Establishment of mini-guts organoid and research on intestinal disease from the new perspective / 中华胃肠外科杂志

Intestinal organoids, also named "mini-guts", reconstitute sophisticated three-dimensional architecture recapitulating diversified intestinal epithelial cell types and physiology, which is driven by the proliferative and self-assembling characteristics of crypt stem cells. The initiation of organoids study relies on the identification of Lgr5+ crypt stem cells from different intestinal segments and the key role of EGF, Wnt, BMP/TGF-β, Notch signal pathways within the microenvironment during the cultivation process. Besides constituting polarized crypt-villus structures, these "mini-guts" exhibit various effective functions of intestinal epithelium. Since 2009 when the culture system of small intestinal organoids was established by Sato et al, intestinal organoids excel conventional intestinal models depending on genetical mutation in multiple aspects and thus have become the hotspot among the research on intestinal diseases. Combined with genomics, material science and engineering, "mini-guts" have been widely applied to the research on intestinal development, intestinal transport physiology, epithelial barrier, pathogen-host interaction and the study on cystic fibrosis, infectious diarrhea, ulcerative colitis, Crohn's disease, intestinal cancer, etc. In this review, we summarize the new insights introduced by organoid into the research on intestinal diseases, and related research advances and applications.

Afectación intestinal por un hongo dematiáceo / Intestinal disease by a dematiaceous fungi

Resumen Introducción: Los hongos dematiáceos se caracterizan por la presencia de abundante melanina en su pared celular. Presentan una distribución mundial, siendo más comunes en climas tropicales y subtropicales. Producen infecciones cutáneas y subcutáneas, además de enfermedades alérgicas, neumonías, abscesos cerebrales o infecciones diseminadas. Caso Clínico: Presentamos el caso de un paciente con adenocarcinoma de recto intervenido quirúrgicamente con hallazgo incidental de divertículo de Meckel y en el cual en el estudio anatomopatológico reveló la presencia de un hongo dematiáceo

Introduction: Dematiaceous fungi are characterized by the presence of brown melanine or melanine like pigments in their cell wall. They are generally distributed worldwide, being more common in tropical and subtropical climates. The clinical syndromes are often cutaneous and subcutaneous infections, but can be also responsible of allergic diseases, pneumonias, cerebral abscesses or disseminated infections. Clinical Case: We present the case of a patient with a diagnosis of rectal adenocarcinoma intervening surgically and with an incidental finding of Meckel's Diverticulum. The anatomopathological study revealed the presence of a dematiaceous fungi.

Recent advances in relationship of Fusobacterium nucleatum to intestinal immunity / 中华微生物学和免疫学杂志

Gut microbial ecosystem is closely related to the immune system and influences human health. Fusobacterium nucleatum ( F. nucleatum) is one of the species of great concern. Increasing evidence shows that F. nucleatum promotes intestinal inflammation and influences the tumor-associated immune micro-environment. This review focused on the recent progress in the influence of F. nucleatum on intestinal immu-nity and the pathogenesis of intestinal diseases in order to discover the immune mechanism of F. nucleatum-associated intestinal diseases and find new therapeutic targets for immunotherapy.

Distal Ileal Lymphoma Presenting Ileocecal Intussusception with Spontaneous Reduction / 대한소화기학회지

Intussusception is a rare disease in adults. A demonstrable etiology is found in approximately 85% of all cases, and approximately 40% of them are caused by malignant tumors. A 65-year-old patient visited the outpatient department with mild abdominal pain without other symptoms. The initial laboratory test and simple X-ray showed normal findings. CT revealed intussusception in the ileocecal area. The initial colonoscopic biopsy revealed atypical cells. Follow up colonoscopy showed spontaneous reduction of the intussusception. Diffuse large B-cell lymphoma was suspected in the second colonoscopic biopsy. An elective operation was performed. This case reports a case of a spontaneous reduction of adult intussusception with a brief review of literature.

