Intestinal Research

Original Articles

IBD/Endoscopy

Endoscopic radial incision and cutting using balloon-assisted enteroscopy for small intestinal stenosis related to Crohn’s disease: a pilot study: Rintaro Moroi, Kotaro Nochioka, Satoshi Miyata, Hideya Iwaki, Hirofumi Chiba, Hiroshi Nagai, Yusuke Shimoyama, Takeo Naito, Hisashi Shiga, Masaki Tosa, Yoichi Kakuta, Shoichi Kayaba, Seiichi Takahashi, Yoshitaka Kinouchi, Atsushi Masamune; Intest Res 2025;23(3):302-308. Published online January 21, 2025; DOI: https://doi.org/10.5217/ir.2024.00143

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Background/Aims
Radial incision and cutting (RIC) is an alternative dilation method for stenosis of the lower gastrointestinal tract. However, its safety and efficacy for the small intestine requiring balloon-assisted enteroscopy (BAE) remain limited. Therefore, this pilot study aimed to evaluate the safety and efficacy of RIC using BAE.
Methods
We included 10 patients with Crohn’s disease and performed 12 sessions of RIC for 10 lesions. The rate of adverse events 1 month after RIC was the primary outcome, whereas short- and long-term prognoses and improvements in subjective symptoms that were evaluated using a visual analog scale were the secondary outcomes.
Results
The technical success rate for RIC, defined as scope passage immediately following the procedure, was 100% (12/12). The rates of delayed bleeding and perforation were 0% (0/12). One patient developed restenosis because of the worsening of Crohn’s disease and underwent surgery 2 months after RIC. The cumulative restenosis-, reintervention-, and surgery-free rates at 1 year after RIC were 67.5%, 78.7%, and 90.0%, respectively. Abdominal pain, abdominal bloating, nausea, and difficulties in defecation significantly improved 4 weeks after RIC.
Conclusions
RIC for small intestine using BAE has the potential to be safe and effective for relieving symptoms (jRCT identifier jRCTs022200040).

Citations

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EUS-Guided Radial Incision for Duodenal and Colonic Strictures: First Report Emphasizing Muscularis Propria Integrity as a Safety Predictor
Zhang-Xiu Jiang, Song-Da Chen, Xiu-Xiu Yin, Fu-Jian Li
Digestive Diseases and Sciences.2026; 71(2): 331. CrossRef
Recent advances in the management of small bowel Crohn’s disease
Kwangwoo Nam, Hee Seok Moon
The Korean Journal of Internal Medicine.2026; 41(4): 563. CrossRef

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IBD

Assessing quality of magnetic resonance enterography and its impact on disease assessment of ileal Crohn’s disease: Anuj Bohra, Declan J Connoley, Danny Con, Jonathan P Segal, Olga Niewiadomski, Abhinav Vasudevan, Daniel R Van Langenberg, Numan Kutaiba; Intest Res 2024;22(2):152-161. Published online January 5, 2024; DOI: https://doi.org/10.5217/ir.2023.00095

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Background/Aims
Assessment of quality of magnetic resonance enterography (MRE) in small bowel Crohn’s disease (CD) activity evaluation has received little attention. We assessed the impact of bowel distention and motion artifact on MRE activity indices in ileal CD.
Methods
A cohort of patients who underwent contemporaneous MRE and colonoscopy for ileal CD assessment between 2014 and 2021 at 2 centers were audited. An abdominal radiologist blinded to clinical data reviewed each MRE, graded bowel distention and motion artifact upon a pre-specified 3-point scale and calculated the original magnetic resonance index of activity (MaRIA) and simplified MaRIA (sMaRIA), London index and CD MRE index (CDMI). Ileal endoscopic activity was graded via the Simplified Endoscopy Score for CD (SES-CD). The performance of MRE indices in discriminating active disease (SES-CD ≥3) stratified by MRE quality was measured by receiver operator characteristic analyses.
Results
One hundred and thirty-seven patients had MRE and colonoscopy within a median of 16 days (range, 0–30 days) with 63 (46%) exhibiting active disease (SES-CD ≥3). Forty-four MREs (32%) were deemed low quality due to motion artifact and/or moderate to poor distention. Low-quality MREs demonstrated reduced discriminative performance between ileal SES-CD ≥3 and MRE indices (MaRIA 0.838 vs. 0.634, sMaRIA 0.834 vs. 0.527, CDMI 0.850 vs. 0.595, London 0.748 vs. 0.511, P<0.05 for all). Individually the presence of any motion artifact markedly impacted the discriminative performance (e.g., sMaRIA area under the curve 0.544 vs. 0.814, P<0.05).
Conclusions
Image quality parameters can significantly impact MRE disease activity interpretation. Quality metrics should be reported, enabling cautious interpretation in lower-quality studies.

