Proximal jejunal GIST associated with massive gastrointestinal bleeding. Case report.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are rare, reported incidence is between 10 to 15 cases per million of habitants. They are usually located in the stomach (56%), small intestine (32%), colon-rectum (6%), and esophagus (<1%). Its symptoms include nausea, vomiting and abdominal fullness; 30% are asymptomatic. Incidental finding during abdominal surgery or imaging studies is common. Resection with negative margins is the standard treatment. CASE REPORT: A 69-year-old female patient who debuted with massive digestive tract bleeding, requiring surgical treatment. A tumor was detected at jejunum compatible with a GIST.

INTRODUCCIÓN: Los tumores del estroma gastrointestinal (GIST) son poco frecuentes, con una incidencia de 10 a 15 casos por millón de habitantes. Suelen localizarse en el estómago (56%), el intestino delgado (32%), el colon-recto (6%) y el esófago (< 1%). Sus síntomas incluyen náusea, vómito y plenitud abdominal; el 30% son asintomáticos. Es común su hallazgo incidental durante una cirugía abdominal o en estudios de imagen. La resección con márgenes negativos es el tratamiento estándar. CASO CLÍNICO: Mujer de 69 años que debuta con hemorragia masiva de tubo digestivo, requiriendo tratamiento quirúrgico. Se detecta un tumor de yeyuno compatible con GIST.

Neumatosis quística intestinal, un reto diagnóstico: reporte de caso / Cystic intestinal pneumatosis, a diagnostic challenge: case report

Introducción. La neumatosis quística intestinal se describe como la presencia de gas dentro de la pared intestinal. Es una entidad poco frecuente, con una incidencia del 0,03 % en la población global. Aparece con predilección en el género masculino después de los 45 años yse localiza principalmente en el intestino delgado (42 %) y el colon. Se puede asociar a varias condiciones que en ocasiones requieren manejo quirúrgico. Caso clínico. Se presenta el caso de un hombre 75 años, con antecedente de hipertensión arterial, quien consultó por un cuadro de 15 días de evolución consistente en distensión abdominal, dolor y estreñimiento. En urgencias se solicitó una radiografía de tórax que mostró neumoperitoneo y varios niveles hidroaéreos, por lo que el cirujano de turno consideró una posible ruptura de víscera hueca. Resultados. Fue llevado a laparotomía exploratoria, donde se identificó neumatosis quística intestinal y estómago muy aumentado de tamaño, compatible con gastroparesia. Como resultado del tratamiento brindado, el paciente tuvo un desenlace satisfactorio logrando alta médica, apoyado con cuidados básicos de enfermería. Conclusiones. Si bien los casos de neumatosis quística intestinal son de presentación inusual, se puede encontrar en pacientes con hallazgos imagenológicos de neumoperitoneo. Por eso, se debe realizar un análisis concienzudo de cada paciente e individualizar el caso para el correcto diagnóstico.

Introduction. Cystic pneumatosis intestinalis is described as the presence of gas within the intestinal wall. It is a rare entity, with an incidence of 0.03% in the global population. It appears with a predilection in the male gender after 45 years of age and is located mainly in the small intestine (42%) and the colon. It can be associated with several conditions that sometimes require surgical management. Clinical case. The case of a 75-year-old man with a history of high blood pressure is presented, who consulted for a 15-day history consisting of abdominal distention, pain and constipation. In the emergency room, a chest x-ray was requested, which showed pneumoperitoneum and several air-fluid levels. The surgeon on call considered a possible rupture of the hollow viscus. Results. The patient was taken to exploratory laparotomy, where intestinal cystic pneumatosis and a greatly enlarged stomach were identified, compatible with gastroparesis. As a result of the treatment provided, the patient had a satisfactory outcome, achieving medical discharge, supported with basic nursing care. Conclusions. Although cases of intestinal cystic pneumatosis have an unusual presentation, it can be found in patients with imaging findings of pneumoperitoneum. Therefore, a thorough analysis of each patient must be carried out and the case individualized for the correct diagnosis.

Effect of Different Levels of Extruded Coffee (Coffea arabica) Pulp Flour on the Productive Performance and Intestinal Morphometry of Cobb 500 Broiler Chickens.

