Intestinal Research

Original Article

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

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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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
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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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
Multiple Small Bowel Gastrointestinal Stromal Tumors Associated with Neurofibromatosis Type 1 that Were Not Detected by Endoscopy: A Case Report
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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123 Download
5 Web of Science
4 Crossref

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;[Epub] 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
Usefulness of a double immunofluorescence technique for detection of intestinal tTG-IgA deposits in diabetic and non-diabetic children with celiac disease
Raghav Lal, Ranjeet Bhardwaj, Ranjana Walker Minz, Kaushal Kishore Prasad, Sadhna Lal, Devi Dayal, Yashwant Kumar
Pediatrics & Neonatology.2023; 64(4): 388. CrossRef
The global burden of coeliac disease: opportunities and challenges
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
Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
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
Nutrients.2022; 14(12): 2487. CrossRef
The Role of Nerve Fibers in the Tumor Immune Microenvironment of Solid Tumors
Sharia Hernandez, Alejandra G. Serrano, Luisa M. Solis Soto
Advanced Biology.2022;[Epub] CrossRef
Case Report: Morphologic and Functional Characteristics of Intestinal Mucosa in a Child With Short Bowel Syndrome After Treatment With Teduglutide: Evidence in Favor of GLP-2 Analog Safety
Enrico Costantino Falco, Antonella Lezo, Pierluigi Calvo, Caterina Rigazio, Anna Opramolla, Ludovica Verdun, Giovanna Cenacchi, Marianna Pellegrini, Marco Spada, Gabriella Canavese
Frontiers in Nutrition.2022;[Epub] CrossRef
Quantitative histology as a diagnostic tool for celiac disease in children and adolescents
Mateus M. Vargas, Ricardo Artigiani Neto, Vera L. Sdepanian
Annals of Diagnostic Pathology.2022; 61: 152031. CrossRef
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
Artificial intelligence in small intestinal diseases: Application and prospects
Yu Yang, Yu-Xuan Li, Ren-Qi Yao, Xiao-Hui Du, Chao Ren
World Journal of Gastroenterology.2021; 27(25): 3734. CrossRef
Opportunities and challenges in the management of celiac disease in Asia
Ashish Agarwal, Ashish Chauhan, Vineet Ahuja, Govind K Makharia
JGH Open.2020; 4(5): 795. CrossRef
Digital histology in celiac disease: A practice changer
Daniel Vasile Balaban, Mariana Jinga
Artificial Intelligence in Gastroenterology.2020; 1(1): 1. CrossRef
Digital histology in celiac disease: A practice changer
Daniel Vasile Balaban, Mariana Jinga
Artificial Intelligence in Gastroenterology.2020; 1(1): 1. CrossRef

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183 Download
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15 Crossref

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.

