disease (CD) from other etiologies. Methods: This retrospective study included 258 patients who underwent DBE for suspected small-bowel inflammatory lesions at Dokuz Eylül University Hospital (2010-2024). Patients were categorized into the CD and non-CD groups. The clinical, radiological, and endoscopic findings were also analyzed. Statistical comparisons were performed to assess the differences in presentation and DBE findings between the groups. Results: The mean patient age was 48.2 ± 17.3 years. Abdominal pain (47.7%) and diarrhea (31.8%) were the most common symptoms. The DBE findings included ulcers (45.0%), superficial mucosal changes (23.3%), and strictures (9.7%). The ileum was the most commonly affected site (31.7%). CD was diagnosed in 27.5% of the patients, while other etiologies included non-steroidal anti-inflammatory drug-induced (NSAID) enteropathy (12.0%) and malignancies (15.9%). Ulcers were significantly more frequent in patients with CD than in those without (60.3% vs. 39.0%, p = 0.002). Conclusions: DBE plays a crucial role in diagnosing small-bowel inflammatory lesions, distinguishing CD from other conditions, and guiding clinical management. It remains essential for cases requiring histopathological confirmation, offering superior diagnostic accuracy compared to noninvasive imaging.
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Affiliation(s)
- Suleyman Dolu
- Department of Gastroenterology, Faculty of Medicine, Dokuz Eylul University, 15 July Medicine and Art Campus, Inciralti-Balcova, Izmir 35340, Turkey
| | - Mehmet Emin Arayici
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey;
- Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey
| | - Soner Onem
- Department of Gastroenterology, Samsun Training and Research Hospital, Samsun 55090, Turkey
| | - Huseyin Dongelli
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey
| | - Mesut Akarsu
- Private Gastroenterology Clinic, Izmir 35000, Turkey
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Shukla RM, Tiwari P, Dariya S, Jain S, Sharma SS, Laddha A, Lahoti BK, Thanna H. Peutz-Jeghers Syndrome: Lessons to be Learned in the Clinical Diagnosis. J Indian Assoc Pediatr Surg 2023; 28:218-222. [PMID: 37389385 PMCID: PMC10305958 DOI: 10.4103/jiaps.jiaps_197_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/08/2022] [Accepted: 01/10/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Peutz-Jeghers Syndrome (PJS) is an autosomal dominant disease presenting with hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on lips and oral mucosa. The incidence of this syndrome is approximately 1 in 1,20,000 births. Materials and Methods In this article, we are presenting 11 cases of PJS which were misdiagnosed and patients were compelled to visit hospital repeatedly. All these cases were diagnosed based on clinical suspicion, family history, and histopathological examination of specimens. Most of the cases presented with intussusception and required emergency surgical management. Results PJS can be diagnosed by the presence of microscopically confirmed hamartomatous polyps and a minimum of two of the following clinical criteria: Family history, mucocutaneous melanotic spots, and small bowel polyps with bleeding per rectally. The diagnosis can be missed if the melanotic spots on the face are missed. Routine investigations, imaging, and endoscopy were done in all cases. PJS patients need regular follow-up due to chance of recurrence of symptoms and susceptibility to cancer. Conclusion PJS needs a high index of suspicion for diagnosis in cases of recurrent abdominal pain with bleeding per rectum. Proper family history and meticulous clinical examination for melanosis are very important to prevent the misdiagnosis of these cases.
