scholarly journals Histological Evaluation of Patients with Chronic Nonbloody Large Bowel Diarrhea and Normal Colonoscopy

2019 ◽  
Vol 10 (01) ◽  
pp. 049-052
Author(s):  
Varun Kumar Karri ◽  
Sravan Kumar Korrapati ◽  
L. R. S. Girinadh
Keyword(s):  
Large Bowel ◽  
Chronic Diarrhea ◽  
Diagnostic Yield ◽  
Stool Culture ◽  
Histological Evaluation ◽  
Ascending Colon ◽  
Histological Changes ◽  
Watery Stool ◽  
Normal Limits ◽  
Stool Analysis

ABSTRACT Introduction: Chronic diarrhea is defined as the passage of soft or watery stool more than three times per day with or without blood and/or mucous or the passage of stool of more than 200 g per day and lasts for more than 4 weeks. Studies exploring the causes of chronic diarrhea in the developing countries are scarce and might not be generalizable from one setting to another. Aim: The aim of the study is to study the colonic and terminal ileal macroscopic and mucosal histopathological findings in chronic large bowel diarrhea patients. Methods: Eighty-six patients with chronic large bowel diarrhea were included after negative HIV status, stool analysis, and stool culture. A full-length colonoscopy with terminal ileoscopy was done. When the colon was within normal limits, randomly four biopsies each were taken from terminal ileum, ascending colon, transverse colon, and rectosigmoid region, respectively. Results: In a total of 86 patients, most of the patients (48%) were in the age group of 41–60 years. Females predominated in the present study in the ratio of 3:2. Ileal intubation was possible in all (100%) cases. Histology is normal in 35 patients. Fifty-one patients had histological changes of which 22 were diagnostic for specific disease which altered the treatment. Among 22 patients, 21 (95.4%) had histological changes in ascending colon and only 9 (40.9%) had changes in biopsy from rectosigmoid. In our study, definite diagnostic histology was obtained in 25.5% of cases. Conclusion: The yield of colonoscopy and biopsy in chronic large bowel diarrhea is moderate. Colonoscopy and biopsy have higher diagnostic yield than sigmoidoscopic biopsies.

scholarly journals Terminal ileum of patients who underwent colonoscopy: endoscopic, histologic and clinical aspects

2009 ◽  
Vol 46 (2) ◽  
pp. 102-106 ◽  
Author(s):  
Marcelo Maia Caixeta de Melo ◽  
Patrícia Maluf Cury ◽  
Luiz Sérgio Ronchi ◽  
Francisco de Assis Gonçalves-Filho ◽  
Geni Satomi Cunrath ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Terminal Ileum ◽  
Chronic Diarrhea ◽  
Clinical Importance ◽  
Histological Evaluation ◽  
Clinical Aspects ◽  
Ileal Mucosa ◽  
Histological Alterations ◽  
Kappa Test ◽  
A Prospective Study

CONTEXT: For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE: Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS: In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS: The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1%. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS: The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.

Helicobacter pylori colonisation of duodenal foveolar metaplasia requires concurrent gastric infection

2020 ◽  
pp. jclinpath-2020-206844
Author(s):  
Adam L Booth ◽  
Raul S Gonzalez
Keyword(s):  
Helicobacter Pylori ◽  
Chronic Gastritis ◽  
Immunohistochemical Staining ◽  
Acute Inflammation ◽  
Common Symptom ◽  
Routine Examination ◽  
Histological Changes ◽  
Normal Limits ◽  
H Pylori ◽  
Duodenal Biopsies

AimsEvaluate the rate and significance of Helicobacter pylori (H. pylori) involving duodenal foveolar metaplasia of chronic peptic duodenitis (CPD).MethodsWe identified 100 biopsy cases of CPD with synchronous stomach biopsies. All 200 were reviewed for histological changes (eg, chronic gastritis, acute inflammation) and underwent immunohistochemical staining for H. pylori. Results were correlated with patient age, sex, endoscopy indication and findings on stomach biopsy.ResultsCases included 49 men and 51 women, with a median age of 56 years. Reflux or dysphagia was the most common symptom. Chronic gastritis was present in 46 stomach biopsies, with 54 within normal limits. Twelve stomach biopsies showed H. pylori, all of which showed gastritis. Two duodenal biopsies (2%) demonstrated H. pylori organisms on immunohistochemistry, both from patients with H. pylori gastritis.ConclusionsRoutine examination of CPD samples for H. pylori appears unnecessary if a stomach biopsy is available for review.

