Fructose and/or Sorbitol Intolerance in a Subgroup of Lactose Intolerant Patients

The diagnosis and treatment of lactose intolerance often does not resolve all the symptoms of postcibal bloating and flatulence. Included in this study were 104 lactose intolerant patients (71 female, 33 male) who complained of residual postcibal discomfort in spite of adherence to and benefit from appropriate measures for their documented lactose intolerance (at least 20 ppm H2after 25 g lactose as well as appropriate symptomatic discomfort). Clinical characteristics common to this group included: symptomatic diarrhea (12.5%), history of foreign travel (5.8%), endoscopic and pathological evidence of gastritis and helicobacter infection (19.2 and 8.7%, respectively), nonspecific abnormalities of small bowel follow-through (15.4%), Crohn’s disease (8.7%) and colonic cliverticulosis (14.4%). Intolerance co fructose (at least 10 ppm H2after 25 g fructose plus appropriate symptoms) or sorbitol (at least 10 ppm H2after 5 g sorbitol plus appropriate symptoms) was documented in 17.3 and 18.3%, respectively. Intolerance to both fructose and sorbicol (administered as separate challenges), more than twice as common as intolerance to either one alone, occurred in 41.4% and was independent of sex. In conclusion, additional carbohydrate intolerances contribute to postcibal discomfort in more than 75% of lactose intolerant patients who remain symptomatic in spite of adherence to appropriate measures for this condition. While 62% of all patients had benefited significantly (greater than 50%) from appropriate dietary measures and enzyme replacement for lactose intolerance, only 40% of those who were also fructose intolerant and 47% who were sorbitol intolerant benefited (greater than 50%) from appropriate dietary measures (no enzyme replacement yet available) for intolerance to these sugars.

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628 Natural History of Radiological Transmural Healing in Small Bowel Crohn's Disease Patients Undergoing Serial Enterography

Gastroenterology ◽

10.1016/s0016-5085(16)30542-x ◽

2016 ◽

Vol 150 (4) ◽

pp. S130-S131

Author(s):

Parakkal Deepak ◽

Joel G. Fletcher ◽

Jeff L. Fidler ◽

John M. Barlow ◽

Shannon P. Sheedy ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Natural History ◽

History Of

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Small Bowel Adenocarcinoma Complicating Crohn's Disease: Case Series and Review of the Literature

The American Surgeon ◽

10.1177/000313480707301122 ◽

2007 ◽

Vol 73 (11) ◽

pp. 1181-1187 ◽

Cited By ~ 14

Author(s):

Lesly A. Dossett ◽

Lisa M. White ◽

Dereck C. Welch ◽

Alan J. Herline ◽

Roberta L. Muldoon ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

De Novo ◽

Metastatic Cancer ◽

Case Series ◽

Small Bowel Adenocarcinoma ◽

Review Of The Literature ◽

Disease Case ◽

History Of

Colonic adenocarcinoma frequently complicates inflammatory bowel disease of the colon, but small bowel adenocarcinoma (SBA) is a rare complication of Crohn's disease (CD). We present two patients with SBA in CD and review the literature with regards to CD-related SBA. A 45-year-old male with a 17-year history of ileal CD presented with obstructive symptoms but no radiographic evidence of a mass. After laparoscopic ileocolectomy and repair of incidental ileosigmoid fistula, pathology showed a T3N0 adenocarcinoma within the ileal CD. Two years after his resection he was without evidence of disease. A 59-year-old male with a 15-year history of CD presented with an acute exacerbation. Small bowel follow through demonstrated a long ileal stricture for which he underwent an ileocolic resection. Postoperative pathology confirmed a T3N1 CD-related SBA. He died from metastatic cancer 3 months later. Review of the literature identified 154 cases of SBA complicating CD with several distinguishing features from de novo SBA. Patients with SBA and CD are, as a group, younger and more likely to be male. SBA is rarely diagnosed preoperatively in these patients, and has a poor prognosis due to its advanced stage at diagnosis.