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Affiliation(s)
- Ram Mohan Shukla
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Pooja Tiwari
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Samprati Dariya
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Sarvagya Jain
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Shashi Shankar Sharma
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Ashok Laddha
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Brijesh Kumar Lahoti
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
| | - Hemant Thanna
- Department of Pediatric Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India
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Ahmed M. Video Capsule Endoscopy in Gastroenterology. Gastroenterology Res 2022; 15:47-55. [PMID: 35572472 PMCID: PMC9076159 DOI: 10.14740/gr1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 11/27/2022] Open
Abstract
Video capsule endoscopy (VCE) is a wireless technology used by gastroenterologists for various indications in their clinical practice. There has been significant improvement in this technology since its start about two decades ago. Specific video capsules have been made to evaluate the small bowel, colon, and esophagus. Now pan-enteric video capsule is available to assess both the small bowel and colon. VCE is a non-invasive procedure that has been tremendously evaluated for various gastrointestinal disorders, particularly small intestinal bleeding. There are specific contraindications and complications of VCE. This procedure has the technical part and video reading part. Newer software programs will come to reduce the reading time. Artificial intelligence is also coming for quick and accurate diagnosis of any positive findings during VCE. VCE is an important diagnostic test in the field of gastroenterology. Although it is an addition to optical endoscopic procedures to visualize the gastrointestinal mucosa, it has advantages and disadvantages.
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Affiliation(s)
- Monjur Ahmed
- Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Nguyen J, Lee S, Yang GY. Comprehensive Evaluation and Unique Morphologic Features of Nonsteroidal Anti-Inflammatory Drug (NSAID) Enteropathy in the Terminal Ileum. Int J Surg Pathol 2022; 30:616-622. [PMID: 35098774 DOI: 10.1177/10668969221076549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Differentiating NSAID enteropathy from Crohn disease can be challenging on terminal ileum biopsy. It is important to distinguish these two entities for management. In this study, clinical, radiographic, endoscopic, and histologic features of 30 patients diagnosed with NSAID enteropathy and 30 patients diagnosed with Crohn disease on terminal ileal biopsy were compared. None of the patients in the NSAID cohort demonstrated significant changes on imaging performed prior to biopsy. Depending on disease severity, patients with Crohn disease showed imaging findings ranging from minimal changes to significant bowel wall and/or luminal changes. Endoscopically, erythema, erosions, and/or ulcers in the terminal ileum were observed in a majority of NSAID cases. Patients with active Crohn disease were noted to have erythema, ulcers, strictures, and/or visible inflammation throughout the distal ileum and colon. Histologically, at least 80% of cases in each cohort showed ulceration/erosion and cryptitis/crypt abscesses. The Crohn disease cohort had significantly higher degree of lymphoplasmacytic inflammation in the lamina propria compared to the NSAID cohort. In contrast, a significantly higher percentage of the NSAID cohort had gland/crypt atrophy. A decrease in number of Paneth cells was found in the NSAID cohort. Decreased lamina propria lymphoplasmacytic inflammation was the most specific and the presence of gland atrophy the most sensitive feature favoring NSAID enteropathy. In summary, the combination of gland/crypt/Paneth cell atrophy with decreased lamina propria lymphoplasmacytic inflammation can aid in differentiating NSAID enteropathy from Crohn disease in terminal ileal biopsies; however, correlation with clinical, radiographic, and endoscopic findings is still required.
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Affiliation(s)
| | - Sherry Lee
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Guang-Yu Yang
- Northwestern Memorial Hospital, Chicago, IL 60611, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Abstract
AbstractA case of diagnostic difficulty facing the patient with colonic polyposis secondary to Peutz–Jeghers syndrome, but without family history and pathognomonic clinical features of the disease, is illustrated. The exams, including biopsy, led to diagnostic uncertainty and the definitive diagnosis was characterized in therapeutic of exception.