Coffee pulp is a by-product of the coffee industry. Due to conventional management techniques, it represents a severe environmental problem due to its negative impact on the soil (anaerobic fermentation and pH changes), water sources (the infiltration of pollutants into streams, acidification of water sources, and modification of microorganisms), and biodiversity (soil microbiology, fish, crustaceans, and other vertebrates). Therefore, it is essential to develop protocols for the treatment of this waste so that it can be used again in other productive activities under the circular economy approach. This means that all the waste from a production process can be reused, can generate value for the benefit of the producer, and, in turn, mitigate the environmental impact. The objective of this study was to evaluate the replacement of 5 levels of wheat bran (WB) with extruded coffee pulp flour (ECPF) as an alternative to a conventional fiber source in broiler finisher diets. A total of 300 Cobb 500 chickens in the finishing phase were assessed in the study, grouped in 5 treatments: T1, a conventional diet or control treatment (100% WB and 0% ECPF), T2 (75% WB and 25% ECPF), T3 (50% WB and 50% ECPF), T4 (25% WB and 75% ECPF), and T5 (0% WB and 100% ECPF). Feed intake, weight gain, feed conversion ratio (FCR), and intestinal morphometry (villus length: VL, villus width: VW, crypt depth: CD, villus height/crypt depth ratio: V/C, and villus surface area: VSA) were evaluated at the level of the duodenum, jejunum, and ileum. Feed intake decreased correspondingly as the ECPF in the diet was increased, with statistical differences (p < 0.01) between their averages; the most significant weight gain (834.61 g) was evidenced with the T2 treatment, this being statistically different (p < 0.01) from T4 and T5; similarly, the best FCR (1.58) was evidenced with the T2 treatment, followed by the control treatment T1 (with 1.64); however, they were not statistically different (p > 0.05). All treatment results were similar to the VL control samples in the three intestinal portions, except for the T5 in the jejunum, which showed statistical differences from the control. In VW, the treatment results were similar to the control samples of the jejunum and ileum; however, in the duodenum, the T5 results showed the highest value (172.18 µm), being statistically different (p < 0.05) from the other treatments being evaluated. For CD, it was only in the duodenum that the T2 and T3 treatments were similar to the control. Likewise, for V/C in the duodenum, only the T2 results were similar to the control. There was no significant difference in the VSA among the different treatment groups. T2 showed better production parameters without altering the intestinal villi. In conclusion, ECPF is a potential input for use to replace up to 25% of WB in the feed of broilers in the finishing phase.

Duodenal mucosa of untreated celiac disease patients has altered expression of the GAS6 and PROS1 and the negative regulator tyrosine kinase TAM receptors subfamily.

Celiac disease (CD) is an immune-driven disease characterized by tissue damage in the small intestine of genetically-susceptible individuals. We evaluated here a crucial immune regulatory pathway involving TYRO3, AXL, and MERTK (TAM) receptors and their ligands PROS1 and GAS6 in duodenal biopsies of controls and CD patients. We found increased GAS6 expression associated with downregulation of PROS1 and variable TAM receptors levels in duodenum tissue of CD patients. Interestingly, CD3+ lymphocytes, CD68+, CD11c+ myeloid and epithelial cells, showed differential expressions of TAM components comparing CD vs controls. Principal component analysis revealed a clear segregation of two groups of CD patients based on TAM components and IFN signaling. In vitro validation demonstrated that monocytes, T lymphocytes and epithelial cells upregulated TAM components in response to IFN stimulation. Our findings highlight a dysregulated TAM axis in CD related to IFN signaling and contribute to a deeper understanding of the pathophysiology of CD.

Hemorragia digestiva por intususcepción de un lipoma ulcerado en yeyuno / Gastrointestinal bleeding due to ulcerated intussuscepted jejunal lipoma

RESUMEN Los lipomas yeyunales son tumores gastrointestinales benignos e infrecuentes, de origen mesenquimático, compuestos por adipocitos que suelen estar confinados a la submucosa. Generalmente son asintomáticos y se descubren de manera incidental al realizar estudios por imágenes o endoscópicos. Sin embargo, aquellos mayores de 2 cm pueden presentar síntomas como resultado de complicaciones, como intususcepción intestinal, obstrucción o rara vez, hemorragias. Presentamos un caso infrecuente de intususcepción de un lipoma yeyunal ulcerado en un adulto, diagnosticado en el contexto de un cuadro de hemorragia digestiva.

