Small bowel strictures

Purpose of review Strictures of the small bowel are an underdiagnosed entity with significant morbidity because of obstruction and risk of perforation and penetrating disease. Recent findings Recent advances in imaging, enteroscopy, and therapeutic advances particularly in Crohn's disease have enabled gastroenterologists to target and individualize management of small bowel strictures, preventing untimely surgery and complications. Summary All patients with obstructive symptoms, suspected small bowel disease, and negative panendoscopy should be evaluated for small intestinal strictures with cross-sectional imaging and considered for capsule endoscopy. Furthermore, the role of device-assisted enteroscopy, initially employed as a diagnostic tool, has evolved into triaging and delivering further medical and interventional treatments.
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: SMALL INTESTINE: Edited by Reena Sidhu Source Type: research

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A 63-year-old man presented with a history of abdominal pain, diarrhea, and weight loss. He had an abdominal computed tomography scan, which revealed duodenal, jejunal, and colonic thickening. This was followed by colonoscopy with biopsies, and the patient was diagnosed with inflammatory bowel disease, likely Crohn disease. However, upper endoscopy was performed, which revealed duodenal thickening, and biopsy revealed amyloid deposits by Congo red staining. Stool cultures were negative, and no source of infection was found.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Letter to the Editor Source Type: research
Abstract Upper gastrointestinal (UGI) tract involvement of inflammatory bowel disease (IBD) is commonly seen in pediatric patients. Upper endoscopy is included in the routine workup of children with suspected IBD to enhance the diagnosis and management of these patients. Currently, childhood IBD is classified into ulcerative colitis (UC), atypical UC, Crohn's disease (CD) and IBD unclassified. Histologic confirmation of UGI tract involvement, in particular the presence of epithelioid (non-caseating) granulomas, is helpful in confirming the diagnosis of IBD and its classification. Herein, we reviewed selected IBD-a...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Conclusions: MRE cannot reliably assess the UGI in pediatric CD and cannot replace EGD for this purpose.
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Gastroenterology: Inflammatory Bowel Disease Source Type: research
ABSTRACT: Exclusive enteral nutrition is effective in pediatric Crohn disease but challenging as maintenance therapy. There is interest in food-based therapies such as the specific carbohydrate diet (SCD) but paucity of data on efficacy and effect on mucosal healing, an evolving target of IBD therapy. We conducted a retrospective review of the mucosal healing effect of the SCD in pediatric Crohn disease (CD). The endoscopic findings for children younger than 18 years with CD treated exclusively with the SCD or modified SCD (mSCD; SCD + addition of “illegal foods”) were reviewed before and after the diet. Il...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Short Communication: Gastroenterology: Inflammatory Bowel Disease Source Type: research
The initial diagnosis of inflammatory bowel disease (IBD) requires multiple diagnostic modalities; however, endoscopic evaluation as a diagnostic test is considered the gold standard. Endoscopic evaluation includes colonoscopy with ileoscopy, esophagogastroduodenoscopy, enteroscopy, and capsule endoscopy. IBD encompasses Crohn ’s disease, ulcerative colitis, and IBD unclassified. Colonoscopy with ileoscopy along with biopsy collection is essential in most IBD cases for diagnosis and to rule out alternative findings that may mimic IBD including ischemia, diverticulitis, segmental colitis associated with diverticulosis...
Source: Techniques in Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Source Type: research
The initial diagnosis of inflammatory bowel disease (IBD) requires multiple diagnostic modalities, however endoscopic evaluation is considered the gold standard diagnostic test. Endoscopic evaluation includes colonoscopy with ileoscopy, esophagogastroduodenoscopy, enteroscopy, and capsule endoscopy. IBD encompasses Crohn ′s disease, Ulcerative colitis, and IBD-unclassified. Colonoscopy with ileoscopy and biopsy collection is essential in the vast majority of IBD cases for diagnosis, and to rule out alternative diagnoses that may mimic IBD including ischemia, diverticulitis, segmental colitis associated with divert ic...
Source: Techniques in Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: SI: Imaging in IBD Source Type: research
Conclusions: A high prevalence of upper GI involvement was observed in newly diagnosed patients with CD, with a majority of the patients being asymptomatic. Focally enhanced gastritis was common in both patients with CD and patients with UC, whereas granulomatous inflammation was restricted to patients with CD.
Source: Inflammatory Bowel Diseases - Category: Gastroenterology Tags: Original Clinical Articles Source Type: research
CONCLUSIONS: We found a prevalence of 34% for CD involving the upper GI tract across these 20 studies. Routine upper endoscopy with biopsies of the upper GI tract in the diagnostic workup of patients with CD can correctly classify the distribution and extent of the disease. PMID: 26539952 [PubMed - as supplied by publisher]
Source: Southern Medical Journal - Category: Journals (General) Tags: South Med J Source Type: research
Abstract AIM: To assess the evolution of duodenal lymphocytosis (DL), a condition characterized by increased intraepithelial lymphocytes (IELs), over 2 years of follow-up. METHODS: Consecutive patients undergoing upper endoscopy/histology for abdominal pain, diarrhea, weight loss, weakness or other extraintestinal features compatible with celiac disease (CD) were included. Evaluation of IELs infiltrate in duodenal biopsy samples was carried out by CD3-immunohistochemistry and expressed as number of positive cells/100 enterocytes. Diagnostic agreement on the IELs count was tested by calculating the weighted k ...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
CONCLUSION: Routine biopsy of normal appearing duodena in patients with abdominal pain should be reserved for those with a high pre-test probability given its low diagnostic yield. PMID: 26139995 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
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