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Kim Y, Jeon SR, Choi SM, Kim HG, Lee TH, Cho JH, Jung Y, Kim WJ, Ko BM, Kim JO, Lee JS, Lee MS. Practice patterns and clinical significance of use of capsule endoscopy in suspected and established Crohn's disease. Intest Res 2017; 15:467-474. [PMID: 29142514 PMCID: PMC5683977 DOI: 10.5217/ir.2017.15.4.467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/16/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Although the role of capsule endoscopy (CE) in Crohn's disease (CD) has expanded, CE is not used routinely for diagnosing and evaluating CD in Korea. We aimed to investigate current patterns of practice and evaluate the clinical significance of the use of CE in CD in Korean patients. Methods Among 651 CE procedures performed for various indications, we retrospectively analyzed the medical records of patients who underwent CE in 57 cases of suspected CD (sCD) and 14 cases of established CD (eCD). Results In the sCD group, CE was most commonly used for the initial diagnosis of CD (54.4%). Capsule retention was found in only 1 patient in the eCD group (1/71, 1.4%). In the sCD group, 28.1% of patients were diagnosed with CD on the basis of CE findings; other diseases diagnosed included tuberculous enteritis (7.0%), non-steroidal anti-inflammatory drug-induced enteropathy (5.3%), and other enteritis (17.5%). Only 11.5% of patients with eCD (14/122) underwent CE. The indication for CE in the 14 patients with eCD was to assess disease extent and activity. The overall diagnostic yield of CE was 59.7%. Therapeutic strategies were changed in 70.2% of patients in the sCD group and 50% of those in the eCD group based on CE findings. Conclusions In clinical practice, CE was most commonly indicated for the initial diagnosis of CD and was not generally performed in patients with eCD. CE appears to be an effective diagnostic modality for evaluating sCD and is useful for determining therapeutic strategies for patients with sCD and those with eCD.
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Affiliation(s)
- Yonghyun Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Myung Choi
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun-Hyung Cho
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yunho Jung
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Wan Jung Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bong Min Ko
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joon Sung Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Moon Sung Lee
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
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Hardy BT, Gentile-Solomon J, Solomon JA. Multiple gastric erosions diagnosed by means of capsule endoscopy in a dog. J Am Vet Med Assoc 2017; 249:926-930. [PMID: 27700263 DOI: 10.2460/javma.249.8.926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 6-year-old spayed female Golden Retriever was evaluated for a 2-week history of progressive hyporexia, signs of abdominal pain, and weight loss. CLINICAL FINDINGS Physical examination findings included mild signs of pain on palpation of the cranial part of the abdomen and a body condition score of 4 (scale, 1 to 9). A CBC revealed mild microcytosis and hypochromasia; results of serum biochemical analysis were within the respective reference ranges, and abdominal ultrasonography revealed no abnormalities. Capsule endoscopy was performed, and numerous gastric erosions and hemorrhages were detected, with rare dilated lacteals in the proximal aspect of the small intestine. TREATMENT AND OUTCOME Treatment was initiated with omeprazole and sucralfate for 6 weeks, and the dog was transitioned to a novel protein diet. Capsule endoscopy was repeated at the end of the initial treatment course and revealed overall improvement, with a few small erosions remaining; medical treatment was continued for an additional 2 weeks. At last follow-up 9 months after treatment ended, the dog was clinically normal. CLINICAL RELEVANCE Capsule endoscopy was useful for initial detection and subsequent reevaluation of gastrointestinal lesions in this patient without a need for sedation or anesthesia. Information obtained in the follow-up evaluation was valuable in identifying a need to extend the duration of medical treatment.
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Tachecí I, Kopáčová M, Rejchrt S, Bureš J. Non-steroidal Anti-inflammatory Drug Induced Injury to the Small Intestine. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016. [DOI: 10.14712/18059694.2016.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Non-steroidal anti-inflammatory drug (NSAIDs) induced enteropathy represents an important complication of one of the most commonly used drugs worldwide. Due to previous diagnostics difficulties the real prevalence of this disease was underestimated for a long time. The pathogenesis of NSAID-enteropathy is more multifactorial and complex than formerly assumed but has still not been fully uncovered. A combination of the local and systemic effect plays an important role in pathogenesis. Thanks to novel enteroscopy methods (wireless capsule endoscopy, double balloon enteroscopy), small bowel lesions are described in a substantial section of NSAID users although most are clinically asymptomatic. The other non-invasive tests (small bowel permeability, faecal calprotectin, scintigraphy using faecal excretion of 111-indium-labelled leukocytes etc.) proposed for diagnostics are not generally used in clinical practice, mainly because of their non-specificity. Despite intensive research into possible treatment, the main measure for patients with NSAID-enteropathy is still withdrawal of NSAIDs. Double balloon enteroscopy plays an important role in the treatment of complications (bleeding, strictures).
