Gastrointestinal motility disorders in inflammatory bowel diseases

The relationship between motility and inflammatory gastrointestinal disorders is at the same time complex and intriguing since these conditions might share some genetic,environmental,immunological and microbial predisposing factors.In addition,significant symptom overlapping may occur,muddling the waters within the clinical context.Although on one hand this represents a challenge for the clinician for a potential under-or over-treatment and diagnostic delay,on the other hand it possibly represents an opportunity for the researcher to better disclose the intimate relationship between chronic(often low-grade)inflammation,motor disorders and deranged sensory function.The best example is probably represented by Crohn’s disease and ulcerative colitis.In fact,a number of gastrointestinal motor disorders have been described in association with these diseases,disorders which span from the esophagus to the anorectum,and which will be extensively covered in this review.It is conceivable that at least part of this derangement is strictly related to inflammatory cytokine trafficking and neuromuscular changes;however,given the high prevalence of functional gastrointestinal disorders in the general population,this overlap might also be serendipitous.However,it is worth noting that literature data on this topic are relatively scarce,sometimes quite outdated,and mostly focused on the interplay between irritable bowel syndrome and inflammatory bowel disease.Nevertheless,both researchers and clinicians must be aware that symptoms related to gastrointestinal motility disorders may be highly prevalent in both active and inactive inflammatory bowel disease,correlate with greater psychological comorbidity and poorer quality of life,and may negatively influence the therapeutic approaches.

Adenomyomatosis of the gallbladder in childhood: A systematic review of the literature and an additional case report

AIM: To investigate the diagnostic and therapeutic assessment in children with adenomyomatosis of the gallbladder(AMG).METHODS: AMG is a degenerative disease characterized by a proliferation of the mucosal epithelium which deeply invaginates and extends into the thickened muscular layer of the gallbladder, causing intramural diverticula. Although AMG is found in up to 5% of cholecystectomy specimens in adult populations, this condition in childhood is extremely uncommon. Authors provide a detailed systematic review of the pediatric literature according to PRISMA guidelines, focusing on diagnostic and therapeutic assessment. An additional case of AMG is also presented. RESULTS:Five studies were finally enclosed, encompassing 5 children with AMG. Analysis was extended to our additional 11-year-old patient, who presented diffuse AMG and pancreatic acinar metaplasia of the gallbladder mucosa and was successfully managed with laparoscopic cholecystectomy. Mean age at presentation was 7.2 years. Unspecific abdominal pain was the commonest symptom. Abdominal ultrasound was performed on all patients, with a diagnostic accuracy of 100%. Five patients underwent cholecystectomy, and at follow-up were asymptomatic. In the remaining patient, completely asymptomatic at diagnosis, a conservative approach with monthly monitoring via ultrasonography was undertaken. CONCLUSION: Considering the remote but possible degeneration leading to cancer and the feasibility of laparoscopic cholecystectomy even in small children, evidence suggests that elective laparoscopic cholecystectomy represent the treatment of choice. Preoperative evaluation of the extrahepatic biliary tree anatomy with cholangio-MRI is strongly recommended.

Fulminant ulcerative colitis in a healthy pregnant woman

This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.