A narrative review on the role and main findings of the Videofluoroscopic Study of Swallowing in Parkison's disease.

PURPOSE: Dysphagia is a common symptom in patients with Parkinson's disease (PD), though it may go undiagnosed until severe complications arise. Dysphagia can be suspected on a clinical basis, but an instrumental assessment is mandatory to confirm its presence and evaluate pathophysiological aspects and severity of the swallowing impairment. Aim of this review is to inform the clinician and the radiologist on the importance and the main radiological findings of the Video-Fluoroscopic-Swallow-Study (VFSS) in patients with PD starting from the most recent literature data on the topic. MATERIALS AND METHODS: Databases analysis identified 98 papers (January 2000/October 2022) of which 55 were excluded after reading title, abstract and full-text. After evaluation of the selected articles and their references 7 additional papers were added. RESULTS: Fifty papers were reviewed to answer the following four main questions: Should VFSS be routinely used to screen dysphagia? Compared to other diagnostic tools, what is the role of VFSS in PD patients with suspected dysphagia? What are the main VFSS findings and technical expedients ? What is the role of VFSS in the choice of the best treatment strategy ? CONCLUSIONS: VFSS represents a gold standard technique in the diagnostic evaluation of dysphagia in PD, having a fundamental role in the identification of patients with high risk of aspiration pneumonia and also being extremely helpful to guide to the choice of treatment strategies for dysphagia.

Is really megacolon a contraindication to infliximab in Crohn's disease?

Toxic megacolon (TM) is a rare complication of severe ulcerative colitis (UC) and colonic Crohn's disease (CD), defined as a clinical syndrome accompanied by radiographic evidence of colonic dilatation that in many cases must be treated aggressively with surgical intervention (1). We report two cases of steroid and antibiotic-refractory fulminant Crohn's colitis, complicated by toxic megacolon, who were successfully treated with infliximab (IFX), thus avoiding surgical intervention. Although there are no well defined recommendation about the correct timing of colectomy in CD-associated TM, and despite the fact that it may be imprudent to advocate delaying surgery in favour of anti-tumor necrosis (anti-TNF) factor therapy in these cases, we think that a medical "rescue therapy" can be considered in a subset of patients with stable clinical condition during corticosteroid treatment.

Delayed-onset superior mesenteric artery syndrome presenting as oesophageal peptic stricture.

Superior mesenteric artery (SMA) syndrome is an infrequent cause of vomiting and weight loss due to compression of the third part of the duodenum by the SMA. We describe the case of a 17-year-old woman, admitted to our department for progressive dysphagia and severe weight loss due to an oesophageal peptic stricture, caused by chronic acid reflux secondary to duodenal compression by the SMA. Symptoms improved after (par)enteral nutrition and repeated oesophageal dilatation, thus supporting the role of intensive medical and endoscopic intervention as an alternative to surgery, at least in some cases.

Acquired double pylorus, due to penetrating gastric ulcer, presenting with melena.

Acquired double pylorus (DP) is an uncommon condition consisting of two communicating channels between the gastric antrum and the first part of duodedum. Little is known about the origin of DP. As there is no specific gastrointestinal symptom due to DP, most often it is diagnosed by gastroscopy while performing for other indicationsFew data are also known about the clinical course of DP. In the patients with peptic ulcer symptoms, the pyloroplasty-like drainage effect, improving gastric emptying after the estabilishment of the fistula, could relieve these symptoms. This represents an unresolved issues about the necessity of repeating endoscopy to document in the patients with DP its final outcome, as the risk of ulcer recurrence. We describe a case of a 76-years-old woman admitted to our department for hyposideremic anemia associated to a recent history of melena.

Crohn's disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema.

