Inflammatory bowel disease in developing tropical countries: abdominal pain caused by Ascaris lumbricoides diagnosed with single-balloon enteroscopy

The evaluation of small bowel in inflammatory bowel disease (IBD) is mainly performed in cases with newly diagnosed or suspected Crohn’s disease (CD). The available modalities for small bowel evaluation include radiological imaging (barium meal follow through, magnetic resonance enteroclysis, computed tomography enteroclysis) and small bowel endoscopy also known as enteroscopy. The main advantage of small bowel endoscopy over radiological imaging is that it allows for obtaining biopsy specimen required for histological confirmation of the diagnosis. Various endoscopic modalities for endoscopic evaluation of small bowel include push enteroscopy and device assisted enteroscopy (DAE). Push enteroscopy allows only limited evaluation of proximal small bowel. Therefore, DAE is generally preferred over push enteroscopy for small bowel evaluation. DAE includes single balloon enteroscopy, double balloon enteroscopy, and spiral enteroscopy. The available literature suggests that there is no significant difference in the diagnostic yield among the available DAE devices. Therefore, the choice of DAE is largely dependent on the availability as well as local expertise. More recently, motorised spiral enteroscopy has been introduced. The main advantage of this novel DAE is ease of use with the possibility of evaluating the entire small bowel via per-oral route. However, the data regarding the use of motorised spiral enteroscopy is limited and comparative trials are required in future.

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Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽

10.3390/medicina57070643 ◽

2021 ◽

Vol 57 (7) ◽

pp. 643

Author(s):

Angela Saviano ◽

Mattia Brigida ◽

Alessio Migneco ◽

Gayani Gunawardena ◽

Christian Zanza ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Emergency Department ◽

Abdominal Pain ◽

Human Health ◽

Bowel Disease ◽

Chronic Constipation ◽

Lactobacillus Reuteri ◽

Current Knowledge ◽

Gastrointestinal Symptoms ◽

Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

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Chronic Nonspecific Inflammatory Bowel Disease of the Cecum and Proximal Colon in Children With Grossly Normal-Appearing Colonic Mucosa: Diagnosis by Colonoscopic Biopsies

PEDIATRICS ◽

10.1542/peds.80.2.255 ◽

1987 ◽

Vol 80 (2) ◽

pp. 255-261

Author(s):

Melvin B. Heyman ◽

Jay A. Perman ◽

Linda D. Ferrell ◽

M. Michael Thaler

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Bowel Disease ◽

Colonic Mucosa ◽

Disease Process ◽

Proximal Colon ◽

Chronic Abdominal Pain ◽

Medical Attention ◽

Inflammatory Bowel ◽

Inflammatory Changes

The diagnosis of inflammatory bowel disease rests on radiologic, endoscopic, and histologic creteria. Five patients, 2 to 17 years of age, sought medical attention because of chronic abdominal pain, diarrhea, and heme-positive stools. Rectal biopsies, visual inspection of colonic mucosa through the colonoscope, and contrast radiographs of the large and small intestine yielded nonspecific results. Serial endoscopic biopsies demonstrated a gradient of inflammatory changes diminishing in severity distally from the ileocecal valve and cecum. The disease process was most evident in specimens from the cecum, whereas biopsies distal to the transverse colon had a normal histologic appearance in all five patients. Biopsies from the proximal colon may provide evidence of inflammatory bowel disease not detectable using standard techniques. The combination of chronic abdominal pain, diarrhea, and heme-positive stools associated with inflammatory changes in biopsy specimens obtained from the proximal colon, but normal findings on radiologic, colonoscopic, and rectal biopsy examinations, may represent an early stage in the evolution of chronic nonspecific inflammatory bowel disease, including ulcerative colitis or regional enteritis (Crohn disease).

