RESUMO
Intestinal tissue is highly susceptible to ischemia/reperfusion injury in many hazardous health conditions. The anti-inflammatory and antioxidant glycoprotein fetuin-A showed efficacy in cerebral ischemic injury; however, its protective role against intestinal ischemia/reperfusion remains elusive. Therefore, this study investigated the protective role of fetuin-A supplementation against intestinal structural changes and dysfunction in a rat model of intestinal ischemia/reperfusion. We equally divided 72 male rats into control, sham, ischemia/reperfusion, and fetuin-A-pretreated ischemia/reperfusion (100 mg/kg/day fetuin-A intraperitoneally for three days prior to surgery and a third dose 1 h prior to the experiment) groups. After 2 h of reperfusion, the jejunum was dissected and examined for spontaneous contractility. A jejunal homogenate was used to assess inflammatory and oxidative stress enzymes. Staining of histological sections was carried out with hematoxylin, eosin and Masson's trichrome stain for evaluation. Immunohistochemistry was performed to detect autophagy proteins beclin-1, LC3, and p62. This study found that fetuin-A significantly improved ischemia/reperfusion-induced mucosal injury by reducing the percentage of areas of collagen deposition, increasing the amplitude of spontaneous contraction, decreasing inflammation and oxidative stress, and upregulating p62 expression, which was accompanied by beclin-1 and LC3 downregulation. Our findings suggest that fetuin-A treatment can prevent ischemia/reperfusion-induced jejunal structural and functional changes by increasing antioxidant activity and regulating autophagy disturbances observed in the ischemia/reperfusion rat model. Furthermore, fetuin-A may provide a protective influence against intestinal ischemia/reperfusion complications.
Assuntos
Intestinos/irrigação sanguínea , Traumatismo por Reperfusão/patologia , alfa-2-Glicoproteína-HS/farmacologia , Animais , Morte Celular Autofágica/efeitos dos fármacos , Morte Celular Autofágica/imunologia , Proteína Beclina-1/metabolismo , Colágeno/metabolismo , Modelos Animais de Doenças , Enterite/tratamento farmacológico , Enterite/patologia , Intestinos/efeitos dos fármacos , Intestinos/patologia , Doenças do Jejuno/tratamento farmacológico , Doenças do Jejuno/patologia , Jejuno/irrigação sanguínea , Jejuno/efeitos dos fármacos , Jejuno/fisiologia , Masculino , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/fisiologia , Substâncias Protetoras/farmacologia , Ratos , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/prevenção & controleAssuntos
Doença Celíaca/complicações , Enterite/etiologia , Doenças do Jejuno/etiologia , Enterite/diagnóstico por imagem , Enterite/tratamento farmacológico , Evolução Fatal , Humanos , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico , Úlcera/diagnóstico por imagem , Úlcera/tratamento farmacológico , Úlcera/etiologiaAssuntos
Diverticulite/diagnóstico , Doenças do Íleo/diagnóstico , Doenças do Jejuno/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Diverticulite/tratamento farmacológico , Diverticulite/cirurgia , Humanos , Doenças do Íleo/tratamento farmacológico , Doenças do Íleo/cirurgia , Doenças do Jejuno/tratamento farmacológico , Doenças do Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Falha de TratamentoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Crioglobulinemia/tratamento farmacológico , Úlcera Duodenal/diagnóstico , Doenças do Jejuno/diagnóstico , Úlcera/diagnóstico , Vasculite/patologia , Adulto , Compostos de Boro/administração & dosagem , Bortezomib/administração & dosagem , Crioglobulinemia/complicações , Crioglobulinemia/diagnóstico , Crioglobulinas/efeitos adversos , Cristalização , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Enteroscopia de Duplo Balão , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/etiologia , Glicina/administração & dosagem , Glicina/análogos & derivados , Humanos , Doenças do Jejuno/tratamento farmacológico , Doenças do Jejuno/etiologia , Masculino , Úlcera/tratamento farmacológico , Úlcera/etiologia , Vasculite/tratamento farmacológico , Vasculite/etiologiaAssuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Técnica de Fontan , Hemorragia Gastrointestinal/tratamento farmacológico , Hemostáticos/uso terapêutico , Doenças do Jejuno/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Enteropatias Perdedoras de Proteínas/etiologia , Administração Oral , Criança , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças do Jejuno/etiologia , MasculinoRESUMO
Jejunal diverticulosis is an underdiagnosed condition due to its relatively benign existence and uncharacteristic presentation. The complications can be very severe and, due to its often late diagnosis, patients may require urgent surgery. We present a woman who initially complained of non-specific abdominal symptoms but was diagnosed with a contained jejunal diverticular perforation relatively early. We managed her non-operatively with intravenous antibiotics from which she recovered well. She was discharged 2 days later and has remained completely well. Follow-up at 3 months showed no recurrence. Our case differs from most of the literature due to the early diagnosis and successful non-operative management of the patient. We conclude that, in cases of non-specific abdominal pain with diagnostic ambiguity, a diagnosis of small bowel diverticulosis should be considered. It should be managed non-operatively where possible.