BACKGROUND: Small intestine contrast ultrasonography (SICUS), when performed after distention of the small bowel lumen with an iso-osmolar polyethylene glycol electrolyte-balanced solution, shows high sensitivity (100%) and specificity (97%) in detecting small bowel abnormalities in patients who have not received a diagnosis but in whom there is a suspicion of intestinal diseases. The diagnostic yield of SICUS remains to be established in detecting small bowel lesions in patients with proven Crohn's disease (CD) in comparison with transabdominal ultrasonography (TUS), and in relationship to the experience of the operator, using small bowel enema (SBE) as the "gold standard." AIM: The aim of this study was to evaluate the diagnostic value of SICUS, when performed by a sonologist with 1 year of experience, and TUS, when performed by a sonologist with 10 years of experience, compared to SBE in the assessment of the site, extension, and stenosis of small intestinal lesions in CD patients. PATIENTS AND METHODS: A total of 28 consecutive patients (men, 16; women, 12; age range, 21 to 60 yr) with a diagnosis of CD underwent TUS and SICUS, which were performed by 2 sonologists who were unaware of the radiologic findings, on the same day. SICUS was performed after the ingestion of 375 mL of a polyethylene glycol contrast solution. A standard SBE was performed on a different day by an expert radiologist who was unaware of the sonographic findings. RESULTS: Sensitivities in the detection of small bowel lesions were 96% for TUS and 100% for SICUS. Compared with SBE, SICUS detected the presence of 4 lesions in the jejunum that had been missed by TUS. The mean (+/-SD) extent of the ileal disease was 22 +/- 12.5 cm when measured during SBE, 14.5 +/- 8.6 cm when measured during TUS, and 19.5 +/- 12.5 cm when measured during SICUS [P = 0.05 (SICUS versus SBE)]. The correlation of the extension of the lesions between SICUS and SBE (r = 0.88) was better than that between TUS and SBE (r = 0.64). The sensitivities of TUS and SICUS in the detection of at least 1 stricture were 76% and 94%, respectively. Sensitivity and specificity in assessing prestenotic dilatation were 50% and 100%, respectively, at TUS, and 100% and 90%, respectively, at SICUS. CONCLUSION: In inexperienced hands, SICUS is a more accurate technique for assessing CD lesions, and the accuracy is better than that of TUS performed by an expert sonologist. The use of SICUS, instead of SBE, could be indicated for the follow-up of patients with CD.

Radiology and adult celiac disease. Current indications of small bowel barium examinations.

PURPOSE: To evaluate the current role of small bowel (SB) radiologic barium examinations in adult celiac disease (ACD). MATERIALS AND METHODS: Retrospective review of 61 SB barium examinations in 280 ACD patients. Sixty-one examinations in 61 patients were performed: 7/61 with small bowel ''follow-through'' (SBFT) method, and 54/61 with small bowel double-contrast enteroclysis (SBE). Radiological criteria for ACD diagnosis were divided in four groups: 1) definite ACD (reversal of jejuno-ileal fold pattern); 2) possible ACD (malabsorption pattern and ileal jejunization); 3) malabsorption (fluid, dilatation, ''moulage'', flocculation); 4) complicated ACD (irregular, thickened, nodular folds; wall thickening; masses). RESULTS: In 49/61 patients RX examinations were performed before ACD diagnosis. In this group, clinical presentations included one or more of the following: diarrhea, weight loss, malabsorption, anemia, abdominal pain; 7/49 had a SBFT, and 42/49 a SBE. All 7 SBFTs showed pattern 3, and 8/42 SBEs showed pattern 2 (suspected ACD). In 34/42 patients SBE allowed a definite ACD diagnosis (pattern 1); however, 6/34 were also false-positive for complicated ACD (pattern 4). Ten out of sixty-one patients were clinically suspected of having complicated ACD, correctly excluded (8/8) or confirmed (2/2) by SBE. None of these 59/61 patients had a radiologic diagnosis of normal' SB. The last 2/61 patients with ACD, examined for persisting chronic anemia, had a normal SBE. CONCLUSIONS: This study confirm that SB radiology may be of value either in ACD diagnosis or in excluding complications: SBE is currently the most accurate examination. SBE alone is however less accurate in confirming complicated ACD; further imaging techniques are always needed in this clinical context.