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Chronic intestinal pseudo-obstruction  

PubMed Central

Chronic intestinal pseudo-obstruction (CIPO) is a severe digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Although uncommon in clinical practice, this syndrome represents one of the main causes of intestinal failure and is characterized by high morbidity and mortality. It may be idiopathic or secondary to a variety of diseases. Most cases are sporadic, even though familial forms with either dominant or recessive autosomal inheritance have been described. Based on histological features intestinal pseudo-obstruction can be classified into three main categories: neuropathies, mesenchymopathies, and myopathies, according on the predominant involvement of enteric neurones, interstitial cells of Cajal or smooth muscle cells, respectively. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases.

Antonucci, Alexandra; Fronzoni, Lucia; Cogliandro, Laura; Cogliandro, Rosanna F; Caputo, Carla; Giorgio, Roberto De; Pallotti, Francesca; Barbara, Giovanni; Corinaldesi, Roberto; Stanghellini, Vincenzo



Chronic intestinal pseudo-obstruction.  


Chronic intestinal pseudo-obstruction (CIP) is a rare and serious disorder of the gastrointestinal (GI) tract characterized as a motility disorder with the primary defect of impaired peristalsis; symptoms are consistent with a bowel obstruction, although mechanical obstruction cannot be identified. CIP is classified as a neuropathy, myopathy, or mesenchymopathy; it is a neuropathic process in the majority of patients. The natural history of CIP is generally that of a progressive disorder, although occasional patients with secondary CIP note significant symptomatic improvement when the underlying disorder is identified and treated. Symptoms vary from patient to patient depending on the location of the luminal GI tract involved and the degree of involvement; however, the small intestine is nearly always involved. Common symptoms include dysphagia, gastroesophageal reflux, abdominal pain, nausea, vomiting, bloating, abdominal distension, constipation or diarrhea, and involuntary weight loss. Unfortunately, these symptoms are nonspecific, which can contribute to misdiagnosis or a delay in diagnosis and treatment. Since many of the symptoms and signs suggest a mechanical bowel obstruction, diagnostic tests typically focus on uncovering a mechanical obstruction, although routine tests do not identify an obstructive process. Nutrition supplementation is required for many patients with CIP due to symptoms of dysphagia, nausea, vomiting, and weight loss. This review discusses the epidemiology, etiology, pathogenesis, diagnosis, and treatment of patients with CIP, with an emphasis on nutrition assessment and treatment options for patients with nutrition compromise. PMID:23612903

Gabbard, Scott L; Lacy, Brian E



Chronic intestinal pseudo-obstruction  

Microsoft Academic Search

Opinion statement  For many patients, nutritional support and relief of symptoms remain the primary management goal of pseudo-obstruction. Specific\\u000a pharmacological agents for this disorder are, in general, lacking. Given that the efficacy of many of the individual available\\u000a agents is far from excellent, several centers have turned to combination therapy. Though there is at present no evidence from\\u000a controlled studies to

Eamonn M. M. Quigley



Chronic Intestinal Pseudo-obstruction.  


For many patients, nutritional support and relief of symptoms remain the primary management goal of pseudo-obstruction. Specific pharmacological agents for this disorder are, in general, lacking. Given that the efficacy of many of the individual available agents is far from excellent, several centers have turned to combination therapy. Though there is at present no evidence from controlled studies to support this strategy, it is, at the very least, theoretically attractive as these agents act through a number of separate mechanisms. The combination of a prokinetic and an emetic may prove especially useful. As the pseudo-obstruction syndromes are, individually, rare, and experience with any given prokinetic agent in these disorders limited, it is difficult to develop strict guidelines for their use in this context. It stands to reason that a response to a prokinetic agent would seem unlikely in a patient with an advanced myopathic process; anecdotal evidence suggests, however, that some patients with severe scleroderma may derive some symptomatic improvement. Where oral therapy is tolerated, cisapride would appear the best choice among available agents. When this fails, subcutaneous octreotide may be added or substituted. In the acute situation, intravenous erythromycin may alleviate gastroparesis, but probably exerts little beneficial effect beyond the pylorus; parenteral metoclopramide may be tried, but, here again, convincing evidence of efficacy is lacking. The roles of endoscopy and surgery are largely confined to facilitating nutrition and providing decompression. PMID:11097724




Gastric antral dysrhythmias in children with chronic idiopathic intestinal pseudoobstruction  

Microsoft Academic Search

Chronic idiopathic intestinal pseudoobstruction is a serious disorder of intestinal neuromuscular function resulting in recurrent episodes of intestinal obstruction, and is caused by primary disease of the enteric nerves or enteric smooth muscle. Gastric electrical control activity detected by the non-invasive technique of surface electrogastrography was investigated in 11 children (0.1-16 years) with proven chronic idiopathic intestinal pseudoobstruction (four with

S P Devane; A M Ravelli; W M Bisset; V V Smith; B D Lake; P J Milla



Chronic intestinal pseudo-obstruction in a dog.  


A three-year-old neutered female Border Collie was presented with inappetence, vomiting and diarrhoea. Abdominal radiographs revealed an obstructive pattern but no physical obstruction was evident at laparotomy. A diagnosis of chronic intestinal pseudo-obstruction was made based on histopathological changes in intestinal biopsies. Treatment was unsuccessful and the dog deteriorated progressively until euthanased five weeks after presentation. PMID:8198514

Lamb, W A; France, M P



Chronic Intestinal Pseudoobstruction Associated with Fetal Alcohol Syndrome  

Microsoft Academic Search

Alcohol acts as a teratogen in the fetus,resulting in prenatal or postnatal growth failure,characteristic facial dysmorphic features, and centralnervous system dysfunction. The toxic effects of alcohol on the developing brain are well recognized,but gastrointestinal neuropathy has not been describedin fetal alcohol syndrome (FAS). Five children with FASpresented in infancy with signs and symptoms suggestive of chronic intestinal pseudoobstruction. Theywere not

E. Vasiliauskas; D. A. Piccoli; A. F. Flores; C. Di Lorenzo; P. E. Hyman



Visceral myopathy causing chronic intestinal pseudoobstruction and intestinal failure in a child with Sanjad-Sakati syndrome  

Microsoft Academic Search

Sanjad-Sakati syndrome is a rare autosomal recessive disorder mainly occurring in the Arab Peninsula. This condition is associated with metabolic and septic complications starting in the neonatal period. Chronic intestinal pseudoobstruction owing to visceral myopathy is a rare disabling condition. We report a rare concurrence of Sanjad-Sakati syndrome and chronic intestinal pseudoobstruction in a Saudi child complicated by intestinal failure,

Kamalesh Pal; Hissa Moammar; Dilip K. Mitra



Quality of life outcomes in congenital chronic intestinal pseudo-obstruction.  


The goal of this study was to assess the quality of life for children with chronic intestinal pseudoobstruction. We used a retrospective chart review to identify children with congenital chronic intestinal pseudoobstruction, then a structured telephone interview with parents that included the Child Health Questionnaire to gather information about the current status and quality of life for each patient and family. Children with chronic intestinal pseudo-obstruction had less freedom from pain, depression, and anxiety than healthy children or children with juvenile rheumatoid arthritis (P < 0.05 for all three parameters). Parents of children with chronic intestinal pseudo-obstruction had poorer emotional status than parents of healthy children or children with juvenile rheumatoid arthritis. The time required for parents to care for children with chronic intestinal pseudo-obstruction was greater than the time required to care for healthy children or children with juvenile rheumatoid arthritis (P < 0.01). In conclusion, the quality of life for children with chronic intestinal pseudo-obstruction lags behind that of healthy children and children with another chronic illness. Appropriate treatment of chronic pain may improve the quality of life for children with chronic intestinal pseudo-obstruction and their families. Moreover, attention to reducing each family's burden of time and emotional distress may help them cope better with their chronically ill child. PMID:12353838

Schwankovsky, Lenore; Mousa, Hayat; Rowhani, Anita; DI Lorenzo, Carlo; Hyman, Paul E



Visceral myopathy causing chronic intestinal pseudoobstruction and intestinal failure in a child with Sanjad-Sakati syndrome.  


Sanjad-Sakati syndrome is a rare autosomal recessive disorder mainly occurring in the Arab Peninsula. This condition is associated with metabolic and septic complications starting in the neonatal period. Chronic intestinal pseudoobstruction owing to visceral myopathy is a rare disabling condition. We report a rare concurrence of Sanjad-Sakati syndrome and chronic intestinal pseudoobstruction in a Saudi child complicated by intestinal failure, sepsis, and early mortality. PMID:20152369

Pal, Kamalesh; Moammar, Hissa; Mitra, Dilip K



Two Cases of Chronic Idiopathic Intestinal Pseudo-obstruction with Different Clinical Features  

PubMed Central

Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder characterized by a severe impairment of gastrointestinal propulsion in the absence of mechanical obstruction. We experienced a case of chronic pseudo-obstruction in the initial phase mimicking acute pseudo-obstruction, which was treated medically. This ongoing case was compared to another recurrent and intractable case successfully treated with surgery and diagnosed as hypoganglionosis. These two cases showed different clinical features and therapeutic approaches for CIPO; one with the first episode of CIPO mimicking Ogilvie's syndrome; the other with recurrent episodes of CIPO with typical features. In conclusion, CIPO is a difficult disorder with various clinical manifestations and different treatment modalities, therefore individualized diagnostic and therapeutic approaches are needed.

Lee, Byoung Hwan; Kang, Sung-Bum; Lee, Kyoung-Ho; Oh, Jane C.; Kim, Sun-Mi; Park, Young Soo; Lee, Dong Ho



Chronic intestinal pseudo-obstruction in adult patients: multidetector row helical CT features  

Microsoft Academic Search

Chronic intestinal pseudo-obstruction (CIPO) is a rare condition due to severe gastrointestinal motility disorder. Adult patients\\u000a with CIPO experience symptoms of mechanical obstruction, but reliable clinical signs that may help distinguish between actual\\u000a mechanical obstruction and CIPO are lacking. Additionally, abdominal plain films that commonly show bowel dilatation with\\u000a air-fluid levels do not reach acceptable degrees of specificity to exclude

Aurélie Merlin; Philippe Soyer; Mourad Boudiaf; Lounis Hamzi; Roland Rymer



Clinical recovery of chronic intestinal pseudo-obstruction with cisapride in a complex pediatric patient.  


Cisapride is a gastrointestinal prokinetic that facilitates or restores motility along the entire gastrointestinal tract. It has been used successfully to treat acute and chronic intestinal pseudo-obstructions (CIPs) in adults, but there is a paucity of literature surrounding the treatment of CIP in pediatric patients and therapies for CIP are limited and their impact is often unsatisfactory. This case report presents the use of cisapride in the management of pseudo-obstruction. Treatment with cisapride substantially improved the patient's symptoms and improved feeding tolerance. It improved his prognosis remarkably and prevented the need for end-of-life care. He experienced no adverse effects throughout the course of therapy. The treatment regimen is discussed in this case report. PMID:22964344

Cameron, Jean-Christy F; Vaillancourt, Régis; Major-Cook, Nathalie; Boland, Margaret; Zucker, Marc; Lariviere, Doris



Repetitive Colonoscopic Decompression as a Bridge Therapy before Surgery in a Pregnant Patient with Chronic Intestinal Pseudo-Obstruction  

PubMed Central

Chronic intestinal pseudo-obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors. Here, we report a case of a woman with intractable intestinal pseudo-obstruction that was precipitated by pregnancy. She could not make any stool passage for more than 4 weeks until a fetal gestational age of 17 weeks was reached. However, the patient could be maintained by repetitive colonoscopic decompressions and finally total colectomy could be performed successfully at a fetal gestational age of 21 weeks.

Kim, Joon Sung; Kim, Byung-Wook; Choi, Hwang; Lee, Yun-Seok; Maeng, Leeso



Mitochondrial myopathy (complex I deficiency) associated with chronic intestinal pseudo-obstruction.  


We report a patient presenting with severe muscular impairment and chronic intestinal pseudo-obstruction (CIP) at the age of eight months. Due to the aggravated symptoms, assisted ventilation, an ileostomy and total parenteral nutrition were required. Later on, the patient developed a locked-in syndrome (Leigh's subacute necrotising encephalomyelopathy) and finally died due to recurrent pneumonia and chronic renal failure. The assessment of muscle biopsies revealed a moderate single-fibre type II atrophy, a variation of muscle fibre calibre with focal fatty degeneration and a decreased reactivity of cytochrome-c oxidase. Although ragged red fibres had not been found, mitochondrial enzyme activities were markedly decreased with the lowest residual activity detected for NADH:Q1 oxidoreductase and NADH:O2 oxidoreductase (complex I deficiency), thereby confirming the diagnosis of mitochondrial myopathy. A molecular genetic analysis could not identify known mutations of mitochondrial DNA. Gastrointestinal full-thickness biopsies revealed myenteric hypoganglionosis of the colon and stomach and hyperplasia of the submucosal plexus of the ileum. Some of the intestinal smooth muscle cells displayed bulbous protrusions filled with lateralised mitochondria. Mitochondrial myopathies are known to be associated with a variety of clinical syndromes including CIP. However, in contrast to previous reports in which CIP has been attributed to visceral intestinal myopathies, the present case is characterised by neuronal intestinal malformations. Therefore, a mitochondrial myopathy associated with CIP requires a subtle assessment of both the intestinal smooth muscle and the enteric nervous system to identify the underlying pathology. PMID:12939706

Wedel, T; Tafazzoli, K; Söllner, S; Krammer, H J; Aring, C; Holschneider, A M



Radiation-induced intestinal pseudoobstruction  

SciTech Connect

A case of intestinal pseudoobstruction occurring 30 yr after radiation therapy is described. Mechanical causes of obstruction were excluded by laparotomy. Histology of full-thickness sections of the small bowel revealed vascular ectasia and sclerosis, serosal fibrosis, neuronal proliferation within the submucosa, and degeneration of the muscle fibers of the circular layer of the muscularis propria. On the basis of the clinical and histologic findings we conclude that, in this patient, intestinal pseudoobstruction was due to muscular and neuronal injury from abdominal irradiation.

Perino, L.E.; Schuffler, M.D.; Mehta, S.J.; Everson, G.T.



Emergency surgery in chronic intestinal pseudo-obstruction due to mitochondrial neurogastrointestinal encephalomyopathy: case reports  

PubMed Central

Chronic intestinal pseudo-obstruction (CIPO) is a syndrome characterized by recurrent clinical episodes of intestinal obstruction in the absence of any mechanical cause occluding the gut. There are multiple causes related to this rare syndrome. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is one of the causes related to primary CIPO. MNGIE is caused by mutations in the gene encoding thymidine phosphorylase. These mutations lead to an accumulation of thymidine and deoxyuridine in blood and tissues of these patients. Toxic levels of these nucleosides induce mitochondrial DNA abnormalities leading to an abnormal intestinal motility. Herein, we described two rare cases of MNGIE syndrome associated with CIPO, which needed surgical treatment for gastrointestinal complications. In one patient, intra-abdominal hypertension and compartment syndrome generated as a result of the colonic distension forced to perform emergency surgery. In the other patient, a perforated duodenal diverticulum was the cause that forced to perform surgery. There is not a definitive treatment for MNGIE syndrome and survival does not exceed 40 years of age. Surgery only should be considered in some selected patients.



Epidemiology and Clinical Experience of Chronic Intestinal Pseudo-Obstruction in Japan: A Nationwide Epidemiologic Survey  

PubMed Central

Background We estimated the prevalence and incidence of chronic intestinal pseudo-obstruction (CIPO) in Japan, investigated the patterns of hospital visits among those with CIPO, and examined present knowledge of CIPO among medical professionals. Methods A self-administered questionnaire survey was distributed to targeted hospitals throughout Japan, which were selected using stratified random sampling. The questionnaire asked about the number of patients receiving treatment for CIPO, the frequency of their hospital visits, and overall clinical knowledge of CIPO among medical professionals. Results CIPO prevalence was estimated to be 1.00 and 0.80 cases per 100 000 males and females, respectively. Incidence was 0.21 and 0.24 cases per 100 000 males and females, respectively. Prevalence and incidence did not significantly differ males and females. Mean age of patients was 63.1 years for males and 59.2 for females. Accurate diagnosis of CIPO sometimes required more than 3 months after initial presentation. Most medical professionals were unaware of or poorly understood CIPO. Conclusions We estimated the prevalence and incidence of CIPO in Japan, using data from a nationwide survey. The findings suggest that knowledge of CIPO should be further disseminated so that the disease is not overlooked and is diagnosed without delay.

Iida, Hiroshi; Ohkubo, Hidenori; Inamori, Masahiko; Nakajima, Atsushi; Sato, Hajime



Intestinal Pseudo-Obstruction  


... cause diarrhea. Over time, the condition can cause bacterial infections, malnutrition, weight loss, and muscle problems in ... may include medications, such as antibiotics to treat bacterial infections, pain medication, and medication to treat intestinal ...


Intestinal pseudo-obstruction  


... bed for long periods of time (bedridden) Taking narcotic (pain) medications or medications that slow intestinal movements ( ... that may have caused the problem (such as narcotic drugs) In severe cases, surgery may be needed.


Detection of anticonductive tissue autoantibodies in a patient with chronic intestinal pseudo-obstruction and sick sinus syndrome.  


A 26-year-old patient was diagnosed as having chronic intestinal pseudo-obstruction with manometric and histopathologic features suggestive of an intestinal myopathy. Histology was characterized by smooth muscle degeneration without inflammatory or immune cells. The severe gut dysfunction required full parenteral nutritional support. After a few months, the patient developed symptomatic tachy-brady arrhythmia episodes with syncopes. A thorough diagnostic work-up led to a diagnosis of sick sinus syndrome, which was managed by pacemaker implantation and administration of ?-blockers. This led to a partial improvement in tachy-brady arrhythmia episodes. Nonetheless, the patient continued to experience sustained supraventricular tachyarrhythmia runs, poorly responsive to increasing ?-blocker doses. To investigate the origin of the cardiologic impairment, the patient was tested for anticonductive tissue autoantibodies, which were positive, thus supporting a possible autoimmune origin of the dysrhythmia. Other autoantibodies were negative. On the basis of these findings, the patient was treated with high-dose steroids, which were then tapered. The patient responded to the steroid treatment and did not experience further episodes of syncope and tachyarrhythmias. The severe gut dysfunction remained unchanged. This case highlights an association between severe gut dysfunction and cardiac conductive tissue abnormalities, with autoantibodies to conductive tissue possibly causing the dysrhythmia. The severe gut and heart (likely autoimmune-mediated) dysfunction presented in this case provides a basis to further assess a link between intestinal and cardiac abnormal rhythmicity. PMID:24081107

Caio, Giacomo; Volta, Umberto; Cerrato, Enrico; Clavenzani, Paolo; Montali, Nicolò; Cogliandro, Rosanna; Stanghellini, Vincenzo; Golzio, Pier Giorgio; Gaita, Fiorenzo; Farrugia, Gianrico; De Giorgio, Roberto



Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction  

Microsoft Academic Search

Treatment of chronic intestinal pseudoobstruction with prokinetic agents has been disappointing. Our study was designed to determine if octreotide and erythromycin would provide sustained relief from nausea, abdominal pain, and bloating in pseudoobstruction. Using gastrointestinal manometry, quantitative parameters of the activity front of the migrating motor complex at baseline and after prokinetic therapy with erythromycin and octreotide were determined in

G. Nicholas Verne; Ervin Y. Eaker; Ester Hardy; Charles A. Sninsky



Intestinal pseudo-obstruction: An uncommon condition with heterogeneous etiology and unpredictable outcome  

PubMed Central

Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatively, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.

Georgescu, Eugen Florin; Vasile, Ion; Ionescu, Reanina



Randomised clinical trial: the efficacy of prucalopride in patients with chronic intestinal pseudo-obstruction - a double-blind, placebo-controlled, cross-over, multiple n = 1 study  

PubMed Central

Background Chronic intestinal pseudo-obstruction is a disabling condition for which there are no established drug therapies. The condition is caused by a diverse range of intestinal myopathies and neuropathies. Aim To assess the therapeutic efficacy of prucalopride, a selective high-affinity 5-HT4 receptor agonist, we employed a multiple n = 1 study design. Each patient acted as his/her own control, each day counting as one treatment episode, allowing comparison of 168 days on each of active drug and placebo. Methods Double-blind, randomised, placebo-controlled, cross-over trial of four 12-week treatment periods, with 2–4 mg prucalopride or placebo daily. In each of the first and second 6 months there was a prucalopride and a placebo treatment. Patients with proven chronic intestinal pseudo-obstruction, including dilated gut, were included. Evaluation was by patient diary and global evaluation. Results Seven patients participated (mean 42 years, five female, median symptom duration 11 years). Three discontinued, two due to study length, and one on prucalopride due to unrelated malnutrition and bronchopneumonia. Four patients (three visceral myopathy and one visceral neuropathy) completed the study; prucalopride significantly improved pain in three of four patients, nausea in two, vomiting in one, bloating in four and analgesic intake. Bowel function was not changed substantially. Conclusions n = 1 studies in rare conditions allow drug efficacy assessment. Prucalopride relieves symptoms in selected patients with chronic pseudo-obstruction.

Emmanuel, A V; Kamm, M A; Roy, A J; Kerstens, R; Vandeplassche, L



Idiopathic Myenteric Ganglionitis Underlying Acute 'Dramatic' Intestinal Pseudoobstruction: Report of an Exceptional Case  

PubMed Central

Inflammation of the myenteric plexus of the gastrointestinal tract is a very rare pathological condition, with few reports in the medical literature. This pathological condition causes atonic gut motor dysfunction and is principally secondary to other diseases, being reported nearly solely as a paraneoplastic phenomenon in neuroendocrine lung tumors, including small cell carcinomas or neuroblastomas. In addition it can also be associated with disorders of the central nervous system, although it has rarely been described in Chagas disease. It has been named ‘idiopathic myenteric ganglionitis’ because no apparent causes can be demonstrated. We report the clinicopathologic findings of an exceptional case of a young woman affected by severe chronic constipation suddenly changing into acute intestinal pseudoobstruction with dramatic evolution. Relationships between ganglionitis, idiopathic constipation and acute intestinal pseudoobstruction as well as therapeutic implications are discussed.

Racalbuto, A.; Magro, G.; Lanteri, R.; Aliotta, I.; Santangelo, M.; Di Cataldo, A.



A novel approach to paraneoplastic intestinal pseudo-obstruction.  


Paraneoplastic neurologic syndromes (PNS) are uncommon, affecting fewer than 1 in 10,000 patients with cancer. PNS, while rare, can cause significant morbidity and impose enormous socio-economic costs, besides severely affecting quality of life. PNS can involve any part of the nervous system and can present as limbic encephalitis, subacute cerebellar ataxias, opsoclonus-myoclonus, retinopathies, chronic intestinal pseudo-obstruction (CIPO), sensory neuronopathy, Lambert-Eaton myasthenic syndrome, stiff-person syndrome, and encephalomyelitis. The standard of care for CIPO includes the use of promotility and anti-secretory agents and the resection of the non-functioning gut segment; all of which can cause significant compromise in the quality of life. There is significant evidence that paraneoplastic neurologic syndromes are associated with antibodies directed against certain nerve antigens. We successfully treated a patient with CIPO in the setting of small cell lung cancer with a combination of rituximab and cyclophosphamide. The patient, who had failed to respond to prokinetic agents, anti-secretory therapy, and multiple resections, responded to the immunomodulatory therapy, with minimal residuals with PEG tube feeding and sustained ostomy output. The use of rituximab and cyclophosphamide should therefore be considered in patients with CIPO, especially if it can avoid complicated surgical procedures. PMID:22072051

Badari, Ambuga; Farolino, Deborah; Nasser, Eiad; Mehboob, Shahid; Crossland, David



Intestinal pseudo-obstruction (Ogilvie's syndrome) in theophylline overdose.  


Intestinal pseudo-obstruction (Ogilvie's syndrome) has previously been reported in 2 patients with theophylline toxicity treated with activated charcoal (AC), mechanical ventilation and opioid induced sedation. We report a case of Ogilvie's syndrome in a theophylline toxic patient treated with AC. A 45-y-old male with severe chronic obstructive pulmonary disease presented with vomiting and multifocal atrial tachycardia after an intentional theophylline overdose. His initial potassium concentration was 2.7 mEq/L and his theophylline was 191 mg/L (1060 mumol/L). The patient was hemodialyzed and given a total of 1,000 g of AC without cathartics during the first hospital day. He also received iv potassium replacement. On the second hospital day he required mechanical ventilation for respiratory acidosis. Clindamycin was given for purulent sputum and fever. Haloperidol was given to treat agitation. No other anticholinergic agents or opioids were given. The patient's potassium rose to 6.5 mEq/L and he was given kayexalate. During the third hospital day the patient developed abdominal distention, tenderness and leukocytosis. Abdominal radiographs revealed a distended cecum. In the operating room the cecum was found dilated to 16 cm with no distal obstruction. A cecostomy tube drained AC and pill fragments. A 6 cm charcoal bezoar was found in the stomach. The patient recovered uneventfully. PMID:8888546

Brubacher, J R; Levine, B; Hoffman, R S



Beneficial effects of naloxone in a patient with intestinal pseudoobstruction  

SciTech Connect

A 15-day course of Naloxone treatment was given to a patient with intestinal pseudoobstruction who had previously undergone subtotal colectomy with terminal ileostomy for invalidating constipation. The effects of the drug were assessed according to symptoms, by recording the myoelectric activity of the stomach, and by measuring gastric emptying of a radiolabeled solid-liquid meal and the intestinal transit time of radiopaque markers. All tests were performed 1) at baseline; 2) after 2 wk with Naloxone 1.6 mg subcutaneous per day; and 3) after 8 days of placebo. Results showed that before treatment gastric emptying of solids was delayed, emptying of liquids was normal, myoelectric activity of the stomach was normal, small intestinal transit time of radiopaque markers was considerably increased while ileal output was markedly decreased. After Naloxone, gastric emptying of solids was markedly accelerated, emptying of liquids remained normal, gastric electrical spiking activity increased, small intestinal transit time strikingly decreased, and ileal output increased. After placebo, a tendency to return to pretreatment values was observed. This observation suggests that Naloxone may be helpful in the treatment of some patients with intestinal pseudoobstruction.

Schang, J.C.; Devroede, G.



Intestinal Pseudo-obstruction with Steatorrhoea *  

PubMed Central

A hitherto undescribed syndrome is recorded. Its features are gross overactivity of the small intestine with episodes of obstruction, but without any mechanical factor being found, and steatorrhoea. In one patient the inner circular coat showed gross hypertrophy. ImagesFig. 1Fig. 2

Naish, J. M.; Capper, W. M.; Brown, N. J.



[From starving to life-threatening nutrition--the history of an intestinal pseudoobstruction].  


It is the story of a 70-year-old lady, who suffered from chronic intestinal pseudoobstruction since her adolescence. In the early 90ies progressive cachexia developed. In 1994 parenteral nutrition was begun via a port-à-cath-system with good success in the first years. Later, various complications occurred: thrombotic events, several catheter-related infections with various bacterial strains, an endocarditis of the aortic valve, which was replaced by a bioprosthesis, and finally a relapsing endocarditis of this artificial valve with a life-threatening paravalvular abscess and regurgitation. She also survived this second heart surgery and is currently under parenteral nutrition again, with a more than uncertain future. PMID:17133296

Reinhart, W H



Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient  

PubMed Central

Intestinal pseudo-obstruction is a massive colonic dilation with signs and symptoms of colonic obstruction, but without a mechanical cause. A 49-year-old female patient complained of nausea, vomiting, and abdominal distension 1 month after a massive brainstem hemorrhage. No improvement was seen with conservative treatments. An extended-length rectal tube was inserted to perform glycerin enema. In addition, bethanechol (35 mg per day) was administered to stimulate colonic motility. The patient's condition gradually improved over a 2-month period without any surgical intervention. Extended length rectal tube enema and bethanechol can be used to improve intestinal pseudo-obstruction in stroke patients.

Lee, Sang-jee; Choi, Eun-seok; Jung, Sung-hee; Yoon, Jong-soo



Disorganised electrical activity in a child with idiopathic intestinal pseudo-obstruction.  

PubMed Central

This report presents the findings of investigation of a child with idiopathic intestinal pseudo-obstruction (IIP). Functional abnormalities of the smooth muscle of the gastrointestinal tract were disclosed by electrical recordings from the gut obtained after laparotomy. In vitro analysis of tissue and ultrastructure were undertaken and a possible aetiology of the disorder in this patient based on these findings is presented.

Waterfall, W E; Cameron, G S; Sarna, S K; Lewis, T D; Daniel, E E



Deletion of Pten in the mouse enteric nervous system induces ganglioneuromatosis and mimics intestinal pseudoobstruction  

PubMed Central

Intestinal ganglioneuromatosis is a benign proliferation of nerve ganglion cells, nerve fibers, and supporting cells of the enteric nervous system (ENS) that can result in abnormally large enteric neuronal cells (ENCs) in the myenteric plexus and chronic intestinal pseudoobstruction (CIPO). As phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a phosphatase that is critical for controlling cell growth, proliferation, and death, we investigated the role of PTEN in the ENS by generating mice with an embryonic, ENC-selective deletion within the Pten locus. Mutant mice died 2 to 3 weeks after birth, with clinical signs of CIPO and hyperplasia and hypertrophy of ENCs resulting from increased activity of the PI3K/PTEN-AKT-S6K signaling pathway. Further analysis revealed that PTEN was only expressed in developing mouse embryonic ENCs from E15.5 and that the rate of ENC proliferation decreased once PTEN was expressed. Specific deletion of the Pten gene in ENCs therefore induced hyperplasia and hypertrophy in the later stages of embryogenesis. This phenotype was reversed by administration of a pharmacological inhibitor of AKT. In some human ganglioneuromatosis forms of CIPO, PTEN expression was found to be abnormally low and S6 phosphorylation increased. Our study thus reveals that loss of PTEN disrupts development of the ENS and identifies the PI3K/PTEN-AKT-S6K signaling pathway as a potential therapeutic target for ganglioneuromatosis forms of CIPO.

Puig, Isabel; Champeval, Delphine; De Santa Barbara, Pascal; Jaubert, Francis; Lyonnet, Stanislas; Larue, Lionel



Characteristics of intestinal pseudo-obstruction in patients with mitochondrial diseases  

PubMed Central

AIM: To reveal the frequency, characteristics and prog-nosis of chronic intestinal pseudo-obstruction (CIP) in mitochondrial disease patients. METHODS: Between January 2000 and December 2010, 31 patients (13 males and 18 females) were diagnosed with mitochondrial diseases at our hospital. We conducted a retrospective review of the patients’ sex, subclass of mitochondrial disease, age at onset of mitochondrial disease, frequency of CIP and the age at its onset, and the duration of survival. The age at onset or at the first diagnosis of the disorder that led to the clinical suspicion of mitochondrial disease was also examined. RESULTS: Twenty patients were sub-classified with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), 8 with chronic progressive external ophthalmoplegia (CPEO), and 3 with myoclonus epilepsy associated with ragged-red fibers (MERRF). Nine patients were diagnosed with CIP, 8 of the 20 (40.0%) patients with MELAS, 0 of the 8 (0.0%) patients with CPEO, and 1 of the 3 (33.3%) patients with MERRF. The median age (range) at the diagnosis and the median age at onset of mitochondrial disease were 40 (17-69) and 25 (12-63) years in patients with CIP, and 49 (17-81) and 40 (11-71) years in patients without CIP. During the survey period, 5 patients (4 patients with MELAS and 1 with CPEO) died. The cause of death was cardiomyopathy in 2 patients with MELAS, cerebral infarction in 1 patient with MELAS, epilepsy and aspiration pneumonia in 1 patient with MELAS, and multiple metastases from gastric cancer and aspiration pneumonia in 1 patient with CPEO. CONCLUSION: Patients with CIP tend to have disorders that are suspected to be related to mitochondrial diseases at younger ages than are patients without CIP.

Sekino, Yusuke; Inamori, Masahiko; Yamada, Eiji; Ohkubo, Hidenori; Sakai, Eiji; Higurashi, Takuma; Iida, Hiroshi; Hosono, Kunihiro; Endo, Hiroki; Nonaka, Takashi; Takahashi, Hirokazu; Koide, Tomoko; Abe, Yasunobu; Gotoh, Eiji; Koyano, Shigeru; Kuroiwa, Yoshiyuki; Maeda, Shin; Nakajima, Atsushi



Visceral neuropathy and intestinal pseudo-obstruction in a murine model of a nuclear inclusion disease  

PubMed Central

Background & Aims Intestinal dysmotility is a component of many neurodegenerative disorders, including some characterized by neuronal intranuclear inclusions. PrP-SCA7-92Q transgenic mice phenocopy many aspects of the human polyglutamine neurodegenerative disorder, spinocerebellar ataxia type 7 (SCA7). The enteric neuropathology of PrP-SCA7-92Q mice was investigated after observing that they develop signs of intestinal pseudo-obstruction. Methods Gastrointestinal transit of radio-opaque pellets through pre-symptomatic and symptomatic PrP-SCA7-92Q mice and non-transgenic littermates were compared. Gross, microscopic, and ultrastructural studies were conducted, along with histological and whole-mount immunohistochemistry, to identify intranuclear inclusions and quantify subsets of enteric neurons. Immunoblot analysis was performed to confirm selective loss of particular neuronal populations. Results A subset of cholinergic enteric ganglion cells in PrP-SCA7-92Q mice harbor nuclear inclusions comprised of transgene-derived ataxin-7, which contains a pathogenic polyglutamine expansion. These animals die between 15 and 20 weeks with intestinal distension and enterocolitis. Signs of disease are preceded by selective loss of nitric oxide synthase-positive neurons (which lack nuclear inclusions), loss of nerve fibers in the myenteric nerve plexus, and delayed gastrointestinal transit. Cholinergic neurons, including those with inclusions, are spared. Conclusions PrP-SCA7-92Q mice may be useful models for human intestinal pseudo-obstruction, particularly visceral neuropathies with neuronal intranuclear inclusions. Loss of inclusion-free inhibitory neurons supports the hypothesis that inclusions may be neuroprotective or coincidental, as opposed to harbingers of neuron death. Since enteric neuropathology in PrP-SCA7-92Q animals is easily missed by routine histopathology, quantitative immunohistochemical approaches may be required to recognize analogous forms of human enteric neuropathy.

Clarke, Christine M.; Plata, Cara; Cole, Bonnie; Tsuchiya, Karen; La Spada, Albert R.; Kapur, Raj P.



Colonic pseudo-obstruction.  


Colonic pseudo-obstruction is often confused with mechanical intestinal obstruction. It occurs when there is an autonomic imbalance resulting in sympathetic over-activity affecting some part of the colon. The patient is often elderly with numerous comorbidities. Once mechanical obstruction is excluded by contrast enema, the patient should be treated conservatively with nasogastric and flatus tubes for at least 48 hours, and precipitating factors should be treated. When pseudo-obstruction does not settle with waitful watching, prokinetic agents and/or colonoscopic decompression can be tried. When there is a risk of impending perforation of the caecum from massive colonic dilatation and colonic ischaemia, it should be dealt with by caecostomy or hemicolectomy. In spite of available medical and surgical interventions, the outcome remains poor. PMID:19352564

Durai, R



Pseudo-obstrucción intestinal crónica  

Microsoft Academic Search

Chronic intestinal pseudo-obstruction (CIPO) is a syndrome characterized by the presence of recurrent episodes of clinical in- testinal obstruction in the absence of obstructive lesions. Although this syndrome is rare, it causes a high morbidity. It is caused by a disturbance of the intestinal motility, that results in a failure of the progression of the intestinal content. Basically, the failure

M. T. Muñoz; J. A. Solís Herruzo



Prebiotics in chronic intestinal inflammation.  


Prebiotics are nondigestible fermentable fibers that are reported to have health benefits for the host. Older as well as more recent studies show beneficial effects in experimental colitis and lately also in human inflammatory bowel diseases (IBD), such as Crohn's disease, ulcerative colitis, and chronic pouchitis. In this review we give an overview of the benefits of prebiotics in rodent IBD models and in IBD patients and discuss their possible protective mechanisms. Commensal intestinal bacteria induce and perpetuate chronic intestinal inflammation, whereas others are protective. However, most of the current medications are directed against the exaggerated proinflammatory immune response of the host, some of them toxic and costly. Feeding prebiotics changes the composition of the intestinal microflora toward more protective intestinal bacteria and alters systemic and mucosal immune responses of the host. Therapy for IBD targeting intestinal bacteria and their function is just emerging. Prebiotics have the promise to be relatively safe, inexpensive, and easy to administer. Unraveling their protective mechanisms will help to develop rational applications of prebiotics. However, the initial promising results with dietary prebiotics in preclinical trials as well as small studies in human IBD will need to be confirmed in large randomized controlled clinical trials. PMID:18831524

Looijer-van Langen, Mirjam A C; Dieleman, Levinus A



Congenital Enteropathy and Intestinal Transplantation  

Microsoft Academic Search

Intestinal failure (IF) requires the use of parenteral nutrition (PN). Causes of severe protracted IF include short bowel syndrome, severe motility disorders (total or subtotal aganglionosis or chronic intestinal pseudo-obstruction syndrome) and congenital diseases of enterocyte development. Severe liver disease may develop in patients with IF as a consequence of both underlying digestive disease and unadapted PN. Catheter-related sepsis and\\/or

Olivier Goulet



[Chronic bacterial overgrowth in the small intestine].  


The small intestinal bacterial overgrowth (SIBO) is defined by the presence in the proximal part of the intestine of a bacterial population and qualitatively abnormal. It is necessary to distinguish the "non-symptomatic" SIBO and the "symptomatic" SIBO responsible for a chronic diarrhoea and/or of a malabsorption syndrome. The main factor encouraging the intervening of a SIBO is the stasis of the intestinal juice. The gold standard test to confirm the diagnosis of SIBO is the jejunal bacteriological intubation, but it is about a trying and expensive method. It is currently supplanted by the respiratory test to hydrogen after ingestion of glucose that is simple, no invasive and little expensive. The treatment usually consists on the repeated administration of antibiotics and nutritional support. PMID:11458610

Bouhnik, Y



[Chronic inflammatory intestinal diseases. Pathophysiology and therapy].  


The pathogenesis and therapy of chronic inflammatory intestinal diseases are characterized by an obvious discrepancy. There is extensive agreement that the pathogenesis is substantially based on a disruption of the barrier of the intestinal mucous membrane against luminal bacteria. This has been demonstrated in recent years by evidence from various disciplines, in particular from genetics, microbiology, morphology and innate immunology. However, there is also the evidence-based therapy which, as in the past, is aimed against the effectors of the adaptive immune system. In this case the therapy with biologicals is more aggressive and takes the risk of a series of undesired side-effects. This dichotomy of pathological knowledge and therapeutic innovation is not only medically unsatisfactory but also makes it difficult to present a consistent picture of these symptoms. Despite this an attempt will be made to bridge these inconsistencies and to demonstrate possible future developments which will lead to a final causal therapy. An extended version of this article appears in our newly published book "Colitis ulcerosa und Morbus Crohn". PMID:19777197

Herrlinger, K; Wittig, B; Stange, E F



Fish Oil Enhances Recovery of Intestinal Microbiota and Epithelial Integrity in Chronic Rejection of Intestinal Transplant  

PubMed Central

Background The intestinal chronic rejection (CR) is the major limitation to long-term survival of transplanted organs. This study aimed to investigate the interaction between intestinal microbiota and epithelial integrity in chronic rejection of intestinal transplantation, and to find out whether fish oil enhances recovery of intestinal microbiota and epithelial integrity. Methods/Principal Findings The luminal and mucosal microbiota composition of CR rats were characterized by DGGE analysis at 190 days after intestinal transplant. The specific bacterial species were determined by sequence analysis. Furthermore, changes in the localization of intestinal TJ proteins were examined by immunofluorescent staining. PCR-DGGE analysis revealed that gut microbiota in CR rats had a shift towards Escherichia coli, Bacteroides spp and Clostridium spp and a decrease in the abundance of Lactobacillales bacteria in the intestines. Fish oil supplementation could enhance the recovery of gut microbiota, showing a significant decrease of gut bacterial proportions of E. coli and Bacteroides spp and an increase of Lactobacillales spp. In addition, CR rats showed pronounced alteration of tight junction, depicted by marked changes in epithelial cell ultrastructure and redistribution of occuldin and claudins as well as disruption in TJ barrier function. Fish oil administration ameliorated disruption of epithelial integrity in CR, which was associated with an improvement of the mucosal structure leading to improved tight junctions. Conclusions/Significance Our study have presented novel evidence that fish oil is involved in the maintenance of epithelial TJ integrity and recovery of gut microbiota, which may have therapeutic potential against CR in intestinal transplantation.

Li, Qiurong; Zhang, Qiang; Wang, Chenyang; Tang, Chun; Zhang, Yanmei; Li, Ning; Li, Jieshou



Serum Markers and Intestinal Mucosal Injury in Chronic Gastrointestinal Ischemia  

Microsoft Academic Search

Background: Diagnosing chronic gastrointestinal ischemia (CGI) is a challenging problem in clinical practice. Serum markers for CGI would be of great diagnostic value as a non-invasive test method. Aims: This study investigated serum markers in patients with well-defined ischemia. Furthermore, intestinal mucosal injury was also evaluated in CGI patients. Methods: Consecutive patients suspected of CGI were prospectively enrolled and underwent

Noord van D; P. B. F. Mensink; Knegt de R. J; M. Ouwendijk; J. Francke; Vuuren van A. J; B. E. Hansen; E. J. Kuipers



Ogilvie's syndrome (acute colonic pseudo-obstruction)  

Microsoft Academic Search

Four additional cases of Ogilvie's syndrome (acute colonic pseudo-obstruction), representing the first cases described in\\u000a Italy, are reported. The medical literature concerning the subject is also thoroughly reviewed.\\u000a \\u000a Ogilvie's syndrome is an acute massive dilatation of the large bowel without organic obstruction of the distal colon. Three\\u000a hundred and fifty-one cases have been described in the literature to date. Eighty-eight

Ciacinto Nanni; Alberto Garbini; Pierluigi Luchetti; Giuseppe Nanni; Paolo Ronconi; Marco Castagneto



Colonic pseudo-obstruction with distinct transitional zone in adult constipation patients: pathological analysis and results of surgical treatment.  


There are subsets of chronic constipation patients showing features of colonic pseudo-obstruction (CPO) with distinct transitional zone (TZ). We intended to analyze the clinicopathologic characteristics and surgical outcomes of these patients. Twenty-five consecutive patients who underwent surgery for constipation over the 9-year period were analyzed. TZ (+) group was defined as patients showing symptoms or signs of large bowel obstruction with dilated proximal and collapsed distal colon around the TZ at the time of operation, but without any evidence of mechanical causes of obstruction. Nineteen (76%) patients had features of CPO with TZ. All TZs were located in the left colon. Pathologically, segmental hypoganglionosis was identified at the TZ in all TZ (+) patients. On the other hand, pathologic diagnosis was intestinal neuronal dysplasia type B in the remaining six (24%) patients having a uniform colon diameter without demonstrable dilatations (TZ (-) group). Among TZ (+) patients, 17 (90%) underwent total colectomy with ileorectal anastomosis and two (10%) underwent enterostomy. Long-term follow-up (median 56 months) showed no recurrence of constipation in this group of patients. All six TZ (-) patients underwent total colectomy with ileorectal anastomosis and two (33%) of them had persistent symptoms of constipation on long-term follow-up (median 60 months). In a subset of adult constipation patients presenting with features of CPO with TZ, segmental hypoganglionosis was the final pathologic diagnosis. Constipation patients with features of CPO with distinct TZ in the left colon are expected to benefit from surgical intervention. PMID:21679643

Choe, Eun Kyung; Park, Sung-Hye; Park, Kyu Joo



Patients with Chronic Renal Failure Have Abnormal Small Intestinal Motility and a High Prevalence of Small Intestinal Bacterial Overgrowth  

Microsoft Academic Search

Background\\/Aims: Gastrointestinal (GI) symptoms are common among patients with chronic renal failure (CRF). The pathogenesis of these symptoms is probably multifactorial. Our aims were to assess gastric and small intestinal motility and the prevalence of small intestinal bacterial overgrowth (SIBO) in order to clarify possible pathophysiological mechanisms behind these symptoms in CRF patients. Methods: Twenty-two patients with CRF, 12 with

Hans Strid; Magnus Simrén; Per-Ove Stotzer; Gisela Ringström; Hasse Abrahamsson; Einar S. Björnsson



Serum Markers and Intestinal Mucosal Injury in Chronic Gastrointestinal Ischemia  

Microsoft Academic Search

Background  Diagnosing chronic gastrointestinal ischemia (CGI) is a challenging problem in clinical practice. Serum markers for CGI would\\u000a be of great diagnostic value as a non-invasive test method.\\u000a \\u000a \\u000a \\u000a \\u000a Aims  This study investigated serum markers in patients with well-defined ischemia. Furthermore, intestinal mucosal injury was also\\u000a evaluated in CGI patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Consecutive patients suspected of CGI were prospectively enrolled and underwent a diagnostic work-up

Désirée van Noord; Peter B. F. Mensink; Robert J. de Knegt; Martine Ouwendijk; Jan Francke; Anneke J. van Vuuren; Bettina E. Hansen; Ernst J. Kuipers



Intestinal Absorption and Biliary Secretion of Zinc in Rats with Chronic Renal Failure  

Microsoft Academic Search

Background\\/Aims: In chronic renal failure (CRF), zinc deficiency is partially attributed to decreased intestinal zinc absorption, but the mechanism of this decrease in intestinal zinc absorption is obscure. Therefore, the objective of this study was to investigate the cause of decreased intestinal zinc absorption in a uremic rat model using an in vivo perfusion technique as well as to evaluate

Shu-Ming Chen; Jyh-Fei Liao; Cheng-Deng Kuo; Low-Tone Ho



Exclusion of linkage between RET and Neuronal Intestinal Dysplasia type B  

SciTech Connect

Neuronal Intestinal Dysplasia type B (NID B) is a complex alteration of the enteric nervous system belonging to the group of intestinal dysganglionoses which may involve rectum, colon, and small intestine. Second only to Hirschsprung diseases (HSCR), NID B is one of the most frequent causes of chronic constipation and pseudo-obstructive intestinal dysmotility. Since NID B is often associated with HSCR and point mutations in the RET proto-oncogene have been identified in HSCR patients, we analyzed two NID B pedigrees to investigate if RET mutations might cause also the NID B phenotype. Linkage analysis demonstrated that the NID B locus is not linked to RET in the pedigrees analysed. Further genetic analyses will possibility improve the understanding of the cause and facilitate diagnostic procedures in NID B. 20 refs., 1 fig., 2 tabs.

Barone, V.; Yin Luo; Brancolini, V.; Romeo, G. [Instituto G. Gaslini, Genova (Italy); Weber, D. [Children`s Hospital, Luzern (Switzerland); Brancolini, V.; Devoto, M. [Columbia Univ., New York, NY (United States)



Intestinal failure in children: the European view.  


Intestinal failure (IF) is a condition in which severe intestinal malabsorption mandates artificial nutrition through a parenteral route. Causes of severe protracted IF include short bowel syndrome, congenital diseases of enterocyte development, and severe motility disorders (total or subtotal aganglionosis or chronic intestinal pseudo-obstruction syndrome). IF can result in nutritional failure, defined as the long-term failure to nourish a child by natural or artificial means. Today, IF-associated liver disease is the most common cause of parenteral nutrition (PN) failure, but catheter-related sepsis and extensive vascular thrombosis may also jeopardize the health of those receiving PN. For a child with nutritional failure, intestinal transplantation, often in the form of a composite visceral graft, offers the only chance for long-term survival. The management of IF requires a multidisciplinary approach. There have been a number of recent advances in both medical and surgical treatments of IF. In particular, new intestinal lengthening techniques and the use of PN formulas rich in fish oil both have resulted in decreased rates of severe complications of IF and its treatments. In addition, better awareness of the risks and benefits of intestinal transplantation have resulted in better patient selection, and ultimately in improved patient survival, hence restricting the indication to transplantation only to patients with nutritional failure and no other chance to survive. PMID:22820123

D'Antiga, Lorenzo; Goulet, Olivier



[Chronic renal failure after heart, lung, liver, or intestine transplantation].  


Acute and especially chronic renal failure (CRF) are relatively common and important risk factor for morbidity and mortality in patients after heart, lung, liver or intestine transplantation. Numerous factors contribute to the development of CRF in this group of patients, like treatment with calcineurin inhibitors and other nephrotoxic drugs in the perioperative period, hemodynamical changes during and after the surgery, preexistent renal disease, hypertension, diabetes mellitus, dyslipidemia and anemia. Pretransplant evaluation of renal function is mandatory to predict which patients have increased risk for development of CRF. In the posttransplantation course it is necessary to timely diagnose and treat renal failure, while patients with insufficient renal function have 4.55-fold increased risk of death compared to patients with normal renal function. Special problem is diagnostic approach to patients with suspected chronic renal disease who are candidates for transplantation of other parenhimatose organs. Diagnostic value of serum creatinine and estimation of renal function based on its value is very limited. Gold diagnostic standard is radioisotope estimation of glomerular filtration, but this method is not widely available. It seems that this problem may be solved with the use of cystatin C, but this approach needs to be validated in large studies. Numerous different immunosuppressive drugs available on the market enable individualization of immunosuppression. Different drugs combinations may have less nephrotoxic potential, but one must be careful because of the possible risk of organ rejection with the change of immunosuppression. Use of angiotensin convertase enzyme inhibitors and/or angiotensin receptor blockers, statins with drugs for control of hyperglycemia, may prevent or postpone development of CRF. Although technical advances of contemporary hemodialysis machines and peritoneal dialysis equipment enable well tolerated dialysis even in critically ill patients, renal transplantation remains the method of choice for treatment of patients with transplanted parenhimatous organ that developed CRF. PMID:18578334

Kes, Petar; Basi?-Juki?, Nikolina; Juri?, Ivana



Association of small intestinal diverticulosis with chronic pancreatitis leading to severe malabsorption. Report of three cases.  

PubMed Central

Three cases of chronic pancreatitis occurring in patients with small intestinal diverticulosis and bacterial overgrowth are reported. In two of the cases, pancreatic supplements were therapeutically beneficial (the third being unable to tolerate them). Two of the patients also developed diverticular perforation. The possible nature of the association between small intestinal diverticulosis and chronic pancreatitis is discussed. Images Figure 1 Figure 2 Figure 3 Figure 4

Mahida, Y. R.; Chapman, R. W.; Jewell, D. P.



Selective impairment of nutrient absorption from intestines with chronic venous hypertension.  


