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Simon M, Morell-Dubois S, Venturelli G, Launay D. Atteinte digestive diagnostiquée par une vidéocapsule au cours d’une granulomatose éosinophilique avec polyangéite. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kawasaki K, Nakamura S, Esaki M, Kurahara K, Eizuka M, Okamoto Y, Hirata T, Hirahashi M, Oshiro Y, Yanai S, Sato K, Toya Y, Maemondo M, Terayama Y, Sugai T, Matsumoto T. Gastrointestinal involvement in patients with vasculitis: IgA vasculitis and eosinophilic granulomatosis with polyangiitis. Endosc Int Open 2019; 7:E1333-E1343. [PMID: 31673603 PMCID: PMC6805183 DOI: 10.1055/a-0977-2777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Among vasculitides, IgA vasculitis (IgAV) and eosinophilic granulomatosis with polyangiitis (EGPA) frequently damage the gastrointestinal tract. However, only a few studies have investigated the entire gastrointestinal tract in patients with IgAV or EGPA by endoscopy. The aim of this study was to clarify endoscopic characteristics of patients with IgAV and those with EGPA. Patients and methods Clinicopathological and endoscopic findings were retrospectively compared between 33 patients with IgAV and 19 patients with EGPA. Results Gastrointestinal involvement was observed in 33 patients with IgAV (100 %) and in 8 patients with EPGA (42 %; P = 0.0001). Duodenal involvement was more frequent in patients with IgAV (75.8 %) than in those with EGPA (21.1 %, P = 0.0002). Jejunoileal involvement was frequent in both groups (IgAV 94.4 %; EGPA 77.8 %). Gastric mucosal erythema was more frequent in patients with IgAV (18.2 %) than in those with EGPA (0 %, P = 0.0481). Duodenal mucosal erythema (IgAV 54.6 %; EGPA 21.1 %, P = 0.0227), ulcer (IgAV 33.3 %; EGPA 0 %, P = 0.0041), and hematoma-like protrusion (IgAV 21.1 %; EGPA 0 %, P = 0.039) were more frequently observed in patients with IgAV than in those with EGPA. Conclusions Frequent duodenal involvement, gastric mucosal erythema, and duodenal lesions including erythema, ulcer, and hematoma-like protrusion are characteristic of patients with IgAV. Because jejunoileal involvement was frequent in both groups of patients, small-bowel endoscopies should be performed for diagnosis of small-bowel lesions in patients with IgAV and EGPA.
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Affiliation(s)
- Keisuke Kawasaki
- Division of Gastroenterology, Iwate Medical University, Morioka, Japan,Corresponding author Keisuke Kawasaki, MD Division of Gastroenterology, Department of Internal MedicineIwate Medical University19-1, UchimaruMorioka, 020-8505Japan+81-19-652-6664
| | - Shotaro Nakamura
- Division of Gastroenterology, Iwate Medical University, Morioka, Japan
| | - Motohiro Esaki
- Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Makoto Eizuka
- Department of Diagnostic Pathology, Iwate Medical University, Morioka, Japan
| | - Yasuharu Okamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Hirata
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Minako Hirahashi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yumi Oshiro
- Department of Pathology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, Iwate Medical University, Morioka, Japan
| | - Kunihiko Sato
- Division of Gastroenterology, Iwate Medical University, Morioka, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Iwate Medical University, Morioka, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University, Morioka, Japan
| | - Yasuo Terayama
- Division of Neurology and Gerontology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Morioka, Japan
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Eriksson P, Segelmark M, Hallböök O. Frequency, Diagnosis, Treatment, and Outcome of Gastrointestinal Disease in Granulomatosis with Polyangiitis and Microscopic Polyangiitis. J Rheumatol 2018; 45:529-537. [DOI: 10.3899/jrheum.170249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 12/17/2022]
Abstract
Objective.Involvement of the gastrointestinal (GI) tract is a rare complication of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). The aim was to describe frequency, diagnosis, treatment, and outcome of GI disease in a large series of patients in a single center.Methods.A database that includes all patients with GPA and MPA diagnosed since 1997 in a defined area of southeastern Sweden as well as prevalent older cases and tertiary referral patients was screened for patients with GI disease. Data were retrieved from the patient’s medical records, and GI manifestations of vasculitis were defined as proposed by Pagnoux,et alin 2005.Results.Fourteen (6.5%) of 216 consecutive patients with GPA/MPA had GI manifestations. Abdominal pain and GI bleeding were the most common symptoms. Radiology was important for detection of GI disease, while endoscopy failed to support the diagnosis in many patients. Because of perforation, 5 patients underwent hemicolectomy or small intestine resection. Primary anastomosis was created in 2/5 and enterostomy in 3/5 patients. One patient had a hemicolectomy because of lower GI bleeding. One sigmoid abscess was treated with drainage, and 1 intraabdominal bleeding condition with arterial coiling. Two patients died from GI disease. GPA and MPA patients with and without GI disease exhibited a similar overall survival.Conclusion.GI disease was found in 6.5% among 216 patients with GPA or MPA. Surgery was judged necessary only in cases with GI perforation or severe bleeding. Multidisciplinary engagement is strongly recommended.