scholarly journals Shigella sonneiBacteremia Presenting with Profound Hepatic Dysfunction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Oluwaseun Shogbesan ◽  
Andrew Rettew ◽  
Bilal Shaikh ◽  
Abdullateef Abdulkareem ◽  
Anthony Donato
Keyword(s):  
Laboratory Data ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Shigella Sonnei ◽  
Public Health Issue ◽  
Watery Stool ◽  
Normal Limits ◽  
Significant Public Health ◽  
History Of

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases ofShigellainfection are reported annually in the United States.Shigellabacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of aShigella sonneibacteremia with marked hepatic derangement in a 27-year-old previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two close contacts in preceding days. On examination, he was fully oriented but dehydrated, icteric, and febrile. Laboratory data revealed WBC of 2200/μL, elevated AST and ALT (201 IU/L, 73 IU/L resp.), normal alkaline phosphatase, elevated total and direct bilirubin of 8.2 mg/dL and 4.4 mg/dL, albumin of 3.2 g/dL, INR of 2.9, prothrombin time of 31.7, and platelet of 96,000/μL. Workup for infectious, autoimmune and medication-induced hepatitis, Wilson’s disease, and hemochromatosis was negative. Abdominal ultrasound and computed tomography of the abdomen showed hepatic steatosis and right-sided colitis. Stool and blood cultures were positive forShigella sonnei. He was treated with ciprofloxacin with improvement in liver function. Follow-up blood test 4 months later was within normal limits.

Diarrheal Morbidity in Patients Undergoing Hematopoietic Cell Transplantation - the Diagnostic Yield of Stool Cultures

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Tamar Berger ◽  
Odil Giladi ◽  
Dafna Yahav ◽  
Haim Ben-Zvi ◽  
Oren Pasvolsky ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Diagnostic Yield ◽  
Significant Proportion ◽  
Stool Culture ◽  
Hematopoietic Cell ◽  
Advisory Committees ◽  
Positive Stool ◽  
Autologous Hct ◽  
Stool Cultures

Diarrhea affects a significant proportion of patients undergoing hematopoietic cell transplantation (HCT). In this single center retrospective study, we explored the diagnostic yield of stool cultures for enteric pathogens among patients undergoing HCT. Between May 2007 and April 2020, a total of 1072 individuals underwent autologous (n=603) and allogeneic (n=469) HCT. Overall, 947 stool culture samples were obtained from 561 (52%) patients with diarrheal illness during hospitalization for HCT. Most (99%) samples were obtained beyond 3 days of admission and mainly (77%) during neutropenia. Overall, only four (autologous HCT, n=3; allogeneic HCT, n=1) patients were diagnosed with positive stool culture (0.42%) and in all cases, Campylobacter spp. was the pathogen identified. All isolates grew from the first stool culture obtained. The number of stool cultures needed-to-test to diagnose one case of bacterial infection was 237. The cost of diagnosing one case of bacterial infectious diarrhea was 8,770 US dollars. The median time from admission to positive stool culture sample was 12 (range, 7 to 13) days. Patients with a positive stool culture did not have discerning clinical or laboratory characteristics. In conclusion, according to our experience, the yield of stool cultures for enteropathogens in patients undergoing HCT is extremely low and thus should be avoided in most cases. Disclosures Wolach: Amgen: Other: Fees for lectures and Consultancy; Janssen: Other: Fees for lectures and Consultancy; Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Other: Fees for lectures and Consultancy; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Fees for lectures and Consultancy, Research Funding; Astellas: Consultancy, Honoraria, Other: Fees for lectures and Consultancy.

scholarly journals P151 Validation of the MaRIA Score in pediatric patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S231-S232
Author(s):  
L M Palomino Pérez ◽  
M Velasco Rodríguez-Belvis ◽  
S I Sirvent Cerdá ◽  
J A Vazquez Gómez ◽  
R A Muñoz Codoceo
Keyword(s):  
Clinical Remission ◽  
Pediatric Population ◽  
Fecal Calprotectin ◽  
Stool Culture ◽  
Mr Enterography ◽  
Acute Phase Reactants ◽  
Cross Sectional ◽  
Clostridium Difficile Toxin ◽  
Histological Remission ◽  
Stool Analysis

