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1.
Mol Nutr Food Res ; 59(8): 1629-34, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25929669

RESUMEN

In order to increase beneficial effects of bioactive compounds in functional food and dietary supplements, enormous efforts are put in the technological development of microcapsules. Although these products are often tailor-made for disease susceptible consumer, the physiological impact of microcapsule uptake on the respective target consumer has never been addressed. The present study aimed to assess the relevance of this aspect by analyzing the impact of milk protein based microcapsules on experimental inflammatory bowel disease. Long-term feeding of sodium caseinate or rennet gel microcapsules resulted in significant alterations in the intestinal microbiota of healthy mice. In TNFΔARE/wt mice, a model for chronic ileal inflammation, rennet gel microcapsules resulted in further increased splenomegaly, whereas ileal inflammation was unchanged. In IL10(-/-) mice, a model for chronic colitis, both types of microcapsules induced a local increase of the intestinal inflammation. The present study is the first to demonstrate that, independent of their cargo, microcapsules have the potential to affect the intestinal microbiota and to exert unprecedented detrimental effects on disease-susceptible individuals. In conclusion, the impact of microcapsule uptake on the respective target consumer groups should be thoroughly investigated in advance to their commercial use in functional food or dietary supplements.


Asunto(s)
Suplementos Dietéticos , Modelos Animales de Enfermedad , Microbioma Gastrointestinal , Enfermedades Inflamatorias del Intestino/dietoterapia , Proteínas de la Leche/administración & dosificación , Animales , Cápsulas , Caseínas/efectos adversos , Caseínas/química , Quimosina/efectos adversos , Quimosina/química , Colitis/sangre , Colitis/dietoterapia , Colitis/microbiología , Colitis/fisiopatología , Suplementos Dietéticos/efectos adversos , Femenino , Geles , Ileítis/sangre , Ileítis/dietoterapia , Ileítis/microbiología , Ileítis/fisiopatología , Mediadores de Inflamación/sangre , Enfermedades Inflamatorias del Intestino/sangre , Enfermedades Inflamatorias del Intestino/microbiología , Enfermedades Inflamatorias del Intestino/fisiopatología , Masculino , Ratones Endogámicos , Ratones Noqueados , Ratones Mutantes , Proteínas de la Leche/efectos adversos , Proteínas de la Leche/uso terapéutico , Índice de Severidad de la Enfermedad , Esplenomegalia/etiología
2.
Br J Pharmacol ; 166(4): 1444-60, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22300105

RESUMEN

BACKGROUND AND PURPOSE: Cannabichromene (CBC) is a major non-psychotropic phytocannabinoid that inhibits endocannabinoid inactivation and activates the transient receptor potential ankyrin-1 (TRPA1). Both endocannabinoids and TRPA1 may modulate gastrointestinal motility. Here, we investigated the effect of CBC on mouse intestinal motility in physiological and pathological states. EXPERIMENTAL APPROACH: Inflammation was induced in the mouse small intestine by croton oil. Endocannabinoid (anandamide and 2-arachidonoyl glycerol), palmitoylethanolamide and oleoylethanolamide levels were measured by liquid chromatography-mass spectrometry; TRPA1 and cannabinoid receptors were analysed by quantitative RT-PCR; upper gastrointestinal transit, colonic propulsion and whole gut transit were evaluated in vivo; contractility was evaluated in vitro by stimulating the isolated ileum, in an organ bath, with ACh or electrical field stimulation (EFS). KEY RESULTS: Croton oil administration was associated with decreased levels of anandamide (but not 2-arachidonoyl glycerol) and palmitoylethanolamide, up-regulation of TRPA1 and CB1 receptors and down-regulation of CB2 receptors. Ex vivo CBC did not change endocannabinoid levels, but it altered the mRNA expression of TRPA1 and cannabinoid receptors. In vivo, CBC did not affect motility in control mice, but normalized croton oil-induced hypermotility. In vitro, CBC reduced preferentially EFS- versus ACh-induced contractions. Both in vitro and in vivo, the inhibitory effect of CBC was not modified by cannabinoid or TRPA1 receptor antagonists. CONCLUSION AND IMPLICATIONS: CBC selectively reduces inflammation-induced hypermotility in vivo in a manner that is not dependent on cannabinoid receptors or TRPA1.