Malnutrition is frequently associated with advanced cirrhosis. To investigate the role of portal hypertension in nutritional impairment, we developed an animal model to isolate and characterize the effects of chronic intestinal venous hypertension on intestinal nutrient absorption. We performed mesenteric arteriovenous anastomosis combined with portal vein banding in rats. Hepatic architecture and excretory function (bile flow and bile salt output) were unaltered, while severe and persistent intestinal venous hypertension was produced. We then measured in vivo absorption rates of three test nutrients (vitamin D3, valine, and tryptophan) and water. Vitamin D3 absorption was significantly impaired by intestinal congestion, while amino acid absorption was unaffected. Splanchnic hypertensive rats absorbed less water than controls. We conclude that chronic intestinal venous hypertension alone selectively impairs nutrient absorption. PMID:3003945

Sarfeh, I J; Aaronson, S; Lombino, D; Rypins, E B; Mason, G R; Dadufalza, L; Hollander, D



Modifications of Inflammatory Pathways in Rat Intestine Following Chronic Ingestion of Depleted Uranium  

Microsoft Academic Search

The environmental contamination by dispersion of depleted uranium (DU) might result in its chronic ingestion of DU by local populations. The aim of this study was to determine if chronic ingestion of DU at low doses induces inflammatory reactions in intestine, first biological system exposed to uranium after in- gestion. Experiments were performed with rats receiving uranium in drinking water

I. Dublineau; L. Grandcolas; S. Grison; C. Baudelin; F. Paquet; P. Voisin; J. Aigueperse; P. Gourmelon



The effect of chronic cholesterol feeding on intestinal lipoproteins in the rat  

Microsoft Academic Search

Chronic cholesterol feeding has been shown to produce abnormal plasma lipoproteins in a variety of ex- perimental animals and man. In order to explore the role of the intestine in the production of these abnormal lipo- proteins, rats were chronically fed a diet containing 1% cholesterol and 10% olive oil and were compared to con- trol animals, fed either normal

John W. Riley; Robert M. Glickman; Peter H. R. Green; Alan R. Tall


Epithelial NEMO links innate immunity to chronic intestinal inflammation  

Microsoft Academic Search

Deregulation of intestinal immune responses seems to have a principal function in the pathogenesis of inflammatory bowel disease. The gut epithelium is critically involved in the maintenance of intestinal immune homeostasis-acting as a physical barrier separating luminal bacteria and immune cells, and also expressing antimicrobial peptides. However, the molecular mechanisms that control this function of gut epithelial cells are poorly

Arianna Nenci; Christoph Becker; Andy Wullaert; Ralph Gareus; Geert van Loo; Silvio Danese; Marion Huth; Alexei Nikolaev; Clemens Neufert; Blair Madison; Deborah Gumucio; Markus F. Neurath; Manolis Pasparakis



The intestinal microbiota and chronic disorders of the gut  

Microsoft Academic Search

Mucosal surfaces of the gut are colonized by large numbers of heterogeneous bacteria that contribute to intestinal health and disease. In genetically susceptible individuals, a 'pathogenic community' may arise, whereby abnormal gut flora contributes to alterations in the mucosa and local immune system leading to gastrointestinal disease. These diseases include enteric infections, such as Clostridium difficile infection, small intestinal bacterial

Herbert L. DuPont; Andrew W. DuPont



Acute colonic pseudo-obstruction after total hip replacement  

Microsoft Academic Search

Acute colonic pseudo-obstruction is a poorly recognised and potentially fatal complication of hip surgery. Between 1991 and 1994 six patients were observed who required laparotomy after failure of medical management. In three the indication was signs of peritonism, while in the other three exploration was required to exclude segmental ischaemia and to decompress the bowel. In all, there was no

A. Ballaro; C. L. M. Gibbons; D. M. Murray; M. G. W. Kettlewell; M. K. Benson



Inhibition of intestinal biotin absorption by chronic alcohol feeding: cellular and molecular mechanisms  

PubMed Central

The water-soluble vitamin biotin is essential for normal cellular functions and its deficiency leads to a variety of clinical abnormalities. Mammals obtain biotin from exogenous sources via intestinal absorption, a process mediated by the sodium-dependent multivitamin transporter (SMVT). Chronic alcohol use in humans is associated with a significant reduction in plasma biotin levels, and animal studies have shown inhibition in intestinal biotin absorption by chronic alcohol feeding. Little, however, is known about the cellular and molecular mechanisms involved in the inhibition in intestinal biotin transport by chronic alcohol use. These mechanisms were investigated in this study by using rats and transgenic mice carrying the human full-length SLC5A6 5?-regulatory region chronically fed alcohol liquid diets; human intestinal epithelial Caco-2 cells chronically exposed to alcohol were also used as models. The results showed chronic alcohol feeding of rats to lead to a significant inhibition in carrier-mediated biotin transport events across jejunal brush border and basolateral membrane domains. This inhibition was associated with a significant reduction in level of expression of the SMVT protein, mRNA, and heterogenous nuclear RNA. Chronic alcohol feeding also inhibited carrier-mediated biotin uptake in rat colon. Studies with transgenic mice confirmed the above findings and further showed chronic alcohol feeding significantly inhibited the activity of SLC5A6 5?-regulatory region. Finally, chronic exposure of Caco-2 cells to alcohol led to a significant decrease in the activity of both promoters P1 and P2 of the human SLC5A6 gene. These studies identify for the first time the cellular and molecular parameters of the intestinal biotin absorptive processes that are affected by chronic alcohol feeding.

Subramanya, Sandeep B.; Subramanian, Veedamali S.; Kumar, Jeyan S.; Hoiness, Robert



Drosophila as a model for intestinal dysbiosis and chronic inflammatory diseases.  


The association between deregulated intestinal microbial consortia and host diseases has been recognized since the birth of microbiology over a century ago. Intestinal dysbiosis refers to a state where living metazoans harbor harmful intestinal microflora. However, there is still an issue of whether causality arises from the host or the microbe because it is unclear whether deregulation of the gut microbiota community is the consequence or cause of the host disease. Recent studies using Drosophila and its simple microbiota have provided a valuable model system for dissecting the molecular mechanisms of intestinal dysbiosis. In this review, we examine recent exciting observations in Drosophila gut-microbiota interactions, particularly the links among the host immune genotype, the microbial community structure, and the host inflammatory phenotype. Future genetic analyses using Drosophila model system will provide a valuable outcome for understanding the evolutionarily conserved mechanisms that underlie intestinal dysbiosis and chronic inflammatory diseases. PMID:23685204

Lee, Kyung-Ah; Lee, Won-Jae



Acute pseudo-obstruction of the colon (Ogilvie's syndrome)  

Microsoft Academic Search

This study analyzes 400 cases of acute pseudo-obstruction of the colon (Ogilvie's syndrome). Seven cases were reported at\\u000a St. Elizabeth Hospital Medical Center between October 1982 and February 1985; 393 cases were reported in the literature from\\u000a 1970–1985. Ogilvie's syndrome is most commonly reported in patients in the sixth decade, and is more predominant in men. It\\u000a is caused by

Vincent W. Vanek; Musbah Al-Salti



Effect of sodium ion coupled nutrient transport on intestinal permeability in chronically catheterised rats  

PubMed Central

Background—The significance of Na-nutrient cotransport induced alterations in paracellular permeability is controversial. Most previous studies have measured intestinal permeability using in vitro methods or in vivo methods immediately after surgical bowel manipulation, and therefore may not be applicable to normal physiological conditions. ?Aims—To determine whether activation of Na coupled nutrient transport increases intestinal permeability under normal physiological conditions. ?Methods—The effect of Na-nutrient cotransport on intestinal permeability was measured in unrestrained, unanaesthetised, chronically catheterised male Sprague-Dawley rats using two different methods: measurement of the rate of absorption of passively absorbed hexoses, mannitol and L-glucose; and measurement of the mannitol:urea diffusion ratio. ?Results—L-Glucose and mannitol absorption were not increased in the presence of D-glucose, alanine, maltose, or peptides. The mannitol:urea diffusion ratio was not increased by the presence of D-glucose. The presence of D-glucose in the intestinal lumen for 20 minutes did not alter intestinal permeability. ?Conclusions—Under normal physiological conditions, Na coupled nutrient transport does not increase intestinal permeability. ?? Keywords: intestinal permeability; tight junctions; paracellular absorption; Na-nutrient cotransport

Uhing, M



Alteration of the purinergic modulation of enteric neurotransmission in the mouse ileum during chronic intestinal inflammation.  


1. The effect of chronic intestinal inflammation on the purinergic modulation of cholinergic neurotransmission was studied in the mouse ileum. Chronic intestinal inflammation was induced by infection of mice with the parasite Schistosoma mansoni during 16 weeks. 2. S. mansoni infection induced a chronic inflammatory response in the small intestine, which was characterised by intestinal granuloma formation, increased intestinal wall thickness, blunted mucosal villi and an enhanced activity of myeloperoxidase. 3. In control ileum and in chronically inflamed ileum, electrical field stimulation (EFS) of longitudinal muscle strips induced frequency-dependent contractions that were abolished by tetrodotoxin (TTX) and atropine. Carbachol induced dose-dependent contractions that were not affected by TTX but abolished by atropine. 4. In control ileum, adenosine and ATP dose-dependently inhibited the contractions to EFS. Theophylline and 8-phenyltheophylline, P(1) and A(1) receptor antagonists respectively, prevented this inhibitory effect of adenosine and ATP. PPADS, DMPX and MRS 1220, antagonists of P(2), A(2) and A(3) receptors, respectively, did not prevent this inhibitory effect of adenosine and ATP. Adenosine and ATP did not affect the contractions to carbachol. 5. The inhibitory effect of adenosine and ATP on contractions to EFS in control ileum was mimicked by the stable adenosine analogue methyladenosine and by the A(1)-receptor agonist N(6)-cyclohexyladenosine, but not by the A3 receptor agonist 2-Cl IB-MECA or by the ATP analogues alphabeta-methylene-ATP and ADPbetaS. The inhibitory effect of adenosine on contractions to EFS was lost after prolonged (90 min) treatment of control ileum with methyladenosine (100 micro M). 6. In chronically inflamed ileum, adenosine, methyladenosine, N(6)-cyclohexyladenosine and ATP all failed to inhibit the cholinergic nerve-mediated contractions to EFS. Also theophylline, 8-phenyltheophylline, PPADS, DMPX and MRS 1220 had no effect on the contractions to EFS and carbachol. The loss of effect of adenosine and ATP was still evident after 52 weeks of infection. 7. These results indicate that in physiological conditions neuronal adenosine A(1) receptors modulate cholinergic nerve activity in the mouse ileum. However, during chronic intestinal inflammation, this purinergic modulation of cholinergic nerve activity is impaired. This suggests that chronic intestinal inflammation leads to a dysfunction of specific neuronal regulatory mechanisms in the enteric nervous system. PMID:12746236

De Man, Joris G; Seerden, Tom C; De Winter, Benedicte Y; Van Marck, Eric A; Herman, Arnold G; Pelckmans, Paul A



Chronic alcohol feeding inhibits physiological and molecular parameters of intestinal and renal riboflavin transport.  


Vitamin B2 (riboflavin, RF) is essential for normal human health. Mammals obtain RF from exogenous sources via intestinal absorption and prevent its urinary loss by reabsorption in the kidneys. Both of these absorptive events are carrier-mediated and involve specific RF transporters (RFVTs). Chronic alcohol consumption in humans is associated with a high prevalence of RF deficiency and suboptimal levels, but little is known about the effect of chronic alcohol exposure on physiological and molecular parameters of the intestinal and renal RF transport events. We addressed these issues using rats chronically fed an alcohol liquid diet and pair-fed controls as a model. The results showed that chronic alcohol feeding significantly inhibits carrier-mediated RF transport across the intestinal brush-border and basolateral membrane domains of the polarized enterocytes. This inhibition was associated with a parallel reduction in the expression of the rat RFVT-1 and -3 at the protein, mRNA, and heterogeneous nuclear RNA (hnRNA) levels. Chronic alcohol feeding also caused a significant inhibition in RF uptake in the colon. Similarly, a significant inhibition in carrier-mediated RF transport across the renal brush-border and basolateral membrane domains was observed, which again was associated with a significant reduction in the level of expression of RFVT-1 and -3 at the protein, mRNA, and hnRNA levels. These findings demonstrate that chronic alcohol exposure impairs both intestinal absorption and renal reabsorption processes of RF and that these effects are, at least in part, mediated via transcriptional mechanism(s) involving the slc52a1 and slc52a3 genes. PMID:23804199

Subramanian, Veedamali S; Subramanya, Sandeep B; Ghosal, Abhisek; Said, Hamid M



From chronic feed-induced intestinal inflammation to adenocarcinoma with metastases in salmonid fish.  


Neoplasms in fish normally show poor abilities for metastasis, and there are no reports on intestinal cancer with metastasis to other organs. In aquaculture production, carnivorous salmonids in Northern Europe receive commercial feeds with plant ingredients. Such contents have been shown to cause chronic intestinal inflammation. Inflammation provokes carcinogenesis in the human gut, and here, we report a similar pathologic progression in salmonids. Nine commercially farmed groups of Atlantic salmon and rainbow trout (n = 39,160) and one experimental positive group (n = 789) fed the same commercial feed and two negative control groups (n = 3009) were investigated for the occurrence of intestinal tumors and metastases. Exposure period, gender, and sexual maturation were registered. Autopsy revealed an overall intestinal tumor occurrence of 10.62%, of which liver metastasis varied from 0% to 11.35% between the groups. Intestinal cancer prevalence increased from 0.50% to 14.81% during 4 months of feeding in the experimental group. A significant gender effect was registered in the commercially farmed groups but not in the experimental group. Histologic examination showed adenocarcinomas evolving through progressive epithelial dysplasia associated with severe chronic inflammation. One intestinal tumor was registered in one individual in the negative control groups. This is the first report on feed-induced intestinal carcinogenesis and metastasizing adenocarcinomas in fish fed an approved commercial diet. The pathogenesis was associated with a certain commercial diet provoking the inflammation-dysplasia-carcinoma sequence. The histologic progression was analogous to that of human colorectal cancer associated with inflammatory bowel disease. PMID:19417130

Dale, Ole B; Tørud, Brit; Kvellestad, Agnar; Koppang, Hanna S; Koppang, Erling O



Impaired Intestinal Fat Absorption in Chronic Renal Failure  

Microsoft Academic Search

We performed oral fat loading tests in 10 patients with chronic renal failure (CRF) on hemodialysis (5 children and 5 adults). Fat absorption was measured by hourly determination of serum triglycerides (TG), cholesterol (CHOL), and lipoproteins (LP) after oral administration of a ‘milkshake’ containing 50 g of fat of dairy origin. 10 age-matched healthy volunteers with normal fasting serum TG

Alfred Drukker; Emile Levy; Naomi Bronza; Halina Stankiewicz; Robert Goldstein



A New Method of Intestinal Perfusion for the Management of Chronic Renal Failure  

PubMed Central

Usefulness of intestinal perfusion in the treatment of uremia is limited by (a) low clearances, (b) atrophy of the perfused mucous membrane, and (c) poor toleration by the patient. A method of intestinal perfusion has been devised which uses most of the small bowel without exclusion from the fecal stream. Two Roux-en-Y anastomoses are made, the proximal 12? below the ligament of Treitz, the distal 18? above the ileocecal valve. Perfusion is carried out between the proximal jejunostomy and distal ileostomy, daily. Six litres of fluid are perfused in four hours. The bowel is used for digestion during the remaining 20 hours of the day. Patients have solid bowel movements daily, prior to perfusion. Reflux of intestinal contents, between perfusions, is slight. The method allows maximal diffusion, may prevent bowel atrophy and is well tolerated by the patient. The method is being used, in conjunction with hemodialysis, in treatment of chronic uremia.

Taguchi, Y.; MacKinnon, K. J.; Helle, S.; Dossetor, J. B.



Current Status of Intestinal Transplantation in Children  

PubMed Central

Purpose A clinical trial of intestinal transplantation (Itx) under tacrolimus and prednisone immunosuppression was initiated in June 1990 in children with irreversible intestinal failure and who were dependent on total parenteral nutrition (TPN). Methods Fifty-five patients (28 girls, 27 boys) with a median age of 3.2 years (range, 0.5 to 18 years) received 58 intestinal transplants that included isolated small bowel (SB) (n = 17), liver SB (LSB) (n = 33), and multivisceral (MV) (n = 8) allografts. Nine patients also received bone marrow infusion, and there were 20 colonic allografts. Azathioprine, cyclophosphamide, or mycophenolate mofetil were used in different phases of the series. Indications for Itx included: gastroschisis(n = 14), volvulus (n = 13), necrotizing enterocolitis (n = 6), intestinal atresia (n = 8), chronic intestinal pseudoobstruction (n = 5), Hirschsprung’s disease (n = 4), microvillus inclusion disease (n = 3), multiple polyposis (n = 1), and trauma (n = 1). Results Currently, 30 patients are alive (patient survival, 55%; graft survival, 52%). Twenty-nine children with functioning grafts are living at home and off TPN, with a mean follow-up of 962 (range, 75 to 2,424) days. Immunologic complications have included liver allograft rejection (n = 18), intestinal allograft rejection (n = 52), posttransplant lymphoproliferative disease (n = 16), cytomegalovirus (n = 16) and graft-versus-host disease (n = 4). A combination of associated complications included intestinal perforation (n = 4), biliary leak (n = 3), bile duct stenosis (n = 1), intestinal leak (n = 6), dehiscence with evisceration (n = 4), hepatic artery thrombosis (n = 3), bleeding (n = 9), portal vein stenosis (n = 1), intraabdominal abscess (n = 11), and chylous ascites (n = 4). Graft loss occurred as a result of rejection (n = 8), infection (n = 12), technical complications (n = 8), and complications of TPN after graft removal (n = 3). There were four retransplants (SB, n = 1; LSB n = 3). Conclusions Intestinal transplantation is a valid therapeutic option for patients with intestinal failure suffering complications of TPN. The complex clinical and immunologic course of these patients is reflected in a higher complication rate as well as patient and graft loss than seen after heart, liver, and kidney transplantation, although better than after lung transplantation.

Reyes, Jorge; Bueno, Javier; Kocoshis, Samuel; Green, Mike; Abu-Elmagd, Kareem; Furukawa, Hiro; Barksdale, Edward M.; Strom, Sharon; Fung, John J.; Todo, Satoru; Irish, William; Starzl, Thomas E.



Chronic alcohol consumption and intestinal thiamin absorption: effects on physiological and molecular parameters of the uptake process  

PubMed Central

Thiamin is essential for normal cellular functions, and its deficiency leads to a variety of clinical abnormalities. Humans and other mammals obtain the vitamin via intestinal absorption. The intestine is exposed to two sources of thiamin, a dietary and a bacterial (i.e., normal microflora of the large intestine) source. Chronic alcohol consumption is associated with thiamin deficiency, which is caused (in part) by inhibition in intestinal thiamin absorption. However, little is known about the physiological and molecular aspects of the intestinal thiamin uptake process that are affected by chronic alcohol use. To address these issues, we used rats fed an alcohol-liquid diet and human intestinal epithelial HuTu-80 cells chronically exposed to ethanol as model systems. The results showed that chronic alcohol feeding to rats led to a significant inhibition in carrier-mediated thiamin transport across both the jejunal brush-border membrane and basolateral membrane domains. This was associated with a significant reduction in level of expression of thiamin transporter-1 (THTR-1), but not THTR-2, at the protein and mRNA levels. Level of expression of the heterogenous nuclear RNA of THTR-1 in the intestine of alcohol-fed rats was also decreased compared with their pair-fed controls. Chronic alcohol feeding also caused a significant inhibition in carrier-mediated thiamin uptake in rat colon. Studies with HuTu-80 cells chronically exposed to ethanol also showed a significant inhibition in carrier-mediated thiamin uptake. This inhibition was associated with a reduction in level of expression of human THTR-1 and THTR-2 at the protein, mRNA, and transcriptional (promoter activity) levels. These studies demonstrate that chronic alcohol feeding inhibits intestinal thiamin absorption via inhibition of the individual membrane transport event across the polarized absorptive epithelial cells. Furthermore, the inhibition is, at least in part, mediated via transcriptional mechanism(s).

Subramanya, Sandeep B.; Subramanian, Veedamali S.



Chronic alcohol consumption and intestinal thiamin absorption: effects on physiological and molecular parameters of the uptake process.  


Thiamin is essential for normal cellular functions, and its deficiency leads to a variety of clinical abnormalities. Humans and other mammals obtain the vitamin via intestinal absorption. The intestine is exposed to two sources of thiamin, a dietary and a bacterial (i.e., normal microflora of the large intestine) source. Chronic alcohol consumption is associated with thiamin deficiency, which is caused (in part) by inhibition in intestinal thiamin absorption. However, little is known about the physiological and molecular aspects of the intestinal thiamin uptake process that are affected by chronic alcohol use. To address these issues, we used rats fed an alcohol-liquid diet and human intestinal epithelial HuTu-80 cells chronically exposed to ethanol as model systems. The results showed that chronic alcohol feeding to rats led to a significant inhibition in carrier-mediated thiamin transport across both the jejunal brush-border membrane and basolateral membrane domains. This was associated with a significant reduction in level of expression of thiamin transporter-1 (THTR-1), but not THTR-2, at the protein and mRNA levels. Level of expression of the heterogenous nuclear RNA of THTR-1 in the intestine of alcohol-fed rats was also decreased compared with their pair-fed controls. Chronic alcohol feeding also caused a significant inhibition in carrier-mediated thiamin uptake in rat colon. Studies with HuTu-80 cells chronically exposed to ethanol also showed a significant inhibition in carrier-mediated thiamin uptake. This inhibition was associated with a reduction in level of expression of human THTR-1 and THTR-2 at the protein, mRNA, and transcriptional (promoter activity) levels. These studies demonstrate that chronic alcohol feeding inhibits intestinal thiamin absorption via inhibition of the individual membrane transport event across the polarized absorptive epithelial cells. Furthermore, the inhibition is, at least in part, mediated via transcriptional mechanism(s). PMID:20448146

Subramanya, Sandeep B; Subramanian, Veedamali S; Said, Hamid M



Long-term home parenteral nutrition in children with chronic intestinal failure: A 15-year experience at a single Italian centre  

Microsoft Academic Search

Background and aimsChronic intestinal failure is a condition causing severe impairment of intestinal functions; long-term total parenteral nutrition is required to provide adequate nutritional support.

Paolo Gandullia; Francesca Lugani; Laura Costabello; Serena Arrigo; Angela Calvi; Emanuela Castellano; Silvia Vignola; Angela Pistorio; Arrigo V. Barabino



Acute colonic pseudoobstruction (Ogilvie's syndrome) in two patients receiving high dose clonidine for delirium tremens  

Microsoft Academic Search

We describe two cases of severe colonic pseudo-obstruction (Ogilvie's Syndrome) after high dose clonidine i. v. infusions\\u000a for delirium tremens. The first symptoms occurred 36 h and 5 days, respectively, after institution of therapy. The diagnosis\\u000a of colonic pseudo-obstruction (CPO) was confirmed during emergency laparotomy in both cases. While other known risk factors\\u000a may have been present, we propose that

D. S. Stieger; R. Cantieni; A. Frutiger



Massive acute colonic pseudo-obstruction successfully managed with conservative therapy in a patient with cerebral palsy  

PubMed Central

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a massive dilation of the colon in the absence of mechanical obstruction. Treatment measures may include anticholinergic agents such as neostigmine, colonoscopy, or fluoroscopic decompression, surgical decompression, and partial or complete colectomy. We reviewed the case of a 26-year-old male with cerebral palsy who had a history of chronic intermittent constipation who presented to the emergency department (ED) with signs of impaction despite recurrent fleet enemas and oral polyethylene glycol 3350. The patient was found to have a massive colonic distention of 26 cm likely because of bowel dysmotility, consistent with ACPO. This article includes a discussion of the literature and images that represent clinical examination, x-ray, and computed tomography (CT) findings of this patient, who successfully underwent conservative management only. Emergency department detection of this condition is important, and early intervention may prevent surgical intervention and associated complications.



Methylnaltrexone for treatment of acute colonic pseudo-obstruction.  


Acute colonic pseudo-obstruction (ACPO) or Ogilvie syndrome is an idiopathic syndrome of dilation of the colon without mechanical obstruction that develops in hospitalized patients usually in the setting of significant medical and surgical conditions. Standard care therapy includes colonoscopic decompression or neostigmine. The latter is not Food and Drug Administration-approved for this indication but has been the recent intervention of choice. A patient with ACPO failed 2 injections of neostigmine. A clinical trial of subcutaneous methylnaltrexone was administered because she was on opioid therapy. There was a brisk response to methylnaltrexone, a ?-opioid-receptor antagonist which does not cross the blood-brain barrier. This is the first case report in the literature and in the pharmaceutical company's data bank that illustrates a potential role for methylnaltrexone in ACPO. Prospective, larger studies to determine the role of methylnaltrexone in ACPO are warranted. PMID:21992933

Weinstock, Leonard B; Chang, Amy Caroline


[Microfloral changes in the small and large intestines of chronic enteritis patients on diet therapy including sour milk products].  


The microflora of the small and large intestines was studied in 105 patients with chronic enteritis. Significant amounts of various microorganisms were detected in the small intestine. The content of E. coli, bacteroids, bifidobacteria in feces diminished, while that of staphylococcus, enterococcus and fungi rose. The patients were given diet N 4 (intended for enteritis patients) containing lactic acid products (200 ml, 5 times/day, during 24 days); 38 patients received shubat, 30--koumiss and 37--kefir. Koumiss proved to be most effective in the treatment of intestinal dysbacteriosis. Shubat possessed a lower antibiotic activity. Kefir administration did not produce significant shifts in the intestinal microflora. Lactic acid products were ineffective in fungous and Proteus dysbacteriosis. Koumiss and shubat could be recommended for the therapy of certain types of intestinal dysbacteriosis, thus restricting the use of antibacterial drugs. PMID:3765530

Sukhov, S V; Kalamkarova, L I; Il'chenko, L A; Zhangabylov, A K


Noninvasive monitoring of small intestinal oxygen in a rat model of chronic mesenteric ischemia.  


We noninvasively monitored the partial pressure of oxygen (pO2) in rat's small intestine using a model of chronic mesenteric ischemia by electron paramagnetic resonance oximetry over a 7-day period. The particulate probe lithium octa-n-butoxynaphthalocyanine (LiNc-BuO) was embedded into the oxygen permeable material polydimethyl siloxane by cast-molding and polymerization (Oxy-Chip). A one-time surgical procedure was performed to place the Oxy-Chip on the outer wall of the small intestine (SI). The superior mesenteric artery (SMA) was banded to ~30 % of blood flow for experimental rats. Noninvasive measurement of pO2 was performed at the baseline for control rats or immediate post-banding and on days 1, 3, and 7. The SI pO2 for control rats remained stable over the 7-day period. The pO2 on day-7 was 54.5 ± 0.9 mmHg (mean ± SE). SMA-banded rats were significantly different from controls with a noted reduction in pO2 post banding with a progressive decline to a final pO2 of 20.9 ± 4.5 mmHg (mean ± SE; p = 0.02). All SMA-banded rats developed adhesions around the Oxy-Chip, yet remained asymptomatic. The hypoxia marker Hypoxyprobe™ was used to validate the low tissue pO2. Brown cytoplasmic staining was consistent with hypoxia. Mild brown staining was noted predominantly on the villus tips in control animals. SMA-banded rats had an extended region of hypoxic involvement in the villus with a higher intensity of cytoplasmic staining. Deep brown stainings of the enteric nervous system neurons and connective tissue both within layers and in the mesentery were noted. SMA-banded rats with lower pO2 values had a higher intensity of staining. Thus, monitoring SI pO2 using the probe Oxy-Chip provides a valid measure of tissue oxygenation. Tracking pO2 in conditions that produce chronic mesenteric ischemia will contribute to our understanding of intestinal tissue oxygenation and how changes impact symptom evolution and the trajectory of chronic disease. PMID:23636684

Fisher, Elaine M; Khan, Mahmood; Salisbury, Ronald; Kuppusamy, Periannan



A patient with systemic lupus erythematosus who developed massive small intestinal hemorrhaging during treatment for chronic lupus peritonitis.  


A 50-year-old Japanese woman, a patient with systemic lupus erythematosus (SLE) complicated with chronic lupus peritonitis, developed massive small intestinal hemorrhaging. She was treated with intravenous pulse of methylprednisolone, intravenous pulse of cyclophosphamide (IVCY), and immunoabsorption, but the peritonitis was refractory to these treatments. Subsequently, she was treated with oral corticosteroid and tacrolimus, and received IVCY monthly, but she developed massive small intestinal hemorrhaging 1 year after. Abdominal angiography detected multiple bleeding sites from the jejunal and ileal arteries. After transarterial embolization treatment, the melena disappeared. The pathology of this case appeared to be lupus mesenteric vasculitis. PMID:21761227

Kawashiri, Shin-ya; Nishino, Ayako; Sueyoshi, Eijun; Okada, Akitomo; Koga, Tomohiro; Yamasaki, Satoshi; Nakamura, Hideki; Origuchi, Tomoki; Kawakami, Atsushi



Assessment of predictors of response to neostigmine for acute colonic pseudo-obstruction  

Microsoft Academic Search

OBJECTIVE:Acute colonic pseudoobstruction (ACPO) most commonly develops after surgery, with narcotic administration, or in association with severe illness. Most cases resolve with conservative management. Colonoscopic decompression may be required in patients failing to respond to conservative treatment. Neostigmine has been proposed as an effective treatment for ACPO as an alternative to colonoscopic decompression. We sought to identify factors associated with

Conor G. Loftus; Gavin C. Harewood; Todd H. Baron



[Effect of dietotherapy incorporating koumiss and shubat on vitamin B12 absorption in the intestines and on its content in the blood of chronic enterocolitis patients].  


The intestinal absorption of vitamin B12 and its blood content have been proved to lower in patients with chronic enterocolitis. Dietetics including kumiss and shubat promotes normalization of vitamin B12 absorption (p less than 0.05), its blood content growth (p less than 0.05), the intestinal microflora becoming normal. PMID:3705536

Zhangabylov, A k; Nikolaeva, S V; Kalamkarova, L I; Il'chenko, L A; Muzapbarov, B


Loss of the TGF?-Activating Integrin ?v?8 on Dendritic Cells Protects Mice from Chronic Intestinal Parasitic Infection via Control of Type 2 Immunity  

PubMed Central

Chronic intestinal parasite infection is a major global health problem, but mechanisms that promote chronicity are poorly understood. Here we describe a novel cellular and molecular pathway involved in the development of chronic intestinal parasite infection. We show that, early during development of chronic infection with the murine intestinal parasite Trichuris muris, TGF? signalling in CD4+ T-cells is induced and that antibody-mediated inhibition of TGF? function results in protection from infection. Mechanistically, we find that enhanced TGF? signalling in CD4+ T-cells during infection involves expression of the TGF?-activating integrin ?v?8 by dendritic cells (DCs), which we have previously shown is highly expressed by a subset of DCs in the intestine. Importantly, mice lacking integrin ?v?8 on DCs were completely resistant to chronic infection with T. muris, indicating an important functional role for integrin ?v?8-mediated TGF? activation in promoting chronic infection. Protection from infection was dependent on CD4+ T-cells, but appeared independent of Foxp3+ Tregs. Instead, mice lacking integrin ?v?8 expression on DCs displayed an early increase in production of the protective type 2 cytokine IL-13 by CD4+ T-cells, and inhibition of this increase by crossing mice to IL-4 knockout mice restored parasite infection. Our results therefore provide novel insights into how type 2 immunity is controlled in the intestine, and may help contribute to development of new therapies aimed at promoting expulsion of gut helminths.

Rahman, Sayema; Czajkowska, Beata I.; Smedley, Catherine; Waldmann, Herman; Sparwasser, Tim; Grencis, Richard K.; Travis, Mark A.



Nonoperative management of acute idiopathic colonic pseudo-obstruction (Ogilvie's syndrome).  


In a four-year experience (35 episodes in 27 patients) with the use of medical and colonoscopic therapy for acute idiopathic colonic pseudo-obstruction, we have found that initial conservative measures followed by flexible colonoscopy in nonresponders are effective and safe. Contrary to previous reports, an initial nonoperative approach including colonscopy is frequently successful and the outcome with this approach is not adversely affected even in the few patients who eventually require surgical decompression. PMID:3839954

Fausel, C S; Goff, J S



Prevalence and identification of fungal DNA in the small intestine of healthy dogs and dogs with chronic enteropathies.  


Limited information is available about the prevalence and phylogenetic classification of fungal organisms in the gastrointestinal tract of dogs. Also, the impact of fungal organisms on gastrointestinal health and disease is not well understood. The aim of this study was to evaluate the prevalence of fungal DNA in the small intestine of healthy dogs and dogs with chronic enteropathies. Small intestinal content was analyzed from 64 healthy and 71 diseased dogs from five different geographic locations in Europe and the USA. Fungal DNA was amplified with panfungal primers targeting the internal transcriber spacer (ITS) region. PCR amplicons were subjected to phylogenetic analysis. Fungal DNA was detected in 60.9% of healthy dogs and in 76.1% of dogs with chronic enteropathies. This prevalence was not significantly different between the two groups (p=0.065). Fungal DNA was significantly more prevalent in mucosal brush samples (82.8%) than in luminal samples (42.9%; p=0.002). Sequencing results revealed a total of 51 different phylotypes. All sequences belonged to two phyla and were classified as either Ascomycota (32 phylotypes) or Basidiomycota (19 phylotypes). Three major classes were identified: Saccharomycetes, Dothideomycetes, and Hymenomycetes. The most commonly observed sequences were classified as Pichia spp., Cryptococcus spp., Candida spp., and Trichosporon spp. Species believed to be clinically more important were more commonly observed in diseased dogs. These results indicate a high prevalence and diversity of fungal DNA in the small intestine of both healthy dogs and dogs with chronic enteropathies. The canine gastrointestinal tract of diseased dogs may harbor opportunistic fungal pathogens. PMID:18586415

Suchodolski, Jan S; Morris, Erin K; Allenspach, Karin; Jergens, Albert E; Harmoinen, Jaana A; Westermarck, Elias; Steiner, Jörg M



Mechanistic insights of intestinal absorption and renal conservation of folate in chronic alcoholism.  


Folate mediated one-carbon metabolism is of fundamental importance for various cellular processes, including DNA synthesis and methylation of biological molecules. Due to the exogenous requirement of folate in mammals, there exists a well developed epithelial folate transport system for regulation of normal folate homeostasis. The intestinal and renal folate uptake is tightly and diversely regulated and disturbances in folate homeostasis like in alcoholism have pathological consequences. The study was sought to delineate the regulatory mechanism of folate uptake in intestine and reabsorption in renal tubular cells that could evaluate insights of malabsorption during alcoholism. The folate transporters PCFT and RFC were found to be associated with lipid rafts of membrane surfaces in intestine and kidney. Importantly, the observed lower intestinal and renal folate uptake was associated with decreased levels of folate transporter viz. PCFT and RFC in lipid rafts of intestinal and renal membrane surfaces. The decreased association of folate transporters in lipid rafts was associated with decreased protein and mRNA levels. In addition, immunohistochemical studies showed that alcoholic conditions deranged that localization of PCFT and RFC. These findings could explain the possible mechanistic insights that may result in folate malabsorption during alcoholism. PMID:23267781

Wani, Nissar Ahmad; Thakur, Shilpa; Najar, Rauf Ahmad; Nada, Ritambhara; Khanduja, Krishan Lal; Kaur, Jyotdeep



Epidermal growth factor chronically upregulates Ca2+-dependent Cl? conductance and TMEM16A expression in intestinal epithelial cells  

PubMed Central

Dysregulated epithelial fluid and electrolyte transport is a common feature of many intestinal disorders. However, molecular mechanisms that regulate epithelial transport processes are still poorly understood, thereby limiting development of new therapeutics. Previously, we showed that epidermal growth factor (EGF) chronically enhances intestinal epithelial secretory function. Here, we investigated a potential role for altered expression or activity of apical Cl? channels in mediating the effects of EGF. Cl? secretion across monolayers of T84 colonic epithelia was measured as changes in short-circuit current. Protein expression/phosphorylation was measured by RT-PCR and Western blotting. Under conditions that specifically isolate apical Ca2+-activated Cl? channel (CaCC) currents, EGF pretreatment (100 ng ml?1 for 15 min) potentiated carbachol (CCh)-induced responses to 173 ± 25% of those in control cells, when measured 24 h later (n= 26; P < 0.01). EGF-induced increases in CaCC currents were abolished by the transmembrane protein 16A (TMEM16A) inhibitor, T16Ainh-A01 (10 ?m). Furthermore, TMEM16A mRNA and protein expression was increased by EGF to 256 ± 38% (n= 7; P < 0.01) and 297 ± 46% (n= 9, P < 0.001) of control levels, respectively. In contrast, EGF did not alter CFTR expression or activity. EGF-induced increases in Cl? secretion, CaCC currents and TMEM16A expression were attenuated by a PKC? inhibitor, rottlerin (20 ?m), and a phosphatidylinositol 3-kinase (PI3K) inhibitor, LY290042 (25 ?m). Finally, LY290042 inhibited EGF-induced phosphorylation of PKC?. We conclude that EGF chronically upregulates Ca2+-dependent Cl? conductances and TMEM16A expression in intestinal epithelia by a mechanism involving sequential activation of PI3K and PKC?. Therapeutic targeting of EGF receptor-dependent signalling pathways may provide new approaches for treatment of epithelial transport disorders.

Mroz, Magdalena S; Keely, Stephen J



Novel cytokine signaling pathways in inflammatory bowel disease: insight into the dichotomous functions of IL-33 during chronic intestinal inflammation  

PubMed Central

In 2010, four independent groups almost simultaneously reported the association of the novel interleukin-1 (IL-1) family member, IL-33, with inflammatory bowel disease (IBD). The findings were remarkably consistent and demonstrated that IL-33 is markedly upregulated in, and specific to, ulcerative colitis (UC). In addition, although a variety of gut-associated immune cell subsets express IL-33, the primary source appears to be the intestinal epithelium. IL-33’s receptor, ST2, a formerly orphaned IL-1 receptor-related protein, was also found to be increased in UC patients, although the cellular source of ST2 appears to be somewhat more ambiguous. In fact, emerging evidence indicates that the IL-33/ST2 axis plays a critical role in several other chronic inflammatory and immune disorders. In the gut, IL-33 has been shown to be important in the clearance of intestinal parasites, and inducing epithelial cell hyperplasia, mucus production and mucosal eosinophilic infiltration. However, despite the established trend of increased IL-33 and ST2 expression during IBD, specifically UC, the precise pathophysiologic relevance of these findings has yet to be determined. Interestingly, IL-33 has the ability to potentiate pathogenic Th2 and Th17 responses in gut-associated lymphoid tissues, while also promoting healing of damaged mucosa following inflammatory insults. Indeed, further mechanistic studies are warranted to confirm the possible dichotomous functions of IL-33 during chronic intestinal inflammation and better define its precise role in the pathogenesis of IBD. Herein, we discuss what is currently known about IL-33/ST2 in the gut and speculate as to the potential role of the IL-33/ST2 system in IBD.

Pastorelli, Luca; De Salvo, Carlo; Cominelli, Marissa A.; Vecchi, Maurizio; Pizarro, Theresa T.



Idiopathic Myenteric Ganglionitis Underlying Acute ‘Dramatic’ Intestinal Pseudoobstruction: Report of an Exceptional Case  

Microsoft Academic Search

Inflammation of the myenteric plexus of the gastrointestinal tract is a very rare pathological condition, with few reports in the medical literature. This pathological condition causes atonic gut motor dysfunction and is principally secondary to other diseases, being reported nearly solely as a paraneoplastic phenomenon in neuroendocrine lung tumors, including small cell carcinomas or neuroblastomas. In addition it can also

A. Racalbuto; G. Magro; R. Lanteri; I. Aliotta; M. Santangelo; A. Di Cataldo



Severe intestinal pseudo-obstruction following withdrawal from over-the-counter steroid abuse.  


Relative adrenal insufficiency (RAI) is commonly diagnosed in critically ill patients failing to maintain a pressor response and/or with electrolyte abnormalities. We report a case of a 59-year-old man who presented with diverticular bleeding and developed prolonged ileus postoperatively. After observing arthritic joints on examination, further questioning revealed long-term, high-dose steroid use for analgesic effect. Failure to produce an effective cortisol response was due to adrenal suppression from continuous steroid use. Immediate improvement of his ileus was seen after steroid replacement. Unreported self-medication is a frequent problem encountered in developing countries. RAI can be easily missed and requires a high index of suspicion in any patient who fails to respond to conventional treatment or with long-term steroid use. PMID:21941061

Sharma, A; Naraynsingh, V; Goalan, R; Teelucksingh, S T


[Beta 2-microglobulin amyloidosis presenting as intestinal perforation in a haemodialysis patient].  


Long term haemodialysis patient is subject to several complications such as generalised amyloidosis which is the result of deposits of beta2-microglobulin not depurated by haemodialysis. Digestive location causes ischemic accidents such as ulcer, infarctus, digestive haemorrhage, pseudo-obstruction and perforation manifested by a surgical emergency. Our observation is the 6th case of intestinal perforation caused by amyloidosis deposit reported in the literature. PMID:17349721

Farah-Klibi, F; Ferchichi, L; Jarboui, S; Ben Slama, S; Zaouche, A; Ben Jilani, S; Zermani, R



Collagen accumulation and dysfunctional mucosal barrier of the small intestine in patients with chronic heart failure  

Microsoft Academic Search

Chronic heart failure is a systemic disease with a devastating prognosis, which affects many organ systems other than the cardiovascular system. A total of 45 Chronic heart failure patients of ischemic etiology and 18 control subjects aged 45–65 years were recruited. All subjects underwent a physical examination by a qualified physician, echocardiography, an evaluation of the trophological status (including height and

Gregory P. Arutyunov; Olga I. Kostyukevich; Roman A. Serov; Natalya V. Rylova; Nadezda A. Bylova



Food proteins and gut mucosal barrier. IV. Effects of acute and chronic ethanol administration on handling and uptake of bovine serum albumin by rat small intestine  

SciTech Connect

The effects of ethanol exposure on small intestinal handling and uptake of radiolabeled bovine serum albumin were investigated using everted gut sacs. There was less breakdown of BSA after acute ethanol administration in vitro and after acute and chronic in vivo exposure. Thus, the vascular compartment of the small intestine was confronted with more complete and potentially more antigenic material after ethanol. Changes in BSA binding and uptake after acute exposure were shown to be reversible after 4-6 hr. In all groups, there was more BSA binding when the small intestine was exposed to ethanol. This difference was most pronounced after chronic exposure. In the same group, uptake of BSA was correlated with binding and significantly increased. Combined effects of ethanol on the gut mucosal barrier may account for changes in food antigen handling and uptake.

Stern, M.; Carter, E.A.; Walker, W.A.



Type IV intestinal atresia, congenital bilateral perisylvian syndrome, and chronic pulmonary hypertension secondary to multiple vascular disruption syndrome in a monochorionic twin.  


We describe a rare case of multiple intestinal atresias, congenital bilateral perisylvian polymicrogyria, and chronic pulmonary hypertension in a surviving monochorionic twin with co-twin demise. This constellation of congenital anomalies represents a multiple vascular disruption syndrome due to intrauterine vascular compromise in the setting of possible twin-to-twin transfusion syndrome. PMID:23084212

Shue, Eveline H; Soares, Bruno; Courtier, Jesse; Hogue, Jacob; Shimotake, Thomas; MacKenzie, Tippi C



Neonatal maternal separation in male rats increases intestinal permeability and affects behavior after chronic social stress.  


Prolonged maternal separation in rats has several effects on health and behavior. Here we investigated how maternal separation might interact with social stress in adulthood on behavior and gastrointenstinal permeability. The effects of either daily 180 min long term pup-dam separation (LMS) during the stress hyporesponsive period or daily 10 min brief maternal separation (BMS) on behavior, corticosterone and intestinal permeability were investigated, compared to a non-handling (NH) condition in male offspring. The animals from each separation condition were then randomly assigned to adult stress and control conditions, where the stress condition was exposure to 14 days of social instability (CSI). Sucrose preference, elevated plus maze behavior and corticosterone were measured. Colitis was experimentally induced by dextran sulfate sodium for 7 days, followed by measurement of intestinal permeability using the (51)CrEDTA method. Granulocyte marker protein was measured in feces and colons were examined histologically for inflammation. Prior to the social stress, the LMS offspring showed elevated corticosterone levels, lower elevated plus maze activity and less fluid consumption. After social stress, corticosterone levels were suppressed in LMS animals and again they showed less fluid consumption. LMS animals had significantly higher intestinal permeability, but only when also exposed to the social stress in adulthood. The current results support a two-hit model, whereby early life events interact with adult life events in altering animals' vulnerability. PMID:22155491

Oines, E; Murison, R; Mrdalj, J; Grønli, J; Milde, A M



Central Role of the Gut Epithelial Barrier in the Pathogenesis of Chronic Intestinal Inflammation: Lessons Learned from Animal Models and Human Genetics  

PubMed Central

The gut mucosa is constantly challenged by a bombardment of foreign antigens and environmental microorganisms. As such, the precise regulation of the intestinal barrier allows the maintenance of mucosal immune homeostasis and prevents the onset of uncontrolled inflammation. In support of this concept, emerging evidence points to defects in components of the epithelial barrier as etiologic factors in the pathogenesis of inflammatory bowel diseases (IBDs). In fact, the integrity of the intestinal barrier relies on different elements, including robust innate immune responses, epithelial paracellular permeability, epithelial cell integrity, as well as the production of mucus. The purpose of this review is to systematically evaluate how alterations in the aforementioned epithelial components can lead to the disruption of intestinal immune homeostasis, and subsequent inflammation. In this regard, the wealth of data from mouse models of intestinal inflammation and human genetics are pivotal in understanding pathogenic pathways, for example, that are initiated from the specific loss of function of a single protein leading to the onset of intestinal disease. On the other hand, several recently proposed therapeutic approaches to treat human IBD are targeted at enhancing different elements of gut barrier function, further supporting a primary role of the epithelium in the pathogenesis of chronic intestinal inflammation and emphasizing the importance of maintaining a healthy and effective intestinal barrier.

Pastorelli, Luca; De Salvo, Carlo; Mercado, Joseph R.; Vecchi, Maurizio; Pizarro, Theresa T.



Small intestinal bacterial overgrowth syndrome.  


Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO. PMID:20572300

Bures, Jan; Cyrany, Jiri; Kohoutova, Darina; Förstl, Miroslav; Rejchrt, Stanislav; Kvetina, Jaroslav; Vorisek, Viktor; Kopacova, Marcela



[A combined lesion of the digestive organs and chronic inflammatory diseases of the large intestine].  


An analysis was carried out of 222 medical records and autopsies from patients with inflammatory diseases of the large intestine, the immediate causes of death of whom were different disorders. The incidence of hepatitis running an active course correlated with age of patients and came up to 58.8% in the group of subjects 20 to 40 years old. In age group running between 40 to 60 and 60 to 80 years there prevailed colorectal carcinoma (18.3% and 42.5% respectively). PMID:10424048

Skliar, S I; Denisiuk, A I; Moskvichev, N A; Prusskaia, L I; Kirilko, S N; Sapozhnikov, A R



Effect of chronic (4 weeks) ingestion of ethanol on transport of proline into intestinal brush border membrane vesicles  

SciTech Connect

Hamsters were separated into two groups and fed liquid diets ad lib. Controls were given a diet similar to that described by DeCarli and Lieber while alcoholics received the same diet containing 5% ethanol isocalorically substituted for sucrose. The volume of diet consumed daily and the gain in body weights of alcoholics were not significantly different from those of controls. After four weeks the animals were sacrificed and the upper third of the small intestine was used to prepare brush border membrane vesicles. In the presence of a Na/sup +/ gradient, uptake of proline into vesicles prepared from both groups was rapid, reaching a maximum accumulation in 1 to 2 min and then decreasing to the equilibrium level. To normalize the results, the amount of proline take up at each time point was divided by the amount present at equilibrium. From the normalized data it was concluded that both the rate of uptake and the maximum accumulation of proline into brush border membrane vesicles isolated from alcoholics were significantly less than those obtained with vesicles from controls. These results suggest that chronic ingestion of ethanol results in a reduction in Na/sup +/-dependent transport of proline across the brush border membrane and, thus, may contribute to the malnutrition which is frequently associated with chronic alcoholism.

Beesley, R.C.; Jones, T.D.



Chronic ingestion of cadmium and lead alters the bioavailability of essential and heavy metals, gene expression pathways and genotoxicity in mouse intestine.  


Chronic ingestion of environmental heavy metals such as lead (Pb) and cadmium (Cd) causes various well-documented pathologies in specific target organs following their intestinal absorption and subsequent accumulation. However, little is known about the direct impact of the non-absorbed heavy metals on the small intestine and the colon homeostasis. The aim of our study was to compare the specific bioaccumulation and retention of Cd and Pb and their effect on the essential metal balance in primary organs, with those occurring specifically in the gastrointestinal tract of mice. Various doses of Cd (5, 20 and 100 mg l(-1)) and Pb (100 and 500 mg l(-1)) chloride salts were provided in drinking water for subchronic to chronic exposures (4, 8 and 12 weeks). In contrast to a clear dose- and time-dependent accumulation in target organs, results showed that intestines are poor accumulators for Cd and Pb. Notwithstanding, changes in gene expression of representative intestinal markers revealed that the transport-, oxidative- and inflammatory status of the gut epithelium of the duodenum, ileum and colon were specifically affected by both heavy metal species. Additionally, in vivo comet assay used to evaluate the impact of heavy metals on DNA damage showed clear genotoxic activities of Cd, on both the upper and distal parts of the gastrointestinal tract. Altogether, these results outline the resilience of the gut which balances the various effects of chronic Cd and Pb in the intestinal mucosa. Collectively, it provides useful information for the risk assessment of heavy metals in gut homeostasis and further disease's susceptibility. PMID:23503628

Breton, Jérôme; Le Clère, Kelly; Daniel, Catherine; Sauty, Mathieu; Nakab, Lauren; Chassat, Thierry; Dewulf, Joëlle; Penet, Sylvie; Carnoy, Christophe; Thomas, Patrick; Pot, Bruno; Nesslany, Fabrice; Foligné, Benoît



[Intestinal obstruction during pregnancy].  


This is a review of literature concerning intestinal obstruction in pregnant women. Approximately 50-90% and 30% of pregnant women, respectively suffer from nausea and vomiting, mostly during the first trimester. There is also increased risk of constipation. During the perioperative period, the administration of tocolytics should be considered only in women showing symptoms of a threatening premature delivery. Intensive hydration should be ordered to sustain uterine blood flow. The incidence of intestinal obstruction during pregnancy is estimated at 1:1500-1:66431 pregnancies and is diagnosed in II and III trimester in most cases. However, it can also occur in the I trimester (6%) or puerperium. Symptoms of intestinal obstruction in pregnancy include: abdominal pains (98%), vomiting (82%), constipation (30%). Abdominal tenderness on palpation is found in 71% and abnormal peristalsis in 55% of cases. The most common imaging examination in the diagnosis of intestinal obstruction is the abdominal X-ray. However ionizing radiation may have a harmful effect on the fetus, especially during the first trimester. X-ray is positive for intestinal obstruction in 82% of pregnant women. Ultrasonography and magnetic resonance imaging are considered safe and applicable during pregnancy. Intestinal obstruction in pregnant women is mostly caused by: adhesions (54.6%), intestinal torsion (25%), colorectal carcinoma (3.7%), hernia (1.4%), appendicitis (0.5%) and others (10%). Adhesive obstruction occurs more frequently in advanced pregnancy (6% - I trimester 28% - II trimester; 45% - III trimester 21% - puerperium). Treatment should begin with conservative procedures. Surgical treatment may be necessary in cases where the pain turns from recurrent into continuous, with tachycardia, pyrexia and a positive Blumberg sign. If symptoms of fetal anoxia are observed, a C-section should be carried out before surgical intervention. The extent of surgical intervention depends on the intraoperative evaluation. Intestinal torsion during pregnancy mostly occurs in the sigmoid colon and cecum. Small bowel torsion secondary to adhesions is diagnosed in 42% of pregnant women with intestinal obstruction. The risk of intestinal torsion is higher in the 16-20 and 32-36 weeks of pregnancy and during puerperium. Intestinal torsion results in vessel occlusion which induces more severe symptoms and makes urgent surgical intervention necessary. The overall prognosis is poor--during II and III trimester the fetal mortality rate reaches 36% and 64%, respectively while the risk of maternal death is 6%. Acute intestinal pseudoobstruction can be diagnosed during puerperium, especially following a C-section. Diagnosis is made on the basis of radiological confirmation of colon distension at the cecum as > 9cm, lack of air in the sigmoid colon and rectum, exclusion of mechanical obstruction. In most cases, the treatment is based on easing intestine gas evacuation and administering neostigmine. The authors point out the need for multi-specialty cooperation in the diagnostic-therapeutic process of pregnant women suspected with intestinal obstruction, since any delay in making a correct diagnosis increases the risk of severe complications, both for the woman and the fetus. PMID:23668061

Stukan, Maciej; Kruszewski Wies?aw, Janusz; Dudziak, Miros?aw; Kopiej?, Arkadiusz; Preis, Krzysztof



Na-glutamine co-transporters B(0)AT1 in villus and SN2 in crypts are differentially altered in chronically inflamed rabbit intestine.  