ABSTRACT Jejunal lipomas are rare benign mesenchymal tumors made up of adipocytes confined to the submucosa layer. They are usually asymptomatic and are incidentally found during imaging or endoscopic tests. Those measuring > 2 cm may become symptomatic as a result of complications as intestinal intussusception, obstruction and bleeding. We herein report a rare case of intussusception of an ulcerated jejunal lipoma in an adult patient, that was diagnosticated in the setting of an intestinal hemorrhage.

Morphology of the small and large intestines of the six-banded armadillo (Euphractus sexcinctus) Linnaeus, 1758.

Euphractus sexcinctus has a diverse diet, so it needs anatomical and habitual features to help it get its meals. Therefore, the objective is to study the morphology of the small and large intestines of the six-banded armadillo (E. sexcinctus). The research was authorized and approved under number 136/16. Six animals, obtained from victims of predatory hunting, were dissected for the research. For the anatomical analysis, the specimens were dissected and photographed. The fragments of each organ were submitted to histological routine to obtain slides stained with hematoxylin-eosin, toluidine blue and Masson's trichrome for further analysis. The small intestine has three parts: duodenum, jejunum, and ileum. Histologically, it has the typical four layers of tubular organs. The mucosa is covered by simple cylindrical epithelium with the presence of specializations in the form of microvilli and variation in the number of goblet cells, depending on the portion observed. In the duodenal portion, the presence of the serous layer was not observed. In the jejunal portion, it is possible to observe lymphoid tissue aggregates in the submucosa, which become more evident in the ileum. The large intestine is divided into cecum, colon, and rectum and has the same histological subdivisions as the small intestine, but with some specializations. The presence of simple cylindrical intestinal crypts is clearly observed and the presence of a large number of goblet cells, which increase as it approaches the rectum. In the submucosa of the large intestine, the presence of organized lymphoid plaques is detected. RESEARCH HIGHLIGHTS: The presence of large numbers of goblet cells, which increase as one approaches the rectum. The presence of organized lymphoid plaques is detected. The duodenal portion was not observed presence of the serous layer.

Matrix metalloproteinases inhibition reveals the association between inflammation, collagen accumulation and intestinal translocation of Schistosoma mansoni eggs in vivo.

Schistosomiasis mansoni is a parasitic infection that causes enterohepatic morbidity associated with severe granulomatous inflammation triggered by parasite eggs. In this disease, granulomatous inflammation leads to intestinal erosion and environmental excretion of S. mansoni eggs from feces, an essential process for propagating the parasite and infecting host organisms. Metalloproteinases (MMP) are involved in S. mansoni-induced hepatic granulomatous inflammation and fibrosis. However, the relationship between MMP and collagen accumulation with the intestinal excretion of parasite eggs remains unclear. Thus, the present study investigated whether MMP inhibition is capable of modulating granulomatous inflammation, collagen accumulation and mechanical resistance to the point of influencing the dynamics between intestinal retention and excretion of S. mansoni eggs in infected mice. Our findings indicated that doxycycline (a potent MMP inhibitor) aggravates intestinal inflammation and subverts collagen dynamics in schistosomiasis. By attenuating MMP-2 and MMP-9 activity, this drug is capable of enhancing fibrosis and mechanical resistance of the intestinal wall, hindering S. mansoni eggs translocation. Although collagen content was not correlated with MMP activity, intestinal retention and fecal excretion of parasite eggs in untreated mice; these correlations were observed for doxycycline-treated animals. Thus, our study provides evidence that doxycycline is able to attenuate fecal elimination of S. mansoni eggs by inhibiting MMP-2 and MMP-9 activity, events potentially associated with excessive collagen accumulation, which increases intestinal mechanical resistance and hinders eggs translocation through the intestinal wall. Variations in intestinal collagen dynamics are relevant since they may represent changes in the environmental dispersion of S. mansoni eggs, bringing repercussions for schistosomiasis propagation.