Citations

Citations to this article as recorded by

Motion Mitigation Techniques for Abdominal and Cardiac MR Imaging
Eric M. Schrauben, Gastao Lima da Cruz, Christopher W. Roy, Thomas Küstner
Journal of Magnetic Resonance Imaging.2026; 63(4): 917. CrossRef
Temporal AI-assisted compressed sensing for high-resolution, motion-robust small-bowel MR enterography without antiperistaltic agents: a feasibility study
Ziman Xiong, Yufan Wang, Liya Ma, Xiaopeng Song, Wei Mao, Zhen Li, Yaqi Shen
European Radiology.2026; 36(8): 6776. CrossRef
Evaluating luminal and post-operative Crohn’s disease activity on magnetic resonance enterography: A review of radiological disease activity scores
Richard W Lo, Gauraang Bhatnagar, Numan Kutaiba, Ashish R Srinivasan
World Journal of Gastroenterology.2025;[Epub] CrossRef
Magnetic resonance enterography in diagnosing and monitoring of adult-onset IgA vasculitis (Henoch-Schönlein purpura) with gastro-intestinal involvement: Report of two cases
Edoardo Conticini, Susanna Guerrini, Paolo Falsetti, Maria Antonietta Mazzei, Luca Cantarini, Bruno Frediani
The Egyptian Rheumatologist.2024; 46(2): 90. CrossRef
Advocating for Consensus: The Crucial Role of Standardised Magnetic Resonance Imaging Protocols and Image Quality Metrics in Assessment of Crohn’s Disease
Mustafa Mohamedrashed, Mayur Garg, Anuj Bohra
Journal of Crohn's and Colitis.2024; 18(9): 1524. CrossRef
Achieving high-quality magnetic resonance enterography is critical for assessing Crohn’s disease activity
Kyoung Doo Song
Intestinal Research.2024; 22(2): 117. CrossRef
Bowel preparation after mid-gut tubing enhanced the efficacy and compliance of magnetic resonance enterography in Crohn’s disease: a randomized controlled trial
Yun Wang, Min Dai, Minghui Zheng, Yan Jin, Quan Wen, Bota Cui, Zulun Zhang, Jianguo Zhu, Faming Zhang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef

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Statement

Endoscopy

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases: Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung, The Small Intestine Research Group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2023;21(1):3-19. Published online January 31, 2023; DOI: https://doi.org/10.5217/ir.2022.00108

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The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

Citations

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Clinical implications of endoscopic phenotypes in primary small intestinal lymphoma
Yoo Jin Lee
Clinical Endoscopy.2026; 59(2): 242. CrossRef
Effect of Different Types of Antithrombotic Agents on Clinical Outcomes in Patients With Small Bowel Bleeding Who Underwent Balloon‐Assisted Enteroscopy: A KASID Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong‐Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Journal of Gastroenterology and Hepatology.2025; 40(2): 456. CrossRef
Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef
Comparative Study of MiroCam MC2000 and PillCam SB3 in Detecting Small Bowel Bleeding: A Multicenter Prospective Randomized Crossover Study
Ji Eun Kim, Eun Ran Kim, Jae Jun Park, Kyeong Ok Kim, Yehyun Park, Young Joo Yang, Hyun Joo Jang
Gut and Liver.2025; 19(4): 569. CrossRef
From Data to Insights: How Is AI Revolutionizing Small-Bowel Endoscopy?
Joana Mota, Maria João Almeida, Francisco Mendes, Miguel Martins, Tiago Ribeiro, João Afonso, Pedro Cardoso, Helder Cardoso, Patrícia Andrade, João Ferreira, Miguel Mascarenhas, Guilherme Macedo
Diagnostics.2024; 14(3): 291. CrossRef
Role of Device-Assisted Enteroscopy in Crohn’s Disease
Giulia Catassi, Clelia Marmo, Antonio Gasbarrini, Maria Elena Riccioni
Journal of Clinical Medicine.2024; 13(13): 3919. CrossRef
Discordance Rate and Risk Factor of Other Diagnostic Modalities for Small Bowel Tumors Detected by Device-Assisted Enteroscopy: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong-Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Gut and Liver.2024; 18(4): 686. CrossRef

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Review

IBD

Effect of resistance exercise training on Crohn’s disease patients: Konstantinos Papadimitriou; Intest Res 2021;19(3):275-281. Published online November 20, 2020; DOI: https://doi.org/10.5217/ir.2020.00043

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Crohn’s disease (CD) is observed with increased levels of cytokines which cause inflammation in many parts of the digestive tract. Aerobic exercise contributes to the reduction of the intestine’s inflammation and increases the quality of life. Another type of exercise that shows research interest about its effects on CD symptoms is the resistance exercise (RE). The aim of the study was to review the influence of RE on CD patients. The study’s literature was collected from PubMed and Scholar databases. According to the results, the main phase of a RE training program must have a gradual increase of intensity (60%–80%) and resting periods of 15–30 seconds after each exercise, and 2–3 minutes between exercises. Also, CD patients who were in remission improved the muscle strength and quality of life via their participation in RE training program. However, the secretion of interleukin-6 in both CD and RE contributes in various physiological mechanisms setting a contradictory role in the effectiveness of RE at the disease’s inflammatory situation. So, the use of RE training in CD patients needs more research for safer participation.