Abstract Background To validate the Magnetic Resonance Index of Activity (MaRIA Score) in the pediatric population and determine if it would be possible to monitor inflammatory bowel disease (IBD) without invasive tests in some cases. Methods A cross-sectional and descriptive study of paediatric patients with previously diagnosed or suspected IBD who underwent upper endoscopy (EGD) and colonoscopy, blood tests, stool analysis and MR Enterography (MRE) in a 15 days range, from October 2018 to February 2020. The clinical and endoscopic situation were assessed with the activity indices PUCAI/PCDAI/shPCDAI and the activity scores UCEIS/Mayo/SES-CD respectively, according to the underlying pathologies. We considered analytical remission as FC< 250 mcg/g, ERS< 20 mm and CRP< 1 mg/dl. The MRE results were assessed with the MaRIA Score, that is validated for adults. Results Amongst 21 patients, 12 (57%) were males. 12 patients had Crohn ́s disease (CD) (57%), 3 had ulcerative colitis (UC) (14%), 6 had IBD unclassified (IBDu) (28%). The mean age at diagnosis was 14.2 ± 0.7 and the progression time of the disease was 3.9 ± 0.6 years. A total of 16 patients showed clinical remission (76%), 6 of them (28%) also had endoscopic and histological remission. Eight patients were receiving biological treatment (38%). The measured acute phase reactants (APR) were: CRP 0.9 ± 0.5 mg/dl, ESR 13.7 ± 2.6 mm, α1 acid glycoprotein 95.5 ± 1.1 mg/dl and fecal calprotectin (FC) of 1154.3 ± 254.8 mcg/g. Rotavirus, adenovirus, Clostridium difficile toxin analysis and stool culture were performed in 14 patients, all of them negative. The MaRIA Score values were 54.3 ± 53.3, being 0 in 11 cases. We found no differences between the MaRIA Score and the analytical remission. We found a significant correlation between the MaRIA Score and the PUCAI value (p < 0.05), but not with other clinical scores. Patients in clinical remission showed a tendency to have a lower MaRIA Scores, but these differences were not statistically significant (p = 0.09). The MaRIA Score showed lower values for those with endoscopic and histological remission (p < 0.05), All the patients with MaRIA Score> 0 were CD except one, diagnosed with UC. Out of the 15 patients with endoscopic/histological involvement, 10 presented a MaRIA Score> 0. Five of the 11 patients (45%) in whom the MaRIA Score was 0 did not have endoscopic and histological remission, only one of them had a diagnosis of CD. Conclusion The MaRIA Score was significantly correlated with endoscopic scores in pediatric IBD patients, especially in CD. However, based on the results of this study, the MRE should not replace the EGD and colonoscopy in order to thoroughly evaluate the disease activity.

scholarly journals Low Yield of FilmArray GI Panel in Hospitalized Patients with Diarrhea: an Opportunity for Diagnostic Stewardship Intervention

2017 ◽  
Vol 56 (3) ◽  
Author(s):  
Matthew M. Hitchcock ◽  
Carlos A. Gomez ◽  
Niaz Banaei
Keyword(s):  
Salt Lake ◽  
Diagnostic Yield ◽  
Salt Lake City ◽  
Stool Culture ◽  
False Positives ◽  
Hospitalized Patients ◽  
Adult Patients ◽  
Content Type ◽  
Infectious Gastroenteritis ◽  
Lake City

ABSTRACTThe FilmArray GI panel (BioFire Diagnostics, Salt Lake City, UT) is a multiplex, on-demand, sample-to-answer, real-time PCR assay for the syndromic diagnosis of infectious gastroenteritis that has become widely adopted and, in some instances, has replaced conventional stool culture and parasite exams. Conventional testing has historically been restricted among hospitalized patients due to low diagnostic yield, but it is not known whether use of the FilmArray GI panel should be circumscribed. Cary-Blair stool samples submitted for FilmArray GI panel in adult patients admitted to an academic hospital from August 2015 to January 2017 were included in this study. Of 481 tests performed >72 h after admission, 29 (6.0%) were positive, all for a single target, excludingClostridium difficile. When follow-up tests beyond the first positive per hospitalization were excluded, 20 (4.8%) of 414 tests were positive. There was no difference in yield by immune status. Most targets detected were viral (79% of all positives [n= 23] and 70% in unique patients [n= 14]). All four cases positive for a bacterial target could not be confirmed and presentation was atypical, suggesting possible false positives. After removing potential false positives and chronic viral shedders, the yield was 3.0% (12/406). Repeat testing performed >72 h after admission and following a negative result within the first 72 h was done in 19 patients and 100% (22/22) remained negative. The FilmArray GI panel has low yield in adult patients hospitalized for >72 h, similar to conventional stool microbiology tests, and it is reasonable to restrict its use in this population.