Diffuse Gastrointestinal Motor Compromise in Patients with Scleroderma: Utility of Minimally Invasive Techniques.

BACKGROUND: Scleroderma is a systemic inflammatory disorder that can compromise the gastrointestinal tract in up to 90% of patients. AIM: The purpose of this work is to characterize esophageal, gastric, and intestinal compromise in patients with scleroderma by means of minimally invasive methods and its association with symptoms and severity of their rheumatological condition. METHODS: Patients with systemic sclerosis were recruited according to the criteria of the American College of Rheumatology. The study of digestive involvement was carried out on four consecutive days: esophageal manometry was performed on the first day, intestinal manometry on the second day, surface electrogastrography on the third, and hydrogen breath test on the fourth. The Mann-Whitney test was used for quantitative variables and the chi-squared test for categorical variables (p < 0.05). RESULTS: A total of 30 patients were included, with an average age of 52.7 years and 93% women. Average disease evolution duration was 6.5 years, 70% with limited variety. Rodnan averaged 12 points, being higher in the diffuse variety. The main symptom was heartburn, followed by abdominal distension, with no differences between subtypes except for diffuse nausea; 80% had intestinal manometric compromise, 76% esophageal manometric compromise, and 30% electrogastrographic compromise. Bacterial overgrowth was evidenced in two-thirds (66%) of the patients, and 23% of the patients had simultaneous esophageal, gastric, and intestinal involvement, which correlated with greater skin involvement but not with gastrointestinal symptoms. CONCLUSIONS: Gastrointestinal involvement in patients with scleroderma is frequent and is observed regardless of the symptoms and clinical characteristics of the latter, except for skin involvement.

Exercise improves intestinal IgA production by T-dependent cell pathway in adults but not in aged mice.

Introduction: Hypermutated high-affinity immunoglobulin A (IgA), neutralizes toxins and drives the diversification of bacteria communities to maintain intestinal homeostasis although the mechanism underlies the impact of moderate aerobic exercise (MAE) on the IgA-generation via T-dependent (TD) is not fully know. Therefore, the aim of this study was to determine the effect of long-time MAE on the production of IgA through the TD pathway in Peyer´s patches of the small intestine from aged mice. Methods: MAE protocol consisted of twenty 3-month-old (young) BALB/c mice running in an endless band at 0° inclination and a speed of 10 m/h for 5 days a week and resting 2 days on the weekend until reaching 6-month-old (adulthood, n=10) or 24-month-old (aging, n=10). Groups of young, adult, or elderly mice were included as sedentary controls (n=10/per group). At 6 or 24 months old, all were sacrificed, and small intestine samples were dissected to prepare intestinal lavages for IgA quantitation by ELISA and to obtain suspensions from Peyer´s patches (PP) and lamina propria (LP) cells for analysis of T, B, and plasma cell subpopulations by flow cytometry and mRNA analysis expression by RT-qPCR of molecular factors related to differentiation of B cells to IgA+ plasma cells, class switch recombination, and IgA-synthesis. Statistical analysis was computed with two-way ANOVA (factor A=age, factor B=group) and p<0.05 was considered for statistically significant differences. Results: Compared to age-matched sedentary control, in exercised elderly mice, parameters were either increased (IgA concentration, IL-21, IL-10 and RDH mRNA expression), decreased (α-chain mRNA, B cells, mIgA+ B cells, mIgM+ B cells and IL-4 mRNA) or unchanged (PP mIgA+ plasmablasts and LP cyt-IgA+ plasma cells). Regarding the exercised adult mice, they showed an up-modulation of IgA-concentration, mRNA expression IL-21, IL-10, and RDH and cells (PP B and T cells, mIgM+ plasmablasts and LP cyt-IgA+plasma cells). Conclusion: Our findings suggest that MAE restored the IgA production in adult mice via the TD cell pathway but does not in aged mice. Other studies are necessary to know in more detail the impact of long-time MAE on the TD pathway to produce IgA in aging.

