Pectin from sunflower by-products obtained by ultrasound: Chemical characterization and in vivo evaluation of properties in inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a public health challenge and the use of pectin for symptom amelioration is a promising option. In this work, sunflower pectin has been extracted without (CHP) and with assistance of ultrasound (USP) using sodium citrate as a food-grade extracting agent. At optimal conditions (64 °C, 23 min) the highest yield was obtained with ultrasound application (15.5 vs. 8.1 %). Both pectins were structurally characterized by 1H NMR, HPSEC-ELSD, FT-IR and GC-FID. Unlike CHP, USP showed a lower molecular weight, higher galacturonic acid, lower degree of methyl-esterification and, overall, higher viscosity. These characteristics could affect the anti-inflammatory activity of pectins, evaluated using DSS-induced IBD model mice. So, USP promoted the defence (ICAM-1) and repair of the gastrointestinal mucosa (TFF3, ZO-1) more effectively than CHP. These results demonstrate the potential amelioration of acute colitis in IBD mice through USP supplementation. Taking into account the biomarkers analysed, these results demonstrate, for the first time, the positive impact of sunflower pectin extracted by ultrasound under very soft conditions on inflammatory bowel disease that might open up new possibilities in the treatment of this serious pathology.

Computer-Aided Imaging Analysis of Probe-Based Confocal Laser Endomicroscopy With Molecular Labeling and Gene Expression Identifies Markers of Response to Biological Therapy in IBD Patients: The Endo-Omics Study.

BACKGROUND: We aimed to predict response to biologics in inflammatory bowel disease (IBD) using computerized image analysis of probe confocal laser endomicroscopy (pCLE) in vivo and assess the binding of fluorescent-labeled biologics ex vivo. Additionally, we investigated genes predictive of anti-tumor necrosis factor (TNF) response. METHODS: Twenty-nine patients (15 with Crohn's disease [CD], 14 with ulcerative colitis [UC]) underwent colonoscopy with pCLE before and 12 to 14 weeks after starting anti-TNF or anti-integrin α4ß7 therapy. Biopsies were taken for fluorescein isothiocyanate-labeled infliximab and vedolizumab staining and gene expression analysis. Computer-aided quantitative image analysis of pCLE was performed. Differentially expressed genes predictive of response were determined and validated in a public cohort. RESULTS: In vivo, vessel tortuosity, crypt morphology, and fluorescein leakage predicted response in UC (area under the receiver-operating characteristic curve [AUROC], 0.93; accuracy 85%, positive predictive value [PPV] 89%; negative predictive value [NPV] 75%) and CD (AUROC, 0.79; accuracy 80%; PPV 75%; NPV 83%) patients. Ex vivo, increased binding of labeled biologic at baseline predicted response in UC (UC) (AUROC, 83%; accuracy 77%; PPV 89%; NPV 50%) but not in Crohn's disease (AUROC 58%). A total of 325 differentially expressed genes distinguished responders from nonresponders, 86 of which fell within the most enriched pathways. A panel including ACTN1, CXCL6, LAMA4, EMILIN1, CRIP2, CXCL13, and MAPKAPK2 showed good prediction of anti-TNF response (AUROC >0.7). CONCLUSIONS: Higher mucosal binding of the drug target is associated with response to therapy in UC. In vivo, mucosal and microvascular changes detected by pCLE are associated with response to biologics in inflammatory bowel disease. Anti-TNF-responsive UC patients have a less inflamed and fibrotic state pretreatment. Chemotactic pathways involving CXCL6 or CXCL13 may be novel targets for therapy in nonresponders.

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application.

Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.

Comparative Acceptability and Perceived Clinical Utility of Monitoring Tools: A Nationwide Survey of Patients with Inflammatory Bowel Disease.