Distal Ileal Lymphoma Presenting Ileocecal Intussusception with Spontaneous Reduction / 대한소화기학회지

Intussusception is a rare disease in adults. A demonstrable etiology is found in approximately 85% of all cases, and approximately 40% of them are caused by malignant tumors. A 65-year-old patient visited the outpatient department with mild abdominal pain without other symptoms. The initial laboratory test and simple X-ray showed normal findings. CT revealed intussusception in the ileocecal area. The initial colonoscopic biopsy revealed atypical cells. Follow up colonoscopy showed spontaneous reduction of the intussusception. Diffuse large B-cell lymphoma was suspected in the second colonoscopic biopsy. An elective operation was performed. This case reports a case of a spontaneous reduction of adult intussusception with a brief review of literature.

Enteroparasitosis en niños de dos Centros de Atención a la Infancia y la Familia (CAIF) del barrio Casavalle, Montevideo / Children enteroparasitosis in Centers for Child and Family Care (CAIF) in Casavalle neighborhood, Montevideo

Resumen Las enteroparasitosis son enfermedades del tubo digestivo causadas por protozoarios, hongos y/o helmintos. Afectan principalmente a niños con condiciones socioeconómicas desfavorables, pudiendo tener repercusión sobre el crecimiento y desarrollo. Con el objetivo de contribuir a generar conocimiento sobre la prevalencia de las enteroparasitosis en niños de dos Centros de Atención a la Infancia y la Familia (CAIF) del barrio Casavalle, zona de influencia de la Policlínica Los Ángeles (Montevideo), entre marzo y diciembre de 2015, se realizaron coproparasitarios y espátulas adhesivas a niños mayores de 6 meses y menores de 5 años. Se devolvieron los resultados a las comunidades participantes, al centro de salud de referencia y a las autoridades de la zona. Se planificaron y realizaron jornadas de formación y sensibilización sobre las parasitosis, aportando información para su prevención. Los niños que tuvieron resultados positivos fueron tratados en la policlínica o derivados para su tratamiento. De los 577 niños matriculados, participaron en el proyecto 317 (54,9%), a todos los cuales se les realizaron los estudios coproparasitario y espátula adhesiva. Resultaron positivos 97 niños (30,6%), de los cuales 22 poliparasitados (6,9%). Los agentes más frecuentemente encontrados fueron: Giardia lamblia (18,6%), Ascaris lumbricoides (6,6%) y Enterobius vermicularis (5,7 %). Se evidenciaron tres mecanismos de transmisión con vía de entrada oral: por contaminación fecal, por contacto con el suelo y transmisión directa, por lo que son necesarios esfuerzos para mejorar hábitos de higiene personal, vigilancia epidemiológica con georreferenciación y acciones dirigidas a mejorar la salud ambiental y saneamiento.

Summary Enteroparasitosis are diseases of the digestive tract caused by protozoan, fungi and/or helminths. They mainly affect children under unfavorable socio-economic conditions, and they may have an impact on growth and development. Coproparasitary tests and Graham technique tests were performed to children between 6 months and five years old from March to December 2015, with the purpose of generating knowledge on the prevalence of enteroparasitosis in children seen in two Centers for Child and Family Care (CAIF) in Casavalle neighborhood, in the area of influence of the Los Angeles Polyclinics (Montevideo). The results of the tests were given to participants, the reference health care centers and the authorities in the area. Subsequently, activities geared to training and raising awareness on parasitosis were organized, providing information for prophylactic purposes. Children whose results were positive were treated in the polyclinic or referred for treatment. 577 children were registered in the institution and 317 of them (54.9%) participated in the project, all of whom underwent coproparasitary and Graham technique tests. 97 children were positive (30.6%), 22 of which were poliparasitized (6.9%). The most frequently found agents were Giardia lamblia (18.6%), Ascaris lumbricoides (6.6%) and Enterobius vermicularis (5.7%). Three mechanisms of transmission with oral entry route were evidenced: fecal contamination, contact with the soil and direct transmission, so efforts are needed to improve personal hygiene habits, epidemiological surveillance with georeferencing and actions aimed at improving environmental health and sanitation.