Citations

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Colonic strictures in Crohn’s disease: a non-surgical survival
Sarra Laabidi, Hamed Aboubecrine, Salma Souissi, Donia Gouiaa, Asma Labidi, Nadia Ben Mustapha, Anis Haddad, Amine Sebai, Meriem Serghini, Monia Fekih, Hanene Jaziri, Jalel Boubaker
Future Science OA.2025;[Epub] CrossRef
Comprehensive review and update of stricturing Crohn’s disease
Alexander T. Elford, Zaid Ardalan, Paul Simkin, Britt Christensen
Indian Journal of Gastroenterology.2024; 43(1): 64. CrossRef
A global consensus on the definitions, diagnosis and management of fibrostenosing small bowel Crohn’s disease in clinical practice
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
Nature Reviews Gastroenterology & Hepatology.2024; 21(8): 572. CrossRef
Reliability of MR Enterography Features for Describing Fibrostenosing Crohn Disease
Florian Rieder, Mark E. Baker, David H. Bruining, Jeff L. Fidler, Eric C. Ehman, Shannon P. Sheedy, Jay P. Heiken, Justin M. Ream, David R. Holmes, Akitoshi Inoue, Payam Mohammadinejad, Yong S. Lee, Stuart A. Taylor, Jaap Stoker, Guangyong Zou, Zhongya Wa
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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
Radiology.2024;[Epub] CrossRef
Use of oral diet and nutrition support in management of stricturing and fistulizing Crohn's disease
Kush Fansiwala, Neha D. Shah, Kelly A. McNulty, Mary R. Kwaan, Berkeley N. Limketkai
Nutrition in Clinical Practice.2023; 38(6): 1282. CrossRef
Sarcopenia hinders the decline in disease activity after surgery for people with Crohn's disease: Preliminary results
Asuka Yasueda, Yuki Sekido, Takashi Takeda, Takayuki Ogino, Norikatsu Miyoshi, Hidekazu Takahashi, Mamoru Uemura, Yuichiro Doki, Hidetoshi Eguchi, Tsunekazu Mizushima
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Efficacy of drug and endoscopic treatment of Crohn's disease strictures: A systematic review
Julien D Schulberg, Emily K Wright, Bronte A Holt, Helen E Wilding, Amy L Hamilton, Alyson L Ross, Michael A Kamm
Journal of Gastroenterology and Hepatology.2021; 36(2): 344. CrossRef
Comparison of Long-term Outcomes of Infliximab versus Adalimumab in 1,488 Biologic-Naive Korean Patients with Crohn’s Disease
Yoon Suk Jung, Minkyung Han, Sohee Park, Jae Hee Cheon
Gut and Liver.2021; 15(1): 92. CrossRef
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Muaad Abdulla, Thean Soon Chew
Current Opinion in Gastroenterology.2021; 37(3): 275. CrossRef
Real world analysis on the efficacy and safety of anti-tumor necrosis factor therapy in patients with stricturing Crohn’s disease
Sudheer K. Vuyyuru, Bhaskar Kante, Peeyush Kumar, Pabitra Sahu, Saurabh Kedia, Mukesh Kumar Ranjan, Raju Sharma, Rajesh Panwar, Govind Makharia, Vineet Ahuja
Scientific Reports.2021;[Epub] CrossRef
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Manreet Kaur, Robin L. Dalal, Seth Shaffer, David A. Schwartz, David T. Rubin
Clinical Gastroenterology and Hepatology.2020; 18(6): 1346. CrossRef
Surgical treatment of intestinal stricture in inflammatory bowel disease
Helen M. Mohan, John C. Coffey
Journal of Digestive Diseases.2020; 21(6): 355. CrossRef

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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

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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.

Citations

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Drug-Induced Spontaneous Intramural Hematoma of the Gastrointestinal Tract: A Real-World Pharmacovigilance Analysis
Xuehong Wang, Min Luo, Wenyu Li, Yuqian Zhou
Journal of Cardiovascular Pharmacology.2025; 85(4): 297. CrossRef
Idiopathic Duodenal Hematoma: A Case Report and Literature Review
Ebtesam Al-Najjar, Abdullah Esmail, Bayan Khasawneh, Saifudeen Abdelrahim, Maen Abdelrahim
Reports.2025; 8(2): 73. CrossRef
A Case of Direct-Acting Oral Anticoagulant-Induced Intramural Colon Hematoma Successfully Treated by Laparoscopic Surgery
Daisuke Tomita, Shigeo Toda, Ryo Miyazaki, Shuichiro Matoba, Hiroya Kuroyanagi
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Sigrid L. Williamson, Aishwarya Suresh, Adrian Ong
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Intramural duodenal hematoma: diagnosis and management of a rare entity
Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
Cirugía Española (English Edition).2023; 101(7): 515. CrossRef
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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Richelle G. Butcher, Baukje Lenting, Alison S. Clarke, Kelly Buckle, Cristina Gans
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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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Intramural Hematoma of Gastrointestinal Tract in People with Hemophilia A and B
Wei-Jung Teng, Ching-Huei Kung, Mei-Mei Cheng, Jia-Ruey Tsai, Chia-Yau Chang
Journal of Clinical Medicine.2023; 12(9): 3093. CrossRef
Endoscopic management of intramural spontaneous duodenal hematoma: A case report
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Ding-Han Chen, Khay-Seng Soh, Ying-Tso Wang, Te-Chun Shen
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Spontaneous duodenal haematoma in a patient taking rivaroxaban
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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Small Bowel Obstruction
Allison A. Aka, Jesse P. Wright, Teresa DeBeche-Adams
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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

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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.