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Telemedicine-based individualised aerobic exercise training in Chinese adults with inactive or mildly active inflammatory bowel disease: study protocol for a single-centre, semi-crossover randomised controlled trial
Ying Zhou, Huiwei Liu, Xiaojian Qian, Xie Zhang, Feng Xu
BMJ Open.2026; 16(1): e103297. CrossRef
Nutritional Habits in Crohn’s Disease Onset and Management
Konstantinos Papadimitriou, Georgia-Eirini Deligiannidou, Gavriela Voulgaridou, Constantinos Giaginis, Sousana K. Papadopoulou
Nutrients.2025; 17(3): 559. CrossRef
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Zita Kovács, Péter Bacsur, Blanka Bernadett Kasza, Tamás Molnár, Andrea Domján
Journal of Clinical Medicine.2025; 14(23): 8602. CrossRef
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BMJ Open.2024; 14(1): e076095. CrossRef
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S. V. Kostyukevich, I. G. Bakulin
Koloproktologia.2024; 23(1): 152. CrossRef
Analysis of current situation and influencing factors of marital adjustment in patients with Crohn’s disease and their spouses
Ting Pan, Danlei Chen, Zhihui Yu, Qing Liu, Yan Chen, Ailing Zhang, Fang Kong
Medicine.2024; 103(11): e37527. CrossRef
Progress in research of exercise intervention in inflammatory bowel disease
Shao-Peng Sun, Jia-Jia Chen, Ming-Xu Zheng, Yi-Hong Fan, Bin Lv
World Chinese Journal of Digestology.2024; 32(5): 339. CrossRef
Sarcopenia as a Preoperative Risk Stratification Tool among Older Adults with Inflammatory Bowel Disease

Advances in Geriatric Medicine and Research.2024;[Epub] CrossRef
Impact of Different Nutrition Strategies on Patients with Inflammatory Bowel Disease (IBD)
Konstantinos Papadimitriou, Sousana K. Papadopoulou
Nutrients.2023; 15(4): 1056. CrossRef
Nutritional Risk and Sarcopenia Features in Patients with Crohn’s Disease: Relation to Body Composition, Physical Performance, Nutritional Questionnaires and Biomarkers
Konstantinos Papadimitriou, Paraskevi Detopoulou, Konstantinos Soufleris, Gavriela Voulgaridou, Despoina Tsoumana, Panagiotis Ntopromireskou, Constantinos Giaginis, Ioanna P. Chatziprodromidou, Maria Spanoudaki, Sousana K. Papadopoulou
Nutrients.2023; 15(16): 3615. CrossRef
A Repeated Cross-Sectional Pilot Study of Physical Activity, Levels of Depression and Anxiety during the COVID-19 Pandemic in Young Greek Adults
Smaragda Skalidou, Andreas Anestis, Emmanouil Skalidis, Ourania Kontaxi, Athanasia Kyrezi, Panagiota Konstantinou, Konstantinos Papadimitriou
Healthcare.2023; 11(18): 2493. CrossRef
Attitude and influencing factors on exercise in patients with moderately to severely active inflammatory bowel disease: a qualitative study
Jing Wang, Shuping Tong, Yuehong Niu, Bingqing Lu
BMJ Open.2023; 13(12): e080084. CrossRef
The Influence of Aerobic Type Exercise on Active Crohn’s Disease Patients: The Incidence of an Elite Athlete
Konstantinos Papadimitriou
Healthcare.2022; 10(4): 713. CrossRef
Evaluación de actividad física como coadyuvante terapéutico para pacientes con enfermedad inflamatoria intestinal: una revisión.
Diego Fernández-Lázaro, Nuria Hernández-Burgos, Raúl Cobreros Mielgo, Sandra García-Lázaro
Investigación Clínica.2022; 63(3): 304. CrossRef
Acute Low-Intensity Treadmill Running Upregulates the Expression of Intestinal Glucose Transporters via GLP-2 in Mice
Kai Aoki, Takuji Suzuki, Fang Hui, Takuro Nakano, Koki Yanazawa, Masato Yonamine, Shinichiro Fujita, Takehito Sugasawa, Yasuko Yoshida, Naomi Omi, Yasushi Kawakami, Kazuhiro Takekoshi
Nutrients.2021; 13(5): 1735. CrossRef

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Original Articles

Colorectal neoplasia

Endoscopic features of gastrointestinal stromal tumor in the small intestine: Yutaro Ihara, Takehiro Torisu, Tomohiko Moriyama, Junji Umeno, Atsushi Hirano, Yasuharu Okamoto, Yoshifumi Hori, Hidetaka Yamamoto, Takanari Kitazono, Motohiro Esaki; Intest Res 2019;17(3):398-403. Published online July 25, 2019; DOI: https://doi.org/10.5217/ir.2018.00161