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Capsule Endoscopy for Ileitis with Potential Involvement of Other Sections of the Small Bowel. Gastroenterol Res Pract 2016; 2016:9804783. [PMID: 26880904 PMCID: PMC4737449 DOI: 10.1155/2016/9804783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/11/2015] [Accepted: 08/23/2015] [Indexed: 02/08/2023] Open
Abstract
Ileitis is defined as inflammation of the ileum. This condition includes ulcers, aphthous ulcers, erosions, and nodular or erythematous mucosa. Various etiologies are associated with ileitis. Crohn's disease, ulcerative colitis, medications such as nonsteroidal anti-inflammatory drugs, infectious conditions, neoplasms, infiltrative disorders, vasculitides, spondyloarthritis, endometriosis, and radiation therapy-related conditions involve the ileum. However, the differential diagnosis of terminal ileitis can be difficult in many cases. Video capsule endoscopy (VCE) has become a useful tool for the diagnosis of a variety of small bowel lesions. This review describes each of the various conditions associated with ileitis and the diagnostic value of VCE for ileitis, which may help identify and evaluate these conditions in clinical practice. Based on the information provided by VCE, a definitive diagnosis could be made using the patients' medical history, clinical course, laboratory and ileocolonoscopic findings, radiologic imaging findings, and histologic findings.
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Rondonotti E, Koulaouzidis A, Silvia P, Franco R, Pennazio M. Obscure gastrointestinal bleeding and iron-deficiency anemia—Where does capsule endoscopy fit? TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015. [DOI: 10.1016/j.tgie.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Gurkan OE, Karakan T, Dogan I, Dalgic B, Unal S. Comparison of double balloon enteroscopy in adults and children. World J Gastroenterol 2013; 19:4726-4731. [PMID: 23922469 PMCID: PMC3732844 DOI: 10.3748/wjg.v19.i29.4726] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/18/2013] [Accepted: 05/09/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients. METHODS The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative enema. The patients were followed up for 2 h after the procedure in terms of possible complications. RESULTS DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); Peutz-Jeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation. CONCLUSION With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.
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Whipple's Disease: Our Own Experience and Review of the Literature. Gastroenterol Res Pract 2013; 2013:478349. [PMID: 23843784 PMCID: PMC3703430 DOI: 10.1155/2013/478349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 05/22/2013] [Indexed: 12/17/2022] Open
Abstract
Whipple's disease is a chronic infectious systemic disease caused by the bacterium Tropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients.
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Mateescu BR, Bengus A, Marinescu M, Staniceanu F, Micu G, Negreanu L. First Pillcam Colon 2 capsule images of Whipple's disease: Case report and review of the literature. World J Gastrointest Endosc 2012; 4:575-578. [PMID: 23293729 PMCID: PMC3536856 DOI: 10.4253/wjge.v4.i12.575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 03/04/2012] [Accepted: 10/10/2012] [Indexed: 02/05/2023] Open
Abstract
Whipple's disease is a rare chronic systemic infection determined by the Gram-positive bacillus Tropheryma whipplei. The infection usually mainly involves the small bowel, but sometimes other organs are affected as well. Since the current standard clinical and biological tests are nonspecific, diagnosis is very difficult and relies on histopathology. Here we present the case of a 52-year-old man with chronic diarrhea and weight loss whose symptoms had been evolving for 2 years and whose diagnosis came unexpectedly after capsule examination. Diagnosis was confirmed by the histopathologic examination of endoscopic biopsy samples, and treatment with co-trimoxazole resulted in remission of symptoms. We present the first images of Whipple's disease obtained with the Pillcam Colon 2 video capsule system.