Asunto(s)
Cannabinoides/uso terapéutico , Cannabis/química , Motilidad Gastrointestinal/efectos de los fármacos , Ileítis/tratamiento farmacológico , Íleon/efectos de los fármacos , Yeyuno/efectos de los fármacos , Canales de Potencial de Receptor Transitorio/agonistas , Amidas , Animales , Ácidos Araquidónicos/metabolismo , Duodeno/efectos de los fármacos , Duodeno/inmunología , Duodeno/metabolismo , Duodeno/fisiopatología , Endocannabinoides , Etanolaminas , Fármacos Gastrointestinales/farmacología , Regulación de la Expresión Génica/efectos de los fármacos , Ileítis/inmunología , Ileítis/metabolismo , Ileítis/fisiopatología , Íleon/inmunología , Íleon/metabolismo , Íleon/fisiopatología , Técnicas In Vitro , Yeyuno/inmunología , Yeyuno/metabolismo , Yeyuno/fisiopatología , Masculino , Ratones , Ratones Endogámicos ICR , Contracción Muscular/efectos de los fármacos , Ácidos Palmíticos/metabolismo , Alcamidas Poliinsaturadas/metabolismo , ARN Mensajero/metabolismo , Receptor Cannabinoide CB1/agonistas , Receptor Cannabinoide CB1/antagonistas & inhibidores , Receptor Cannabinoide CB1/genética , Receptor Cannabinoide CB1/metabolismo , Receptor Cannabinoide CB2/antagonistas & inhibidores , Receptor Cannabinoide CB2/genética , Receptor Cannabinoide CB2/metabolismo , Canal Catiónico TRPA1 , Canales de Potencial de Receptor Transitorio/antagonistas & inhibidores , Canales de Potencial de Receptor Transitorio/genética , Canales de Potencial de Receptor Transitorio/metabolismo
3.
Neurogastroenterol Motil ; 23(8): 745-e331, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21689210

RESUMEN

BACKGROUND: Bromelain (BR) is a cysteine protease with inhibitory effects on intestinal secretion and inflammation. However, its effects on intestinal motility are largely unexplored. Thus, we investigated the effect of this plant-derived compound on intestinal contractility and transit in mice. METHODS: Contractility in vitro was evaluated by stimulating the mouse isolated ileum, in an organ bath, with acetylcholine, barium chloride, or electrical field stimulation. Motility in vivo was measured by evaluating the distribution of an orally administered fluorescent marker along the small intestine. Transit was also evaluated in pathophysiologic states induced by the pro-inflammatory compound croton oil or by the diabetogenic agent streptozotocin. KEY RESULTS: Bromelain inhibited the contractions induced by different spasmogenic compounds in the mouse ileum with similar potency. The antispasmodic effect was reduced or counteracted by the proteolytic enzyme inhibitor, gabexate (15 × 10(-6) mol L(-1) ), protease-activated receptor-2 (PAR-2) antagonist, N(1) -3-methylbutyryl-N(4) -6-aminohexanoyl-piperazine (10(-4) mol L(-1) ), phospholipase C (PLC) inhibitor, neomycin (3 × 10(-3) mol L(-1) ), and phosphodiesterase 4 (PDE4) inhibitor, rolipram (10(-6) mol L(-1) ). In vivo, BR preferentially inhibited motility in pathophysiologic states in a PAR-2-antagonist-sensitive manner. CONCLUSIONS & INFERENCES: Our data suggest that BR inhibits intestinal motility - preferentially in pathophysiologic conditions - with a mechanism possibly involving membrane PAR-2 and PLC and PDE4 as intracellular signals. Bromelain could be a lead compound for the development of new drugs, able to normalize the intestinal motility in inflammation and diabetes.


