S0516 Small Bowel and Colonic Postprandial Response Related to Bloating in Patients With Upper GI Symptoms Suggestive of Gastroparesis

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

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Reliability and validity of a modified questionnaire of upper GI symptoms utilized in a disease management program of patients on chronic acid suppression

Gastroenterology ◽

10.1016/s0016-5085(03)82556-8 ◽

2003 ◽

Vol 124 (4) ◽

pp. A505

Author(s):

Braden Kuo ◽

Timothy Ferris

Keyword(s):

Disease Management ◽

Disease Management Program ◽

Reliability And Validity ◽

Management Program ◽

Acid Suppression ◽

Upper Gi ◽

Gi Symptoms

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620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doab052.620 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Kathryn Peterson ◽

Robert Genta ◽

Henrik Rasmussen ◽

Bradford Youngblood ◽

Amol Kamboj

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Eosinophilic Esophagitis ◽

Life Experience ◽

Real Life ◽

Gastrointestinal Disorder ◽

Control Group ◽

Abdominal Symptoms ◽

Gi Symptoms ◽

Initial Work

Abstract Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms. Methods 52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment. Results 45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group. Conclusion In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.

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Video Capsule Endoscopy In Comparison To Radiological Examination In Detection Of Small Bowel Lesions

QJM ◽

10.1093/qjmed/hcab100.029 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Amir Helmy Samy ◽

Nevine Ibrahim Musa ◽

Shereen Abou Bakr Saleh ◽

Ahmed Sayed Elgammal

Keyword(s):

Small Bowel ◽

Capsule Endoscopy ◽

Positive Contrast ◽

Video Capsule Endoscopy ◽

Vascular Lesions ◽

Deficiency Anemia ◽

Mesenteric Angiography ◽

Upper Gi ◽

Negative Results ◽

Upper Gi Endoscopy

Abstract BACKGROUND Small bowel obscured its lesions as secrets which were difficult to diagnose before video capsule endoscopy as a new modality for investigation. Aim of the study Evaluation of video capsule endoscopy in comparison to radiological examination in detection of small bowel lesions. Patients and methods Fifty patients were recruited from Kafrawy Video Capsule Endoscopy Unit of Internal Medicine Department and endoscopy unit of Ain Shams University Hospital. The study included patients with occult or overt GIT bleeding, patients with unexplained microcytic iron deficiency anemia, patients with chronic diarrhea and abdominal pain, with normal upper GI endoscopy and colonoscopy. Exclusion of any patient younger than 18 years old, has intestinal stricture, achalasia, or dysphagia. All patients were studied biochemically with CBC and radiological by CT pelvis and abdomen with IV and oral positive contrast some of them were radiologically examined with CTE or CT mesenteric angiography. All patients were endoscopically examined by OGD, colonoscopy, VCE, and some of them were examined also with enteroscope. Results The study revealed that the detection rate of SB lesions with VCE was 84%. In the current study, (44%) of cases had AVMs, (72.73) % of them were above the age of forty five, and (27.27) % were below the age of forty five. All patients who were investigated with CT mesenteric angiography revealed negative results. In this study (20) % of patients had SB masses and polyps, (70) % of them were at age of forty five or more and only (30) % of them were below the age of forty five. All patients underwent CT pelvis and abdomen with IV and oral positive contrast, and we found that all patients had a negative results regarding the SB lesions. In comparison between CTE and VCE in detection of SB vascular lesions CTE did not detect SB vacular lesions. On the other hand, VCE detected the AVMs in the cases with negative CTE results. In this study one patient (2)% was diagnosed with hookworm infection. All patient underwent for OGD. We found that (20)% of patients had a significant gastric or duodenal lesions (proximal to the papilla) by VCE but missed by upper GI endoscopy. In our study the concomitant of VCE and enteroscope increase the detection of SB vascular lesions than isolated use of VCE only. Conclusion VCE has a high detection rate of SB lesions (84)%. CTE has a low significance in detection of SB vascular lesions and CT mesenteric angiography sensitivity relatively low. AVMs more common with increasing the age. PHE and SB ectopic varicies, were found to be common causes of GIT bleeding in CLD patient. There is a significant rate of missed gastric and duodenal (proximal to the papilla) lesions that the cause of GIT bleeding and unexplained iron deficiency anemia in OGD examination that were detected by VCE.