Assuntos
Antibacterianos/administração & dosagem , Divertículo/tratamento farmacológico , Perfuração Intestinal/tratamento farmacológico , Intestino Delgado/anormalidades , Doenças do Jejuno/tratamento farmacológico , Administração Intravenosa , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/patologia , Feminino , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/patologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Síndrome da Alça Cega/diagnóstico por imagem , Síndrome da Alça Cega/tratamento farmacológico , Divertículo/diagnóstico por imagem , Divertículo/microbiologia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/microbiologia , Antibacterianos/uso terapêutico , Enteroscopia de Balão , Síndrome da Alça Cega/microbiologia , Divertículo/tratamento farmacológico , Seguimentos , Humanos , Doenças do Jejuno/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: Chronic nonspecific multiple ulcers of the small intestine (CNSU), an entity with female preponderance and manifestations including anemia and hypoproteinemia reflecting persistent gastrointestinal bleeding and intestinal protein loss, has been considered idiopathic. Umeno et al recently reported that CNSU is caused by loss-of-function mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) encoding a prostaglandin transporter, renaming the disorder "chronic enteropathy associated with SLCO2A1 gene mutation" (CEAS). Treatments for chronic enteropathies such as inflammatory bowel disease, including 5-aminosalicylic acid, corticosteroids, azathioprine, and anti-tumor necrosis factor-α antibody, often are ineffective in CEAS, which frequently requires surgery. CASE PRESENTATION: A 14-year-old girl had refractory anemia and hypoproteinemia for more than 2 years. Video capsule endoscopy showed nonspecific jejunal and ileal ulcers with varied sizes and shapes. She was diagnosed with CEAS resulting from compound heterozygous mutation of the SLCO2A1 gene. After corticosteroid treatment without improvement, azathioprine treatment improved her anemia and edema as hemoglobin and serum protein increased. Video capsule endoscopy 1 year after initiation of azathioprine showed improvement of small intestinal ulcers. CONCLUSION: Physicians should consider CEAS in patients with refractory anemia, hypoproteinemia, and multiple small intestinal ulcers. Why our patient responded to azathioprine but not to corticosteroids is unclear, but azathioprine might benefit some other patients with CEAS.
