Life-threatening gastrointestinal bleeding in Crohn disease

Massive gastrointestinal bleeding is a very rare complication in Crohn's disease. Its occurrence has been quoted as 1-2% in the literature. A case of a 16-year old boy is reported here, who had a three-year history of Crohn's disease. After a three-day's therapy of bronchopneumonia a massive rectal bleeding began and an emergency operation had to be made. Site of the bleeding was localised by intraoperative colonoscopy and an ileocolic resection was made. The patient recovered and has done well since. Some characteristics, diagnostic and therapeutic problems of the massive bleeding in Crohn's disease are discussed.     

Lower extremity manifestations of nutritional deficiencies in gastrointestinal disease

Voluminous information can be written on the nutritional deficiencies that are secondary to gastrointestinal disease. This highly complicated system, with its immunologic pathogenesis, can affect every system of the body. This article describes how these manifestations of gastrointestinal disease affect the lower extremities.     

Upper gastrointestinal disease in patients with familial adenomatous polyposis

BACKGROUND: Upper gastrointestinal disease has become an important aspect in the management of patients with familial adenomatous polyposis (FAP). METHODS: A review of the literature was carried out using Medline. Epidemiology, pathology and treatment options are considered. RESULTS AND CONCLUSION: Despite the fact that over 90 per cent of patients with FAP develop duodenal adenomas, only 5 per cent go on to develop cancer. In the absence of methods to detect who is at risk of cancer, all patients undergo regular endoscopic surveillance at present. Chemoprevention in the form of drug therapy may be the answer to controlling the disease.     

Evaluation of the clinical impact of endoscopic ultrasonography in gastrointestinal disease

A total of 120 gastro-intestinal tracts and 960 faecal samples were examined to assess the prevalence and seasonal changes in the gastro-intestinal helminth parasites of Red Sokoto (maradi) goats slaughtered at Ibadan between May 1991 and April 1992. Egg types of strongyles, Strongyloides, Trichuris, Skrjabinema, Dicrocoelium and Moniezia were encountered in 93%, 83%, 44%, 0.9%, 2.3% and 31% of the faecal samples respectively. However, only strongyle, Strongyloides and Trichuris eggs occurred in large numbers and were more common during the rainy season than in the dry season. The parasites recorded and their prevalences were Haemonchus contortus (90.0%), H. ovis (5.0%), Strongyloides papillosus (80.8%), Trichostrongylus colubriformis (78.3%), T. axei (69.2%), Trichuris ovis (72.5%), T. globulosa (38.3%), Oesophagostomum columbianum (67.5%), Cooperia curticei (58.3%) Gaigeria pachyscelis (40.8%), Skrjabinema ovis (5.0%), Nematodirus battus (5.8%), Moniezia expansa (29.2%), M. benedeni (10.0%), Paramphistomum spp. (5.0%) and Cysticercus tenuicollis (33.3%). Haemonchus ovis is reported for the first time in Nigeria. Mixed infections were most prevalent. Young goats were more commonly infected and had higher worm counts than adult goats. Only Haemonchus, Trichostrongylus, Strongyloides and Cooperia spp. occurred in large numbers. Irrespective of the age of the goats, higher worm counts were generally encountered during the rainy season than in the dry season. The results are discussed in relation to the control of helminthiasis in grazing animals in Nigeria.     

The risks and costs of upper gastrointestinal disease attributable to NSAIDs

NSAIDs, including both aspirin and nonaspirin NSAIDs, are among the most frequently used drugs, and their use may result in serious adverse gastrointestinal outcomes and significant medical costs. The increased risks for adverse upper GI hemorrhage and peptic ulcer disease associated with NSAID use have been demonstrated in observational studies and clinical trials; an overview of these results is presented in this article. The magnitude of these risks should play an important role in clinical decision making and should influence decisions regarding the use of this class of drugs.     