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Diagnostic yield of magnetically assisted capsule endoscopy versus gastroscopy in recurrent and refractory iron deficiency anemia

Endoscopy ◽

10.1055/a-0750-5682 ◽

2018 ◽

Vol 51 (05) ◽

pp. 409-418 ◽

Cited By ~ 10

Author(s):

Hey-Long Ching ◽

Melissa F. Hale ◽

Matthew Kurien ◽

Jennifer A. Campbell ◽

Stefania Chetcuti Zammit ◽

...

Keyword(s):

Small Bowel ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Deficiency Anemia ◽

Gi Tract ◽

Upper Gi ◽

Upper Gi Tract ◽

Magnetically Assisted

Abstract Background Small-bowel capsule endoscopy is advocated and repeat upper gastrointestinal (GI) endoscopy should be considered for evaluation of recurrent or refractory iron deficiency anemia (IDA). A new device that allows magnetic steering of the capsule around the stomach (magnetically assisted capsule endoscopy [MACE]), followed by passive small-bowel examination might satisfy both requirements in a single procedure. Methods In this prospective cohort study, MACE and esophagogastroduodenoscopy (EGD) were performed in patients with recurrent or refractory IDA. Comparisons of total (upper GI and small bowel) and upper GI diagnostic yields, gastric mucosal visibility, and patient comfort scores were the primary end points. Results 49 patients were recruited (median age 64 years; 39 % male). Combined upper and small-bowel examination using the new capsule yielded more pathology than EGD alone (113 vs. 52; P < 0.001). In upper GI examination (proximal to the second part of the duodenum, D2), MACE identified more total lesions than EGD (88 vs. 52; P < 0.001). There was also a difference if only IDA-associated lesions (esophagitis, altered/fresh blood, angioectasia, ulcers, and villous atrophy) were included (20 vs. 10; P = 0.04). Pathology distal to D2 was identified in 17 patients (34.7 %). Median scores (0 – 10 for none – extreme) for pain (0 vs. 2), discomfort (0 vs. 3), and distress (0 vs. 4) were lower for MACE than for EGD (P < 0.001). Conclusion Combined examination of the upper GI tract and small bowel using the MACE capsule detected more pathology than EGD alone in patients with recurrent or refractory IDA. MACE also had a higher diagnostic yield than EGD in the upper GI tract and was better tolerated by patients.

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Gastrointestinal (GI) symptoms, quality of life and endoscopic diagnoses in patients with upper GI symptoms

Gastroenterology ◽

10.1016/s0016-5085(08)81187-0 ◽

2001 ◽

Vol 120 (5) ◽

pp. A239-A240

Author(s):

Elisabeth Bolling-Sternevald ◽

Rolf Carlsson ◽

Claus Aalykke ◽

Benedicte Wilson ◽

Ola Junghard ◽

...

Keyword(s):

Quality Of Life ◽

Upper Gi ◽

Gi Symptoms

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Silent Unrecognized GERD in an Unselected Population of Primary Care Patients With Upper GI Symptoms

Gastroenterology ◽

10.1016/s0016-5085(11)62585-7 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-625

Author(s):

Nimish B. Vakil ◽

Katarina Halling ◽

Börje Wernersson ◽

Lis Ohlsson

Keyword(s):

Primary Care ◽

Upper Gi ◽

Gi Symptoms ◽

Primary Care Patients ◽

Unselected Population

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Clinical Applications of Electrogastrography