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Predicting inflammatory bowel disease in children with abdominal pain and diarrhoea: calgranulin-C versus calprotectin stool tests

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314081 ◽

2018 ◽

Vol 103 (6) ◽

pp. 565-571 ◽

Cited By ~ 6

Author(s):

Anke Heida ◽

Els Van de Vijver ◽

Don van Ravenzwaaij ◽

Stephanie Van Biervliet ◽

Thalia Z Hummel ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Bowel Disease ◽

Secondary Outcome ◽

Test Accuracy ◽

Diagnostic Study ◽

Operating Characteristics ◽

Reference Test ◽

Cross Sectional ◽

Inflammatory Bowel

ObjectiveCalgranulin-C (S100A12) is a new faecal marker of inflammation that is potentially more specific for inflammatory bowel disease (IBD) than calprotectin, since it is only released by activated granulocytes. We compared calgranulin-C and calprotectin to see which of the two tests best predicted IBD in children with chronic abdominal pain and diarrhoea.DesignDelayed-type cross-sectional diagnostic study.Setting and patientsPreviously undiagnosed patients aged 6–17 years, who were seen in paediatric clinics in the Netherlands and Belgium, sent in a stool sample for analysis. Patients with a high likelihood of IBD underwent upper and lower endoscopy (ie, preferred reference test), while those with a low likelihood were followed for 6 months for latent IBD to become visible (ie, alternative reference test). We used Bayesian modelling to correct for differential verification bias.Main outcome measuresPrimary outcome was the specificity for IBD using predefined test thresholds (calgranulin-C: 0.75 µg/g, calprotectin: 50 µg/g). Secondary outcome was the test accuracy with thresholds based on receiver operating characteristics (ROC) analysis.ResultsIBD was diagnosed in 93 of 337 patients. Calgranulin-C had significantly better specificity than calprotectin when predefined thresholds were used (97% (95% credible interval (CI) 94% to 99%) vs 71% (95% CI 63% to 79%), respectively). When ROC-based thresholds were used (calgranulin-C: 0.75 µg/g, calprotectin: 400 µg/g), both tests performed equally well (specificity: 97% (95% CI 94% to 99%) vs 98% (95% CI 95% to 100%)).ConclusionsBoth calgranulin-C and calprotectin have excellent test characteristics to predict IBD and justify endoscopy.Trial registration numberNCT02197780.

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Characterizing Clinical Features and Creating a Gene Expression Profile Associated With Pain Burden in Children With Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz240 ◽

2019 ◽

Vol 26 (8) ◽

pp. 1283-1290 ◽

Cited By ~ 2

Author(s):

Victoria Grossi ◽

Jeffrey S Hyams ◽

Nicole C Glidden ◽

Brittany E Knight ◽

Erin E Young

Keyword(s):

Gene Expression ◽

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Bowel Disease ◽

Newly Diagnosed ◽

Pain Experience ◽

Factors Affecting ◽

Cq Method ◽

Inflammatory Bowel ◽

Rectal Biopsies

Abstract Background There is often dissociation between inflammatory activity and abdominal pain in children with inflammatory bowel disease (IBD), suggesting other factors may play a role in the pain experience. Methods Patients (8 to 17 years) newly diagnosed with IBD were enrolled in the ALLAY Study: Assessing Risk Factors for Abdominal Pain in Children with Inflammatory Bowel Disease (NCT02984059). At diagnostic colonoscopy, 3 rectal biopsies were collected, and gene expression analysis was performed using Qiagen RT2 Profiler Neuropathic and Inflammatory Pain PCR Array. Relative fold difference in gene expression for 84 pain-associated genes was calculated using the 2-ΔΔ Cq method compared with pain-free controls. Factors affecting pain burden (Pain Burden Interview; PBI) were analyzed, including age, sex, rectal inflammation, and gene expression. Data were analyzed using multiple stepwise linear regression and 2-tailed t tests (P ≤ 0.05). Results Thirty-nine newly diagnosed IBD patients were included (65% male, mean age 12.75 years [SD 2.63], 23 Crohn’s disease, 16 ulcerative colitis), along with 3 controls. Mean PBI score was 7.73 (SD 6.4, range 0 to 23) for all patients. Age and sex were not predictive of pain burden, but disease activity score was (P = 0.03). Expression of TRPV3, OPRM1, P2X3, SCN9A, PTGS2, and MAPK14 were associated with PBI score. Subsequent 2-tailed t tests comparing patients with no pain (PBI score ≦ 2, N = 11) to those with pain (PBI > 2, N = 28) confirmed differential expression of TRPV3, PTGS2, and MAPK14 was in patients with pain (all P < 0.05). Conclusion Pain burden in newly diagnosed IBD patients may be linked to TRPV3, PTGS2, and MAPK14 expression, suggesting potential therapeutic targets for managing pain in IBD.

