Journal of Yeungnam Medical Science

Review article

Pathophysiology and protective approaches of gut injury in critical illness: Chang Yeon Jung, Jung Min Bae; Yeungnam Univ J Med. 2021;38(1):27-33. Published online September 23, 2020; DOI: https://doi.org/10.12701/yujm.2020.00703

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The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

Citations

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Sarmed H. Kathem, Yasameen Sh. Nasrawi, Shihab H. Mutlag, Surya M. Nauli
Biomolecules.2024; 14(3): 334. CrossRef
S2k-Leitlinie Klinische Ernährung in der Hepatologie
Mathias Plauth, Lars Bechmann, Donata Grajecki, Felix Gundling, Ludwig Kramer, Andreas E. Kremer, Monika Rau, Andrea Schneider, Frank Tacke, Ingo van Thiel
Aktuelle Ernährungsmedizin.2024; 49(04): 256. CrossRef
Bacillus licheniformis reverses the environmental ceftriaxone sodium-induced gut microbial dysbiosis and intestinal inflammation in mice
Zhibo Zeng, Wen Yue, Cermon Kined, PengPeng Wang, Ran Liu, Jing Liu, Xinzhu Chen
Ecotoxicology and Environmental Safety.2023; 257: 114890. CrossRef
Severe gastrointestinal injury associated with SARS-CoV-2 infection: Thrombosis or Inflammation?: A retrospective case series study
Henry Robayo-Amortegui, Alex Forero-Delgadillo, Michel Pérez-Garzón, Claudia Poveda-Henao, Conny Muñoz-Claros, Andrea Bayona-Solano, Carlos Orozco, Ricardo Buitrago-Bernal
Medicine.2022; 101(42): e31188. CrossRef
The Gut-Liver Axis in Cholestatic Liver Diseases
Andreas Blesl, Vanessa Stadlbauer
Nutrients.2021; 13(3): 1018. CrossRef
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Original article

Comparison of small bowel findings using capsule endoscopy between Crohn’s disease and intestinal tuberculosis in Korea: Yong Gil Kim, Kyung-Jo Kim, Young-Ki Min; Yeungnam Univ J Med. 2020;37(2):98-105. Published online November 22, 2019; DOI: https://doi.org/10.12701/yujm.2019.00374

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Abstract PDF

Background
Little is known about capsule endoscopy (CE) findings in patients with intestinal tuberculosis who exhibit small bowel lesions. The aim of the present study was to distinguish between Crohn’s disease (CD) and intestinal tuberculosis based on CE findings.
Methods
Findings from 55 patients, who underwent CE using PillCam SB CE (Given Imaging, Yoqneam, Israel) between February 2003 and June 2015, were retrospectively analyzed.
Results
CE revealed small bowel lesions in 35 of the 55 patients: 19 with CD and 16 with intestinal tuberculosis. The median age at diagnosis for patients with CD was 26 years and 36 years for those with intestinal tuberculosis. On CE, three parameters, ≥10 ulcers, >3 involved segments and aphthous ulcers, were more common in patients with CD than in those intestinal tuberculosis. Cobblestoning was observed in five patients with CD and in none with intestinal tuberculosis. The authors hypothesized that a diagnosis of small bowel CD could be made when the number of parameters in CD patients was higher than that for intestinal tuberculosis. The authors calculated that the diagnosis of either CD or intestinal tuberculosis would have been made in 34 of the 35 patients (97%).
Conclusion
The number of ulcers and involved segments, and the presence of aphthous ulcers, were significantly higher and more common, respectively, in patients with CD than in those with intestinal tuberculosis. Cobblestoning in the small bowel may highly favor a diagnosis of CD on CE.

Citations

Citations to this article as recorded by

Deep Learning Radiomics Analysis of CT Imaging for Differentiating Between Crohn’s Disease and Intestinal Tuberculosis
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Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review
Arup Choudhury, Jasdeep Dhillon, Aravind Sekar, Pankaj Gupta, Harjeet Singh, Vishal Sharma
BMC Gastroenterology.2023;[Epub] CrossRef
Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
M. N. Reshetnikov, D. V. Plotkin, Yu. R. Zyuzya, A. A. Volkov, O. N. Zuban, E. M. Bogorodskaya
Acta Biomedica Scientifica.2021; 6(5): 196. CrossRef
Differentiating intestinal tuberculosis and Crohn disease: Quo Vadis
Vishal Sharma
Expert Review of Gastroenterology & Hepatology.2020; 14(8): 647. CrossRef

Case Reports

Ileal epithelioid leiomyosarcoma with omental and peritoneal seeding: Chung Hyoun Kim, Sun Young Kim, Chang Kil Jung, Jung Pil Choi, Keum Soo Seo, Jun Ho Lee, Jae Hyung Choi; Yeungnam Univ J Med. 2017;34(1):132-136. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.132

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Abstract PDF: Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.

A Case of Reversed Intestinal Rotation: Won Kyu Park, Jae Ho Cho, Jay Chun Chang, Jae Woon Kim, Mi Soo Hwang; Yeungnam Univ J Med. 2007;24(2 Suppl):S632-635. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S632

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Abstract PDF: Diagnosis and treatment of a patient with a congenital anomaly of the midgut with persistent symptom in adult can be difficult because it is particularly in adults. Reversed rotation of the midgut is the rarest of all malrotation anomalies. We report a case of reversed intestinal rotation and review the embryology, clinical presentation, and radiographic findings of this disorder. Although this anomaly is rare, it may be diagnosed by the knowledge of embryology and anatomy.

