[Algorithm for diagnosis of small intestinal diseases].

AIM: To review diagnostic approaches in chronic diseases of the small intestine. MATERIAL AND METHODS: A total of 1096 patients with chronic diseases of the small intestine were admitted to the clinic of the Central Research Institute of Gastroenterological Diseases in 1987-2006. RESULTS: Most of the patients (90.5%) had celiac disease, hypolactasia and other types of disaccharidase deficiency, yersiniosis ileitis, Krohn's disease, postresection syndrome of a short small intestine, mesenterial ischemia and endocrine enteropathy. Rare diseases (general variable hypogammaglobulinemia, lymphoma, Wipple's disease and diverticulosis of the small intestine) were diagnosed in 5.8% cases. Primary amyloidosis of the small intestine, eosinophilic gastroenteritis, arteriomesenterial obstruction, primary intestinal pseudoobstruction, hypogammaglobulinemic spru, primary intestinal lymphangiectasia, tuberculosis, total polyposis, Peutz-Eggers and Cronkhite-Canada syndromes, collagenic sprue, erosive-ulcerative jejunoileitis, adenocarcinoma and heavy alpha-chain disease were detected in 3.7% examinees. These diseases were encountered in one to 5 cases for the latest 20 years. CONCLUSION: Clinical diagnosis of small intestinal diseases is based on the syndromes of chronic diarrhea, defective absorption, enteral protein loss, small intestinal obstruction and intestinal hemorrhage. Differential diagnosis of the nosological entities employs x-ray, endoscopic, histological, immunological and other methods. Most of the small intestinal diseases including rare can be diagnosed in any gastroentorological department.

[Radiological examination in chronic pancreatitis].

All stated in lecture grows out of long-term personal experience of the author based on a considerable quantity of clinical supervision for patients with chronic pancreatitis. Supervision confirms an important role of radiodiagnosis in basic disease recognition, the arisen complications and accompanying diseases. We would like to underline necessity of preservation classical (base) roentgenology among other methods of roentgen diagnostics, especially for applied medicine.

[Prevalence of celiac disease in patients with chronic diarrhea]. / Rasprostranenie tseliakii sredi bol'nykh s khronicheskoi diareei.

The objective of this research was to study the frequency of celiac disease in patients with chronic diarrhea. The biopsy materials of the small intestine and levels of antibodies to alpha-gliadin of class A immunoglobulins (IgA) and tissue transglutaminase were studied in 206 patients with chronic diarrhea. Morphologic celiac-specific symptoms were discovered in 35 (16.9%) patients. Symptoms of the total atrophy were discovered in 28 patients (13.5%); those of subtotal one were found in 7 (3.4%) patients. The increase of antibody levels to IgA alpha-gliadin and tissue transglutaminase was discovered in all 35 patients. Their average level made up 123.7 21.2 units per milliliter and 48.7 11.3 units per milliliter, respectively. It was possible to observe the typical celiac form only in 4 (11.4%) patients; the latent form was found in 30 (85.7%) patients, and the torpid (refractory) form was discovered in 1 (2.8%) patient. The frequency of celiac disease in patients with chronic diarrhea is equal to 16.9%. Patients with the latent form of the disease prevail among patients with celiac disease. Immunological screenings with the subsequent morphologic study of the mucous coat of the small intestine should be prescribed to all patients with the chronic diarrhea syndrome to enable the early diagnostics of celiac disease.

[Incidence of celiac disease in patients with chronic diarrhea]. / Chastota tseliakii u bol'nykh s khronicheskoi diareei.

AIM: To study prevalence of celiac disease (CD) among patients with chronic diarrhea (ChD). MATERIAL AND METHODS: Serum levels of IgA-antibodies to gliadin, endomysium, reticulin and tissue transglutaminase were examined in 206 patients with CD. Biopsies were obtained from a distal portion of the duodenum or a proximal portion of the jejunum. RESULTS: CD was diagnosed in 35 (16.9%) of 206 patients with ChD. The disease was typical in 5 (2.4%) patients and was latent in 30 (14.5%) patients. Antibodies to gliadin, endomysium, reticulin and tissues transglutaminase in diagnostically significant titers were detected in the serum of all the examinees with CD. Formation of the antitissue antibodies occurred because of destructive-dystrophic alterations of the connective tissue of the lamina propria mucosae pointing to the autoimmune nature of a pathological process in celiac disease. CONCLUSION: To diagnose CD in ChD patients, it is necessary to supplement standard examination with duodenobiopsy, tests for antibodies to gliadin, tissue transglutaminase and to tissue structures--endomysium and reticulin.

[General variable hypogammaglobulinemia]. / Obshchaia variabel'naia gipogammaglobulinemiia.

The purpose of the paper was studying the features of course and treatment of common variable hypogammaglobulinemia (CVHG), proceeding with intestinal function disorders functions.

[Diagnosis of peritoneal adhesions of abdominal cavity organs]. / Diagnostika spaechnoi bolezni organov briushnoi polosti.

The best results produced by objective methods in cases of scheduled examinations of patients with peritoneal commissures of the abdominal cavity organs are observed in a complex study being a combination of X-ray and radionuclide methods of study, ultrasonic method, MRI and laparoscopy.