Transglycosylation catalysed by Caco-2 membrane disaccharidases: A new approach to understand carbohydrates digestibility.

Under appropriate experimental conditions, some glycoside hydrolases can catalyze transglycosylation reactions; a hypothesis associated with this is that the glycosidic linkages formed will be preferentially hydrolyzed under optimal conditions. Therefore, the hydrolytic and transglycosylation activities of isolated membranes from differentiated Caco-2 cells on sucrose, maltose and isomaltulose were evaluated. After the enzymatic reactions, the di- and trisaccharides obtained were identified by gas chromatography coupled to a mass spectrometer. Differentiated Caco-2 cell membranes exerted hydrolytic and transglycosylation activities towards the studied disaccharides. The obtained di- and trisaccharides were detected for the first time using human cell models. Due to the absence of maltase-glucoamylase complex (MGAM) in Caco-2 cells, and the known hydrolytic activity of sucrase-isomaltase (SI) towards sucrose, maltose and isomaltulose, it is plausible that the glycosidic linkages obtained after the transglycosylation reaction, mainly α-glucosyl-fructoses and α-glucosyl-glucoses, were carried out by SI complex. This approach can be used as a model to explain carbohydrate digestibility in the small intestine and as a tool to design new oligosaccharides with low intestinal digestibility.

Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Rosuvastatin enhances alterations caused by Toxoplasma gondii in the duodenum of mice.

Infection by Toxoplasma gondii may compromise the intestinal histoarchitecture through the tissue reaction triggered by the parasite. Thus, this study evaluated whether treatment with rosuvastatin modifies duodenal changes caused by the chronic infection induced by cysts of T. gondii. For this, female Swiss mice were distributed into infected and treated group (ITG), infected group (IG), group treated with 40 mg/kg rosuvastatin (TG) and control group (CG). After 72 days of infection, the animals were euthanized, the duodenum was collected and processed for histopathological analysis. We observed an increase in immune cell infiltration in the IG, TG and ITG groups, with injury to the Brunner glands. The infection led to a reduction in collagen fibers and mast cells. Infected and treated animals showed an increase in collagen fibers, acidic mucin-producing goblet cells, intraepithelial lymphocytes and mast cells, in addition to the reduction of muscle, neutral mucin-producing and Paneth cells. While treatment with rosuvastatin alone led to increased muscle layer, proportion of neutral mucin-producing goblet cells, Paneth cells, and reduction of collagen fibers. These findings indicate that the infection and treatment caused changes in the homeostasis of the intestinal wall and treatment with rosuvastatin potentiated most parameters indicative of inflammation.

Coexistence of apoptosis, pyroptosis, and necroptosis pathways in celiac disease.

Usually, the massive elimination of cells under steady-state conditions occurs by apoptosis, which is also acknowledged to explain the loss of enterocytes in the small intestine of celiac disease (CD) patients. However, little is known about the role of proinflammatory cell death pathways in CD. Here, we have used confocal microscopy, western blot, and RT-qPCR analysis to assess the presence of regulated cell death pathways in the duodenum of CD patients. We found an increased number of dead (TUNEL+) cells in the lamina propria of small intestine of CD patients, most of them are plasma cells (CD138+). Many dying cells expressed FAS and were in close contact with CD3+ T cells. Caspase-8 and caspase-3 expression was increased in CD, confirming the activation of apoptosis. In parallel, caspase-1, IL-1ß, and GSDMD were increased in CD samples indicating the presence of inflammasome-dependent pyroptosis. Necroptosis was also present, as shown by the increase of RIPK3 and phosphorylate MLKL. Analysis of published databases confirmed that CD has an increased expression of regulated cell death -related genes. Together, these results reveal that CD is characterized by cell death of different kinds. In particular, the presence of proinflammatory cell death pathways may contribute to mucosal damage.

Effect of high-refined carbohydrate diet on intestinal integrity.