Glutamine is a major nutrient utilized by the intestinal epithelium and is primarily assimilated via Na-glutamine co-transport (NGcT) on the brush border membrane (BBM) of enterocytes. Recently we reported that B(0)AT1 (SLC6A19) mediates glutamine absorption in villus while SN2 (SLC38A5) does the same in crypt cells. However, how B(0)AT1 and SN2 are affected during intestinal inflammation is unknown. In the present study it was shown that during chronic enteritis NGcT was inhibited in villus cells, however, it was stimulated in crypt cells. Our studies also demonstrated that the mechanism of inhibition of NGcT during chronic enteritis was secondary to a reduction in the number of B(0)AT1 co-transporters in the villus cell BBM without a change in the affinity of the co-transporter. In contrast, stimulation of NGcT in crypt cells was secondary to an increase in the affinity of SN2 for glutamine without an alteration in the number of co-transporters. Thus, glutamine assimilation which occurs via distinct transporters in crypt and villus cells is altered in the chronically inflamed intestine. PMID:22100603

Saha, Prosenjit; Arthur, Subha; Kekuda, Ramesh; Sundaram, Uma



Intestinal epithelial cell proteome from wild-type and TNFDeltaARE/WT mice: effect of iron on the development of chronic ileitis.  


Environmental factors substantially contribute to the development of chronic intestinal inflammation in the genetically susceptible host. Nutritional components like iron may act as pro-oxidative mediators affecting inflammatory processes and cell stress mechanisms. To better characterize effects of dietary iron on epithelial cell responses under the pathological conditions of chronic intestinal inflammation, we characterized the protein expression profile (proteome) in primary intestinal epithelial cells (IEC) from iron-adequate and low-iron fed wild-type (WT) and TNFDeltaARE/WT mice. We performed all possible comparisons between the 4 groups according to genotype or diet. Histological analysis of iron-adequate fed TNFDeltaARE/WT mice (approximately 0.54 mg of iron/day) revealed severe ileal inflammation with a histopathology score of 8.3+/-0.91 (score range from 0-12). Interestingly, low-iron fed mice (approximately 0.03 mg of iron/day) were almost completely protected from the development of inflammatory tissue destruction (histopathology score of 2.30+/-0.73). In total, we identified 74 target proteins with significantly altered steady state expression levels in primary IEC using 2D-gel electrophoresis (2D SDS-PAGE) and peptide mass fingerprinting via MALDI-TOF mass spectrometry (MS). Interestingly, the overlap between the comparison of iron-adequate fed WT and TNFDeltaARE/WT mice (inflamed conditions) and the comparison between the iron-adequate and iron-low fed TNFDeltaARE/WT mice (absence of inflammation) revealed 4 contrarily regulated proteins including aconitase 2, catalase, intelectin 1 and fumarylacetoacetate hydrolase (FAH). These proteins are associated with energy homeostasis, host defense, oxidative and endoplasmic reticulum (ER) stress responses. In conclusion, the iron-low diet affected the epithelial cell proteome and inhibited the development of chronic intestinal inflammation, suggesting a critical role for nutritional factors in the pathogenesis of IBD. PMID:19422269

Werner, Tanja; Hoermannsperger, Gabriele; Schuemann, Klaus; Hoelzlwimmer, Gabriele; Tsuji, Shoutaro; Haller, Dirk



Frequency of Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome and Chronic Non-Specific Diarrhea  

PubMed Central

Introduction Small intestinal bacterial overgrowth (SIBO) occurs in varying frequency in irritable bowel syndrome (IBS). We studied the frequency of SIBO in IBS and chronic non-specific diarrhea (CNSD). Methods 129 patients with IBS (Manning's criteria), 73 with CNSD (? 4 weeks diarrhea with two of these tests normal [urine D-xylose, fecal fat and duodenal biopsy]) and 51 healthy controls (HC) were evaluated for SIBO using glucose hydrogen breath test (GHBT). Diarrhea-predominant IBS (D-IBS) was grouped into CNSD. Rise in breath hydrogen 12 ppm above basal following 100 g glucose was diagnostic of SIBO. Results Of 129 patients with IBS, 7 were constipation (C-IBS), and 122 were of indeterminate type (I-IBS). Patients with IBS were younger than HC and CNSD (IBS vs. HC: 36.6 yr ± 11.4 vs. 44.1 yr ± 13.6, p = 0.001; IBS vs. CNSD: 36.6 yr ± 11.4 vs. 42 yr ± 14.5, p = 0.003). Patients with CNSD were comparable to HC in age (42 yr ± 14.5 vs. 44.1 yr ± 13.6, p = ns). Patients with IBS were more often male than HC [108/129 (83.7%) vs. 34/51 (66.7%) p = 0.02]; gender of CNSD and HC was comparable [male 39/73 (53.4%) vs. 34/51 (66.7%) p = ns]. SIBO was commoner in CNSD than HC [16 (21.9%) vs. 1 (2%), p = 0.003], but was comparable in IBS and HC [11 (8.5%) vs. 1 (2%), p = 0.18]. Patients with CNSD more often had SIBO than IBS [16 (21.9%) vs. 11 (8.5%), p = 0.007]. Conclusions SIBO was more common in CNSD including D-IBS than other types of IBS and HC.

Kumar, Sunil; Mehrotra, Mansi; Lakshmi, CP; Misra, Asha



Mortality after steroid-resistant acute cellular rejection and chronic rejection episodes in adult intestinal transplants: report from a single center in induction/preconditioning era.  


Steroid-resistant acute cellular rejection (ACR) and chronic rejection (CR) are still major concerns after intestinal transplantation. We report our experience from a single center on 48 adults recipients using 49 grafts from 2001 to 2011, immunosuppressing them initially with daclizumab initially and later Alemtuzumab. Overall patient survival was 41.9% at 10 years while graft survival was 38.5%. The steroid-resistant ACR population of 14 recipients (28.5%) experienced 50% mortality mainly due to sepsis, while the five (8%) CR recipients, included two survivors. All but 1 graft was placed without a liver. CR was often preceded by ACR episodes. Mortality related to steroid-resistant ACR and CR still affects the intestinal transplant population despite induction/preconditioning, especially in the absence of a protective liver effect of the liver. New immunosuppressive strategies are needed. PMID:23769102

Lauro, A; Bagni, A; Zanfi, C; Pellegrini, S; Dazzi, A; Del Gaudio, M; Ravaioli, M; Di Simone, M; Ramacciato, G; Pironi, L; Pinna, A D



Advances and challenges in the management of acute colonic pseudo-obstruction (ogilvie syndrome).  


Although acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a well-known clinical entity, in many respects it remains poorly understood and continues to challenge physicians and surgeons alike. Our understanding of ACPO continues to evolve and its epidemiology has changed as new conditions have been identified predisposing to ACPO with critical illness providing the common thread among them. A physician must keep ACPO high in the list of differential diagnoses when dealing with the patient experiencing abdominal distention, and one must be prepared to employ and interpret imaging studies to exclude mechanical obstruction. Rapid diagnosis is the key, and institution of conservative measures often will lead to resolution. Fortunately, when this fails pharmacologic intervention with neostigmine often proves effective. However, it is not a panacea: consensus on dosing does not exist, administration techniques vary and may impact efficacy, contraindications limit its use, and persistence and or recurrence of ACPO mandate continued search for additional medical therapies. When medical therapy fails or is contraindicated, endoscopy offers effective intervention with advanced techniques such as decompression tubes or percutaneous endoscopic cecostomy providing effective results. Operative intervention remains the treatment of last resort; surgical outcomes are associated with significant morbidity and mortality. Therefore, a surgeon should be aware of all options for decompression-conservative, pharmacologic, and endoscopic-and use them in best combination to the advantage of patients who often suffer from significant concurrent illnesses making them poor operative candidates. PMID:23449274

Jain, Arpana; Vargas, H David



Advances and Challenges in the Management of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome)  

PubMed Central

Although acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a well-known clinical entity, in many respects it remains poorly understood and continues to challenge physicians and surgeons alike. Our understanding of ACPO continues to evolve and its epidemiology has changed as new conditions have been identified predisposing to ACPO with critical illness providing the common thread among them. A physician must keep ACPO high in the list of differential diagnoses when dealing with the patient experiencing abdominal distention, and one must be prepared to employ and interpret imaging studies to exclude mechanical obstruction. Rapid diagnosis is the key, and institution of conservative measures often will lead to resolution. Fortunately, when this fails pharmacologic intervention with neostigmine often proves effective. However, it is not a panacea: consensus on dosing does not exist, administration techniques vary and may impact efficacy, contraindications limit its use, and persistence and or recurrence of ACPO mandate continued search for additional medical therapies. When medical therapy fails or is contraindicated, endoscopy offers effective intervention with advanced techniques such as decompression tubes or percutaneous endoscopic cecostomy providing effective results. Operative intervention remains the treatment of last resort; surgical outcomes are associated with significant morbidity and mortality. Therefore, a surgeon should be aware of all options for decompression—conservative, pharmacologic, and endoscopic—and use them in best combination to the advantage of patients who often suffer from significant concurrent illnesses making them poor operative candidates.

Jain, Arpana; Vargas, H. David



Effect of chronic, extrinsic denervation on functional NANC innervation with vasoactive intestinal polypeptide and substance P in longitudinal muscle of rat jejunum1  

PubMed Central

Intestinal denervation contributes to enteric motor dysfunction after intestinal transplantation [small bowel transplantation (SBT)]. Our aim was to determine long-term effects of extrinsic denervation on functional non-adrenergic, non-cholinergic innervation with vasoactive intestinal polypeptide (VIP) and substance P. Contractile activity of jejunal longitudinal muscle from six age-matched, naïve control rats (NC) and eight rats 1 year after syngeneic SBT were studied in tissue chambers. Spontaneous contractile activity did not differ between groups. Exogenous VIP inhibited contractile activity dose-dependently in both groups, greater in NC than in SBT. The VIP antagonist ([D-p-Cl-Phe6,Leu17]-VIP) and the nitric oxide synthase inhibitor L-NG-nitro arginine prevented inhibition by exogenous VIP and electrical field stimulation (EFS) in both groups. Exogenous substance P increased contractile activity dose-dependently, greater in NC than in SBT. The substance P antagonist ([D-Pro2,D-Trp7,9]-substance P) inhibited effects of exogenous substance P and increased the EFS-induced inhibitory response. Immunohistofluorescence showed staining for tyrosine hydroxylase in the jejunoileum 1 year after SBT suggesting sympathetic reinnervation. In rat jejunal longitudinal muscle after chronic denervation, response to exogenous VIP and substance P is decreased, while endogenous release of both neurotransmitters is preserved. These alterations in excitatory and inhibitory pathways occur despite extrinsic reinnervation and might contribute to enteric motor dysfunction after SBT.




Enterococcus faecalis strains differentially regulate Alix/AIP1 protein expression and ERK 1/2 activation in intestinal epithelial cells in the context of chronic experimental colitis.  


Monoassociation of germfree Interleukin 10 gene deficient (IL-10-/-) 129SvEv but not wild-type mice with Enterococcus faecalis induces severe chronic colitis. Bacterial strain-specific effects on the development of chronic intestinal inflammation are not understood. We investigated the molecular mechanisms of E. faecalis OG1RF (human clinical isolate, colitogenic) and E. faecalis ms2 (endogenous isolate from an IL-10-/- mouse) in initiating chronic experimental colitis using IL-10-/- mice. Monoassociation of IL-10-/- mice for 14 weeks revealed significant differences in colonic inflammation (3.6 +/- 0.2 and 2.4 +/- 0.6 for OG1RF and ms2, respectively) (n = 5 mice in each group) (histological scoring (0-4)). Consistent with the tissue pathology, gene expression of the pro-inflammatory chemokine interferon-gamma inducible protein-10 (IP-10) was significantly higher in intestinal epithelial cells (IEC) derived from E. faecalis OG1RF monoassociated IL-10-/- mice. We further compared the differentially E. faecalis induced colitis on the epithelial level by 2D-SDS PAGE coupled with MALDI-TOF MS. Proteome analysis identified 13 proteins which were differentially regulated during disease progression in the epithelium of E. faecalis-monoassociated IL-10-/- mice. Regulation of Alix/AIP1 protein expression and ERK1/2 phosphorylation was validated in primary IEC and epithelial cell lines, suggesting a protective role for Alix/AIP1 in the process of disease progression. Alix/AIP1 protein expression was further characterized in epithelial cell lines using siRNA-mediated knock-down. Our study demonstrates E. faecalis strain-specific induction of colitis in IL-10-/- mice after 14 weeks of monoassociation. Our study suggests that Alix/AIP1 protein expression and ERK1/2 activation are decreased in severe colitis. PMID:19166300

Hoffmann, Micha; Kim, Sandra C; Sartor, R Balfour; Haller, Dirk



Regulation of SRF/CArG-dependent gene transcription during chronic partial obstruction of murine small intestine.  


Intestinal obstructions lead to a variety of motility disorders. Small intestine smooth muscles undergo dramatic phenotypic changes in response to obstruction, but the underlying molecular mechanisms are unknown. Using RT-PCR, ChIP, Re-ChIP, and Western blots, we examined the effect of small bowel mechanical obstruction on smooth muscle gene expression. Obstruction caused a transient hyperplasia, followed by a prolonged hypertrophic response of small intestine smooth muscle cells. Smooth muscle myosin heavy chain (MHC), alpha-actin, and gamma-actin expression decreased initially, and then increased as hypertrophy developed. Myocardin expression decreased initially and then increased, while kruppel-like factors (KLF)4 and KLF5 expression increased initially, and then decreased. Serum response factor (SRF) expression decreased initially, and then recovered to sham-operated levels as hypertrophy developed. SRF binding to smooth muscle MHC and alpha-actin promoters decreased initially, but then increased above sham-operated levels as hypertrophy developed. Elk-1 binding to smooth muscle myosin heavy chain and alpha-actin promoters increased initially, and then decreased to sham-operated levels as hypertrophy developed. c-fos expression increased initially, which was associated with increased SRF/Elk-1 binding to the c-fos promoter. The Elk-1 phosphorylation inhibitor U-0126 inhibited the increase in c-fos expression. These findings indicate a dynamic response of small intestine smooth muscles to bowel obstruction involving switching between differentiated, proliferative, and hypertrophic phenotypes. These results suggest that changes in the expression and interactions between SRF, myocardin, Elk-1, and c-fos play key roles in the phenotypic switching of small intestine smooth muscles in response to mechanical obstruction. PMID:18557893

Chen, J; Chen, H; Sanders, K M; Perrino, B A



High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients.  


Human intestinal microbiota plays an important role in the maintenance of host health by providing energy, nutrients, and immunological protection. Intestinal dysfunction is a frequent complaint in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients, and previous reports suggest that dysbiosis, i.e. the overgrowth of abnormal populations of bacteria in the gut, is linked to the pathogenesis of the disease. We used high-throughput 16S rRNA gene sequencing to investigate the presence of specific alterations in the gut microbiota of ME/CFS patients from Belgium and Norway. 43 ME/CFS patients and 36 healthy controls were included in the study. Bacterial DNA was extracted from stool samples, PCR amplification was performed on 16S rRNA gene regions, and PCR amplicons were sequenced using Roche FLX 454 sequencer. The composition of the gut microbiota was found to differ between Belgian controls and Norwegian controls: Norwegians showed higher percentages of specific Firmicutes populations (Roseburia, Holdemania) and lower proportions of most Bacteroidetes genera. A highly significant separation could be achieved between Norwegian controls and Norwegian patients: patients presented increased proportions of Lactonifactor and Alistipes, as well as a decrease in several Firmicutes populations. In Belgian subjects the patient/control separation was less pronounced, however some abnormalities observed in Norwegian patients were also found in Belgian patients. These results show that intestinal microbiota is altered in ME/CFS. High-throughput sequencing is a useful tool to diagnose dysbiosis in patients and could help designing treatments based on gut microbiota modulation (antibiotics, pre and probiotics supplementation). PMID:23791918

Frémont, Marc; Coomans, Danny; Massart, Sebastien; De Meirleir, Kenny



Chronic epithelial NF-?B activation accelerates APC loss and intestinal tumor initiation through iNOS up-regulation  

PubMed Central

The role of NF-?B activation in tumor initiation has not been thoroughly investigated. We generated Ikk?(EE)IEC transgenic mice expressing constitutively active I?B kinase ? (IKK?) in intestinal epithelial cells (IECs). Despite absence of destructive colonic inflammation, Ikk?(EE)IEC mice developed intestinal tumors after a long latency. However, when crossed to mice with IEC-specific allelic deletion of the adenomatous polyposis coli (Apc) tumor suppressor locus, Ikk?(EE)IEC mice exhibited more ?-catenin+ early lesions and visible small intestinal and colonic tumors relative to Apc+/?IEC mice, and their survival was severely compromised. IEC of Ikk?(EE)IEC mice expressed high amounts of inducible nitric oxide synthase (iNOS) and elevated DNA damage markers and contained more oxidative DNA lesions. Treatment of Ikk?(EE)IEC/Apc+/?IEC mice with an iNOS inhibitor decreased DNA damage markers and reduced early ?-catenin+ lesions and tumor load. The results suggest that persistent NF-?B activation in IEC may accelerate loss of heterozygocity by enhancing nitrosative DNA damage.

Shaked, Helena; Hofseth, Lorne J.; Chumanevich, Alena; Chumanevich, Alexander A.; Wang, Jin; Wang, Yinsheng; Taniguchi, Koji; Guma, Monica; Shenouda, Steve; Clevers, Hans; Harris, Curtis C.; Karin, Michael



Cadmium accumulation and in vitro analysis of calcium and cadmium transport functions in the gastro-intestinal tract of trout following chronic dietary cadmium and calcium feeding.  


Juvenile rainbow trout (Oncorhynchus mykiss) were fed diets made from Lumbriculus variegatus containing environmentally relevant concentrations of Cd (approximately 0.2 and 12 microg g(-1) dry wt) and/or Ca (1, 10, 20 and 60 mg g(-1) dry wt) for 4 weeks. Ten fish per treatment were removed weekly for tissue metal burden analysis. In all portions of the gastro-intestinal tract (GIT) (stomach, anterior, mid, and posterior intestine), chronic exposure to elevated dietary Ca decreased Cd tissue accumulation to varying degrees. At week five, the GITs of the remaining fish were subjected to an in vitro gut sac technique. Pre-exposure to the different treatments affected unidirectional uptake and binding rates of Cd and Ca in different manners, dependent on the specific GIT section. Ca and Cd uptake rates were highly correlated within all sections of the GIT, and the loosely binding rate of Cd to the GIT surfaces predicted the rate of new Cd absorption. Overall, this study indicates that elevated dietary Ca is protective against Cd uptake from an environmentally relevant diet, and that Ca and Cd uptake may occur through both common and separate pathways in the GIT. PMID:19527800

Klinck, Joel S; Ng, Tania Y-T; Wood, Chris M



Chronic inflammatory and non-inflammatory diseases of the gastrointestinal tract in cats: diagnostic advantages of full-thickness intestinal and extraintestinal biopsies.  


An evaluation of histological findings in full-thickness biopsies from the gastrointestinal tract (GIT) and extraintestinal samples of 43 cats with chronic GIT disease signs was performed. In the majority of cases (46.5%) inflammatory bowel disease, ie, lymphocytic-plasmacytic enteritis/colitis (32.6%), eosinophilic gastroenterocolitis (11.6%) and mixed inflammatory infiltration (2.3%), was diagnosed. Furthermore, in four animals non-inflammatory mucosal band-shaped fibrosis (9.3%), and in 10 cats (23.3%) a diffuse lymphoma, was found. Six cats displayed only a gastritis (7.0%) or lymphangiectasia (7.0%), respectively. In two cats a mast cell tumour (4.7%) was diagnosed. In one cat no histopathological lesions were found. The availability of transmural biopsies from all segments of the intestine and the collection of extraintestinal samples, especially mesenteric lymph nodes, is especially helpful for diagnosing intestinal tumours such as lymphomas and tumours of mast cell origin. PMID:19664949

Kleinschmidt, Sven; Harder, Jasmine; Nolte, Ingo; Marsilio, Sina; Hewicker-Trautwein, Marion



Large intestine  

NSDL National Science Digital Library

The large intestine is larger and shorter than the small intestine and connects to the small intestine and the anus. Nutrient deficient material from the small intestine travels through the large intestine to the anus. This material is called feces and is excreted. Feces is made up of material that our bodies cannot break down into smaller parts to be used by the body.

Katie Hale (CSUF;)



Autoimmunity, immunodeficiency and mucosal infections: chronic intestinal inflammation as a sensitive indicator of immunoregulatory defects in response to normal luminal microflora.  


Despite the fact that target antigens and the genetic basis of several autoimmune diseases are now better understood, the initial events leading to a loss of tolerance towards self-components remain unknown. One of the most attractive explanations for autoimmune phenomena involves various infections as possible natural events capable of initiating the process in genetically predisposed individuals. The most accepted explanation of how infection causes autoimmunity is based on the concept of "molecular mimicry" (similarity between the epitopes of an autoantigen and the epitopes in the environmental antigen). Infectious stimuli may also participate in the development of autoimmunity by inducing an increased expression of stress proteins (hsp), chaperones and transplantation antigens, which leads to abnormal processing and presentation of self antigens. Superantigens are considered to be one of the most effective bacterial components to induce inflammatory reactions and to take part in the development and course of autoimmune mechanisms. It has long been known that defects in the host defense mechanism render the individual susceptible to infections caused by certain microorganisms. Impaired exclusion of microbial antigens can lead to chronic immunological activation which can affect the tolerance to self components. Defects in certain components of the immune system are associated with a higher risk of a development of autoimmune disease. The use of animal models for the studies of human diseases with immunological pathogenesis has provided new insights into the influence of immunoregulatory factors and the lymphocyte subsets involved in the development of disease. One of the most striking conclusion arising from work with genetically engineered immunodeficient mouse models is the existence of a high level of redundancy of the components of the immune system. However, when genes encoding molecules involved in T cell immunoregulatory functions are deleted, spontaneous chronic inflammation of the gut mucosa (similar to human inflammatory bowel disease) develops. Surprisingly, when such immunocompromised animals were placed into germfree environment, intestinal inflammation did not develop. Impairment of the mucosal immune response to the normal bacterial flora has been proposed to play a crucial role in the pathogenesis of chronic intestinal inflammation. The use of immunodeficient models colonized with defined microflora for the analysis of immune reactivity will shed light on the mode of action of different immunologically important molecules responsible for the delicate balance between luminal commensals, nonspecific and specific components of the mucosal immune system. PMID:9821323

Tlaskalová-Hogenová, H; St?pánková, R; Tucková, L; Farré, M A; Funda, D P; Verdú, E F; Sinkora, J; Hudcovic, T; Reháková, Z; Cukrowska, B; Kozáková, H; Prokesová, L



Small intestine  

NSDL National Science Digital Library

Smaller food particles move from the stomach to the small intestine. The small intestine is a long tube (like a garden hose), located just below the stomach. Most absorption of nutrients takes place in the small intestine (see absorption illustration). Keep in mind that the intestines are coiled like a snake inside of our bodies and are many feet long.

Katie Hale (CSUF;)



Intestinal permeability to chromium-51 ethylenediamine tetraacetic acid in children with chronic obstructive respiratory disease: relationship with clinical and duodenal biopsy findings  

SciTech Connect

Intestinal permeability (IP) to /sup 51/Cr ethylenediamine tetraacetic acid was investigated in 47 children with chronic obstructive respiratory disease (CORD). Endoscopic duodenal biopsies were performed in 22 of these patients. IP was significantly increased in CORD patients when compared to either control children or adults (P less than 0.001). Mean +/- 1 SD were 4.3 +/- 1.71%, 2.5 +/- 0.78%, and 2.3 +/- 0.77% in the three groups, respectively. IP was not related to the presence of atopy. Significant differences in IP results were found between CORD children with abdominal pain (4.5 +/- 1.4%) and both control children and CORD patients without abdominal pain (2.5 +/- 0.78% and 3.2 +/- 1.49%, respectively). A significant correlation was found between small bowel injury on the one hand and IP on the other hand (P less than 0.02). Furthermore, small bowel injury was significantly related to the presence of abdominal pain (P less than 0.05). We speculate that in CORD patients with abdominal pain, a factor exists that causes small bowel injury responsible for both abdominal pain and increased small bowel permeability. Food intolerance could, presumably, play a role in the mucosal damage-linked IP increase found in the subset of CORD patients who complain of abdominal pain.

Hoyoux, C.; Forget, P.P.; Borlee-Hermans, G.; Geubelle, F.



[Intestinal helminthiases].  


Intestinal helminthiases are infections in which adult helminths (nematodes, trematodes, cestodes) parasitize the intestine. In Central Europe intestinal helminthiases are usually acquired during travel or are imported by migrants. In contrast, in developing countries, intestinal helminthiases are highly prevalent. The mode of transmission and the clinical picture depend on the helminth species. Special laboratory methods are needed to diagnose the different intestinal helminthiases. Nematodes are usually treated with the benzimidazoles mebendazole and albendazole. Ivermectin, a macrocyclic lactone, is an alternative. Praziquanel is the drug of choice for the treatment of intestinal cestodes. PMID:20687462

Feldmeier, Hermann



[Simultaneous study of the motor and secretory functions of the small intestine following surgery of the abdominal organs in chronic experiments].  


The suggested method of an experimental animal preparation for simultaneous study of the motor and secretory functions of the small intestine through the single fistula consists in transection of the intestine with its distal end tightly sutured, and the proximal one end-to-end anastomosed to the efferent loop 22-24 cm from the sutured end. Into the formed in such a way "blind" site of the intestine, a fistula is inserted, which divides it into the "secretory" (12 cm in length) and "communicant" (10 cm) segments. From the "secretory" one the pure intestinal juice is aspirated through the fistula by a catheter, and intestinal motility is registered by means of a pressure gauge brought through the "communicant" segment into the intestine. PMID:2724792

Kurygin, A A; Bagaev, V A



Cytokine profile, proliferation and phosphorylation of ERK1/2 and Akt in circulating mononuclear cells from individuals during the chronic intestinal phase of Schistosomiasis mansoni infection  

PubMed Central

Background The immune response to Schistosoma mansoni is characterized by a granulomatous reaction around the parasite eggs that are trapped in the host liver, and this reaction modulates the immune response during the chronic phase of the disease. The typical peripheral blood mononuclear cell (PBMC) response of patients during the chronic intestinal phase of infection is characterized by a decreased response to an S. mansoni soluble egg antigen. To obtain a greater understanding of Schistosoma infections, this study investigated the effects of the soluble egg antigen (SEA) and soluble adult worm antigen (SWAP) of S. mansoni on cellular proliferation, cytokine production, and ERK1/2 and Akt phosphorylation in PBMCs from infected (XTO) and egg-negative (NI) individuals living in the same endemic area. Methods The activation status was evaluated by cell immunophenotypic staining (cytometry). The cell proliferation assay was by CFSE method. Cytokine detection assay (Th1 and Th2) was by Cytometric Bead and Array phosphorylation status was by ELISA. Results The XTO, NI and BD (blood donor) individuals from an area not endemic for schistosomiasis were compared. The CD4+ T lymphocyte proliferation rate was lower in the XTO group, but not the NI group, after SEA stimulation compared to the BD group. The CD8+ T cell proliferation rate was lower in the XTO group in the unstimulated cultures and after both SEA and SWAP stimulation compared to the BD group. Cytokine analysis after either SEA or SWAP stimulation showed a balanced cytokine pattern in the XTO and NI groups. ERK1/2 and Akt phosphorylation were only marginally detected in all groups; however, a decrease in ERK 1/2 phosphorylation was observed in the SWAP-stimulated XTO group compared to both the NI and BD groups. Conclusions The data indicate that SEA-stimulated CD4+ T cells from infected patients have a lower proliferation rate than the same cells from the NI group. Furthermore, we observed that SWAP stimulation influences ERK1/2 phosphorylation in the XTO group.



Intestinal Malrotation  

Microsoft Academic Search

PURPOSE: Complications of intestinal malrotation are familiar to pediatric surgeons but are rarely encountered by those caring strictly for adults. The aim of this study was to review our experience with disorders of intestinal rotation in adult patients and to emphasize the clinical presentation, radiographic features, and results of surgical treatment. METHODS: Ten adult patients (mean age, 42 (range, 22–73)

David W. Dietz; R. Matthew Walsh; Sharon Grundfest-Broniatowski; Ian C. Lavery; Victor W. Fazio; David P. Vogt



Intestinal Parasitoses.  

ERIC Educational Resources Information Center

|Intestinal parasites have become a serious public health problem in tropical countries because of the climate and the difficulty of achieving efficient hygiene. The objectives of this journal issue are to increase awareness of the individual and collective repercussions of intestinal parasites, describe the current conditions of contamination and…

Lagardere, Bernard; Dumburgier, Elisabeth



Pathophysiology and Diagnosis of Gastrointestinal Motility Dysfunction  

Microsoft Academic Search

During the last decade, considerable advances in the understanding of the pathophysiology and in the development of diagnostic methods for gastrointestinal motility disorders have been made. The following review focuses on the motility of the small intestine and the colon and illustrates with three clinical examples (chronic intestinal pseudo-obstruction, irritable bowel syndrome, and slow-transit constipation) the diagnostic application and therapeutic

Thomas Schmidt; Wolfgang Schepp



Gastric-and-intestinal mixed-type intestinal metaplasia: aberrant expression of transcription factors and stem cell intestinalization  

Microsoft Academic Search

Helicobacter pylori plays a causative role in the development of chronic atrophic gastritis, intestinal metaplasia (IM), and stomach cancer.\\u000a Although IM has long attracted attention as a putative preneoplastic lesion for stomach cancers, its clinicopathologic significance\\u000a has yet to be clarified in detail. Using gastric and intestinal epithelial cell markers, IM was here divided into two major\\u000a types: a gastric-and-intestinal

Tetsuya Tsukamoto; Tsutomu Mizoshita; Masae Tatematsu



Abnormal intestinal permeability in Crohn's disease pathogenesis.  


Increased small intestinal permeability is a longstanding observation in both Crohn's disease patients and in their healthy, asymptomatic first-degree relatives. However, the significance of this compromised gut barrier function and its place in the pathogenesis of the disease remains poorly understood. The association between abnormal small intestinal permeability and a specific mutation in the NOD2 gene, which functions to modulate both innate and adaptive immune responses to intestinal bacteria, suggests a common, genetically determined pathway by which an abnormal gut barrier could result in chronic intestinal inflammation. Furthermore, rodent colitis models show that gut barrier defects precede the development of inflammatory changes. However, it remains possible that abnormal permeability is simply a consequence of mucosal inflammation. Further insight into whether abnormal barrier function is the cause or consequence of chronic intestinal inflammation will be crucial to understanding the role of intestinal permeability in the pathogenesis of Crohn's disease. PMID:22731729

Teshima, Christopher W; Dieleman, Levinus A; Meddings, Jon B



Intestinal permeability is decreased in anorexia nervosa  

Microsoft Academic Search

Malnutrition and absence of exogenous luminal nutrients in the gastrointestinal tract affect intestinal permeability (IP) leading to an increased penetration of substances that passively cross intestinal epithelium via intercellular pathways. We hypothesised that an increase in IP could occur in patients with anorexia nervosa because of their prolonged fasting and chronic malnutrition. Therefore, we assessed IP in 14 drug-free anorexic

P Monteleone; R Carratù; M Cartenì; M Generoso; M Lamberti; L De Magistris; F Brambilla; B Colurcio; M Secondulfo; M Maj



Intestinal and hepatic first-pass extraction of the 11?-HSD1 inhibitor AMG 221 in rats with chronic vascular catheters.  


Abstract 1. A catheterized rat model was used to define the intestinal and hepatic components of oral bioavailability for an 11?-HSD1 inhibitor, AMG 221. These data were integrated with standard in vivo metabolism studies to elucidate the components contributing to the oral disposition of a novel drug candidate. 2. Intestinal and hepatic extraction ratios of AMG 221 obtained using a five-catheter rat model were 0.56 and 0.32, respectively. Therefore, both intestinal and hepatic extraction contributed to the first-pass component of oral bioavailability. There was no evidence for significant gut extraction of systemically administered drug. 3. Mass balance data and in vivo metabolite characterization obtained after administration of [(14)C] AMG 221 to rat showed that AMG 221 was completely absorbed from the gut lumen following an oral dose, primarily excreted in urine and was almost completely metabolized prior to excretion. 4. Hepatic bioavailability (FH), measured in two animals at various time points after oral dose administration was somewhat variable but generally characterized by an initial reduction during the absorption phase followed by an increase during the elimination phase, consistent with hepatic distribution of AMG 221. 5. The five-catheter rat model afforded estimates of hepatic and intestinal contribution to oral bioavailability that were used with other data to define the preclinical ADME characteristics of a drug candidate. PMID:23517558

Gao, Qiuxia; Kimura, Robert E; Zhang, Xiping; Nam, Joon; Amore, Benny M; Hickman, Dean; Greg Slatter, J; Emery, Maurice G



Intestinal Transplantation  


... nutrients must be put directly into the blood stream (intravenous or IV) in liquid form. These nutrients ... hole (stoma) leading outside the body (a colostomy). Waste that comes out of the intestine through the ...


Small Intestine  


... Multimedia Table Index In This Topic Digestive Disorders Biology of the Digestive System Small Intestine Back to ... Subjects Women's Health Issues Chapters in Digestive Disorders Biology of the Digestive System Symptoms of Digestive Disorders ...


Nuclear Bile Acid Receptor FXR Protects against Intestinal Tumorigenesis  

Microsoft Academic Search

Bile acids have been considered intestinal tumor promoters, and because they are natural ligands for the nuclear receptor FXR, we examined the role of FXR in intestinal tumorigenesis. Using gain- and loss-of-function studies, we found that FXR suppresses intestinal tumorigenesis in vivo. Loss of FXR in the ApcMin\\/+ and in the chronic colitis mouse models of intestinal tumorigenesis resulted in

Salvatore Modica; Stefania Murzilli; Lorena Salvatore; Daniel R. Schmidt; Antonio Moschetta



Simvastatin does not influence the intestinal P-glycoprotein and MPR2, and the disposition of talinolol after chronic medication in healthy subjects genotyped for the ABCB1, ABCC2 and SLCO1B1 polymorphisms  

PubMed Central

Aims To evaluate whether simvastatin influences (i) the intestinal expression of P-glycoprotein (P-gp) and MRP2, and (ii) the disposition of the ?1-selective blocker talinolol, a substrate of these transporter proteins. Methods The disposition of talinolol after intravenous (30 mg) and single or repeated oral administration (100 mg daily) was monitored before and after chronic treatment with simvastatin (40 mg daily) in 18 healthy subjects (10 males, eight females, body mass index 19.0–27.0 kg m?2) genotyped for ABCB1, ABCC2 and SLCO1B1 polymorphisms. The steady-state pharmacokinetics of simvastatin was evaluated before and after repeated oral talinolol administration. The duodenal expression of ABCB1 and ABCC2 mRNA before and after simvastatin treatment was quantified using real-time reverse transcriptase-polymerase chain reaction (TaqMan®). Results Simvastatin did not influence the expression of duodenal ABCB1 and ABCC2. There was no significant pharmacokinetic interaction between simvastatin and talinolol. Duodenal ABCB1 mRNA content was significantly correlated with the AUC0–? (r = 0.627, P = 0.039) and Cmax (r = 0.718, P = 0.013) of oral talinolol. The ABCB1 and ABCC2 gene polymorphisms did not influence simvastatin and talinolol disposition. The half-life of the latter was significantly shorter in the nine carriers with a SLCO1B1*1b allele compared with the seven subjects with the wild-type SLCO1B1*1a/*1a genotype (12.2 ± 1.6 h vs. 14.5 ± 1.4 h, P = 0.01). Conclusions Simvastatin does not influence the intestinal expression of P-gp and MRP2 in man. There was no pharmacokinetic interaction between talinolol and simvastatin during their chronic co-administration to healthy subjects.

Bernsdorf, Annika; Giessmann, Thomas; Modess, Christiane; Wegner, Danilo; Igelbrink, Stefanie; Hecker, Ute; Haenisch, Sierk; Cascorbi, Ingolf; Terhaag, Bernd; Siegmund, Werner



Effects of Intestinal Electrical Stimulation on Intestinal Dysrhythmia and Symptoms in Dogs  

Microsoft Academic Search

The aim of this study was to investigate the effect of intestinal electrical stimulation on small intestinal dysrhythmia and motion sickness-like symptoms induced by vasopressin. Female dogs chronically implanted with two pairs of electrodes on jejunum serosa were used in a four-session study. Saline and vasopressin were infused in sessions 1 and 2, respectively. Sessions 3 and 4 were the

Jinsong Liu; Lijie Wang; J. D. Z. Chen



Intestinal gas  

Microsoft Academic Search

Opinion statement  The most common symptoms associated with intestinal gas are excessive eructation, flatulence, and abdominal bloating and distention.\\u000a Unfortunately, few therapies have been shown to be effective in treating these symptoms. Excessive eructation can be treated\\u000a by decreasing excessive air swallowing. Bloating and gaseous distension can improve in some patients by avoiding foods containing\\u000a partially digested or absorbed polysaccharides, by

Rebecca N. Fink; Anthony J. Lembo



Intestinal parasitoses.  

PubMed Central

BACKGROUND: Intestinal parasitoses is a clinical problem in the developing world and severe parasitaemia may be associated with retroviruses. OBJECTIVE: Studies on intestinal parasitoses were conducted in Dominica, and the health implications in an HTLV-1 endemic area were discussed. METHOD OF STUDY: A retrospective study of data of stool samples analysed at the parasitology unit of the medical laboratory services of Princess Margaret Hospital, Dominica, was conducted in January-December 1999. RESULTS: Parasites were found in 393 out of 3,752 stool samples (10.47%). The main parasites were Entamoeba coli, 1.4% (51/3,752); hookworm, 1.5% (56/3,752); Giardia lamblia, 1.4% (51/3,752); Strongyloides stercoralis, 1.0% (37/3,752); Ascaris lumbricoides, 0.8% (28/3,752); and Trichuris trichiura, 0.9% (34/3,752). CONCLUSION: Intestinal parasites are still endemic in Dominica, but significant reduction in prevalence has occurred over the last two decades.

Adedayo, Olayinka; Nasiiro, Robert



Sphingosine-1-phosphate: Driver of NF?B and STAT3 persistent activation in chronic intestinal inflammation and colitis-associated cancer.  


Inflammatory bowel disease is associated with an increased risk of colorectal cancer. Colitis-associated cancer is a classical inflammation-driven cancer in which constitutive NF?B and STAT3 activation drive tumorigenesis. Recent findings published by Liang et al. in Cancer Cell demonstrate that sphingosine kinase 1 (SphK1)-mediated upregulation of sphingosine-1-phosphate (S1P) drives a persistent NF?B/IL-6/STAT3/sphingosine-1-phosphate receptor 1 (S1PR1) amplification loop that is critical to the development of chronic colitis and colitis-associated cancer. FTY720, an antagonist of S1PR1, abolished persistent NF?B/IL-6/STAT3 signaling and reduced the development and progression of colitis-associated cancer. Targeting SphK1/S1P/S1PR1 may provide a therapeutic option to prevent the progression of colitis to cancer. PMID:24069553

Theiss, Arianne L



Intestinal Gas.  


The most common symptoms associated with intestinal gas are excessive eructation, flatulence, and abdominal bloating and distention. Unfortunately, few therapies have been shown to be effective in treating these symptoms. Excessive eructation can be treated by decreasing excessive air swallowing. Bloating and gaseous distension can improve in some patients by avoiding foods containing partially digested or absorbed polysaccharides, by taking replacement enzymes (such as alfa-galactosidase or lactase), or by taking antibiotics directed toward altering the colonic flora. Activated charcoal or prokinetic agents (such as tegaserod and metoclopramide) also can be effective options in some patients. For noxious odor associated with flatus, bismuth subsalicylate or the charcoal cushion may improve patients' symptoms. PMID:11469992

Fink, Rebecca N.; Lembo, Anthony J.



Intestinal fibrosis in IBD—a dynamic, multifactorial process  

Microsoft Academic Search

Intestinal fibrosis is a common and potentially serious complication of IBD that results from the reaction of intestinal tissue to the damage inflicted by chronic inflammation. The traditional view that fibrosis is inevitable or irreversible in patients with IBD is progressively changing in light of improved understanding of the cellular and molecular mechanisms that underlie the pathogenesis of fibrosis in

Florian Rieder; Claudio Fiocchi



Role of Intestinal Bacteria in Gliadin-Induced Changes in Intestinal Mucosa: Study in Germ-Free Rats  

Microsoft Academic Search

Background and AimsCeliac disease (CD) is a chronic inflammatory disorder of the small intestine that is induced by dietary wheat gluten proteins (gliadins) in genetically predisposed individuals. The overgrowth of potentially pathogenic bacteria and infections has been suggested to contribute to CD pathogenesis. We aimed to study the effects of gliadin and various intestinal bacterial strains on mucosal barrier integrity,

Jana Cinova; Giada de Palma; Renata Stepankova; Olga Kofronova; Miloslav Kverka; Yolanda Sanz; Ludmila Tuckova; François Leulier



Dose-dependence of ethimizole absorption from the dog small intestine  

Microsoft Academic Search

Absorption of E from the small intestine was studied by means of an intestinal loop in chronic experiments [7, 12] on four male mongrel dogs weighing 10-12 kg. An intestinal segment about 30 cm long, with its vascular branches intact, was used for the loop. An anasto ~ mosis was formed at the divided ends of the gut to restore

T. Trnovec; V. Faberova; L. B. Piotrovskii; M. Durisova; I. Gabauer; J. Styk



Traveler's Diarrhea Due to Intestinal Protozoa  

Microsoft Academic Search

Intestinal protozoa account for a minority of cases of acute traveler's diarrhea, but they are common pathogens in travelers who experience protracted diarrhea during or after travel. Evaluation of the traveler with chronic diarrhea should include a careful examination for typical infecting organisms, such as Giardia and Entamoeba species, as well as for emerging parasites, such as Cryptosporidium species, Cyclospora



Pericryptal fibroblast sheath in intestinal metaplasia and gastric carcinoma  

PubMed Central

Background and aims: In the progression of chronic gastritis, gastric mucosal cells deviate from the normal pathway of gastric differentiation to an intestinal phenotype which is closely related to gastric carcinoma. However, to date, it has not been elucidated whether the intestinal metaplasia is merely a change in the epithelium or whether the underlying mesenchyme also changes from gastric type to intestinal type. We have investigated the relationship between intestinal metaplasia and the pericryptal fibroblast sheath (PCFS) in the mesenchyme. In addition, we also examined PCFS in gastric carcinoma. Methods: We determined the existence of PCFS in the intestinal metaplastic mucosa and carcinoma of both human and Cdx2 transgenic mouse stomach. PCFS was determined using the antibody against ?-smooth muscle actin and electron microscopic observations. Results: PCFS formed an almost complete layer around the small and large intestinal crypts while it did not exist around the normal gastric glands in both mice and humans. PCFS was seen around the glands of intestinal metaplastic mucosa in both Cdx2 transgenic mouse and human stomachs. However, PCFS was virtually absent in the intestinal-type gastric adenocarcinoma area. Conclusion: We successfully demonstrated that the epithelium as well as the mesenchyme changed from the gastric type to the intestinal type in intestinal metaplasia and that PCFS disappeared in intestinal-type gastric carcinoma.

Mutoh, H; Sakurai, S; Satoh, K; Osawa, H; Tomiyama, T; Kita, H; Yoshida, T; Tamada, K; Yamamoto, H; Isoda, N; Ido, K; Sugano, K



Small Intestine Disorders  


Your small intestine is the longest part of your digestive system - about twenty feet long! It connects your stomach to ... many times to fit inside your abdomen. Your small intestine does most of the digesting of the foods ...


Small intestine (image)  


The small intestine is the portion of the digestive system most responsible for absorption of nutrients from food into the ... the duodenum. This short first portion of the small intestine is followed by the jejunum and the ileum. ...


Interstitial cells of Cajal in the gut - A gastroenterologist's point of view  

PubMed Central

Alterations of normal function of interstitial cells of Cajal (ICC) are reported in many intestinal disorders. Diagnosis of their involvement is rare (infrequent), but necessary to propose a specific treatment. This article reviews the place of ICC in the pathogenesis of achalasia, gastroesophageal reflux disease, infantile hypertrophic pyloric stenosis, chronic intestinal pseudo-obstruction and slow transit constipation. Moreover we discuss the role of the Cajal cells in the development of stromal tumors of the gastrointestinal tract.

Negreanu, Lucian M; Assor, Philippe; Mateescu, Bogdan; Cirstoiu, Catalin



Healing of intestinal inflammation by IL-22  

PubMed Central

An IL-10 family cytokine IL-22 is characterized by several unique biological properties, including 1) the target restricted to innate cells, 2) the distinct expression pattern between large and small intestines, 3) alteration of the cellular source depending on several factors, 4) the dual abilities to serve as protective versus proinflammatory mediators in inflammatory responses, and 5) the close association with some major IBD susceptibility genes. The major functions of IL-22 in the intestine are the stimulation of epithelial cells to produce a wide variety of antibacterial proteins, the reinforcement of mucus barrier through stimulation of mucin 1 production under intestinal inflammatory conditions, and the enhancement of epithelial regeneration with goblet cell restitution. Through these beneficial functions, IL-22 contributes to the improvement of some types of experimental chronic colitis, which are mediated by Th1 or Th2 responses. Most importantly, studies using both loss-of-function and gain-of-function approaches have clearly demonstrated the ability of IL-22 to promote intestinal wound healing from acute intestinal injury. These findings highlight IL-22 as an attractive and promising target for future IBD therapy. Alternatively, the enormous progress in the field of IL-22 biology has also suggested more complicated mechanism with IL-22 pathway than previously predicted. This review article briefly summarizes previous and current knowledge on IL-22 particularly associated with intestinal inflammation.

Mizoguchi, Atsushi



Prevalence of celiac disease in patients with juvenile chronic arthritis  

Microsoft Academic Search

We estimated the prevalence of celiac disease in children with juvenile chronic arthritis (JCA), using antiendomysium antibodies as the screening test to select patients for intestinal biopsy. We studied 119 children with JCA and found four patients with antiendomysium antibodies. In three of these patients (2.5%), intestinal biopsy revealed villous atrophy; in the fourth the intestinal mucosa was normal. We

Loredana Lepore; Stefano Martelossi; Marco Pennesi; Fernanda Falcini; Maria Luisa Ermini; Roberto Ferrari; Sandra Perticarari; Gianni Presani; Ariella Lucchesi; Manuela Lapini; Alessandro Ventura



Vertebrate Intestinal Endoderm Development  

PubMed Central

The endoderm gives rise to the lining of the esophagus, stomach and intestines, as well as associated organs. To generate a functional intestine, a series of highly orchestrated developmental processes must occur. In this review, we attempt to cover major events during intestinal development from gastrulation to birth, including endoderm formation, gut tube growth and patterning, intestinal morphogenesis, epithelial reorganization, villus emergence as well as proliferation and cytodifferentiation. Our discussion includes morphological and anatomical changes during intestinal development as well as molecular mechanisms regulating these processes.

Spence, Jason R.; Lauf, Ryan; Shroyer, Noah F.



Intestinal epithelial barrier function in liver cirrhosis: an extensive review of the literature.  


Recent evidence suggests that translocation of bacteria and bacterial products, such as endotoxin from the intestinal lumen into the systemic circulation is a contributing factor in the pathogenesis of chronic liver diseases and the development of complications in cirrhosis. In addition to alterations in the intestinal microbiota and immune system, dysfunction of the intestinal epithelial barrier may be an important factor facilitating bacterial translocation. This review aims to provide an overview of the current evidence of intestinal epithelial barrier dysfunction in human chronic liver diseases and cirrhosis, and to discuss possible contributing factors and mechanisms. Data suggest the presence of intestinal epithelial barrier dysfunction in patients with chronic liver diseases, but are more convincing in patients with cirrhosis, especially in those with complications. The barrier dysfunction can result from both direct and indirect effects of aetiological factors, such as alcohol and obesity, which can cause chronic liver diseases and ultimately cirrhosis. On the other hand characteristics of cirrhosis itself, including portal hypertension, alterations in the intestinal microbiota, inflammation and oxidative stress can affect barrier function of both small and large intestine and may contribute to the development of complications. In conclusion, there are indications for intestinal epithelial barrier dysfunction in patients with chronic liver diseases and especially in patients with cirrhosis, which can be caused by various factors affecting both the small and large intestine. PMID:23879434

Pijls, Kirsten E; Jonkers, Daisy M A E; Elamin, Elhaseen E; Masclee, Ad A M; Koek, Ger H



Innate defenses of the intestinal epithelial barrier.  


The innate immune system plays a crucial role in maintaining the integrity of the intestine and protecting the host against a vast number of potential microbial pathogens from resident and transient gut microflora. Mucosal epithelial cells and Paneth cells produce a variety of antimicrobial peptides (defensins, cathelicidins, crytdinrelated sequence peptides, bactericidal/permeabilityincreasing protein, chemokine CCL20) and bacteriolytic enzymes (lysozyme, group IIA phospholipase A2) that protect mucosal surfaces and crypts containing intestinal stem cells against invading microbes. Many of the intestinal antimicrobial molecules have additional roles of attracting leukocytes, alarming the adaptive immune system or neutralizing proinflammatory bacterial molecules. Dysfunction of components of the innate immune system has recently been implicated in chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, illustrating the pivotal role of innate immunity in maintaining the delicate balance between immune tolerance and immune response in the gut. PMID:15971105

Müller, C A; Autenrieth, I B; Peschel, A



Intestinal Behçet's disease appearing during treatment with adalimumab in a patient with ankylosing spondylitis.  


Behçet's disease (BD) is a chronic inflammatory disease affecting multiple organ systems, such as the skin, joints, blood vessels, central nervous system, and gastrointestinal tract. Intestinal BD is characterized by intestinal ulcerations and gastrointestinal symptoms. The medical treatment of intestinal BD includes corticosteroids and immunosupressants. There have been several reports of tumor necrosis factor-? (TNF-?) blockers being successful in treatment of refractory intestinal BD. Here, we report on a patient who was diagnosed with intestinal BD despite treatment with the fully humanized TNF-? blocker (adalimumab) for underlying ankylosing spondylitis. This patient achieved clinical remission and complete mucosal healing through the addition of a steroid and azathioprine to the adalimumab regimen. PMID:23983446

Chung, Sook Hee; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho



Intestinal Beh?et's disease appearing during treatment with adalimumab in a patient with ankylosing spondylitis  

PubMed Central

Behçet’s disease (BD) is a chronic inflammatory disease affecting multiple organ systems, such as the skin, joints, blood vessels, central nervous system, and gastrointestinal tract. Intestinal BD is characterized by intestinal ulcerations and gastrointestinal symptoms. The medical treatment of intestinal BD includes corticosteroids and immunosupressants. There have been several reports of tumor necrosis factor-? (TNF-?) blockers being successful in treatment of refractory intestinal BD. Here, we report on a patient who was diagnosed with intestinal BD despite treatment with the fully humanized TNF-? blocker (adalimumab) for underlying ankylosing spondylitis. This patient achieved clinical remission and complete mucosal healing through the addition of a steroid and azathioprine to the adalimumab regimen.

Chung, Sook Hee; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho



Crohn's disease of the mouth: an indicator of intestinal involvement.  

PubMed Central

Nineteen patients with clinical evidence of oral Crohn's disease but no intestinal symptoms were studied. Oral lesions in all patients were shown histologically to have lymphoedema with or without chronic granulomas consistent with Crohn's disease. Seven patients (37%) had demonstrable intestinal disease on rectal biopsy and four of these had abnormal bowel radiology. All seven had evidence of nutritional deficiency. Patients with clinical features suggesting oral Crohn's disease may have evidence of Crohn's disease in the intestine, although this may not be clinically apparent.

Scully, C; Cochran, K M; Russell, R I; Ferguson, M M; Ghouri, M A; Lee, F D; MacDonald, D G; McIntyre, P B



Intestinal Epithelium and Autophagy: Partners in Gut Homeostasis  

PubMed Central

One of the most significant challenges of cell biology is to understand how each type of cell copes with its specific workload without suffering damage. Among the most intriguing questions concerns intestinal epithelial cells in mammals; these cells act as a barrier between the internally protected region and the external environment that is exposed constantly to food and microbes. A major process involved in the processing of microbes is autophagy. In the intestine, through multiple, complex signaling pathways, autophagy including macroautophagy and xenophagy is pivotal in mounting appropriate intestinal immune responses and anti-microbial protection. Dysfunctional autophagy mechanism leads to chronic intestinal inflammation, such as inflammatory bowel disease (IBD). Studies involving a number of in vitro and in vivo mouse models in addition to human clinical studies have revealed a detailed role for autophagy in the generation of chronic intestinal inflammation. A number of genome-wide association studies identified roles for numerous autophagy genes in IBD, especially in Crohn’s disease. In this review, we will explore in detail the latest research linking autophagy to intestinal homeostasis and how alterations in autophagy pathways lead to intestinal inflammation.