Asunto(s)
Ananas/enzimología , Bromelaínas/farmacología , Motilidad Gastrointestinal/efectos de los fármacos , Tránsito Gastrointestinal/efectos de los fármacos , Acetilcolina/farmacología , Animales , Compuestos de Bario/farmacología , Bromelaínas/metabolismo , Células CACO-2 , Cloruros/farmacología , Agonistas Colinérgicos/farmacología , Aceite de Crotón/farmacología , Diabetes Mellitus Experimental/fisiopatología , Estimulación Eléctrica , Inhibidores Enzimáticos/metabolismo , Inhibidores Enzimáticos/farmacología , Humanos , Ileítis/inducido químicamente , Ileítis/fisiopatología , Masculino , Ratones , Contracción Muscular/efectos de los fármacos , Péptidos/metabolismo , Receptor PAR-1/antagonistas & inhibidores , Receptor PAR-2/antagonistas & inhibidores
4.
BMC Physiol ; 9: 6, 2009 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-19374741

RESUMEN

BACKGROUND: Glutathione, the main antioxidant of intestinal epithelial cells, is suggested to play an important role in gut barrier function and prevention of inflammation-related oxidative damage as induced by acute bacterial infection. Most studies on intestinal glutathione focus on oxidative stress reduction without considering functional disease outcome. Our aim was to determine whether depletion or maintenance of intestinal glutathione changes susceptibility of rats to Salmonella infection and associated inflammation.Rats were fed a control diet or the same diet supplemented with buthionine sulfoximine (BSO; glutathione depletion) or cystine (glutathione maintenance). Inert chromium ethylenediamine-tetraacetic acid (CrEDTA) was added to the diets to quantify intestinal permeability. At day 4 after oral gavage with Salmonella enteritidis (or saline for non-infected controls), Salmonella translocation was determined by culturing extra-intestinal organs. Liver and ileal mucosa were collected for analyses of glutathione, inflammation markers and oxidative damage. Faeces was collected to quantify diarrhoea. RESULTS: Glutathione depletion aggravated ileal inflammation after infection as indicated by increased levels of mucosal myeloperoxidase and interleukin-1beta. Remarkably, intestinal permeability and Salmonella translocation were not increased. Cystine supplementation maintained glutathione in the intestinal mucosa but inflammation and oxidative damage were not diminished. Nevertheless, cystine reduced intestinal permeability and Salmonella translocation. CONCLUSION: Despite increased infection-induced mucosal inflammation upon glutathione depletion, this tripeptide does not play a role in intestinal permeability, bacterial translocation and diarrhoea. On the other hand, cystine enhances gut barrier function by a mechanism unlikely to be related to glutathione.


Asunto(s)
Traslocación Bacteriana/fisiología , Glutatión/fisiología , Mucosa Intestinal/fisiología , Salmonelosis Animal/fisiopatología , Animales , Traslocación Bacteriana/efectos de los fármacos , Butionina Sulfoximina/farmacología , Cistina/administración & dosificación , Cistina/farmacología , Diarrea/etiología , Diarrea/fisiopatología , Susceptibilidad a Enfermedades , Glutatión/antagonistas & inhibidores , Ileítis/fisiopatología , Interleucina-1beta/análisis , Lipopolisacáridos/toxicidad , Hígado/metabolismo , Masculino , Óxido Nítrico/metabolismo , Estrés Oxidativo , Peroxidasa/análisis , Ratas , Ratas Wistar , Salmonelosis Animal/complicaciones , Salmonelosis Animal/microbiología , Salmonella enteritidis/fisiología , Organismos Libres de Patógenos Específicos
5.
Br J Pharmacol ; 155(5): 681-9, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18622408

RESUMEN

BACKGROUND AND PURPOSE: Salvinorin A, the active component of the hallucinogenic herb Salvia divinorum, inhibits intestinal motility through activation of kappa-opioid receptors (KORs). However, this compound may have target(s) other than the KORs in the inflamed gut. Because intestinal inflammation upregulates cannabinoid receptors and endogenous cannabinoids, in the present study we investigated the possible involvement of the endogenous cannabinoid system in salvinorin A-induced delay in motility in the inflamed gut. EXPERIMENTAL APPROACH: Motility in vivo was measured by evaluating the distribution of a fluorescent marker along the small intestine; intestinal inflammation was induced by the irritant croton oil; direct or indirect activity at cannabinoid receptors was evaluated by means of binding, enzymic and cellular uptake assays. KEY RESULTS: Salvinorin A as well as the KOR agonist U-50488 reduced motility in croton oil treated mice. The inhibitory effect of both salvinorin A and U-50488 was counteracted by the KOR antagonist nor-binaltorphimine and by the cannabinoid CB(1) receptor antagonist rimonabant. Rimonabant, however, did not counteract the inhibitory effect of salvinorin A on motility in control mice. Binding experiments showed very weak affinity of salvinorin A for cannabinoid CB(1) and CB(2) and no inhibitory effect on 2-arachidonoylglycerol and anandamide hydrolysis and cellular uptake. CONCLUSIONS AND IMPLICATIONS: The inhibitory effect of salvinorin A on motility reveals a functional interaction between cannabinoid CB(1) receptors and KORs in the inflamed--but not in the normal--gut in vivo.