BACKGROUND: Objective control of intestinal inflammation during inflammatory bowel disease (IBD) is becoming the main driver for medical treatment. However, the monitoring tools-related burden remains poorly investigated. We aimed to evaluate their comparative acceptability and utility according to patients with IBD. METHODS: After a preliminary phase, the final questionnaire encompassing self-administered and physician questionnaires was prospectively and consecutively submitted to 916 patients with IBD from 20 public and private centers. Acceptability and utility visual analog scales (VAS) were expressed as median with interquartile range. RESULTS: Regarding the group of patients with Crohn's disease (n = 618), venipuncture (VAS = 9.3 [8.8-9.7]) and ultrasonography (VAS = 9.3 [8.7-9.7]) were the most acceptable tools (P < 0.0001, for each comparison), whereas rectosigmoidoscopy was the least acceptable tool (VAS = 4.4 [1.2-7.3]) (P < 0.0001, for each comparison). Wireless capsule endoscopy (VAS = 8.5 [5.2-9.3]), magnetic resonance enterocolonography (VAS = 8.0 [5.0-9.2]), and stools collection (VAS = 7.7 [4.6-9.3]) were more acceptable than colonoscopy (VAS = 6.7 [4.3-8.9]) (P < 0.0001, for each comparison). The acceptability was assessed in 298 patients with ulcerative colitis for venipuncture (VAS = 9.4 [8.8-9.7]), stools collection (VAS = 8.1 [5.7-9.4]), colonoscopy (VAS = 7.5 [4.7-9.2]), and rectosigmoidoscopy (VAS = 6.7 [2.8-9.1]); (P < 0.001 for each comparison). All monitoring tools were considered as highly useful by patients with IBD. Decreased acceptability was related to embarrassment for the collection/transport of stools (60.7%), bowel cleansing (76.3%) for colonoscopy, abdominal discomfort (51.3%) and rectal enema (36.6%) for rectosigmoidoscopy, bowel distension (48.3%) for magnetic resonance enterocolonography, and potential capsule retention (21.4%) for wireless capsule endoscopy. CONCLUSIONS: Among the IBD monitoring tools, endoscopy demonstrated the lowest acceptability supporting the development of alternative modalities. Patients' information and examination conditions should be improved to ensure proper monitoring adherence.

MR colonography with a fecal tagging technique and water-based enema for the assessment of inflammatory bowel disease.

PURPOSE: To assess the usefulness of MR colonography (MRC) with a fecal tagging technique and water-based enema in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS: Twenty-two patients with suspected or known IBD underwent MRC with a 1.5-T MR system (Siemens Symphony) using a phased-array coil. A fecal tagging technique was performed by oral administration of dense barium sulfate (200 ml) at major meals starting 2 days before the MRI. After a water enema (2000-2500 ml), the MR protocol was carried out, starting with HASTE and true-FISP sequences. Coronal T1w 3D VIBE (2.0 mm thick) was obtained before and 60 s after intravenous administration of Gd chelate. MR images were evaluated by consensus agreement of two observers in terms of image quality and by searching for bowel abnormalities. MRC findings were correlated with our gold standard-conventional colonoscopy (incomplete in 6/22 patients) with histopathological analysis, and surgery (performed in 8/22 subjects). RESULTS: The MR imaging protocol was completed in all of the investigated subjects. In terms of image quality, 128 out of 132 colon segments (97 %) were considered diagnostic on MR examinations by the two reviewers; signs of bowel inflammation were identified in 74 and 72 % of colon segments of patients with ulcerative colitis (n = 6) and Crohn's disease (n = 15), respectively. In 13/15 patients with Crohn's disease, involvement of both the large and small bowel was demonstrated on MR imaging; perianal abscesses and fistulas were also identified in 2 and 3 of these patients, respectively. In one patient with normal MRC, a diagnosis of IBD could not be confirmed. CONCLUSION: MRC with a fecal tagging technique and water-based enema is a promising minimally invasive technique for evaluating the bowel in patients with a suspected or established diagnosis of IBD.

[Efficacy, tolerability, and safety of cannabinoids in gastroenterology: A systematic review]. / Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden in der Gastroenterologie : Eine systematische Übersichtsarbeit.

