Nonsteroidal anti-inflammatory drug-induced enteropathy: case discussion and review of the literature

A computer simulation of a catheter manometer system was used to quantify measurement errors in neonatal blood pressure parameters. Accurate intra-arterial pressure recordings of 21 critically ill newborns were fed into this simulated system. The dynamic characteristics, natural frequency and damping coefficient, were varied from 2.5 to 60 Hz and from 0.1 to 1.4, respectively. As a result, errors in systolic, diastolic and pulse arterial pressure were obtained as a function of natural frequency and damping coefficient. Iso-error curves for 2%, 5% and 10% were constructed. Using these curves, the maximum inaccuracy of any neonatal catheter manometer system can be determined and used in the clinical setting.     

A case report of ulcerative colitis complicated with protein losing enteropathy and colon cancer in a young female

AIMS: To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers. PATIENTS AND METHODS: A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6). RESULTS: Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with beta-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present). CONCLUSION: A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.     

Surgical treatment of Cronkhite-Canada syndrome associated with protein-losing enteropathy: report of a case

PURPOSE: The case of a patient with Cronkhite-Canada syndrome, who developed a protein-losing enteropathy, is reported. METHODS: After localization of the protein-losing region, a right colectomy was performed. RESULTS: Hypoproteinemia and ectodermal changes improved postoperatively. CONCLUSIONS: Surgery is an effective treatment for protein-losing enteropathy in Cronkhite-Canada syndrome. Ectodermal changes improve after correcting malnutrition.     

Nutritional management of enteropathy

The prognosis for nutritional management of enteropathy in children is good when the enteropathy is reversible with the use of a food elimination diet, such as cow's-milk-sensitive enteropathy, but is poor when enteropathy is irreversible, such as microvillous atrophy. However, nutritional management is central to the care of all children with small intestinal enteropathy. Enteral nutrition (provision of liquid formula diets by mouth or by tube) is possible in most cases, but in some children with intractable diarrhea, parenteral nutrition needs to supplement enteral feeding. The choice of enteral feeding ranges from elemental to partial hydrolysate.     

4 cases of potassium enteropathy

The oral use of enteric-coated potassium chloride (and apparently of its slow-release form too) to compensate potassium loss during thiazide diuretic treatment may engender ischemic enteropathy. This iatrogenic condition is linked to the vaso-active properties of KCl, which act on blood vessels often damaged by hypertension or chronic heart failure. Four observations are presented involving stenosing ulceration or perforation of the small bowel following oral KCl treatment. The main clinical, pathological and therapeutic aspects are discussed.     

A thymic hormone protects mice from enteropathy during acute graft-versus-host disease

We have previously reported that a nonapeptide thymic hormone, facteur thymique serique (FTS), is involved in the differentiation and activation of intestinal intraepithelial lymphocytes (i-IEL) in mice. In this study, we examined the effect of FTS treatment on enteropathy in a murine model for acute graft-vs.-host disease (GVHD) induced by injection of parental C57BL/6 splenocytes into unirradiated (C57BL/6 x DBA/2) F1 hybrids. FTS treatment significantly protected mice from developing acute GVHD as assessed by mortality rate, splenomegaly and enteropathy. The infiltration of donor-derived TCR alpha beta i-IEL bearing CD8 alpha beta was significantly inhibited in the small intestine of FTS-treated mice, and the frequencies of apoptosis of crypt cells in the intestinal mucosa were decreased in these mice during acute GVHD. These results suggest that FTS treatment contributes to protection against enteropathy of acute GVHD. Thus, FTS may provide a useful approach to control acute GVHD after blood transfusion or bone marrow transplantation.     

Families with multiple cases of gluten-sensitive enteropathy

Early detection of oligosymptomatic gluten-sensitive enteropathy (GSE) may contribute to the prevention of late complications, such as malignancy. Family members of known GSE patients are at higher risk of being affected. To evaluate the frequency and clinical significance of multiple occurrence, we routinely offered an antiendomysium antibody (EmA)-based non-invasive screening to affected families. Among 997 family members of 396 GSE patients, we identified 89 subjects with EmA positivity and/or severe jejunal villous atrophy. In 83 cases GSE has been verified, four patients refused the biopsy and two subjects are under further observation for latent celiac disease. Prevalence of GSE was 8.5% (80/943) among the first-degree relatives, with significantly higher values in the siblings (13.8%) and offsprings (12.0%) than in the parents (4.2%) of the probands (p < 0.001). In 55 families (13.9% of the families studied) two, in ten families (2.5%) three, in one family four and in one other family six members were affected. Combinations of the clinical presentations of index and screening-detected cases were highly variable, with a high percentage of silent and atypical forms in the relatives. GSE cases presenting both with and without dermatitis herpetiformis occurred in 15 families. Six GSE cases with atypical or mild dermatitis herpetiformis were detected in consequence of the screening. CONCLUSIONS: EmA-assisted family screening resulted in the detection of a clinically significant number of additional GSE patients.     

Portal hypertensive enteropathy in biliary atresia

We report the case of a 10-year-old girl with repaired abdominal aortic coarctation in whom chronic mesenteric ischemia was clinically suspected. Cine phase-contrast magnetic resonance (MR) was used to determine the difference between fasting and postprandial portal blood flow. Fasting flow rates in the portal vein were normal. After a meal, blood flow in the portal vein increased 226% over the fasting state, showing normal augmentation. To the best of our knowledge, this is the first application of this technique to a pediatric setting.     