Enteroparasitosis en niños de una comunidad rural de Lima-Perú / Enteric parasites in children of a rural community in Lima, Peru

Determinar la frecuencia de enteroparasitosis en niños de 1 a 10 años de una comunidad rural del departamento de Lima-Perú. Material y métodos: Estudio observacional, descriptivo y transversal. La población de estudio fueron los niños de 1 a 10 años. Se usó el examen coproparasitológico microscópico directo y el método de Graham. Se analizaron los datos mediante el programa Microsoft Excel 2010. Resultados: Se estudiaron 36 (100%)niños, 22 (61,1%) resultaron ser mono parasitados y 10 (27,8%) multiparasitados. El parásito intestinal más observadofue el Blastocystis hominis en el 33,3% de los casos. Conclusiones: Se identificó a una población que en su granmayoría presentaron carencias sanitarias y que vivían en condiciones rurales, y que tuvieron una alta frecuencia de enteroparasitosis tanto con el examen coproparasitológico microscópico directo como con el método de Graham.

Objective: To determine the prevalence of enteric parasites in 1-10 year children of a rural community in Lima, Peru. Methods: A cross-sectional study was conducted involving children from 1-10 years of age. Direct microscopic examination and Graham test were performed. Data were analyzed using Microsoft Excel 2010. Results: 36 children were studied; 22 (61.1%) were mono infected and 10 (27.8%) were poli-infected. The most common parasite identified was Blastocystis hominis in 33.3% of cases. Conclusions: We identified a population with a high prevalence of enteric parasitic infections that lived in a rural area with poor sanitary conditions.

Prevalence of intestinal parasitic infections in preschool-children from vulnerable neighborhoods in Bogotá / Prevalencia de parásitos intestinales en niños preescolares de barrios vulnerables de Bogotá

Introduction: Intestinal parasitic infections (IPIs) are neglected tropical diseases, even though their prevalence is high in many developing countries. The public health impact of IPIs is substantial, in particular for children due to the negative effect on growth and development. Objectives: This study examines the prevalence and risk factors of IPIs in preschool-children from at-risk neighborhoods, including those from internally displaced families. Materials and Methods: A cross-sectional study among 239 preschool-children from two vulnerable neighborhoods in Bogotá. Fecal samples were collected and microscopically examined (direct and Ritchie technique) and data regarding related factors was obtained through a questionnaire. Results: A prevalence of 26.4% for pathogenic parasites (Giardia duodenalis, Blastocystis spp, Trichuris trichiura, Ascaris lumbricoides, and Hymenolepis nana) was found. Logistic regression resulted in four risk factors: siblings ≤5 years (OR 2.33 [1.077-5.021]), stray dogs (OR 2.91 [0.867-9.767]), household members (OR 2.57 [1.155-5.706]) and child's sex (OR 2.17 [1.022-4.615]). Discussion: IPI presence in preschool children is an important health issue in Bogotá which should be addressed. A high protozoan prevalence was found compared to helminthes. Implementing policies addressing risk factors could be a first step in decreasing IPI prevalence.

Introducción: Infecciones parasitarias intestinales (IPI) son enfermedades tropicales desatendidas, a pesar de que su prevalencia es alta en muchos países en desarrollo. El impacto en la salud pública de los IPI es importante, especialmente para los niños debido al efecto negativo sobre el crecimiento y el desarrollo. Objectivos: Este estudio examina la prevalencia y factores de riesgo de IPI en niños preescolares de barrios en riesgo, incluidos los de las familias desplazadas. Materiales y Métodos: estudio transversal entre 239 niños preescolares de dos barrios vulnerables de Bogotá. Se recogieron muestras fecales y se examinaron microscópicamente utilizando dos técnicas (directa y Ritchie). Se aplicó cuestionario para indagar factores relacionados con el parasitismo intestinal. Resultados: Se encontró una prevalencia de 26,4% de parásitos intestinales patógenos (Giardia duodenalis, Blastocystis spp, Trichuris trichiura, Ascaris lumbricoides y Hymenolepis nana). La regresión logística resultó en cuatro factores de riesgo: hermanos ≤5 años (OR 2.33 [1.077-5.021]), los perros callejeros (OR 2.91 [0.867-9.767]), los ocupantes de la casa (OR 2.57 [1.155-5.706]) y el sexo del niño/a (OR 2.17 [1.022-4.615]). Discusión: La presencia del IPI en los niños preescolar es un problema de salud importante en Bogotá y que debe abordarse. Una alta prevalencia de protozoos se encontró comparado con helmintos. La implementación de políticas que aborden los factores de riesgo podría ser un primer paso en la disminución de la prevalencia del IPI. El antecedente de desplazamiento no cambio ni el tipo de parásito ni la prevalencia de parasitismo.