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Background/Aims
Gastrointestinal stromal tumor (GIST) is one of the most common types of submucosal tumors (SMTs). Because of GIST’s malignant potential, it is crucial to differentiate it from other SMTs. The present study aimed to identify characteristic endoscopic findings of GISTs in the small intestine.
Methods
We reviewed the clinicopathological and endoscopic findings of 38 patients with endoscopically or surgically resected SMTs in the small intestine. SMTs were classified into GIST and non-GIST groups, and clinicopathological and endoscopic findings were compared between the 2 groups.
Results
Fifteen patients had GIST and 23 patients had other types of SMTs in the small intestine. Comparison of the endoscopic findings between the 2 groups revealed that dilated vessels in the surrounding mucosa were significantly more in number in the GIST group than in the non-GIST group (P<0.05). However, there were no other differences in endoscopic findings between the 2 groups. Among patients with GISTs, the presence of dilated vessels in the surrounding mucosa was not associated with bleeding risk, tumor size, or metastasis rate at diagnosis.
Conclusions
Dilated vessels in the surrounding mucosa, identified during balloon-assisted endoscopy, may be a diagnostic indicator for GIST in the small intestine. However, its clinical significance should be further analyzed.

Citations

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Rapidly Growing Gastrointestinal Stromal Tumor on the Esophagus
Ji Hye Park, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(1): 64. CrossRef
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Satomi Saito, Teppei Omori, Shun Murasugi, Maria Yonezawa, Yukiko Takayama, Takeshi Ohki, Hiromi Onizuka, Yoji Nagashima, Katsutoshi Tokushige
Case Reports in Gastroenterology.2023; 17(1): 167. CrossRef
Convolutional neural network‐based object detection model to identify gastrointestinal stromal tumors in endoscopic ultrasound images
Chang Kyo Oh, Taewan Kim, Yu Kyung Cho, Dae Young Cheung, Bo‐In Lee, Young‐Seok Cho, Jin Il Kim, Myung‐Gyu Choi, Han Hee Lee, Seungchul Lee
Journal of Gastroenterology and Hepatology.2021; 36(12): 3387. CrossRef
Small Bowel Malignancies in Patients Undergoing Capsule Endoscopy for Iron Deficiency Anemia
Su Hwan Kim, Ji Won Kim
Diagnostics.2021; 12(1): 91. CrossRef

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Inflammatory bowel diseases

Quantitative histology-based classification system for assessment of the intestinal mucosal histological changes in patients with celiac disease: Prasenjit Das, Gaurav PS Gahlot, Alka Singh, Vandana Baloda, Ramakant Rawat, Anil K Verma, Gaurav Khanna, Maitrayee Roy, Archana George, Ashok Singh, Aasma Nalwa, Prashant Ramteke, Rajni Yadav, Vineet Ahuja, Vishnubhatla Sreenivas, Siddhartha Datta Gupta, Govind K Makharia; Intest Res 2019;17(3):387-397. Published online April 22, 2019; DOI: https://doi.org/10.5217/ir.2018.00167

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Background/Aims
The existing histological classifications for the interpretation of small intestinal biopsies are based on qualitative parameters with high intraobserver and interobserver variations. We have developed and propose a quantitative histological classification system for the assessment of intestinal mucosal biopsies.
Methods
We performed a computer-assisted quantitative histological assessment of digital images of duodenal biopsies from 137 controls and 124 patients with celiac disease (CeD) (derivation cohort). From the receiver-operating curve analysis, followed by multivariate and logistic regression analyses, we identified parameters for differentiating control biopsies from those of the patients with CeD. We repeated the quantitative histological analysis in a validation cohort (105 controls and 120 patients with CeD). On the basis of the results, we propose a quantitative histological classification system. The new classification was compared with the existing histological classifications for interobserver and intraobserver agreements by a group of qualified pathologists.
Results
Among the histological parameters, intraepithelial lymphocyte count of ≥25/100 epithelial cells, adjusted villous height fold change of ≤0.7, and crypt depth-to-villous height ratio of ≥0.5 showed good discriminative power between the mucosal biopsies from the patients with CeD and those from the controls, with 90.3% sensitivity, 93.5% specificity, and 96.2% area under the curve. Among the existing histological classifications, our quantitative histological classification showed the highest intraobserver (69.7%–85.03%) and interobserver (24.6%–71.5%) agreements.
Conclusions
Quantitative assessment increases the reliability of the histological assessment of mucosal biopsies in patients with CeD. Such a classification system may be used for clinical trials in patients with CeD. (Intest Res, Published online)

