Chronic enteropathy-related malabsorption syndrome in an adult with common variable immunodeficiency and symptomatic norovirus infection of the gut.

Common variable immunodeficiency (CVID) causes a chronic debilitating syndrome in affected patients and often leads to high morbidity and mortality. Among its several presentations, chronic enteropathy leading to malabsorption syndrome continues to offer a major diagnostic dilemma. Lately, higher testing for norovirus infection in patients with CVID enteropathy has correlated its presence to chronic diarrhoeas, severe villous atrophy and malabsorption syndromes. There have been no such reports of its clinical and histopathological manifestations in CVID from India. Here, we demonstrate the significance of testing for norovirus in the gut with multiplex PCRs in an adult patient with a chronic undiagnosed CVID enteropathy and its response to monthly intravenous immunoglobulin (IVIG) therapy. Our patient responded after three cycles of monthly IVIG with a complete clinical recovery of his bowel functions, leading to a significant improvement in his quality of life and performance status.

Single-balloon enteroscopy: a single-center experience of 48 procedures.

The aim of this study was to report the analysis of a single-center experience with single-balloon enteroscopy (SBE). A retrospective analysis of patients with small-bowel disorder who underwent SBE procedure from February 2011 to February 2013 was carried out. A total of 40 patients underwent 48 SBE procedures. Antegrade and retrograde approaches were used in 68.8 % and 31.2 % of subjects, respectively. The main indications were obscure gastrointestinal bleeding (n = 28), chronic diarrhea (n = 6), and chronic abdominal pain (n = 6). Average (SD) insertion length by antegrade approach was 150.6 (31.4) cm (range 90-210 cm) beyond the duodenojejunal flexure and by retrograde approach was 106.6 (29.4) cm (range 40-140 cm) proximal to the ileocecal junction. Average procedure time for antegrade approach was 46.3 (9.0) min (range 25-60 min) and for retrograde approach was 61.3 (12.8) min (range 45-90 min). Panendoscopy was not possible in any of the eight patients in whom antegrade and retrograde approaches were performed. Overall diagnostic yield was 55 % and therapeutic procedures were done in 20 % of patients. There were no significant complications. SBE is a safe and effective method to diagnose patients with small-bowel disease and provides a useful tool for intervention.