Prevalence of Giardiasis among children in childcare centers in Kermanshah, Iran.

Background: Giardia is a common and widespread intestinal protozoan parasite which occurs in of both humans and animals. The aim of this study is determining the prevalence rate of Giardiasis in children, Kermanshah childcare centers (2012). Methods: This cross-sectional study was performed on 632 children (330 were female and 302 were male) with an average of 0-6 years in children, Kermanshah childcare centers (2012). Three stool samples were obtained on three consecutive days and were tested for the detection of trophozoites, and/or cysts, using both direct laboratory methods and Formalin-Ether concentration. Informations were collected by a questionnaire. Results: Of the 632 cases in this study, the prevalence rate of gut parasite infection was 169 (26.74%), so that Giardia lamblia with 13.93%, Entamoeba histolytica with 3.48%, and Entamoeba coli with 2.53 were the most predominant isolate. The prevalence rate ranged in rural residents (15.67%) was more than urban residents (11.07%). The age group 4-6 years had the highest rate (14.24%) and 0-2 years the lowest (1.74%); boys with 16.29% had a higher rate than girls (10.45%). Parasitic infection was more prevalent in children whose parents had no high education (17.25). The maximum percentage of infections was in August with 5.86%. Conclusion: With attention to the above findings, it seems that in order to decrease, control and prevent of parasitic infection we should have the necessary public education to teachers and parents of children.

Research advances of fecal calprotectin in intestinal diseases / 国际儿科学杂志

Calprotectin is a calcium-and zinc-binding protein of the S100 family expressed mainly by neutrophils with important extracellular activity.This paper reviews current findings about the implication of faecal calprotectin in the diagnosis, follow-up, assessment of relapses, and response to treatment in intestinaldiseases, such as inflammatory bowel disease, intestinal tumor, necrotizing enterocolitis, allergy and intestinal infection.

Celiac Disease: A Disorder Emerging from Antiquity, Its Evolving Classification and Risk, and Potential New Treatment Paradigms

Celiac disease is a chronic genetically based gluten-sensitive immune-mediated enteropathic process primarily affecting the small intestinal mucosa. The disorder classically presents with diarrhea and weight loss; however, more recently, it has been characterized by subclinical occult or latent disease associated with few or no intestinal symptoms. Diagnosis depends on the detection of typical histopathological biopsy changes followed by a gluten-free diet response. A broad range of clinical disorders may mimic celiac disease, along with a wide range of drugs and other therapeutic agents. Recent and intriguing archeological data, largely from the Gobleki Tepe region of the Fertile Crescent, indicate that celiac disease probably emerged as humans transitioned from hunter-gatherer groups to societies dependent on agriculture to secure a stable food supply. Longitudinal studies performed over several decades have suggested that changes in the prevalence of the disease, even apparent epidemic disease, may be due to superimposed or novel environmental factors that may precipitate its appearance. Recent therapeutic approaches are being explored that may supplement, rather than replace, gluten-free diet therapy and permit more nutritional options for future management.

Colostomía laparoscópica por puerto único con técnica de guante / Single port laparoscopic colostomy using the glove technique

La cirugía por puerto único con técnica de guante (glove port) es un abordaje adecuado al momento económico y tecnológico que vivimos. Entre las intervenciones susceptibles de su aplicación está la realización de colostomías. Describimos la técnica quirúrgica y resultados de los pacientes a los que se realizó colostomía por puerto único con técnica de guante, a lo largo de los años 2011 y 2012, en dos hospitales de Asturias, España. Realizamos seis colostomías sigmoideas. Cuatro pacientes presentaban enfermedad tumoral, otro caso fue por una fascitis necrosante perineal, y el sexto un paciente con enfermedad de Crohn y fístulas perianales complejas. La edad media de los pacientes, cuatro hombres y dos mujeres, fue de 54 años (rango 42-67 años). El tiempo medio de intervención fue de 42 minutos (rango 30-65 minutos). No hubo complicaciones durante la cirugía ni en el postoperatorio. En nuestro medio, el gasto en material se redujo a la mitad con respecto a otros dispositivos convencionales de puerto único. La técnica de guante representa el abordaje por puerto único más económico y mínimamente invasivo para la realización de estomas, siendo en nuestra experiencia una técnica sencilla, segura y fácilmente reproducible.