Citations

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Follow-up of Celiac Disease After Diagnosis
Luca Elli, Govind K. Makharia, Daniel A. Leffler, Lucia Scaramella, Georgia Malamut
Gastrointestinal Endoscopy Clinics of North America.2025; 35(4): 789. CrossRef
“Celiac Disease-2025”: Project of Clinical Guidelines for the Diagnosis and Treatment of Celiac Disease in Children
Nataliya A. Averkina, Aleksander A. Baranov, Sergey V. Bel’mer, Tatiyana T. Boraeva, Tatiyana A. Borovik, Tatiyana V. Bushueva, Elena A. Vishneva, Aleksander V. Gorelov, Olga S. Gundobina, Margarita M. Gurova, Yuliya A. Dmitrieva, Irina N. Zakharova, Nata
Pediatric pharmacology.2025; 22(4): 495. CrossRef
Celiac Disease Deep Learning Image Classification Using Convolutional Neural Networks
Joaquim Carreras
Journal of Imaging.2024; 10(8): 200. CrossRef
CD, or not CD, that is the question: a digital interobserver agreement study in coeliac disease
James Denholm, Benjamin A Schreiber, Florian Jaeckle, Mike N Wicks, Emyr W Benbow, Tim S Bracey, James Y H Chan, Lorant Farkas, Eve Fryer, Kishore Gopalakrishnan, Caroline A Hughes, Kathryn J Kirkwood, Gerald Langman, Betania Mahler-Araujo, Raymond F T Mc
BMJ Open Gastroenterology.2024; 11(1): e001252. CrossRef
Role of Serology, Dietary Assessment, and Fecal Gluten Immunogenic Peptides for Predicting Histologic Recovery in Children with Celiac Disease
Keerthivasan Seetharaman, Sadhna Bhasin Lal, Kaushal Kishor Prasad, Yashwant Kumar, Alka Bhatia, Sunita Malhotra
Digestive Diseases and Sciences.2023; 68(2): 529. CrossRef
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Raghav Lal, Ranjeet Bhardwaj, Ranjana Walker Minz, Kaushal Kishore Prasad, Sadhna Lal, Devi Dayal, Yashwant Kumar
Pediatrics & Neonatology.2023; 64(4): 388. CrossRef
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Govind K. Makharia, Prashant Singh, Carlo Catassi, David S. Sanders, Daniel Leffler, Raja Affendi Raja Ali, Julio C. Bai
Nature Reviews Gastroenterology & Hepatology.2022; 19(5): 313. CrossRef
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Kamran Rostami, Arzu Ensari, Michael N. Marsh, Amitabh Srivastava, Vincenzo Villanacci, Antonio Carroccio, Hamid Asadzadeh Aghdaei, Julio C. Bai, Gabrio Bassotti, Gabriel Becheanu, Phoenix Bell, Camillo Di Bella, Anna Maria Bozzola, Moris Cadei, Giovanni
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Sharia Hernandez, Alejandra G. Serrano, Luisa M. Solis Soto
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Mateus M. Vargas, Ricardo Artigiani Neto, Vera L. Sdepanian
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Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology
Prasenjit Das, Kim Vaiphei, AnjaliD Amarapurkar, Puja Sakhuja, Ritambhra Nada, RoopaRachel Paulose, Rachana Chaturvedi, Anuradha Sekaran, Usha Kini, Archana Rastogi, Niraj Kumari, Anna Pulimood, Mala Banerjee, Prateek Kinra, Lavleen Singh, AmarenderSingh
Indian Journal of Pathology and Microbiology.2021; 64(5): 8. CrossRef
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Yu Yang, Yu-Xuan Li, Ren-Qi Yao, Xiao-Hui Du, Chao Ren
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Daniel Vasile Balaban, Mariana Jinga
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Daniel Vasile Balaban, Mariana Jinga
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Inflammatory bowel diseases

Risk of surgery in patients with stricturing type of Crohn’s disease at the initial diagnosis: a single center experience: Yuji Maehata, Yutaka Nagata, Tomohiko Moriyama, Yuichi Matsuno, Atsushi Hirano, Junji Umeno, Takehiro Torisu, Tatsuya Manabe, Takanari Kitazono, Motohiro Esaki; Intest Res 2019;17(3):357-364. Published online February 21, 2019; DOI: https://doi.org/10.5217/ir.2018.00107

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Background/Aims
It remains uncertain which patients with stricturing-type Crohn’s disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD.
Methods
We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up.
Results
Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5–14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78–10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24–9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15–0.99; P=0.048) showed a negative correlation.
Conclusions
CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.

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Risk factors for stricture-related surgery in stricturing Crohn’s disease
Emil Yunusov, Betul Piyade, Ilkay Ergenc, Muhammed Enes Tasci, Nisanur Sariyar, Yesim Ozen Alahdab, Ozlen Atug, Haluk Tarik Kani
BMC Gastroenterology.2026;[Epub] CrossRef
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Dominik Bettenworth, Mark E. Baker, Joel G. Fletcher, Vipul Jairath, Cathy Lu, Willem Bemelman, Geert d’Haens, Andre d’Hoore, Axel Dignass, Iris Dotan, Roger Feakins, Phillip Fleshner, Christina Ha, Gaylyn Henderson, Ruishen Lyu, Julian Panes, Gerhard Rog
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Reliability of MR Enterography Features for Describing Fibrostenosing Crohn Disease
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Reliability of CT Enterography for Describing Fibrostenosing Crohn Disease
Florian Rieder, Christopher Ma, Jurij Hanzel, Joel G. Fletcher, Mark E. Baker, Zhongya Wang, Leonardo Guizzetti, Lisa M. Shackelton, Julie Rémillard, Mihir Patel, Jiafei Niu, Ronald Ottichilo, Cynthia S. Santillan, Nunzia Capozzi, Stuart A. Taylor, David
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10,798 View
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Colorectal neoplasia