BACKGROUND: The medical use of cannabis is discussed in gastroenterology for inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS), and chronic pancreatitis. MATERIALS AND METHODS: A systematic literature search until March 2015 was performed in the databases Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, www.cannabis-med.org , and clinicaltrials.gov. Randomized controlled trials (RCT) investigating herbal cannabis and/or pharmaceutical cannabinoids in IBD, IBS, or chronic pancreatitis with a study duration of ≥ 4 weeks and a sample size of at least n = 10 per study arm were identified. Clinical outcomes comprised efficacy (pain, nausea, appetite/weight, diarrhea, health-related quality of life, and remission rates for IBD), tolerability (drop-out rate due to side effects), and safety (severe side effects). Methodology quality of RCTs was evaluated with the Cochrane Risk of Bias Tool. RESULTS: Only one RCT treating 21 patients with Crohn's disease and herbal cannabis was identified. The study revealed no significant differences of remission rate because of low statistical power. However, there was a clear tendency for less abdominal pain and improved appetite with medical cannabis. The methodological risk of the study was high. Furthermore, results of two RCTs investigating synthetic cannabis in IBD and chronic pancreatitis, respectively, have not yet been released. No RCT for IBS was found. Several case reports described cannabis-induced acute pancreatitis. CONCLUSIONS: Cannabis may be useful for symptom relief in Crohn's disease such as pain, nausea, and loss of appetite. However, studies with high methodological quality, sufficient sample size, and study duration are mandatory to determine potential therapeutic effects and risks of cannabis in gastroenterology. Currently, use of tetrahydrocannabinol to alleviate symptoms such as pain and appetite loss in Crohn's disease should only be considered in individual patients after failure of established medical therapies and only after careful risk-benefit assessment.

Imaging trends and radiation exposure in pediatric inflammatory bowel disease at an academic children's hospital.

OBJECTIVE: The purpose of this study was to retrospectively evaluate diagnostic imaging trends and radiation exposure in pediatric inflammatory bowel disease (IBD) at a U.S. academic children's hospital between 2001 and 2010. MATERIALS AND METHODS: Pediatric IBD patients within our health system during the 2001, 2006, and 2010 calendar years were identified. The number of abdominopelvic radiologic and endoscopic examinations (total and by modality) performed during each 1-year-period was recorded for each subject. Means were compared using the Wilcoxon rank sum test. The cumulative lifetime number of diagnostic examinations by modality and estimated effective radiation dose (using Monte Carlo simulation software and CT dose-length product values) was calculated for the 2010 IBD subject cohort. RESULTS: There was a 53% increase in the average number of abdominopelvic diagnostic examinations obtained per pediatric IBD patient comparing 2001 with 2010 (1.29 ± 2.19 vs 1.98 ± 3.46, p = 0.004). Abdominal radiography (p = 0.02), MRI (p < 0.0001), and esophagogastroduodenoscopy (EGD) (p = 0.01) showed significantly increased use. The increase in use of CT and ileocolonoscopy was not significant (p > 0.05). There was significantly reduced use of contrast enema, small-bowel follow-through (SBFT), and upper gastrointestinal (UGI) series (all, p < 0.0001). The average pediatric IBD patient seen in 2010 (mean age, 13.9 years) had undergone 1.08 CT, 0.82 MRI, 1.36 abdominal radiographic, 0.14 contrast enema, 0.52 SBFT, 0.54 UGI, 1.00 ileocolonoscopy, and 0.72 EGD examinations during his or her lifetime, with an average cumulative lifetime estimated effective radiation dose of 4.6 mSv. CONCLUSION: Although the number of yearly diagnostic examinations performed for pediatric IBD patients increased significantly between 2001 and 2010, the cumulative lifetime estimated effective radiation dose is relatively low in most of these patients.

Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis.