The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment .Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohn's disease and complex peri-anal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.

Analysis of the characteristics of medicine taking in patients with gastroesophageal reflux disease in Beijing / 中华消化杂志

Objective To investigate the characteristics of medicine taking,the type and ratio of long-term medication and treatment satisfaction in patients with gastroesophageal reflux disease (GERD),to analyze the effects of GERD combined with functional bowel disease (FBD) on the treatment satisfaction,and to compare the changes of type of medication and treatment satisfaction in patients with GERD in recent years.Methods From April to June in 2011,the questionnaire survey was conducted in gastroenterology clinic of People's Hospital of Peking University.The incidence of typical GERD symptoms was investigated by a validated reflux disease questionnaire (RDQ),the score between one and five was considered there might be reflux symptoms and the score over 12 was diagnosed as GERD.FBD was diagnosed according to Rome Ⅲ criteria.The information of GERD related medication taking within one year before the survey,long-term medication taking (≥ 1 year)and the treatment satisfaction of patients whose RDQ score over zero was recorded and compared with the data collected in the same method in 2004.The chi-square test was performed for data statistical analyses with SPSS 17.0 software.Results Among 1074 patients who completed questionnaire survey in 2011,the percentage of patients with reflux symptoms was 32.7％ (351/1074),the percentage of diagnosed GERD was 10.0％ (107/1074),and GERD combined with FBD was 25.2％ (27/107) of GERD.A total of 304 cases (86.6％) of patients with reflux symptoms had information of medication taking; 78.0％ (237/304) of whom had taken GERD related medication within one year before the survey.The rate of GERD related medication taking especially proton pump inhibitor (PPI) and antiacid medication taking increased along with RDQ score (x2 =24.2,13.1 and 18.2,all P＜0.05).A total of 104 cases of GERD patients had information of medication taking; 88.5 ％ (92/104) GERD patients had taken GERD related medication within one year before the survey,52.9％ (55/104) GERD patients had taken PPI medication,30.8％ (32/104) needed long-term medication and 20.2％ (21/104) needed longterm PPI treatment.There was no significant difference in treatment satisfaction between different RDQ score ranges (x2 =3.3,P＞0.05).Among GERD patients who appraised the effects of treatment,the percentage of satisfied,acceptable and not satified with the treatment was 37.1％(26/70),48.6％ (34/70)and 14.3％(10/70),respectively.There was no significant difference in treatment satisfation between GERD with and without FBD (x2 =3.1,P＞0.05).In 2011,the rates of medication taking (88.5％,92/104) and PPI taking (52.9％,55/104) in GERD patients significantly increased compared with those in 2004 (57.3％,98/171; 7.6％,13/171,x2 =29.4,71.4,both P＜0.05).The percentage of treatment satisfaction in 2011(37.1％,26/70) increased compared with that in 2004(25.7％,18/70,x2 =12.8,P＜0.01).Conclusions Some of patients with GERD symptoms need long-term medication,especially PPI treatment.In recent years,the rate of medication taking in GERD patients increased in outpatients department,PPI taking significantly increased and the treatment satisfaction also increased.Maybe the treatment satisfaction is not affected by GERD combined with FBD.