Asunto(s)
Diterpenos de Tipo Clerodano/farmacología , Motilidad Gastrointestinal/efectos de los fármacos , Ileítis/fisiopatología , Receptor Cross-Talk/efectos de los fármacos , Receptor Cannabinoide CB1/metabolismo , Receptores Opioides kappa/metabolismo , Salvia/química , Amidohidrolasas/biosíntesis , Animales , Células COS , Chlorocebus aethiops , Aceite de Crotón/farmacología , Diterpenos de Tipo Clerodano/aislamiento & purificación , Estimulación Eléctrica , Ileítis/inducido químicamente , Ileítis/enzimología , Ileítis/metabolismo , Intestino Delgado/efectos de los fármacos , Intestino Delgado/enzimología , Intestino Delgado/metabolismo , Masculino , Ratones , Ratones Endogámicos ICR , Hojas de la Planta/química , Unión Proteica , Receptor Cannabinoide CB2/metabolismo , Receptores Opioides kappa/agonistas
6.
Br J Pharmacol ; 154(5): 1001-8, 2008 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-18469842

RESUMEN

BACKGROUND AND PURPOSE: Cannabidiol is a Cannabis-derived non-psychotropic compound that exerts a plethora of pharmacological actions, including anti-inflammatory, neuroprotective and antitumour effects, with potential therapeutic interest. However, the actions of cannabidiol in the digestive tract are largely unexplored. In the present study, we investigated the effect of cannabidiol on intestinal motility in normal (control) mice and in mice with intestinal inflammation. EXPERIMENTAL APPROACH: Motility in vivo was measured by evaluating the distribution of an orally administered fluorescent marker along the small intestine; intestinal inflammation was induced by the irritant croton oil; contractility in vitro was evaluated by stimulating the isolated ileum, in an organ bath, with ACh. KEY RESULTS: In vivo, cannabidiol did not affect motility in control mice, but normalized croton oil-induced hypermotility. The inhibitory effect of cannabidiol was counteracted by the cannabinoid CB1 receptor antagonist rimonabant, but not by the cannabinoid CB2 receptor antagonist SR144528 (N-[-1S-endo-1,3,3-trimethyl bicyclo [2.2.1] heptan-2-yl]-5-(4-chloro-3-methylphenyl)-1-(4-methylbenzyl)-pyrazole-3-carboxamide), by the opioid receptor antagonist naloxone or by the alpha2-adrenergic antagonist yohimbine. Cannabidiol did not reduce motility in animals treated with the fatty acid amide hydrolase (FAAH) inhibitor N-arachidonoyl-5-hydroxytryptamine, whereas loperamide was still effective. In vitro, cannabidiol inhibited ACh-induced contractions in the isolated ileum from both control and croton oil-treated mice. CONCLUSIONS AND IMPLICATIONS: Cannabidiol selectively reduces croton oil-induced hypermotility in mice in vivo and this effect involves cannabinoid CB1 receptors and FAAH. In view of its low toxicity in humans, cannabidiol may represent a good candidate to normalize motility in patients with inflammatory bowel disease.