Clinical features and outcomes in spontaneous intramural small bowel hematoma: cohort study and literature review: Eun Ae Kang, Seung Jun Han, Jaeyoung Chun, Hyun Jung Lee, Hyunsoo Chung, Jong Pil Im, Sang Gyun Kim, Joo Sung Kim, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Hyun Chae Jung; Intest Res 2019;17(1):135-143. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00085

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Spontaneous intramural small bowel hematoma (SISBH) is an extremely rare complication of anticoagulant or antiplatelet therapy. We assessed the clinical characteristics and outcomes of patients with SISBH according to the anatomical location of the hematoma.
Methods
From January 2003 to February 2016, medical records for all patients hospitalized for SISBH at 2 tertiary referral hospitals were retrospectively reviewed. The primary outcome was requirement for surgery.
Results
A total of 37 patients were enrolled. The mean age was 74.1 years. Among them, 33 patients (89.2%) were taking anticoagulant and/or antiplatelet agents. Duodenal intramural hematoma was detected in 4 patients (10.8%), jejunal in 16 (43.2%), and ileal in 17 (45.9%). Compared to jejunal and ileal involvement, duodenal intramural hematoma was significantly associated with high Charlson comorbidity index and low levels of white blood cells, hemoglobin, and platelets in the blood. SISBH in the duodenum was related to thrombocytopenia in 3 patients following systemic chemotherapy for malignancy. All patients with SISBH showed clinical improvement with conservative therapy. Mean length of hospital stay was 9.35 days. Independent predictors of a hospital stay of more than 7 days were body weight less than 60 kg (odds ratio [OR], 12.213; 95% confidence interval [CI], 1.755–84.998; P=0.011) and a history of cerebrovascular accidents (OR, 6.667; 95% CI, 1.121–39.650; P=0.037).
Conclusions
Compared to jejunal and ileal involvement, thrombocytopenia may result in spontaneous duodenal intramural hematoma among patients who are treated with systemic chemotherapy for malignancies. Patients with SISBH have excellent clinical outcomes with conservative therapy regardless of the anatomical location of the hematoma.

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Noemi Zorzetti, Augusto Lauro, Cinzia Baccaro, Giuseppe Ponticelli, Pasquale Ascenzi, Vincenzo Cennamo, Giuseppe Giovanni Navarra
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Spontaneous intramural small-bowel hematoma secondary to coagulopathy in patients receiving vitamin K antagonists: A case series report
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Hematoma intramural duodenal: diagnóstico y manejo de una entidad infrecuente
Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
Cirugía Española.2023; 101(7): 515. CrossRef
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Mazin N Habhab, Asad J Torabi, Julie M Clary, George E Revtyak
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Karim El Aidaoui, Wahib Lahlou, Abderrahim Bourial, Nawal Bouknani, Chafik El Kettani
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Giorgio Valerii, Vittorio Maria Ormando, Carlo Cellini, Luca Sacco, Carmelo Barbera
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Ding-Han Chen, Khay-Seng Soh, Ying-Tso Wang, Te-Chun Shen
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Rebeca de Barros Lopes, Finn McLennan Battleday, Toby Calvert, Rob Gwynne‐Jones, Rebecca Thomas
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SPONTANEOUS INTRAMURAL SMALL-BOWEL HEMATOMA: A CAUSE OF ACUTE ABDOMEN IN ANTICOAGULATED PATIENTS
Sergio Gil Rojas, Luis Miguel Estela Villa, Elsa María Jiménez Vicente
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Luísa Martins Figueiredo, David Valadas Horta, Jorge A. Reis
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264 Download
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Case Report

Endoscopy

Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series: Kenichiro Takahashi, Shigeki Bamba, Masahiro Kawahara, Atsushi Nishida, Osamu Inatomi, Masaya Sasaki, Tomoyuki Tsujikawa, Ryoji Kushima, Mitsushige Sugimoto, Katsuyuki Kitoh, Akira Andoh; Intest Res 2018;16(4):628-634. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00003

Abstract PDF Supplementary Material PubReader ePub

The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying singleballoon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma.