Assuntos
Azatioprina/uso terapêutico , Imunossupressores/uso terapêutico , Intestino Delgado , Transportadores de Ânions Orgânicos/genética , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/genética , Adolescente , Endoscopia por Cápsula , Doença Crônica , Feminino , Humanos , Doenças do Íleo/tratamento farmacológico , Doenças do Íleo/genética , Doenças do Jejuno/tratamento farmacológico , Doenças do Jejuno/genéticaRESUMO
OBJECTIVE To examine effects of continuous rate infusion of lidocaine on transmural neutrophil infiltration in equine intestine subjected to manipulation only and remote to ischemic intestine. ANIMALS 14 healthy horses. PROCEDURES Ventral midline celiotomy was performed (time 0). Mild ischemia was induced in segments of jejunum and large colon. A 1-m segment of jejunum was manipulated by massaging the jejunal wall 10 times. Horses received lidocaine (n = 7) or saline (0.9% NaCl) solution (7) throughout anesthesia. Biopsy specimens were collected and used to assess tissue injury, neutrophil influx, cyclooxygenase expression, and hypoxia-inducible factor 1α (HIF-1α) expression at 0, 1, and 4 hours after manipulation and ischemia. Transepithelial resistance (TER) and mannitol flux were measured by use of Ussing chambers. RESULTS Lidocaine did not consistently decrease neutrophil infiltration in ischemic, manipulated, or control tissues at 4 hours. Lidocaine significantly reduced circular muscle and overall scores for cyclooxygenase-2 expression in manipulated tissues. Manipulated tissues had significantly less HIF-1α expression at 4 hours than did control tissues. Mucosa from manipulated and control segments obtained at 4 hours had lower TER and greater mannitol flux than did control tissues at 0 hours. Lidocaine did not significantly decrease calprotectin expression. Severity of neutrophil infiltration was similar in control, ischemic, and manipulated tissues at 4 hours. CONCLUSIONS AND CLINICAL RELEVANCE Manipulated jejunum did not have a significantly greater increase in neutrophil infiltration, compared with 4-hour control (nonmanipulated) jejunum remote to sites of manipulation, ischemia, and reperfusion. Lidocaine did not consistently reduce neutrophil infiltration in jejunum.
Assuntos
Doenças dos Cavalos/tratamento farmacológico , Inflamação/veterinária , Doenças do Jejuno/veterinária , Lidocaína/uso terapêutico , Animais , Ciclo-Oxigenase 2/metabolismo , Doenças dos Cavalos/patologia , Cavalos , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Mucosa Intestinal/metabolismo , Isquemia/metabolismo , Doenças do Jejuno/tratamento farmacológico , Jejuno/irrigação sanguínea , Lidocaína/farmacologia , Neutrófilos/metabolismoRESUMO
Fungal enteritis was rarely reported. A case of fungal enteritis manifestation with jejunum multiple ulcers and obstruction was treated by Department of Gastroenterology, Third Xiangya Hospital, Central South University. After antifungal treatment, the clinical symptoms were relieved, and the ulcers in jejunal and upper gastrointestinal tract were healed completely. Clinical manifestation for small fungal enteritis is special, and the small intestine ulcer is easily to be misdiagnosed. It is helpful to prevent the misdiagnose for small fungal enteritis if we can tell the clinical features for this disease.
Assuntos
Enterite/diagnóstico , Enterite/etiologia , Hemorragia Gastrointestinal/etiologia , Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Micoses/complicações , Micoses/diagnóstico , Úlcera/etiologia , Enterite/tratamento farmacológico , Hemorragia Gastrointestinal/tratamento farmacológico , Humanos , Obstrução Intestinal/tratamento farmacológico , Doenças do Jejuno/tratamento farmacológico , Micoses/tratamento farmacológico , Úlcera/tratamento farmacológicoAssuntos
Endoscopia por Cápsula/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Intestinais/diagnóstico por imagem , Doenças do Jejuno/diagnóstico por imagem , Linfoma Plasmablástico/diagnóstico por imagem , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Humanos , Neoplasias Intestinais/tratamento farmacológico , Doenças do Jejuno/tratamento farmacológico , Masculino , Linfoma Plasmablástico/tratamento farmacológicoAssuntos
Síndrome de Churg-Strauss/complicações , Doenças do Íleo/etiologia , Doenças do Jejuno/etiologia , Úlcera/etiologia , Biópsia , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/tratamento farmacológico , Quimioterapia Combinada , Endoscopia Gastrointestinal , Feminino , Glucocorticoides/administração & dosagem , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/tratamento farmacológico , Imunossupressores/administração & dosagem , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/tratamento farmacológico , Pessoa de Meia-Idade , Pulsoterapia , Indução de Remissão , Resultado do Tratamento , Úlcera/diagnóstico , Úlcera/tratamento farmacológicoRESUMO
A 66-year-old Japanese man consulted our institution due to paroxysmal and repetitive bouts of fever and abdominal pain that had persisted for more than one week. Capsule and double-balloon endoscopy (DBE) showed petal-shaped mucosal redness with white hemming in the jejunum and ileum, and histopathology of the biopsy specimens revealed villous atrophy and cryptitis with extensive severe neutrophil infiltration. A genetic examination disclosed compound heterozygous MEFV mutations (E84K, P369S), and familial Mediterranean fever was diagnosed. Treatment with colchicine and infliximab was very effective in inducing the complete disappearance of symptoms and normalization of the endoscopic findings. To the best of our knowledge, this is the first report to describe the findings of small intestinal endoscopic images obtained using capsule and DBE.