Asunto(s)
Cannabidiol/farmacología , Cannabis , Fármacos Gastrointestinales/farmacología , Motilidad Gastrointestinal/efectos de los fármacos , Ileítis/tratamiento farmacológico , Íleon/efectos de los fármacos , Acetilcolina/farmacología , Amidohidrolasas/antagonistas & inhibidores , Amidohidrolasas/metabolismo , Animales , Cannabis/química , Colinérgicos/farmacología , Aceite de Crotón , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Inhibidores Enzimáticos/farmacología , Tránsito Gastrointestinal/efectos de los fármacos , Ileítis/inducido químicamente , Ileítis/fisiopatología , Íleon/metabolismo , Íleon/fisiopatología , Loperamida/farmacología , Masculino , Ratones , Ratones Endogámicos ICR , Piperidinas/farmacología , Pirazoles/farmacología , Receptor Cannabinoide CB1/efectos de los fármacos , Rimonabant
7.
Neurogastroenterol Motil ; 11(1): 69-76, 1999 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-10087537

RESUMEN

Inflammatory bowel disease is associated with altered intestinal motility and epithelial damage. Hyperthermia induces heat shock protein expression, components of a basic cellular defence mechanism, and consequently prevents ischaemic damage. Here we investigate whether hyperthermia may prevent altered smooth muscle function as well as underlying inflammation in a model of inflammatory bowel disease. Ileal heat shock protein expression was induced in rats by hyperthermic shock (41.5 degrees C; 5 min). Two hours after heating or sham treatment, ileitis was evoked by TNBS. Ileal samples were taken 4 h later to determine the contractile response of circular muscle strips, and to measure heat shock protein expression, LTB4 generation and damage/inflammation. Ileitis was associated with an increase in the contractile response of circular muscle to substance P but not neurokinin A or nerve stimulation. Hyperthermia induced heat shock protein expression and also prevented this functional change as well as TNBS-induced LTB4 production, subsequent infiltration of neutrophils and epithelial damage. Thus, intestinal inflammation is associated with alterations in tachykinergic control of smooth muscle as well as inflammatory changes. Hyperthermia prevents these changes and induces heat shock protein expression. Pharmacological induction of these proteins may offer a novel clinical strategy in treating both of these aspects of disease.


Asunto(s)
Hipertermia Inducida , Ileítis/patología , Ileítis/fisiopatología , Animales , Motilidad Gastrointestinal/fisiología , Proteínas del Choque Térmico HSP72 , Proteínas de Choque Térmico/metabolismo , Ileítis/metabolismo , Íleon/inervación , Íleon/patología , Íleon/fisiopatología , Leucotrieno B4/metabolismo , Masculino , Músculo Liso/fisiopatología , Fenómenos Fisiológicos del Sistema Nervioso , Ratas , Ratas Sprague-Dawley
8.
Zentralbl Veterinarmed B ; 45(2): 115-27, 1998 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9557133

RESUMEN

The aim of this study was to evaluate the effect of different antibiotics used as growth promoters on the control of porcine intestinal adenomatosis when administered in weaning, growing and fattening pig diets, according to Annex I of the European Union directive (70/524/EEC and its subsequent amendments to date) for the use of feed additives. On a farm with a previous history of proliferative enteropathy outbreaks, 648 weaned piglets (23 days old) were divided into nine experimental groups according to bodyweight and sex ratio, each group comprising four pens with 18 pigs in each pen. One group served the trial as a negative (unmedicated) control: another (the positive control) received monensin via feed at 100 p.p.m. up to the end of the growing phase (107 days old) and 50 p.p.m. up to slaughter age (156 days old). The remaining seven groups were offered feed with the addition of the following antibiotics: virginia-mycin (50-20 p.p.m.), avilamycin (40-20 p.p.m.), spiramycin (50-20 p.p.m.), zinc bacitracin (50-10 p.p.m.), avoparcin (40-20 p.p.m.), tylosin (40-20 p.p.m.) and salinomycin (60-30 p.p.m.), respectively. The performance of the pigs in the positive control group was very satisfying and among the highest in the trial, verifying earlier field studies. As a general conclusion it seems that all tested growth promoters had a beneficial effect compared with the untreated control, indicated by the decrease of mortality rate, the elimination of diarrhoeal incidence and the enhancement of growth performance, although the proliferative enteropathy control achieved by each substance was not always satisfactory. More specifically, the antibiotic growth promoters tested can be scaled according to their total efficacy as follows: 1. Salinomycin, tylosin, spiramycin; 2. Virginiamycin, zinc bacitracin, avilamycin; and 3. Avoparcin. Finally, it is considered that part of the growth promotion efficacy of the tested substances is due to their potential capacity to control porcine intestinal adenomatosis; thus, in future growth performance trials, the disease background of the trial farms must be examined, especially for porcine enteropathy challenges.


Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica/veterinaria , Infecciones Bacterianas/veterinaria , Sustancias de Crecimiento/uso terapéutico , Ileítis/veterinaria , Enfermedades de los Porcinos , Porcinos/crecimiento & desarrollo , Mataderos , Animales , Antibacterianos/administración & dosificación , Bacitracina/administración & dosificación , Bacitracina/uso terapéutico , Infecciones Bacterianas/prevención & control , Brotes de Enfermedades/veterinaria , Femenino , Alimentos Fortificados , Glicopéptidos , Grecia/epidemiología , Sustancias de Crecimiento/administración & dosificación , Ileítis/epidemiología , Ileítis/fisiopatología , Ileítis/prevención & control , Íleon , Mucosa Intestinal/microbiología , Mucosa Intestinal/patología , Masculino , Monensina/administración & dosificación , Monensina/uso terapéutico , Oligosacáridos/administración & dosificación , Oligosacáridos/uso terapéutico , Piranos/administración & dosificación , Piranos/uso terapéutico , Espiramicina/administración & dosificación , Espiramicina/uso terapéutico , Enfermedades de los Porcinos/epidemiología , Tilosina/administración & dosificación , Tilosina/uso terapéutico , Virginiamicina/administración & dosificación , Virginiamicina/uso terapéutico
9.
Gastroenterology ; 95(5): 1287-93, 1988 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-3169496

RESUMEN

Using a novel labeling technique with technetium 99m-hexamethyl propylene amine oxine, we studied 29 patients with known or suspected Crohn's disease. Technetium 99m-hexamethyl propylene amine oxine leukocyte scanning (99mTc scan) was prospectively compared with the results of independently performed radiologic, endoscopic, and histologic examinations, and with findings at surgery, to assess the clinical usefulness of this technique to localize inflammatory lesions. In addition, uptake of technetium 99m-hexamethyl propylene amine oxine in the bowel was graded by comparing it with the uptake in liver and bone marrow and correlating this with established parameters of disease activity. The viability of homologous labeled leukocytes was greater than 95%. Less than 5% of lymphocytes were found in the final preparation. It was found that 45% +/- 12% of the label was bound to granulocytes, and 98% of the unbound label was washed off before reinjection. The results of 99mTc scan revealed a good correlation with those of barium enema (r = 0.880, p less than 0.001), of endoscopy/surgery (r = 0.983, p less than 0.001), and of all combined reference methods (r = 0.981, p less than 0.001). Activity as determined by 99mTc scan was weakly correlated with the results of Crohn's disease activity index (r = 0.559, p less than 0.01), van Hees index (r = 0.606, p less than 0.01), and erythrocyte sedimentation rate (r = 0.456, p less than 0.05) in 24 patients with proven Crohn's disease. The correlation was improved when the 99mTc scan was compared with a combination of these activity parameters and C-reactive protein (r = 0.781, p less than 0.001). Extraintestinal manifestations (joints) and complications (cholecystitis) were also identified correctly by the 99mTc scan. The study demonstrates that leukocyte scanning with technetium 99m-hexamethyl propylene amine oxine as a label can reliably assess the location and, to a lesser degree, activity of Crohn's disease. This technique is more convenient and provides images far superior to those produced by indium 111-labeled leukocyte scanning.


Asunto(s)
Enfermedad de Crohn/diagnóstico por imagen , Granulocitos , Intestinos/diagnóstico por imagen , Compuestos Organometálicos , Oximas , Tecnecio , Adolescente , Adulto , Sulfato de Bario , Colitis/diagnóstico por imagen , Colitis/fisiopatología , Enfermedad de Crohn/fisiopatología , Enema , Femenino , Humanos , Ileítis/diagnóstico por imagen , Ileítis/fisiopatología , Intestinos/fisiopatología , Masculino , Persona de Mediana Edad , Radiografía , Cintigrafía , Exametazima de Tecnecio Tc 99m
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