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A case of intestinal T‐cell lymphoma, not otherwise specified, that showed characteristic findings by magnified endoscopy combined with narrow‐band imaging
Yuki Hirose, Satoshi Saito, Takanori Nishiguchi, Dai Yamazaki, Tsubasa Tateishi, Yuuichi Saito, Yukiko Komeno, Makoto Kodama, Shiho Iwamoto, Masayuki Fukata, Minako Sako
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Predictive factors for the progression of primary localized stage small-bowel follicular lymphoma
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Journal of Gastroenterology.2022; 57(9): 667. CrossRef

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Review

Non-steroidal anti-inflammatory drug-induced enteropathy: Sung Jae Shin, Choong-Kyun Noh, Sun Gyo Lim, Kee Myung Lee, Kwang Jae Lee; Intest Res 2017;15(4):446-455. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.446

Abstract PDF PubReader ePub

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.

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Case Report

Ischemic enteritis with intestinal stenosis: Yorimitsu Koshikawa, Hiroshi Nakase, Minoru Matsuura, Takuya Yoshino, Yusuke Honzawa, Naoki Minami, Satoshi Yamada, Yumiko Yasuhara, Shigehiko Fujii, Toshihiro Kusaka, Dai Manaka, Hiroyuki Kokuryu; Intest Res 2016;14(1):89-95. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.89

Abstract PDF PubReader ePub

A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patient's nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patient's postoperative course was uneventful.

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Reviews

Current status and future perspectives of capsule endoscopy: Hyun Joo Song, Ki-Nam Shim; Intest Res 2016;14(1):21-29. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.21

Abstract PDF PubReader ePub

Small bowel capsule endoscopy (CE) was first introduced 15 years ago, and a large amount of literature has since been produced, focused on its indication, diagnostic yields, and safety. Guidelines that have made CE the primary diagnostic tool for small bowel disease have been created. Since its initial use in the small bowel, CE has been used for the esophagus, stomach, and colon. The primary indications for small bowel CE are obscure gastrointestinal bleeding, unexplained iron deficiency anemia, suspected Crohn's disease, small bowel tumors, nonsteroidal anti-inflammatory drug enteropathy, portal hypertensive enteropathy, celiac disease, etc. Colon CE provides an alternative to conventional colonoscopy, with possible use in colorectal cancer screening. Guidelines for optimal bowel preparation of CE have been suggested. The main challenges in CE are the development of new devices with the ability to provide therapy, air inflation for better visualization of the small bowel, biopsy sampling systems attached to the capsule, and the possibility of guiding and moving the capsule by an external motion controller. We review the current status and future directions of CE, and address all aspects of clinical practice, including the role of CE and long-term clinical outcomes.

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Myeloid-Derived Suppressor Cells in Inflammatory Bowel Disease: Yeon-Jeong Kim, Sun-Young Chang, Hyun-Jeong Ko; Intest Res 2015;13(2):105-111. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.105

Abstract PDF PubReader

Immature myeloid cells, also known as myeloid-derived suppressor cells (MDSCs), include neutrophilic and monocytic myeloid cells, and are found in inflammatory loci and secondary lymphoid organs in mice with intestinal inflammation, inflammatory bowel disease (IBD) patients, and tumor tissues. However, the roles of MDSCs in IBD are not yet well understood, and there are controversies regarding their immunosuppressive functions in IBD. In addition, recent studies have suggested that endoplasmic reticulum (ER) stress in intestinal epithelial cells, especially in Paneth cells, is closely associated with the induction of IBD. However, the ER stress in MDSCs accumulated in the inflamed tissues of IBD patients is not yet fully understood. In the current review, we discuss the presence of accumulated MDSCs in the intestines of IBD patients, and further speculate on their physiological roles in the inflammatory condition with interleukin 17-producing cells, including Th17 cells. In particular, we will discuss the divergent functions of MDSCs in ER stressed intestinal environments, including their pro-inflammatory or immunosuppressive roles, based on the consideration of unfolded protein responses initiated in intestinal epithelial cells by ER stress.

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Statement

Seminar Report From the 2014 Taiwan Society of Inflammatory Bowel Disease (TSIBD) Spring Forum (May 24th, 2014): Crohn's Disease Versus Intestinal Tuberculosis Infection: Meng-Tzu Weng, Shu-Chen Wei, Chun-Che Lin, Yuk-Min Tsang, Chia-Tung Shun, Jann-Yuan Wang, Ming-Jium Shieh, Cheng-Yi Wang, Jau-Min Wong; Intest Res 2015;13(1):6-10. Published online January 29, 2015; DOI: https://doi.org/10.5217/ir.2015.13.1.6

Abstract PDF PubReader

Since Taiwan is an endemic area for tuberculosis (TB), differential diagnosis between the intestinal TB and Crohn's disease is an important issue. The steering committee of Taiwan Society of Inflammatory Bowel Disease (TSIBD) has arranged a seminar accordingly on May 24th, 2014 and the different point of views by gastroenterologist, radiologist, pathologist and infectious disease specialist were suggested to help the proper diagnosis and management of these two diseases.