Citations

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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
DEN Open.2024;[Epub] 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
Predictive factors for the progression of primary localized stage small-bowel follicular lymphoma
Akihiko Sumioka, Shiro Oka, Issei Hirata, Sumio Iio, Akiyoshi Tsuboi, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Kazuki Boda, Tomohiko Kohno, Hideharu Okanobu, Yasuhiko Kitadai, Koji Arihiro, Shinji Tanaka
Journal of Gastroenterology.2022; 57(9): 667. CrossRef

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Review

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

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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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Antea Krsek, Lara Baticic
Gastrointestinal Disorders.2024; 6(3): 557. CrossRef
Capsule endoscopy for small bowel bleed: Current update
Uday C. Ghoshal, Akash Roy, Mahesh K. Goenka
Indian Journal of Gastroenterology.2024; 43(5): 896. CrossRef
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Giuseppe Galloro, Mario Musella, Saverio Siciliano, Giovanna Berardi, Antonio Vitiello, Nunzio Velotti, Fernando Rizzello, Paolo Gionchetti, Carlo Calabrese
Endoscopy International Open.2022; 10(02): E183. CrossRef
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Nick Lung-Ngai Ting, Harry Cheuk-Hay Lau, Jun Yu
Gut.2022; 71(7): 1412. CrossRef
Iron Deficiency Anaemia and Anaemia of Inflammation in Enteropathies Caused by Commonest Small Intestine Disorders: Current Evidence
Olesja Basina, Jelena Derova, Aleksejs Derovs, Sandra Lejniece
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences..2022; 76(5-6): 561. CrossRef
Double-headed small-bowel capsule endoscopy: Real-world experience from a multi-centre British study
DE Yung, AR Robertson, M Davie, R Sidhu, M McAlindon, I Rahman, P Patel, L Sinha, S Mason, J Brzeszczynska, S Douglas, JN Plevris, A Koulaouzidis
Digestive and Liver Disease.2021; 53(4): 461. CrossRef
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Young Kyu Cho, Heesu Park, Jung Rock Moon, Seong Ran Jeon, Hyun Gun Kim, Tae Hee Lee, Junseok Park, Jin-Oh Kim, Joon Seong Lee, Hyeon Jeong Goong, Bong Min Ko, Suyeon Park
Diagnostics.2021; 11(4): 657. CrossRef
Application of Structural Entropy and Spatial Filling Factor in Colonoscopy Image Classification
Brigita Sziová, Szilvia Nagy, Zoltán Fazekas
Entropy.2021; 23(8): 936. CrossRef
Indicaciones, rendimiento diagnóstico y seguridad de la cápsula endoscópica de intestino delgado en pacientes mexicanos. Experiencia de un centro de tercer nivel
G. Blanco-Velasco, C. Mendoza-Segura, O.M. Solórzano-Pineda, O.V. Hernández-Mondragón, V. Paz-Flores, J.M. Blancas-Valencia
Revista de Gastroenterología de México.2020; 85(2): 140. CrossRef
Indications for small bowel capsule endoscopy and its safety and diagnostic yield in Mexican patients. Experience at a tertiary care hospital center
G. Blanco-Velasco, C. Mendoza-Segura, O.M. Solórzano-Pineda, O.V. Hernández-Mondragón, V. Paz-Flores, J.M. Blancas-Valencia
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Analysis of current and future technologies of capsule endoscopy: A mini review
Brown Alexander P, Jayatissa Ahalapitiya H
Archives of Preventive Medicine.2020; : 031. CrossRef
Capsule endoscopy for small‐intestinal disorders: Current status
Naoki Hosoe, Kaoru Takabayashi, Haruhiko Ogata, Takanori Kanai
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Evaluation of Gastric Disease with Capsule Endoscopy
Seung-Joo Nam, Hyun Seok Lee, Yun Jeong Lim
Clinical Endoscopy.2018; 51(4): 323. CrossRef
Rebleeding rate and risk factors in nonsteroidal anti‐inflammatory drug‐induced enteropathy
Junseok Park, Seong Ran Jeon, Jin‐Oh Kim, Hyun Gun Kim, Tae Hee Lee, Jun‐Hyung Cho, Bong Min Ko, Joon Seong Lee, Moon Sung Lee
Journal of Digestive Diseases.2018; 19(5): 279. CrossRef
The gut microbiota influences anticancer immunosurveillance and general health
Bertrand Routy, Vancheswaran Gopalakrishnan, Romain Daillère, Laurence Zitvogel, Jennifer A. Wargo, Guido Kroemer
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Diagnostic Value of Small Bowel Capsule Endoscopy in Isolated Ileitis: A CAPENTRY Study
Hyun Seok Lee, Yun Jeong Lim, Ki Nam Shim, Chang Mo Moon, Hyun Joo Song, Jin Oh Kim, Seong Ran Jeon, Dae Young Jung, Ji Hyun Kim, Kyeong Ok Kim, Bo-In Lee
Digestive Diseases and Sciences.2017; 62(1): 180. CrossRef
Quality Indicators for Small Bowel Capsule Endoscopy
Ki-Nam Shim, Seong Ran Jeon, Hyun Joo Jang, Jinsu Kim, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Song, Hyun Seok Lee, Jae Jun Park, Ji Hyun Kim, Jaeyoung Chun, Soo Jung Park, Dong-Hoon Yang, Yang Won Min, Bora Keum, Bo-In Lee
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Hyun Joo Jang
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Intestinal Research.2016; 14(3): 199. CrossRef

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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

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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.