Randall-Demllo, Sarron; Chieppa, Marcello; Eri, Rajaraman



Promotion of Hepatocellular Carcinoma by the Intestinal Microbiota and TLR4  

PubMed Central

SUMMARY Increased translocation of intestinal bacteria is a hallmark of chronic liver disease and contributes to hepatic inflammation and fibrosis. Here we tested the hypothesis that the intestinal microbiota and Toll-like receptors (TLRs) promote hepatocellular carcinoma (HCC), a long-term consequence of chronic liver injury, inflammation and fibrosis. Hepatocarcinogenesis in chronically injured livers depended on the intestinal microbiota, and TLR4 activation in non-bone marrow-derived resident liver cells. TLR4 and the intestinal microbiota were not required for HCC initiation but for HCC promotion, mediating increased proliferation, expression of the hepatomitogen epiregulin, and prevention of apoptosis. Gut sterilization restricted to late stages of hepatocarcinogenesis reduced HCC suggesting that the intestinal microbiota and TLR4 represent therapeutic targets for HCC prevention in advanced liver disease.

Dapito, Dianne H.; Mencin, Ali; Gwak, Geum-Youn; Pradere, Jean-Philippe; Jang, Myoung-Kuk; Mederacke, Ingmar; Caviglia, Jorge M.; Khiabanian, Hossein; Adeyemi, Adebowale; Bataller, Ramon; Lefkowitch, Jay H.; Bower, Maureen; Friedman, Richard; Sartor, R. Balfour; Rabadan, Raul; Schwabe, Robert F.



Intestinal adaptation after massive intestinal resection  

PubMed Central

Patients with short bowel syndrome require long term parenteral nutrition support. However, after massive intestinal resection the intestine undergoes adaptation and nutritional autonomy may be obtained. Given that the complications of parenteral nutrition may be life threatening or result in treatment failure and the need for intestinal transplantation, a more attractive option is to wean patients off nutrition support by optimising the adaptive process. The article examines the evidence that after extensive small bowel resection adaptation occurs in humans and focuses on the factors that influence adaptation and the strategies that have been used to optimise this process. The review is based on an English language Medline search with secondary references obtained from key articles. There is evidence that adaptation occurs in humans. Adaptation is a complex process that results in response to nutrient and non-nutrient stimuli. Successful and reproducible strategies to improve adaptation remain elusive despite an abundance of experimental data. Nevertheless given the low patient survival and quality of life associated with other treatments for irreversible intestinal failure it is imperative that clinical research continues into the optimisation of the adaptation.

Weale, A; Edwards, A; Bailey, M; Lear, P



Gatekeepers of intestinal inflammation.  


The intestine is subjected to a barrage of insults from food, bacterial flora, and pathogens. Despite this constant antigenic challenge, the mucosal tissues lining the intestinal tract remain largely under control. The mechanisms regulating the homeostatic balance in the gut have been investigated for many years by many groups, but the precise nature of the regulatory control remains elusive. In this review, we provide an overview of pathways proposed to be involved in dampening the inflammatory response and maintaining the homeostatic balance in the intestine, and how these pathways may be disrupted in ulcerative colitis and Crohn's disease. PMID:20066780

Arnett, Heather A; Viney, Joanne L



Effect of pretransplant graft irradiation on canine intestinal transplantation  

SciTech Connect

This study was done to define the tolerance of ex vivo administered irradiation to intestinal allograft and to assess the effect of irradiation on the incidence and severity of rejection and graft versus host disease after intestinal transplantation in dogs. Excessive intestinal damage was produced by 2,500 rads, but 750 and 1,500 rads produced no detectable acute or chronic damage in dogs observed from 100 days to two years. Using cyclosporine for postoperative immunosuppression, 1,500 rads reduced the incidence of acute (p = 0.05) and chronic rejection (p = 0.08), yet did not impair intestinal absorption of cyclosporine. The greatest improvement in survival occurred with 750 rads (p = 0.02). Histologic evidence of graft versus host disease appeared in the native small intestine in two of four long term surviving dogs receiving a nonirradiated graft but in none of the dogs receiving irradiated grafts. Irradiation of the graft may be a promising adjunct in the search for a clinically applicable method of intestinal transplantation.

Williams, J.W.; McClellan, T.; Peters, T.G.; Nag, S.; Dean, P.; Banner, B.; Vera, S.R.; Stenz, F.



Intestinal mucosal adaptation.  


Intestinal failure is a condition characterized by malnutrition and/or dehydration as a result of the inadequate digestion and absorption of nutrients. The most common cause of intestinal failure is short bowel syndrome, which occurs when the functional gut mass is reduced below the level necessary for adequate nutrient and water absorption. This condition may be congenital, or may be acquired as a result of a massive resection of the small bowel. Following resection, the intestine is capable of adaptation in response to enteral nutrients as well as other trophic stimuli. Identifying factors that may enhance the process of intestinal adaptation is an exciting area of research with important potential clinical applications. PMID:16937429

Drozdowski, Laurie; Thomson, Alan B R



Gastric and intestinal lactobezoars.  


Two male full-term infants presented with unusual features of lactobezoar. One had gastric disease while the other had small bowel bezoar. The gastric lactobezoar was managed medically while the intestinal one required surgical intervention. PMID:11400808

Rao PVH; Raveenthiran, V; Dhanalakshmi, M


Intestinal Stem Cells  

PubMed Central

Self-renewal in the intestinal epithelia is fueled by a population of undifferentiated intestinal stem cells (ISCs) that give rise to daughter or progenitor cells, which can subsequently differentiate into the mature cell types required for normal gut function. The cellular signals that regulate self-renewal are poorly understood and the factors that mediate the transition from a stem cell to a progenitor cell in the gut are unknown. Recent studies have suggested that ISCs are located either at the crypt base interspersed between the Paneth cells (eg, Lgr-5+ve cells) or at or near position 4 within the intestinal crypt (eg, DCAMKL-1 or Bmi-1+ve cells). This raises the possibility that distinct stem cell regions exist in the crypts and that ISC's state of activation will determine how the self-renewal is regulated in the intestinal tract.



Aluminum Phagocytosis in Quadriceps Muscle following Vaccination in Children: Relationship to Macrophagic Myofasciitis  

Microsoft Academic Search

Macrophagic myofasciitis (MMF) is a rare, seemingly emerging entity among adult patients in France. We encountered two children\\u000a with the first two cases of MMF in North America. A 5-year-old male with chronic intestinal pseudo-obstruction required nighttime\\u000a parenteral nutrition. Abnormal pupillary reflexes and urinary retention suggested a diffuse dysautonomia, which prompted a\\u000a neurological diagnostic work-up. A 3-year-old child had developmental

Atilano G. Lacson; Cyril A. D'Cruz; Enid Gilbert-Barness; Leroy Sharer; Sergio Jacinto; Rosa Cuenca



Lubiprostone stimulates small intestinal mucin release  

PubMed Central

Background Lubiprostone is a synthetic bicyclic fatty acid derivative of prostaglandin E1 (PGE1) used for chronic constipation. The best known action of lubiprostone is simulation of Cl- dependent fluid secretion. In a mouse model of the genetic disease cystic fibrosis, we previously showed that in vivo administration of lubiprostone resulted in greater mucus accumulation in the small intestine. The aim of this study was to directly test whether lubiprostone stimulates intestinal mucin release. Methods Mucin release was measured by mounting segments (4-5 cm) of mouse proximal-mid small intestine in an organ bath, allowing access to the perfusate (luminal) and the bath (serosal) solutions. Nifedipine (10-6 M) and indomethacin (10-5 M) were included in all solutions to inhibit smooth muscle activity and endogenous prostaglandin production, respectively. The tissue was equilibrated under flow for 30 min, using the perfusate collected during the final 10 min of the equilibration period to measure unstimulated release rate. Stimulus was then added to either the perfusate or the bath and the perfusate was collected for another 30 min to measure the stimulated mucin release rate. Mucin in perfusates was quantified by periodic acid-Schiff's base dot-blot assay, using purified pig gastric mucin as a standard. Results When applied luminally at 1 ?M lubiprostone was ineffective at stimulating mucin release. When added to the serosal solution, 1 ?M lubiprostone stimulated mucin release to ~300% of the unstimulated rate. As a positive control, serosal 1 ?M prostaglandin E2 increased mucin release to ~400% of the unstimulated rate. Conclusions These results support the idea that lubiprostone has prostaglandin-like actions on the intestine, which includes stimulation of mucin release. Stimulation of mucin release by lubiprostone may be protective in gastrointestinal conditions where loss of mucus is believed to contribute to pathogenesis. Thus, in addition to chronic constipation, there is greater potential for the therapeutic applications of lubiprostone.



Regulation of early and delayed radiation responses in rat small intestine by capsaicin-sensitive nerves  

SciTech Connect

Purpose: Mast cells protect against the early manifestations of intestinal radiation toxicity, but promote chronic intestinal wall fibrosis. Intestinal sensory nerves are closely associated with mast cells, both anatomically and functionally, and serve an important role in the regulation of mucosal homeostasis. This study examined the effect of sensory nerve ablation on the intestinal radiation response in an established rat model. Methods and Materials: Rats underwent sensory nerve ablation with capsaicin or sham ablation. Two weeks later, a localized segment of ileum was X-irradiated or sham irradiated. Structural, cellular, and molecular changes were examined 2 weeks (early injury) and 26 weeks (chronic injury) after irradiation. The mast cell dependence of the effect of sensory nerve ablation on intestinal radiation injury was assessed using c-kit mutant (Ws/Ws) mast cell-deficient rats. Results: Capsaicin treatment caused a baseline reduction in mucosal mast cell density, crypt cell proliferation, and expression of substance P and calcitonin gene-related peptide, two neuropeptides released by sensory neurons. Sensory nerve ablation strikingly exacerbated early intestinal radiation toxicity (loss of mucosal surface area, inflammation, intestinal wall thickening), but attenuated the development of chronic intestinal radiation fibrosis (collagen I accumulation and transforming growth factor {beta} immunoreactivity). In mast cell-deficient rats, capsaicin treatment exacerbated postradiation epithelial injury (loss of mucosal surface area), but none of the other aspects of radiation injury were affected by capsaicin treatment. Conclusions: Ablation of capsaicin-sensitive enteric neurons exacerbates early intestinal radiation toxicity, but attenuates development of chronic fibroproliferative changes. The effect of capsaicin treatment on the intestinal radiation response is partly mast cell dependent.

Wang Junru [Department of Surgery, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR (United States); Zheng Huaien [Department of Surgery, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR (United States); Kulkarni, Ashwini [Department of Surgery, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR (United States); Ou Xuemei [Department of Surgery, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR (United States); Hauer-Jensen, Martin [Department of Surgery, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR (United States) and Department of Pathology, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR (United States)]. E-mail:



Endocervicosis of the small intestine.  


A case of endocervicosis of the small intestine incidentally found as a mass lesion during a gastric bypass surgery is reported. No previous cases of intestinal endocervicosis have been reported in the literature. PMID:11927973

Chen, Karl T K



Small intestine contrast injection (image)  


... and throat, through the stomach into the small intestine. When in place, contrast dye is introduced and ... means of demonstrating whether or not the small intestine is normal when abnormality is suspected.


Enzymes in feces: Useful markers of chronic inflammatory bowel disease  

Microsoft Academic Search

BackgroundUlcerative colitis and Crohn's disease are characterized by a chronic intestinal inflammation. Since the precise etiology is still unknown, current therapies are aimed at reducing or eliminating inflammation.

Imerio Angriman; Marco Scarpa; Renata D'Incà; Daniela Basso; Cesare Ruffolo; Lino Polese; Giacomo C. Sturniolo; Davide F. D'Amico; Mario Plebani



Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases.  

PubMed Central

Mesenteric vein thrombosis associated with intestinal stricture, as a consequence of intestinal ischaemia, has only been mentioned twice in published works. The clinical, biological, and morphological aspects as well as the treatment of this morbid association were studied in three patients. In all, a two stage clinical course (initial acute abdominal pain and fever, followed by chronic intestinal obstruction), corresponding to the sequence thrombosis/stricture, was found. x Ray studies showed a regularly contoured intestinal stricture. Surgical resection was required in all three cases for stricture, associated in one case with mesenteric infarction. Anticoagulation treatment was used to preclude recurrence. Increased clinical awareness could lead to the diagnosis of intestinal stricture secondary to mesenteric vein thrombosis more often and at an earlier stage. Treatment consists of evaluation of predisposing features, intestinal resection when necessary, and anticoagulation therapy, as indicated. Images Figure 1 Figure 2

Eugene, C; Valla, D; Wesenfelder, L; Fingerhut, A; Bergue, A; Merrer, J; Felsenheld, C; Moundji, A; Etienne, J C



Mimicry and Deception in Inflammatory Bowel Disease and Intestinal Beh?et Disease  

PubMed Central

Behçet disease (BD) is a rare, chronic, multisystemic, inflammatory disease characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Intestinal BD occurs in 10–15% of BD patients and shares many clinical characteristics with inflammatory bowel disease (IBD), making differentiation of the 2 diseases very difficult and occasionally impossible. The diagnosis of intestinal BD is based on clinical findings—as there is no pathognomonic laboratory test—and should be considered in patients who present with abdominal pain, diarrhea, weight loss, and rectal bleeding and who are susceptible to intestinal BD. Treatment for intestinal BD is similar to that for IBD, but overall prognosis is worse for intestinal BD. Although intestinal BD is extremely rare in the United States, physicians will increasingly encounter these challenging patients in the future due to increased immigration rates of Asian and Mediterranean populations.

Grigg, Erika L.; Kane, Sunanda



CT recognition of intestinal lipomatosis  

SciTech Connect

Lipomas are among the most common benign tumors of the small intestine. They are generally solitary lesions and asymptomatic. The extensive involvement of the small intestine with multiple lipomas is rare. The authors report a case of intestinal lipomatosis of the small bowel in which CT was specific enough to make the diagnosis without resorting to more invasive procedures.

Ormson, M.J.; Stephens, D.H.; Carlson, H.C.



Intestinal Failure – The Clinical Problem  

Microsoft Academic Search

Intestinal failure can be the end result of a wide variety of disease processes that impair the ability of the gut to adequately digest and absorb food. Patients with established intestinal failure may require parenteral nutrition support and\\/or abdominal surgery to reverse the disease process involved. Selected patients with irreversible intestinal failure can be managed in experienced units by home

N. A. Scott; M. H. Irving



Gastrointestinal adaptation to enhanced small intestinal lipid exposure.  

PubMed Central

Studies were performed on 20 male adult rats to investigate the effects of chronic intermittent infusion of lipid and physiological emulsifier into the distal small intestine on stomach to caecum transit time (SCTT) of the head of a test meal. SCTT was measured using environmental hydrogen analysis. Ileal lipid infusion normally delays gastric emptying and small intestinal transit (p < 0.001), but chronic intermittent infusion of lipid, given three times a week gradually reduced the delay in transit time until by four weeks it was no longer than control values. The lipid induced delay did not return during the four weeks after the chronic infusion had finished. Intermittent infusion of physiological emulsifier into the distal small intestine for four weeks did not change the control SCTT or the acute response to an ileal lipid infusion. SCTT of the head of the meal did not change in the four weeks after the physiological emulsifier infusion had stopped. In conclusion these results show that infusing rats intermittently with lipid for four weeks results in desensitisation of the mechanisms by which distal small intestinal lipid regulate SCTT of the head of a meal. This adaptation is not reversed within four weeks of withdrawal of the lipid infusion. These results emphasise the importance of assessing recent dietary history when assessing gastric emptying and small bowel transit times.

Brown, N J; Rumsey, R D; Read, N W



Therapy of intestinal protozoa  

Microsoft Academic Search

Protozoa that parasitize the human intestine and cause disease include Entamoeba histolytica, Giardia lamblia, Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli, and the microsporidia (which are now classified as fungi). The new and broad-spectrum agent nitazoxanide now has an Food and Drug Administration indication for the treatment of cryptosporidiosis and giardiasis in children, making C. parvum for the first time a

William A. Petri Jr



Aging and the intestine.  


Over the lifetime of the animal, there are many changes in the function of the body's organ systems. In the gastrointestinal tract there is a general modest decline in the function of the esophagus, stomach, colon, pancreas and liver. In the small intestine, there may be subtle alterations in the intestinal morphology, as well as a decline in the uptake of fatty acids and sugars. The malabsorption may be partially reversed by aging glucagon-like peptide 2 (GLP2) or dexamethasone. Modifications in the type of lipids in the diet will influence the intestinal absorption of nutrients: for example, in mature rats a diet enriched with saturated as compared with polysaturated fatty acids will enhance lipid and sugar uptake, whereas in older animals the opposite effect is observed. Thus, the results of studies of the intestinal adaptation performed in mature rats does not necessarily apply in older animals. The age-associated malabsorption of nutrients that occurs with aging may be one of the several factors which contribute to the malnutrition that occurs with aging. PMID:17171784

Drozdowski, Laurie; Thomson, Alan B R



Intestinal permeability: An overview  

Microsoft Academic Search

The noninvasive assessment of intestinal permeability in humans has a 20-year history. Because the tests are increasingly used in clinical practice and research and because there is much controversy, we reviewed the literature and outlined the potential and possible shortcomings of these procedures. Data was obtained from personal files and from a systemic search through MEDLINE and EMBASE. The principle

Ingvar Bjarnason; Andrew Macpherson; Daniel Hollander



Experiences with intestinal antisepsis  

Microsoft Academic Search

From 1955 through 1964, the authors were actively engaged in experimental and clinical studies concerned with intestinal antisepsis, a form of antimicrobial prophylaxis used by the surgeon to lower the high rate of infectious complications following colorectal operations. Controversy has existed regarding the protective action of antibacterial agents and whether such a regimen has significant advantage over simple mechanical cleansing.

Isidore Cohn; George H. Bornside



Importance of different CD44v6 expression in human gastric intestinal and diffuse type cancers for metastatic lymphogenic spreading  

Microsoft Academic Search

In 42 human gastric adenocarcinomas of intestinal (n=25) and diffuse types (n=17) the expression of CD44v6 splice variants was investigated immunohistochemically and compared with the pattern of lymphogenic tumor spreading. Distinct differences were observed between the two cancer types: 92% of intestinal-type tumors expressed CD44v6 as in the intestinal metaplasia in chronic atrophic gastritis, while v6 expression occurred in only

J. Dämmrich; H. P. Vollmers; K.-H. Heider; H.-K. Müller-Hermelink



Cellular and molecular mechanisms of intestinal fibrosis.  


Fibrosis is a chronic and progressive process characterized by an excessive accumulation of extracellular matrix (ECM) leading to stiffening and/or scarring of the involved tissue. Intestinal fibrosis may develop in several different enteropathies, including inflammatory bowel disease. It develops through complex cell, extracellular matrix, cytokine and growth factor interactions. Distinct cell types are involved in intestinal fibrosis, such as resident mesenchymal cells (fibroblasts, myofibroblasts and smooth muscle cells) but also ECM-producing cells derived from epithelial and endothelial cells (through a process termed epithelial- and endothelial-mesenchymal transition), stellate cells, pericytes, local or bone marrow-derived stem cells. The most important soluble factors that regulate the activation of these cells include cytokines, chemokines, growth factors, components of the renin-angiotensin system, angiogenic factors, peroxisome proliferator-activated receptors, mammalian target of rapamycin, and products of oxidative stress. It soon becomes clear that although inflammation is responsible for triggering the onset of the fibrotic process, it only plays a minor role in the progression of this condition, as fibrosis may advance in a self-perpetuating fashion. Definition of the cellular and molecular mechanisms involved in intestinal fibrosis may provide the key to developing new therapeutic approaches. PMID:22851857

Speca, Silvia; Giusti, Ilaria; Rieder, Florian; Latella, Giovanni



Intestinal Secretion Induced by Vasoactive Intestinal Polypeptide  

PubMed Central

The effect of vasoactive intestinal polypeptide (VIP) on intestinal water and electrolyte transport and transmucosal potential difference was investigated in the dog jejunum in vivo and compared to secretion induced by cholera toxin. Isolated jejunal loops were perfused with a plasma-like electrolyte solution. VIP (0.08 ?g/kg per min) was administered directly into the superior mesenteric artery by continuous infusion over 1 h. From a dye dilution method, it was estimated that a mean plasma VIP concentration of 12,460 pg/ml reached the loops. VIP caused secretion of water and electrolytes; for example, chloride: control, 8 ?eq/cm per h absorption; VIP, 92 ?eq/cm per h secretion. A marked increase in transmucosal potential difference (control, ?1.0 mV; VIP, ?5.9 mV, lumen negative) occurred within 1 min after starting VIP infusion. Analysis of unidirectional fluxes showed increased plasma-to-lumen flux of sodium and chloride and decreased lumen-to-plasma flux of sodium. Chloride and bicarbonate were actively secreted against an electrochemical gradient. Although sodium secretion occurred down an electrochemical gradient, flux ratio analysis suggested a component of active sodium secretion. VIP caused a slight increase in protein output into the loops; light microscopy revealed capillary dilatation and closed intercellular spaces. The effect of VIP was readily reversible. Except for the delayed onset of secretion, the effect of cholera toxin was qualitatively similar to VIP; however, capillary dilatation and increased protein output were not noted with cholera toxin. Images

Krejs, Guenter J.; Barkley, Ronald M.; Read, Nicholas W.; Fordtran, John S.



Presystemic metabolism and intestinal absorption of antipsoriatic fumaric acid esters.  


Psoriasis is a chronic inflammatory skin disease. Its treatment is based on the inhibition of proliferation of epidermal cells and interference in the inflammatory process. A new systemic antipsoriasis drug, which consists of dimethylfumarate and ethylhydrogenfumarate in the form of their calcium, magnesium and zinc salts has been introduced in Europe with successful results. In the present study, a homologous series of mono- and diesters of fumaric acid has been studied with respect to the sites and kinetics of presystemic ester degradation using pancreas extract, intestinal perfusate, intestinal homogenate and liver S9 fraction. In addition, intestinal permeability has been determined using isolated intestinal mucosa as well as Caco-2 cell monolayers, in order to obtain estimates of the fraction of the dose absorbed for these compounds. Relationships between the physicochemical properties of the fumaric acid esters and their biological responses were investigated. The uncharged diester dimethylfumarate displayed a high presystemic metabolic lability in all metabolism models. It also showed the highest permeability in the Caco-2 cell model. However, in permeation experiments with intestinal mucosa in Ussing-type chambers, no undegraded DMF was found on the receiver side, indicating complete metabolism in the intestinal tissue. The intestinal permeability of the monoesters methyl hydrogen fumarate, ethyl hydrogen fumarate, n-propylhydrogen fumarate and n-pentyl hydrogen fumarate increased with an increase in their lipophilicity, however, their presystemic metabolism rates likewise increased with increasing ester chain length. It is concluded that for fumarates, an increase in intestinal permeability of the more lipophilic derivatives is counterbalanced by an increase in first-pass extraction. PMID:12973823

Werdenberg, D; Joshi, R; Wolffram, S; Merkle, H P; Langguth, P



Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope  

PubMed Central

AIM: To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. METHODS: Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann® Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. RESULTS: A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen between acute large bowel obstruction and large bowel pseudo-obstruction. For patients with small bowel obstruction, the sound-to-sound interval was significantly longer in those who subsequently underwent surgery compared with those treated non-operatively (median 1.29 s vs 0.63 s, P < 0.001). There was no correlation between bowel calibre and bowel sound characteristics in both acute small bowel obstruction and acute large bowel obstruction. CONCLUSION: Auscultation of bowel sounds is non-specific for diagnosing bowel obstruction. Differences in sound characteristics between large bowel and small bowel obstruction may help determine the likely site of obstruction.

Ching, Siok Siong; Tan, Yih Kai



Intestinal Ferroportin Expression in Pediatric Crohn's Disease  

PubMed Central

Background Anemia is a frequent complication of Crohn’s disease (CD). The intestinal iron exporter ferroportin (FPN) is involved in both iron deficiency anemia and the anemia of chronic disease. To examine its role in CD, intestinal FPN expression was studied in subjects with and without CD. Methods Duodenal mucosal biopsies from 29 pediatric subjects with CD (n = 19) and without CD (n = 10) were obtained. FPN protein was measured using Western blot analysis and mRNA was assessed using quantitative real-time polymerase chain reaction (PCR). Results Intestinal FPN protein was higher in anemic CD subjects than in nonanemic CD subjects (P = 0.01), while FPN mRNA levels were not different (P = 0.66). In nonanemic CD subjects, erythrocyte sedimentation rate (ESR) (P = 0.04), C-reactive protein (CRP) (P = 0.03), and interleukin-6 (IL-6) (P = 0.01) levels were elevated compared to controls. Nonanemic CD subjects had a lower median FPN protein than nonanemic controls, although it did not reach statistical significance (P = 0.07). Median FPN mRNA was similar between groups (P = 0.71). Although no correlation between FPN protein and IL-6 was noted, there was a strong negative correlation between serum iron and IL-6, both in subjects with CD (r = ?0.88, P < 0.0001) and those without anemia (r = ?0.58, P = 0.02). Conclusions Intestinal FPN protein is upregulated in anemic CD subjects, suggesting that iron deficiency or anemia is the driving force regulating FPN levels. A transporter distinct from FPN appears to be involved in the hypoferremia associated with the inflammatory process of CD.

Burpee, Tyler; Mitchell, Paul; Fishman, Douglas; Islam, Shabana; Nemeth, Elizabeta; Westerman, Mark; Wessling-Resnick, Marianne; Grand, Richard J.



Intestinal sugar transport.  


Carbohydrates are an important component of the diet. The carbohydrates that we ingest range from simple monosaccharides (glucose, fructose and galactose) to disaccharides (lactose, sucrose) to complex polysaccharides. Most carbohydrates are digested by salivary and pancreatic amylases, and are further broken down into monosaccharides by enzymes in the brush border membrane (BBM) of enterocytes. For example, lactase-phloridzin hydrolase and sucrase-isomaltase are two disaccharidases involved in the hydrolysis of nutritionally important disaccharides. Once monosaccharides are presented to the BBM, mature enterocytes expressing nutrient transporters transport the sugars into the enterocytes. This paper reviews the early studies that contributed to the development of a working model of intestinal sugar transport, and details the recent advances made in understanding the process by which sugars are absorbed in the intestine. PMID:16586532

Drozdowski, Laurie A; Thomson, Alan B R



The small intestine.  


Clinical investigation of the small bowel at The Mount Sinai Hospital began with David Adlersberg's arrival in 1931. His research interests were in bile acids, cholesterol, carotene, and vitamin A. In 1952, he was given a Nutrition Laboratory and later, a Nutrition Clinic. His vitamin A tolerance test and interest in malabsorption led him to a comprehensive study of sprue, the separation of the tropical and non-tropical forms, and their different etiologies and treatments. Adlersberg's work was complemented by (a) Marshak and Wolf's radiologic examination of the small bowel (especially in sprue and other malabsorption disorders); (b) Gerson s perfusion experiments; and (c) Friedman, Waye and Wolf's motility studies. Lieber and his colleagues explored the deleterious effects of alcohol on the function and structure of the small intestine. Gerson explored the nutrition of patients with Crohn's disease of the small intestine, especially after extensive resection or bypass leading to ascorbic and folic acid deficiencies and hypergastrinemia. PMID:10828909

Gerson, C D



On acute intestinal obstruction  

Microsoft Academic Search

Conclusions  Should there be difficulty in finding the site of the obstruction:-\\u000a \\u000a \\u000a (a) \\u000a \\u000a Follow engorged coil of intestines upwards and down wards until point of obstruction is reached or turn out all the intestines.\\u000a \\u000a \\u000a \\u000a \\u000a (b) \\u000a \\u000a Remove all fluid from Douglas’ pouch and loins by irrigation with sterile water.\\u000a \\u000a \\u000a \\u000a \\u000a (c) \\u000a \\u000a Eestore colour of bowel, and establish peristaltic movements by heating with neutral

J. S. M’Ardle



The cystic fibrosis intestine.  


The clinical manifestations of cystic fibrosis (CF) result from dysfunction of the cystic fibrosis transmembrane regulator protein (CFTR). The majority of people with CF have a limited life span as a consequence of CFTR dysfunction in the respiratory tract. However, CFTR dysfunction in the gastrointestinal (GI) tract occurs earlier in ontogeny and is present in all patients, regardless of genotype. The same pathophysiologic triad of obstruction, infection, and inflammation that causes disease in the airways also causes disease in the intestines. This article describes the effects of CFTR dysfunction on the intestinal tissues and the intraluminal environment. Mouse models of CF have greatly advanced our understanding of the GI manifestations of CF, which can be directly applied to understanding CF disease in humans. PMID:23788646

De Lisle, Robert C; Borowitz, Drucy



Fermentations by saccharolytic intestinal  

Microsoft Academic Search

Most nonsporing anaerobes of the intestinal tract use the Embden-Meyerhof- Parnas scheme to ferment carbohydrates. Almost all of them oxidize pyruvate, the key fermentation intermediate, to acetyl coenzyme A and CO2 with reduction of a low-potential electron acceptor. H2 is formed from the low potential acceptor or from NADH. Pyruvate is a precursor of lactate, and phosphoenolpyruvate is a precursor

Terry L. Miller; M. J. Wolin


Stress and intestinal microflora.  


In this overview the actual international knowledge regarding phenomenons and their proven or speculated mechanisms of adaptative microecological, hormonal and immunological responses to neuroemotional stress conditions including space-flights is represented. In most cases a decreased stability of the intestinal microflora provokes further reactions of the body. The necessity to predict the various possible disorders and to find optimal measures for their prophylaxis and elimination is emphasized. PMID:3657919

Lizko, N N



Fetal intestinal graft is the best source for intestinal transplantation  

Microsoft Academic Search

Adult intestinal allografts have demonstrated high immunogenicity in human transplantation, making the search for new and\\u000a more favorable grafts an actual problem. Accepting that fetal and newborn immune systems are relatively immature, their intestines\\u000a could be ideal sources for organ donation. The purpose of this study was to compare the immunogenicity of fetal, newborn,\\u000a and adult intestine for selection of

M. F. Lopes; A. M. S. Cabrita; J. A. B. Patrício



Plasma Cytokine Profiles in Females With Irritable Bowel Syndrome and Extra-Intestinal CoMorbidity  

Microsoft Academic Search

OBJECTIVES:Irritable bowel syndrome (IBS) is a functional disorder that is associated with a number of extra-intestinal co-morbidities and a pro-inflammatory profile. This study was designed to examine the cytokine profile among a group of IBS patients with the extra-intestinal co-morbidities fibromyalgia, premenstrual dysmorphic disorder, and chronic fatigue syndrome.METHODS:In all, 100 female IBS patients with these co-morbidities, 21 IBS subjects without

Paul Scully; Declan P McKernan; John Keohane; David Groeger; Fergus Shanahan; Timothy G Dinan; Eamonn MM Quigley; Eamonn M. M. Quigley



Small intestinal bacterial overgrowth in human cirrhosis is associated with systemic endotoxemia  

Microsoft Academic Search

OBJECTIVES:Systemic endotoxemia has been implicated in various pathophysiological sequelae of chronic liver disease. One of its potential causes is increased intestinal absorption of endotoxin. We therefore examined the association of small intestinal bacterial overgrowth with systemic endotoxemia in patients with cirrhosis.METHODS:Fifty-three consecutive patients with cirrhosis (Child-Pugh group A, 23; group B, 18; group C, 12) were included. Jejunal secretions were

Tilman M. Bauer; Henning Schwacha; Bernhard Steinbrückner; Folke E. Brinkmann; Anette K. Ditzen; John J. Aponte; Klaus Pelz; Dieter Berger; Manfred Kist; Hubert E. Blum



Usefulness and Limitation of Ultrasonography in the Diagnosis of Intestinal Intussusception in Cows  

PubMed Central

The present study was conducted on 6 chronically ill Jersey/Red Sindhi cross-bred cows, which were suspected for intestinal obstruction on the basis of history and clinical signs. These cows were ultimately diagnosed with intestinal intussusception based on a combination of clinical, ultrasonographic and surgical examinations. “Bull's eye lesion” was the most prominent ultrasonographic finding, diagnostic for intussusception either trans-abdominally or transrectally. Dilated intestinal loops greater than 3.1?cm (mean ± SE, 4.41 ± 0.25) were imaged in the lower flank and the 12th intercostal space on the right side. Ultrasonography proved to be a useful tool in supplementing and substantiating the transrectal findings in cases of the bovine intestinal intussusception. However, ultrasonography was not significantly helpful where transrectal examination of the cows did not reveal any suspected intestinal mass.

Imran, Sheikh; Tyagi, S. P.; Kumar, Adarsh; Kumar, Amit; Sharma, Arvind; Sharma, Shivali



Usefulness and limitation of ultrasonography in the diagnosis of intestinal intussusception in cows.  


The present study was conducted on 6 chronically ill Jersey/Red Sindhi cross-bred cows, which were suspected for intestinal obstruction on the basis of history and clinical signs. These cows were ultimately diagnosed with intestinal intussusception based on a combination of clinical, ultrasonographic and surgical examinations. "Bull's eye lesion" was the most prominent ultrasonographic finding, diagnostic for intussusception either trans-abdominally or transrectally. Dilated intestinal loops greater than 3.1?cm (mean ± SE, 4.41 ± 0.25) were imaged in the lower flank and the 12th intercostal space on the right side. Ultrasonography proved to be a useful tool in supplementing and substantiating the transrectal findings in cases of the bovine intestinal intussusception. However, ultrasonography was not significantly helpful where transrectal examination of the cows did not reveal any suspected intestinal mass. PMID:21547218

Imran, Sheikh; Tyagi, S P; Kumar, Adarsh; Kumar, Amit; Sharma, Arvind; Sharma, Shivali



The gut microbiome in intestinal fibrosis: environmental protector or provocateur?  


In individuals with inflammatory bowel diseases, intestinal fibrosis is a serious clinical complication with no specific therapies. Patients develop bowel fistulae and strictures that usually require surgery and often reoccur. The main driver of gut fibrogenesis is believed to be chronic inflammation, which leads to mesenchymal cell recruitment and activation. Recent findings suggest that the environment--in particular, the microbiome--plays a critical role in this process. PMID:23785034

Rieder, Florian



Diagnosis of small intestinal disorders in dogs and cats.  


Laboratory tests are an important part of the workup of small intestinal diseases in dogs and cats. Especially in chronic cases, when extragastrointestinal causes need to be ruled out, it is important to adhere to a systematic workup. This article details the newest available data on tests to aid this diagnostic process. Once the diagnosis of a chronic enteropathy is made, there are many laboratory tests that can help in monitoring the disease and providing prognostic information. Several new tests being evaluated for clinical usefulness are discussed. PMID:24144087

Allenspach, Karin



Intestinal mucosal injury in critically ill surgical patients: preliminary observations.  


This was a prospective study designed to evaluate the extent to which intestinal mucosal compromise occurs in adult critical care patients with and without systemic inflammatory response syndrome (SIRS) and to correlate the degree of intestinal injury with outcome. Ten patients from a university hospital surgical intensive care unit were identified who manifested SIRS at the time of admission to the intensive care unit. Five other critical care patients without SIRS were also evaluated. The Acute Physiology and Chronic Health Evaluation II score was determined. Intestinal mucosal viability was assessed by serial measurement of serum and urine iFABP intestinal fatty acid binding protein (iFABP), a sensitive and specific marker for mucosal injury. Outcome in terms of the development of multiorgan dysfunction syndrome, adult respiratory distress syndrome, and survival was determined. iFABP was detectable in the serum or urine in 8 out of 10 patients with SIRS. Among the 4 patients with detectable serum iFABP, 2 died and 1 developed severe adult respiratory distress syndrome. Nine of 11 patients without detectable serum iFABP recovered without major morbidity. iFABP was detectable in most patients with SIRS, suggesting that subclinical intestinal mucosal compromise is a frequent component of this syndrome. When iFABP was detectable, particularly in the serum, the prognosis was poor, even in the absence of SIRS, indicating that iFABP may be a relevant and independent predictor of outcome in critical care patients. PMID:9915525

Gollin, G; Zieg, P M; Cohn, S M; Lieberman, J M; Marks, W H



T regulatory cells maintain intestinal homeostasis by suppressing ?? T cells  

PubMed Central

Immune tolerance against enteric commensal bacteria is important for preventing intestinal inflammation. Deletion of phosphoinositide dependent protein kinase 1 (Pdk1) in T cells using Cd4-Cre induced chronic inflammation of the intestine despite the importance of PDK1 in T cell activation. Analysis of colonic intraepithelial lymphocytes of PDK1-deficient mice revealed markedly increased CD8?+ T cell receptor (TCR)??+ T cells, including an interleukin-17 (IL-17)-expressing population. TCR??+ T cells were responsible for the inflammatory colitis as deletion of Tcrd abolished spontaneous colitis in the PDK1 deficient mice. This dysregulation of intestinal TCR??+ T cells was attributable to a reduction in the number and functional capacity of PDK1-deficient T-regulatory (Treg) cells. Adoptive transfer of wild-type Treg cells abrogated the spontaneous activation and proliferation of intestinal TCR??+ T cells observed in PDK1-deficient mice and prevented the development of colitis. Therefore suppression of intestinal TCR??+ T cells by Treg cells maintains enteric immune tolerance.

Park, Sung-Gyoo; Mathur, Ramkumar; Long, Meixiao; Hosh, Namiko; Hao, Liming; Hayden, Matthew S.; Ghosh, Sankar



Toxicity evaluation in nematode Caenorhabditis elegans after chronic metal exposure  

Microsoft Academic Search

In this study, specific developmental stage for adults from day 1 to day 10 was selected to evaluate the chronic metal toxicity, because the population of dead nematodes and the accumulation of intestinal autofluorescence increased sharply after day 10. Chronic exposure to Cr, Pb, Cu, and Hg caused a significant elevation in fractions of dead animals after day 4, and

Lulu Shen; Jing Xiao; Huayue Ye; Dayong Wang



Intestinal pathology from NSAIDs  

Microsoft Academic Search

We describe the pathology of 17 patients with NSAID-associated stricturing and non-stricturing, erosive-ulcerative intestinal\\u000a pathology. Eight patients had stricturing lesions mainly localized in the caecal region and right-sided colon. All except\\u000a one patient who suffered exclusively from jejuno-ileal pathology had been treated with the slow-release form of diclofenac.\\u000a The lesions observed satisfied the macroscopic and microscopic criteria of diaphragm disease

F. Halter; A. Gut; C. Ruchti



[Primary intestinal T lymphoma].  


Primary gastrointestinal lymphoma comprises a group of distinctive clinicopathological entities. They may be of B or T-cell type. Intestinal T-cell lymphomas are much less common and include the entity: lymphomas T enteropathy-associated T-cell lymphoma, the most common, and T-cell lymphoma without features of enteropathy. The morphologic and immunologic findings suggest that derived from mucosal T lymphocytes population. Clinically, the patients were usually males with constitutional symptoms and acute perforation and/or obstruction of the small bowel. Their prognosis are very poor and tumor are very aggressive. PMID:9595939

Remacha, B; Palau, A; Velicia, R; Caro-Patón, A; Ripollés, V



Small Intestinal Glucose Transport  

PubMed Central

Proximal and distal small intestinal segments of the rat were perfused in situ at two different rates with isotonic solutions containing glucose in concentrations ranging from 25 to 600 mg/100 ml. Absorption was measured as glucose disappearance rate from the lumen. Glucose absorption had not previously been studied at intraluminal concentrations above and below blood glucose. Absorption was more rapid from the proximal segment. In both segments absorption was independent of perfusion rate and of whether glucose was analyzed by counting 14C or by the Somogyi method. The latter finding suggests that of the unidirectional fluxes, flux out of the bowel is much greater than flux into the bowel. In contrast to the findings in previous studies neither segment showed rate-limiting kinetics, and the Michaelis-Menten analysis was not applicable. The form of the curve depicting absorption rate in relation to concentration differed between the two segments. At the higher concentrations absorption rate continued to increase much more rapidly in the proximal than in the distal segment. The observations could not be explained by known mechanisms of glucose transport and illustrate the difficulties of achieving biochemically and physiologically meaningful in vivo studies of intestinal absorption.

Rider, Alan K.; Schedl, Harold P.; Nokes, George; Shining, Streeter



Endocervicosis of the Small Intestine  

Microsoft Academic Search

A case of endocervicosis of the small intestine incidentally found as a mass lesion dur ing a gastric bypass surgery is reported. No previous cases of intestinal endocervico sis have been reported in the literature. Int J Surg Pathol 10(1):65-67, 2002

Karl T. K. Chen



Primary intestinal lymphangiectasia (Waldmann's disease)  

Microsoft Academic Search

Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. PIL is generally diagnosed before 3 years of age but may be diagnosed in older patients. Prevalence is unknown. The main symptom is predominantly bilateral lower limb

Stéphane Vignes; Jérôme Bellanger



Clinical approach and management of chronic diarrhea.  


Chronic diarrhea is defined as the passage of loose stools that last for more than 4 weeks. Although generally it is estimated that the prevalence of chronic diarrhea only ranges 3-5% of population, but it poses some specific equally essential challenges compared to acute diarrhea because there are many differential diagnosis that should be considered as the cause of chronic diarrhea. One of them includes colorectal cancer and the small intestinal bacterial overgrowth, known as SIBO. In general, chronic diarrhea can be categorized into watery, malabsorption, and inflammatory diarrhea. A proper history taking, physical examination and laboratory investigation is therefore necessary for clinician in managing chronic diarrhea. Overall, the management of chronic diarrhea includes two types, i.e. supportive and pharmacological management both for infectious and non-infectious etiologies. Pharmacological treatment can also be classified into two kinds of treatment including symptomatic and causal treatment, which can be achieved through empirical therapy. PMID:23770798

Abdullah, Murdani; Firmansyah, M Adi



HDAC1 and HDAC2 Restrain the Intestinal Inflammatory Response by Regulating Intestinal Epithelial Cell Differentiation.  


Acetylation and deacetylation of histones and other proteins depends on histone acetyltransferases and histone deacetylases (HDACs) activities, leading to either positive or negative gene expression. HDAC inhibitors have uncovered a role for HDACs in proliferation, apoptosis and inflammation. However, little is known of the roles of specific HDACs in intestinal epithelial cells (IEC). We investigated the consequences of ablating both HDAC1 and HDAC2 in murine IECs. Floxed Hdac1 and Hdac2 homozygous mice were crossed with villin-Cre mice. Mice deficient in both IEC HDAC1 and HDAC2 weighed less and survived more than a year. Colon and small intestinal sections were stained with hematoxylin and eosin, or with Alcian blue and Periodic Acid Schiff for goblet cell identification. Tissue sections from mice injected with BrdU for 2 h, 14 h and 48 h were stained with anti-BrdU. To determine intestinal permeability, 4-kDa FITC-labeled dextran was given by gavage for 3 h. Microarray analysis was performed on total colon RNAs. Inflammatory and IEC-specific gene expression was assessed by Western blot or semi-quantitative RT-PCR and qPCR with respectively total colon protein and total colon RNAs. HDAC1 and HDAC2-deficient mice displayed: 1) increased migration and proliferation, with elevated cyclin D1 expression and phosphorylated S6 ribosomal protein, a downstream mTOR target; 2) tissue architecture defects with cell differentiation alterations, correlating with reduction of secretory Paneth and goblet cells in jejunum and goblet cells in colon, increased expression of enterocytic markers such as sucrase-isomaltase in the colon, increased expression of cleaved Notch1 and augmented intestinal permeability; 3) loss of tissue homeostasis, as evidenced by modifications of claudin 3 expression, caspase-3 cleavage and Stat3 phosphorylation; 4) chronic inflammation, as determined by inflammatory molecular expression signatures and altered inflammatory gene expression. Thus, epithelial HDAC1 and HDAC2 restrain the intestinal inflammatory response, by regulating intestinal epithelial cell proliferation and differentiation. PMID:24040068

Turgeon, Naomie; Blais, Mylène; Gagné, Julie-Moore; Tardif, Véronique; Boudreau, François; Perreault, Nathalie; Asselin, Claude



HDAC1 and HDAC2 Restrain the Intestinal Inflammatory Response by Regulating Intestinal Epithelial Cell Differentiation  

PubMed Central

Acetylation and deacetylation of histones and other proteins depends on histone acetyltransferases and histone deacetylases (HDACs) activities, leading to either positive or negative gene expression. HDAC inhibitors have uncovered a role for HDACs in proliferation, apoptosis and inflammation. However, little is known of the roles of specific HDACs in intestinal epithelial cells (IEC). We investigated the consequences of ablating both HDAC1 and HDAC2 in murine IECs. Floxed Hdac1 and Hdac2 homozygous mice were crossed with villin-Cre mice. Mice deficient in both IEC HDAC1 and HDAC2 weighed less and survived more than a year. Colon and small intestinal sections were stained with hematoxylin and eosin, or with Alcian blue and Periodic Acid Schiff for goblet cell identification. Tissue sections from mice injected with BrdU for 2 h, 14 h and 48 h were stained with anti-BrdU. To determine intestinal permeability, 4-kDa FITC-labeled dextran was given by gavage for 3 h. Microarray analysis was performed on total colon RNAs. Inflammatory and IEC-specific gene expression was assessed by Western blot or semi-quantitative RT-PCR and qPCR with respectively total colon protein and total colon RNAs. HDAC1 and HDAC2-deficient mice displayed: 1) increased migration and proliferation, with elevated cyclin D1 expression and phosphorylated S6 ribosomal protein, a downstream mTOR target; 2) tissue architecture defects with cell differentiation alterations, correlating with reduction of secretory Paneth and goblet cells in jejunum and goblet cells in colon, increased expression of enterocytic markers such as sucrase-isomaltase in the colon, increased expression of cleaved Notch1 and augmented intestinal permeability; 3) loss of tissue homeostasis, as evidenced by modifications of claudin 3 expression, caspase-3 cleavage and Stat3 phosphorylation; 4) chronic inflammation, as determined by inflammatory molecular expression signatures and altered inflammatory gene expression. Thus, epithelial HDAC1 and HDAC2 restrain the intestinal inflammatory response, by regulating intestinal epithelial cell proliferation and differentiation.

Turgeon, Naomie; Blais, Mylene; Gagne, Julie-Moore; Tardif, Veronique; Boudreau, Francois; Perreault, Nathalie; Asselin, Claude



Strongyloidiasis and other intestinal nematode infections.  


In contrast to other helminthic parasites, Strongyloides stercoralis can replicate within humans, causing a chronic persistent infection that can be severe and fatal in compromised hosts. This article reviews new developments to help meet the clinical challenges of this infection, including clinical clues to the diagnosis, new diagnostic methods, including stool culture and serological assays, new drugs such as albendazole and ivermectin, and difficult treatment issues. The other major intestinal nematode parasites, including Ascaris, hookworm, and Trichuris, are extremely common worldwide, but in North America their clinical presentation is often more subtly related to low-grade worm burdens or allergic manifestations. Special consideration is given to difficult management issues, including the patient with unexplained eosinophilia, the pregnant patient, and the patient who passes a worm. PMID:8254165

Liu, L X; Weller, P F



[Transplantation of the intestines and bacterial translocation].  


Infections, sepsis and multiple organ failure syndrome are associated with high morbidity and mortality in human and experimental small bowel transplantation (SBTx). These complications are attributed to bacterial translocation demonstrated in animal and human studies. Bacterial translocation (BT) is defined as the passage of viable bacteria from the intestinal lumen to other tissues or organs. BT has been associated with different clinical and experimental situations, hemorrhagic shock, trauma, bowel obstruction, immunodepression, total parenteral nutrition, antibiotics. Although BT has been investigated in several small and large animal models of SBTx, precise information on the mechanisms involved are not available. It is possible that the operative procedure by itself may promote BT for the interaction of a number of factors such as preservation, ischemia/reperfusion, abnormal motility, lymphatic disruption and aberrant systemic venous drainage, acute or chronic rejection and antibiotic therapy. Furthermore, the potent immunosuppressive therapy used in these patients may augment the deleterious effects caused by BT. In this review we examined the existing literature concerning BT with particular regard to intestinal transplantation, to better understand the alterations in the symbiotic relationship between immunocompromised host and his gut microflora after SBTx. PMID:10812777

Sileri, P; Rastellini, C; Dicuonzo, G; Gaspari, A; Benedetti, E; Cicalese, L



Oral Crohn's disease without intestinal manifestations  

PubMed Central

Crohn?s disease is a granulomatous inflammatory bowel disease and was described in 1932 as a chronic granulomatous disorder of the terminal ileum and is now considered a distinct member of the inflammatory bowel disease family. It may affect any part of the gastrointestinal tract. Oral Crohn?s disease has been reported frequently in the last three decades with or without intestinal manifestations. In the latter case, it is considered as one of the orofacial granulomatosis. There has been much doubt whether intestinal manifestations of Crohn?s disease will eventually develop in the orofacial granulomatosis. We present a female patient aged 22 years with prominent clinical findings such as persistent swelling of lower and upper lip with fissuring and angular cheilitis, granulomatous gingival enlargement, and cobblestone or corrugated appearance of labial mucosa, which are suggestive of Crohn?s disease, but with no evidence of other gastrointestinal involvement. The patient underwent surgical treatment with external gingivectomy procedure. A 6-month follow-up showed minimal recurrence.

Harikishan, Gingisetty; Reddy, Nagate Raghavendra; Prasad, Harikrishnan; Anitha, Subappa



Gastric intestinal metaplasia with basal gland atypia: a morphological and biologic evaluation in a large Chinese cohort.  


Gastric intestinal metaplasia can display cytoarchitectural atypia that falls short of qualifying for dysplasia but can be classified as indefinite for dysplasia. Yet few studies have evaluated the prevalence, the morphologic, and biologic characteristics of this variant. Out of a cohort of 554 biopsies with chronic atrophic gastritis and/or dysplasia, we categorized the cases as either (1) simple intestinal metaplasia; (2) intestinal metaplasia with hyperplasia; (3) intestinal metaplasia with basal gland atypia; and (4) gastric dysplasia. The relationship between the subtypes and various clinicopathologic features, mucin immunophenotypes, and biologic characteristics was evaluated. The final cohort consisted of 424 cases of simple intestinal metaplasia, 93 intestinal metaplasia with hyperplasia, 16 intestinal metaplasia with basal gland atypia, and 21 gastric dysplasia. Intestinal metaplasia with basal gland atypia had a prevalence of 2.8% and similar to gastric dysplasia, 3.7%. Both of these lesions were similar in body/fundus distribution (12.5%) and paucity of goblet cells (68.8%). Intestinal metaplasia with basal gland atypia and gastric dysplasia seem to share some biologic similarities but with a lower frequency of alpha-methylacyl-CoA racemase expression (25% versus 62%), p53 expression (6.3% versus 47.6%), and increased Ki-67 index on surface/pit and isthmus in intestinal metaplasia with basal gland atypia. Alternatively, simple intestinal metaplasia and intestinal metaplasia with hyperplasia did not differ statistically with regard to the various characteristics evaluated. We concluded that gastric intestinal metaplasia can be divided into 2 broad categories that are readily defined by cytoarchitectural and biologic characteristics. Based on the characteristics of intestinal metaplasia with basal gland atypia and in keeping with others, we confirm that this subtype could represent a preneoplastic lesion that needs further evaluation. PMID:23079203

Li, Yuan; Chang, Xiaoyan; Zhou, Weixun; Xiao, Yu; Nakatsuka, Laura N; Chen, Jie; Lauwers, Gregory Y



Chronic Pain  


... cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain from nerve damage Chronic pain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, ...