OBJECTIVE: To critically analyze the diagnostic value of transvaginal sonography (TVS) for non-invasive, presurgical detection of bowel endometriosis. METHODS: MEDLINE (1966-2010) and EMBASE (1980-2010) databases were searched for relevant studies investigating the diagnostic accuracy of TVS for diagnosing deep infiltrating endometriosis involving the bowel. Diagnosis was established by laparoscopy and/or histopathological analysis. Likelihood ratios (LRs) were recalculated in addition to traditional measures of effectiveness. RESULTS: Out of 188 papers, a total of 10 studies fulfilled predefined inclusion criteria involving 1106 patients with suspected endometriosis. The prevalence of bowel endometriosis varied from 24 to 73.3%. LR+ ranged from 4.8 to 48.56 and LR- ranged from 0.02 to 0.36, with wide confidence intervals. Pooled estimates of sensitivities and specificities were 91 and 98%; LR+ and LR- were 30.36 and 0.09; and positive and negative predictive values were 98 and 95%, respectively. Three of the studies used bowel preparations to enhance the visibility of the rectal wall; one study directly compared the use of water contrast vs. no prior bowel enema, for which the LR- was 0.04 and 0.47, respectively. CONCLUSIONS: TVS with or without the use of prior bowel preparation is an accurate test for non-invasive, presurgical detection of deep infiltrating endometriosis of the rectosigmoid.

CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease.

OBJECTIVE: The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease. METHODS: 145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n = 75) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n = 70). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel follow-through examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by χ² testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient. RESULTS: Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p<0.05: statistically significant difference). No significant difference was present for others sites (p>0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv). CONCLUSION: PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.

Is 99mTc-HMPAO granulocyte scan an alternative to endoscopy in pediatric chronic inflammatory bowel disease (IBD)?

Although endoscopy with biopsy is the gold standard for the diagnosis of inflammatory bowel disease (IBD), this procedure is invasive and its repetition is stressful, especially in children. The purpose of this study was to evaluate prospectively the role of (99m)Tc-HMPAO-labeled granulocyte scintigraphy in the diagnosis and follow-up of pediatric IBD and its possible use as an alternative to colonoscopy to determine the disease extent and severity beyond its ability to differentiate ulcerative colitis from Crohn's disease. During a 10-year period, 52 children, aging between 2 and 17 years (median, 11.09 years), were subjected to (99m)Tc-HMPAO granulocyte scan 7-28 days from conventional diagnostic tests, and the results were compared with endoscopic and bioptic results. Disease severity was graded by the focal uptake intensity versus iliac bone uptake (Scan Activity Index) and compared with Endoscopy Mayo Score. In 15 out of 16 patients, IBD diagnosis was obtained with a full correspondence of location and severity of lesions, respectively, in 14 out of 16 and 13 out of 16, while in 31 out of 36 patients, IBD was correctly excluded (sensitivity of 93.7%, specificity of 86.1%, and negative predictive value of 96.4%). During the follow-up, all relapses (24) and remissions (13) were correctly recognized (sensibility and specificity of 100%). In conclusion, (99m)Tc-HMPAO granulocyte scan is an accurate minimally invasive technique with very good accuracy, able to diagnose and to grade the intensity and extent of the disease; it is also a useful tool in the follow-up of pediatric IBD where it could reliably replace the invasive endoscopic assessment in most cases.

[Analysis of risk factors for low bone mineral density in patients with inflammatory bowel disease].

BACKGROUND/AIMS: Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient. METHODS: BMD of the lumbar spine and femur was evaluated using dual-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records. RESULTS: Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohns disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD. CONCLUSIONS: Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment.

Inflammatory chronic disease of the colon: how to image.

Inflammatory bowel disease, including Crohn's disease and UC, is a chronic disorder of the gastrointestinal tract. The inflammatory process in UC is confined to the mucosa and submucosa and it involves only the colon. In contrast, in Crohn's disease the inflammation process extends through the bowel wall layers and it can involve any part of gastrointestinal tract. Moreover, inflammatory bowel disease of the colon may be associated with complications, such as toxic megacolon, fulminant colitis, acute bleeding, fistulas and abscesses. Radiographic imaging studies are useful for the diagnosis of inflammatory bowel disease, and may be used to assess the extent and severity of disease, rule out complications, and monitor the response to therapy. The double-contrast barium study is a valuable technique for diagnosing inflammatory bowel disease colonic alterations, even in patients with early mucosal abnormalities. The earliest finding of UC is characterized by a fine granular appeareance of the colonic mucosa, usually involving the rectosigmoid junction. In chronic UC double-contrast enema may reveal marked colonic shortening with tubular narrowing of the bowel and loss of haustration. The earliest radiographics findings of Crohn's disease are represented by aphthous ulcers. As disease progresses, aphthous ulcers may enlarge and coalesce to form stellate or linear areas of ulceration. In advanced Crohn's disease, transmural ulceration may lead to the development of fissures, sinus tracts, fistulas, and abscesses. Cross sectional studies such as computed tomography, magnetic resonance imaging and sometimes ultrasound, are useful alternative tools not only in the assessment of bowel wall abnormalities, but also for the assessment of extraluminal alterations in patients with advanced disease.