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The Clinical Characteristics and Prognosis of Crohn's Disease in Korean Patients Showing Proximal Small Bowel Involvement: Results from the CONNECT Study

Gut and Liver ◽

10.5009/gnl16500 ◽

2018 ◽

Vol 12 (1) ◽

pp. 67-72 ◽

Cited By ~ 4

Author(s):

One Zoong Kim ◽

Dong Soo Han ◽

Chan Hyuk Park ◽

Chang Soo Eun ◽

You Sun Kim ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Clinical Characteristics ◽

Korean Patients ◽

Proximal Small Bowel ◽

Bowel Involvement

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Review: Advances in the diagnosis and treatment of small bowel lesions with Crohn’s disease using double-balloon endoscopy

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x09343542 ◽

2009 ◽

Vol 2 (6) ◽

pp. 357-366 ◽

Cited By ~ 23

Author(s):

Keijiro Sunada ◽

Hironori Yamamoto ◽

Tomonori Yano ◽

Kentaro Sugano

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Diagnosis And Treatment ◽

Double Balloon Endoscopy ◽

Double Balloon

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Clinical characteristics and imaging features of small bowel adenocarcinomas in Crohn’s disease

Abdominal Imaging ◽

10.1007/s00261-014-0144-7 ◽

2014 ◽

Vol 40 (5) ◽

pp. 1060-1067 ◽

Cited By ~ 21

Author(s):

Nicholas K. Weber ◽

Joel G. Fletcher ◽

Jeff L. Fidler ◽

John M. Barlow ◽

Shiv Pruthi ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Clinical Characteristics ◽

Imaging Features

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W1084 Capsule Endoscopy (CE) in ‘Suspected’ Small Bowel (SB) Crohn's Disease (CD): Economic Impact of Disease Diagnosis and Treatment

Gastroenterology ◽

10.1016/s0016-5085(09)62998-x ◽

2009 ◽

Vol 136 (5) ◽

pp. A-650

Author(s):

Jonathan A. Leighton ◽

Ian M. Gralnek ◽

Randel E. Richner ◽

Michael J. Lacey ◽

Frank J. Papatheofanis

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Economic Impact ◽

Capsule Endoscopy ◽

Disease Diagnosis ◽

Diagnosis And Treatment

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Case of Invasive Metastatic Breast Cancer Mimicking Crohn’s Disease

10.31487/j.gscr.2019.01.04 ◽

2019 ◽

pp. 1-3

Author(s):

Bryce E. Haac ◽

Jonah N. Rubin ◽

Andrea Chao Bafford ◽

Bryce E. Haac ◽

Fikru Merechi ◽

...

Keyword(s):

Breast Cancer ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Bowel Obstruction ◽

Lobular Carcinoma ◽

Lobular Breast Cancer ◽

Gi Tract ◽

Presumptive Diagnosis ◽

History Of

Background: A female patient with a history of stage IIB invasive lobular breast cancer presented with symptoms of partial small bowel obstruction and workup led to a presumptive diagnosis of Crohn’s disease. However, at the time of surgical intervention, she was found to have metastatic lobular breast cancer with carcinomatosis and metastases to the small and large intestines. Summary: Our patient presented at age 55 with intermittent nausea and vomiting, dyspepsia, altered bowel habits, and weight loss. She had a history of invasive lobular carcinoma of the right breast treated with right modified radical mastectomy followed by adjuvant chemoradiation and hormonal therapy 5 years earlier. She was thought to be in remission. Initial workup of her GI complaints was notable for thickening of the sigmoid colon and hepatic flexure on CT scan and stricturing and colitis in these areas on colonoscopy. Mucosal biopsies showed nonspecific active colitis. The patient was treated for a presumptive diagnosis of Crohn’s disease without significant improvement. She was eventually taken for surgery after presenting with a high-grade small bowel obstruction. On exploration, numerous additional small and large bowel strictures, some associated with intraluminal masses, were found and a small bowel resection and ileostomy performed. Pathology revealed metastatic invasive lobular breast carcinoma. Although isolated metastases to the bowel wall are rare, they have been reported secondary to a wide range of malignancies. Breast cancer, especially lobular carcinoma, is one of the most common tumors to metastasize to the GI tract and can present years after the primary cancer diagnosis. Therefore, the differential diagnosis for a patient with signs and symptoms of bowel obstruction and a history of lobular breast cancer should include metastatic disease. Conclusion: Metastatic cancer to the GI tract can mimic Crohn’s disease and should be on the differential in older patients with abdominal complaints, particularly those with a history of breast cancer.

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