Handbook of Electrogastrography ◽

10.1093/oso/9780195147889.003.0010 ◽

2003 ◽

Keyword(s):

Nausea And Vomiting ◽

Chronic Mesenteric Ischemia ◽

Early Satiety ◽

Postprandial Fullness ◽

Upper Gi ◽

Gastric Dysrhythmias ◽

Organ Systems ◽

Gi Symptoms ◽

Chronic Nausea ◽

Clinical Conditions

Electrogastrography methods have been used in many clinical studies over the past 80 years. In 1922,Alvarez predicated that electrical abnormalities of the stomach may be related to gastrointestinal (GI) symptoms and abnormal gastric function. In 1980, antral dysrhythmias were recorded with mucosal electrodes in a series of patients with unexplained nausea and vomiting. These gastric dysrhythmias were 6— to 7—cycles per minute (cpm) tachygastrias, bu there were also very irregular rhythms that changed from bradygastria to tachygastria (mixed dysrhythmias or tachyarrhythmias). Bradygastrias also were recorded in patients with unexplained nausea and vomiting. Further studies showed a relationship between the presence of nausea and gastric dysrhythmias during motion sickness, in nausea and vomiting of pregnancy, and in patients with idiopathic and diabetic gastroparesis. Infusion of a variety of drugs and physical distention of the antrum also induced gastric dysrhythmias and symptoms of nausea. Ischemic gastroparesis with gastric dysrhythmias due to chronic mesenteric ischemia is an unusual cause of chronic nausea and vomiting. Ischemic gastroparesis is important to recognize because after revascularization the symptoms resolved, the gastric dysrhythmias were eradicated and normal 3-cpm EGG activity and normal gastric emptying were restored. Thus, gastric dysrhythmias are found in many disorders in which nausea and vomiting are prominent symptoms. Clinical conditions associated with gastric dysrhythmias were reviewed. Finally, a variety of drugs and nondrug therapies convert gastric dysrhythmias to normal 3-cpm gastric myoelectrical rhythms and the correction of the gastric dysrhythmia correlates with improvement in symptoms. Taken together, these findings indicate that gastric dysrhythmias are objective, pathophysiological events related to the upper GI symptoms, especially nausea and dysmotility-like functional dyspepsia symptoms such as early satiety, fullness, and vomiting. The recording of gastric dysrhythmias is an important tool for the clinician when patients have symptoms that suggest gastric dysfunction such as unexplained nausea, bloating, postprandial fullness, and early satiety. On the other hand, these upper GI symptoms are nonspecific, and diseases or disorders of other organ systems such as esophagus, gallbladder, small bowel, colon, and non-GI diseases must be considered.

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Jejunum and Ileum

Mayo Clinic General Surgery ◽

10.1093/med/9780190650506.003.0010 ◽

2020 ◽

pp. 139-153

Author(s):

Jad M. Abdelsattar ◽

Moustafa M. El Khatib ◽

T. K. Pandian ◽

Samuel J. Allen ◽

David R. Farley

Keyword(s):

Small Bowel ◽

Abdominal Surgery ◽

Paralytic Ileus ◽

Lymphoid Tissue ◽

Plain Radiography ◽

Counterclockwise Rotation ◽

Upper Gi ◽

Antimesenteric Border ◽

Calcium And Magnesium ◽

Electrolyte Replacement

During development, there is physiologic herniation of the midgut into the umbilical cord, and it then slips back in with a counterclockwise rotation. Jejunum and ileum occupy the mid abdomen and pelvis. The jejunum is involved in calcium and magnesium absorption. The ileum contains lymphoid tissue at the antimesenteric border. Small bowel infections present with a range of symptoms from diarrhea to severe dehydration to sepsis. Suspected SBO can be evaluated with plain radiography, upper GI studies, or CT. The treatment of SBO is initially nonoperative. Paralytic ileus occurs in many patients after abdominal surgery and is treated with IV fluids, nothing by mouth, and electrolyte replacement.

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