A morphological and histochemical study of a drug-induced enteropathy in the Alderley Park rat

Two experiments were devised to produce an experimental enteropathy. In Experiment I, male Alderley Park rats were dosed daily by gavage with 20 mg/kg and 60 mg/kg of an antibacterial compound ICI 17,363. Animals were killed sequentially at daily intervals up to and including Day 9 to study the development of the enteropathy. In Experiment II rats were dosed daily with 60 mg/kg of the same compound. All animals were killed on Day 5 owing to a rapid development of the enteropathic condition. The duodenum was examined histologically and histochemically. Duodenal changes included vacuolation of columnar epithelial cells and villus stunting. There were marked reductions in mitotic activity in the crypt epithelial cells from Day 7 onwards (Experiment I) and almost total loss of hydrolytic and oxidative enzyme activity. In Experiment II the changes were more severe and haemorrhage and erosion of the duodenal mucosa were observed. The development of the enteropathic lesion appears to be due largely to the antimitotic effect of the compound, although a direct toxic effect upon the intestinal mucosa cannot be ruled out.     

Systemic lupus erythematosus with a protein-losing enteropathy

Anasarca with pronounced hypoalbuminemia developed in a young woman 15 months after the onset of a mild, arthralgic type of systemic lupus erythematosus (SLE) without evidence of active nephritis. Investigation indicated a gastrointestinal rather than a renal site for protein loss. A full clinical remission was achieved with low-dose corticosteroid therapy.     

Questionnaire survey of proliferative enteropathy on British pig farms

Risk factors for proliferative enteropathy were investigated by means of a postal questionnaire survey of randomly selected British pig farms. Replies were received from 319 (56 per cent) of the 569 questionnaires posted, representing 1.5 per cent of the total number of pig farms in Britain. Thirty-one per cent of the farms had experienced at least one episode of proliferative enteropathy within the previous three years, usually confirmed by their veterinary surgeon. There was a strong association for the occurrence of proliferative enteropathy in herds of over 500 sows (P < 0.005) and in herds with enzootic pneumonia (P < 0.01). Outbreaks had occurred in five of the six nucleus herds surveyed, the other had only 80 sows. Outbreaks occurred in 32 of 69 herds that had obtained their replacement boars from nucleus herds (P < 0.05), suggesting that infected boars may carry the disease into distant herds. The use of either fully slatted (P < 0.05) or fully meshed floors (P < 0.01) above sunken pits in buildings used to house pigs immediately after weaning, and the use of partially (P < 0.05) or fully slatted floors (P < 0.05) in buildings used to house pigs two to six months old, were risk factors for outbreaks of proliferative enteropathy, compared with the use of straw bedding or solid floors. The destocking of entire buildings containing pigs two to four months old before the introduction of fresh pigs, was associated with a reduced risk (P < 0.05), but the destocking of selected pens rather than the whole building had no such association. The type of diet, or feeding or watering system and the types of buildings used were not identified as risk factors.     

Gastroesophageal reflux with protein-losing enteropathy and finger clubbing

Finger clubbing, protein-losing enteropathy, and iron deficiency were documented in three children with severe gastroesophageal reflux. One patient had Sandifer syndrome and the other two had the rumination syndrome. In each case, surgical repair of the gastroesophageal reflux resulted in immediate clearing of signs of the Sandifer syndrome, gastroesophageal reflux, and anemia and the return of serum protein levels to normal. There was definite regression of the finger clubbing during the ensuing year. It is suggested that finger clubbing, protein-losing enteropathy, Sandifer syndrome, and rumination be viewed as parts of an extended syndrome of unusual presentations of gastroesophageal reflux.     

The modern enigma of radiation enteropathy: sequelae and solutions

With the extended indications for abdominal and pelvic radiation therapy, administered at higher dosage levels, an increased incidence of radiation injury to the intestine can be anticipated. Increased efforts are urgently needed to develop innovative methods in the detection, prevention, and management of radiation-induced intestinal injury. Fifty cases of radiation enteropathy have been reviewed to highlight problems in management and to suggest preventive and therapeutic measures, both surgical and nonsurgical.     

Mucosal enterokinase activity in cow's milk protein sensitive enteropathy

Enterokinase has a critical role in initiating proteolytic digestion by hydrolysing the conversion of pancreatic trypsinogen into trypsin. The enzyme is synthesised by enterocytes of the proximal small intestine and initially incorporated into the brush border from where it is released into the intestinal lumen by the action of pancreatic secretions. The aim of the study was to analyse enterokinase activity in the duodenal mucosa of infants with diarrhoeal disease including cow's milk protein-sensitive enteropathy. Our observations show that the mean depletion of enterokinase was only 17% compared to 60-80% for other brush border enzymes like disaccharidases, peptidases and alkaline phosphatases in infants with diarrhoea. This suggests that enterokinase activity in the small bowel enteropathies may be dependent not only on the degree of mucosal damage specifically but also on the extent of damage to the goblet cell population where the enzyme is synthesised. Thus the enterokinase activity was reduced in acute and chronic diarrhoea with marked mucosal damage where significant reduction of goblet cell population was evident but the enzyme was relatively little affected when the mucosa was damaged mildly.