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Colitis as a form of presentation of eosinophilic granulomatosis with polyangiitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2017. [PMID: 28645447 DOI: 10.1016/j.gastrohep.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zeng M, Liu X, Liu Y. Eosinophilic Granulomatosis with Polyangiitis Presenting with Skin Rashes, Eosinophilic Cholecystitis, and Retinal Vasculitis. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:864-868. [PMID: 27857032 PMCID: PMC5117240 DOI: 10.12659/ajcr.899441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome (CSS), is a rare vasculitis of unknown etiology. Most of the patients have a long history of asthma and then develop autoimmune inflammation of small and medium-sized blood vessels, with consequent reduction of blood flow to various organs and tissues. EGPA can cause disorders in multiple systems; the most seriously affected organs are the retina, kidney, brain, cardiovascular system, and skin. CASE REPORT The patient was hospitalized for high fever and skin rashes and then developed right upper abdominal pain, decreased visual acuity, coma, and convulsions. Laboratory investigations showed marked eosinophilia (9412/mm3). Following cholecystectomy, histopathological examination revealed a marked inflammatory cell infiltrate composed mainly of eosinophils. Retinal vasculitis and medium and peripheral vascular closure were confirmed by fundus fluorescence angiography (FFA). The coma and convulsions were controlled successfully by high-dose methylprednisolone. After gradual tapering of the methylprednisolone, the patient's blood count recovered to a normal level, and the other systematic disorders disappeared; however, she was left with irreversible blindness. CONCLUSIONS EGPA can cause eosinophilic cholecystitis, retinal vasculitis, and neuropathy in the short term and calls for effective treatments in order to avoid binocular blindness.
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Affiliation(s)
- Mingbing Zeng
- Zhongshang Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Xialin Liu
- Zhongshang Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yizhi Liu
- Zhongshang Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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Beye B, Lesur G, Claude P, Martzolf L, Kieffer P, Sondag D. Small bowel involvement documented by capsule endoscopy in Churg-Strauss syndrome. Pan Afr Med J 2015; 22:41. [PMID: 26664542 PMCID: PMC4662522 DOI: 10.11604/pamj.2015.22.41.7810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022] Open
Abstract
Churg-Strauss syndrome is a small and medium vessel vasculitis and is also known as allergic granulomatous angiitis. Gastrointestinal involvement is common in patients with Churg-Strauss syndrome (20-50%). The most common symptoms are abdominal pain, diarrhoea and occasionally gastrointestinal bleeding and perforation. We present a case of Churg-Strauss syndrome with small bowel lesions documented by video capsule endoscopy.
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Affiliation(s)
- Birane Beye
- Service de Gastroentérologie, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100 Boulogne, France ; UFR 2S, Université Gaston Berger, St-Louis, Sénégal
| | - Gilles Lesur
- Service de Gastroentérologie, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100 Boulogne, France
| | - Pierre Claude
- Service de Gastroentérologie, Centre Hospitalier, 20 Avenue Réné Laennec, 68100 Mulhouse, France
| | - Lionel Martzolf
- Service de Médecine Interne, Centre Hospitalier, 20 Avenue Réné Laennec, 68100 Mulhouse, France
| | - Pierre Kieffer
- Service de Médecine Interne, Centre Hospitalier, 20 Avenue Réné Laennec, 68100 Mulhouse, France
| | - Daniel Sondag
- Service de Gastroentérologie, Centre Hospitalier, 20 Avenue Réné Laennec, 68100 Mulhouse, France
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Sawano M, Umeno J, Esaki M. An Unusual Cause of Small Intestinal Ulcers. Gastroenterology 2015; 149:e10-1. [PMID: 26319034 DOI: 10.1053/j.gastro.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/05/2015] [Accepted: 02/10/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Miyuki Sawano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Esaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Redondo-Cerezo E, Sánchez-Capilla AD, De La Torre-Rubio P, De Teresa J. Wireless capsule endoscopy: Perspectives beyond gastrointestinal bleeding. World J Gastroenterol 2014; 20:15664-15673. [PMID: 25400450 PMCID: PMC4229531 DOI: 10.3748/wjg.v20.i42.15664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/09/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.