Citations

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Review

Intestinal Stricture in Crohn's Disease: Chen-Wang Chang, Jau-Min Wong, Chien-Chih Tung, I-Lun Shih, Horng-Yuan Wang, Shu-Chen Wei; Intest Res 2015;13(1):19-26. Published online January 29, 2015; DOI: https://doi.org/10.5217/ir.2015.13.1.19

Abstract PDF PubReader

Crohn's disease (CD) is a disease with chronic inflammation of unknown etiology involving any part of the gastrointestinal tract. The incidence and prevalence of CD are increasing recently in Asia. Half of the CD patients will have intestinal complications, such as strictures or fistulas, within 20 years after diagnosis. Twenty-five percentage of CD patients have had at least one small bowel stricture and 10% have had at least one colonic stricture and lead to significant complications. Most of these patients will require at least one surgery during their lifetime. Early diagnosis and evaluation with adequate managements for the patients can prevent disability and mortality of these patient. Here, we reviewed the current incidence of CD with stricture, the etiology of stricture, and how to diagnose and manage the stricture.

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Case Report

A Case of Localized Amyloid Light-Chain Amyloidosis in the Small Intestine: Jong Hyo Choi, Bong Min Ko, Cheol Kim, Hee Kyung Kim, Jae Pil Han, Su Jin Hong, Jong Ho Moon, Moon Sung Lee; Intest Res 2014;12(3):245-250. Published online July 25, 2014; DOI: https://doi.org/10.5217/ir.2014.12.3.245

Abstract PDF PubReader ePub

Amyloidosis is characterized by the abnormal deposition of extracellular amyloid fibrils. Cases involving amyloid light-chain amyloidosis in the small intestine have been reported infrequently in Korea. Here, we report a case of localized light chain protein amyloidosis in the small intestine. Esophagogastroduodenoscopy, push enteroscopy, and capsule endoscopy revealed submucosal tumor-like lesions, multiple shallow ulcers, and several erosions in the distal duodenum and jejunum. An endoscopic biopsy established the diagnosis of amyloidosis. In through an immunohistochemical analysis, the presence of lambda light chain protein was detected. The patient had no evidence of an underlying clonal plasma cell disorder or additional organ involvement. Therefore, we concluded that the patient had localized amyloidosis of the small intestine.

Citations

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European Journal of Haematology.2024; 113(4): 400. CrossRef
Iatrogenic Sigma Perforation in a Patient with Localized Rectal and Sigma AL Amyloidosis: A Forensic Case and a Literature Review
Giuseppe Davide Albano, Stefania Zerbo, Simone Di Franco, Elisabetta Orlando, Eleonora Formisano, Antonina Argo, Beatrice Belmonte
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Renugadevi Swaminathan, Samuel Igbinedion, Sudha Pandit
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Sachin Mohan, Elliot Graziano, James Campbell, Irshad H Jafri
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Raghav Bansal, Umer Syed, Jacob Walfish, Joshua Aron, Aaron Walfish
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Tomoya Iida, Hiroo Yamano, Hiroshi Nakase
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Original Article

Expression of Heat Shock Proteins and Cytokines in Response to Ethanol Induced Damage in the Small Intestine of ICR Mice: Sung Won Lee, Dong Wook Choi, Sung Chul Park, Hee Jung Kim, Yang Hoon Nam, Dae Hee Choi, Chang Don Kang, Sung Joon Lee, Wan Joo Chun, Young-Joon Ryu; Intest Res 2014;12(3):205-213. Published online July 25, 2014; DOI: https://doi.org/10.5217/ir.2014.12.3.205

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

Ethanol administration causes intestinal epithelial cell damage by increasing intestinal permeability and the translocation of endotoxins from intestinal bacterial flora. Heat shock proteins (HSPs) are associated with recovery and protection from cell damage. The aim of the current study was to investigate differences in the expression of HSPs in the small intestine and the biochemical changes attributable to ethanol-induced intestinal damage.

Methods

Ethanol (20%) was injected intraperitoneally (2.75 g/kg, 5.5 g/kg, 8.25 g/kg) in ICR mice and the same volume of saline was administered to controls. After 1 hour, the proximal, middle, and distal segments were taken from the small intestine and the degree of damage was analyzed. In each segment, the expression of HSPs was analyzed by western blotting. The expression of inflammatory mediators including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), cyclooxygenase-2 (COX-2), and antioxidant enzyme such as glutathione-S-transferase were compared using real-time polymerase chain reaction assays.

Results

In the control group, HSP70 increased in all segments of small intestine. Additionally, increases in the expression of HSP40 and HSP90 in the distal regions and an increase in HSP32 in the middle regions were observed. After ethanol treatment, greater histological damage was observed in the distal small intestine and significant decreases in HSPs were observed generally. Increased expression of IL-1β, TNF-α, and COX-2 was observed in small intestinal tissues exposed to ethanol-induced damage. However, there was no significant difference in the expression of an antioxidant enzyme.

Conclusions

Significant differences in the expression of HSPs in different intestinal regions were observed. These differences may have been attributable to the distribution of intestinal bacteria.

Citations

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Marie-Édith Arnal, Jean-Paul Lallès
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Amino Acids.2015; 47(12): 2635. CrossRef

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