Clinical Intestinal Transplantation: A Decade of Experience at a Single Center  

PubMed Central

Objective To assess the long-term efficacy of intestinal transplantation under tacrolimus-based immunosuppression and the therapeutic benefit of newly developed adjunct immunosuppressants and management strategies. Summary Background Data With the advent of tacrolimus in 1990, transplantation of the intestine began to emerge as therapy for intestinal failure. However, a high risk of rejection, with the consequent need for acute and chronic high-dose immunosuppression, has inhibited its widespread application. Methods During an 11-year period, divided into two segments by a 1-year moratorium in 1994, 155 patients received 165 intestinal allografts under immunosuppression based on tacrolimus and prednisone: 65 intestine alone, 75 liver and intestine, and 25 multivisceral. For the transplantations since the moratorium (n = 99), an adjunct immunosuppressant (cyclophos-phamide or daclizumab) was used for 74 transplantations, adjunct donor bone marrow was given in 39, and the intestine of 11 allografts was irradiated with a single dose of 750 cGy. Results The actuarial survival rate for the total population was 75% at 1 year, 54% at 5 years, and 42% at 10 years. Recipients of liver plus intestine had the best long-term prognosis and the lowest risk of graft loss from rejection (P = .001). Since 1994, survival rates have improved. Techniques for early detection of Epstein-Barr and cytomegaloviral infections, bone marrow augmentation, the adjunct use of the interleukin-2 antagonist daclizumab, and most recently allograft irradiation may have contributed to the better results. Conclusion The survival rates after intestinal transplantation have cumulatively improved during the past decade. With the management strategies currently under evaluation, intestinal transplant procedures have the potential to become the standard of care for patients with end-stage intestinal failure.

Abu-Elmagd, Kareem; Reyes, Jorge; Bond, Geoffrey; Mazariegos, George; Wu, Tong; Murase, Noriko; Sindhi, Rakesh; Martin, Dolly; Colangelo, Joanne; Zak, Marsha; Janson, Douglas; Ezzelarab, Mohamed; Dvorchik, Igor; Parizhskaya, Maria; Deutsch, Melvin; Demetris, Anthony; Fung, John; Starzl, Thomas E.




PubMed Central

Background The passenger leukocytes in the intestine have a lineage profile that predisposes to graft-versus-host disease (GVHD) in some animal models and have inferior tolerogenic qualities compared with the leukocytes in the liver, other solid organs, and bone marrow. Elimination by ex vivo irradiation of mature lymphoid elements from the bowel allografts is known to eliminate the GVHD risk. We hypothesized that infusion of donor bone marrow cells (BMC) in recipients of irradiated intestine would improve tolerogenesis without increasing the risk of GVHD. Methods Orthotopic small intestine transplantation was performed with the GVHD-prone Lewis (LEW)-to-Brown Norway (BN) combination and the reverse GVHD-resistant BN-to-LEW model under a short course of tacrolimus treatment (1 mg/kg/day, days 0–13, 20, 27). Grafts were irradiated ex vivo, using a 137Cs source. In selected experimental groups, donor BMC (2.5×l08) were infused on the day of small intestine transplantation. Results The unmodified LEW intestine remained intact, whether transplanted alone or with adjunct donor BMC infusion, but all of the BN recipients died of GVHD after approximately 2 months. Intestinal graft irradiation (10 Gy) effectively prevented the GVHD and prolonged survival to 92.5 days, but all of the BN recipients died with chronic rejection of the LEW grafts, which was prevented by infusion of adjunct donor BMC without causing GVHD. In the GVHD-resistant reverse strain direction (BN ? LEW), all intestinal recipients treated for 27 days with tacrolimus survived ?150 days without regard for graft irradiation or adjunct BMC, but chronic rejection was severe in the irradiated intestine, moderate in the unaltered graft, and least in the irradiated intestine transplanted with adjunct BMC. Mild arteritis in the 150 day allografts of both strain combinations (i.e., LEW ? BN and BN ? LEW) may have been irradiation associated, but this was prevented when weekly doses of tacrolimus were continued for the duration of the experiment rather than being stopped at 27 days. Conclusions Recipients are protected from GVHD by irradiating intestinal allografts, but the resulting leukocyte depletion leads to chronic rejection of the transplanted bowel. The chronic rejection is prevented with adjunct donor BMC without causing GVHD. Although application of the strategy may be limited by the possibility of radiation injury, the results are consistent with the paradigm that we have proposed to explain organ-induced graft acceptance, tolerance, and chronic rejection.

Murase, Noriko; Ye, Qing; Nalesnik, Michael A.; Demetris, Anthony J.; Abu-Elmagd, Kareem; Reyes, Jorge; Ichikawa, Naoya; Okuda, Toyokazu; Fung, John J.; Starzl, Thomas E.



Intestinal inflammation induces genotoxicity to extraintestinal tissues and cell types in mice  

PubMed Central

Chronic intestinal inflammation leads to increased risk of colorectal and small intestinal cancers, and is also associated with extraintestinal manifestations such as lymphomas, other solid cancers, and autoimmune disorders. We have previously found that acute and chronic intestinal inflammation causes DNA damage to circulating peripheral leukocytes, manifesting a systemic effect in genetic and chemically-induced models of intestinal inflammation. This study addresses the scope of tissue targets and genotoxic damage induced by inflammation-associated genotoxicity. Using several experimental models of intestinal inflammation, we analyzed various types of DNA damage in leukocyte subpopulations of the blood, spleen, mesenteric and peripheral lymph nodes; and, in intestinal epithelial cells, hepatocytes, and the brain. Genotoxicity in the form of DNA single and double stranded breaks accompanied by oxidative base damage was found in leukocyte subpopulations of the blood, diverse lymphoid organs, intestinal epithelial cells, and hepatocytes. The brain did not demonstrate significant levels of DNA double strand breaks as measured by ?-H2AX immunostaining. CD4+ and CD8+ T-cells were most sensitive to DNA damage versus other cell types in the peripheral blood. In vivo measurements and in vitro modeling suggested that genotoxicity was induced by increased levels of systemically circulating proinflammatory cytokines. Moreover, genotoxicity involved increased damage rather than reduced repair, since it not associated with decreased expression of the DNA double-strand break recognition and repair protein, ataxia telangiectasia mutated (ATM). These findings suggest that levels of intestinal inflammation contribute to the remote tissue burden of genotoxicity, with potential effects on non-intestinal diseases and cancer.

Westbrook, Aya M.; Wei, Bo; Braun, Jonathan; Schiestl, Robert H.



Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study  

Microsoft Academic Search

BACKGROUND: Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we

Andreas Michalsen; Markus Riegert; Rainer Lüdtke; Marcus Bäcker; Jost Langhorst; Myriam Schwickert; Gustav J Dobos



Campylobacter concisus - A New Player in Intestinal Disease  

PubMed Central

Over the last decade Campylobacter concisus, a highly fastidious member of the Campylobacter genus has been described as an emergent pathogen of the human intestinal tract. Historically, C. concisus was associated with the human oral cavity and has been linked with periodontal lesions, including gingivitis and periodontitis, although currently its role as an oral pathogen remains contentious. Evidence to support the role of C. concisus in acute intestinal disease has come from studies that have detected or isolated C. concisus as sole pathogen in fecal samples from diarrheic patients. C. concisus has also been associated with chronic intestinal disease, its prevalence being significantly higher in children with newly diagnosed Crohn’s disease (CD) and adults with ulcerative colitis than in controls. Further C. concisus has been isolated from biopsy specimens of patients with CD. While such studies support the role of C. concisus as an intestinal pathogen, its isolation from healthy individuals, and failure of some studies to show a significant difference in C. concisus prevalence in subjects with diarrhea and healthy controls has raised contention as to its role in intestinal disease. Such findings could argue against the role of C. concisus in intestinal disease, however, the fact that C. concisus strains are genetically diverse raises the possibility that differences exist in their pathogenic potential. Evidence to support this view comes from studies showing strain specific differences in the ability of C. concisus to attach to and invade cells and produce virulence factors, including toxins and hemolytic phospholipase A. Further, sequencing of the genome of a C. concisus strain isolated from a child with CD (UNSWCD) and comparison of this with the only other fully sequenced strain (BAA-1457) would suggest that major differences exist in the genetic make-up of this species which could explain different outcomes of C. concisus infection.

Kaakoush, Nadeem Omar; Mitchell, Hazel Marjory



Heterotrophic nitrification by intestinal microorganisms.  


From studies of nitrate balance in man and analyses of fecal and ileostomy samples, the possibility that nitrite and nitrate are formed de novo in the intestine, possibly by heterotrophic nitrification has emerged. This proposition significantly alters our previous conceptions of man's exposure to nitrite and suggests that nitrite may play a role in the cause of intestinal cancer. Heterotrophic nitrification has been demonstrated in various microorganisms. Our work has shown that intestinal heterotrophic microbial isolates from man are able to oxidize nitrogenous compounds to nitrite. These isolates include both procaryotes and eucaryotes. PMID:7357502

Gomez, R F; Tannenbaum, S R; Savoca, J; Ralt, D; Rockowitz, N



Recent advances in intestinal imaging  

PubMed Central

In recent years, advances in scanner technology and competition from other specialties have produced rapid changes in the way the intestines are imaged. MRI and CT scan along with the traditional enteroclysis examination have emerged at the forefront of intestinal imaging. Functional modalities such as diffusion and perfusion imaging are also changing the way tumors and inflammatory bowel diseases are evaluated. CT colonography is now a valid alterative to optical colonoscopy. Contrast-enhanced USG is being used for the assessment of inflammation and post-treatment changes. In this review, recent advances in intestinal imaging are described.

Sinha, Rakesh



The effect of gastric inhibitory polypeptide on intestinal glucose absorption and intestinal motility in mice  

Microsoft Academic Search

Gastric inhibitory polypeptide (GIP) is released from the small intestine upon meal ingestion and increases insulin secretion from pancreatic ? cells. Although the GIP receptor is known to be expressed in small intestine, the effects of GIP in small intestine are not fully understood. This study was designed to clarify the effect of GIP on intestinal glucose absorption and intestinal

Eiichi Ogawa; Masaya Hosokawa; Norio Harada; Shunsuke Yamane; Akihiro Hamasaki; Kentaro Toyoda; Shimpei Fujimoto; Yoshihito Fujita; Kazuhito Fukuda; Katsushi Tsukiyama; Yuichiro Yamada; Yutaka Seino; Nobuya Inagaki



Assessment of the mode of action underlying development of rodent small intestinal tumors following oral exposure to hexavalent chromium and relevance to humans.  


Abstract Chronic exposure to high concentrations of hexavalent chromium (Cr(VI)) in drinking water causes intestinal adenomas and carcinomas in mice, but not in rats. Cr(VI) causes damage to intestinal villi and crypt hyperplasia in mice after only one week of exposure. After two years of exposure, intestinal damage and crypt hyperplasia are evident in mice (but not rats), as are intestinal tumors. Although Cr(VI) has genotoxic properties, these findings suggest that intestinal tumors in mice arise as a result of chronic mucosal injury. To better understand the mode of action (MOA) of Cr(VI) in the intestine, a 90-day drinking water study was conducted to collect histological, biochemical, toxicogenomic and pharmacokinetic data in intestinal tissues. Using MOA analyses and human relevance frameworks proposed by national and international regulatory agencies, the weight of evidence supports a cytotoxic MOA with the following key events: (a) absorption of Cr(VI) from the intestinal lumen, (b) toxicity to intestinal villi, (c) crypt regenerative hyperplasia and (d) clonal expansion of mutations within the crypt stem cells, resulting in late onset tumorigenesis. This article summarizes the data supporting each key event in the MOA, as well as data that argue against a mutagenic MOA for Cr(VI)-induced intestinal tumors. PMID:23445218

Thompson, Chad M; Proctor, Deborah M; Suh, Mina; Haws, Laurie C; Kirman, Christopher R; Harris, Mark A



Assessment of the mode of action underlying development of rodent small intestinal tumors following oral exposure to hexavalent chromium and relevance to humans  

PubMed Central

Chronic exposure to high concentrations of hexavalent chromium (Cr(VI)) in drinking water causes intestinal adenomas and carcinomas in mice, but not in rats. Cr(VI) causes damage to intestinal villi and crypt hyperplasia in mice after only one week of exposure. After two years of exposure, intestinal damage and crypt hyperplasia are evident in mice (but not rats), as are intestinal tumors. Although Cr(VI) has genotoxic properties, these findings suggest that intestinal tumors in mice arise as a result of chronic mucosal injury. To better understand the mode of action (MOA) of Cr(VI) in the intestine, a 90-day drinking water study was conducted to collect histological, biochemical, toxicogenomic and pharmacokinetic data in intestinal tissues. Using MOA analyses and human relevance frameworks proposed by national and international regulatory agencies, the weight of evidence supports a cytotoxic MOA with the following key events: (a) absorption of Cr(VI) from the intestinal lumen, (b) toxicity to intestinal villi, (c) crypt regenerative hyperplasia and (d) clonal expansion of mutations within the crypt stem cells, resulting in late onset tumorigenesis. This article summarizes the data supporting each key event in the MOA, as well as data that argue against a mutagenic MOA for Cr(VI)-induced intestinal tumors.

Proctor, Deborah M.; Suh, Mina; Haws, Laurie C.; Kirman, Christopher R.; Harris, Mark A.



Intestinal ischaemia associated with phaeochromocytoma.  

PubMed Central

The present case report describes a patient with an adrenal phaeochromocytoma who presented with infarction of the small intestine. The clinical features, diagnosis and treatment of this case are described. Despite excision of the tumour and necrotic intestine, this patient died in the postoperative period from overwhelming sepsis and multi-organ failure. Special reference is made to the delayed effects of established intestinal ischaemia on immune function and it is suggested that this was major contributory factor to the fatal outcome in the present case. The onset of gastro-intestinal symptoms in patients with phaeochromocytoma should suggest the possibility of imminent gut ischaemia and indicate the necessity for prompt excision of the tumour. Images Figure 1

Carr, N. D.; Hulme, A.; Sheron, N.; Lees, W. R.; Russell, R. C.



Calcium Transport in the Intestine.  

National Technical Information Service (NTIS)

The effects of colchicine and cytochalasin B (CB) on the ultrastructure, calcium distribution and transport characteristics of the intestine were investigated. Colchicine at low doses inhibited both cellular uptake and transepithelial transport of calcium...

B. P. Halloran



Audiofrequency Electrotheraphy in Intestinal Adhesions.  

National Technical Information Service (NTIS)

Audiofrequency electrotherapy (AFET) is used in 140 intestinal adhesion (IA) cases regardless of patient's age, duration of illness, severity of symptoms, number of operations and recurrences and failure of other methods of treatment with 72.8% cures, 18....



Nutritional Support of Irradiated Intestine.  

National Technical Information Service (NTIS)

Eating, digestion, and the presence of food within the intestinal lumen produce a series of complex physiological responses that result in the growth of gastrointestinal (31) mucosa and the maintenance of gut mass. Pancreaticobiliary secretion and hormone...

V. Srinivasan A. Dubois



Establishment of intestinal homeostasis during the neonatal period.  


The intestinal mucosa faces the challenge of regulating the balance between immune tolerance towards commensal bacteria, environmental stimuli and food antigens on the one hand, and induction of efficient immune responses against invading pathogens on the other hand. This regulatory task is of critical importance to prevent inappropriate immune activation that may otherwise lead to chronic inflammation, tissue disruption and organ dysfunction. The most striking example for the efficacy of the adaptive nature of the intestinal mucosa is birth. Whereas the body surfaces are protected from environmental and microbial exposure during fetal life, bacterial colonization and contact with potent immunostimulatory substances start immediately after birth. In the present review, we summarize the current knowledge on the mechanisms underlying the transition of the intestinal mucosa during the neonatal period leading to the establishment of a stable, life-long host-microbial homeostasis. The environmental exposure and microbial colonization during the neonatal period, and also the influence of maternal milk on the immune protection of the mucosa and the role of antimicrobial peptides, are described. We further highlight the molecular mechanisms of innate immune tolerance in neonatal intestinal epithelium. Finally, we link the described immunoregulatory mechanisms to the increased susceptibility to inflammatory and infectious diseases during the neonatal period. PMID:21952827

Stockinger, Silvia; Hornef, Mathias W; Chassin, Cécilia



Influence of the Escherichia coli Nissle 1917 strain on complications of chronic experimental liver damage  

Microsoft Academic Search

The aim of the study was evaluate the influence of the probiotic Escherichia coli Nissle 1917 strain (Mutaflor ® suspension, Ardeypharm GmbH, Herdecke, Germany) on bacterial translocation in cases of liver damage, damage to the intestinal mucosa, potential portal hypertension associated with possible development of oesophageal varices and on the bacterial population of the intestine during chronic experimental liver damage

D. Kosakova; P. Scheer; J. Lata; J. Doubek


Lymphoid organogenesis in the intestine  

Microsoft Academic Search

Lymphoid organogenesis is dependent upon a series of intricate cellular interactions involving adhesion molecules, chemokines,\\u000a and cytokines that generate fully compartmentalized lymphoid structures. Development of organized lymphoid structures in the\\u000a intestine begins prenatally and continues through adulthood, with constant adaptations to changes in the luminal flora. While\\u000a much is known about the mechanisms that govern the development of macroscopic intestinal

Rebekah T. Taylor; Ifor R. Williams



CT of the small intestine.  


CT of the small intestine continues to be a diagnostic challenge. Three protocols have turned out to be useful. The frequently used general protocol is highly suitable for most indications that require an overview of the small intestine and in cases where no specific queries regarding the small intestine have to be answered. A dedicated protocol with opacification of the small intestine by means of a probe appears to be useful in patients with a suspected tumour or to exclude a tumour as well as in cases of inflammatory bowel disease. Filling of the bowel ensures optimal distention and, in combination with intravenous contrast medium administration, allows differentiation of tumours from inflammatory lesions. In cases of suspected intestinal ischaemia, angiographic techniques should be used. State-of-the-art techniques such as bolus tracking and acquisition of a dynamic scan for determination of individual circulation time facilitate optimal arterial opacification of the intestinal wall. The results obtained in our patients suggest that the use of multislice CT in combination with optimal opacification improves sensitivity. Further studies have to show whether the improved diagnostic options also translate into an improved clinical outcome or survival rate. PMID:16479665

Rogalla, Patrik



Schistosomiasis as a Cause of Chronic Lower Abdominal Pain  

PubMed Central

Background: Chronic intestinal schistosomiasis is rare in the United Kingdom. The symptoms are nonspecific and may mimic several other gastrointestinal conditions. We present a case of chronic intestinal schistosomiasis in a West Indian woman presenting to a genitourinary clinic. Case: The patient presented with chronic lower abdominal pain and dysuria. A sexually transmitted disease (STD) screen was negative and midstream urine cultures were sterile. A rectal biopsy revealed a non-necrotizing granulomatous reaction around the ova of Schistosoma. Her symptoms resolved with anti-schistosomiasis therapy. Conclusion: This case illustrates that physicians should be aware of chronic schistosomiasis in the differential diagnosis of chronic lower abdominal pain in women who have come from or visited areas where schistosomiasis is endemic.

McManus, Tom J.



Complicated intestinal atresias.  


In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction. PMID:156011

Miller, R C



Complicated Intestinal Atresias  

PubMed Central

In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction.

Miller, Richard C.



Probiotics and prebiotics in chronic inflammatory bowel diseases.  


The prokaryotic and eukaryotic cells of the colon exist in a highly complex, but harmonious relationship. Disturbances in this remarkable symbiosis can result in the development of inflammatory bowel diseases (IBD). Although the etiology of IBD is not entirely understood, it is known that the chronic inflammation of Crohn's disease, ulcerative colitis and chronic pouchitis are a result of an overly aggressive immune response to the commensal intestinal flora in genetically susceptible hosts. Recent studies have enhanced our ability to understand the interaction between the host and its intestinal microflora and the role the microflora plays in maintaining intestinal homeostasis. As we begin to understand the benefits conferred to the intestine by the microflora, the notion of modifying the composition of the bacterial load to improve human health has arisen. A significant body of research now exists investigating the role of probiotics and prebiotics in ameliorating chronic intestinal inflammation. This article will begin with an overview of the role of the commensal microflora in maintaining mucosal immune homeostasis, and how a dysregulated immune response to the intestinal microflora results in IBD. This will be followed by a summary of the use of probiotics and prebiotics in experimental and human IBD. PMID:17009391

Ewaschuk, Julia B; Dieleman, Levinus A



Effect of fluoride on the intestinal epithelial cell brush border membrane  

SciTech Connect

Fluoride consumed by man and animals is chiefly absorbed in the intestine. Chronic fluoride exposure causes mottled teeth and osteosclerosis. Over-fluoridation (126 mM) of drinking water have been reported to cause nausea, vomiting and diarrhea. Furthermore, the effect of acute and low concentrations of fluoride on gastric secretion, ion transport and other disorders have also been studied. Fluoride also causes alterations in the permeability of membranes and membrane bound enzymes. The intestinal cell lining plays an important role in digestion and absorption. It automatically becomes the most exposed site of contact to fluoride following ingestion. Earlier study have shown significant alterations in the formation of lipid peroxides in rat intestine following oral administration of fluoride. The present study was undertaken to investigate the damage of rat intestinal epithelium in situ caused by relatively high and low fluoride concentrations.

Rastogi, R.; Upreti, R.K.; Kidwai, A.M.



Plasmablastic Lymphoma presenting as small intestinal polyposis: A case-report  

PubMed Central

Background Plasmablastic lymphoma (PBL) is a relatively new entity, classified by WHO as a rare variant of diffuse large B cell lymphoma. The present case report introduces a 17 year old girl with chronic diarrhea, abdominal pain, intra-abdominal venous thromboses, ascites, mesenteric lymphadenopathies and small intestinal polyposis, the pathologic and immunohistochemistric examinations of the polypoid lesions were in favor of PBL. Numerous cases of PBL have been reported, but to our knowledge, this is the first report of PBL presenting as small intestinal polyposis.Among lymphomas, only mantle cell lymphoma and follicular cell lymphoma have been previously reported to cause intestinal polyposis. This report introduces Plasmablastic lymphoma, a rare variant of diffuse large B cell lymphoma, as a possible cause of small intestinal polyposis.

Bahari, A; Jahantigh, M; Mashhadi, A; Bari, Z; Bari, AR



Innate immunity modulation by the IL-33/ST2 system in intestinal mucosa.  


Innate immunity prevents pathogens from entering and spreading within the body. This function is especially important in the gastrointestinal tract and skin, as these organs have a large surface contact area with the outside environment. In the intestine, luminal commensal bacteria are necessary for adequate food digestion and play a crucial role in tolerance to benign antigens. Immune system damage can create an intestinal inflammatory response, leading to chronic disease including inflammatory bowel diseases (IBD). Ulcerative colitis (UC) is an IBD of unknown etiology with increasing worldwide prevalence. In the intestinal mucosa of UC patients, there is an imbalance in the IL-33/ST2 axis, an important modulator of the innate immune response. This paper reviews the role of the IL-33/ST2 system in innate immunity of the intestinal mucosa and its importance in inflammatory bowel diseases, especially ulcerative colitis. PMID:23484079

García-Miguel, Marina; González, M Julieta; Quera, Rodrigo; Hermoso, Marcela A



Small intestinal bacterial overgrowth is diagnosed in some cases of irritable bowel syndrome  

Microsoft Academic Search

Introduction: Irritable bowel syndrome (IBS) is a chronic gastrointestinal tract disfunction characterized by abdominal pain (or discomfort) and alteration in bowel movements. The etiology of presented symptoms despite numerous studies is unclear. Small intestinal bacterial overgrowth (SIBO) is one of potential factors causing symptoms of some gastrointe- stinal functional disorders. The aim of the study was to check whether SIBO

Agnieszka Meder


Technical Note: Pig Model for Studying Nutrient Assimilation by the Intestine and Colon1  

Microsoft Academic Search

We have developed a system for chronically catheterizing 10- to 25-d-old pigs that permits stable isotope tracer studies of intestinal or colonic assimilation of nutrients. This model also can be used to ensure constant enteral feeding or to assess the rate of entry into the terminal ileum of carbohy- drates, fats, and amino acids. A plastic cannula with a luminal

C. Lawrence Kien; Anton H. Ailabouni; Robert D. Murray; Priscilla A. Powers; Richard E. McClead; Jon Kepner


Mycobacterium avium paratuberculosis Invades Human Small?Intestinal Goblet Cells and Elicits Inflammation  

Microsoft Academic Search

Crohn disease is a chronic inflammatory bowel disease of un- known etiology. Mycobacterium avium paratuberculosis (MAP) was found in the gut of patients with Crohn disease, but causality was not established. Fully developed, germ-free hu- man small intestine and colon were established by subcutane- ous transplantation of fetal gut into SCID (severe combined immunodeficiency) mice thereafter infected by direct intralu-

L. Golan; E. Gonen; S. Yagel; I. Rosenshine



Inefficacy of intestinal secretory immune response to Cryptosporidium in acquired immunodeficiency syndrome  

Microsoft Academic Search

Background\\/Aims: An alteration of the secretory immune response has been forwarded to explain frequent and chronic mucosal infections in patients with acquired immunodeficiency syndrome (AIDS). The aim of this study was to explore the intestinal immunoglobulin (Ig) secretions in patients with AIDS and their relationships to cryptosporidiosis. Methods: Patients with AIDS and enteric cryptosporidiosis (n = 12), other enteric infections

Yves Benhamou; Nathalie Kapel; Catherine Hoang; Hiam Matta; Dominique Meillet; Denis Magne; Martine Raphael; Marc Gentilini; Pierre Opolon; Jean-Gerard Gobert



Effect of prolonged intraluminal ?-amylase inhibition on eating, weight, and the small intestine of rats  

Microsoft Academic Search

Effects of chronic intraluminal amylase inhibition on eating and the digestive system are unclear. In growing rats, we determined the effect of ingesting a wheat amylase inhibitor (AI) on eating, weight, small intestinal mucosal growth, and disaccharidases. Three groups of 12 rats received AI, were pair-fed controls (PFC), or had free access to food (FAC). After measuring food intake and

Keisho Kataoka; Eugene P DiMagno



Mechanisms of intestinal inflammation and development of associated cancers: Lessons learned from mouse models  

PubMed Central

Chronic inflammation is strongly associated with approximately 1/5th of all human cancers. Arising from combinations of factors such as environmental exposures, diet, inherited gene polymorphisms, infections, or from dysfunctions of the immune response, chronic inflammation begins as an attempt of the body to remove injurious stimuli; however, over time, this results in continuous tissue destruction and promotion and maintenance of carcinogenesis. Here we focus on intestinal inflammation and its associated cancers, a group of diseases on the rise and affecting millions of people worldwide. Intestinal inflammation can be widely grouped into inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and celiac disease. Long-standing intestinal inflammation is associated with colorectal cancer and small-bowel adenocarcinoma, as well as extraintestinal manifestations, including lymphomas and autoimmune diseases. This article highlights potential mechanisms of pathogenesis in inflammatory bowel diseases and celiac disease, as well as those involved in the progression to associated cancers, most of which have been identified from studies utilizing mouse models of intestinal inflammation. Mouse models of intestinal inflammation can be widely grouped into chemically induced models; genetic models, which make up the bulk of the studied models; adoptive transfer models; and spontaneous models. Studies in these models have lead to the understanding that persistent antigen exposure in the intestinal lumen, in combination with loss of epithelial barrier function, and dysfunction and dysregulation of the innate and adaptive immune responses lead to chronic intestinal inflammation. Transcriptional changes in this environment leading to cell survival, hyperplasia, promotion of angiogenesis, persistent DNA damage, or insufficient repair of DNA damage due to an excess of proinflammatory mediators are then thought to lead to sustained malignant transformation. With regards to extraintestinal manifestations such as lymphoma, however, more suitable models are required to further investigate the complex and heterogeneous mechanisms that may be at play.

Westbrook, Aya M.; Szakmary, Akos; Schiestl, Robert H.



Effect of Klebsiella pneumoniae enterotoxin on intestinal transport in the rat.  

PubMed Central

The effects on intestinal transport of either a semipurified preparation of enterotoxin elaborated by Klebsiella pneumoniae or similaryly prepared control material were tested by marker perfusion studies in the small intestine of rats. At a concentration of 2 mg/ml, the enterotoxin produced net secretion of water, Na, and Cl in both jejunal and ileal segments; HCO3 transport was not affected. Net secretion was evident within 30 min after intorduction of the toxin and was maximal after 90 min. The addition of 56 mM glucose to the enterotoxin-containing perfusion fluid resulted in reversal of water and Na transport to net absorption in both intestinal segments. The enterotoxin also produced a significant depression of xylose absorption in both the jejunum and ileum but did not affect the absorption of either glucose or L-leucine. Intestinal structure was not altered after perfusion of the toxin but insillation of approximately one-quarter of the total perfusion dose into a ligated jejunal loop for 18 h produced fluid secretion and structural abnormalities. These observations confirm the fact that other species of coliform bacteria in addition to tescherichia coli are capable of elaborating an enterotoxin. Such species commonly contaminate the small intestine of persons with tropical sprue and it is suggested that chronic exposure of the intestinal mucosa to the enterotoxin elaborated by these bacteria may be a factor in the pathogenesis of intestinal abnormalities in thid disorder. Images

Klipstein, F A; Horowitz, I R; Engert, R F; Schnenk, E A



Quality of life after pediatric intestinal transplantation: the perception of pediatric recipients and their parents.  


The objective was to examine the perception of physical and psychosocial functioning of pediatric intestinal transplant recipients who are beyond the perioperative period and compare these with normal and chronically ill children. Child and parent forms of the Child Health Questionnaire were administered to all 29 pediatric intestinal transplant recipients between the ages of 5 and 18 years who had had a small bowel transplantation 1 year previous and had a functional allograft. Comparison was made with published norms and scores for pediatric patients on hemodialysis. Intestinal transplant recipients (on average 5 years after intestinal transplantation and at a mean age 11 years) reported similar scores in all domains compared with normal children. Parents of intestinal transplant recipients noted decreased function in several domains related to their child's general health, physical functioning, and the impact of the illness on parental time, emotions and family activities. Intestinal transplant recipients beyond the perioperative period perceive their physical and psychosocial functioning as similar to normal school children. Parental proxy assessments differ from the recipients, with the parent's perception of decreased general health and physical functioning for intestinal transplant recipients compared with norms. PMID:14961994

Sudan, Debra; Horslen, Simon; Botha, Jean; Grant, Wendy; Torres, Clarivet; Shaw, Byers; Langnas, Alan



Intestinal alkaline phosphatase prevents metabolic syndrome in mice  

PubMed Central

Metabolic syndrome comprises a cluster of related disorders that includes obesity, glucose intolerance, insulin resistance, dyslipidemia, and fatty liver. Recently, gut-derived chronic endotoxemia has been identified as a primary mediator for triggering the low-grade inflammation responsible for the development of metabolic syndrome. In the present study we examined the role of the small intestinal brush-border enzyme, intestinal alkaline phosphatase (IAP), in preventing a high-fat-diet–induced metabolic syndrome in mice. We found that both endogenous and orally supplemented IAP inhibits absorption of endotoxin (lipopolysaccharides) that occurs with dietary fat, and oral IAP supplementation prevents as well as reverses metabolic syndrome. Furthermore, IAP supplementation improves the lipid profile in mice fed a standard, low-fat chow diet. These results point to a potentially unique therapy against metabolic syndrome in at-risk humans.

Kaliannan, Kanakaraju; Hamarneh, Sulaiman R.; Economopoulos, Konstantinos P.; Nasrin Alam, Sayeda; Moaven, Omeed; Patel, Palak; Malo, Nondita S.; Ray, Madhury; Abtahi, Seyed M.; Muhammad, Nur; Raychowdhury, Atri; Teshager, Abeba; Mohamed, Mussa M. Rafat; Moss, Angela K.; Ahmed, Rizwan; Hakimian, Shahrad; Narisawa, Sonoko; Millan, Jose Luis; Hohmann, Elizabeth; Warren, H. Shaw; Bhan, Atul K.; Malo, Madhu S.; Hodin, Richard A.



Intestinal alkaline phosphatase prevents metabolic syndrome in mice.  


Metabolic syndrome comprises a cluster of related disorders that includes obesity, glucose intolerance, insulin resistance, dyslipidemia, and fatty liver. Recently, gut-derived chronic endotoxemia has been identified as a primary mediator for triggering the low-grade inflammation responsible for the development of metabolic syndrome. In the present study we examined the role of the small intestinal brush-border enzyme, intestinal alkaline phosphatase (IAP), in preventing a high-fat-diet-induced metabolic syndrome in mice. We found that both endogenous and orally supplemented IAP inhibits absorption of endotoxin (lipopolysaccharides) that occurs with dietary fat, and oral IAP supplementation prevents as well as reverses metabolic syndrome. Furthermore, IAP supplementation improves the lipid profile in mice fed a standard, low-fat chow diet. These results point to a potentially unique therapy against metabolic syndrome in at-risk humans. PMID:23569246

Kaliannan, Kanakaraju; Hamarneh, Sulaiman R; Economopoulos, Konstantinos P; Nasrin Alam, Sayeda; Moaven, Omeed; Patel, Palak; Malo, Nondita S; Ray, Madhury; Abtahi, Seyed M; Muhammad, Nur; Raychowdhury, Atri; Teshager, Abeba; Mohamed, Mussa M Rafat; Moss, Angela K; Ahmed, Rizwan; Hakimian, Shahrad; Narisawa, Sonoko; Millán, José Luis; Hohmann, Elizabeth; Warren, H Shaw; Bhan, Atul K; Malo, Madhu S; Hodin, Richard A



[Clinical and etiologic study of 90 cases of chronic diarrhea].  


90 patients with chronic diarrhoea underwent this prospective study. They were seen in a private hospital of Lima during 1990 and 1991. According to a methodologic plan for determining sources and the diseases that originate chronic diarrhoea. In all patients hematologic, bioquimic, coprocultures, coproparasitologic exams were done, chest and intestinal transit X-rays. All underwent duodenal content culture. Colon X-ray in 25 cases; proctosigmoidoscopy in 14 and upper digestive endoscopy in 19 patients. Abdominal echography in 12 and TAC in 2 cases. The final results showed as determinant diseases for chronic diarrhoea, according to their frequency: enteroparasitosis (23.3%), functional digestive disorders (20.0%), intestinal bacterial overpopulation (15.5%) of unknown origin (8.8%), colon diverticulus (7.7%) proven and probably (5.5%), lactose intolerance (3.3%), diabetes mellitus (2.2%), and in one case (1.1%) the following: intestinal linfoma, pancreas malignancy, AIDS, colonic and deformation and megaloblastic anemia. The causes of chronic diarrhoea are several and multifactorals and in this study we prove the preeminence of the intestinal parasitosis, functional disorders and intestinal bacterial overpopulation and with less frequency other pathologies. PMID:8219099

Farfán Flores, G; Sánchez, G; Tello, R; Villanueva, G



Small intestinal physiology and pathophysiology.  


The small intestine, like the rest of the gastrointestinal tract, is an intelligent organ. It generates a wide variety of motor patterns to meet motility requirements in different situations. Its basic motor function after a meal is to mix the chyme with exocrine and intestinal secretions, agitate its contents to uniformly and evenly expose them to the mucosal surface, and to propel them distally at a rate that allows optimal absorption of food components, and reabsorption of bile. Most of these functions are performed by individual phasic contractions. In humans, the phasic contractions are largely disorganized in time and space. These contractions may cause mixing and agitation of luminal contents with slow distal propulsion. Occasionally, an individual contraction of large amplitude and long duration migrates over several centimeters and may rapidly propel the contents over this distance. In general, the spatial and temporal relationships of individual phasic contractions become less organized distally, resulting in a slower propulsion rate in the distal small intestine than in the proximal small intestine. The migrating clustered contractions generated after a meal may also be propulsive, but because of their unpredictable and irregular occurrence, their precise role in postprandial propulsion is incompletely understood. Rapidly migrating contractions may occur when the electrical control activity is obliterated by pharmacologic agents or during parasitic infections. Their effects on motility are not known yet. Between meals, when digestion is complete, the small intestine generates migrating motor complexes that help keep the small intestine clean by dislodging debris from the villi and dumping them into the colon. This may prevent decay of these materials in the small intestine and limit their contribution to bacterial overgrowth. Giant migrating contractions may perform a similar function in the distal small intestine as well as return any refluxed fecal material back to the colon. However, the major role of giant migrating contractions may be, in pathologic states, associated with abdominal cramping and diarrhea. Giant migrating contractions are associated with mass movements. Vomiting is preceded by a retrograde giant contraction. This contraction rapidly empties the contents of the proximal half of small intestine into the stomach in preparation for vomitus expulsion by contraction of abdominal and diaphragmatic muscles. The three basic mechanisms of control of spatial and temporal patterns of contractions are myogenic, neural, and chemical.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2668175

Sarna, S K; Otterson, M F



Intestinal circulation during inhalation anesthesia  

SciTech Connect

This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of /sub 86/Rb and 9-microns spheres labeled with /sup 141/Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO/sub 2/) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines.

Tverskoy, M.; Gelman, S.; Fowler, K.C.; Bradley, E.L.



Sonography of the small intestine  

PubMed Central

In the last two decades, there has been substantial development in the diagnostic possibilities for examining the small intestine. Compared with computerized tomography, magnetic resonance imaging, capsule endoscopy and double-balloon endoscopy, ultrasonography has the advantage of being cheap, portable, flexible and user- and patient-friendly, while at the same time providing the clinician with image data of high temporal and spatial resolution. The method has limitations with penetration in obesity and with intestinal air impairing image quality. The flexibility ultrasonography offers the examiner also implies that a systematic approach during scanning is needed. This paper reviews the basic scanning techniques and new modalities such as contrast-enhanced ultrasound, elastography, strain rate imaging, hydrosonography, allergosonography, endoscopic sonography and nutritional imaging, and the literature on disease-specific findings in the small intestine. Some of these methods have shown clinical benefit, while others are under research and development to establish their role in the diagnostic repertoire. However, along with improved overall image quality of new ultrasound scanners, these methods have enabled more anatomical and physiological changes in the small intestine to be observed. Accordingly, ultrasound of the small intestine is an attractive clinical tool to study patients with a range of diseases.

Nylund, Kim; ?degaard, Svein; Hausken, Trygve; Folvik, Geir; Lied, Gulen Arslan; Viola, Ivan; Hauser, Helwig; Gilja, Odd-Helge



Therapeutic modulation of intestinal dysbiosis.  


The human gastrointestinal tract is home to an extremely numerous and diverse collection of microbes, collectively termed the "intestinal microbiota". This microbiota is considered to play a number of key roles in the maintenance of host health, including aiding digestion of otherwise indigestible dietary compounds, synthesis of vitamins and other beneficial metabolites, immune system regulation and enhanced resistance against colonisation by pathogenic microorganisms. Conversely, the intestinal microbiota is also a potent source of antigens and potentially harmful compounds. In health, humans can therefore be considered to exist in a state of natural balance with their microbial inhabitants. A shift in the balance of microbiota composition such that it may become deleterious to host health is termed "dysbiosis". Dysbiosis of the gut microbiota has been implicated in numerous disorders, ranging from intestinal maladies such as inflammatory bowel diseases and colorectal cancer to disorders with more systemic effects such as diabetes, metabolic syndrome and atopy. Given the far reaching influence of the intestinal microbiota on human health a clear future goal must be to develop reliable means to alter the composition of the microbiota and restore a healthy balance of microbial species. While it is clear that much fundamental research remains to be done, potentially important therapeutic options include narrow spectrum antibiotics, novel probiotics, dietary interventions and more radical techniques such as faecal transplantation, all of which aim to suppress clinical dysbiosis, restore intestinal microbiota diversity and improve host health. PMID:23017673

Walker, Alan W; Lawley, Trevor D



Intestinal drug transporters: An overview.  


The importance of drug transporters as one of the determinants of pharmacokinetics has become increasingly evident [1]. While much research has been conducted focusing the role of drug transporters in the liver [2-5] and kidney [2,6,7] less is known about the importance of uptake and efflux transporters identified in the intestine [8]. Over the past years the effects of intestinal transporters have been studied using in vivo models, in situ organ perfusions, in vitro tissue preparations and cell lines. This review aims to describe up to date findings regarding the importance of intestinal transporters on drug absorption and bioavailability, highlighting areas in need of further research. Wu and Benet [9] proposed a Biopharmaceutics Drug Disposition Classification System (BDDCS) that allows the prediction of transporter effects on the drug disposition of orally administered drugs. This review also discusses BDDCS predictions with respect to the role of intestinal transporters and intestinal transporter-metabolizing enzyme interplay on oral drug pharmacokinetics. PMID:23041352

Estudante, Margarida; Morais, José G; Soveral, Graça; Benet, Leslie Z



Intestinal hormones and growth factors: effects on the small intestine.  


There are various hormones and growth factors which may modify the intestinal absorption of nutrients, and which might thereby be useful in a therapeutic setting, such as in persons with short bowel syndrome. In part I, we focus first on insulin-like growth factors, epidermal and transferring growth factors, thyroid hormones and glucocorticosteroids. Part II will detail the effects of glucagon-like peptide (GLP)-2 on intestinal absorption and adaptation, and the potential for an additive effect of GLP2 plus steroids. PMID:19152442

Drozdowski, Laurie; Thomson, Alan B R



Intestinal hormones and growth factors: Effects on the small intestine  

PubMed Central

There are various hormones and growth factors which may modify the intestinal absorption of nutrients, and which might thereby be useful in a therapeutic setting, such as in persons with short bowel syndrome. In partI, we focus first on insulin-like growth factors, epidermal and transferring growth factors, thyroid hormones and glucocorticosteroids. Part II will detail the effects of glucagon-like peptide (GLP)-2 on intestinal absorption and adaptation, and the potential for an additive effect of GLP2 plus steroids.

Drozdowski, Laurie; Thomson, Alan BR



[Intestinal microbiota and Kampo medicine].  


More than 70% of clinicians presently use Kampo medicine. However, pharmacological studies on Kampo medicine, the characteristics of herbs, and their relations with intestinal microbiota in particular are insufficiently understood. Many of the main active ingredients of Kampo medicine are glycosides, a molecular group accounting for more than 10% of all Kampo medicine. Orally administered glycosides reach the lower digestive tract without being absorbed, and are then hydrolyzed by enteric bacteria, which utilize them as a food source. The aglycon they produce is absorbed into the body and becomes activated. The activation mechanism is altered by changes in the intestinal microbiota, and may also cause changes in this microbiota. For Kampo medicine, combined use with probiotics is expected, and Kampo medicine may act as a prebiotic itself. The concepts of "Sho" or "Kampo diagnosis" should also be considered based on differences in the intestinal microbiota. PMID:19621786

Ohta, Keiichiro; Kitajima, Masaki



Hernia repair with porcine small-intestinal submucosa  

Microsoft Academic Search

Purpose  Although at present nonabsorbable meshes are the preferred material for tension-free hernioplasty, some problems with their\\u000a use have yet to be addressed (i.e., chronic pain and infections). In order to address these disadvantages, a collagen-based\\u000a material, the porcine small-intestinal submucosa mesh (Surgisis Inguinal Hernia Matrix, Cook Surgical, Bloomington, IN, USA),\\u000a has recently been developed for hernia repair.\\u000a \\u000a \\u000a \\u000a Methods  With the aim

L. Ansaloni; F. Catena; S. Gagliardi; F. Gazzotti; L. D’Alessandro; A. D. Pinna



Investigation of chronic diarrhoea in infancy.  


Diarrhoea in infants and young children is defined as >200g/day of stools, and occurs when there is an imbalance between intestinal fluids absorption and secretion. This may be caused by either a decreased absorption (osmotic diarrhoea) or an increased secretion (secretory diarrhoea). Chronic diarrhoea defines intestinal loss of water and electrolytes with increased stool frequency, reduced consistency and larger volume over more than 14days. This disorder in children shows a wide range of aetiologies depending on the age. The knowledge of common and rare aetiologies is important to optimize the diagnostic approach. A stepwise approach, starting with a comprehensive history, physical examination, inspection and collection of stool samples, helps to devise appropriate diagnostic and therapeutic management. In this article we discuss the pathophysiology, aetiology and possible approach to chronic diarrhoea in infancy. PMID:24021917

Pezzella, Vincenza; De Martino, Lucia; Passariello, Annalisa; Cosenza, Linda; Terrin, Gianluca; Berni Canani, Roberto



Chronic radiation enteritis and malnutrition.  


Radiation enteritis is defined as the loss of absorptive capacity of the intestine following irradiation, which is most commonly seen after radiotherapy for pelvic and abdominal malignancies. It is divided into acute and chronic forms and usually presents with diarrhea and malabsorption. Malnutrition is a common complication of chronic radiation enteritis (CRE). We reviewed the etiology, prevalence, symptoms, diagnosis and management of CRE and CRE with malnutrition in this article. Functional short bowel syndrome as a cause of malnutrition in CRE is also considered. The diagnostic work-up includes serum markers, endoscopy, cross-sectional imaging and the exclusion of alternative diagnoses such as recurrent malignancy. Management options of CRE include dietary manipulation, anti-motility agents, electrolyte correction, probiotics, parenteral nutrition, surgical resection and small bowel transplantation. Treatment may also be required for coexisting conditions including vitamin B12 deficiency, bile acid malabsorption and depression. PMID:23560564

Webb, Gwilym James; Brooke, Rachael; De Silva, Aminda Niroshan



Intrinsic primary afferent neuronsof the intestine  

Microsoft Academic Search

After a long period of inconclusive observations, the intrinsic primary afferent neurons of the intestine have been identified. The intestine is thus equipped with two groups of afferent neurons, those with cell bodies in cranial and dorsal root ganglia, and these recently identified afferent neurons with cell bodies in the wall of the intestine.The first, tentative, identification of intrinsic primary




Neurodevelopmental outcomes of infant intestinal transplant recipients  

Microsoft Academic Search

Little is known about the impact of intestinal transplantation on development of the infant brain. In this study we report four neurodevelopmental studies on children receiving either liver or intestinal\\/multivisceral transplants. Our preliminary investigation examined the pretransplant status of 27 infants, who were either liver or intestinal\\/multivisceral candidates, using the Bayley Scales of Infant Development. A second study examined 23

D. M Thevenin; N Mittal; T Kato; A Tzakis



Contribution of intestinal flora to surgical infections.  


Postoperative septic complications related to intestinal injury are regulated by a complex group of factors, including intestinal microflora, site of injury, surgical procedures used, and the type of antimicrobial therapy; however, a large number of yet-to-be understood factors also exist that influence septic morbidity associated with intestinal surgery. The authors present an overview of this serious complication of surgery. PMID:3404556

Mandal, A K; Thadepalli, H



Endoplasmic reticulum stress and intestinal inflammation  

Microsoft Academic Search

The intestinal epithelial cell (IEC) is increasingly recognized to play a prominent role as an important intermediary between the commensal microbiota and the intestinal immune system. Moreover, it is now recognized that intestinal inflammation in inflammatory bowel disease (IBD) may arise primarily from IEC dysfunction due to unresolved endoplasmic reticulum (ER) stress as a consequence of genetic disruption of X

A Kaser; R S Blumberg



Chronic Illness  


... giving up cherished activities, adapting to new physical limitations and special needs, and paying for what can ... as long as eight years after diagnosis. Physical limitations imposed by heart disease and other chronic illnesses ...


Chronic Pericarditis  


... unknown. However, it may be caused by cancer, tuberculosis, or an underactive thyroid gland (hypothyroidism). Usually, the ... injury, heart surgery, or a bacterial infection. Previously, tuberculosis was the most common cause of chronic pericarditis ...


Loss of transforming growth factor ? signalling in the intestine contributes to tissue injury in inflammatory bowel disease  

PubMed Central

BACKGROUND—Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract caused by an abnormal and uncontrolled immune response to one or more normally occurring gut constituents.?AIM—Given the effects of transforming growth factor ?1 (TGF-?1) on both the immune system and extracellular matrix, we postulated that alterations in TGF-? signalling in intestinal epithelial cells may play an important role in the development of IBD.?METHODS—TGF-? signalling was inactivated in mouse intestine by expressing a dominant negative mutant form of the TGF-? type II receptor under the control of the mouse intestinal trefoil peptide (ITF)/TFF3 promoter. Transgenic mice (ITF-dnRII) developed spontaneous colitis presenting with diarrhoea, haematochezia, and anal prolapse when not maintained under specific pathogen free (SPF) conditions. Under SPF conditions we induced colitis by mixing dextran sodium sulphate (DSS) in drinking water to examine the significance of loss of TGF-? signalling in the pathogenesis of IBD.?RESULTS—Transgenic mice showed increased susceptibility to DSS induced IBD, and elicited increased expression of major histocompatibility complex class II, generation of autoantibodies against intestinal goblet cells, and increased activity of matrix metalloproteinase in intestinal epithelial cells compared with wild-type littermates challenged with DSS.?CONCLUSIONS—Deficiency of TGF-? signalling specifically in the intestine contributes to the development of IBD. Maintenance of TGF-? signalling may be important in regulating immune homeostasis in the intestine???Keywords: inflammatory bowel disease; transforming growth factor ?; matrix metalloproteinases; intestinal trefoil factor; mouse

Hahm, K; Im, Y; Parks, T; Park, S; Markowitz, S; Jung, H; Green, J; Kim, S



[Intestinal obstruction caused by endometriosis ].  


We report a case of a 29-year old woman with intestinal obstruction caused by endometriosis localised in the proximity of the ileocecal valve. Right hemicolectomy was carried out. No other pathology was found. We discuss difficulties of establishing the preoperative diagnosis. PMID:12916263

Grodzi?ski, Tomasz; Gackowski, Wojciech; Radwa?ski, Pawe?



Richard Wood and intestinal transplantation  

Microsoft Academic Search

Richard Wood (1943–2003) developed an interest in small bowel transplantation on his appointment to the Chair of Surgery at the Medical College of St Bartholomew's Hospital, London, UK, in 1984 and he organized the first international symposium on the subject in October 1989. His research which initially focused on intestinal function evolved to assess the role of migration of leukocytes

A. G. Pockley



Intestinal Malabsorption in the Elderly  

Microsoft Academic Search

Background: Intestinal malabsorption in the elderly is infrequent, and clinical features are muted so that the diagnosis is often missed. Physiologic changes with aging are restricted to altered absorption of calcium and perhaps zinc and magnesium; however, achlorhydria can lead to impaired absorption of vitamin B12, folic acid, and calcium. Methods and Results: Small bowel bacterial overgrowth occurs more commonly

Peter R. Holt



Intestinal perfusion monitoring using photoplethysmography  

NASA Astrophysics Data System (ADS)

In abdominal trauma patients, monitoring intestinal perfusion and oxygen consumption is essential during the resuscitation period. Photoplethysmography is an optical technique potentially capable of monitoring these changes in real time to provide the medical staff with a timely and quantitative measure of the adequacy of resuscitation. The challenges for using optical techniques in monitoring hemodynamics in intestinal tissue are discussed, and the solutions to these challenges are presented using a combination of Monte Carlo modeling and theoretical analysis of light propagation in tissue. In particular, it is shown that by using visible wavelengths (i.e., 470 and 525 nm), the perfusion signal is enhanced and the background contribution is decreased compared with using traditional near-infrared wavelengths leading to an order of magnitude enhancement in the signal-to-background ratio. It was further shown that, using the visible wavelengths, similar sensitivity to oxygenation changes could be obtained (over 50% compared with that of near-infrared wavelengths). This is mainly due to the increased contrast between tissue and blood in that spectral region and the confinement of the photons to the thickness of the small intestine. Moreover, the modeling results show that the source to detector separation should be limited to roughly 6 mm while using traditional near-infrared light, with a few centimeters source to detector separation leads to poor signal-to-background ratio. Finally, a visible wavelength system is tested in an in vivo porcine study, and the possibility of monitoring intestinal perfusion changes is showed.

Akl, Tony J.; Wilson, Mark A.; Ericson, M. Nance; Coté, Gerard L.



Ear infection - chronic  


Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... Chole RA, Sudhoff HH. Chronic otitis media, mastoiditis, and ... eds. Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, ...


Intestinal and cloacal strictures in free-ranging and aquarium-maintained green sea turtles (Chelonia mydas).  