Assuntos
Dor Abdominal/etiologia , Endoscopia Gastrointestinal , Febre Familiar do Mediterrâneo/complicações , Febre Familiar do Mediterrâneo/patologia , Ileíte/complicações , Doenças do Jejuno/complicações , Colchicina/uso terapêutico , Febre Familiar do Mediterrâneo/tratamento farmacológico , Febre Familiar do Mediterrâneo/genética , Fármacos Gastrointestinais/uso terapêutico , Heterozigoto , Humanos , Ileíte/tratamento farmacológico , Ileíte/patologia , Infliximab/uso terapêutico , Doenças do Jejuno/tratamento farmacológico , Doenças do Jejuno/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Valor Preditivo dos TestesRESUMO
We present two patients with jejunal diverticulitis. Diverticula in jejunum and ileum are very rare, occurring with an incidence of 0.07-2% in the gastrointestinal tract. They are often associated with unspecific symptoms as intermittent abdominal pain, nausea and diarrhoea. The treatment of mild diverticular disease is intravenous fluids and antibiotics. If there is an occurrence of peritonitis as a complication of jejunal diverticulitis, laparatomy may be indicated. Both of the patients received a conservative treatment with intravenous fluids and antibiotics with good response.
Assuntos
Abdome Agudo/etiologia , Diverticulite/complicações , Doenças do Jejuno/complicações , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Tratamento Conservador , Diverticulite/diagnóstico por imagem , Diverticulite/tratamento farmacológico , Feminino , Humanos , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND/AIMS: We classified intestinal lymphangiectasia (IL) into two categories, the white and non-white villi types, and evaluated their clinical characteristics and therapeutic responses. METHODS: Of the 988 patients who underwent double-balloon enteroscopy, 14 consecutive patients (7 men and 7 women, median age at onset 34 years) were enrolled with immunohistochemically confirmed IL with protein-losing enteropathy. RESULTS: Enteroscopically the white villi type (n = 8) showed white plaques and white-tipped villi were scattered in the small bowel, while non-white villi type (n = 6) showed that apparently normal but under more detailed observation, low and round villi with a normal color were diffused. The serum albumin levels and fecal α1-antitrypsin clearance before treatment were significantly worse in the non-white villi type (p = 0.017 and 0.039, respectively), whereas the serum immunoglobulin A and M levels were significantly lower in the white villi type (p = 0.010 and 0.046, respectively). At gastroscopy, a non-cirrhotic snakeskin appearance was significantly observed in the non-white villi type (p = 0.015). The corticosteroid response was better in the non-white villi type (p = 0.015). CONCLUSION: Two distinct subgroups were found in IL. This classification was useful in pathophysiological clustering and in predicting the therapeutic response.
Assuntos
Duodenopatias/patologia , Doenças do Jejuno/patologia , Linfangiectasia Intestinal/patologia , Enteropatias Perdedoras de Proteínas/patologia , Adolescente , Adulto , Idade de Início , Criança , Pré-Escolar , Enteroscopia de Duplo Balão , Duodenopatias/sangue , Duodenopatias/classificação , Duodenopatias/tratamento farmacológico , Duodenopatias/etiologia , Fezes/química , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lactente , Recém-Nascido , Doenças do Jejuno/sangue , Doenças do Jejuno/classificação , Doenças do Jejuno/tratamento farmacológico , Doenças do Jejuno/etiologia , Linfangiectasia Intestinal/sangue , Linfangiectasia Intestinal/classificação , Linfangiectasia Intestinal/complicações , Linfangiectasia Intestinal/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Prognóstico , Enteropatias Perdedoras de Proteínas/sangue , Enteropatias Perdedoras de Proteínas/tratamento farmacológico , Enteropatias Perdedoras de Proteínas/etiologia , alfa 1-Antitripsina/análiseRESUMO
Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient's symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.
Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/administração & dosagem , Divertículo/tratamento farmacológico , Doenças do Íleo/tratamento farmacológico , Perfuração Intestinal/tratamento farmacológico , Doenças do Jejuno/tratamento farmacológico , Dor Abdominal/etiologia , Abscesso/diagnóstico , Abscesso/etiologia , Administração Intravenosa , Idoso , Divertículo/complicações , Divertículo/diagnóstico , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Diabetes and its complications appear to be multifactorial. Substances with antioxidant potential have been used to protect enteric neurons in experimental diabetes. AIM: This study evaluated the effects of supplementation with L-glutamine and L-glutathione on enteric neurons in the jejunum in diabetic rats. METHODS: Rats at 90 days of age were distributed into six groups: normoglycemic, normoglycemic supplemented with 2 % L-glutamine, normoglycemic supplemented with 1 % L-glutathione, diabetic (D), diabetic supplemented with 2 % L-glutamine (DG), and diabetic supplemented with 1 % L-glutathione (DGT). After 120 days, the jejunums were immunohistochemically stained for HuC/D+ neuronal nitric oxide synthase (nNOS) and vasoactive intestinal polypeptide (VIP). Western blot was performed to evaluate nNOS and VIP. Submucosal and myenteric neurons were quantitatively and morphometrically analyzed. RESULTS: Diabetic neuropathy was observed in myenteric HuC/D, nNOS, and VIP neurons (p < 0.05). In the submucosal plexus, diabetes did not change nitrergic innervation but increased VIPergic neuronal density and body size (p < 0.05). Supplementation with L-glutathione prevented changes in HuC/D neurons in the enteric plexus (p < 0.05), showing that supplementation with L-glutathione was more effective than with L-glutamine. Myenteric nNOS neurons in the DGT group exhibited a reduced density (34.5 %) and reduced area (p < 0.05). Submucosal neurons did not exhibit changes. The increase in VIP-expressing neurons was prevented in the submucosal plexus in the DG and DGT groups (p < 0.05). CONCLUSION: Supplementation with L-glutathione exerted a better neuroprotective effect than L-glutamine and may prevent the development of enteric diabetic neuropathy.
Assuntos
Diabetes Mellitus Experimental/tratamento farmacológico , Neuropatias Diabéticas/prevenção & controle , Glutamina/uso terapêutico , Glutationa/uso terapêutico , Enteropatias/tratamento farmacológico , Doenças do Jejuno/tratamento farmacológico , Animais , Western Blotting , Diabetes Mellitus Experimental/complicações , Neuropatias Diabéticas/tratamento farmacológico , Suplementos Nutricionais , Sistema Nervoso Entérico/citologia , Sistema Nervoso Entérico/efeitos dos fármacos , Enteropatias/etiologia , Doenças do Jejuno/etiologia , Masculino , Óxido Nítrico Sintase Tipo I/genética , Óxido Nítrico Sintase Tipo I/metabolismo , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
A 74-year-old woman with refractory IgG-κ multiple myeloma developed massive melena caused by hemorrhagic submucosal tumors in the duodenum and middle jejunum. A biopsy revealed the tumor to be marked AL amyloid deposition. Treatment with bortezomib did not improve the melena or the underlying disease. The patient also developed multiple amyloidomas in the bilateral femoral heads, which caused a fracture in the left femoral head. Treatment with lenalidomide, as the final therapeutic option, resolved the intractable melena and improved both the intestinal lesions and myeloma. This case shows that successful treatment of multiple myeloma leads to marked improvement of accompanying AL amyloidosis.