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Ileocecal Burkitt’s Lymphoma Presenting as Acute Abdominal Pain

Case Reports in Oncology ◽

10.1159/000508998 ◽

2020 ◽

Vol 13 (2) ◽

pp. 968-972

Author(s):

Mostafa Mosbeh Abdelmaksoud ◽

Maram Kheder Alshareef ◽

Alaa Osama Jamjoom ◽

Mohamed Tarek Hafez

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Renal Transplantation ◽

Gastrointestinal Tract ◽

Bowel Disease ◽

Acute Abdominal Pain ◽

Emergency Laparotomy ◽

Ileocecal Region ◽

Inflammatory Bowel ◽

Hodgkin's Lymphomas

Primary gastrointestinal non-Hodgkin’s lymphomas are rare tumors which account for about 0.9% of all gastrointestinal tract tumors. They are usually associated with inflammatory bowel disease, previous radiotherapy, and renal transplantation. We report a case of non-Hodgkin’s lymphoma involving the ileocecal region in a 46-year-old gentleman who presented with acute abdominal pain that mandated emergency laparotomy.

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Sulphasalazine-Induced Pseudomembranous Colitis

Canadian Journal of Gastroenterology ◽

10.1155/1991/420864 ◽

1991 ◽

Vol 5 (5) ◽

pp. 167-170 ◽

Cited By ~ 4

Author(s):

Hugh J Freeman ◽

Urs P Steinbrecher ◽

WC Peter Kwan ◽

Stephanie Ensworth

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Ankylosing Spondylitis ◽

Clostridium Difficile ◽

Bowel Disease ◽

Pseudomembranous Colitis ◽

Flexible Sigmoidoscopy ◽

Frequent Use ◽

Toxin Assay ◽

Inflammatory Bowel

An 18-year-old female with ankylosing spondylitis developed fever, abdominal pain and diarrhea on two occasions after starting sulphasalazine therapy. Flexible sigmoidoscopy revealed pseudomembranous colitis; fecal cultures were positive forClostridium difficile; andC difficiletoxin assay was positive. Despite the frequent use of sulphasalazine in the management of inflammatory bowel disease, this complication has been apparently rare. Clinicians should be wary of the onset of diarrhea in patients receiving sulphasalazine, whether for inflammatory bowel disease or other conditions.

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Treatment of intestinal tuberculosis with small bowel perforation: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02752-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Daniel Sasse ◽

Christoph D. Spinner ◽

Kathrin Rothe ◽

Jochen Schneider ◽

Jochen Gaa ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Abdominal Pain ◽

Bowel Disease ◽

Bowel Perforation ◽

Good Condition ◽

Intestinal Tuberculosis ◽

Lower Abdominal Pain ◽

Granulomatous Inflammation ◽

Bowel Habit ◽

Inflammatory Bowel

Abstract Background Diagnosis of intestinal tuberculosis poses a dilemma to physicians due to nonspecific symptoms like abdominal pain, fever, nausea, and a change in bowel habit. In particular, the distinction between inflammatory bowel disease and intestinal tuberculosis remains challenging. Case presentation A 27-year-old man from Colombia presented with fever, night sweats, and progressive lower abdominal pain. Computed tomography revealed a thickening of the bowel wall with a mesenterial lymphadenopathy, ascites ,and a pleural tumor mass. Histology of intestinal and pleural biopsy specimens showed a granulomatous inflammation. Although microscopy and polymerase chain reaction (PCR) for Mycobacterium tuberculosis (MTB) were negative, empirical MTB treatment was initiated on suspicion. Due to a massive post-stenotic atrophied intestinal bowel, MTB medications were administered parenterally in the initial phase of treatment to guarantee adequate systemic resorption. The complicated and critical further course included an intra-abdominal abscess and bowel perforation requiring a split stoma, before the patient could be discharged in good condition after 3 months of in-hospital care. Conclusions This case highlights the clinical complexity and diagnostic challenges of intestinal MTB infection. A multidisciplinary team of physicians should be sensitized to a timely diagnosis of this disease, which often mimics inflammation similar to inflammatory bowel disease, other infections, or malignancies. In our case, radiological findings, histological results, and migratory background underpinned the suspected diagnosis and allowed early initiation of tuberculostatic treatment.

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