[Imaging diagnosis of inflammatory bowel disease]. / Bildgebende Diagnostik chronisch entzündlicher Darmerkrankungen.

The term "chronic inflammatory bowel disease" represents a spectrum of diseases out of which ulcerous colitis and Crohn's disease are the far most common. Large bowel enemas have lost their relevance compared to colonoscopy over the past years and small bowel enteroclysis has also been widely replaced by CT- and especially MR-enteroclysis meanwhile. The diagnostic value of computed tomography and MR-tomography in chronic inflammatory bowel disease is based on the excellent visualization and documentation of extent and severity of bowel wall inflammation, estimation of inflammatory activity of the disease and of detection of potential extraintestinal complications and/or additional diagnoses by these two methods. Nevertheless, conventional radiological techniques as well as sonography may still be valuable under certain conditions. Furthermore, nowadays imaging of chronic inflammatory bowel diseases includes also White Blood Cell scintigraphy as well as Positrone Emission Tomography which provide informations about extent and especially activity of the disease. The presented article provides an overview of the possibilities and limitations of the available imaging modalities in inflammatory bowel diseases and helps the reader to decide under what conditions which one of the available examinations should be regarded as the most appropriate and promising one.

Comparison of multidetector CT and barium studies of the small bowel: inflammatory bowel disease in children.

OBJECTIVE: We compared barium studies of the small bowel with multidetector CT (MDCT) in the evaluation of the small bowel during the initial presentation of inflammatory bowel disease in a pediatric population. SUBJECTS AND METHODS: This was a prospective study. Eighteen children undergoing workup for inflammatory bowel disease underwent MDCT, colonoscopy, and barium studies of the small bowel before commencement of therapy. Examinations were independently reviewed. The patients and their guardians completed a questionnaire assessing the acceptability of each study. RESULTS: In 13 of 18 children, the findings of MDCT and barium studies of the small bowel concurred in the evaluation of terminal ileum disease. In three of these children, MDCT detected skip segments of small-bowel disease not detected on barium studies of the small bowel. In two of 18 children, the terminal ileum was not visualized on barium studies of the small bowel, whereas MDCT showed substantial terminal ileum disease in both children. In three of 18 children, there was discordance between the two tests regarding terminal ileum disease. However, these discordant imaging findings were all subtle. In addition, MDCT revealed extraenteric abnormalities, clinically relevant in two children (ureteric obstruction and perirectal abscess), and showed the colon in all children, seven of whom had incomplete colonoscopy. The questionnaire revealed that 16 of 18 patients preferred MDCT to small-bowel barium studies. The reasons given were poor tolerance of oral barium and the long duration of barium studies of the small bowel. CONCLUSION: MDCT can be an alternative to barium studies of the small bowel for evaluation of the small bowel in patients with inflammatory bowel disease. MDCT also offers additional, clinically relevant information not obtained by small-bowel barium studies.

[Barium examinations of the small intestine and the colon in inflammatory bowel disease]. / Konventionelle Dünn- und Dickdarmdiagnostik bei entzündlichen Darmerkrankungen.