[Diagnosis of adhesions in abdominal cavity organs]. / Diagnostika spaechnoi bolezni organov briushnoi polosti.

The best results produced by objective methods in cases of scheduled examinations of patients with peritoneal commissures of the abdominal cavity organs are observed in a complex study being a combination of X-ray and radionuclide methods of study, ultrasonic method, MRI and laparoscopy.

[Comparative diagnostic value of data of intestinoscopy with biopsy obtained from different regions of the small intestine]. / Sravnitel'naia diagnosticheskaia znachimost' dannykh, poluchennykh pri intestinoskopii s biopsiei razlichnykh otdelov tonkoi kishki.

AIM: To study diagnostic value of intestinoscopy with biopsy of the mucosa from different portions of the small intestine in patients with chronic diarrhea and malabsorption. MATERIAL AND METHODS: The examination of 116 patients with chronic diarrhea and malabsorption (endoscopic and histological study of biopsy specimens from different portions of the small intestine) detected gluten enteropathy (n = 51), Wipple's disease (n = 8), general variable hypogammaglobulinemia (n = 11), lymphangioectasy (n = 9), lymphangiomatosis (n = 1), lymphoma (n = 2), amyloidosis (n = 3), eosinophilic gastroenteritis (n = 1), duodenoejunitis without atrophy (n = 7). 23 patients had normal mucosa of the small intestine. RESULTS: Pathological changes in the jejunum and duodenum were identical in glutenic enteropathy (GE), Wipple's disease (WD), variable hypogammaglobulinemia (VH) and amyloidosis. CONCLUSION: For diagnosis of GE, WD, VH and amyloidosis it is sufficient to take biopsy from distal duodenum. Spot biopsy from sites of lymphostasis or nodular lymphoid hyperplasia is most informative for identification of lymphangioectasy, lymphangiomatosis and small intestinal lymphoma. Pathological changes in the ileum in GE, WD, VH and amyloidosis indicate severe total lesion of the small intestine.

[Crohn's disease. The problem of early diagnosis]. / Bolezn' Krona. Problema rannei diagnostiki.

A retrospective analysis was made of the diagnostic period of Crohn's disease as well as of x-ray and endoscopic signs in 28 patients. Three forms of the disease were distinguished: acute (pseudoappendicular), stenosing with chronic intestinal obstruction syndrome and primary chronic characterized by the triad (pains in the stomach, diarrhea, fever) or by the syndrome of malabsorption with extraintestinal manifestations. In the stenosing and primary chronic forms of Crohn's disease, a correct diagnosis was established in the majority of the patients 3-5 years after appearance of the symptoms. To improve early diagnosis of Crohn's disease, it is recommended that indications for x-ray and endoscopic examinations be extended. These examinations are indicated in all the patients with recurrent pains in the right iliac area, fever of obscure genesis and chronic diarrhea.

[Gluten enteropathy]. / Glutenovaia énteropatiia.

The authors relate the results of 10 years of observations of 113 patients suffering from gluten enteropathy (GE) of the adults. In all the patients, the diagnosis was supported by the presence of hyper-regenerative atrophy of the small intestinal mucosa (total in 70% and subtotal in 30%). Metabolic disorders and cellular immunity were investigated. At the onset of the observations 70.7% of the patients demonstrated malabsorption, stage III gravity, and 29.3% stage II. It has been proved that permanent and strict adherence to the agluten diet and administration of corticosteroids in the most severe cases in combination with pathogenetic therapy of diarrhea and metabolic disorders permit attaining a steady clinical remission, improvement of normalization of the biochemical and immunological characteristics, a tendency toward normalization of the small intestinal mucosa, and even the recovery of its normal structure in part of the cases.

[The value of the x-ray study method in the diagnosis of celiac-sprue]. / Znachenie rentgenologicheskogo metoda issledovaniia v diagnostike tseliakii-spru.

The authors describe some features of x-ray symptoms of Gee-Herter disease with relation to severity and a period of disease. Altogether 106 adult patients with this disease were followed up, of them 78 patients with diagnosis of Gee-Herter disease, confirmed by histology of intestinal biopsy specimens, were selected for analysis. Three groups of patients with different x-ray symptoms were singled out. Some distinctive features of differential diagnosis and complications of Gee-Herter disease in adults were noted.

[Radiodiagnosis of malignant lymphoma of the small intestine]. / Rentgenodiagnostika zlokachestvennoi limfomy tonkoi kishki.

The authors observed 10 patients with malignant lymphoma revealed by x-ray; 2 of them were supposed to be afflicted with heavy alpha-chain disease with malignant transformation. An x-ray picture revealed a triad of pathognomonic symptoms and a regular parallelism of intestinal changes with clinicolaboratory findings. In all the cases the diagnosis was confirmed by morphological data.

[Radiologic diagnosis of malignant lymphoma of the small intestine]. / Rentgenodiagnostika zlokachestvennoi limfomy tonkoi kishki.

The authors observed 10 patients with malignant lymphoma revealed by x-ray; 2 of them were supposed to be afflicted with heavy alpha-chain disease with malignant transformation. An x-ray picture revealed a triad of pathognomonic symptoms and a regular parallelism of intestinal changes with clinico-laboratory findings. In all the cases the diagnosis was confirmed by morphological data.