Actividad antiinflamatoria y antioxidante de Bauhinia kalbreyeri Harms en un modelo de inflamación intestinal agudo en ratas / Anti-inflammatory and antioxidant action of Bauhinia kalbreyeri Harms in an acute intestinal inflammation model used in rats

Objetivo: evaluar la actividad antiinflamatoria y antioxidante de extractos acuosos de hojas y corteza de Bauhinia kalbreyeri Harms mediante un modelo de inflamación intestinal en ratas. Métodos: se utilizaron ratas Wistar, a las cuales se les indujo inflamación intestinal aguda mediante el uso de indometacina (15 mg/kg). Los extractos se administraron por gavage (40 mg/kg) durante 7 d. Se midieron los niveles enzimáticos de glutatión peroxidasa (GPX/L de sangre), se determinó el índice de actividad de la enfermedad y se realizó una caracterización macroscópica y microscópica de las lesiones. Resultados: se determinó que la administración oral de los extractos tiene un efecto moderado sobre el modelo agudo de enteritis inducida por indometacina, con la disminución concomitante de los parámetros clínicos, patológicos e inflamatorios. Tanto el análisis histológico como el macroscópico de las muestras de animales tratados con extractos, confirmaron el efecto beneficioso ejercido por estos en el modelo de enteritis aguda inducida por indometacina, el cual se atribuye a los metabolitos secundarios presentes en la planta ya que se evidenció recuperación de la citoarquitectura, disminución en el grado de lesión y del índice de actividad de la enfermedad; así como la estabilización de los niveles de glutatión peroxidasa, que aumenta la viabilidad de las fibras de colágeno, evita el daño celular y promueve la síntesis de ADN, para iniciar la recuperación de la lesión. Conclusión: este estudio se muestra como uno de los pioneros en dilucidar la actividad antiinflamatoria y antioxidante de Bauhinia kalbreyeri en un modelo in vivo.

Objective: to evaluate the anti-inflammatory and antioxidant activity of aqueous extracts of leaves and bark from Bauhinia kalbreyeri Harms in an intestinal inflammation model applied to Wistar rats. Methods: the Wistar rats were induced acute intestinal inflammation by using indomethacin (15 mg/kg). The extracts were administered by gavage (40 mg/kg) for 7 days. The enzyme levels of glutathione peroxidase (GPX/L of blood) were measured, the rate of disease activity was estimated, and finally the lesions were macroscopically and microscopically characterized. Results: it was found that oral administration of the extracts has a modest effect on acute enteritis model induced by indomethacin, with concomitant decrease in the clinical parameters and inflammatory disease. Both the macroscopic and histological analysis of samples from the animals treated with extracts confirmed their beneficial effect on the indomethacin-induced acute enteritis model. This effect is attributed to the secondary metabolites in the plant since the experiment evidenced recovery of cytoarchitecture, lower degree of injury, reduced rate of disease activity, as well as stabilization of glutathione peroxidase levels that cause more viability of the collagen fibers, prevent cell damage and encourage DNA synthesis to start recovery from injury. Conclusions: this study seems to be one of the pioneers in elucidating the anti-inflammatory and antioxidant properties of Bauhinia kalbreyeri in an in vivo model.

Perianal Crohn´s disease in a pre-pubertal girl versus sexual abuse: clinical and medicolegal implications / Moléstia de Crohn em menina pré-puberal versus abuso sexual: implicações clínicas e médico-legais

Objectives: To describe a case of Crohn's disease presenting as an anal ulceration in a 12 year-old girl, diagnosed initially as sexual abuse. Description: We study a case of Crohn?s disease presenting as a perianal ulcer in a 12 year-old girl, diagnosed initially as sexual abuse with serious medico-legal, psychological and socio-familiar implications. Comments: Crohn?s disease is rare during childhood, and a minority presents as perianal ulcers. Considering sexual abuse against adolescents is much commoner it turns essential to consider the differential diagnosis correctly, because of the risks involved, mainly represented by psychological and familiar disruption, medico-legal implications and treatment delay.

Dose Endoscopic Ultrasonography Impact Diagnosis of Intestinal Diseases?