PURPOSE: This article gives an overview of the possibilities of conventional radiography in the diagnosis of inflammatory bowel disease of the small intestine and colon. MATERIAL AND METHODS: For more than 25 years we examine the small bowel employing enteroclysis with barium and methylcellulose and the colon with the usual double-contrast method. In the last 152 months 1560 small bowel enemas were performed. In the last 40 months 410 examinations of the colon were performed. RESULTS: There is a thirty percent decrease in enteroclysis examinations within the past 5 years,however, the rate of examinations with positive results increased from 46 to 57%. The proportion of the inflammatory small intestinal diseases (not only Crohn's disease) remained constant with 18%.Concerning the examinations of the colon for inflammatory disease we confirmed the diagnosis in seven cases. The radiation exposure for the enteroclysis in inflammatory diseases was 7 mSv, for colon examinations 14 mSv. CONCLUSION: Barium examinations, especially of the stomach and colon are decreasing in frequency. Therefore the art of performance and interpretation might get lost.Enteroclysis, however, is still the method of reference for the other imaging methods. The advantages compared to the other imaging methods are the excellent presentation of the details of the mucosal surface and the observation of functional disorders.

[Computed tomography in the diagnosis of inflammatory bowel disease -- methodology of MSCT and clinical results]. / Die Computertomographie in der Diagnostik entzündlicher Darmerkrankungen: Methodik der MSCT und klinische Ergebnisse.

PURPOSE: This paper discusses the diagnostic yield of multislice computed tomography (MSCT) in inflammatory bowel disease. METHODS: Contrast media are administered intraluminally (colon, small intestine) and intravenously (triple contrast CT). Filling of small bowel is achieved by means of jejunal tube ("Sellink CT") or via the oral route. Pharmacological relaxation of the intestine decreases motion artifact. Intraluminal contrast media consist of either hyperdense, "positive" or hypodense, "negative" liquids. RESULTS: Thin-slice MSCT of the entire abdomen allows high-quality post processing (MPR, thin-slice MIP). Due to superior distension, Sellink CT improves estimation of stenosis or changes in thickness and contrast of bowel wall. Positive contrast is superior in the detection and preoperative localization of abscess, fistula or conglomerate tumour, because it accurately differentiates between intra- and extraluminal structures.However, negative contrast facilitates quantitative evaluation of bowel wall thickening or enhancement and demonstrates gastrointestinal bleeding. CONCLUSION: MSCT of the small intestine is superior to conventional enteroclysis, especially in the diagnosis of mesenterial or other extraintestinal disease. As a side effect, the colon is assessed in the same examination. Radiation dose is less in MSCT (7.8-13.3 mSv) than in conventional fluoroscopy (13.99+/-7.57 mSv). MSCT can be performed as an alternative or adjunct to colonoscopy, if endoscopic access is restricted. It is already the imaging modality of choice in acute diverticulitis.

Evaluación de pacientes con enfermedad de Crohn mediante RM con enteroclisis y ecografía Doppler / Doppler ultrasound and MR enteroclysis imaging of Crohns disease

Objetivo: presentar nuestra experiencia en pacientes con enfermedad de Crohn del intestino delgado evaluados con ecografía Doppler (ED) y resonancia magnética con enteroclisis (RM). Material y métodos: se evaluaron 12 pacientes mediante ED y RM con contraste negativo (bario y metilcelulosa) y gadolinio. Se analizó la presencia de flujo en ED y tinción en la pared de las asas en RM, espesor parietal y complicaciones. Resultados: Todos los pacientes mostraron tinción de la pared por RM y en once flujo por ED. La correlación entre ambos métodos fue total en 10 pacientes. La RM mostró en 10 pacientes áreas de estenosis, mientras que la ecografía en 5 pacientes. Ambos métodos mostraron engrosamiento parietal, y en igual porcentaje fístulas y abscesos. Conclusión: Ambos métodos permiten identificar y cuantificar alteraciones en el intestino delgado en pacientes con enfermedad de Crohn, pudiendo ser útiles en la evaluación y seguimiento de estos pacientes (AU)

Enteroclysis and computed tomography enteroclysis.

Enteroclysis, the most detailed radiologic examination of the small bowel, can be a challenge for both patient and radiologist. This article broadly outlines the principal technical features of the standard enteroclysis procedure and discusses its diagnostic advantages and indications, as well as its limitations and difficulties. A comparative assessment of computed tomography-enteroclysis and the emerging magnetic resonance adaptation complements the survey of current approaches to radiologic small bowel diagnostics.