A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: A case report

肠的 lymphangiectasia (IL ) 是扩大淋巴的 vessles 在肠的墙和导致蛋白质和淋巴细胞的损失进肠腔的小肠肠系膜中描绘的稀罕疾病。因为它最经常发生在肠并且不能被上面的胃的内视镜检查法或结肠镜检查检测，并且象 X 光检查和计算机化的断层摄影术(CT ) 那样的普通图象考试的值被限制 IL 的诊断是困难的，通常需要外科的帮助。囊内视镜检查法在诊断肠的疾病是有用的，例如 IL。我们这里在为在最后二十年伴有腹泻和腹的疼痛，并且十天以前加重了的周期性的浮肿的抱怨被招收的一个女病人报导 IL 的一个案例。她被 M2A 囊内视镜检查法作为主要 IL 诊断并且由外科、病理学的检查证实了。

Phenotypic and genotypic characterization of inflammatory bowel disease in children under six years of age in China

AIM To analyze clinical differences between monogenic and nonmonogenic very-early-onset inflammatory bowel disease(VEO-IBD) and to characterize monogenic IBD phenotypically and genotypically via genetic testing. METHODS A retrospective analysis of children aged 0 to 6 years diagnosed with VEO-IBD in a tertiary hospital in southern China from 2005 to 2017 was performed. Clinical data for VEO-IBD patients were collected, and genetic characteristics were analyzed using whole exome sequencing or target gene panel sequencing. RESULTS A total of 54 VEO-IBD patients were included in this study. A diagnosis of Crohn's disease(CD) or CDlike intestinal manifestations accounted for 72.2% of the VEO-IBD cases. Nine patients(16.7%) were identified by genetic testing as having monogenic IBD. The median age of diagnosis in the monogenic group was younger than that of the nonmonogenic IBD group, at 18 mo(interquartile range(IQR): 4 to 78) and 43.5 mo(IQR: 3 to 173), respectively; the P-value was 0.021. The incidence of perianal disease in the monogenic group was higher than that in the nonmonogenic group(P = 0.001). However, there were no significant differences between weight-forage and height-for-age Z-scores between the two groups, and similar laboratory results were obtained for the two groups. Five patients were found to have IL10 receptor mutation, two patients had chronic granulomatous disease, one patient had common variable immunodeficiency disease, and one patient had X-linked inhibitor of apoptosis protein deficiency. CONCLUSION A high proportion of monogenic IBD was observed in the VEO-IBD group, especially with disease onset before the age of 6 mo. Monogenic IBD and nonmonogenic IBD exhibited similar clinical features. Furthermore, next-generation sequencing played an important role in the diagnosis of monogenic IBD, and IL10 receptor mutation was predominant in this cohort.

Single-center experience of 309 consecutive patients with obscure gastrointestinal bleeding

AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE fi ndings.RESULTS: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common fi nding in the entire cohort, these accounted for 30% of clinically signifi cant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleedinggroup, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.

Effect of small bowel preparation with simethicone on capsule endoscopy

Background: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. Methods: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and sime- thicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. Results: Simethicone significantly reduced luminal bubbles both in the proximal and distal small intes- tines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). Conclusion: Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

Nasogastric or nasojejunal feeding in pediatric acute pancreatitis: a randomized controlled trial

Background The aim of this study was to compare nasogastric(NG)feeding with nasojejunal(NJ)feeding when treating pediatric patients with acute pancreatitis(AP)..Methods We performed a single-center,prospective,randomized,active-controlled trial involving 77 pediatric patients with AP from April 2014 to December 2017.The patients were randomized into two groups:the NG tube feeding group(34 patients)and the NJ tube feeding group(33 patients).The primary outcome measures included the enteral nutrition intoler-ance,the length of tube feeding time,the recurrent pain of pancreatitis and complications.Results A total of 62 patients with AP(31 patients for each group)came into the final analysis.No differences were found in baseline characteristics,pediatric AP score and computed tomography severity score between the lwo groups.Three(9.7%)patients in the NG group and one(3.2%)patient in the NJ group developed intolerance(relative risk=3.00,95%confidence interval 0.33-27.29,P=0.612).The tube feeding time and length of hospital stay of the NG group were significantly shorter than those of the NJ group(P=0.016 and 0.027,respectively).No patient died in the trial.No significant differences were found in recurrent pain,complications,nutrition delivery efficacy,and side effects between the two groups.Conclusions NG tube feeding appears to be effective and safe for acute pediatric pancreatitis compared with NJ tube feeding.In addition,high qualifed,large sample sized,randomized controlled trials in pediatric population are needed.

Case Report:Takayasu's arteritis associated with Crohn's disease

Takayasu's arteritis(TA),also known as the "pulseless disease," is a chronic vasculitis of the aorta and aortic branches.TA with Crohn's disease is rare and has not been documented in China before.In this paper we report on a case of Takayasu's arteritis associated with concurrent Crohn's disease.A 17-year-old Chinese male developed upper limb sourness and a sensation of fatigue,and his upper limb pulses were absent.He was diagnosed with TA and underwent an axillary artery bypass with autologous great saphenous vein on the left subclavian artery.After the surgery,he regained the normal blood pressure.This patient also had years of diarrhea and developed an anal canal ulcer,and was diagnosed with inflammatory bowel disease and ulcerative colitis before.Five months after the TA surgery,he was hospitalized for severe stomachache and diarrhea and was finally diagnosed with Crohn's disease.The possible pathophysiological mechanisms responsible for concurrent existence of TA and Crohn's disease may be associated with immune disorders,especially autoimmunity.