Prevalence of upper gastrointestinal lesions and Helicobacter pylori infection in Crohn's disease

Crohn's disease can affect the upper gut with reported variable frequency, although concurrent Helicobacter pylori infection has been reported to be low. We prospectively investigated the prevalence of esophageal, gastric, and duodenal lesions and Helicobacter pylori infection in 67 Crohn's disease, 41 ulcerative colitis patients, and 43 controls. Symptoms, esophagogastroduodenoscopy, and multiple biopsies were performed on all patients consecutively. Endoscopic lesions were found in 63% of Crohn's disease patients, with a Helicobacter pylori prevalence of 28%. Granulomas were found in three patients. Twenty-two percent of the ulcerative colitis patients had lesions, with a 29% prevalence of Helicobacter pylori infection. Half of the controls had pathological endoscopy, and Helicobacter pylori was positive in 40% of the cases. Subjective symptoms did not predict the presence of endoscopic lesions or Helicobacter pylori infection in inflammatory bowel disease patients. Chronic gastritis and duodenitis are common in Crohn's disease patients, and the majority are not associated with Helicobacter pylori infection.     

Review article: the diagnosis and treatment of haematinic deficiency in gastrointestinal disease

Deficiency of any of the vitamins and minerals essential for normal erythropoiesis (haematinics), including iron, copper, cobalt, vitamins A, B12, B6, C, E, folic acid, riboflavin and nicotinic acid, may be associated with defective erythropoiesis and anaemia. Iron, vitamin B12 and folate are the haematinics for which deficiency states manifest most often clinically and are the focus of this review. The normal absorption of these haematinics and gastrointestinal causes of their deficiency are described. Investigations, including the use of homocysteine metabolite levels and new techniques such as serum transferrin receptor assays, and treatment of haematinic deficiency are discussed in detail.     

The CEA test and other immunological tests as disease course controls in gastrointestinal adenocarcinoma

161 patients with adenocarcinoma of the gastrointestinal tract were studied to determine the value of the CEA test and a battery of non-specific immunological tests during the course of the disease. The ability of these tests to detect a tumor recurrence in radically operated patients was evaluated. A false negative preoperative CEA value was found in 40% of the patients with gastric carcinoma and 32% with colorectal carcinoma. Patients with a negative preoperative CEA value, and those with only slightly elevated values, had a distinctly better prognosis regarding initial operability and tendency to postoperative recurrence than patients with primarily markedly elevated values. With few exceptions, the development of distant metastases was detected earlier and more easily with the CEA test than by the usual routine follow-up methods. However, in the event of isolated local recurrence the CEA test was positive in only 1 of 5 patients. This reflects the direct correlation between tumor size and CEA elevation. The CEA test is a valuable supplement in the follow-up of patients with gastrointestinal carcinoma.     

Diffuse gastrointestinal angiodysplasia associated with cryptogenic hepatic cirrhosis and coagulopathy simulating von Willebrand disease

Angiodysplasic lesions can be located anywhere in the gastrointestinal tract, but most of them are found in the cecum and right colon. Angiodysplasias are very infrequent in the stomach and small bowel. These lesions can be associated with several clinical conditions, such as certain coagulation disorders and liver diseases. We report the case of a diffuse gastrointestinal angiodysplasia in a female patient with idiopathic cirrhosis of the liver who developed a coagulopathy which mimicked von Willebrand disease. After repeated blood transfusions, which were not able to control the anemia of the patient, an antrectomy was performed because most lesions were located in the antrum. The procedure did not achieve a suitable control of the bleeding. Finally, a hormonal therapy combining estrogens and progestagens, was able to control, at least partially, the patient's chronic gastrointestinal bleeding.     

Immunoproliferative small intestinal disease (IPSID): an unusual form of gastrointestinal lymphoma

Worsening of long-lasting diarrhea, abdominal discomfort and weight loss were main symptoms in a 27-year-old Moroccan woman who had lived in Germany for 18 years. Pseudomonas, salmonella and lamblia cysts were found in stools. Histological examination of the gastrointestinal tract showed immunoproliferative small intestinal disease (IPSID), characterized by atrophy of the villi and lymphoplasmocytic infiltrates. alpha 1-heavy chains were found immunohistologically in the biopsy specimen, but not in serum, urine or jejunal juice. HLA-typing gave evidence of A9. Antibiotic treatment was successful for almost one year. Clinical, histological and immunological diagnosis of IPSID in an African woman living for nearly 20 years in Europe shows that, besides environmental factors, genetic disposition is an essential factor in the development of IPSID.