OBJECTIVES: One of the leading causes of obesity is the consumption of excess nutrients. Obesity is characterized by adipose tissue expansion, chronic low-grade inflammation, and metabolic alterations. Although consumption of a high-fat diet has been demonstrated to be a diet-induced obesity model associated with gut disorders, the same effect is not well explored in a mild-obesity model induced by high-refined carbohydrate (HC) diet intake. The intestinal tract barrier comprises mucus, epithelial cells, tight junctions, immune cells, and gut microbiota. This system is susceptible to dysfunction by excess dietary components that could increase intestinal permeability and bacterial translocation. The aim of this study was to evaluate whether an HC diet and the alterations resulting from its intake are linked to small intestine changes. METHODS: Male BALB/c mice were fed a chow or an HC diet for 8 wk. RESULTS: Although differences in body weight gain were not observed between the groups, mice fed the HC diet showed increased adiposity associated with metabolic alterations. The interferon-γ expression and myeloperoxidase levels were increased in the small intestine in mice fed an HC diet. However, the intestinal villi length, the expression of tight junctions (zonula occludens-1 and claudin-4) and tumor necrosis factor-α cytokine, and the percentage of intraepithelial lymphocytes did not differ in the jejunum or ileum between the groups. We did not observe differences in intestinal permeability and bacterial translocation. CONCLUSION: Metabolic alterations caused by consumption of an HC diet lead to a mild obesity state that does not necessarily involve significant changes in intestinal integrity.

Regionalized analysis of gut barrier components in the small intestine of BALB/c mice following chronic immobilization stress.

BACKGROUND: Microbiota and tight junction proteins (TJPs) are components of the gut barrier, and are considered stress targets that have deleterious effects on intestinal homeostasis. OBJECTIVES: This study aimed to evaluate the effects of chronic immobilization stress on selected small intestine homeostasis parameters. MATERIAL AND METHODS: Female BALB/c mice were divided into a stress group that underwent short-term immobilization for 2 h per day for 4 consecutive days, and a non-stressed control group (n = 6 per group). Proximal and distal small intestine samples were excised to assess colony-forming units per gram (CFU/g) of total bifidobacteria in selective agar plates, luminal albumin was assessed using immune-enzymatic assay, pro-inflammatory cytokines were evaluated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and TJPs (pore-forming, claudin (Cld)-2; pore-sealing, Cld-4; ambiguous, Cld-7, -12 and -15) were assessed with RT-qPCR and western blotting. RESULTS: Compared with the control group, the stress group had lower body weight and energy intake. In the distal region, the stressed mice had lower bifidobacteria count and messenger ribonucleic acid (mRNA) expression of Cld-2, Cld-4 and Cld-12, though they had more albumin and higher interleukin (IL)-6 mRNA expression. Within the proximal region, the stressed mice had higher mRNA expression of tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), IL-6, Cld-7, Cld-12, and Cld-15, along with lower levels of IL-10 and Cld-4. However, mRNA and protein expression of TJPs were discordant. CONCLUSIONS: These findings indicate divergent stress-induced outcomes in the small intestine, evidenced by the elicitation of a pro-inflammatory response and decreased anti-inflammatory response in the duodenum, and by increased albumin transudation and decreased bifidobacterial growth in the distal region.

Congenital Paraduodenal Hernia: A Case Report

Paraduodenal hernia is a rare congenital anomaly that arises from an alteration in the midgut rotation during embryogenesis. Consequently, the small intestine becomes trapped in a sac of the posterior mesentery of the colon. This entity can compromise the intestinal segment's viability and the patient's life. Its diagnosis is difficult, rarely suspected, and often confused with other causes of abdominal pain. We present the case of a 29-year-old male patient with a documented paraduodenal hernia during surgery, its correction, and follow-up, in which no complications were reported.

La hernia paraduodenal es una anomalía congénita poco frecuente que surge de una alteración en la rotación del intestino medio durante la embriogénesis. En consecuencia, el intestino delgado queda atrapado en un saco del mesenterio colónico posterior. Dicha entidad puede comprometer la viabilidad del segmento intestinal y la vida del paciente. Su diagnóstico es difícil, pocas veces sospechado y muchas veces confundido con otras causas de dolor abdominal. Presentamos el caso de un paciente de 29 años con una hernia paraduodenal documentada durante la cirugía, su corrección y seguimiento, en el cual no se documentaron complicaciones.

