Perplexing Gastrointestinal Pathology: A Case Report on Ectopic Gastric Tissue Presenting as Rectal Mass

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S70-S70
Author(s):  
Suhalika Sahni ◽  
Vikas Mehta
Keyword(s):  
Inflammatory Bowel Disease ◽  
Gastric Mucosa ◽  
Bowel Disease ◽  
Clinical Signs ◽  
Lower Abdominal Pain ◽  
Antral Mucosa ◽  
Gastric Tissue ◽  
Gastric Heterotopia ◽  
Rectal Mass ◽  
Inflammatory Bowel

Abstract Objectives Gastric heterotopia (GHT) is a commonly reported epithelial heterotopia and has been described as heteroplasia (congenital) during organogenesis or metaplasia (acquired) during process of damaged epithelial repair. GHT can occur along the GI tract from nose to anus; it is predominantly seen in esophagus, duodenum, and Meckel’s diverticulum. It is the most common subtype of epithelial heterotopia. However, the presence of gastric mucosa in the rectum is a very uncommon entity. The endoscopic prevalence of GHT can reach up to 11% in foregut and midgut with a lesser prevalence in hindgut. Methods We present an interesting case of heterotopic gastric mucosa presenting as a rectal mass. A 27-year-old female patient presented with lower abdominal pain and episodic bloody diarrhea. After initial workup, a colonoscopy was done, which showed a 3-cm mass in the rectum. Features of inflammatory bowel disease were not identified. Results At the first rectal biopsy, multiple fragments of gastric mucosa, with some minimally attached rectal crypts, were identified and a diagnosis of gastric heterotopia was made. Subsequently, the mass was resected and similar findings were identified, confirming the diagnosis. Our case showed mixed oxyntic and antral mucosa comingling with rectal-type mucosa. Immunohistochemical studies were performed, which showed CDX2 and CK20 being positive in rectal and CK7 in gastric mucosa. Conclusion Gastric heterotopia is a rare entity that can present as a solitary lesion. The clinical signs and symptoms can mimic those of inflammatory bowel disease. Floater or contamination is an important pitfall in this entity and can lead to an erroneously diagnose. Due to high frequency of having floater in some histology laboratories, we recommend ordering multiple deeper recuts on cases when the pathologist sees closeness or attachment of gastric tissue to the rectal tissue.

scholarly journals Evaluation of Objective Signs and Subjective Symptoms of Dry Eye Disease in Patients with Inflammatory Bowel Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Zsolt Barta ◽  
Levente Czompa ◽  
Aniko Rentka ◽  
Eva Zold ◽  
Judit Remenyik ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Dry Eye ◽  
Bowel Disease ◽  
Clinical Signs ◽  
Tear Film ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
Subjective Symptoms ◽  
Ocular Surface Disease Index ◽  
Inflammatory Bowel

Aim. To evaluate tear film parameters and relationship of objective clinical signs and subjective symptoms of dry eye disease (DED) in inflammatory bowel disease (IBD) subgroups. Methods. 39 patients with Crohn’s disease (CD), 26 patients with ulcerative colitis (UC), and 39 control persons with no ocular symptoms or surface disorders were included in this prospective, case-control, and cross-sectional study. The ocular surface disease index (OSDI) questionnaire was applied to evaluate dry eye symptoms, and objective tests of DED were performed on both eyes of each subject. Results. The average of OSDI scores was 30.59 (±16.68) in CD patients, 24.67 (±23.48) in UC patients, and 11.19 (±5.8) in controls. Except for tear film breakup time (tBUT) and Schirmer-I values other objective parameters were better in UC patients, than in CD patients. CD patients rather than UC patients tend to develop DED. This was associated with immunosuppressant and TNF-α inhibitor use. Conclusions. Clinicians must be aware of the spectrum of DED involvement in IBD and suggest using artificial tears in order to decrease severity of ocular complications.

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

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.