Intestinal or cloacal strictures that resulted in intestinal obstruction were diagnosed in six green sea turtles (Chelonia mydas) from three rehabilitation facilities and two zoologic parks. The etiologies of the strictures were unknown in these cases. It is likely that anatomic adaptations of the gastrointestinal tract unique to the green sea turtle's herbivorous diet, paired with causes of reduced intestinal motility, may predispose the species to intestinal damage and subsequent obstructive intestinal disease. In aquarium-maintained green sea turtles, obesity, diet, reduced physical activity, chronic intestinal disease, and inappropriate or inadequate antibiotics might also be potential contributing factors. Clinical, radiographic, and hematologic abnormalities common among most of these sea turtles include the following: positive buoyancy; lethargy; inappetence; regurgitation; obstipation; dilated bowel and accumulation of oral contrast material; anemia; hypoglycemia; hypoalbuminemia; hypocalcemia; and elevated creatine kinase, aspartate aminotransferase, and blood urea nitrogen. Although these abnormalities are nonspecific with many possible contributing factors, intestinal disease, including strictures, should be considered a differential in green sea turtles that demonstrate all or a combination of these clinical findings. Although diagnostic imaging, including radiographs, computed tomography, or magnetic resonance imaging, are important in determining a cause for suspected gastrointestinal disease and identifying an anatomic location of obstruction, intestinal strictures were not successfully identified when using these imaging modalities. Lower gastrointestinal contrast radiography, paired with the use of oral contrast, was useful in identifying the suspected site of intestinal obstruction in two cases. Colonoscopy was instrumental in visually diagnosing intestinal stricture in one case. Therefore, lower gastrointestinal contrast radiography and colonoscopy should be considered in green turtles when gastrointestinal obstructions are suspected. Although partial strictures of the cloacal opening may be identified on gross examination and might be managed with appropriate medical treatment, surgical intervention or humane euthanasia are likely the only options for sea turtles once small or large intestinal strictures have formed. PMID:23805560

Erlacher-Reid, Claire D; Norton, Terry M; Harms, Craig A; Thompson, Rachel; Reese, David J; Walsh, Michael T; Stamper, M Andrew



Metagenomic Applications and the Potential for Understanding Chronic Liver Disease  

Microsoft Academic Search

\\u000a Liver fibrosis is characterized by an excessive deposition of extracellular matrix proteins that occurs in chronic liver disease\\u000a of any origin. Cirrhosis occurs with the development of regenerating nodules of hepatocytes. Patients with decompensated liver\\u000a cirrhosis have a poor prognosis, and liver transplantation is often necessary. There are no effective antifibrotic treatments\\u000a for patients with chronic liver diseases. Intestinal dysbiosis

Bernd Schnabl


Intestinal immune cells in Strongyloides stercoralis infection.  

PubMed Central

BACKGROUND: Strongyloides stercoralis can cause a wide spectrum of disease in man, ranging from a chronic asymptomatic infection to a hyperinfective, often fatal syndrome. In rodents, spontaneous expulsion of Strongyloides spp occurs after experimental infection. Mast cells, goblet cells, and eosinophils have been identified as possible effectors of this expulsion. AIMS: To investigate intestinal histopathology and mucosal immunity in immunocompetent patients with chronic S stercoralis infection. METHODS: Jejunal biopsies were performed in 19 immunocompetent patients with a positive stool examination for S stercoralis and few or no symptoms, and in seven healthy controls. Specimens were processed for histopathological analysis and stained by the immunoperoxidase technique, using the following monoclonal antibodies: CD2, CD3, CD4, CD8, anti-T cell receptor (TcR) gamma/delta, RFD1 and RFD7 (two different macrophage markers), Ki67+ (proliferating) cells, antihuman leucocyte antigen (HLA)-DR, and anticollagen IV. In addition, CD25+ cells, mast cells, IgE expressing cells, calprotectin containing cells, and neutrophil elastase positive cells were stained by the alkaline phosphatase method. RESULTS: Jejunal morphology and the numbers of different T cell subsets, mast cells, IgE expressing cells, eosinophils, and goblet cells were unaffected by S stercoralis infection. Conversely, the numbers of mature macrophages and dividing enterocytes in the crypts were reduced significantly. Crypt enterocytes did not express HLA-DR in both groups. The expression of HLA-DR by villus enterocytes was also comparable in patients and controls. There were no activated (CD25+) cells in the mucosa of either patients or controls. CONCLUSIONS: Compared with seven healthy uninfected volunteers, a group of 19 Brazilians with clinically mild strongyloides infection showed no abnormality of mucosal structure and no increase in non-specific inflammatory cells. Likewise, there was no increase in mucosal T cells or macrophages. Images

Trajman, A; MacDonald, T T; Elia, C C



[Bacterial overgrowth syndrome in the small intestine: pathogenesis, clinical significance and therapy tactics].  


The redundant bacterial growth syndrome in the small intestine is associated with the increased total semination of over 10(5) CFU/ml presented by enterobacteria, bacteroids, clostridia, fusobacteria, etc. It is developed at the dysfunction of the gastrointestinal tract, insufficient bacteria inhibition at the time when they come from the large intestine (atony, stasis, bypasses) and is accompanied by the enhanced intestinal barrier permeability along with chronic diarrhea and intoxication. Intestinal absorption disorders cause B12-deficiency anemia, hypovitaminosis and protein deficiency. The redundant growth is diagnosed based on the hydrogen concentration in the expired air or bacterial inoculation of the small intestine aspirate. Tetracycline, Vancomycin, Metronidazole and aminoglycoside are used for the therapy; Amoxicillin/clavunate and cephalosporins of the second generation are also applied with success. Decontamination of the small intestine is more successful when probiotics are prescribed (both after antibiotics and independently), which suppress the opportunistic flora, protect the mucous coat, improve digestion and arrest diarrhea. Probifor or Bifidumbacterin forte in the complex with probiotics comprising lactobacteria can also have a therapeutic effect. PMID:17378388

Lykova, E A; Bondarenko, V M; Parfenov, A I; Matsulevich, T V



Apoptosis, necrosis and necroptosis: cell death regulation in the intestinal epithelium.  


Intestinal epithelial cells (IEC) are organised as a single cell layer which covers the intestine. Their primary task is to absorb nutrients present in the intestinal lumen. However, IEC also play an important role in the immune defence of our body by building a barrier that separates the bowel wall from potentially hazardous bacteria present in the gut lumen. The life cycle of IEC is determined by the time span in which cells migrate from their place of origin at the crypt base to the villus tip, from where they are shed into the lumen. Cell death in the intestinal epithelium has to be tightly regulated and irregularities might cause pathologies. Excessive cell death has been associated with chronic inflammation as seen in patients with Crohn's disease and ulcerative colitis. While until recently apoptosis was discussed as being essential for epithelial turnover and tissue homeostasis in the intestinal epithelium, recent data using gene deficient mice have challenged this concept. Moreover, an apoptosis-independent mode of programmed cell death, termed necroptosis, has been identified and described in the intestinal epithelium. The following article reviews previous studies on cell death regulation in IEC and a potential role of necroptosis for gut homeostasis. PMID:22689519

Günther, Claudia; Neumann, Helmut; Neurath, Markus F; Becker, Christoph



Intestinal glutathione: determinant of mucosal peroxide transport, metabolism, and oxidative susceptibility  

SciTech Connect

The intestine is a primary site of nutrient absorption and a critical defense barrier against dietary-derived mutagens, carcinogens, and oxidants. Accumulation of oxidants like peroxidized lipids in the gut lumen can contribute to impairment of mucosal metabolic pathways, enterocyte dysfunction independent of cell injury, and development of gut pathologies, such as inflammation and cancer. Despite this recognition, we know little of the pathways of intestinal transport, metabolism, and luminal disposition of dietary peroxides in vivo or of the underlying mechanisms of lipid peroxide-induced genesis of intestinal disease processes. This chapter summarizes our current understanding of the determinants of intestinal absorption and metabolism of peroxidized lipids. I will review experimental evidence from our laboratory and others (Table 1) supporting the pivotal role that glutathione (GSH) and reduced nicotinamide adenine dinucleotide phosphate (NADPH) play in mucosal transport and metabolism of lipid hydroperoxides and how reductant availability can be compromised under chronic stress such as hypoxia, and the influence of GSH on oxidative susceptibility, and redox contribution to genesis of gut disorders. The discussion is pertinent to understanding dietary lipid peroxides and GSH redox balance in intestinal physiology and pathophysiology and the significance of luminal GSH in preserving the integrity of the intestinal epithelium.

Aw, Tak Yee [Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932 (United States)]. E-mail:



Intestinal glutathione: determinant of mucosal peroxide transport, metabolism, and oxidative susceptibility.  


The intestine is a primary site of nutrient absorption and a critical defense barrier against dietary-derived mutagens, carcinogens, and oxidants. Accumulation of oxidants like peroxidized lipids in the gut lumen can contribute to impairment of mucosal metabolic pathways, enterocyte dysfunction independent of cell injury, and development of gut pathologies, such as inflammation and cancer. Despite this recognition, we know little of the pathways of intestinal transport, metabolism, and luminal disposition of dietary peroxides in vivo or of the underlying mechanisms of lipid peroxide-induced genesis of intestinal disease processes. This chapter summarizes our current understanding of the determinants of intestinal absorption and metabolism of peroxidized lipids. I will review experimental evidence from our laboratory and others (Table 1) supporting the pivotal role that glutathione (GSH) and reduced nicotinamide adenine dinucleotide phosphate (NADPH) play in mucosal transport and metabolism of lipid hydroperoxides and how reductant availability can be compromised under chronic stress such as hypoxia, and the influence of GSH on oxidative susceptibility, and redox contribution to genesis of gut disorders. The discussion is pertinent to understanding dietary lipid peroxides and GSH redox balance in intestinal physiology and pathophysiology and the significance of luminal GSH in preserving the integrity of the intestinal epithelium. PMID:15845421

Aw, Tak Yee



Method for identifying an intestinal phenotype  

US Patent & Trademark Office Database

The present invention relates to a method for identifying cells having a predisposition to develop an intestinal phenotype, wherein the cells are characterized by the loss of expression of the RUNX3 gene and the expression of one or more intestinal marker genes. In particular, the invention is directed to the identification of cells, which exhibit an intestinal phenotype representing a precursor of gastric cancer. Furthermore, the invention discloses a method for identifying a compound inhibiting the development of an intestinal phenotype in cells having a predisposition to develop an intestinal phenotype. Finally, the invention also relates to kits of parts for performing these methods.



Carbon monoxide ameliorates chronic murine colitis through a heme oxygenase 1- dependent pathway  

Microsoft Academic Search

Heme oxygenase (HO)-1 and its metabolic product carbon monoxide (CO) play regulatory roles in acute inflammatory states. In this study, we demonstrate that CO administration is effective as a therapeutic modality in mice with established chronic colitis. CO administration ameliorates chronic intestinal inflammation in a T helper (Th)1-mediated model of murine colitis, interleukin (IL)-10-deficient ( IL-10 ? \\/ ? )

Refaat A. F. Hegazi; Kavitha N. Rao; Aqila Mayle; Antonia R. Sepulveda; Leo E. Otterbein; Scott E. Plevy



Isolation and culture of mouse intestinal cells.  


Complex cell signal transduction mechanisms regulate intestinal epithelial shape, polarity, motility, organelles, cell membrane components as well as physical and mechanical properties to influence alimentary digestion, absorption, secretion, detoxification and fluid balance. Interactions between the epithelial cells and adjacent mesenchyme are central to intestinal homeostasis although the key regulatory molecules of specific differentiation steps remain unclear. Isolation and primary culture of heterotypic murine intestinal cells provides a model system for elucidation of essential molecular cross-talk between epithelium and mesenchyme that may provide several biological and practical advantages over transformed cell lines. An in vitro primary culture system for neonatal rat or mouse intestinal cells has been established that forms monolayers, expresses intestine-specific epithelial features including intestinal brush borders and appropriate hydrolase enzymes. Our studies confirm the promise of this method which may advance our understanding of heterotypic cellular interactions implicated in intestinal function and may provide important insights into the pathobiology of disease. PMID:20204629

Campbell, Charles Frederick



Prostacyclin inhibits gastric emptying and small-intestinal transit in rats and dogs.  


Prostacyclin (PGI2) antagonizes 16,16-dimethyl prostaglandin E2-induced diarrhea in rats, presumably by inhibiting the fluid accumulation of "enteropooling" in the small intestine. The effect of PGI2 on gastric emptying, small intestinal transit, and colonic transit was examined in rats and dogs to determine if interference with propulsion might also contribute to the antidiarrheal properties of this compound. Rats implanted with chronic duodenal cannulas were given subcutaneous PGI2 (0.1-1000 microgram/kg) followed 10 min later by intragastric 51Cr and a visually detectable duodenal transit marker. Forty-five minutes later, the animals were killed. Small-intestinal transit was expressed as the percentage of small intestinal length traveled by the visually detected marker. Gastric emptying was expressed as the percentage of the total 51Cr found in the small intestine. Subcutaneous PGI2 inhibited gastric emptying maximally at 10 micrograms/kg. Small-intestinal transit was significantly decreased at 50 micrograms/kg and almost completely suppressed at 1.0 mg/kg. Subcutaneous naloxone (0.5 mg/kg) given 10 min before and 20 min after subcutaneous PGI2 administration did not block PGI2's effects. Intravenous or oral PGI2 in doses as high as 0.2 or 10 mg/kg, respectively, had none of these effects. However, a high-dose intravenous bolus (1.0 mg/kg) or infusion (1.0 mg/kg X 45 min) both inhibited gastric emptying. Small intestinal transit was only decreased by PGI2 infusion, suggesting that this parameter was more sensitive to a sustained blood level than gastric emptying. Hourly injections of subcutaneous PGI2 (0.5 mg/kg) had no effect on rat colonic transit measured over a 3-h period after deposition of the transit marker through a colonic cannula in a manner similar to that described for small-intestinal transit above. Small-intestinal transit was also measured in dogs given a barium suspension through a chronic duodenal cannula. The animals simultaneously received subcutaneous PGI2 (10 micrograms/kg) and were given an additional treatment and an abdominal x-ray every 30 min thereafter. In vehicle-treated dogs, barium reached the cecal area in an average of 2.8 h after instillation. In PGI2-treated dogs, barium never reached the cecum in the 5-h examination period. Thus, PGI2 inhibits gastric emptying in rat and small-intestinal transit in rat and dog but has no effect on rat colonic transit. These properties could contribute to PGI2's antidiarrheal activity. PMID:6376267

Ruwart, M J; Rush, B D



Bacterial adhesion and disease activity in Helicobacter associated chronic gastritis  

Microsoft Academic Search

Ultrastructural examination of biopsies showing Helicobacter pylori associated chronic gastritis reveals close attachment between gastric surface epithelial cells and the organism. The finding of 'adhesion pedestals', which represents a cellular response to the presence of the organism, is analogous to the response of intestinal cells to enteropathogenic E coli. Thus the development of bacterial attachment sites in H pylori associated

S J Hessey; J Spencer; J I Wyatt; G Sobala; B J Rathbone; A T Axon; M F Dixon



Nonreceptor-mediated intestinal vasoconstriction in portal hypertensive rats.  


Previous studies have demonstrated that receptor-mediated vasoconstriction is impaired in chronic portal hypertension (PH). Furthermore, it has been suggested that altered vasoconstrictor effectiveness in chronic PH is due to a defect in the intracellular events associated with smooth muscle activation and not to impaired coupling of vasoconstrictors with vascular smooth muscle receptors. The present study was designed to determine whether nonreceptor-mediated vasoconstrictor responses are impaired in the PH intestinal microcirculation. Specifically, we examined the effects of aluminum fluoride-induced activation of G proteins, KCl-induced depolarization, caffeine-induced release of intracellular Ca2+, and l-indolactam-induced activation of protein kinase C on the intestinal microcirculation of normal (Norm, n = 39) and PH (n = 42) rats. The small intestine was prepared for microcirculatory studies and transferred to a video microscope. First-order arteriolar (1A) diameter and red cell velocity were measured on-line. Blood flow was calculated from the product of velocity and microvessel cross-sectional area. After a control period, the microvasculature was exposed to a solution containing aluminum chloride plus sodium fluoride, potassium chloride, caffeine, or l-indolactam. Maximal decreases in arteriolar diameter produced by aluminum fluoride, KCl, caffeine, and l-indolactam were significantly greater in Norm rats when compared with PH rats. Changes in arteriolar blood flow were also larger in Norm than in PH rats. The results of the present study provide the first direct evidence of an impaired response to second-messenger activation in the PH circulation. PMID:8048603

Wu, Z Y; Benoit, J N



Treatment of Excessive Intestinal Gas.  


Symptoms of excessive intestinal gas may be related to eructation, excessive or odoriferous gas evacuation, and/or abdominal symptom attributed to gas retention. Patients with aerophagia and excessive eructation can be usually retrained to control air swallowing, but if present, basal dyspeptic symptoms may remain. Patients with excessive or odoriferous gas evacuation may benefit from a low-flatulogenic diet. In patients with gas retention due to impaired anal evacuation, anal incoordination can be resolved by biofeedback treatment, which also improves fecal retention, and thereby reduces the time for fermentation. Other patients complaining of abdominal symptoms that they attribute to intestinal gas, probably have irritable bowel syndrome or functional bloating, and their treatment options specifically targeting gas-related symptoms basically include prokinetics and spasmolytics. There is no consistent evidence to support the use of gas-reducing substances, such as charcoal or simethicone. PMID:15238205

Azpiroz, Fernando; Serra, Jordi



Treatment of excessive intestinal gas  

Microsoft Academic Search

Opinion statement  Symptoms of excessive intestinal gas may be related to eructation, excessive or odoriferous gas evacuation, and\\/or abdominal\\u000a symptom attributed to gas retention. Patients with aerophagia and excessive eructation can be usually retrained to control\\u000a air swallowing, but if present, basal dyspeptic symptoms may remain. Patients with excessive or odoriferous gas evacuation\\u000a may benefit from a low-flatulogenic diet. In patients

Fernando Azpiroz; Jordi Serra



Intestinal complications of Behçet's disease.  


We report a case of a young female patient with long-standing oral and genital Behçet's disease (BD), who presented with progressive severe colonic inflammation and perforation, requiring multiple laparotomies. The case had ultimately a favourable outcome despite posing a number of diagnostic and therapeutic challenges. Intestinal complications, although rare, should be considered as important differential diagnoses in patients with BD presenting with abdominal pain, and is a difficult-to-prove differential diagnosis to Crohn's disease. PMID:23917369

Kovacs, D Botond; Ray, Dipak K; Dasgupta, Kaushik; Borowski, David W



Redox biology of the intestine  

PubMed Central

The intestinal tract, known for its capability for self-renew, represents the first barrier of defense between the organism and its luminal environment. The thiol/disulfide redox systems comprising the glutathione/glutathione disulfide (GSH/GSSG), cysteine/cystine (Cys/CySS) and reduced and oxidized thioredoxin (Trx/TrxSS) redox couples play important roles in preserving tissue redox homeostasis, metabolic functions, and cellular integrity. Control of the thiol-disulfide status at the luminal surface is essential for maintaining mucus fluidity and absorption of nutrients, and protection against chemical-induced oxidant injury. Within intestinal cells, these redox couples preserve an environment that supports physiological processes and orchestrates networks of enzymatic reactions against oxidative stress. In this review, we focus on the intestinal redox and antioxidant systems, their subcellular compartmentation, redox signaling and epithelial turnover, and contribution of luminal microbiota, key aspects that are relevant to understanding redox-dependent processes in gut biology with implications for degenerative digestive disorders, such as inflammation and cancer.

Circu, Magdalena L.; Aw, Tak Yee



[Intestinal anastomosis with biodegradable ring].  


The authors report their experience using biofragmentable anastomosis ring (BAR) in bowel anastomosis. Starting January 1993 to February 1994, 46 intestinal anastomoses were performed using BAR, and particularly 39 end-to-end colo-colostomies, 2 end-to-side colo-colostomies and 5 end-to-side ileo-colostomies. 35 patients were affected by colonic neoplasm, 5 patients by diverticular colonic complications- and 5 patients by several unusual bowel diseases. Four emergency operations were performed, while 42 patients had an accurate bowel preparation before surgery. In this series of patients one case of preoperative mortality is reported, due to massive pulmonary embolism. Instead several minor complications occurred in other patients, such as paroxysmal atrial fibrillation (one case), basal pleuritis (one case), hyperpyrexia (three cases), temporary subocclusion or delayed canalization (five cases). Only one patient suffered from intestinal occlusion induced by adhesions and a second laparotomy was required. Delayed canalization seems to be caused by the small size of the BAR employed (25 mm) or by inadequate intestinal preparation, that usually occurs in emergency operations. After surgery all patients were followed up and 18 of them were examined by coloscopy six months after surgery. No clinical problem connected with bowel anastomosis was reported and all anastomosis looked quite previous and resilient. No anastomotic stenosis was found. In our experience and from recent reviewed reports, BAR seems to be a rapid, effective and safe device for sutureless bowel anastomosis. PMID:9072720

Ragni, F; Braga, M; Balzano, R; Piccini, I; Pezzola, D; Pinelli, D; Pasini, M; Roncali, S; Ghedi, M; Damiani, E



[Intestinal infarction (pathogenesis, diagnosis, therapy)].  


In spite of progress in medical treatment and surgery, intestinal infarctus is still a dramatic clinical event responsible for the death of 80% of all cases involved. The causes of such a remarkable failure rate are due, on one hand, to the precocity of these ischemic intestinal lesions with the resultant serious humoral and septic damage and, on the other hand, to the difficulty and delay in diagnosis. The etiological diagnosis is still more difficult even with the use of angiography which, in any case, cannot be systematically performed on all patients arriving into care. Treatment is based on surgical therapy: intestinal resections with possible subsequent revascularizations and "second looks" and on complimentary medical therapy with vasodilators and anticoagulants. Of 27 cases personally encountered, the total mortality was 70% with a survival rate of 5 cases out of 8 resection operations (62.5%) and of 2 cases out of 5 (40%) embolectomies of the superior mesenteric artery. Significant improvement in results can be obtained by earlier diagnosis obtained by sensitization of cardiologist colleagues and others working in the intensive care units where those patients of high risk are often found. PMID:6529184

Tagliacozzo, S; Daniele, G M; Faret, S


The treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: a case report.  


Recent investigations have shown that bacterial overgrowth of the small intestine is associated with a number of functional somatic disorders, including irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome. A number of controlled studies have shown that enteric-coated peppermint oil (ECPO) is of benefit in the treatment of IBS. However, despite evidence of strong antimicrobial activity, ECPO has not been specifically investigated for an effect on small intestinal bacterial overgrowth (SIBO). A case report of a patient with SIBO who showed marked subjective improvement in IBS-like symptoms and significant reductions in hydrogen production after treatment with ECPO is presented. While further investigation is necessary, the results in this case suggest one of the mechanisms by which ECPO improves IBS symptoms is antimicrobial activity in the small intestine. PMID:12410625

Logan, Alan C; Beaulne, Tracey M



Infection with feline immunodeficiency virus alters intestinal epithelial transport and mucosal immune responses to probiotics.  


HIV infection is associated with intestinal mucosal dysfunction and probiotics offer the therapeutic potential to enhance the mucosal barrier in HIV+ patients. To evaluate the response of immunocompromised hosts to probiotics, we orally administered Lactobacillus acidophilus to cats with chronic feline immunodeficiency virus (FIV) infection. FIV infection significantly affected transcellular, but not paracellular, transport of small molecules across the intestinal epithelium. Additionally, probiotic treatment of FIV+ cats resulted in changes in cytokine release and mucosal leukocyte percentages that were not paralleled in FIV- cats. These results suggest a novel role for FIV in upregulating transcellular transport across the gastrointestinal epithelial barrier and demonstrate the potential therapeutic use of probiotic bacteria to restore intestinal homeostasis. PMID:23453768

Stoeker, Laura L; Overman, Elizabeth L; Nordone, Shila K; Moeser, Adam J; Simões, Rita D; Dean, Gregg A



[Some pathogenetic mechanisms of growth retardation in enzymopathy of the small intestine in children].  


As many as 74 patients with enzymopathy of the small intestine aged 1-7 years were examined. Of these, 41 had coeliac disease, 18 patients presented with the coleiac syndrome having developed in the wake of grave forms of frequent relapses of chronic postinfectious enterocolitis, 15 patients presenting with disaccharidis intolerantis. The control group comprised 15 healthy children at similar ages. Identified in grave forms of intestinal enzymopathy was a somatogenic form of growth inhibition that proved to be more prominent in patients with coeliac disease. Abnormalities in the blood serum content of somatotrophic hormone, thyroid hormones, insulin were detectable with different degree of significance in patients with coeliac disease and intestinal infantilism syndrome. PMID:12669540

Akhmedova, I M



Visceral Myopathy Presenting as Acute Appendicitis and Ogilvie Syndrome  

PubMed Central

Background. Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It often presents with symptoms of chronic intestinal pseudoobstruction of colon. We report a case of visceral myopathy which presented to us as acute appendicitis and Ogilvie syndrome, and we managed it surgically. Method and Result. A case report of 20-year female clinically presented as acute appendicitis and we performed laparoscopic exploration which revealed inflamed appendix with grossly dilated ascending colon. We performed laparoscopic appendectomy and postoperatively managed the patients with IV fluids, antibiotics, neostigmine, and extended length rectal tube for enema and decompression. During postoperative period, she developed abdomen distension and peritonitis, and we ordered abdomen CT which revealed colon pseudo- obstruction. We performed right hemicolectomy with permanent ileostomy, and the histopathology reports of resected colon were visceral myopathy. Conclusion. Visceral myopathy is very rare group of disease and poorly understood condition that may present with chronic or acute intestinal pseudo-obstruction and often mimic other more common gastrointestinal disease. VM should be considered as differential diagnosis whenever the patient presents with acute appendicitis, uncharacteristic abdominal symptoms, recurrent attacks of abdominal distention, and pain with no radiological evidence of intestinal obstruction.

Kharbuja, Punyaram; Thakur, Raghvendra; Suo, Jian



Branchial versus intestinal zinc uptake in wild yellow perch ( Perca flavescens ) from reference and metal-contaminated aquatic ecosystems  

Microsoft Academic Search

Zinc is an essential micronutrient for freshwater fish but can be toxic to them at elevated concentrations. Therefore, the regulation of zinc uptake is important in maintaining homeostasis when fish are chronically exposed to elevated zinc in nature. This study examined the kinetics of in vivo branchial and in vitro intestinal zinc uptake in wild yellow perch (Perca flavescens) from

Soumya Niyogi; Gregory G. Pyle; Chris M. Wood



Vasoactive intestinal peptide inhibits TNF-?-induced apoptotic events in acinar cells from nonobese diabetic mice submandibular glands  

Microsoft Academic Search

INTRODUCTION: The role of apoptotic secretory epithelium as a pro-inflammatory triggering factor of exocrine dysfunction is currently explored in Sjogren's syndrome patients and in the nonobese diabetic (NOD) mouse model. Vasoactive intestinal peptide (VIP) has anti-inflammatory effects in various models of chronic inflammation. Our goal was to analyse the effect of TNF-? on apoptotic mediators in isolated acinar cells from

Mario Calafat; Luciana Larocca; Valeria Roca; Vanesa Hauk; Nicolás Pregi; Alcira Nesse; Claudia Pérez Leirós



Effect of codeine and loperamide on upper intestinal transit and absorption in normal subjects and patients with postvagotomy diarrhoea  

Microsoft Academic Search

Patients with chronic severe diarrhoea after truncal vagotomy and pyloroplasty are often difficult to treat using conventional antidiarrhoeal drugs and remain severely disabled. We examined the effect of two drugs, codeine phosphate and loperamide, on upper intestinal transit and carbohydrate absorption, measured non-invasively by serial exhaled breath hydrogen monitoring, in patients with postvagotomy diarrhoea who had previously failed to gain

J D OBrien; D G Thompson; A McIntyre; W R Burnham; E Walker



Epithelial Intestinal Cell Apoptosis Induced by Helicobacter pylori Depends on Expression of the cag Pathogenicity Island Phenotype  

Microsoft Academic Search

Helicobacter pylori has been shown to induce chronic active gastritis and peptic ulcer and may contribute to the development of duodenal ulcer. Previous studies have shown that H. pylori mediates apoptosis of gastric epithelial cells via a Fas-dependent pathway. However, evidence for the induction of such a mechanism in intestinal epithelial cells (IEC) by H. pylori infection has not been




Intestinal disaccharidases in malnourished infant rats.  


In infants suffering from protein-calorie malnutrition, the decreased intestinal mucosal lactase specific activity could be due either to the protein-calorie malnutrition or to the commonly associated enteritis (viral or bacterial) and intestinal parasites. We studied intestinal mucosal disaccharidase (lactase, sucrase, and maltase) specific activity in suckling (1 and 2 wk old), weanling (3 wk old), and postweaning (4 and 6 wk old) control and growth-retarded (malnourished) rats. Growth retardation was induced by feeding mother rats and postweaning rats a diet deficient in protein. In the malnourished rats, with few exceptions, specific activity of the disaccharidases in the intestinal mucosa were similar to those in the corresponding control groups of rats. However, because of marked mucosal atrophy total intestinal mucosal disaccharidase activities were more than 50% lower in the malnourished rats. These findings suggest that the specific activity of the intestinal mucosal disaccharidases is not affected by malnutrition per se. PMID:6792898

Jambunathan, L R; Neuhoff, D; Younoszai, M K



Effects of interactions between intestinal microbiota and intestinal macrophages on health.  


Macrophages reside in every tissue of the body and play an important role in maintaining homeostasis. The intestinal mucosa is the largest immune organ and harbors macrophages in abundance. Dysfunction of intestinal macrophages is characteristic of patients with certain inflammatory bowel diseases. Although intestinal macrophages exhibit hyporesponsiveness to foreign substances, including various bacterial products, their physiological functions are unknown, but may be related to the contribution of intestinal bacteria to the maintenance of various physiological functions of the host. Moreover, recent reports suggest that there are associations between intestinal microbiota and the onset of pathologies, such as diverse metabolic syndromes, depression, and cancer. Evidence indicates that the host's immune response to intestinal microbiota may be etiologically-linked to these diseases; however, the mechanisms are poorly understood. In the present review, we discuss the possibility that intestinal microbiota influence health through the function of intestinal macrophages. PMID:23780969

Nakata, Kazue; Yamamoto, Mai; Inagawa, Hiroyuki; Soma, Gen-Ichiro



Health Technology Review No. 5. Small Intestine and Combined Liver-Small Intestine Transplantation, August 1993.  

National Technical Information Service (NTIS)

Recent published accounts of experiences with either small intestine or combined liver-small intestine transplants indicate that both types of transplantations may be feasible, with some expectation of successful outcome in terms of graft survival and ben...

S. S. Hotta



Visualization of Chinese Digitized Intestinal Tract  

Microsoft Academic Search

In this study, the successive cross-section images of the intestinal tract were retrieved from the dataset of the first visible Chinese woman (CVH-2) to build up a 3D digitized visible model of human intestine. Following the segmentation on these 2D section images in Photoshop software, the main anatomical structures of the intestine were reconstructed and visualized on a workstation by

Hongyan Luo; Weiping Yang; Li Liu; Min Li; Liwen Tan



Microbial Sensing by the Intestinal Epithelium in the Pathogenesis of Inflammatory Bowel Disease  

PubMed Central

Recent years have raised evidence that the intestinal microbiota plays a crucial role in the pathogenesis of chronic inflammatory bowels diseases. This evidence comes from several observations. First, animals raised under germ-free conditions do not develop intestinal inflammation in several different model systems. Second, antibiotics are able to modulate the course of experimental colitis. Third, genetic polymorphisms in a variety of genes of the innate immune system have been associated with chronic intestinal inflammatory diseases. Dysfunction of these molecules results in an inappropriate response to bacterial and antigenic stimulation of the innate immune system in the gastrointestinal tract. Variants of pattern recognition receptors such as NOD2 or TLRs by which commensal and pathogenic bacteria can be detected have been shown to be involved in the pathogenesis of IBD. But not only pathways of microbial detection but also intracellular ways of bacterial processing such as autophagosome function are associated with the risk to develop Crohn's disease. Thus, the “environment concept” and the “genetic concept” of inflammatory bowel disease pathophysiology are converging via the intestinal microbiota and the recognition mechanisms for an invasion of members of the microbiota into the mucosa.

Scharl, Michael; Rogler, Gerhard



AMP-activated Protein Kinase Mediates the Interferon-?-induced Decrease in Intestinal Epithelial Barrier Function*  

PubMed Central

Impaired epithelial barrier function plays a crucial role in the pathogenesis of inflammatory bowel disease. Elevated levels of the pro-inflammatory cytokine, interferon-? (IFN?), are believed to be prominently involved in the pathogenesis of Crohn disease. Treatment of T84 intestinal epithelial cells with IFN? severely impairs their barrier properties measured as transepithelial electrical resistance (TER) or permeability and reduces the expression of tight junction proteins such as occludin and zonula occludens-1 (ZO-1). However, little is known about the signaling events that are involved. The cellular energy sensor, AMP-activated protein kinase (AMPK), is activated in response to cellular stress, as occurs during inflammation. The aim of this study was to investigate a possible role for AMPK in mediating IFN?-induced effects on the intestinal epithelial barrier. We found that IFN? activates AMPK by phosphorylation, independent of intracellular energy levels. Inhibition of AMPK prevents, at least in part, the IFN?-induced decrease in TER. Furthermore, AMPK knockdown prevented the increased epithelial permeability, the decreased TER, and the decrease in occludin and ZO-1 caused by IFN? treatment of T84 cells. However, AMPK activity alone was not sufficient to cause alterations in epithelial barrier function. These data show a novel role for AMPK, in concert with other signals induced by IFN?, in mediating reduced epithelial barrier function in a cell model of chronic intestinal inflammation. These findings may implicate AMPK in the pathogenesis of chronic intestinal inflammatory conditions, such as inflammatory bowel disease.

Scharl, Michael; Paul, Gisela; Barrett, Kim E.; McCole, Declan F.



Intraoperative scintigraphy for active small intestinal bleeding  

SciTech Connect

Localizing active sites of bleeding within the small intestine remains a difficult task. Endoscopic, angiographic or scintigraphic studies may point to the small intestine as the site of blood loss, but at operation, without a palpable lesion, the exact site of bleeding remains elusive. Patients are managed at laparotomy with intraoperative endoscopy, angiography, multiple enterotomies, blind resections, or placement of an enterostomy. We describe two patients in whom intraoperative scintigraphy accurately identified active sites of bleeding in the small intestine when other modalities failed. Intraoperative scintigraphy is rapid, easy to perform and is an effective means of identifying active sites of bleeding within the small intestine.

Biener, A.; Palestro, C.; Lewis, B.S.; Katz, L.B. (Mount Sinai Medical Center, New York, NY (USA))



Intestinal barriers to bacteria and their toxins  

SciTech Connect

Immunologic and nonimmunologic processes work together to protect the host from the multitude of microorganisms residing within the intestinal lumen. Mechanical integrity of the intestinal epithelium, mucus in combination with secretory antibody, antimicrobial metabolites of indigenous microorganisms, and peristalsis each limit proliferation and systemic dissemination of enteric pathogens. Uptake of microorganisms by Peyer's patches and other intestinal lymphoid structures and translocation circumvent the mucosal barrier, especially in immunosuppressed individuals. Improved understanding of the composition and limitation of the intestinal barrier, coupled with advances in genetic engineering of immunogenic bacteria, development of oral delivery systems, and immunomodulators, now make enhancement of mucosal barriers feasible. 32 references.

Walker, R.I.; Owen, R.L. (Naval Medical Research Institute, Bethesda, MD (USA))



A mathematical model of intestinal oedema formation.  


Intestinal oedema is a medical condition referring to the build-up of excess fluid in the interstitial spaces of the intestinal wall tissue. Intestinal oedema is known to produce a decrease in intestinal transit caused by a decrease in smooth muscle contractility, which can lead to numerous medical problems for the patient. Interstitial volume regulation has thus far been modelled with ordinary differential equations, or with a partial differential equation system where volume changes depend only on the current pressure and not on updated tissue stress. In this work, we present a computational, partial differential equation model of intestinal oedema formation that overcomes the limitations of past work to present a comprehensive model of the phenomenon. This model includes mass and momentum balance equations which give a time evolution of the interstitial pressure, intestinal volume changes and stress. The model also accounts for the spatially varying mechanical properties of the intestinal tissue and the inhomogeneous distribution of fluid-leaking capillaries that create oedema. The intestinal wall is modelled as a multi-layered, deforming, poroelastic medium, and the system of equations is solved using a discontinuous Galerkin method. To validate the model, simulation results are compared with results from four experimental scenarios. A sensitivity analysis is also provided. The model is able to capture the final submucosal interstitial pressure and total fluid volume change for all four experimental cases, and provide further insight into the distribution of these quantities across the intestinal wall. PMID:23036806

Young, Jennifer; Rivière, Béatrice; Cox, Charles S; Uray, Karen



Bile acids in regulation of intestinal physiology.  


In addition to their roles in facilitating lipid digestion and absorption, bile acids are recognized as important regulators of intestinal function. Exposure to bile acids can dramatically influence intestinal transport and barrier properties; in recent years, they have also become appreciated as important factors in regulating cell growth and survival. Indeed, few cells reside within the intestinal mucosa that are not altered to some degree by exposure to bile acids. The past decade saw great advances in the knowledge of how bile acids exert their actions at the cellular and molecular levels. In this review, we summarize the current understanding of the role of bile acids in regulation of intestinal physiology. PMID:19765365

Keating, Niamh; Keely, Stephen J



COX2 inhibition with rofecoxib does not increase intestinal permeability in healthy subjects: a double blind crossover study comparing rofecoxib with placebo and indomethacin  

Microsoft Academic Search

BACKGROUNDAcute and chronic use of non-steroidal anti-inflammatory drugs can increase intestinal permeability. Rofecoxib, which selectively inhibits cyclooxygenase 2 (COX-2), is a novel anti-inflammatory drug with the potential to produce minimal gastrointestinal toxic effects while retaining clinical efficacy.AIMSTo assess the potential for rofecoxib to affect the intestine adversely, in comparison with placebo and indomethacin.SUBJECTSThirty nine healthy subjects (aged 24–30 years).METHODWe performed

G Sigthorsson; R Crane; T Simon; M Hoover; H Quan; J Bolognese; I Bjarnason



Selenium-Enriched Broccoli Decreases Intestinal Tumorigenesis in Multiple Intestinal Neoplasia Mice  

Microsoft Academic Search

Multiple intestinal neoplasia (Min) mice are a good model for the investigation of the effects of dietary alterations in a genetic model for intestinal cancer. Previ- ous studies have shown that selenium-enriched broccoli is protective against chemically induced colon cancer sus- ceptibility. This study investigated whether selenium-en- riched broccoli would be protective against intestinal can- cer susceptibility in Min mice.

Cindy D. Davis; Huawei Zeng; John W. Finley


Intestinal T-cell responses to high-molecular-weight glutenins in celiac disease  

Microsoft Academic Search

Background & Aims:The chronic, small intestinal inflammation that defines celiac disease is initiated by a HLA-DQ2 restricted T-cell response to ingested gluten peptides after their in vivo deamidation by tissue transglutaminase (TG2). To date, celiac disease can only be treated by a lifelong abstinence from foods that contain wheat, rye, or barley; better therapeutic options are hence needed. An attractive

ØYvind Molberg; Nina Solheim flÆte; Tore Jensen; Knut E. A Lundin; Helene Arentz-Hansen; Olin D Anderson; Anne Kjersti Uhlen; Ludvig M Sollid



Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis  

PubMed Central

Intestinal microbiota metabolism of choline/phosphatidylcholine produces trimethylamine (TMA), which is further metabolized to a proatherogenic species, trimethylamine-N-oxide (TMAO). Herein we demonstrate that intestinal microbiota metabolism of dietary L-carnitine, a trimethylamine abundant in red meat, also produces TMAO and accelerates atherosclerosis. Omnivorous subjects are shown to produce significantly more TMAO than vegans/vegetarians following ingestion of L-carnitine through a microbiota-dependent mechanism. Specific bacterial taxa in human feces are shown to associate with both plasma TMAO and dietary status. Plasma L-carnitine levels in subjects undergoing cardiac evaluation (n = 2,595) predict increased risks for both prevalent cardiovascular disease (CVD) and incident major adverse cardiac events (MI, stroke or death), but only among subjects with concurrently high TMAO levels. Chronic dietary L-carnitine supplementation in mice significantly altered cecal microbial composition, markedly enhanced synthesis of TMA/TMAO, and increased atherosclerosis, but not following suppression of intestinal microbiota. Dietary supplementation of TMAO, or either carnitine or choline in mice with intact intestinal microbiota, significantly reduced reverse cholesterol transport in vivo. Intestinal microbiota may thus participate in the well-established link between increased red meat consumption and CVD risk.

Koeth, Robert A.; Wang, Zeneng; Levison, Bruce S.; Buffa, Jennifer A.; Org, Elin; Sheehy, Brendan T.; Britt, Earl B.; Fu, Xiaoming; Wu, Yuping; Li, Lin; Smith, Jonathan D.; DiDonato, Joseph A.; Chen, Jun; Li, Hongzhe; Wu, Gary D.; Lewis, James D.; Warrier, Manya; Brown, J. Mark; Krauss, Ronald M.; Tang, W. H. Wilson; Bushman, Frederic D.; Lusis, Aldons J.; Hazen, Stanley L.



The clinicopathological features of extensive small intestinal CD4 T cell infiltration  

PubMed Central

METHODS—Four patients with clinicopathological features suggesting a new distinct entity defining extensive small intestinal CD4 T cell infiltration were observed.?RESULTS—All four patients presented with chronic diarrhoea, malabsorption, and weight loss. Biopsy specimens of the small intestine disclosed extensive and diffuse infiltration of the lamina propria by pleomorphic small T lymphocytes, which were positive for CD3, CD4, CD5, and the ? chain of T cell receptor in all three cases studied and negative for CD103 in all three cases studied. It is notable that, in all invaded areas, the infiltrating cells showed no histological change throughout the whole evolution. In three patients, lymphocyte proliferation was monoclonal and there was extraintestinal involvement. In one patient, lymphoproliferation was oligoclonal and confined to the small intestine. In all four patients, there was no evidence of coeliac disease. Although none of the four patients responded to single or multiple drug chemotherapy, median survival was five years.?CONCLUSION—Extensive small intestinal CD4 T cell infiltration is a rare entity, distinct from coeliac disease and associated with prolonged survival.???Keywords: CD4; T cells; lymphocytes; small intestine

Carbonnel, F; d'Almagne, H; Lavergne, A; Matuchansky, C; Brouet, J; Sigaux, F; Beaugerie, L; Nemeth, J; Coffin, B; Cosnes, J; Gendre, J; Rambaud, J



[Glucose absorption from mono- and oligosaccharide solutions in the rat small intestine in vivo].  


The rates of maltose and maltotriose hydrolysis, and glucose absorption in the isolated loop of the rat small intestine, perfused by isocaloric solutions of the above substrates, were examined in chronic experiments. In all the experiments, the rates of glucose absorption from the solutions of maltose and maltotriose (M- and MT-glucose, respectively) were almost the same as those from the isocaloric solutions of free glucose (G-glucose). The rate of water absorption in the isolated intestinal loop was significantly higher under the perfusion with maltose (100 mM) and maltotriose (66.6 mM) solutions than under the perfusion with equivalent glucose solutions. The results of mathematical simulation, in which absorptive surface of the small intestine was approximated as a folded surface with an adjoining zone of diffusion, were in a good agreement with the experimental data. The model showed that in the range of physiological concentrations of the substrates their transfer across the pre-epithelial layer by water flux seemed to play a minor role as compared with a transfer by diffusion. According the results obtained, the most significant factors that influence the efficiency of coupling between hydrolysis and absorption of nutrients, are following: a complex geometry of intestinal surface, the pre-epithelial diffusion layer, the rate of water absorption (secretion) in the intestine. PMID:20795480

Gruzdkov, A A; Gromova, L V; Grishina, E V



Kinase suppressor of Ras-1 protects intestinal epithelium from cytokine-mediated apoptosis during inflammation  

PubMed Central

TNF plays a pathogenic role in inflammatory bowel diseases (IBDs), which are characterized by altered cytokine production and increased intestinal epithelial cell apoptosis. In vitro studies suggest that kinase suppressor of Ras-1 (KSR1) is an essential regulatory kinase for TNF-stimulated survival pathways in intestinal epithelial cell lines. Here we use a KSR1-deficient mouse model to study the role of KSR1 in regulating intestinal cell fate during cytokine-mediated inflammation. We show that KSR1 and its target signaling pathways are activated in inflamed colon mucosa. Loss of KSR1 increases susceptibility to chronic colitis and TNF-induced apoptosis in the intestinal epithelial cell. Furthermore, disruption of KSR1 expression enhances TNF-induced apoptosis in mouse colon epithelial cells and is associated with a failure to activate antiapoptotic signals including Raf-1/MEK/ERK, NF-?B, and Akt/protein kinase B. These effects are reversed by WT, but not kinase-inactive, KSR1. We conclude that KSR1 has an essential protective role in the intestinal epithelial cell during inflammation through activation of cell survival pathways.

Yan, Fang; John, Sutha K.; Wilson, Guinn; Jones, David S.; Washington, M. Kay; Polk, D. Brent



Bacterial translocation and changes in the intestinal microbiome associated with alcoholic liver disease  

PubMed Central

Alcoholic liver disease progresses through several stages of tissue damage, from simple steatosis to alcoholic hepatitis, fibrosis, or cirrhosis. Alcohol also affects the intestine, increases intestinal permeability and changes the bacterial microflora. Liver disease severity correlates with levels of systemic bacterial products in patients, and experimental alcoholic liver disease is dependent on gut derived bacterial products in mice. Supporting evidence for the importance of bacterial translocation comes from animal studies demonstrating that intestinal decontamination is associated with decreased liver fibrogenesis. In addition, mice with a gene mutation or deletion encoding receptors for either bacterial products or signaling molecules downstream from these receptors, are resistant to alcohol-induced liver disease. Despite this strong association, the exact molecular mechanism of bacterial translocation and of how changes in the intestinal microbiome contribute to liver disease progression remains largely unknown. In this review we will summarize evidence for bacterial translocation and enteric microbial changes in response to alcoholic liver injury and chronic alcoholic liver disease. We will further describe consequences of intestinal dysbiosis on host biology. We finally discuss how therapeutic interventions may modify the gastrointestinal microflora and prevent or reduce alcoholic liver disease progression.

Yan, Arthur W; Schnabl, Bernd



New ways of thinking about (and teaching about) intestinal epithelial function (Summary)  

NSDL National Science Digital Library

The intestinal epithelium has important ion transport and barrier functions that contribute pivotally to normal physiological functioning of the intestine and other body systems. These functions are also frequently the target of dysfunction that, in turn, results in specific digestive disease states, such as diarrheal illnesses. Three emerging concepts are discussed with respect to ion transport: the complex interplay of intracellular signals that both activate and inhibit chloride secretion; the role of multiprotein complexes in the regulation of ion transport, taking sodium/hydrogen exchange as an example; and acute and chronic regulation of colonic sodium absorption, involving both sodium channel internalization and de novo synthesis of new channels. Similarly, recently obtained information about the molecular components of epithelial tight junctions and the ways in which tight junctions are regulated both in health and disease are discussed to exemplify ways to teach about intestinal barrier properties. Finally, both genetically determined intestinal diseases and those arising as a result of infections and/or inflammation are described, and these can be used as the means to enhance the basic and clinical relevance of teaching about intestinal epithelial physiology as well as the impact that the understanding of such physiology has had on associated therapeutics. The article also indicates, where relevant, how different approaches may be used effectively to teach related concepts to graduate versus medical/professional student audiences.



Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis.  


Intestinal microbiota metabolism of choline and phosphatidylcholine produces trimethylamine (TMA), which is further metabolized to a proatherogenic species, trimethylamine-N-oxide (TMAO). We demonstrate here that metabolism by intestinal microbiota of dietary L-carnitine, a trimethylamine abundant in red meat, also produces TMAO and accelerates atherosclerosis in mice. Omnivorous human subjects produced more TMAO than did vegans or vegetarians following ingestion of L-carnitine through a microbiota-dependent mechanism. The presence of specific bacterial taxa in human feces was associated with both plasma TMAO concentration and dietary status. Plasma L-carnitine levels in subjects undergoing cardiac evaluation (n = 2,595) predicted increased risks for both prevalent cardiovascular disease (CVD) and incident major adverse cardiac events (myocardial infarction, stroke or death), but only among subjects with concurrently high TMAO levels. Chronic dietary L-carnitine supplementation in mice altered cecal microbial composition, markedly enhanced synthesis of TMA and TMAO, and increased atherosclerosis, but this did not occur if intestinal microbiota was concurrently suppressed. In mice with an intact intestinal microbiota, dietary supplementation with TMAO or either carnitine or choline reduced in vivo reverse cholesterol transport. Intestinal microbiota may thus contribute to the well-established link between high levels of red meat consumption and CVD risk. PMID:23563705

Koeth, Robert A; Wang, Zeneng; Levison, Bruce S; Buffa, Jennifer A; Org, Elin; Sheehy, Brendan T; Britt, Earl B; Fu, Xiaoming; Wu, Yuping; Li, Lin; Smith, Jonathan D; DiDonato, Joseph A; Chen, Jun; Li, Hongzhe; Wu, Gary D; Lewis, James D; Warrier, Manya; Brown, J Mark; Krauss, Ronald M; Tang, W H Wilson; Bushman, Frederic D; Lusis, Aldons J; Hazen, Stanley L



Chronic Rhinosinusitis  

Microsoft Academic Search

\\u000a Rhinosinusitis describes a group of inflammatory conditions of the nasal mucosa and paranasal sinuses that affect 31 million\\u000a people in the USA each year. When the term chronic rhinosinusitis (CRS) is used, it implies that the condition has persisted\\u000a for more than 12 weeks despite medical therapy. The diagnosis of CRS requires the presence of at least two of the

Philip Wexler; Helen Hollingsworth


[Chronic pneumonia?].  


The differential diagnosis of persistent radiologic pulmonary shadow is broad and is illustrated and discussed with the help of four patients histories. The term chronic pneumonia is a misnomer. Particularly, slowly growing types of lung cancer should be considered as a potential etiology. They are potentially curable by surgical resection. Other diseases can be treated as soon as they are specified with appropriate diagnostic methods. PMID:23188777

Russi, E



Chronic Diseases  

Microsoft Academic Search

Although diabetes mellitus, cardiovascular disease, and human immunodeficiency virus infection are three separate entities,\\u000a each has causal and non-causal risk factors that are common in the stage 5 chronic kidney disease population. The medical\\u000a nutrition therapies are similar, which emphasize adequate protein and energy intakes, fluid control, and possibly carbohydrate\\u000a and fat modifications. Each patient requires an individualized evaluation, taking

Sharon R. Schatz


Intestinal Phospholipase, a Novel Enzyme  

PubMed Central

We evaluated phospholipase activity in the intestine of rats and other species. Phospholipase activity was assayed by a surface barostat technique or an egg yolk titration system. Mucosal activity was found only by the surface barostat technique with phosphatidylglycerol as substrate; it was not found with phosphatidylcholine as substrate in assays by either technique. In gut luminal fluid activity was found when both phosphatidylcholine and phosphatidylglycerol were used as substrate in assays by the surface barostat technique, and phosphatidylcholine as substrate yielded activity in egg yolk titration. In rats in which pancreatic juice had been diverted, mucosal and gut luminal phospholipase activity was greater than in controls, thus demonstrating that enzyme activity was not due to pancreatic phospholipase. Bacterial origin of phospholipase activity was excluded in that phospholipase activity was found in germ-free rats; gastric and salivary gland origins were excluded in that continued phospholipase activity was found in rats with gastric fistula. The physiological importance of the enzyme was established by the finding that rats with pancreatic fistula absorbed 111 ?mol of phosphatidylcholine and that controls absorbed 119 ?mol of a 135-?mol load. Activity was found to be three times greater in the distal than in the proximal intestine; in cryptal cells it was 10 times greater than in villus tip cells. 65% of the activity in the gut lumen was tightly bound to particulate matter. We propose that intestinal phospholipase may be important in gut bacterial control, in the digestion of vegetable matter (phosphatidylglycerol is a major phospholipid in both plants and bacteria), and in the digestion of phospholipids in the gut lumen.

Mansbach, Charles M.; Pieroni, Gerard; Verger, Robert



Anti-Alpha-Enolase Antibody as a Serologic Marker and Its Correlation with Disease Severity in Intestinal Behçet’s Disease  

Microsoft Academic Search

Background  Intestinal Behçet’s disease (BD) is a chronic inflammatory bowel disease, as are Crohn’s disease (CD) and ulcerative colitis\\u000a (UC). But unlike CD and UC, serologic markers for intestinal BD are not well known. Recently, anti-?-enolase antibody (AAEA)\\u000a has been detected in sera from BD patients.\\u000a \\u000a \\u000a \\u000a \\u000a Aims  The aim of this study was to evaluate the prevalence of AAEA in intestinal BD

Sung Jae Shin; Byung Chang Kim; Tae Il Kim; Sang Kil Lee; Kwang Hoon Lee; Won Ho Kim



Sucrase and Sugar Transport in the Small Intestine.  