Original Articles

Localization of Sensory Neurons Innervating the Rat Intestine Using the Cholera Toxin B Subunit(CTB) and Wheat Germ Agglutinin-Horseradish Peroxidase(WGA-HRP).: Dong Hyup Lee, Chang Hyun Lee, Moo Sam Lee; Yeungnam Univ J Med. 1998;15(1):75-96. Published online June 30, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.1.75

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Abstract PDF: The local arrangement of sensory nerve cell bodies and nerve fibers in the brain stem, spinal ganglia and nodose ganglia were observed following injection of cholera toxin B subunit(CTB) and wheat germ agglutinin-horseradish peroxidase(WGA-HRP) into the rat intestine. The tracers were injected in the stomach(anterior and posterior portion), duodenum, jejunum, ileum, cecum, ascending colon or descending colon. After survival times of 48-96 hours, the rats were perfused and their brain, spinal and nodose ganglia were frozen sectioned(40microM). These sectiones were stained by CTB immunohistochemical and HRP histochemical staining methods and observed by dark and light microscopy. The results were as follows: 1. WGA-HRP labeled afferent terminal fields in the brain stem were seen in the stomach and cecum, and CTB labeled afferent terminal fields in the brain stem were seen in all parts of the intestine. 2. Afferent terminal fields innervating the intestine were heavily labeled bilaterally gelalinous part of nucleus of tractus solitarius(gelNTS), dorsomedial part of gelNTS, commissural part of NTS(comNTS), medial part of NTS(medNTS), wall of the fourth ventricle, ventral border of area postrema and comNTS in midline dorsal to the central canal. 3. WGA-HRP labeled sensory neurons were observed bilaterally within the spinal ganglia, and labeled sensory neurons innervating the stomach were observed in spinal ganglia T2-L1 and the most numerous in spinal ganglia T8-9. 4. Labeled sensory neurons innervating the duodenum were observed in spinal ganglia T6-L2 and labeled cell number were fewer than the other parts of the intestines. 5. Labeled sensory neurons innervating the jejunum were observed in spinal ganglia T6-L2 and the most numerous area in the spinal ganglia were T12 in left and T13 in right. 6. Labeled sensory neurons innervating the ileum were observed in spinal ganglia T6-L2 and the most numerous area in the spinal ganglia were T11 in left and L1 in right. 7. Labeled sensory neurons innervating the cecum were observed in spinal ganglia T7-L2 and the most numerous area in the spinal ganglia were T11 in left and T11-12 in right. 8. Labeled sensory neurons innervating the ascending colon were observed in spinal ganglia T7-L2 in left, and T9-L4 in right. The most numerous area in the spinal ganglia were T9 in left and T11 in right. 9. Labeled sensory neurons innervating the descending colon were observed in spinal ganglia T9-L2 in left, and T6-L2 in right. The most numerous area in the spinal ganglia were T13 in left and L1 in right. 10. WGA-HRP labeled sensory neurons were observed bilaterally within the nodose ganglia, and the most numerous labeled sensory neurons innervating the abdominal organs were observed in the stomach. 11. The number of labeled sensory neurons within the nodose ganglia innervating small and large intestines were fewer than that of labeled sensory neurons innervating stomach These results indicated that area of sensory neurons innervated all parts of intestines were bilaterally gelatinous part of nucleus tractus solitarius(gelNTS), dorsomedial part of gelNTS, commissural part of NTS(comNTS), medial part of NTS, wall of the fourth ventricle, ventral border of area postrema and com NTS in midline dorsal to the central canal within brain stem, spinal ganglia T2-L4, and nodose ganglia. Labeled sensory neurons innervating the intestines except the stomach were observed in spinal ganglia T6-L4. The most labeled sensory neurons from the small intestine to large intestine came from middle thoracic spinal ganglia to upper lumbar spinal ganglia.

Effect of GABA on the contratility of small intestine isolated from rat.: Joon Young Huh, Oh Cheol Kwon, Jeoung Hee Ha, Kwang Youn Lee, Won Joon Kim; Yeungnam Univ J Med. 1991;8(2):95-105. Published online December 31, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.2.95

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Abstract PDF: This study was designed to investigate the effect of GABA and related substances on the spontaneous contraction of rat small intestine. The rats (Sprague-Dawley), weighing 200-250g, were sacrificed by cervical dislocation, and the small intestine was isolated. Longitudinal muscle strips from duodenum, jejunum and ileum were suspended in Biancani's isolated muscle chambers and myographied isometrically. GABA and muscimol, a GABA A receptor agonist relaxed the duodenum and jejunum significantly, but baclofen-induced relaxation in those muscle strips negligible. The effectiveness of GABA and muscimol in various regions were the greatest on duodenum, and greater on jejunum than on ileum The effect of GABA and muscimol was antagonized by bicuculline, a competitive GABA A receptor antagonist and picrotoxin, a noncompetitive GABA A receptor antagonist. Duodenal relaxation induced by GABA and muscimol was unaffected by hexamethonium, but was prevented by tetrodotoxin. These results suggest that GABA inhibit the contractility of smooth muscle with distinct regional difference of efficacy, and the site of inhibitory action is the GABA A receptor existing at the presynaptic membrane of postganglionic excitatory nerves.

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