Oral delivery of recombinant human interleukin-11 decreases clinical signs and histologic lesions in animal models of inflammatory bowel disease

2000 ◽  
Vol 118 (4) ◽  
pp. A701 ◽  
Author(s):  
James Carl Keith ◽  
Leo Albert ◽  
Erik Marchese ◽  
Leo C-M Tseng ◽  
Kyle McCarthy ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Animal Models ◽  
Bowel Disease ◽  
Oral Delivery ◽  
Clinical Signs ◽  
Inflammatory Bowel ◽  
Interleukin 11

scholarly journals Study of Correlations between Clinical Signs and Morphological Features Identified in Dogs Affected with Inflammatory Bowel Disease

2020 ◽  
Vol 43 (1) ◽  
pp. 13-22
Author(s):  
David Farray ◽  
Francisco Rodriguez ◽  
Yaiza Muñoz-Aznar ◽  
Antonio G. Ravelo-García ◽  
José Raduan Jaber
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clinical Signs ◽  
Morphological Features ◽  
Clinical Activity ◽  
Hospital Records ◽  
Epithelial Injury ◽  
Histopathological Findings ◽  
Inflammatory Bowel ◽  
Study Hospital

AbstractThis paper evaluates possible relations between the clinical activity and the histopathological findings of the entire intestine in dogs with inflammatory bowel disease (IBD). To perform this study, hospital records of 64 dogs of different sex and breed diagnosed with IBD were evaluated. The results of this study did not show a statistically significant correlation between clinical activity and the histopathological assessment of dogs with IBD. Certain connections were found between diarrhea and lacteal dilation in duodenum, and hematochezia and villous epithelial injury in colon but no other associations were found between the rest of the lesions and symptoms.

scholarly journals High Prevalence of Ultrasound Verified Enthesitis in Patients With Inflammatory Bowel Disease With or Without Spondylarthritis

2021 ◽  
Vol 8 ◽  
Author(s):  
Rusmir Husic ◽  
Angelika Lackner ◽  
Patrizia Katharina Kump ◽  
Christoph Högenauer ◽  
Winfried Graninger ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Irritable Bowel Syndrome ◽  
Bowel Disease ◽  
Healthy Subjects ◽  
Ultrasound Examination ◽  
Clinical Signs ◽  
Extraintestinal Manifestation ◽  
High Prevalence ◽  
Inflammatory Bowel ◽  
Irritable Bowel

Background: Inflammatory bowel disease (IBD) is closely associated with spondylarthritis (SpA) and enthesitis, as an important feature of SpA, is a common extraintestinal manifestation of IBD. Enthesitis may be clinically silent in a high proportion of patients with IBD without clinical signs or a diagnosis of SpA.Objectives: The aim of this study was to compare the prevalence of ultrasound (US) verified enthesitis in IBD patients with and without SpA, with patients with irritable bowel syndrome (IBS) and healthy subjects (HC) serving as controls.Methods: IBD patients with or without SpA, patients with IBS and HC were prospectively recruited and clinically assessed. Ultrasound examination was performed at 14 entheses. The ultrasound abnormalities were scored according to the Madrid Ankylosing Spondylitis Enthesitis Index (MASEI).Results: We included 33 IBD patients without SpA, 14 IBD patients with SpA, 26 IBS patients and 18 HC. Higher MASEI scores were found in patients with IBD without SpA [median 21.0 range (8.0–53.0)] and IBD associated SpA [33.0 (8–50)] than in IBS patients [10.5 (0–42.0)-p < 0.001 for both comparison] and HC [12.0 (2.0–38.0)-p < 0.01]. PD, enthesophytes and erosions were more common in patients with IBD with or without SpA as compared to IBS patients and HC. IBD patients with SpA compared to IBD without SpA demonstrated significant higher prevalence of erosion and structural irregularity and consequently significant higher MASEI (p < 0.05 for all comparison).Conclusions: Ultrasound verified enthesitis is more common in patients with IBD with or without SpA as compared to patients with IBS or HC.

scholarly journals Headache and inflammatory bowel disease: think cerebral vein!

2019 ◽  
Vol 12 (1) ◽  
pp. e227228
Author(s):  
Martina Orfei ◽  
Marco Gasparetto ◽  
Franco Torrente
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clinical Signs ◽  
Neurological Impairment ◽  
Cerebral Vein ◽  
Cerebral Vein Thrombosis ◽  
Laboratory Findings ◽  
Delay In Diagnosis ◽  
Vein Thrombosis ◽  
Inflammatory Bowel

Cerebral vein thrombosis is a severe complication of inflammatory bowel disease, can cause non-specific symptoms and hence lead to delay in diagnosis. We report the case of an adolescent with inflammatory bowel disease who developed extensive cerebral vein thrombosis requiring a ventriculoperitoneal shunt. Diagnosis was markedly delayed due to repeated misinterpretation of clinical signs and laboratory findings and the lack of reconsidering the working diagnosis despite the involvement of several medical subspecialties. The patient does not suffer from any neurological impairment. This case report highlights the need for clinicians to maintain vigilance for complications of chronic disease and encourages to cast doubt on the working diagnosis constantly.