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A systematic review of the literature on localized gastrointestinal tract amyloidosis: Presentation, management and outcomes
Mariuxi Alexandra Viteri Malone, David Alfonso Alejos Castillo, Heitor Tavares Santos, Anahat Kaur, Tarek Elrafei, Lewis Steinberg, Abhishek Kumar
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
Forensic Sciences.2024; 4(3): 453. CrossRef
Systemic Immunoglobulin Light Chain Amyloidosis Involving the Large Intestine
Renugadevi Swaminathan, Samuel Igbinedion, Sudha Pandit
ACG Case Reports Journal.2021; 8(5): e00578. CrossRef
Unusual case of amyloidosis presenting as a jejunal mass
Sachin Mohan, Elliot Graziano, James Campbell, Irshad H Jafri
BMJ Case Reports.2021; 14(5): e240226. CrossRef
Gastrointestinal AA amyloidosis secondary to chronic pyelonephritis presenting with refractory diarrhea and severe hypoalbuminemia
Tomoko Tanaka, Tatsushi Naito, Yohei Midori, Takuto Nosaka, Kazuto Takahashi, Kazuya Ofuji, Hidetaka Matsuda, Masahiro Ohtani, Katsushi Hiramatsu, Yoshiaki Imamura, Osamu Yokoyama, Hironobu Naiki, Yasunari Nakamoto
Clinical Journal of Gastroenterology.2021; 14(6): 1642. CrossRef
Morphological and Immunohistochemical Characteristics of Experimental Mandibular Fractures Healing Process
A. A. Matchin, A. A. Stadnikov, E. V. Nosov, S. Kh. Kiriakidi
Journal of Anatomy and Histopathology.2019; 8(1): 44. CrossRef
Specific Clinical and Morphological Characteristics of Amyloidosis of the Stomach and Duodenum
Z. V. Gioeva, L. M. Mikhaleva
Journal of Anatomy and Histopathology.2019; 8(1): 39. CrossRef
Localized Gastrointestinal ALλ Amyloidosis
Tomoya Iida, Kentaro Yamashita, Hiroshi Nakase
Clinical Gastroenterology and Hepatology.2018; 16(9): e93. CrossRef
Small Bowel Amyloidosis
Raghav Bansal, Umer Syed, Jacob Walfish, Joshua Aron, Aaron Walfish
Current Gastroenterology Reports.2018;[Epub] CrossRef
Systemic amyloidosis with gastrointestinal involvement: Diagnosis from endoscopic and histological views
Tomoya Iida, Hiroo Yamano, Hiroshi Nakase
Journal of Gastroenterology and Hepatology.2018; 33(3): 583. CrossRef

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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

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<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

Citations to this article as recorded by

Ethanol-induced changes to the gut microbiome compromise the intestinal homeostasis: a review
Konrad Sosnowski, Adam Przybyłkowski
Gut Microbes.2024;[Epub] CrossRef
The Influence of Alcohol Consumption on Intestinal Nutrient Absorption: A Comprehensive Review
Molly Butts, Vijaya Lakshmi Sundaram, Usha Murughiyan, Alip Borthakur, Soudamani Singh
Nutrients.2023; 15(7): 1571. CrossRef
Gut epithelial inducible heat-shock proteins and their modulation by diet and the microbiota
Marie-Edith Arnal, Jean-Paul Lallès
Nutrition Reviews.2016; 74(3): 181. CrossRef
Protéines du choc thermique inductibles dans l’épithélium intestinal : propriétés protectrices et modulation par le microbiote et des facteurs alimentaires
Marie-Édith Arnal, Jean-Paul Lallès
Cahiers de Nutrition et de Diététique.2016; 51(4): 186. CrossRef
Preinduction of heat shock protein 70 protects mice against post-infection irritable bowel syndrome via NF-κB and NOS/NO signaling pathways
Xuchun Zhou, Liwei Dong, Bo Yang, Zhoutao He, Yiyao Chen, Taozhi Deng, Baili Huang, Cheng Lan
Amino Acids.2015; 47(12): 2635. CrossRef

5,391 View
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