ABSTRACT
AIM: Magnetic resonance (MR) enterography is a radiation-free small bowel investigation which identifies luminal and extra-luminal pathology in patients with Crohn's disease. Most studies have validated MR against conventional radiology. We evaluated the results of MR enterography by comparison with findings at elective surgery for patients with Crohn's disease, including complex pathology. METHOD: Between January 2007 and March 2012 the results of preoperative MR enterography for Crohn's disease in consecutive patients in one unit were compared with the detailed findings at surgery. RESULTS: Fifty-one patients underwent 55 laparotomies during the study period. MR enterography identified the presence of Crohn's disease in the distal ileum in 33/34 patients, in the proximal ileum in 7/12 patients, in the jejunum in 7/8 patients, in the large bowel in 10/11 patients and in the duodenum in one of two patients. MR enterography identified ileo-enteric fistula in 10/12 patients, ileosigmoid fistula in all of seven patients and other fistulae in 10/11 patients. An abscess was identified on MR enterography in eight of nine patients. Within abnormal distal ileal segments, the mean contrast enhancement ratio of acute inflammation was 2.39 ± 0.59 compared with 1.82 ± 0.63 (P < 0.05) in segments with fibrosis only. CONCLUSION: Magnetic resonance enterography identifies small bowel Crohn's disease with an accuracy similar to or better than those of previously published series. Fistulation, abscess formation and large bowel disease can be reliably identified and disease activity assessed. Normal, uninvolved small bowel length can also be measured. Discrete proximal small bowel lesions may not always be detected. In our practice, MR enterography has replaced conventional radiology in the assessment of symptomatic patients with Crohn's disease.
Subject(s)
Crohn Disease/diagnosis , Enteritis/diagnosis , Ileal Diseases/diagnosis , Intestinal Fistula/diagnosis , Magnetic Resonance Imaging , Sigmoid Diseases/diagnosis , Abdominal Abscess/diagnosis , Abdominal Abscess/etiology , Adolescent , Adult , Aged , Colitis/diagnosis , Colitis/etiology , Crohn Disease/complications , Crohn Disease/surgery , Enteritis/etiology , Female , Humans , Ileal Diseases/etiology , Intestinal Fistula/etiology , Intestine, Small , Male , Middle Aged , Sigmoid Diseases/etiology , Young AdultABSTRACT
Gastro-oesophageal reflux disease is a common condition, and the typical symptoms of postprandial heartburn and upper abdominal pain usually respond well to acid-suppressive medication. Occasionally, the gastro-oesophageal reflux is secondary to gastric outlet obstruction, and rarely, it is due to more distal intestinal obstruction. Two patients are described who seemed to have a primary diagnosis of gastro-oesophageal reflux but who were subsequently found to have disseminated intra-abdominal malignancy. Further investigation beyond the endoscopic confirmation of oesophagitis should be considered in patients who have typical gastro-oesophageal reflux symptoms but who also have any associated worrying clinical features.
Subject(s)
Gastroesophageal Reflux/etiology , Liver Neoplasms/secondary , Neoplasms, Unknown Primary/diagnosis , Omentum , Peritoneal Neoplasms/diagnosis , Aged , Diagnosis, Differential , Fatal Outcome , Female , Humans , Incidental Findings , Liver Neoplasms/complications , Liver Neoplasms/diagnosis , Male , Middle Aged , Neoplasms, Unknown Primary/complications , Peritoneal Neoplasms/complicationsABSTRACT
BACKGROUND: Functional gastrointestinal symptoms generate a large workload in primary care. Research on functional gastrointestinal disorders is focused on hospital patients, but these patients may differ from those managed in primary care. AIM: To investigate any differences in attitudes of general practitioners and hospital specialists towards functional gastrointestinal illnesses. METHODS: A questionnaire was sent to 200 general practitioners and 200 British Society of Gastroenterology members. RESULTS: The response rate was 76%. Sixty-two general practitioners believed that functional gastrointestinal symptoms represented a 'real' currently unexplained gastrointestinal disorder, and 67 believed such symptoms probably represented somatization of a psychological illness. In contrast, most consultants (120) believed that functional gastrointestinal symptoms represented a 'real' gastrointestinal disorder, with only 36 perceiving them to have a psychological basis (chi2 = 26.7, P < 0.001). More consultants than general practitioners believed that the understanding of functional gastrointestinal disorders had improved in the last 20 years (chi2 = 4.31, P < 0.05). Most consultants and most general practitioners thought that treatment for these disorders had not improved over this period. Only 21% of general practitioners had heard of the Manning criteria for the diagnosis of irritable bowel syndrome, compared to 81% of consultants (chi2 = 107, P < 0.0001); 12% of general practitioners and 83% of consultants had heard of the Rome criteria for the diagnosis of functional gastrointestinal disorders (chi2 = 154, P < 0.0001); 37% of consultants used the Manning criteria and 40% used the Rome criteria; 11% of general practitioners used the Manning criteria and 3% used the Rome criteria. CONCLUSIONS: General practitioners and consultants have differing views on functional gastrointestinal disorders. In both primary and secondary care, most doctors do not use diagnostic criteria. Further research on the factors used to diagnose functional gastrointestinal disorders in primary care is warranted.
