Microscopic enteritis:Bucharest consensus

Microscopic enteritis(ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms,nutrient and micronutrient deficiency.It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy.This work recognises a need to characterize disorders with microscopic and submicroscopic features,currently regarded as functional or non-specific entities,to obtain further understanding of their clinical relevance.The consensus working party reviewed statements about the aetiology,diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment.Following the 5th International Course in Digestive Pathology in Bucharest in November 2012,an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME.A five-step agreement scale(from strong agreement to strong disagreement) was used to score 21 statements,independently.There was strong agreement on all statements about ME histology(95%-100%).Statements concerning diagnosis achieved 85% to 100% agreement.A statement on the management of ME elicited agreement from the lowest rate(60%) up to 100%.The remaining two categories showed general agreement between experts on clinical presentation(75%-95%) and pathogenesis(80%-90%) of ME.There was strong agreement on the histological definition of ME.Weaker agreement on management indicates a need for further investigations,better definitions and clinical trials to produce quality guidelines for management.This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.

Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report

BACKGROUND Intestinal lipomas are rare benign gastrointestinal(GI)tumors,usually asymptomatic,but may become symptomatic as the result of some complications such as intussusception,intestinal obstruction,volvulus or bleeding.They can occur at any site along the entire GI tract,more frequent in colon and rarely in small intestine.The patient reported here is a very rare case of jejunal lipoma,ulcerated and intussuscepted,diagnosed in an adult investigated for a chronic iron deficiency anemia(IDA),and successfully managed by segmental jejunal resection.CASE SUMMARY A 63-year-old male was referred to“St.Spiridon”Hospital,Institute of Gastroenterology and Hepatology,Iasi,to investigate an obscure GI bleeding with an IDA.After upper GI endoscopy and colonoscopy were performed,excluding potentially bleeding lesions,videocapsule endoscopy was then carried out,revealing fresh blood and a protruding lesion in proximal jejunum,findings confirmed by a single-balloon enteroscopy.Multiple biopsies were taken from the lesion,but histological results were inconclusive.Then,contrast-enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density,suggestive for lipoma.A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected enbloc,and sent for further histopathologic analysis.The patient made an uneventful recovery and was discharged seven days later,and at six months follow-up he had no complains and his hemoglobin returned to normal value.CONCLUSION Lipomas are very rarely located in the jejunum,usually asymptomatic,but they may lead to complications such as intussusception and bleeding.Surgical resection remains the treatment of choice.

Effects of Valine and Leucine on Some Antioxidant Enzymes in Hypercholesterolemic Rats

Objective: Reactive oxygen species (ROS) are involved in the endothelial-mediated disorders within atherosclerosis. Considering that an oxidant/antioxidant imbalance might be a key factor in the damaging ROS-mediated effects, the present study intends to determine the influence of a high-fat diet, associated with essential amino acids—valine and leucine, upon the experimental animals, through evaluation of plasmatic level of some antioxidant enzymes. Material and Methods: The study was conducted on 32 male Wistar rats, which were fed with cholesterol, valine and leucine, for 60 days. The animals were divided into four groups, according to the received diet: the first group—standard diet;the second group—cholesterol (C);the third group—cholesterol and valine (C + V);the fourth group—cholesterol and leucine (C + L). Evaluations of the oxidative status, through plasma levels of the antioxidant enzymes: superoxide dismutase (SOD) and glutathione peroxidise (GPx), were made for the four mentioned groups of animals, at the beginning of the study (R0), after one (R1) and two months (R2). Results: The average values of SOD and GPx in group of animals fed exclusively with cholesterol (C) were significantly higher compared to the third group where cholesterol was supplemented with valine (C + V) or fourth group fed with cholesterol and leucine (C + L) (p < 0.001), after one month as well at the end of the experiment (two months). There were no significant differences in the levels of SOD and GPx between group III and group IV (p < 0.05) at the end of the experiment. Conclusion: Our results showed that valine and leucine decreased the serum levels of SOD and GPx and therefore they were useful antioxidants, which could improve the endothelial dysfunctions associated with atherosclerosis. Moreover, analysis of the oxidative status in the context of atherosclerotic mediated endothelial damage suggests that deviation from normal to alter endothelial status may be conditioned by an oxidants/antioxidants imbalance.