Substantial development in equipment such as miniprobe endosonography and enteroscopy has made it possible to use endoscopic ultrasonography (EUS) to detect any part of the digestive tract. EUS plays a vital role in evaluating a lower intestinal malignancy, particularly rectal cancer, to determine whether the disease is localized (T1-2, N0) and appropriate for surgery or locally advanced (T any, N1-2) and would benefit from preoperative neoadjuvant chemoradiation. Moreover, follow-up by EUS may contribute to early recognition of focal tumor recurrence, particularly for lesions that cannot be detected by other imaging modalities. EUS is also an invaluable modality for diagnosing intestinal submucosal tumors, such as gastrointestinal stromal tumors, lipomas, lymphangiomas, leiomyomas, carcinoids, and others such as intestinal endometriosis. Although a definite diagnosis of a submucosal tumor is generally confirmed by cytology or histology results, EUS-guided fine needle aspiration or core biopsy is a fairly helpful practice. EUS is also useful for discriminating between Crohn's disease and ulcerative colitis as well as assessing disease severity. Moreover, it has emerged as a powerful imaging tool to manage perianorectal diseases. EUS also has the potential to be useful for intra-small intestinal ultrasonography for the diagnosis of small bowel diseases in the future.

Prevalencia de parasitosis intestinales y factores asociados en un corregimiento de la Costa Atlántica Colombiana / Prevalence of intestinal parasitism and associated factors in a village on the Colombian Atlantic Coast

Objetivos Determinar la prevalencia del parasitismo intestinal e identificar los factores de riesgo asociados a estos, en el corregimiento de Loma Arena, Departamento de Bolívar, Colombia Metodología Mediante encuesta aplicada a cada grupo familiar, fueron evaluadas las condiciones socio-sanitarias y educativas de la población. Para el estudio coproparasitológico se recolectó por cada persona, dos muestras de heces obtenidas por evacuación espontánea y en dos días diferentes. El análisis de las heces se realizó mediante un examen directo en solución salina fisiológica y coloración temporal con lugol y por el método de concentración formol-éter Resultados Se encontró que el 92 por ciento de las personas estaban parasitadas, 92 por ciento de ellas con al menos un patógeno. El poliparasitismo fue muy importante (89,2 por ciento) encontrándose hasta un máximo de 7 especies por hospedador. La coinfección de protozoarios y helmintos fue frecuente (64 por ciento). Solo se encontró una frecuencia de teniosis de 0,9 por ciento. Se observó una asociación significativa entre sintomatología y presencia de parásitos (p<0,05) no así, entre síntomas y parásitos potencialmente patógenos a excepción de Trichuris trichura y dolor abdominal. El análisis estadístico no mostró asociación entre las parasitosis y los niveles educativos o hábitos higiénicos sanitarios. Conclusión La distribución uniforme de la mayoría de las parasitosis intestinales en los cinco grupos de edad evaluados, da cuenta de la exposición a las fuentes de infección en todas las etapas de la vida de los pobladores de Loma Arena.

Objectives Determining the prevalence of intestinal parasitism and identifying the associated risk factors in the village of Loma Arena, Bolivar department, Colombia. Methodology The community's sanitary and educational conditions were evaluated by using a questionnaire which was applied to each family group. Two stool samples obtained by spontaneous evacuation, on two different days, were gathered from each participating person for the coproparasitological study. The coprological test involved direct examination in saline physiological solution and temporary staining with Lugol's solution and the formol-ether concentration method. Results It was found that 92 percent of the population was parasitised, 92 percent of them with at least one pathogenic parasite. Polyparasitism was very important (89,2 percent); a maximum of 7 species per host was found. Helminth and protozoa coinfection was frequent (64 percent). There was only 0,9 percent teniosis prevalence. There was a significant association between symptomatology and parasite presence (p< 0.05), though such relationship was not seen with potentially pathogenic parasites (with the exception of Trichuris trichura and abdominal pain). The statistical analysis did not reveal any relationship between parasitism and educational level or sanitary habits. Conclusion The uniform distribution of most intestinal parasites amongst the five age-groups evaluated showed that people in Loma Arena were evenly exposed to sources of infection in all age-groups.