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Fukushima M, Inoue S, Ono Y, Tamaki Y, Yoshimura H, Imai Y, Inokuma T. Microscopic polyangiitis complicated with ileal involvement detected by double-balloon endoscopy: a case report. BMC Gastroenterol 2013; 13:42. [PMID: 23452722 PMCID: PMC3598977 DOI: 10.1186/1471-230x-13-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/28/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Microscopic polyangiitis is characterized by pauci-immune, necrotizing small-vessel vasculitis and an anti-neutrophil cytoplasmic antibody-associated vasculitis. Although gastrointestinal involvement in microscopic polyangiitis is not rare, endoscopic observation of it is extremely rare. To the best of our knowledge, this is the first case report of small intestinal involvement in microscopic polyangiitis detected and followed up by double-balloon endoscopy. CASE PRESENTATION A 70-year-old Japanese woman was transferred to our hospital for close examination of suspected small intestinal lymphoma. Retrograde double-balloon endoscopy revealed various forms of ulcers with redness and edema in the ileum. Histological findings suggested ischemic changes. Because mononeuritis multiplex and a fever spike appeared later, vasculitis was suspected. The perinuclear anti-neutrophil cytoplasmic antibody titer was elevated. Nerve biopsy results suggested vasculitis. From these findings, microscopic polyangiitis was diagnosed. It was suggested that microscopic polyangiitis caused the intestinal involvement. Intravenous pulse cyclophosphamide and oral predonisolone were started. After treatment, perinuclear anti-neutrophil cytoplasmic antibodies decreased to the normal range. Retrograde double-balloon endoscopy after treatment showed ulcer scars and no ulcer. CONCLUSION The cause of gastrointestinal involvement in microscopic polyangiitis is ischemia due to vasculitis. It is difficult to diagnose small-vessel vasculitis by endoscopic biopsy. Although histological evidence of microscopic polyangiitis is important, the treatment should not be delayed by repeating the biopsy, because such delay can result in adverse sequela.This case report shows that microscopic polyangiitis should be considered as a differential diagnosis when small intestinal changes like those in the present case are observed by endoscopy.
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Affiliation(s)
- Masashi Fukushima
- Department of Gastroenterology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
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Suzuki T, Matsushima M, Arase Y, Fujisawa M, Okita I, Igarashi M, Koike J, Mine T. Double-balloon endoscopy-diagnosed multiple small intestinal ulcers in a Churg-Strauss syndrome patient. World J Gastrointest Endosc 2012; 4:194-6. [PMID: 22624072 PMCID: PMC3355243 DOI: 10.4253/wjge.v4.i5.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 09/12/2011] [Accepted: 03/30/2012] [Indexed: 02/05/2023] Open
Abstract
Churg-Strauss syndrome (CSS) is a systemic vascular disorder characterized by severe bronchial asthma, hypereosinophilia, and allergic rhinitis. Small intestinal ulcers associated with CSS are a relatively rare manifestation that causes gastrointestinal bleeding. Multiple deep ulcers with an irregular shape are characteristic of small intestinal involvement of CSS. Video-capsule-endoscopy (VCE), double-balloon endoscopy (DBE) and Spirus assisted enteroscopy have been developed recently and enabled observation of the small intestine. In this case report, we have described a patient with CSS who had multiple deep ulcers in the jejunum detected by oral DBE. Since severe gastrointestinal (GI) involvement has been identified as an independent factor associated with poor outcome, the careful investigation of GI tract must be needed for CSS patients with GI symptoms. We describe the usefulness of DBE for diagnosis of small intestinal ulcers in patient with CSS.