Helium gas microbubbles

1998 ◽  
Vol 39 (1) ◽  
pp. 96-99
Author(s):  
T. Nishiharu ◽  
Y. Yamashita ◽  
A. Arakawa ◽  
K. Mitsuzaki ◽  
T. Matsukawa ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Celiac Artery ◽  
Histological Evaluation ◽  
Histological Changes ◽  
Hepatic Cells ◽  
Helium Gas ◽  
Femoral Muscle ◽  
Hematoxylin Eosin ◽  
Different Doses ◽  
Paired T Test

Purpose: To evaluate histological changes and duration of enhancement after the intra-arterial injection of helium gas microbubbles in comparison with conventionally used carbon dioxide (CO2) microbubbles at US Material and Methods: Four different doses of helium gas microbubbles (0, 0.1, 0.2 and 0.5 ml/kg) mixed with normal saline and own blood were injected into the celiac artery of 8 rabbits. After one week, autopsies were performed on all animals and histological changes in the liver, stomach and spleen were studied on hematoxylin-eosin stains. in addition, VX-2 tumor strains were transplanted into the femoral muscle in 5 other rabbits. Four weeks after transplantation, we catheterized the femoral artery and either CO2 or helium gas microbubbles were injected under US observation. We evaluated the duration of enhancement in the tumors with the two types of microbubbles Results: On histological evaluation, damage in hepatic cells as well as multiple areas of gastritis in the stomach were seen when a dose of 0.5 ml/kg of helium gas was used. Damage in the liver and stomach was slight at a dose of 0.2 ml/kg. the spleen was not damaged at doses of under 0.5 ml/kg. in the evaluation of tumor enhancement, the duration of enhancement with helium gas microbubbles ranged from 28 to 45 min (average 36 min) while that with CO2 ranged from 4 to 12 min (average 9 min) (p>0.001 at paired t-test) Conclusion: Intra-arterial injection of helium gas should not exceed 0.2 ml/kg: a dose of 0.5 ml/kg may cause damage to the liver and stomach. the duration of enhancement with helium gas microbubbles is significantly longer than that with CO2 microbubbles

scholarly journals Importance of biopsies and histological evaluation in patients with chronic diarrhea and normal colonoscopies

2014 ◽  
Vol 27 (3) ◽  
pp. 184-187 ◽  
Author(s):  
Franciane Mayra Nicoli KAGUEYAMA ◽  
Fernanda Michely NICOLI ◽  
Mauro Willemann BONATTO ◽  
Ivan Roberto Bonotto ORSO
Keyword(s):  
Differential Diagnosis ◽  
Terminal Ileum ◽  
Chronic Diarrhea ◽  
Collagenous Colitis ◽  
Normal Mucosa ◽  
Cross Sectional Study ◽  
Lymphoid Hyperplasia ◽  
Histological Evaluation ◽  
Cross Sectional ◽  
Eosinophilic Colitis

BACKGROUND: In patients with chronic diarrhea, colonoscopy may identify inflammatory causes or some occult disease, and also can show a normal mucosa. Serial biopsies of intestinal mucosa can be useful for a differential diagnosis, and to modify the treatment. AIM: To evaluate whether the biopsies performed in patients with chronic diarrhea and a normal colonoscopy contribute to the differential diagnosis and alter the therapeutic approach. METHODS: A descriptive, retrospective and cross-sectional study using a computerized database was done. Patients with chronic diarrhea and a normal colonoscopy underwent serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: From 398 records, 214 were excluded. Of the 184 patients enrolled, 91 showed histological changes: 40% nonspecific inflammation; 5.18% lymphocytic inflammation, 10.37% eosinophilic inflammation; 39.26% lymphoid hyperplasia; 2.22% collagenous colitis; 2.22% melanosis; and 0.74% pseudomelanose. The sites with the largest number of changes were the terminal ileum and right colon. CONCLUSIONS: Serial biopsies in patients with chronic diarrhea and normal colonoscopy identified changes in almost 50% of cases and 22% of these cases may had modified the treatment after identification of collagenous, lymphocytic and eosinophilic colitis.

The Practical Value of Comprehensive Stool Analysis in Detecting the Cause of Idiopathic Chronic Diarrhea

2012 ◽  
Vol 41 (3) ◽  
pp. 539-560 ◽  
Author(s):  
Karen J. Steffer ◽  
Carol A. Santa Ana ◽  
Jason A. Cole ◽  
John S. Fordtran
Keyword(s):  
Chronic Diarrhea ◽  
Stool Analysis
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