Effects of Lactobacillus fermentum Administration on Intestinal Morphometry and Antibody Serum Levels in Salmonella-Infantis-Challenged Chickens.

There are no studies reporting the effects of Salmonella enterica subsp. enterica serovar Infantis (S. Infantis) on intestinal architecture and immunoglobulin serum levels in chickens. Here, we measured these parameters and hypothesized whether probiotic administration could modulate the observed outcomes. Two-hundred 1-day-old COBB 500 male chicks were allocated into four groups: (I) the control, (II) the group treated with L. fermentum, (III) the group exposed to S. Infantis, and (IV) the group inoculated with both bacteria. At 11 days post infection, blood was gathered from animals which were then euthanized, and samples from the small intestine were collected. Intestinal conditions, as well as IgA and IgM serum levels, were assessed. S. Infantis reduced villus-height-to-crypt-depth (VH:CD) ratios in duodenal, jejunal, and ileal sections compared to control conditions, although no differences were found regarding the number of goblet cells, muc-2 expression, and immunoglobulin concentration. L. fermentum improved intestinal measurements compared to the control; this effect was also evidenced in birds infected with S. Infantis. IgM serum levels augmented in response to the probiotic in infected animals. Certainly, the application of L. fermentum elicited positive outcomes in S. Infantis-challenged chickens and thus must be considered for developing novel treatments designed to reduce unwanted infections.

Efeitos de Bifidobacterium animalis subsp. Lactis HN019 vivo e inativado na periodontite experimental em ratos / Effects of Bifidobacterium animalis subsp. Lactis HN019 live and inactivated in experimental periodontitis in rats

A periodontite é uma doença crônica e complexa, abrangendo mais de uma forma de tratamento combinados. Os probióticos têm ganhado espaço em casos de terapias adjuvantes e mostrado resultados promissores quando utilizados em casos de periodontite. O objetivo do estudo foi avaliar a ação do probiótico Bifidobacterium lactis vivo e inativado na periodontite induzida por ligadura em ratos. Foram utilizados 32 ratos machos, nos seguintes grupos: GC/controle animais sem periodontite que receberam apenas caldo Man Rogosa-Sharpe (MRS); GP/periodontite experimental e caldo MRS; GP/PROB periodontite experimental + probiótico vivo e o grupo GP/POSB periodontite experimental + posbiótico. Após 45 dias, os animais foram eutanasiados. As hemimandíbulas foram analisadas por microtomografia computadorizada e histomorfometria de perda óssea alveolar. O intestino delgado foi analisado por histomorfometria de altura de vilos e profundidade de criptas intestinais. Os dados foram submetidos à análise estatística apropriada, ao nível de 5%. Os parâmetros de volume ósseo (BV/TV), número de trabéculas (Tb.N), separação das trabéculas (Tb.Sp) e porosidade total (PO total) foram diferentes entre o GC e os demais grupos, GP, GP/POSB e GP/PROB. O GC apresentou maiores valores para BV/TV. Para PO total e Tb.Sp o GC apresentou menores valores. No parâmetro de Tb.n o GP.PROB apresentou maiores valores. Para espessura trabecular (Tb.Th) houve diferença estatística entre o GC e GP e entre GC e GP/PROB, sendo que GC apresentou valores maiores em ambos os casos. Para a perda óssea da furca houve diferença estatística entre o GC e os demais grupos, sendo que GC apresentou menores valores de perda óssea. Em relação ao intestino delgado, não houve diferença estatística entre os grupos. Concluímos que tanto o probiótico vivo como o inativado não foram capazes de atuar na inibição da perda óssea na área de furca bem como não foram capazes de agir como modulador da resposta inflamatória no intestino (AU)