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Affiliation(s)
- Takayoshi Suzuki
- Takayoshi Suzuki, Masashi Matsushima, Yoshitaka Arase, Mia Fujisawa, Ichiro Okita, Muneki Igarashi, Jun Koike, Tetsuya Mine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
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Harada T, Ito S, Sasaki T, Kunisaki R, Shiojima H, Ogawa M, Yokota S. GI involvement of sigmoid mucosal erosion in a 13-year-old girl with microscopic polyangiitis. Gastrointest Endosc 2011; 74:937-9. [PMID: 21195409 DOI: 10.1016/j.gie.2010.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 10/21/2010] [Indexed: 12/11/2022]
Affiliation(s)
- Tomonori Harada
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
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Jolobe OMP. Capsule endoscopy might help to delineate the temporal relationship between intestinal and cardiac manifestations of vasculitis. Eur J Intern Med 2010; 21:571. [PMID: 21111948 DOI: 10.1016/j.ejim.2010.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/25/2010] [Indexed: 11/23/2022]
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Kallel L, Khanfir M, Sassi SB, Mrabet D, Chelly I, Filali A. Une présentation gastro-intestinale rare d’un syndrome de Churg-Strauss. Presse Med 2010; 39:395-7. [DOI: 10.1016/j.lpm.2009.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 10/28/2009] [Accepted: 11/20/2009] [Indexed: 01/22/2023] Open
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Abstract
Double-balloon endoscopy has been available for investigation of the small bowel since 2001, concomitantly with capsule endoscopy. Beyond established indications, endoscopic examination of the small bowel is currently performed in many clinical conditions involving the small bowel, which were under investigated in the past. Biopsies of lesions observed by capsule endoscopy or balloon enteroscopy can be taken and the lesions can sometimes be treated during a balloon Endoscopic procedure. Double-balloon endoscopy can be used in patients when conventional endoscopy was incomplete. The main applications of double-balloon endoscopy are the examination of patients with a surgically modified gastrointestinal tract and colonoscopy after a previously failed attempt to reach the cecum. In the latter indication, using a dedicated double-balloon colonoscope, the success rate of cecal intubation may be nearly 100%.
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Affiliation(s)
- Michel Delvaux
- Department of Internal Medicine and Digestive Pathology, Hôpitaux de Brabois, F - 54511 Vandoeuvre les Nancy, France.
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Gay G, Delvaux M, Frederic M. Capsule endoscopy in non-steroidal anti-inflammatory drugs-enteropathy and miscellaneous, rare intestinal diseases. World J Gastroenterol 2008; 14:5237-44. [PMID: 18785273 PMCID: PMC2744051 DOI: 10.3748/wjg.14.5237] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite significant advances over the last decade, mucosal lesions of the small bowel are poorly detected by imaging studies such as CT scan, MRI-enteroclysis and contrast-enhanced abdominal ultrasound. Capsule endoscopy (CE) has dramatically changed the diagnostic approach to intestinal diseases. Moreover, the use of CE can be extended to include other conditions. However, it is difficult to assess the positive influence of CE on patient outcomes in conditions involving a small number of patients, or in critically ill and difficult to examine patients. CE has the advantage of diagnosing intestinal lesions and of directing the use of double balloon enteroscopy (DBE) in order to obtain biopsy specimens. Moreover, CE allows repeated assessment in chronic conditions, especially to detect relapse of an infectious disease.
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Abstract
Most frequent reasons for intensive care unit (ICU) admission in vasculitis patients are severe respiratory insufficiency due to diffuse alveolar haemorrhage, sepsis and/or pneumonia and an acute abdomen due to bowel infarction. Other reasons are massive gastrointestinal bleeding, thromboembolism and/or scissures. In a patient, not previously diagnosed as having vasculitis, diagnosis can be difficult and must be made as soon as possible, since immunosuppressive therapy should be instituted immediately. Immunosuppressive therapy in severe cases consists of high-dose corticosteroids and cyclophosphamide. In addition, in many cases plasma exchange has to be instituted as well. Prognosis is related to disease activity scores of vasculitis and of severity of illness as measured by the APACHE III scoring system and/or the SOFA score. Septic shock is still the leading cause of death in patients with vasculitis. Nowadays, death due to active untreated vasculitis is rare in experienced clinics.
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Affiliation(s)
- J W Cohen Tervaert
- Department of Clinical and Experimental Immunology, Univerity Hospital Maastricht, The Netherlands.
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