scholarly journals Proposed grading scheme for inflammatory bowel disease in ferrets and correlation with clinical signs

2019 ◽  
Vol 32 (1) ◽  
pp. 17-24
Author(s):  
Paola Cazzini ◽  
Megan K. Watson ◽  
Nicole Gottdenker ◽  
Joerg Mayer ◽  
Drury Reavill ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clinical Utility ◽  
Intestinal Inflammation ◽  
Companion Animals ◽  
Clinical Signs ◽  
Chronic Inflammatory Disease ◽  
Mustela Putorius ◽  
Crypt Abscess ◽  
Inflammatory Bowel

Inflammatory bowel disease (IBD) is an idiopathic, chronic, inflammatory disease of the gastrointestinal tract of companion animals, including ferrets ( Mustela putorius furo). Clinical signs of IBD are nonspecific, and intestinal biopsies are necessary for a definitive diagnosis. A grading scheme has not been established for ferrets. Additionally, the association between histologic severity and clinical signs in ferrets is unknown. We evaluated enteric samples from ferrets diagnosed with IBD, compared histologic grading schemes, and correlated the results with the severity of clinical signs. Enteric sections from 23 ferrets with IBD were analyzed using grading schemes for intestinal inflammation in cats and dogs, and a correlation with clinical signs was evaluated. After dividing the histologic samples into groups based on the severity of clinical signs, main histologic differences were identified. Age and sex were also assessed for correlation with clinical signs. No significant correlation was found between the 2 grading schemes and clinical signs (rho = 0.02, p = 0.89; rho = 0.26, p = 0.18, respectively). Degree of villus fusion, hemorrhage and/or fibrin, epithelial damage, inflammation density, and crypt abscess formation were used retrospectively to create a ferret IBD grading scheme, which was significantly correlated with the severity of clinical signs (rho = 0.48, p = 0.01). A positive correlation was observed between age ( p = 0.04) and females ( p = 0.007) with severity of clinical signs. Our ferret grading scheme may have clinical utility in providing a more objective, consistent evaluation of IBD in ferrets.

scholarly journals Streptococcus thermophilus NCIMB 41856 ameliorates signs of colitis in an animal model of inflammatory bowel disease

2017 ◽  
Vol 8 (4) ◽  
pp. 605-614 ◽  
Author(s):  
J.R. Bailey ◽  
V. Vince ◽  
N.A. Williams ◽  
T.A. Cogan
Keyword(s):  
Inflammatory Bowel Disease ◽  
Gastrointestinal Bleeding ◽  
Bacterial Translocation ◽  
Bowel Disease ◽  
Clinical Signs ◽  
Streptococcus Thermophilus ◽  
Mucosal Barrier ◽  
Bodyweight Loss ◽  
Mucosal Barrier Function ◽  
Inflammatory Bowel

Treatment of inflammatory bowel disease (IBD) is mainly based on suppression of symptoms, often with numerous side effects. Trials of probiotics in IBD have frequently produced disappointing results. The majority of probiotics are unusual, since they do not require iron for growth, unlike many bacteria resident in the intestine. The IBD intestine is iron-rich due to bleeding and use of oral iron supplements; conventional probiotics would be rapidly outcompeted. We have evaluated an iron-responsive Streptococcus thermophilus strain for its potential to reduce signs of colitis. Efficacy of S. thermophilus was evaluated in the dextran sodium sulphate mouse model of colitis. Treated animals were given 1×108 cfu S. thermophilus per day and clinical observations were taken daily. At termination, gross and histopathological signs of disease, cellular infiltration, location of bacteria, and cytokine expression in the intestine were determined. S. thermophilus delayed onset of colitis and reduced clinical signs of disease, including bodyweight loss and gastrointestinal bleeding. It reduced bacterial translocation into the colonic tissue. Increased numbers of CD8+ intraepithelial lymphocytes were seen in control animals treated with S. thermophilus. S. thermophilus had no effect on gross pathology, histopathology or cytokine production in either colitic or control animals. We propose that S. thermophilus promotes maintenance of mucosal barrier function which reduces bacterial translocation, thereby reducing immune stimulation and associated inflammation. This allows mucosal healing, reducing gastrointestinal bleeding and weight loss. This could be studied as a locally-acting adjunct or alternative to current IBD treatments.

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