Periodontitis is a chronic and complex disease, encompassing more than one form of combined treatment. Probiotics have gained space in cases of adjuvant therapies and have shown promising results when used in cases of periodontitis. The aim of the study was to evaluate the action of the live and inactivated probiotic Bifidobacterium lactis on ligature-induced periodontitis in rats. 32 male rats were used in the following groups: CG/control animals without periodontitis that received only Man Rogosa-Sharpe broth (MRS); GP/experimental periodontitis and MRS broth; GP/PROB experimental periodontitis + live probiotic and GP/POSB experimental periodontitis + postbiotic group. After 45 days, the animals were euthanized. The hemimandibles were analyzed by computed microtomography and histomorphometry of alveolar bone loss. The small intestine was analyzed by histomorphometry of villus height and intestinal crypt depth. Data were subjected to appropriate statistical analysis at the 5% level. The parameters of bone volume (BV/TV), number of trabeculae (Tb.N), trabeculae separation (Tb.Sp) and total porosity (total PO) were different between the CG and the other groups, GP, GP/POSB and GP/PROB. The CG showed higher values for BV/TV. For total PO and Tb.Sp, the CG showed lower values. In the Tb.n parameter, GP.PROB presented higher values. For trabecular thickness (Tb.Th) there was a statistical difference between GC and GP and between GC and GP/PROB, with GC showing higher values in both cases. For bone loss in the furcation, there was a statistical difference between the CG and the other groups, with the CG having lower values of bone loss. Regarding the small intestine, there was no statistical difference between the groups. We conclude that both the live and inactivated probiotics were not able to inhibit bone loss in the furcation area, nor were they able to act as a modulator of the inflammatory response in the intestine (AU).

Melanoma metastásico en intestino delgado: causa infrecuente de perforación: reporte de caso / Metastatic melanoma in the small intestine: infrequent cause of perforation: case report / Melanoma metastático em intestino delgado: causa rara de perfuração: relato de caso

El intestino delgado es el sitio de asiento más frecuente del melanoma metastásico. Su diagnóstico es un desafío por cursar asintomático o con síntomas inespecíficos. Son pocos los casos que presentan complicaciones, siendo infrecuente la peritonitis por perforación. El objetivo del trabajo es comunicar el caso clínico de una peritonitis por perforación de una metástasis de melanoma en intestino delgado. Caso clínico: Paciente de sexo masculino de 66 años con diagnóstico de melanoma de cuello y secundario óseo, encefálico y pulmonar, fue intervenido de urgencia por peritonitis aguda por perforación de metástasis en intestino delgado. El estudio histológico confirmó secundarismo de melanoma cutáneo. Conclusión: Sabiendo que el yeyuno íleon es el sitio de asiento más frecuente de las metástasis de melanoma, ante la presencia de síntomas digestivos inespecíficos o anemia se debe sospechar su compromiso y evaluar posibles alternativas terapéuticas.

The small intestine is the most frequent site of metastatic melanoma. However, its diagnosis continues to be a challenge since it is usually asymptomatic or with non-specific symptoms. Few cases result in complications, peritonitis due to perforation being infrequent. The objective of the work is to report a clinical case of peritonitis due to perforation of a melanoma metastasis in the small intestine. Clinical case: A 66-year-old male patient diagnosed with melanoma of the neck and secondary bone, brain and lung melanoma, underwent emergency surgery for acute peritonitis due to perforation of metastasis in the small intestine, which was resected and anastomosed. The histology confirmed the secondary nature of the cutaneous melanoma. Conclusion: Knowing that the jejunum-ileum is the most frequent site of melanoma metastases, in the presence of non-specific digestive symptoms or anemia, its involvement should be suspected and possible therapeutic alternatives should be evaluated.

O intestino delgado é o local mais frequente de melanoma metastático. O diagnóstico é um desafio por ser assintomático ou apresentar sintomas inespecíficos. Há poucos casos que apresentam complicações, sendo pouco frequente a peritonite por perfuração. O objetivo deste trabalho é relatar um caso clínico de peritonite por perfuração de metástase de melanoma no intestino delgado. Caso clínico: Paciente do sexo masculino, 66 anos, diagnosticado com melanoma no pescoço com metástase óssea, cefálica e pulmonar. Foi submetido a cirurgia de emergência por peritonite aguda por perfuração de metástases do intestino delgado. O estudo histológico confirmou melanoma cutâneo. Conclusão: Sabendo que o jejuno e o íleo é o local mais frequente de metástase de melanoma, na presença de sintomas digestivos inespecíficos ou anemia deve-se suspeitar de seu acometimento e avaliar possíveis alternativas terapêuticas.