Effect of capsule endoscopy followed by double-balloon enteroscopy in diagnosis of small bowel disease / 中华消化杂志

Objective To evaluate the clinical effect of capsule endoscopy(CE)followed by a directed double-balloon enteroscopy(DBE)in diagnosis of patients with suspected small bowel disease.Methods Two hundred and ninety-nine consecutive patients with obscure gastrointestinal bleeding or other various indications for CE examination were analyzed.DBE was recommended after negative or indeterminate evaluation on CE.The diagnostic and follow-up data were collected and analyzed.Resails A total of 296 patients completed CE examination.Of whorn,138(46.6%)cases had positive findings,68(23.0%)cases were suspected for small bowel disease and 90(30.4%)cases had negative finding,Those who were suspected(45 cases)and negative(7 cases)for CE examination were performed DBE examination and small bowel lesions were found in 31 cases and 1 case,respectively.The false-negative diagnosis was probably made by DBE in 8 patients,whereas no false-positive case was found by DBE.The false-negative diagnosis was probably made by CE in 2 patients,whereas 8 false-positive cases were found by CE.With the results of CE examination,lesions were found by only one-side procedure of DBE in 90.3%(28/31)of patients.The results that followed up for median 17 months indicated that 93.5% of patients with positive findings by DBE were received optimal therapy.Both CE and DBE procedures were well tolerated and no severe complications occurred.Conclusions The detection rate of sinall bowel lesions with CE was high,whereas the indetermination of CE findings was also significant.Majority of suspected findings by CE may be further confirmed by DBE.The strategy that start with CE and followed by DBE may increase diagnostic yield in patients with suspected small bowel disease and improve the prognosis.

Application of double-balloon endoscopy in subjects of failed conventional colonoscopy and surgically-modified gastrointestinal tract / 中华消化杂志

Objective To investigate the feasibility and clinical value of double-balloon endoscopy in subjects of failed conventional colonoseopy and gastro-intestinal tract modified surgery.Methods Doubleballoon endoscopy was performed in thirty-two subjects of failed conventional colonoscopy,three and nine patients of previous subtotal gastrectomy with BillrothⅡand gastro-intestinal modified surgery for various clinical manifestations.Suceessful intubation rates of terminal ileum or cecum in colonoscopic failure patients,afferent and efferent loop intubation in patients of BillrothⅡand alimentary tract modified surgery,were recorded and diagnostic yields in these patients were also observed.Results The endoscopy was successfully intubated into terminal ileum or cecum in 29 subjects,the intubated rate was 90.6%,the endoscopic diagnosis was obtained in 7 subjects,and endoscopic treatment was performed in 3 subjects.The endoscopy was successfully inserted in terminus of afferent loop and 150-180 cm of efferent below the anastomosis in all 3 patients of Billroth type Ⅱ gastrectomy,and the diagnosis was all clarified.And endoscopic retrograde cholangiopancreatography was performed in one patient.Five of nine patients with previous alimentary tract modified surgery had lesions detected after endoscopic procedure,and double-balloon endoscopy could have a thorough visualization on operated area and suspected region as needed.Abdominal pain and melaena were observed in 8 and 3 subjects respectively.Transient urine amylase elevation was found in one patient.The symptoms were alleviated and amylase was returned to normal after treatment.Conclusions Double-balloon endoscopy was a safe and feasible remediai endoscopic procedure with high diagnostic yields and endotherapeutic interventional capability,in patients of failed conventional colonoscopy and previous BillrothⅡgastrectomy and alimentary modified surgery.

Colitis ulcerosa, a propósito de un caso clínico / Ulcerative colitis. A case report

La colitis ulcerosa es una inflamación crónica no granulomatosa, que afecta fundamentalmente al colon. Se caracteriza por inflamación y ulceraciones de la mucosa intestinal. La etiopatogenia es compleja y multifactorial. Los síntomas gastrointestinales dependen de la situación, magnitud y severidad de la inflamación. El diagnóstico se basa en la sospecha clínica apoyada por estudios de laboratorio y de gabinete y el tratamiento depende de la severidad del cuadro. Presentamos a un niño que curso con un cuadro de colitis ulcerosa fulminante y que evoluciono favorablemente con el tratamiento instaurado.

Ulcerative colitis is a chronic non granulomatous inflammation that affects mainly the colon. It is characterized by inflammation and ulceration of the intestinal mucosa. The etiology and pathogenesis is complex and due to several factors. Gastrointestinal symptoms depend on the location, size and severity of the inflammation. Diagnosis is based upon clinical examination supported by laboratory studies. Treatment depends on the severity of the case. We present the history of a child that showed a very severe case of ulcerative colitis who responded favorably to prescribed treatment.