National Technical Information Service (NTIS)

Intestinal sucrase is activated by Na(+) in the same way and with the same dissociation constants as intestinal sugar transport is. Some inhibition constants have been estimated for other alkali ions for both sucrase and intestinal sugar transport. Both t...

G. Semenza



[Disorders of intestinal absorption in patients treated with cytostatic chemotherapy].  


We have investigated the acute and chronic side effects of cancer chemotherapy on the intestinal absorption of adult patients with neoplastic diseases. D-xylose absorption was reduced by 35% in 34 of 50 patients within 48 hours after one course (p less than 0.001), while the vitamin B12 absorption was diminished by 41% in 27 of 38 patients (p less than 0.001). The serum digoxin level fell in 7 of 8 patients by 43% at the first day (p less than 0.01) and normalized after one week. Electron microscopy of the jejunal biopsy specimens revealed damages of the microvilli and defects in the glycocalix. Chronic effects, which were measured after several courses and a pause of four weeks, showed a diminished D-xylose absorption of 36% in 16 of 19 cases (p less than 0.01). Vitamin B12 absorption was reduced by 37% in 11 of 13 patients (p less than 0.01). Microscopical investigations of the jejunum revealed a shortening of the villi and a destruction of microvilli. Acute and chronic malabsorption after cancer chemotherapy should be considered in patients, who are treated with enteral medication and nutrition. PMID:2588735

Hürter, T; Reis, H E; Borchard, F



Small bowel fistula and its impact: incorrect placement of left ventricular assist device cannulas leads to severe intestinal complications  

PubMed Central

A young man presented with a chronic abdominal dermal irritation 4 years after implantation of a left ventricular assist device (LVAD; Berlin heart excor). The LVAD was needed because of end-stage heart failure following a chronic parvovirus B19 Infection. The implantation of mechanical circulatory support systems (MCS) has nowadays become an accepted treatment modality for patients with end-stage heart failure. Recent literature shows several intestinal complications related to MCS, but no case presents the development of a small bowel fistula to the jejunum, transversal colon and stomach. We present a case of inaccurate placement of Berlin heart excor LVAD cannulas and its impact. This case emphasises the importance of correct placement of VAD cannulas to achieve an optimal long-term result. After surgical treatment the postoperative course was prolonged because of increasing peritonitis probably based on ongoing intraperitoneal chronic contamination with intestinal germs. The patient unfortunately deceased.

Yilmaz, Kadir; Erpenbeck, Heinrich; Drews, Thorsten; Hetzer, Roland



Epithelial barriers in intestinal inflammation.  


The gastrointestinal epithelium transports solutes and water between lumen and blood and at the same time forms a barrier between these compartments. This highly selective and regulated barrier permits ions, water, and nutrients to be absorbed, but normally restricts the passage of harmful molecules, bacteria, viruses and other pathogens. During inflammation, the intestinal barrier can be disrupted, indicated by a decrease in transcellular electrical resistance and an increase in paracellular permeability for tracers of different size. Such inflammatory processes are accompanied by increased oxidative stress, which in turn can impair the epithelial barrier. In this review, we discuss the role of inflammatory oxidative stress on barrier function with special attention on the epithelial tight junctions. Diseases discussed causing barrier changes include the inflammatory bowel diseases Crohn's disease, ulcerative colitis, and microscopic colitis, the autoimmune disorder celiac disease, and gastrointestinal infections. In addition, the main cytokines responsible for these effects and their role during oxidative stress and intestinal inflammation will be discussed, as well as therapeutic approaches and their mode of action. PMID:21294654

John, Lena J; Fromm, Michael; Schulzke, Jörg-Dieter



Reactive angioendotheliomatosis of the intestine.  


We present a case of reactive angioendotheliomatosis (RAE) of the colon, featuring intravascular proliferation of endothelial cells with histologic resemblance to glomeruloid hemangioma. A 19-year-old Japanese male with an anal fistula was diagnosed endoscopically with Crohn's disease. Six months later, he was hospitalized for fever and abdominal pain. Emergency resection of ileocecum and splenic flexure of the colon was undertaken to control massive intestinal hemorrhage, and in all parts of the resected colon, foci of many small vessels with intravascular proliferation of endothelial cells were noted throughout the layers. Moreover, solid proliferation of endothelial cells was seen in the submucosa at the base of open ulcers. Two small granulomas, compatible with Crohn's disease, were also evident in the muscle layer of the terminal ileum. No other hemangiomas or hemangioma-like structures were observed with CT scans, and the vascular lesions were histologically diagnosed as RAE. The pathogenesis of this disorder is unknown, and most cases occur in skin with systemic disease. The present case might thus be a first case of RAE of the intestine without cutaneous involvement. Whether there is a relation with coexistent enteritis suggestive of Crohn's disease needs to be clarified. PMID:15043317

Ogawa, Kumiko; Tada, Toyohiro; Takeuchi, Yuuki; Suenaga, Masahiro; Suzuki, Shugo; Shirai, Tomoyuki



Intestinal Chlamydia in finishing pigs.  


Gut and blood samples from 119 finishing pigs derived from 11 farms were collected during routine slaughter at an abattoir. Sections of formalin-fixed, paraffin-embedded tissues were labeled immunohistochemically using genus-specific, mouse monoclonal antibody against chlamydial lipopolysaccharide; goat polyclonal antiserum against the major outer membrane protein of Chlamydia trachomatis; and mouse monoclonal antibody against the ovine abortion subtype of C. psittaci. Gut samples from 33 of 111 (29.7%) individual pigs stained positive with the genus-specific monoclonal antibody, and of these 30 of 32 (93.7%) also reacted with the C. trachomatis-specific antiserum. Labeled inclusions were restricted to mature enterocytes of the large intestine in 33 of 111 cases. Infection of small intestinal enterocytes was noted in only one of 82 ileal samples. The blood samples were tested for antichlamydial antibodies by enzyme-linked immunosorbent assay (ELISA) and complement fixation test (CFT). With ELISA, 95 of the 115 sera tested (82.6%) yielded positive antichlamydial reactions. With CFT, 34 of the 119 sera tested (28.6%) were unequivocally positive (> or = 1:10, 100% binding), and 10 (7.6%) yielded doubtful positive reactions (1:10, 50-75% binding). Positive ELISA and CFT titers showed poor agreement (kappa = 0.112), whereas the agreement between positive findings by immunohistochemical labeling and CFT was fair (kappa = 0.205). PMID:8817833

Szeredi, L; Schiller, I; Sydler, T; Guscetti, F; Heinen, E; Corboz, L; Eggenberger, E; Jones, G E; Pospischil, A




PubMed Central

Flame photometry reveals that glutaraldehyde and buffer solutions in routine use for electron microscopy contain varying amounts of calcium. The presence of electron-opaque deposits adjacent to membranes in a variety of tissues can be correlated with the presence of calcium in the fixative. In insect intestine (midgut), deposits occur adjacent to apical and lateral plasma membranes. The deposits are particularly evident in tissues fixed in glutaraldehyde without postosmication. They are also observed in osmicated tissue if calcium is added to wash and osmium solutions. Deposits are absent when calcium-free fixatives are used, but are present when traces of CaCl2 (as low as 5 x 10-5 M) are added. The deposits occur at regular intervals along junctional membranes, providing images strikingly similar to those obtained by other workers who have used pyroantimonate in an effort to localize sodium. Other divalent cations (Mg++, Sr++, Ba++, Mn++, Fe++) appear to substitute for calcium, while sodium, potassium, lanthanum, and mercury do not. After postfixing with osmium with calcium added, the deposits can be resolved as patches along the inner leaflet of apical and lateral plasma membranes. The dense regions may thus localize membrane constituents that bind calcium. The results are discussed in relation to the role of calcium in control of cell-to-cell communication, intestinal calcium uptake, and the pyroantimonate technique for ion localization.

Oschman, James L.; Wall, Betty J.



l-Carnitine and Intestinal Inflammation  

Microsoft Academic Search

The intestinal barrier is one of the most dynamic surfaces of the body. It is here where a single layer of epithelial cells mediates the intricate encounters that occur between the host's immune system and a multitude of potential threats present in the intestinal lumen. Several key factors play an important role in the final outcome of this interaction, including

Geneviève Fortin



Intestinal radiation syndrome: sepsis and endotoxin  

SciTech Connect

Rats were whole-body irradiated with 8-MeV cyclotron-produced neutrons and /sup 137/Cs ..gamma.. rays to study the role of enteric bacteria and endotoxin in the intestinal radiation syndrome. Decrease in intestinal weight was used as an index of radiation-induced breakdown of the mucosa. Neutron and ..gamma..-ray doses that were sublethal for intestinal death resulted in a dose-dependent decrease in intestinal weight, reaching minimal values 2 to 3 days after exposure, followed by recovery within 5 days after irradiation. Neutron and photon doses that caused intestinal death resulted in greater mucosal breakdown with little or no evidence of mucosal recovery. The presence of fluid in the intestine and diarrhea, but not bacteremia or endotoxemia, were related to mucosal breakdown and recovery. Neither sepsis nor endotoxin could be detected in liver samples taken at autopsy from animals which died a short time earlier from intestinal injury. These results suggest that overt sepsis and endotoxemia do not play a significant role in the intestinal radiation syndrome.

Geraci, J.P.; Jackson, K.L.; Mariano, M.S.



The Role of Methane in Intestinal Diseases  

Microsoft Academic Search

The volume of human intestinal gas is about 200 ml, and it is derived from complex physiological processes including swallowed air, diffusion from bloodstream into the lumen, and particularly intraluminal production by chemical reactions and bacterial fermentation. Gas is continuously removed by eructation, anal evacuation, absorption through the intestinal mucosa, and bacterial consumption. More than 99% of it is composed

Davide Roccarina; Ernesto Cristiano Lauritano; Maurizio Gabrielli; Francesco Franceschi; Veronica Ojetti; Antonio Gasbarrini



Outcome predictors for intestinal Behçet's disease.  


Behçet's disease (BD) is a multisystem inflammatory disorder that presents as recurrent oral and genital ulcers in conjunction with other dermatological and ocular manifestations. The prevalence of BD is higher in Middle and East Asia than in Western countries. Intestinal BD is a specific subtype of BD, characterized by intestinal ulcers and associated gastrointestinal symptoms. Similar to inflammatory bowel disease, intestinal BD exhibits a fluctuating disease course with repeated episodes of relapse and remission that necessitate adequate maintenance therapy after achievement of clinical remission. Medical treatment of intestinal BD is largely empirical since well-controlled studies have been difficult to perform due to the heterogeneity and rarity of the disease. To date, 5-aminosalicylic acid, systemic corticosteroids, and immunosuppressants have been used anecdotally to treat intestinal BD. The clinical course of intestinal BD shows considerable variability, and the exact point at which more potent agents such as immunosuppressants should be used has not yet been elucidated. Given the difficulty in predicting which patients will experience complicated disease courses and the fact that these drugs are related with certain risk resulting from immunosuppression, proper identification of prognostic factors in intestinal BD may allow physicians to implement tailored medical therapy and individualized patient monitoring based on risk stratification. In this review, the impact of baseline characteristics on the long-term course of intestinal BD, prognostic factors during various medical therapies, and outcome predictors related to surgery will be discussed. PMID:23918555

Park, Jae Jun; Kim, Won Ho; Cheon, Jae Hee



Abnormal intestinal intraepithelial lymphocytes in refractory sprue  

Microsoft Academic Search

Background & Aims: The etiology of refractory sprue is unclear. To gain insight into its pathogenesis, the phenotype and T-cell receptor (TCR) gene rearrangement status of intestinal lymphocytes were analyzed in a group of patients with clinical or biological features of celiac disease but either initially or subsequently refractory to a gluten-free diet. Methods: Intestinal biopsy specimens were obtained from

Christophe Cellier; Natacha Patey; Laurent Mauvieux; Bana Jabri; Eric Delabesse; Yoram Bouhnik; Robert Modigliani; Elisabeth Macintyre; Nicole Brousse



Is intestinal metaplasia of the stomach reversible?  

Microsoft Academic Search

Intestinal metaplasia (IM) of the stomach is a risk factor in developing intestinal-type gastric cancer and hence the question of reversibility is vital. There is emerging epidemiological evidence that with long term follow up, IM may be reversible although a combination of antioxidant agents and eradication of H pylori may be necessary to achieve this. The pathogenesis of IM is

M M Walker



Suppression of intestinal neoplasia by DNA hypomethylation  

Microsoft Academic Search

We have used a combination of genetics and pharmacology to assess the effects of reduced DNA methyltransferase activity on ApcMin-induced intestinal neoplasia in mice. A reduction in the DNA methyltransferase activity in Min mice due to heterozygosity of the DNA methyltransferase gene, in conjunction with a weekly dose of the DNA methyltransferase inhibitor 5-azadeoxycytidine, reduced the average number of intestinal

Peter W Laird; Laurie Jackson-Grusby; Amin Fazeli; Stephanie L Dickinson; W Edward Jung; En Li; Robert A Weinberg; Rudolf Jaenisch



Intestinal Colonization by Enterotoxigenic 'Escherichia coli.'.  

National Technical Information Service (NTIS)

Growth of enterotoxigenic E. coli in porcine small intestine selects for piliated forms which adhere to the intestinal epithelium. Surface antigen K99 on enterotoxigenic E. coli is a pilus. Antigen K99 occurs on porcine enterotoxigenic E. coli strains and...

H. W. Moon



Shiga Toxin Interaction with Human Intestinal Epithelium  

PubMed Central

After ingestion via contaminated food or water, enterohaemorrhagic E. coli colonises the intestinal mucosa and produces Shiga toxins (Stx). No Stx-specific secretion system has been described so far, and it is assumed that Stx are released into the gut lumen after bacterial lysis. Human intestinal epithelium does not express the Stx receptor Gb3 or other Stx binding sites, and it remains unknown how Stx cross the intestinal epithelial barrier and gain access to the systemic circulation. This review summarises current knowledge about the influence of the intestinal environment on Stx production and release, Stx interaction with intestinal epithelial cells and intracellular uptake, and toxin translocation into underlying tissues. Furthermore, it highlights gaps in understanding that need to be addressed by future research.

Schuller, Stephanie



A critical appraisal of lubiprostone in the treatment of chronic constipation in the elderly  

PubMed Central

Chronic constipation is a common disorder in the general population, with higher prevalence in the elderly, and is associated with worse quality of life and with greater health care utilization. Lubiprostone is an intestinal type-2 chloride channel activator that increases intestinal fluid secretion, small intestinal transit, and stool passage. Lubiprostone is currently approved by the US Food and Drug Administration for the treatment of chronic idiopathic constipation and of irritable bowel syndrome with predominant constipation. This review outlines current approaches and limitations in the treatment of chronic constipation in the elderly and discusses the results, limitations, and applicability of randomized, controlled trials of lubiprostone that have been conducted in the general and elderly population, with additional focus on the use of lubiprostone in constipation in Parkinson’s disease and in opioid-induced constipation, two clinical entities that can be comorbid in elderly patients.

Gras-Miralles, Beatriz; Cremonini, Filippo



Chronic urticaria.  


Chronic urticaria is defined as case of spontaneous wheals and/or angioedema persisting for a period of at least six weeks. The disease has an average duration of three to five years and is strongly associated with a decrease of quality of life and performance. Current international guidelines recommend the use of non-sedating antihistamines as the first choice in therapy and up-dosing these up to fourfold in cases of non-response. Alternative treatments for the afflicted who do not respond to antihistamine-treatment are also available but are not approved for use on urticaria. PMID:22638841

Zuberbier, Torsten



Small intestine bleeding due to multifocal angiosarcoma  

PubMed Central

We report a case of an 84-year-old male patient with primary small intestinal angiosarcoma. The patient initially presented with anemia and melena. Consecutive endoscopy revealed no signs of upper or lower active gastrointestinal bleeding. The patient had been diagnosed 3 years previously with an aortic dilation, which was treated with a stent. Computed tomography suggested an aorto-intestinal fistula as the cause of the intestinal bleeding, leading to operative stent explantation and aortic replacement. However, an aorto-intestinal fistula was not found, and the intestinal bleeding did not arrest postoperatively. The constant need for blood transfusions made an exploratory laparotomy imperative, which showed multiple bleeding sites, predominately in the jejunal wall. A distal loop jejunostomy was conducted to contain the small intestinal bleeding and a segmental resection for histological evaluation was performed. The histological analysis revealed a less-differentiated tumor with characteristic CD31, cytokeratin, and vimentin expression, which led to the diagnosis of small intestinal angiosarcoma. Consequently, the infiltrated part of the jejunum was successfully resected in a subsequent operation, and adjuvant chemotherapy with paclitaxel was planned. Angiosarcoma of the small intestine is an extremely rare malignant neoplasm that presents with bleeding and high mortality. Early diagnosis and treatment are essential to improve outcome. A small intestinal angiosarcoma is a challenging diagnosis to make because of its rarity, nonspecific symptoms of altered intestinal function, nonspecific abdominal pain, severe melena, and acute abdominal signs. Therefore, a quick clinical and histological diagnosis and decisive measures including surgery and adjuvant chemotherapy should be the aim.

Zacarias Fohrding, Luisa; Macher, Arne; Braunstein, Stefan; Knoefel, Wolfram Trudo; Topp, Stefan Andreas



Cerebral Scedosporium apiospermum infection presenting with intestinal manifestations.  


We present a case of cerebral Scedosporium apiospermum infection presenting with intestinal manifestations in a 64-year-old male patient on immunosuppression for orthotopic liver transplantation. At admission, the patient's chief complaint was chronic watery diarrhea and he was found to have colonic ulcers on endoscopy. His hospital course was complicated by a tonic-clonic seizure caused by a left frontal brain abscess, with the causative agent being identified by culture. He was treated with lobectomy, high-dose intravenous voriconazole, and liposomal amphotericin with clinical, endoscopic, and histologic improvement. To our knowledge, S. apiospermum has not been previously described as a cause of colitis. The septate branching appearance of the Scedosporium species is similar to the more common Aspergillus species. This case of gastrointestinal Scedosporium brings into question previously reported cases of isolated gastrointestinal aspergillosis diagnosed by histopathology. Clinical suspicion for S. apiospermum must be maintained in immunosuppressed patients presenting with neurologic and gastrointestinal symptoms. PMID:23440749

Lin, D; Kamili, Q; Qurat-Ul-Ain, K; Lai, S; Musher, D M; Hamill, R



Paneth cells in intestinal homeostasis and tissue injury.  


Adult stem cell niches are often co-inhabited by cycling and quiescent stem cells. In the intestine, lineage tracing has identified Lgr5(+) cells as frequently cycling stem cells, whereas Bmi1(+), mTert(+), Hopx(+) and Lrig1(+) cells appear to be more quiescent. Here, we have applied a non-mutagenic and cell cycle independent approach to isolate and characterize small intestinal label-retaining cells (LRCs) persisting in the lower third of the crypt of Lieberkühn for up to 100 days. LRCs do not express markers of proliferation and of enterocyte, goblet or enteroendocrine differentiation, but are positive for Paneth cell markers. While during homeostasis, LR/Paneth cells appear to play a supportive role for Lgr5(+) stem cells as previously shown, upon tissue injury they switch to a proliferating state and in the process activate Bmi1 expression while silencing Paneth-specific genes. Hence, they are likely to contribute to the regenerative process following tissue insults such as chronic inflammation. PMID:22745693

Roth, Sabrina; Franken, Patrick; Sacchetti, Andrea; Kremer, Andreas; Anderson, Kurt; Sansom, Owen; Fodde, Riccardo



Paneth Cells in Intestinal Homeostasis and Tissue Injury  

PubMed Central

Adult stem cell niches are often co-inhabited by cycling and quiescent stem cells. In the intestine, lineage tracing has identified Lgr5+ cells as frequently cycling stem cells, whereas Bmi1+, mTert+, Hopx+ and Lrig1+ cells appear to be more quiescent. Here, we have applied a non-mutagenic and cell cycle independent approach to isolate and characterize small intestinal label-retaining cells (LRCs) persisting in the lower third of the crypt of Lieberkühn for up to 100 days. LRCs do not express markers of proliferation and of enterocyte, goblet or enteroendocrine differentiation, but are positive for Paneth cell markers. While during homeostasis, LR/Paneth cells appear to play a supportive role for Lgr5+ stem cells as previously shown, upon tissue injury they switch to a proliferating state and in the process activate Bmi1 expression while silencing Paneth-specific genes. Hence, they are likely to contribute to the regenerative process following tissue insults such as chronic inflammation.

Roth, Sabrina; Kremer, Andreas; Anderson, Kurt; Sansom, Owen; Fodde, Riccardo



CDX1 confers intestinal phenotype on gastric epithelial cells via induction of stemness-associated reprogramming factors SALL4 and KLF5  

PubMed Central

Intestinal metaplasia of the stomach, a mucosal change characterized by the conversion of gastric epithelium into an intestinal phenotype, is a precancerous lesion from which intestinal-type gastric adenocarcinoma arises. Chronic infection with Helicobacter pylori is a major cause of gastric intestinal metaplasia, and aberrant induction by H. pylori of the intestine-specific caudal-related homeobox (CDX) transcription factors, CDX1 and CDX2, plays a key role in this metaplastic change. As such, a critical issue arises as to how these factors govern the cell- and tissue-type switching. In this study, we explored genes directly activated by CDX1 in gastric epithelial cells and identified stemness-associated reprogramming factors SALL4 and KLF5. Indeed, SALL4 and KLF5 were aberrantly expressed in the CDX1+ intestinal metaplasia of the stomach in both humans and mice. In cultured gastric epithelial cells, sustained expression of CDX1 gave rise to the induction of early intestinal-stemness markers, followed by the expression of intestinal-differentiation markers. Furthermore, the induction of these markers was suppressed by inhibiting either SALL4 or KLF5 expression, indicating that CDX1-induced SALL4 and KLF5 converted gastric epithelial cells into tissue stem-like progenitor cells, which then transdifferentiated into intestinal epithelial cells. Our study places the stemness-related reprogramming factors as critical components of CDX1-directed transcriptional circuitries that promote intestinal metaplasia. Requirement of a transit through dedifferentiated stem/progenitor-like cells, which share properties in common with cancer stem cells, may underlie predisposition of intestinal metaplasia to neoplastic transformation.

Fujii, Yumiko; Yoshihashi, Kyoko; Suzuki, Hidekazu; Tsutsumi, Shuichi; Mutoh, Hiroyuki; Maeda, Shin; Yamagata, Yukinori; Seto, Yasuyuki; Aburatani, Hiroyuki; Hatakeyama, Masanori



Chitin-microparticles for the control of intestinal inflammation  

PubMed Central

Chitin is a polymer of N-acetylglucosamine with the ability to regulate innate and adaptive immune responses. However, the detailed mechanisms of chitin-mediated regulation of intestinal inflammation are only partially known. In this study, Chitin-microparticles (CMPs) or PBS were orally administered to acute and chronic colitis models every three days for six consecutive weeks beginning at weaning age. The effects of this treatment were evaluated by histology, cytokine production, co-culture study and enteric bacterial analysis in DSS-induced colitis or TCR? knockout chronic colitis models. Histologically, chitin-treated mice showed significantly suppressed colitis as compared to PBS-treated mice in both animal models. The production of IFN? was upregulated in the mucosa of chitin-treated mice compared to control mice. The major source of IFN?-producing cells was CD4+ T cells. In mouse dendritic cells (DCs), we found that CMPs were efficiently internalized and processed within 48 hours. Mesenteric lymph nodes (MLNs) CD4+ T cells isolated from chitin-treated mice produced 7-fold higher amount of IFN? in the culture supernatant after being co-cultured with DCs and chitin as compared to the control. Proliferation of CFSElow CD4+ T cells in MLNs and enteric bacterial translocation rates were significantly reduced in chitin-treated mice when compared to the control. In addition, CMPs improved the imbalance of enteric bacterial compositions and significantly increased IL-10-producing cells in non-inflamed colon, indicating the immunoregulatory effects of CMPs in intestinal mucosa. In conclusion, CMPs significantly suppress the development of inflammation by modulating cytokine balance and microbial environment in colon.

Nagatani, Katsuya; Wang, Sen; Llado, Victoria; Lau, Cindy W.; Li, Zongxi; Mizoguchi, Atsushi; Nagler, Cathryn R.; Shibata, Yoshimi; Reinecker, Hans-Christian; Mora, J. Rodrigo; Mizoguchi, Emiko



Adipose triglyceride lipase is a TG hydrolase of the small intestine and regulates intestinal PPAR? signaling  

PubMed Central

Adipose triglyceride lipase (ATGL) is the rate-limiting enzyme mediating triglyceride (TG) hydrolysis. The lack of ATGL results in TG accumulation in multiple tissues, underscoring the critical role of ATGL in maintaining lipid homeostasis. Recent evidence suggests that ATGL affects TG metabolism via activation of peroxisome proliferator-activated receptor ? (PPAR?). To investigate specific effects of intestinal ATGL on lipid metabolism we generated mice lacking ATGL exclusively in the intestine (ATGLiKO). We found decreased TG hydrolase activity and increased intracellular TG content in ATGLiKO small intestines. Intragastric administration of [3H]trioleate resulted in the accumulation of radioactive TG in the intestine, whereas absorption into the systemic circulation was unchanged. Intraperitoneally injected [3H]oleate also accumulated within TG in ATGLiKO intestines, indicating that ATGL mobilizes fatty acids from the systemic circulation absorbed by the basolateral side from the blood. Down-regulation of PPAR? target genes suggested modulation of cholesterol absorption by intestinal ATGL. Accordingly, ATGL deficiency in the intestine resulted in delayed cholesterol absorption. Importantly, this study provides evidence that ATGL has no impact on intestinal TG absorption but hydrolyzes TGs taken up from the intestinal lumen and systemic circulation. Our data support the role of ATGL in modulating PPAR?-dependent processes also in the small intestine.

Obrowsky, Sascha; Chandak, Prakash G.; Patankar, Jay V.; Povoden, Silvia; Schlager, Stefanie; Kershaw, Erin E.; Bogner-Strauss, Juliane G.; Hoefler, Gerald; Levak-Frank, Sanja; Kratky, Dagmar



Rage signalling promotes intestinal tumourigenesis.  


Development of colon cancer is a multistep process that is regulated by intrinsic and extrinsic cellular signals. Extrinsic factors include molecular patterns that are derived from either pathogens (PAMPs) or cellular damage (DAMPs). These molecules can promote tumourigenesis by activation of the innate immune system, but the individual contribution of ligands and their receptors remains elusive. The receptor for advanced glycation end products (Rage) is a pattern recognition receptor that binds multiple ligands derived from a damaged cell environment such as Hmgb1 and S100 protein. Here we show that Rage signalling has a critical role in sporadic development of intestinal adenomas, as Apc(Min/+) Rage(-/-) mice are protected against tumourigenesis. PMID:22469986

Heijmans, J; Büller, N V J A; Hoff, E; Dihal, A A; van der Poll, T; van Zoelen, M A D; Bierhaus, A; Biemond, I; Hardwick, J C H; Hommes, D W; Muncan, V; van den Brink, G R



Intestinal mucosal atrophy and adaptation  

PubMed Central

Mucosal adaptation is an essential process in gut homeostasis. The intestinal mucosa adapts to a range of pathological conditions including starvation, short-gut syndrome, obesity, and bariatric surgery. Broadly, these adaptive functions can be grouped into proliferation and differentiation. These are influenced by diverse interactions with hormonal, immune, dietary, nervous, and mechanical stimuli. It seems likely that clinical outcomes can be improved by manipulating the physiology of adaptation. This review will summarize current understanding of the basic science surrounding adaptation, delineate the wide range of potential targets for therapeutic intervention, and discuss how these might be incorporated into an overall treatment plan. Deeper insight into the physiologic basis of adaptation will identify further targets for intervention to improve clinical outcomes.

Shaw, Darcy; Gohil, Kartik; Basson, Marc D



Acute intestinal anisakiasis: CT findings.  


Small bowel anisakiasis is a relatively uncommon disease that results from consumption of raw or insufficiently pickled, salted, smoked, or cooked wild marine fish infected with Anisakis larvae. We report a case of intestinal anisakiasis in a 63-year-old woman presenting with acute onset of abdominal complaints one day after ingestion of raw wild-caught herring from the Northsea. Computed tomography (CT) scanning demonstrated thickening of the distal small bowel wall, mucosa with hyperenhancement, mural stratification, fluid accumulation within dilated small-bowel loops and hyperemia of mesenteric vessels. In patients with a recent history of eating raw marine fish presenting with acute onset of abdominal complaints and CT features of acute small bowel inflammation the possibility of anisakiasis should be considered in the differential diagnosis of acute abdominal syndromes. PMID:23082711

Ozcan, H N; Avcu, S; Pauwels, W; Mortelé, K J; De Backer, A I



Intestinal metabolism of fatty acids  

PubMed Central

1. The effect of concentration on the oxidation and incorporation into lipids of lauric acid and linoleic acid by rings of rat small intestine has been studied in vitro. 2. In the absence of glucose, the oxidation of lauric acid in the range 0·01–5·0mm showed a maximum at 0·1mm. In the presence of glucose the maximum was at 0·5mm. The oxidation of linoleic acid in the presence of glucose increased throughout the concentration range 0·01–5·0mm. 3. The incorporation of lauric acid into lipids was maximal at 0·5–0·6mm in the presence of glucose, but at 10mm in the absence of glucose. At 0·8mm-lauric acid, in the presence of glucose, over 75% of the incorporated lauric acid was in triglycerides, but at 10mm they only contained 30%. The incorporation of glucose carbon into glycerides paralleled the incorporation of lauric acid. 4. In the range 0·01–2·5mm-linoleic acid the quantity incorporated into lipids increased. In the range 0·01–0·4mm linoleic acid was incorporated predominantly into triglycerides, but between 0·4 and 1·0mm most was in diglycerides, and between 2·5 and 5·0mm most was in monoglycerides. 5. The relationship of fatty acid concentration to the mechanism of absorption is discussed, together with the correlation between the distribution of the absorbed fatty acids within the tissue lipids and the lipase activity of intestinal mucosa.

Enser, M.



Intestinal lymphangiectasia and thymic hypoplasia.  

PubMed Central

We have evaluated the immunological abnormalities present in a 6 year old patient with primary intestinal and generalized lymphangiectasia confirmed by intestinal, lung and lymph node biopsies. Lymphocyte loss through the gut was confirmed by the detection of lymphocytes in her stool. An increased enteric protein loss was suggested by hypoproteinaemia, peripheral oedema, and a very short half-life for i.v. immune serum globulin (3 days). Lymphocyte subpopulation analysis revealed a selective loss of T lymphocytes, with a proportionally increased loss of the OKT4 positive helper/inducer subpopulation. Functionally, there was a decrease in proliferative responses to some mitogens and to allogeneic cells, and a lack of T cell help for in vitro B lymphocyte differentiation into immunoglobulin secreting cells. Natural killer function was normal. In this patient, a concomitant thymic deficiency was documented by failure to identify thymic tissue on a thymus biopsy and by an absence or decrease of the serum thymic factor (thymulin) and thymosin alpha 1. No compensatory lymphopoiesis was detected in the bone marrow. In an attempt to increase T lymphocyte development, the patient was treated with thymosin fraction 5. Daily treatment with this preparation resulted in a transient clinical improvement which could not be sustained on a weekly thymosin treatment schedule. However, lymphocyte numbers did not increase during this treatment. The findings in this patient support the notion that T lymphocytes are needed to stimulate thymic epithelium. In situations of excessive loss of long lived T lymphocytes a secondary thymic atrophy may occur and further contribute to the development of a deficiency in cell-mediated immunity. Images Fig. 1 Fig. 2

Sorensen, R U; Halpin, T C; Abramowsky, C R; Hornick, D L; Miller, K M; Naylor, P; Incefy, G S



Small intestine inflammation in Roquin-mutant and Roquin-deficient mice.  


Roquin, an E3 ubiquitin ligase that localizes to cytosolic RNA granules, is involved in regulating mRNA stability and translation. Mice that have a M199R mutation in the Roquin protein (referred to as sanroque or Roquin(san/san) mice) develop autoimmune pathologies, although the extent to which these occur in the intestinal mucosa has not been determined. Here, we demonstrate that Roquin(san/san) mice reproducibly develop intestinal inflammation in the small intestine but not the colon. Similarly, mice generated in our laboratory in which the Roquin gene was disrupted by insertion of a gene trap cassette (Roquin(gt/gt) mice) had small intestinal inflammation that mimicked that of Roquin(san/san) mice. MLN cells in Roquin(san/san) mice consisted of activated proliferating T cells, and had increased numbers of CD44(hi) CD62L(lo) KLRG1(+) short-lived effector cells. Proportionally more small intestinal intraepithelial lymphocytes in Roquin(san/san) mice expressed the ICOS T cell activation marker. Of particular interest, small intestinal lamina propria lymphocytes in Roquin(san/san) mice consisted of a high proportion of Gr-1(+) T cells that included IL-17A(+) cells and CD8(+) IFN-?(+) cells. Extensive cytokine dysregulation resulting in both over-expression and under-expression of chemotactic cytokines occurred in the ileum of Roquin(san/san) mice, the region most prone to the development of inflammation. These findings demonstrate that chronic inflammation ensues in the intestine following Roquin alteration either as a consequence of protein mutation or gene disruption, and they have implications for understanding how small intestinal inflammation is perpetuated in Crohn's disease (CD). Due to the paucity of animal models of CD-like pathophysiology in the small intestine, and because the primary gene/protein defects of the Roquin animal systems used here are well-defined, it will be possible to further elucidate the underlying genetic and molecular mechanisms that drive the disease process. PMID:23451046

Schaefer, Jeremy S; Montufar-Solis, Dina; Nakra, Niyati; Vigneswaran, Nadarajah; Klein, John R



Wound healing of intestinal epithelial cells  

PubMed Central

The intestinal epithelial cells (IECs) form a selective permeability barrier separating luminal content from underlying tissues. Upon injury, the intestinal epithelium undergoes a wound healing process. Intestinal wound healing is dependent on the balance of three cellular events; restitution, proliferation, and differentiation of epithelial cells adjacent to the wounded area. Previous studies have shown that various regulatory peptides, including growth factors and cytokines, modulate intestinal epithelial wound healing. Recent studies have revealed that novel factors, which include toll-like receptors (TLRs), regulatory peptides, particular dietary factors, and some gastroprotective agents, also modulate intestinal epithelial wound repair. Among these factors, the activation of TLRs by commensal bacteria is suggested to play an essential role in the maintenance of gut homeostasis. Recent studies suggest that mutations and dysregulation of TLRs could be major contributing factors in the predisposition and perpetuation of inflammatory bowel disease. Additionally, studies have shown that specific signaling pathways are involved in IEC wound repair. In this review, we summarize the function of IECs, the process of intestinal epithelial wound healing, and the functions and mechanisms of the various factors that contribute to gut homeostasis and intestinal epithelial wound healing.

Iizuka, Masahiro; Konno, Shiho



Vitamin D and Intestinal Calcium Absorption  

PubMed Central

The principal function of vitamin D in calcium homeostasis is to increase calcium absorption from the intestine. Calcium is absorbed by both an active transcellular pathway, which is energy dependent, and by a passive paracellular pathway through tight junctions. 1,25Dihydroxyvitamin D3 (1,25(OH)2D3) the hormonally active form of vitamin D, through its genomic actions, is the major stimulator of active intestinal calcium absorption which involves calcium influx, translocation of calcium through the interior of the enterocyte and basolateral extrusion of calcium by the intestinal plasma membrane pump. This article reviews recent studies that have challenged the traditional model of vitamin D mediated transcellular calcium absorption and the crucial role of specific calcium transport proteins in intestinal calcium absorption. There is also increasing evidence that 1,25(OH)2D3 can enhance paracellular calcium diffusion. The influence of estrogen, prolactin, glucocorticoids and aging on intestinal calcium absorption and the role of the distal intestine in vitamin D mediated intestinal calcium absorption are also discussed.

Christakos, Sylvia; Dhawan, Puneet; Porta, Angela; Mady, Leila J.; Seth, Tanya



Management and pathophysiology of functional gastrointestinal disorders.  


Since 2005, every annual meeting of the Japanese Gastroenterological Association has included a core symposium for functional gastrointestinal disorders. At the 6th annual meeting, the core symposium was 'Pathophysiology and New Treatment'. At the 7th annual meeting, the core symposium was 'Pathophysiology and Motility'. This review summarizes the papers presented at these meetings. At the 6th meeting, we recognized that Japanese researchers successfully produced and developed many agents that are safe and effective for the treatment of functional gastrointestinal disorders, such as 5-hydroxytryptamine receptor-associated compounds, lubiprostone, Japanese herbal medicine, and other drugs. Data were validated from a clinical as well as an experimental viewpoint. Findings included the effects of sumatriptan and nizatidine, acylated or des-acylated ghrelin, T-cell-activating anti-CD3 antibody, and transient receptor potential vanilloid-1. At the 7th meeting, not only functional dyspepsia and irritable bowel syndrome (IBS), but also non-erosive esophageal reflux disease (NERD) and chronic intestinal pseudo-obstruction were actively discussed from a motility viewpoint, including papers about sham feeding and gastric motility, genetic polymorphism and motility, the role of transient receptor potential A1 on gastric accommodation, esophageal motility and NERD, diagnosis and treatment of chronic intestinal pseudo-obstruction, immunological basis of motility in IBS, developing non-invasive colonic function test, and fecal distribution in IBS patients. PMID:22269284

Fukudo, Shin; Kuwano, Hiroyuki; Miwa, Hiroto



[Chronic constipation].  


Complaints of chronic constipation may substantially impair the quality of life of a patient. The disease feeling is shaped not only by objective parameters but also by subjective perceptions. This is along-considered into the so-called Rome-III-criteria. In the majority of the patients no distinct pathology can be found. A smaller group of patients however exhibit isolated or in combination a slow colonic transit or a pelvic floor dysfunction. Secondary extraintestinal causes are to be looked for particularly during a first clinical evaluation. Apart from general clinical investigations if necessary combined with a colonscopy, specific function tests (transit measurements, defecography) may be applied. Different laxative agents are the primary cornerstone of treatment. In selected cases biofeedback training or even surgical intervention can be successfully adopted. PMID:17663207

Degen, L



Chronic Sinusitis  

PubMed Central

Paranasal sinuses, which communicate with the nasal passages through the sinus ostia, are essentially sterile structures, sterility being maintained by a healthy epithelium with normal actively beating cilia. Irritants, including viruses and bacteria, are trapped in mucus and cilia to allow the clearance of sinuses through the natural ostia into the nasal cavity. Interference with this normal physiological function results in inflammation and infection within the sinus cavities. All of the sinuses are subjected to the same environmental as well as physiological stimuli; thus it is uncommon for a single sinus to be infected and for the others to remain entirely normal. Allergic and non-allergic vasomotor rhinitis should be differentiated from chronic bacterial rhinosinusitis. The understanding of these diseases cannot be separated from the physiological function of the sinus mucosa.

Steinberg, Johannes; Modi, Pradip



Reduced Intestinal Tumorigenesis in APCmin Mice Lacking Melanin-Concentrating Hormone  

PubMed Central

Background Melanin-concentrating hormone (MCH) is an evolutionary conserved hypothalamic neuropeptide that in mammals primarily regulates appetite and energy balance. We have recently identified a novel role for MCH in intestinal inflammation by demonstrating attenuated experimental colitis in MCH deficient mice or wild type mice treated with an anti-MCH antibody. Therefore, targeting MCH has been proposed for the treatment of inflammatory bowel disease. Given the link between chronic intestinal inflammation and colorectal cancer, in the present study we sought to investigate whether blocking MCH might have effects on intestinal tumorigenesis that are independent of inflammation. Methodology Tumor development was evaluated in MCH-deficient mice crossed to the APCmin mice which develop spontaneously intestinal adenomas. A different cohort of MCH?/? and MCH+/+ mice in the APCmin background was treated with dextran sodium sulphate (DSS) to induce inflammation-dependent colorectal tumors. In Caco2 human colorectal adenocarcinoma cells, the role of MCH on cell survival, proliferation and apoptosis was investigated. Results APCmin mice lacking MCH developed fewer, smaller and less dysplastic tumors in the intestine and colon which at the molecular level are characterized by attenuated activation of the wnt/beta-catenin signaling pathway and increased apoptotic indices. Form a mechanistic point of view, MCH increased the survival of colonic adenocarcinoma Caco2 cells via inhibiting apoptosis, consistent with the mouse studies. Conclusion In addition to modulating inflammation, MCH was found to promote intestinal tumorigenesis at least in part by inhibiting epithelial cell apoptosis. Thereby, blocking MCH as a therapeutic approach is expected to decrease the risk for colorectal cancer.

Nagel, Jutta M.; Geiger, Brenda M.; Karagiannis, Apostolos K. A.; Gras-Miralles, Beatriz; Horst, David; Najarian, Robert M.; Ziogas, Dimitrios C.; Chen, XinHua; Kokkotou, Efi



Regulatory mechanisms of intestinal folate uptake in a rat model of folate oversupplementation.  


Folic acid is essential for numerous biological functions, ranging from nucleotide biosynthesis to the remethylation of homocysteine. Folic acid is unable to cross the biological membranes by simple diffusion, so there exists a well-developed epithelial folate transport system for the regulation of normal folate homeostasis in the intestine. Any perturbances in the folate uptake system might lead to a state of folate deficiency, which in turn is strongly associated with the risk of various cancers, birth defects and CVD. Countries with obligatory folate fortification of food (USA and Canada) have documented a significant decrease in neural tube defects in newborns. However, the effect of folate oversupplementation on the intestinal absorption of folic acid has not been studied. We studied the process of folate transport and the expression of folate transporters in the rat intestine after folate oversupplementation. Rats were oversupplemented with tenfold the normal requirement of folic acid for periods of 10 and 60 d. Folate uptake in intestinal brush-border membrane vesicles followed saturable kinetics with pH optimum at 5·5. Acute, but not chronic, folate oversupplementation led to a significant down-regulation in intestinal folate uptake at acidic pH optima and was associated with a decrease in Vmax without any significant change in the Km of the folate uptake process. The decrease in folate uptake was also associated with the down-regulation in the protein levels of major folate transporters, proton-coupled folate transporter (PCFT) and reduced folate carrier (RFC), without altering their mRNA levels. Hence, it was concluded that acute folate oversupplementation results in a significant decrease in intestinal folate uptake by down-regulating the expressions of RFC and PCFT, via some post-transcriptional or translational mechanisms. PMID:21092376

Dev, Som; Ahmad Wani, Nissar; Kaur, Jyotdeep



Rage mediated DAMP signaling in intestinal tumorigenesis  

PubMed Central

In the intestine, a large variety of pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) can instigate innate immune responses, which have been shown to promote colorectal carcinogenesis. We have recently demonstrated an important role for the receptor for advanced glycation end products (Rage) in intestinal adenoma formation. Rage is a receptor for DAMPs that are present in several proteins produced in intestinal adenomas. We found that Rage signaling upholds a pro-inflammatory milieu through a feed-forward loop that stimulates the production of its own ligands.

Heijmans, Jarom; Buller, Nike V. J. A.; Muncan, Vanesa; van den Brink, Gijs R.



Uterine Rotation: A Cause of Intestinal Obstruction  

PubMed Central

Intestinal obstruction is an uncommon surgical emergency during pregnancy that affects seriously the prognosis of gestation. The underlying cause can be identified in the majority of cases and usually consists of adhesions secondary to previous abdominal or pelvic surgery, followed in order of frequency by intestinal volvuli. In recent years there have been no reports in which the gravid uterus has been the cause of intestinal obstruction. We report the case of a woman in week 33 + 4 of pregnancy who developed extrinsic compression of the colon secondary to uterine rotation and pelvic impaction of the head of the fetus.

Gonzalez-Mesa, Ernesto; Narbona, Isidoro; Cohen, Isaac; Villegas, Emilia; Cuenca, Celia



The Intestinal Microflora, the Immune System and Probiotics  

Microsoft Academic Search

2 , is constantly challenged by the enormous amount of antigens from food and from the intestinal microflora and from inhaled particles that also reach the intestines. It is not surprising therefore that approximately 80 % of the immune system is found in the area of the intestinal tract and are particularly prevalent in the small intestine. The immune system

Lennart Cedgård; Anna Widell


Tetrahydrobiopterin in intestinal lumen: Its absorption and secretion in the small intestine and the elimination in the large intestine  

Microsoft Academic Search

Summary  In treating hereditary deficiency of tetrahydrobiopterin (BH4), supplementation with BH4 might be the ultimate choice of therapy. Oral administration of BH4 has been believed to be inefficient owing to poor absorption of BH4 in the intestine. In this study, we found a considerable amount of BH4 as well as its oxidized pterins in the ingredients of intestinal lumen of mice

K. Sawabe; Y. Saeki; A. Ohashi; K. Mamada; K. O. Wakasugi; H. Matsuoka; H. Hasegawa



Chronic Effects of a Salmonella Type III Secretion Effector Protein AvrA In Vivo  

PubMed Central

Background Salmonella infection is a common public health problem that can become chronic and increase the risk of inflammatory bowel diseases and cancer. AvrA is a Salmonella bacterial type III secretion effector protein. Increasing evidence demonstrates that AvrA is a multi-functional enzyme with critical roles in inhibiting inflammation, regulating apoptosis, and enhancing proliferation. However, the chronic effects of Salmonella and effector AvrA in vivo are still unknown. Moreover, alive, mutated, non-invasive Salmonella is used as a vector to specifically target cancer cells. However, studies are lacking on chronic infection with non-pathogenic or mutated Salmonella in the host. Methods/Principal Findings We infected mice with Salmonella Typhimurium for 27 weeks and investigated the physiological effects as well as the role of AvrA in intestinal inflammation. We found altered body weight, intestinal pathology, and bacterial translocation in spleen, liver, and gallbladder in chronically Salmonella-infected mice. Moreover, AvrA suppressed intestinal inflammation and inhibited the secretion of cytokines IL-12, IFN-?, and TNF-?. AvrA expression in Salmonella enhanced its invasion ability. Liver abscess and Salmonella translocation in the gallbladder were observed and may be associated with AvrA expression in Salmonella. Conclusion/Significance We created a mouse model with persistent Salmonella infection in vivo. Our study further emphasizes the importance of the Salmonella effector protein AvrA in intestinal inflammation, bacterial translocation, and chronic infection in vivo.

Lu, Rong; Wu, Shaoping; Liu, Xingyin; Xia, Yinglin; Zhang, Yong-guo; Sun, Jun



The interplay between the gut immune system and microbiota in health and disease: nutraceutical intervention for restoring intestinal homeostasis.  


Gut immune system is daily exposed to a plethora of antigens contained in the environment as well as in food. Both secondary lymphoid tissue, such as Peyer's patches, and lymphoid follicles (tertiary lymphoid tissue) are able to respond to antigenic stimuli releasing cytokines or producing antibodies (secretory IgA). Intestinal epithelial cells are in close cooperation with intraepithelial lymphocytes and possess Toll-like receptors on their surface and Nod-like receptors (NLRs) which sense pathogens or pathogen-associated molecular patterns. Intestinal microbiota, mainly composed of Bacteroidetes and Firmicutes, generates tolerogenic response acting on gut dendritic cells and inhibiting the T helper (h)-17 cell anti-inflammatory pathway. This is the case of Bacteroides fragilis which leads to the production of interleukin-10, an anti-inflammatory cytokine, from both T regulatory cells and lamina propria macrophages. Conversely, segmented filamentous bacteria rather induce Th17 cells, thus promoting intestinal inflammation. Intestinal microbiota and its toxic components have been shown to act on both Nod1 and Nod2 receptors and their defective signaling accounts for the development of inflammatory bowel disease (IBD). In IBD a loss of normal tolerance to intestinal microbiota seems to be the main trigger of mucosal damage. In addition, intestinal microbiota thanks to its regulatory function of gut immune response can prevent or retard neoplastic growth. In fact, chronic exposure to environmental microorganisms seems to be associated with low frequency of cancer risk. Major nutraceuticals or functional foods employed in the modulation of intestinal microbiota are represented by prebiotics, probiotics, polyunsaturated fatty acids, amino acids and polyphenols. The cellular and molecular effects performed by these natural products in terms of modulation of the intestinal microbiota and mostly attenuation of the inflammatory pathway are described. PMID:23151182

Magrone, Thea; Jirillo, Emilio



The effect of gastric inhibitory polypeptide on intestinal glucose absorption and intestinal motility in mice.  


Gastric inhibitory polypeptide (GIP) is released from the small intestine upon meal ingestion and increases insulin secretion from pancreatic ? cells. Although the GIP receptor is known to be expressed in small intestine, the effects of GIP in small intestine are not fully understood. This study was designed to clarify the effect of GIP on intestinal glucose absorption and intestinal motility. Intestinal glucose absorption in vivo was measured by single-pass perfusion method. Incorporation of [(14)C]-glucose into everted jejunal rings in vitro was used to evaluate the effect of GIP on sodium-glucose co-transporter (SGLT). Motility of small intestine was measured by intestinal transit after oral administration of a non-absorbed marker. Intraperitoneal administration of GIP inhibited glucose absorption in wild-type mice in a concentration-dependent manner, showing maximum decrease at the dosage of 50 nmol/kg body weight. In glucagon-like-peptide-1 (GLP-1) receptor-deficient mice, GIP inhibited glucose absorption as in wild-type mice. In vitro examination of [(14)C]-glucose uptake revealed that 100 nM GIP did not change SGLT-dependent glucose uptake in wild-type mice. After intraperitoneal administration of GIP (50 nmol/kg body weight), small intestinal transit was inhibited to 40% in both wild-type and GLP-1 receptor-deficient mice. Furthermore, a somatostatin receptor antagonist, cyclosomatostatin, reduced the inhibitory effect of GIP on both intestinal transit and glucose absorption in wild-type mice. These results demonstrate that exogenous GIP inhibits intestinal glucose absorption by reducing intestinal motility through a somatostatin-mediated pathway rather than through a GLP-1-mediated pathway. PMID:21095180

Ogawa, Eiichi; Hosokawa, Masaya; Harada, Norio; Yamane, Shunsuke; Hamasaki, Akihiro; Toyoda, Kentaro; Fujimoto, Shimpei; Fujita, Yoshihito; Fukuda, Kazuhito; Tsukiyama, Katsushi; Yamada, Yuichiro; Seino, Yutaka; Inagaki, Nobuya



Isoflurane activates intestinal sphingosine kinase to protect against bilateral nephrectomy-induced liver and intestine dysfunction  

PubMed Central

Acute kidney injury (AKI) frequently leads to systemic inflammation and extrarenal organ dysfunction. Volatile anesthetics are potent anti-inflammatory agents and protect against renal ischemia-reperfusion injury. Here, we sought to determine whether isoflurane, a commonly used volatile anesthetic, protects against AKI-induced liver and intestinal injury, the mechanisms involved in this protection, and whether this protection was independent of the degree of renal injury. Bilateral nephrectomy-induced AKI under pentobarbital sodium anesthesia led to severe hepatic and intestinal injury with periportal hepatocyte vacuolization, small intestinal necrosis, apoptosis, and proinflammatory mRNA upregulation. In contrast, isoflurane anesthesia reduced hepatic and intestinal injury after bilateral nephrectomy. Mechanistically, isoflurane anesthesia upregulated and induced small intestinal crypt sphingosine kinase-1 (SK1) as SK1 mRNA, protein, and enzyme activity increased with isoflurane treatment. Furthermore, isoflurane failed to protect mice treated with a selective SK inhibitor (SKI-II) or mice deficient in the SK1 enzyme against hepatic and intestinal dysfunction after bilateral nephrectomy, demonstrating the key role of SK1. Therefore, in addition to its potent anesthetic properties, isoflurane protects against AKI-induced liver and intestine injury via activation of small intestinal SK1 independently of the effects on the kidney. These findings may help to elucidate the cellular signaling pathways underlying volatile anesthetic-mediated hepatic and intestinal protection and result in novel clinical applications of volatile anesthetics to attenuate perioperative complications arising from AKI.

Kim, Minjae; Park, Sang Won; Kim, Mihwa; D'Agati, Vivette D.