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Affiliation(s)
- Bogdan Radu Mateescu
- Bogdan Radu Mateescu, Andreea Bengus, Madalina Marinescu, Department of Gastroenterology, Colentina Hospital, Bucharest 50098, Romania
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Suzuki T, Matsushima M, Arase Y, Fujisawa M, Okita I, Igarashi M, Koike J, Mine T. Double-balloon endoscopy-diagnosed multiple small intestinal ulcers in a Churg-Strauss syndrome patient. World J Gastrointest Endosc 2012; 4:194-6. [PMID: 22624072 PMCID: PMC3355243 DOI: 10.4253/wjge.v4.i5.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 09/12/2011] [Accepted: 03/30/2012] [Indexed: 02/05/2023] Open
Abstract
Churg-Strauss syndrome (CSS) is a systemic vascular disorder characterized by severe bronchial asthma, hypereosinophilia, and allergic rhinitis. Small intestinal ulcers associated with CSS are a relatively rare manifestation that causes gastrointestinal bleeding. Multiple deep ulcers with an irregular shape are characteristic of small intestinal involvement of CSS. Video-capsule-endoscopy (VCE), double-balloon endoscopy (DBE) and Spirus assisted enteroscopy have been developed recently and enabled observation of the small intestine. In this case report, we have described a patient with CSS who had multiple deep ulcers in the jejunum detected by oral DBE. Since severe gastrointestinal (GI) involvement has been identified as an independent factor associated with poor outcome, the careful investigation of GI tract must be needed for CSS patients with GI symptoms. We describe the usefulness of DBE for diagnosis of small intestinal ulcers in patient with CSS.
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Affiliation(s)
- Takayoshi Suzuki
- Takayoshi Suzuki, Masashi Matsushima, Yoshitaka Arase, Mia Fujisawa, Ichiro Okita, Muneki Igarashi, Jun Koike, Tetsuya Mine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
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Park SC, Chun HJ, Kang CD, Sul D. Prevention and management of non-steroidal anti-inflammatory drugs-induced small intestinal injury. World J Gastroenterol 2011; 17:4647-53. [PMID: 22180706 PMCID: PMC3237301 DOI: 10.3748/wjg.v17.i42.4647] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 04/21/2011] [Accepted: 04/28/2011] [Indexed: 02/06/2023] Open
Abstract
Non-steroidal anti-inflammatory drug (NSAID)-induced small bowel injury is a topic that deserves attention since the advent of capsule endoscopy and balloon enteroscopy. NSAID enteropathy is common and is mostly asymptomatic. However, massive bleeding, stricture, or perforation may occur. The pathogenesis of small intestine injury by NSAIDs is complex and different from that of the upper gastrointestinal tract. No drug has yet been developed that can completely prevent or treat NSAID enteropathy. Therefore, a long-term randomized study in chronic NSAID users is needed.
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Kopacova M, Tacheci I, Rejchrt S, Bures J. Peutz-Jeghers syndrome: Diagnostic and therapeutic approach. World J Gastroenterol 2009; 15:5397-408. [PMID: 19916169 PMCID: PMC2778095 DOI: 10.3748/wjg.15.5397] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals. PJS predisposes sufferers to various malignancies (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors). Bleeding, obstruction and intussusception are common complications in patients with PJS. Double balloon enteroscopy (DBE) allows examination and treatment of the small bowel. Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome. Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients. Intraoperative enteroscopy (IOE) was the only possibility for endoscopic treatment of patients with PJS before the DBE era. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening (colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men). Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients.
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Abstract
Capsule endoscopy (CE) is a simple, safe, non-invasive, reliable technique, well accepted and tolerated by the patients, which allows complete exploration of the small intestine. The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine, such as obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, polyposis syndromes, etc. CE has become the gold standard for the diagnosis of most diseases of the small bowel. Lately this technique has also been used for esophageal and colonic diseases.
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