Macroscopic intestinal colonies of mice as a tool for studying differentiation of multipotential intestinal stem cells  

SciTech Connect

Macroscopic nodules composed of regenerating intestinal epithelium were developed within an area of the murine jejunum ulcerated by X-irradiation (1700 rads). The authors investigated whether such intestinal nodules were clonal and whether this method was useful as a tool for studying differentiation of intestinal stem cells. For examination of the clonality, intestinal nodules were produced in the jejunum of (C57BL/6 X DS)F1-Pgk-1b/Pgk-1a mice that carried X-chromosome inactivation mosaicism for the phosphoglycerate kinase gene. All intestinal nodules contained only 1 type of phosphoglycerate kinase, suggesting the monoclonal origin of nodules. Histochemical and electron microscopic studies showed the presence of absorptive epithelial, goblet, and entero-endocrine cells in most intestinal nodules, suggesting the multipotentiality of the nodule-forming stem cells. Moreover, villi developed on the top of some intestinal nodules, implicating the potential of the multipotential stem cell to construct the highly organized structure. The result indicates that the intestinal nodule method is useful for investigating differentiation potentials of multipotential intestinal stem cells.

Inoue, M.; Imada, M.; Fukushima, Y.; Matsuura, N.; Shiozaki, H.; Mori, T.; Kitamura, Y.; Fujita, H.



Human intestinal fatty acid binding protein: Report of an assay with studies in normal volunteers and intestinal ischemia  

Microsoft Academic Search

Background. Human intestinal fatty acid binding protein (hIFABP) is a cytoplasmic protein of mature small intestinal epithelium. Work with the rat demonstrated that serum levels of IFABP correlated with early phases of intestinal mucosal injury. The aim of this study was to develop an assay for hIFABP and assess its usefulness as a marker for intestinal mucosal injury in human

Joshua M Lieberman; James Sacchettini; Christine Marks; William H Marks



Chemotherapy of Intestinal Trematodiasis in Man.  

National Technical Information Service (NTIS)

Human intestinal trematodiases are associated with eating habit and are usually localized to areas where there is water, snail vectors, and reservoir hosts. Most of the parasitoses are in Asia but foci of infections occur in other population groups throug...

J. H. Cross



How Is Small Intestine Adenocarcinoma Diagnosed?  


... used more often before endoscopy was available. Upper GI series: This test, also known as a barium ... pictures of the small intestine than the upper GI with small bowel follow-through. For this procedure, ...


Primary lymphoma of the upper small intestine  

PubMed Central

Seven patients with primary lymphoma involving the upper small intestine and presenting with diarrhoea, non-specific abdominal pain, and clubbing are reported. The disease appears to be more prevalent in young women, and clinical and radiological findings can provide an excellent preliminary diagnosis which is usually confirmed by peroral biopsy of the small intestine. This type of lymphoma is found to be clinically distinguishable both from the primary intestinal lymphomas reported from western countries and also from gastrointestinal involvement as part of a more systemic disease. It appears to be prevalent in the Middle East, and because of clear clinical, radiological, and histological features, it can be singled out from other primary intestinal lymphomas and considered as a distinct clinical entity. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6

Nasr, Khosrow; Haghighi, Parviz; Bakhshandeh, Kiumars; Haghshenas, Mansour



Primary lymphoma of the upper small intestine.  


Seven patients with primary lymphoma involving the upper small intestine and presenting with diarrhoea, non-specific abdominal pain, and clubbing are reported. The disease appears to be more prevalent in young women, and clinical and radiological findings can provide an excellent preliminary diagnosis which is usually confirmed by peroral biopsy of the small intestine. This type of lymphoma is found to be clinically distinguishable both from the primary intestinal lymphomas reported from western countries and also from gastrointestinal involvement as part of a more systemic disease. It appears to be prevalent in the Middle East, and because of clear clinical, radiological, and histological features, it can be singled out from other primary intestinal lymphomas and considered as a distinct clinical entity. PMID:4919259

Nasr, K; Haghighi, P; Bakhshandeh, K; Haghshenas, M



Intestinal Infarctus following Dilatation and Uterine Curettage  

PubMed Central

We present a case of intestinal infarctus through the vagina. This was a consequence of induced abortion done clandestinely. The main objective was to point out the surgical complications of uterine dilatation and curettage by means of this rare case.

Ngowe, N.M.; Atangana, R.; Eyenga, V.C.; Sosso, M.A.



Inflammasome in Intestinal Inflammation and Cancer  

PubMed Central

The activation of specific cytosolic pathogen recognition receptors, the nucleotide-binding-oligomerization-domain- (NOD-) like receptors (NLRs), leads to the assembly of the inflammasome, a multimeric complex platform that activates caspase-1. The caspase-1 pathway leads to the upregulation of important cytokines from the interleukin (IL)-1 family, IL-1?, and IL-18, with subsequent activation of the innate immune response. In this review, we discuss the molecular structure, the mechanisms behind the inflammasome activation, and its possible role in the pathogenesis of inflammatory bowel diseases and intestinal cancer. Here, we show that the available data points towards the importance of the inflammasome in the innate intestinal immune response, being the complex involved in the maintenance of intestinal homeostasis, correct intestinal barrier function and efficient elimination of invading pathogens.

Nunes, Tiago; de Souza, Heitor S.



Motility Disorders of the Small Intestine  


... pain. The second type of contraction is the giant migrating contraction. This occurs primarily in the lower ... and food debris out of the intestine. These giant migrating contractions occur in healthy people and usually ...


Clinical symptoms of intestinal vascular disorders.  


Despite advances made in the diagnostic and therapeutic field, acute intestinal ischemia remains a highly lethal condition. This is related to the variability of symptoms and the absence of typical laboratory alterations in early stage. PMID:19103138

Bartone, Giovanni; Severino, Beatrice Ulloa; Armellino, Mariano Fortunato; Maglio, Mauro Natale Domenico; Castriconi, Maurizio



Recurrent gastrointestinal bleeding associated with chronic pancreatitis.  

PubMed Central

A 52 year old man with chronic pancreatitis presented with recurrent upper gastrointestinal bleeding. Gastroscopy was normal, but visceral angiography suggested that there were gastric varices. Despite treatment with propranolol he had further episodes of bleeding and so underwent splenectomy to decompress the gastric varices. When the spleen was removed, however, an inflammatory mass in the head of the pancreas adherent to the posterior gastric wall was noted. Within it the splenic artery was visible and communicated with the gastric lumen through a small opening in the gastric wall. The artery was ligated and the patient has since had no further bleeding. Thus, chronic pancreatitis should be considered as a cause of recurrent upper gastro-intestinal bleeding, especially when gastroscopy is normal. Images p315-a

Jenkins, A P; el-Omar, M M; Booth, J C; Banerjee, A K; Burnand, K G; Thompson, R P



The effect of ethanol on intestinal L-leucine absorption in rats.  


The chronic effect of ethanol on leucine absorption by the whole rat intestine (between duodenum and rectum) was studied using an in vivo multiple-pass perfusion technique. Leucine concentrations in the perfusion medium were 5, 10 and 25 mM respectively in successive passes. Ethanol was administered in drinking water during a one month induction period and then for a four week period of ad libitum ingestion of 30% ethanol solution. The results were compared with ad libitum-fed control rats. The total calorie consumption due to the chow diet plus ethanol increased in the rats which had ingested ethanol when compared with that of the controls. The daily protein intake in ethanol-fed rats was less than that of the controls. No significant differences in morphometric tissue parameters were found between the two experimental groups. Chronic ethanol ingestion provoked a slight (but not significant) decrease in net leucine absorption at 5 mM leucine concentration. In contrast, minor increases in the absorption values were found at 10 and 25 mM leucine concentrations. These findings suggest that the diminished active mechanisms of leucine absorption provoked by ethanol ingestion are compensated for by the enhanced diffusive processes, the passage of the nutrients through the whole intestine, and that the low protein consumption of ethanol-fed rats in ad libitum conditions isn't enough to provoke significant decreases in leucine absorption by the whole intestine. PMID:7684271

Carreras, O; Vazquez, A L; Rubio, J M; Delgado, M J; Murillo, M L


Activation of RhoA in alcohol-induced intestinal barrier dysfunction.  


Ras homolog gene family, member A (RhoA) is a small GTPase protein known to regulate multiple cellular processes. In the present study, we used both an alcohol-fed mouse model and an alcohol-treated Caco-2 intestinal epithelial cell monolayer in vitro model to investigate whether RhoA is involved in alcohol-induced intestinal barrier dysfunction as well as the underlying mechanisms. We found that chronic alcohol exposure significantly increased both intestinal RhoA mRNA and protein levels in mice and alcohol treatment also increased RhoA activity in Caco-2 cells. The alcohol-induced elevation in RhoA activity was accompanied by an increase in inducible nitric oxide synthase (iNOS) expression and prevented by N?-(1-iminoethyl)-L-lysine dihydrochloride (L-NIL) or small interfering RNA (siRNA) specific for iNOS. Furthermore, alcohol treatment with Caco-2 cells resulted in a significant decrease in the epithelial transepithelial electrical resistance (TEER) value, which was attenuated by knockdown of RhoA. Taken together, our findings suggest that iNOS-mediated activation of RhoA appears to be one of the important mechanisms contributing to the deleterious effects of alcohol on intestinal barrier function. PMID:23361851

Tong, Jing; Wang, Ying; Chang, Bing; Zhang, Dai; Liu, Pengliang; Wang, Bingyuan



Investigation of motility and biofilm formation by intestinal Campylobacter concisus strains  

PubMed Central

Motility helps many pathogens swim through the highly viscous intestinal mucus. Given the differing outcomes of Campylobacter concisus infection, the motility of eight C. concisus strains isolated from patients with Crohn’s disease (n=3), acute (n=3) and chronic (n=1) gastroenteritis and a healthy control (n=1) were compared. Following growth on solid or liquid media the eight strains formed two groups; however, the type of growth medium did not affect motility. In contrast, following growth in viscous liquid medium seven of the eight strains demonstrated significantly decreased motility. In media of increasing viscosities the motility of C. concisus UNSWCD had two marked increases at viscosities of 20.0 and 74.7 centipoises. Determination of the ability of UNSWCD to swim through a viscous medium, adhere to and invade intestinal epithelial cells showed that while adherence levels significantly decreased with increasing viscosity, invasion levels did not significantly change. In contrast, adherence to and invasion of UNSWCD to mucus-producing intestinal cells increased upon accumulation of mucus, as did bacterial aggregation. Given this aggregation, we determined the ability of the eight C. concisus strains to form biofilms, and showed that all strains formed biofilms. In conclusion, the finding that C. concisus strains could be differentiated into two groups based on their motility may suggest that strains with high motility have an increased ability to swim through the intestinal mucus and reach the epithelial layer.



Selenium Deficiency in Pediatric Patients With Intestinal Failure as a Consequence of Drug Shortage.  


Background: Parenteral nutrition (PN) is a lifesaving therapy for children with intestinal failure and can now be used chronically without the life-threatening complications of the past. Adequate intravenous trace element supplementation is required as part of a complete nutrition prescription. According to the U.S. Food and Drug Administration (FDA), the number of drug shortages, including sterile injectable agents used as PN components, has increased since 2010. Selenious acid as an individual additive was recently unavailable at our institution for 9 months due to a national shortage. Materials and Methods: To assess the impact of the selenious acid shortage, we retrospectively compiled data from existing clinical records for eligible patients. We included children with intestinal failure on full PN support who were older than 1 year at the onset of the selenium shortage. Whole-blood selenium concentrations prior to the selenious acid shortage were compared with concentrations drawn during the shortage. Results: Five patients with intestinal failure and complete PN dependence were identified, and all 5 patients had normal serum selenium concentrations prior to the shortage. All 5 patients developed severe biochemical selenium deficiency in direct correlation with the shortage of selenium. No morbidity associated with selenium deficiency was observed. Selenium concentrations recovered after selenium supplementation was reinstituted. Conclusion: A national selenious acid shortage was associated with biochemical selenium deficiency in a cohort of children with intestinal failure. Despite very low selenium concentrations, none of our patients exhibited clinical signs of deficiency. PMID:23587646

Davis, Cheryl; Javid, Patrick J; Horslen, Simon



IL-22BP is regulated by the inflammasome and modulates tumorigenesis in the intestine  

PubMed Central

Chronic mucosal inflammation and tissue damage predisposes patients to the development of colorectal cancer (CRC)1. This association could be explained by the hypothesis that the same factors and pathways important for wound healing also promote tumorigenesis. A sensor of tissue damage should induce these factors to promote tissue repair and regulate their action to prevent development of cancer. IL-22, a cytokine of the IL-10 superfamily, plays an important role for colonic epithelial cell repair, and is increased in the blood and intestine of IBD patients2, 3. This cytokine can be neutralized by the soluble IL-22 receptor, known as the IL-22 binding protein (IL-22BP, IL-22RA2), however the significance of endogenous IL-22BP in vivo and the pathways that regulate this receptor are unknown4, 5. We describe herein that IL-22BP plays a crucial role in controlling tumorigenesis and epithelial cell proliferation in the colon. IL-22BP is highly expressed by dendritic cells (DC) in the colon in steady state conditions. Sensing of intestinal tissue damage via the NLRP3 or NLRP6 inflammasomes led to an IL-18-dependent down regulation of IL-22BP, thereby increasing the ratio of IL-22/IL-22BP. IL-22, which is induced during intestinal tissue damage, exerted protective properties during the peak of damage, but promoted tumor development if uncontrolled during the recovery phase. Thus the IL-22-IL-22BP axis critically regulates intestinal tissue repair and tumorigenesis in the colon.

Huber, Samuel; Gagliani, Nicola; Zenewicz, Lauren A.; Huber, Francis J.; Bosurgi, Lidia; Hu, Bo; Hedl, Matija; Zhang, Wei; O'Connor, William; Murphy, Andrew J.; Valenzuela, David M.; Yancopoulos, George D.; Booth, Carmen J.; Cho, Judy H.; Ouyang, Wenjun; Abraham, Clara; Flavell, Richard A.



Robot-assisted laparoscopic intestinal anastomosis  

Microsoft Academic Search

  Introduction: Robotic telemanipulation systems have been introduced recently to enhance the surgeon's dexterity and visualization\\u000a in videoscopic surgery in order to facilitate refined dissection, suturing, and knot tying. The aim of this study was to demonstrate\\u000a the technical feasibility of performing a safe and efficient robot-assisted handsewn laparoscopic intestinal anastomosis in\\u000a a pig model. Methods: Thirty intestinal anastomoses were performed

J. P. Ruurda; I. A. M. J. Broeders



Altered intestinal microbiota in irritable bowel syndrome.  


Recent studies have suggested that alterations in the composition of the intestinal microbiota may play an important role in irritable bowel syndrome (IBS) symptoms. However, an association between the composition of the intestinal microbiota and IBS symptoms has not been clearly demonstrated. In the current issue of the Journal, Tana et al. suggest that altered intestinal microbiota contributes to the symptoms of IBS through increased levels of organic acids. In fecal samples, IBS patients had significantly higher numbers of Veillonella and Lactobacillus than healthy controls. They also showed significantly higher levels of acetic acid and propionic acid. Furthermore, IBS patients with high acetic acid or propionic acid levels presented more severe symptoms, impaired quality of life and negative emotions. These results are in accordance with the concept that the gut microbiota influences the sensory, motor and immune system of the gut and interacts with higher brain centers. Small intestinal bacterial overgrowth observed in a subset of IBS patients describes quantitative changes in the small intestinal microbiota. Data on qualitative changes in the gut microbiota in IBS patients are lacking. Different members of gut bacteria may have different influence on gut function. The concepts identified here may lead to the development of novel therapeutic strategies for IBS using manipulation of the intestinal microbiota. PMID:20414959

Lee, K J; Tack, J



Methods for the analysis of intestinal function.  

PubMed Central

The intestinal tract, an organ of considerable complexity, requires application of numerous techniques for analysis of its physiology and perturbations by toxicologic agents. This review describes the methodology of importance in analysis of the absorptive function of the intestine and the transit of intestinal contents. Methods for studying absorption are categorized according to the technique for administering the test substance such as inclusion in the diet or by gastric and intestinal placement and the method of quantitating the degree of absorption such as determining the appearance of a test substance in systemic fluids or its disappearance from its site of administration in the intestine. In vitro techniques which have no in vivo analogs, such as the use of the everted sac, are briefly described and their limitations emphasized. Procedures of importance in the clinical diagnosis of malabsorption or in the experimental analysis of absorptive function in man are included and distinguished from techniques used in animal models. In addition, methods for studying aspects of gastrointestinal motility, including the use of luminal markers and analysis of the contractile and electrical activity of intestinal smooth muscle, are reviewed. Images FIGURE 2.

Walsh, C T; Levine, R R




PubMed Central

Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease. A multitude of etiologies have been implicated in the causation of CU, including physical, infective, vasculitic, psychological and idiopathic. An autoimmune basis of most of the ‘idiopathic’ forms is now hypothesized. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterized by wheals that have a tendency to recur. Laboratory investigations aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical search for associated systemic disease is strongly advocated under appropriate circumstances. The mainstay of treatment remains H1 antihistaminics. These may be combined with complementary pharmacopeia in the form of H2 blockers, doxepin, nifedipine and leukotriene inhibitors. More radical therapy in the form of immunoglobulins, plasmapheresis and cyclophosphamide may be required for recalcitrant cases. Autologous transfusion and alternative remedies like acupuncture have prospects for future. A stepwise management results in favorable outcomes. An update on CU based on our experience with patients at a tertiary care centre is presented.

Sachdeva, Sandeep; Gupta, Vibhanshu; Amin, Syed Suhail; Tahseen, Mohd



Chronic insomnia.  


Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce. PMID:22265700

Morin, Charles M; Benca, Ruth



T cell transfer model of chronic colitis: concepts, considerations, and tricks of the trade  

PubMed Central

The inflammatory bowel diseases (Crohn's disease; ulcerative colitis) are idiopathic chronic inflammatory disorders of the intestine and/or colon. A major advancement in our understanding of the pathogenesis of these diseases has been the development of mouse models of chronic gut inflammation. One model that has been instrumental in delineating the immunological mechanisms responsible for the induction as well as regulation of intestinal inflammation is the T cell transfer model of chronic colitis. This paper presents a detailed protocol describing the methods used to induce chronic colitis in mice. Special attention is given to the immunological concepts that explain disease pathogenesis in this model, considerations and potential pitfalls in using this model, and finally different “tricks” that we have learned over the past 12 years that have allowed us to develop a more simplified version of this model of experimental IBD.

Ostanin, Dmitry V.; Bao, Jianxiong; Koboziev, Iurii; Gray, Laura; Robinson-Jackson, Sherry A.; Kosloski-Davidson, Melissa; Price, V. Hugh; Grisham, Matthew B.



Intestinal ischemia after aortic surgery.  


Intestinal ischemia after abdominal aortic surgery is a highly lethal complication. In order to evaluate the pathogenesis, the diagnostic modalities and the best management, in a retrospective review, 12 patients undergoing postoperative small bowel or colonic ischemic lesions were identified between 1983 and 1995. Preoperative occlusion of IMA was present in nine patients, while a selective angiography of SMA demonstrated occlusive disease of peripheral branches in two asymptomatic diabetic patients. No patent IMA was ligated. When possible, hypogastric circulation was preserved by distal anastomosis into iliac bifurcation (4 cases). Postoperative leukocytosis or elevated LDH values were present. Colonscopy showed a suspected ischemic colitis in two patients and necrotic lesions in three cases. One patient died and diagnosis was made at autopsy. Nine patients were submitted to reoperation and a bowel resection with a proximal stoma was performed in seven of them. In two patients, the aorta or iliac artery below the proximal anastomosis and hypogastric artery suffered acute thrombosis, while prosthetic grafts were patent. A coagulation disorder caused thrombosis of intramural arterioles of the small bowel while peripheral branches of SMA were pulsatile. Eight of the patients submitted to relaparotomy died; non-operative management resulted in a left colon late stricture, while the remaining patient survived without sequelae. Overall mortality rate was 66.6%. Symptoms of this complication are not specific and diagnosis is delayed; consequently surgical repair is often unsuccessful. One patient with small bowel necrosis after elective AAA resection survived, which is extremely rare. PMID:8912093

Porcellini, M; Renda, A; Selvetella, L; Bernardo, B; Baldassarre, M


Effect of chronic Giardia lamblia infection on epithelial transport and barrier function in human duodenum  

Microsoft Academic Search

Background:Giardia lamblia causes infection of the small intestine, which leads to malabsorption and chronic diarrhoea.Aim: To characterise the inherent pathomechanisms of G lamblia infection.Methods: Duodenal biopsy specimens from 13 patients with chronic giardiasis and from controls were obtained endoscopically. Short-circuit current (ISC) and mannitol fluxes were measured in miniaturised Ussing chambers. Epithelial and subepithelial resistances were determined by impedance spectroscopy.

Hanno Troeger; Hans-Joerg Epple; Thomas Schneider; Ulrich Wahnschaffe; Reiner Ullrich; Gerd-Dieter Burchard; Tomas Jelinek; Martin Zeitz; Michael Fromm; Joerg-Dieter Schulzke



Tylosin-responsive chronic diarrhea in dogs.  


Fourteen dogs had shown chronic or intermittent diarrhea for more than 1 year. Diarrhea had been successfully treated with tylosin for at least 6 months but recurred when treatment was withdrawn on at least 2 occasions. Tylosin-responsive diarrhea (TRD) affects typically middle-aged, large-breed dogs and clinical signs indicate that TRD affects both the small and large intestine. Treatment with tylosin eliminated diarrhea in all dogs within 3 days and in most dogs within 24 hours. Tylosin administration controlled diarrhea in all dogs, but after it was discontinued, diarrhea reappeared in 12 (85.7%) of 14 dogs within 30 days. Prednisone given for 3 days did not completely resolve diarrhea. Probiotic Lactobacillus rhamnosus GG did not prevent the relapse of diarrhea in any of 9 dogs so treated. The etiology of TRD, a likely form of antibiotic-responsive diarrhea (ARD) is unclear. The following reasons for chronic diarrhea were excluded or found to be unlikely: parasites, exocrine pancreatic insufficiency, inflammatory bowel disease, small intestinal bacterial overgrowth, enteropathogenic bacteria (Salmonella spp., Campylobacter spp., Yersinia spp., or Lawsoni intracellularis), and Clostridium perfringens enterotoxin and Clostridium difficile A toxin. A possible etiologic factor is a specific enteropathogenic organism that is a common resident in the canine gastrointestinal tract and is sensitive to tylosin but difficult to eradicate. Additional studies are required to identify the specific cause of TRD. PMID:15822561

Westermarck, Elias; Skrzypczak, Teresa; Harmoinen, Jaana; Steiner, Jõrg M; Ruaux, Craig G; Williams, David A; Eerola, Erkki; Sundbäck, Pernilla; Rinkinen, Minna


Probiotic bacteria reduce salmonella typhimurium intestinal colonization by competing for iron.  


Host inflammation alters the availability of nutrients such as iron to limit microbial growth. However, Salmonella enterica serovar Typhimurium thrives in the inflamed gut by scavenging for iron with siderophores. By administering Escherichia coli strain Nissle 1917, which assimilates iron by similar mechanisms, we show that this nonpathogenic bacterium can outcompete and reduce S. Typhimurium colonization in mouse models of acute colitis and chronic persistent infection. This probiotic activity depends on E. coli Nissle iron acquisition, given that mutants deficient in iron uptake colonize the intestine but do not reduce S. Typhimurium colonization. Additionally, the ability of E. coli Nissle to overcome iron restriction by the host protein lipocalin 2, which counteracts some siderophores, is essential, given that S. Typhimurium is unaffected by E. coli Nissle in lipocalin 2-deficient mice. Thus, iron availability impacts S. Typhimurium growth, and E. coli Nissle reduces S. Typhimurium intestinal colonization by competing for this limiting nutrient. PMID:23870311

Deriu, Elisa; Liu, Janet Z; Pezeshki, Milad; Edwards, Robert A; Ochoa, Roxanna J; Contreras, Heidi; Libby, Stephen J; Fang, Ferric C; Raffatellu, Manuela



The mechanisms of action of interleukin-1 on rabbit intestinal epithelial cells.  

PubMed Central

Interleukin-1 (IL-1) is an inflammatory mediator that increases Cl- secretion in intestinal epithelial cells. To identify the signal transduction pathway(s) involved in IL-1's action, cells were treated with IL-1 and the levels of cyclooxygenase (COX) enzymes, prostaglandin E2 (PGE2) and phospholipase A2-activating protein (PLAP), and the activity of phospholipase A2 (PLA2) were measured. IL-1 caused concentration- and time-dependent increases in the levels of PLA2 activity, and/or in the levels of PLAP, COX-2 and PGE2. The IL-induced increase in PGE2 levels was biphasic, with the first peak due to the increase in PLAP levels, and the second peak due to the increase in COX-2 levels. This increase in PGE2 levels may provide a mechanism for acute and chronic inflammation in the intestine.

Homaidan, F R; Zhao, L; Chakroun, I; Martin, C A; Burakoff, R



Regulation of intestinal epithelial cells transcriptome by enteric glial cells: impact on intestinal epithelial barrier functions  

Microsoft Academic Search

BACKGROUND: Emerging evidences suggest that enteric glial cells (EGC), a major constituent of the enteric nervous system (ENS), are key regulators of intestinal epithelial barrier (IEB) functions. Indeed EGC inhibit intestinal epithelial cells (IEC) proliferation and increase IEB paracellular permeability. However, the role of EGC on other important barrier functions and the signalling pathways involved in their effects are currently

Laurianne Van Landeghem; Maxime M Mahé; Raluca Teusan; Jean Léger; Isabelle Guisle; Rémi Houlgatte; Michel Neunlist



Expression and activity of the TLR4/NF-?B signaling pathway in mouse intestine following administration of a short-term high-fat diet  

PubMed Central

Insulin resistance in obesity is associated with chronic systemic low-grade inflammation. Although it has been shown that Toll-like receptor 4 (TLR4) in the liver, muscle and adipose tissue plays an important role in obesity-associated inflammation and insulin resistance, the effect of TLR4 activation in the intestine has not been investigated. The aim of this study was to explore the activation of the mouse intestinal TLR4/NF-?B signaling pathway following the administration of a short-term high-fat diet, as well as the function of the signaling pathway in the local enteric inflammatory response. The effect of the high-fat diet on TLR4 activation, NF-?B and phosphorylated I?B (PI?B) activity, and tumor necrosis factor (TNF)-? and IL-6 expression in the intestinal tissues of diet-induced obese C57BL/6 mice was investigated. The results demonstrated that the high-fat diet induced TLR4 mRNA and protein expression in intestinal tissues. TLR4/NF-?B signaling pathway activation gradually increased as the number of days of high-fat diet administration increased, and peaked on day 7. Additionally, activation of the signaling pathway reduced PI?B expression levels and increased TNF-? and IL-6 expression levels in intestinal tissues. Our results demonstrated that a short-term high-fat diet induces activation of the TLR4/NF-?B signaling pathway in intestinal tissues, which causes local intestinal low-grade inflammation. These data improve our understanding of the molecular events involved in intestinal low-grade inflammation, which may be the triggering factor for chronic systemic low-grade inflammation.




Hyperhomocysteinemia decreases intestinal motility leading to constipation  

PubMed Central

Elevated levels of plasma homocysteine (Hcy) called hyperhomocysteinemia (HHcy) have been implicated in inflammation and remodeling in intestinal vasculature, and HHcy is also known to aggravate the pathogenesis of inflammatory bowel disease (IBD). Interestingly, colon is the pivotal site that regulates Hcy levels in the plasma. We hypothesize that HHcy decreases intestinal motility through matrix metalloproteinase-9 (MMP-9)-induced intestinal remodeling leading to constipation. To verify this hypothesis, we used C57BL/6J or wild-type (WT), cystathionine ?-synthase (CBS+/?), MMP-9?/?, and MMP-9?/? + Hcy mice. Intestinal motility was assessed by barium meal studies and daily feces output. Plasma Hcy levels were measured by HPLC. Expression of ICAM-1, inducible nitric oxide synthase, MMP-9, and tissue inhibitors of MMPs was studied by Western blot and immunohistochemistry. Reactive oxygen species (ROS) including super oxide were measured by the Invitrogen molecular probe method. Tissue nitric oxide levels were assessed by a commercially available kit. Plasma Hcy levels in the treated MMP-9 group mice were comparable to CBS+/? mice. Barium meal studies suggest that intestinal motility is significantly decreased in CBS+/? mice compared with other groups. Fecal output-to-body weight ratio was significantly reduced in CBS+/? mice compared with other groups. There was significant upregulation of MMP-9, iNOS, and ICAM-1 expression in the colon from CBS+/? mice compared with WT mice. Levels of ROS, superoxide, and inducible nitric oxide were elevated in the CBS+/? mice compared with other groups. Results suggest that HHcy decreases intestinal motility due to MMP-9-induced intestinal remodeling leading to constipation.

Munjal, C.; Narayanan, N.; Aqil, F.; Tyagi, G.; Metreveli, N.; Tyagi, S. C.



[Reactive changes in the smooth muscle tissue of the rat small intestine during experimental intestinal obstruction].  


Using light, electron microscopy and immunohistochemical methods, the reactive transformation of smooth muscle tissue (SMT) was studied in the intestinal wall during the development of acute partial high intestinal obstruction. The material of small intestine was taken from 10 male rats in both the zone of ligature application, and proximal and distal zones, 3 cm distant from the ligation zone. The results of the study demonstrate that in partial intestinal obstruction, the nature of structural and functional SMT transformation was variable depending upon differences in functional and destructive loads. During these changes, the remodeling of smooth myocyte population was shown to be one of the mechanisms of SMT adaptation to the changing conditions of functioning. Immunohistochemical analysis found no changes in the pattern of expression of marker and phenotypic proteins in the intestinal zones studied during the dynamics of an experiment. PMID:20572395

Zashikhin, A L; Sehlin, J; Barmina, A O



Intestinal cytochromes P450 regulating the intestinal microbiota and its probiotic profile  

PubMed Central

Cytochromes P450 (CYPs) enzymes metabolize a large variety of xenobiotic substances. In this vein, a plethora of studies were conducted to investigate their role, as cytochromes are located in both liver and intestinal tissues. The P450 profile of the human intestine has not been fully characterized. Human intestine serves primarily as an absorptive organ for nutrients, although it has also the ability to metabolize drugs. CYPs are responsible for the majority of phase I drug metabolism reactions. CYP3A represents the major intestinal CYP (80%) followed by CYP2C9. CYP1A is expressed at high level in the duodenum, together with less abundant levels of CYP2C8-10 and CYP2D6. Cytochromes present a genetic polymorphism intra- or interindividual and intra- or interethnic. Changes in the pharmacokinetic profile of the drug are associated with increased toxicity due to reduced metabolism, altered efficacy of the drug, increased production of toxic metabolites, and adverse drug interaction. The high metabolic capacity of the intestinal flora is due to its enormous pool of enzymes, which catalyzes reactions in phase I and phase II drug metabolism. Compromised intestinal barrier conditions, when rupture of the intestinal integrity occurs, could increase passive paracellular absorption. It is clear that high microbial intestinal charge following intestinal disturbances, ageing, environment, or food-associated ailments leads to the microbial metabolism of a drug before absorption. The effect of certain bacteria having a benefic action on the intestinal ecosystem has been largely discussed during the past few years by many authors. The aim of the probiotic approach is to repair the deficiencies in the gut flora and establish a protective effect. There is a tentative multifactorial association of the CYP (P450) cytochrome role in the different diseases states, environmental toxic effects or chemical exposures and nutritional status.

Bezirtzoglou, Eugenia Elefterios Venizelos



[Endoscopical features of precancer changes of the stomach in patients with chronic gastric erosions and biliary tract disease].  


Frequency of the precancer changes of the stomach, diagnosed by using zoom-endoscopy, NBI, chromoscopy, in the three groups of patients: with gastric erosions and biliary tract diseases, with gastric erosions and duodenal ulcer disease, with gastric erosions and chronic gastritis is compared in the article. It is shown, that patients with gastric erosions and biliary tract diseases are characterized by bigger spreading of precancer changes: atrophy, intestinal metaplasia with predominant smalluently intestine in gastric body, intestine metaplasia in antral part of the stomach is revealed more freq in these category of patients. A strong correlation between endoscopical and morphological methods of investigation was demonstrated. PMID:23534277

Solov?ova, H A


Natural killer cell lymphoma of small intestine with features of enteropathy but lack of association with celiac disease  

Microsoft Academic Search

A primary small intestinal natural killer (NK) cell lymphoma with pathologic features of enteropathy but lack of association with celiac disease is reported. A 37-year-old man presented with tarry stool, coffee-ground vomitus, and mild fever. He did not have chronic diarrhea or malabsorption. Segmental resection of the duodenum and jejunum showed multicentric transmural infiltration by medium-sized lymphoma cells expressing CD3,

Shih-Sung Chuang; Yun-Chih Jung



Quality of life in Korean patients with inflammatory bowel diseases: ulcerative colitis, Crohn's disease and intestinal Behçet's disease  

Microsoft Academic Search

Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as inflammatory bowel disease\\u000a (IBD). This study used the Korean translation of the disease-specific, self-administered Inflammatory Bowel Disease Questionnaire\\u000a (IBDQ) to compare HRQOL in ulcerative colitis (UC; n=98), Crohn's disease (CD; n = 49), and intestinal Behçet's disease (BD; n = 34). In addition to the

W. H. Kim; Y. S. Cho; H. M. Yoo; I. S. Park; E. C. Park; J. G. Lim



Involvement of alpha-1 and alpha-2 adrenoceptors in the postlaparotomy intestinal motor disturbances in the rat  

Microsoft Academic Search

The effects of phentolamine, yohimbine and prazosin on laparotomy induced intestinal motor disturbances were studied in anaesthetised fasted rats previously equipped with electrodes, chronically implanted on the duodenum and jejunum. During continuous recording of interdigestive myoelectric activity, laparotomy under thiopental anaesthesia (Nesdonal 40 mg\\/kg ip) induced a primary phase of total inhibition of spiking activity lasting 26.1 +\\/- 1.3 min

A Sagrada; M J Fargeas; L Bueno



Impact of polychlorinated biphenyls on the activity of intestinal proteinases and carbohydrases in juvenile roach Rutilus rutilus (L.)  

Microsoft Academic Search

The chronic effects that polychlorinated biphenyls (PCBs) have on the activities of proteinases and carbohydrates in intestinal\\u000a mucosa and chyme in juvenile roach Rutilus rutilus (L.) have been studied for the first time. Upon consuming food with PCB 50.8 ng\\/g wet weight for 218 days, the exposition\\u000a of fingerlings in aquariums with dirt bottoms (contents PCB 425.6 ng\\/g dry weight)

I. L. Golovanova; V. V. Kuzmina; G. M. Chuiko; N. V. Ushakova; A. A. Filippov



Timing and Indications for Colectomy in Chronic Ulcerative Colitis: Surgical Consideration  

Microsoft Academic Search

Total proctocolectomy (TPC) cures a patient of the intestinal manifestation of chronic ulcerative colitis. The timing of surgery during the illness will influence the choice of operation, the frequency of post-operative complications, and the long-term functional outcomes. Surgery is divided into emergency, urgent, and elective procedures. Emergency cases are performed for complications of fulminant colitis: hemorrhage, perforation, toxic megacolon or

Robert R. Cima



Iron supplementation to treat anemia in patients with chronic kidney disease  

Microsoft Academic Search

Iron deficiency is prevalent in patients with chronic kidney disease (CKD), and use of oral and intravenous iron in patients with CKD who do not require dialysis might obviate or delay the need for treatment with eythropoiesis-stimulating agents (ESAs). Patients on hemodialysis have lower intestinal iron absorption, greater iron losses, and require greater iron turnover to maintain the ESA-driven red

Daniel W. Coyne; Anatole Besarab



Ursodeoxycholic acid therapy of chronic cholestatic conditions in adults and children  

Microsoft Academic Search

Cholestasis can be defined as the manifestation of defective bile acid transport from the liver to the intestine. Most chronic cholestatic conditions can progress towards cirrhosis. At this stage, liver transplantation is the treatment of choice. Most of the drugs so far evaluated show some degree of efficacy but have major side effects. Given that ursodeoxycholic acid (UDCA) has no

Raoul Poupon; Renée E. Poupon



Simotang enhances gastrointestinal motility, motilin and cholecystokinin expression in chronically stressed mice  

PubMed Central

AIM: To investigate the effect of Simotang (Decoction of Four Powered Drugs) on gastrointestinal motility, motilin and cholecystokinin expression in chronically stressed mice. METHODS: Forty mice were randomly divided into control group, stress group (model group), mosapride group and Simotang group, 10 in each group. A variety of unpredictable stimulations were used to induce chronic stress in mice. Then, the mice were treated with distilled water, mosapride or Simotang for 7 d. Gastric emptying and intestinal propulsion function were detected. Serum level of motilin was measured by enzyme-linked immunosorbent assay. Expression of cholecystokinin (CCK) in intestine, spinal cord and brain of mice was detected by immunohistochemistry and semi-quantitative reverse transcription polymerase chain reaction, respectively. RESULTS: Simotang improved the gastric emptying and intestinal propulsion in chronically stressed mice. Furthermore, the serum motilin level was significantly higher and the expression levels of CCK-positive cells and genes were significantly lower in intestine, spinal cord and brain of Simotang group than in those of model group (P < 0.05). No significant difference was found in serum motilin level and expression levels of CCK-positive cells and genes between the mosapride and Simotang groups. CONCLUSION: Simotang enhances the gastrointestinal motility in chronically stressed mice by regulating the serum motilin level and the expression of cholecystokinin.

Cai, Guang-Xian; Liu, Bai-Yan; Yi, Jian; Chen, Xue-Mei; Liu, Fu-Ling



Is chronic fatigue syndrome an autoimmune disorder of endogenous neuropeptides, exogenous infection and molecular mimicry?  

Microsoft Academic Search

Chronic fatigue syndrome is a disorder characterised by prolonged fatigue and debility and is mostly associated with post-infection sequelae although ongoing infection is unproven. Immunological aberration is likely and this may prove to be associated with an expanding group of vasoactive neuropeptides in the context of molecular mimicry and inappropriate immunological memory.Vasoactive neuropeptides including vasoactive intestinal peptide (VIP) and pituitary

Donald R Staines



Elevated expression of forkhead box protein O1 (FoxO1) in alcohol-induced intestinal barrier dysfunction.  


Alcohol-induced intestinal barrier dysfunction is a major contributor to alcoholic liver disease (ALD). Forkhead box protein O1 (FoxO1) is a member of the mammalian forkhead box O class (FoxO) subfamily that regulates a wide array of cellular processes. In the present study, we used both an alcohol-fed mouse model and an alcohol-treated Caco-2 intestinal epithelial cell monolayer in vitro model to investigate whether FoxO1 is involved in alcohol-induced intestinal barrier dysfunction. We found that chronic alcohol exposure to mice significantly increased both mRNA and protein levels of FoxO1 in all the examined intestinal segments with the most remarkable changes in the ileum. Alcohol treatment increased mRNA and protein levels of FoxO1 and promoted nuclear translocation of FoxO1 in Caco-2 cells. Furthermore, alcohol treatment with Caco-2 cells resulted in a significant decrease in the epithelial transepithelial electrical resistance (TEER) value, which was attenuated by knockdown of FoxO1 expression. In conclusion, our data suggest that activation of FoxO1 is likely to be a novel mechanism contributing to the deleterious effects of alcohol on intestinal barrier function. PMID:23347700

Wang, Ying; Tong, Jing; Zou, Dawei; Chang, Bing; Wang, Baifang; Wang, Bingyuan



[Cytotoxicity and genome-wide microarray analysis of intestinal smooth muscle cells in response to hexavalent chromium induction].  


Chronic ingestion of high concentrations of hexavalent chromium [Cr(VI)] in drinking water induces intestinal tumors in mice; however, information on its toxicity on intestinal smooth muscle cells is limited. The present study aimed to assess the in vitro and in vivo toxicological effects of Cr(VI) on intestinal smooth muscle cells. Human intestinal smooth muscle cells (HISM cells) were cultured with different concentrations of Cr(VI) to evaluate effects on cell proliferation ability, oxidative stress levels, and antioxidant system. Furthermore, tissue sections in Cr(VI) exposed rabbits were analyzed to evaluate toxicity on intestinal muscle cells in vivo. Gene chips were utilized to assess differential gene expression profiles at the genome-wide level in 1 ?mol/L Cr(VI) treated cells. Intestinal tissue biopsy results showed that Cr(VI) increased the incidences of diffuse epithelial hyperplasia in intestinal jejunum but caused no obvious damage to the structure of the muscularis. Cell proliferation analysis revealed that high concentrations (?64 ?mol/L) but not low concentrations of Cr(VI) (?16 ?mol/L) significantly inhibited the growth of HISM cells. For oxidative stress levels, the expression of reactive oxygen species (ROS) and nitric oxide (NO) was elevated at high concentrations (?64 ?mol/L) but not at low concentrations of Cr(VI) (?16 ?mol/L). In addition, dose-dependent increases in the activity of oxidized glutathione (GSSH)/total-glutathione (T-GSH) were also observed. Gene chip screened 491 differentially expressed genes including genes associated with cell apoptosis, oxidations, and cytoskeletons. Some of these differentially expressed genes may be unique to smooth muscle cells in response to Cr(VI) induction. PMID:23776007

Jin, Li-Fang; Wang, Yuan-Yuan; Zhang, Zi-Dong; Yuan, Yi-Meng; Hu, Yi-Rui; Wei, Yang-Feng; Ni, Jian



Phosphoinositide 3-Kinase Signaling Mediates ?-Catenin Activation in Intestinal Epithelial Stem and Progenitor Cells in Colitis  

PubMed Central

Background & Aims Mechanisms responsible for crypt architectural distortion in chronic ulcerative colitis (CUC) are not well understood. Data indicate that Akt signaling cooperates with Wnt to activate ?-catenin in intestinal stem and progenitor cells through phosphorylation at Ser552 (P-?-catenin552). We investigated whether phosphoinositide 3- kinase (PI3K) is required for Akt-mediated activation of ?-catenin during intestinal inflammation. Methods The class IA subunit of PI3K was conditionally deleted from intestinal epithelial cells in mice. Acute inflammation was induced in these mice (I-pik3r1KO) and their intestines were analyzed by biochemical and histological methods. The effects of chemically blocking PI3K in colitic IL-10?/? mice were examined. Biopsy samples from patients were examined. Results Compared to wild type mice, I-pik3r1KO mice had reduced T-cell–mediated Akt and ?-catenin signaling in intestinal stem and progenitor cells and limited crypt epithelial proliferation. Biochemical analyses indicated that PI3K–Akt signaling increased nuclear total ?-catenin and P-?-catenin552 levels and reduced phosphorylation of N-terminal ?-catenin, which is associated with degradation. PI3K inhibition in IL-10?/? mice impaired colitis-induced epithelial Akt and ?-catenin activation, reduced progenitor cell expansion, and prevented dysplasia. Human samples had increased numbers of progenitor cells with P-?-catenin552 throughout expanded crypts and increased mRNA expression of ?-catenin target genes in CUC, colitis-associated cancer, tubular adenomas, and sporadic colorectal cancer, compared with control samples. Conclusions PI3K–Akt signaling cooperates with Wnt to increase ?-catenin signaling during inflammation. PI3K-induced and Akt-mediated ?-catenin signaling are required for progenitor cell activation during the progression from CUC to CAC; these factors might be used as biomarkers of dysplastic transformation in the colon.

Lee, Goo; Goretsky, Tatiana; Managlia, Elizabeth; Dirisina, Ramanarao; Singh, Ajay Pal; Brown, Jeffrey B; May, Randal; Yang, Guang-Yu; Ragheb, Josette William; Evers, B Mark; Weber, Christopher R.; Turner, Jerrold R; He, Xi C; Katzman, Rebecca B.; Li, Linheng; Barrett, Terrence A



Environmental Particulate Matter Induces Murine Intestinal Inflammatory Responses and Alters the Gut Microbiome  

PubMed Central

Background Particulate matter (PM) is a key pollutant in ambient air that has been associated with negative health conditions in urban environments. The aim of this study was to examine the effects of orally administered PM on the gut microbiome and immune function under normal and inflammatory conditions. Methods Wild-type 129/SvEv mice were gavaged with Ottawa urban PM10 (EHC-93) for 7–14 days and mucosal gene expression analyzed using Ingenuity Pathways software. Intestinal permeability was measured by lactulose/mannitol excretion in urine. At sacrifice, segments of small and large intestine were cultured and cytokine secretion measured. Splenocytes were isolated and incubated with PM10 for measurement of proliferation. Long-term effects of exposure (35 days) on intestinal cytokine expression were measured in wild-type and IL-10 deficient (IL-10?/?) mice. Microbial composition of stool samples was assessed using terminal restriction fragment length polymorphism. Short chain fatty acids were measured in caecum. Results Short-term treatment of wild-type mice with PM10 altered immune gene expression, enhanced pro-inflammatory cytokine secretion in the small intestine, increased gut permeability, and induced hyporesponsiveness in splenocytes. Long-term treatment of wild-type and IL-10?/? mice increased pro-inflammatory cytokine expression in the colon and altered short chain fatty acid concentrations and microbial composition. IL-10?/? mice had increased disease as evidenced by enhanced histological damage. Conclusions Ingestion of airborne particulate matter alters the gut microbiome and induces acute and chronic inflammatory responses in the intestine.

Kish, Lisa; Hotte, Naomi; Kaplan, Gilaad G.; Vincent, Renaud; Tso, Robert; Ganzle, Michael; Rioux, Kevin P.; Thiesen, Aducio; Barkema, Herman W.; Wine, Eytan; Madsen, Karen L.



Aquaporin 1a Expression in Gill, Intestine, and Kidney of the Euryhaline Silver Sea Bream  

PubMed Central

This study aimed to investigate the effects of chronic salinity acclimation, abrupt salinity transfer, and cortisol administration on aquaporin 1 (AQP1) expression in gill, intestine, and kidney of silver sea bream (Sparus sarba). An AQP1a cDNA was cloned and found to share 83–96% amino acid sequence identity with AQP1 genes from several fish species. Tissue distribution studies of AQP1a mRNA demonstrated that it was expressed in gill, liver, intestine, rectum, kidney, heart, urinary bladder, and whole blood. Semi-quantitative RT-PCR analysis was used to measure AQP1a transcript abundance in sea bream that were acclimated to salinity conditions of 0, 6, 12, 33, 50, and 70?ppt for 1?month. The abundance of gill AQP1a transcript was highest in sea bream acclimated to 0?ppt whereas no differences were found among 0–50?ppt groups. For intestine, the highest AQP1a transcript amounts were found in sea bream acclimated to 12 and 70?ppt whereas the transcript abundance of kidney AQP1a was found to be unchanged amongst the different salinity groups. To investigate the effects of acute salinity alterations on AQP1a expression, sea bream were abruptly transferred from 33 to 6?ppt. For intestine AQP1a levels were altered at different times, post transfer, but remained unchanged in gill and kidney. To study the effects of cortisol on AQP1a expression, sea bream were administered a single dose of cortisol followed by a 3-day acclimation to either 33 or 6?ppt. The findings from this experiment demonstrated that cortisol administration resulted in alterations of AQP1a transcript in gill and intestine but not in kidney.

Deane, Eddie E.; Luk, James C. Y.; Woo, Norman Y. S.



Uptake of botulinum neurotoxin in the intestine.  


Foodborne and intestinal botulism are the most common forms of human botulism; both result from the absorption of botulinum neurotoxin (BoNT) from the digestive tract into the circulation. BoNT is a large protein toxin (approximately 150 kDa), but it is able to pass through the epithelial barrier in the digestive tract. Recent cellular and molecular biology studies have begun to unravel the mechanisms by which this large protein toxin crosses the intestinal epithelial barrier. This review provides an overview of current knowledge relating to the absorption of botulinum toxins (BoNT and BoNT complex) from the gastrointestinal tract, with particular emphasis on the interaction of these toxins with the intestinal epithelial barrier. PMID:23239348

Fujinaga, Yukako; Sugawara, Yo; Matsumura, Takuhiro



The Biology of Intestinal Immunoglobulin A Responses  

PubMed Central

The gut mucosa is exposed to a large community of commensal bacteria that are required for the processing of nutrients and the education of the local immune system. Conversely, the gut immune system generates innate and adaptive responses that shape the composition of the local microbiota. One striking feature of intestinal adaptive immunity is its ability to generate massive amounts of noninflammatory immunoglobulin A (IgA) antibodies through multiple follicular and extrafollicular pathways that operate in the presence or absence of cognate T-B cell interactions. Here we discuss the role of intestinal IgA in host-commensal mutualism, immune protection, and tolerance and summarize recent advances on the role of innate immune cells in intestinal IgA production.

Cerutti, Andrea; Rescigno, Maria



Prevention and management of non-steroidal anti-inflammatory drugs-induced small intestinal injury  

PubMed Central

Non-steroidal anti-inflammatory drug (NSAID)-induced small bowel injury is a topic that deserves attention since the advent of capsule endoscopy and balloon enteroscopy. NSAID enteropathy is common and is mostly asymptomatic. However, massive bleeding, stricture, or perforation may occur. The pathogenesis of small intestine injury by NSAIDs is complex and different from that of the upper gastrointestinal tract. No drug has yet been developed that can completely prevent or treat NSAID enteropathy. Therefore, a long-term randomized study in chronic NSAID users is needed.

Park, Sung Chul; Chun, Hoon Jai; Kang, Chang Don; Sul, Donggeun



Collagen XVI induces formation of focal contacts on intestinal myofibroblasts isolated from the normal and inflamed intestinal tract.  


In Crohn's disease (CD) the stress-shield of intestinal subepithelial myofibroblasts (ISEMF) provided by intact tissue is disturbed due to inflammation and thus, cells start with remodelling activities. This is characterized by increased numbers of collagen-producing ISEMF causing an uncontrolled, irreversible wound-healing response to the chronic inflammation of the gastrointestinal tract. Reconstitution of the original ECM leads ISEMF to exit this cycle. In contrast, during fibrosis, ISEMF persist. It is known that ISEMF produce and deposit collagen types I, III, IV and V; however synthesis and the role of fibrillar peripheral molecules like collagen type XVI have not been addressed yet. Here, we have analyzed the distribution of collagen XVI in the normal and inflamed bowel wall, its gene and protein expression by ISEMF of different inflammation stages, the cell-matrix interactions in different phases of the inflammatory process and their effect on cell spreading, proliferation and migration. Collagen XVI is deposited in the submucosa of the intestinal wall where it co-localizes with fibrillin-1 and integrin alpha1. ISEMF reveal increasing gene and protein expression of collagen XVI concurrent to increasing inflammation. ISEMF reveal more mature focal adhesion contacts when seeded on collagen XVI resulting in an extensive cell spreading. This involves recruitment of alpha1beta1 integrin, which shows increased cell surface expression on ISEMF in late stages of inflammation. We assume that collagen XVI promotes persistence of ISEMF in the normal and, even stronger in the inflamed bowel wall by stabilizing focal adhesion contacts via cell-matrix interaction preferentially through recruitment of alpha1ss1 integrin into the tips of the focal adhesion contacts. PMID:19931388

Ratzinger, Sabine; Eble, Johannes A; Pasoldt, Anja; Opolka, Alfred; Rogler, Gerhard; Grifka, Joachim; Grässel, Susanne



Role of intestinal cytochrome p450 enzymes in diclofenac-induced toxicity in the small intestine.  


The aim of this study was to determine the role of small intestinal (SI) cytochrome P450 (P450) enzymes in the metabolic activation of diclofenac (DCF), a widely used nonsteroidal anti-inflammatory drug, and DCF-induced intestinal toxicity. DCF induces intestinal ulcers in humans and mice, but the underlying mechanisms, including the necessity for drug bioactivation in the target tissues and the sources and identities of reactive intermediates, are not fully understood. We found that the number of DCF-induced (at 50 mg/kg p.o.) intestinal ulcers was significantly smaller in an intestinal epithelium (IE)-specific P450 reductase (CPR) knockout (IE-Cpr-null) mouse model, which has little P450 activity in the IE, than in wild-type (WT) mice, determined at 14 h after DCF administration. The involvement of intestinal P450 enzymes was confirmed by large reductions (>80-90%) in the rates of in vitro formation, in SI microsomal reactions, of hydroxylated DCF metabolites and reactive in