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Diagnosis and Treatment of Small Bowel Disorders
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Diagnosis and Treatment of Small Bowel Disorders

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (25 April 2019) | Viewed by 56586

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Anastasios Koulaouzidis

E-Mail Website
Guest Editor
1. Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
2. Centre for Clinical Implementation of Capsule Endoscopy (CICA), Store Adenomer Tidlige Cancere Centre (SATC-C), Svendborg, Denmark
Interests: capsule endoscopy; gastroenterology; collagenous colitis; microscopic colitis
Special Issues, Collections and Topics in MDPI journals
Dr. Wojciech Marlicz

E-Mail Website
Guest Editor
1. Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
2. Endoklinika sp. z o.o., Szczecin, Poland
Interests: microbiome; colonoscopy; probiotics; colorectal cancer; gastric cancer; stem cells
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the last few decades, remarkable progress has been made in understanding the aetiology and pathophysiology of diseases and many new theories emphasize the importance of the small bowel ‘ecosystem’ in the pathogenesis of acute and chronic illness. Emerging factors such as microbiome, stem cells, innate intestinal immunity and the enteric nervous system along with mucosal and endothelial barriers have key role in the development of gastrointestinal and extra-intestinal diseases.

Therefore, the small intestine is considered key player in metabolic disease development, including diabetes mellitus, and other diet-related disorders such as celiac and non-celiac enteropathies. Another major field is drug metabolism and its interaction with microbiota. Moreover, the emergence of gut-brain, gut-liver and gut-blood barriers points toward the important role of small intestine in the pathogenesis of common disorders, such as liver disease, hypertension and neurodegenerative disease.

However, the small bowel remains an organ that is difficult to fully access and assess and accurate diagnosis often poses a clinical challenge. Eventually, the therapeutic potential remains untapped. Therefore, it is due time to direct our interest towards the small intestine and unravel the interplay between small-bowel and other gastrointestinal (GI) and non-GI related maladies.

Dr. Anastasios Koulaouzidis
Dr. Wojciech Marlicz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Small bowel
  • Microbiome/Microbiota
  • Coeliac and non-coeliac gluten sensitivity
  • Drug-related enteropathies
  • Capsule endoscopy (enteroscopy) & other non-imaging capsules
  • Volatile Organic Compounds
  • Confocal laser endomicroscopy
  • Metagenomics & Metabolomics
  • Gut barrier & Probiotics
  • Enteric nervous system
  • Gut-brain axis
  • Gut-liver axis

Published Papers (9 papers)

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Editorial

Jump to: Research, Review

5 pages, 183 KiB  
Editorial
Small Bowel—Key Player in Health and Disease
by Wojciech Marlicz and Anastasios Koulaouzidis
J. Clin. Med. 2019, 8(10), 1748; https://doi.org/10.3390/jcm8101748 - 21 Oct 2019
Cited by 1 | Viewed by 2325
Abstract
Over the last two decades, remarkable progress has been made in understanding the etiology and pathophysiology of diseases [...] Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)

Research

Jump to: Editorial, Review

9 pages, 844 KiB  
Article
Cancer Risk in Collagenous Colitis
by Johanna K. Larsson, Konstantinos J. Dabos, Peter Höglund, Johan Bohr, Andreas Münch, Andry Giannakou, Artur Nemeth, Gabriele Wurm-Johansson, Ervin Toth, John N. Plevris, Paul Fineron, Anastasios Koulaouzidis and Klas Sjöberg
J. Clin. Med. 2019, 8(11), 1942; https://doi.org/10.3390/jcm8111942 - 11 Nov 2019
Cited by 10 | Viewed by 2595
Abstract
Data on malignancy in patients with collagenous colitis (CC) is scarce. We aimed to determine the incidence of cancers in patients with CC. In a two-stages, observational study, data on cancers in patients diagnosed with CC during 2000–2015, were collected from two cohorts. [...] Read more.
Data on malignancy in patients with collagenous colitis (CC) is scarce. We aimed to determine the incidence of cancers in patients with CC. In a two-stages, observational study, data on cancers in patients diagnosed with CC during 2000–2015, were collected from two cohorts. The risk was calculated according to the age-standardized rate for the first cohort and according to the standardized incidence ratio for the second cohort. The first cohort comprised 738 patients (394 from Scotland and 344 from Sweden; mean age 71 ± 11 and 66 ± 13 years, respectively). The incidence rates for lung cancer (RR 3.9, p = 0.001), bladder cancer (RR 9.2, p = 0.019), and non-melanoma skin cancer (NMSC) (RR 15, p = 0.001) were increased. As the majority of NMSC cases (15/16) came from Sweden, a second Swedish cohort, comprising 1141 patients (863 women, mean age 65 years, range 20–95 years) was collected. There were 93 cancer cases (besides NMSC). The risk for colon cancer was decreased (SIR 0.23, p= 0.0087). The risk for cutaneous squamous cell carcinoma was instead markedly increased (SIR 3.27, p = 0.001). Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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13 pages, 17522 KiB  
Article
Intestinal Inflammation in Children with Cystic Fibrosis Is Associated with Crohn’s-Like Microbiota Disturbances
by Raphaël Enaud, Katarzyna B. Hooks, Aurélien Barre, Thomas Barnetche, Christophe Hubert, Marie Massot, Thomas Bazin, Haude Clouzeau, Stéphanie Bui, Michael Fayon, Patrick Berger, Philippe Lehours, Cécile Bébéar, Macha Nikolski, Thierry Lamireau, Laurence Delhaes and Thierry Schaeverbeke
J. Clin. Med. 2019, 8(5), 645; https://doi.org/10.3390/jcm8050645 - 10 May 2019
Cited by 54 | Viewed by 5764
Abstract
Cystic fibrosis (CF) is a systemic genetic disease that leads to pulmonary and digestive disorders. In the majority of CF patients, the intestine is the site of chronic inflammation and microbiota disturbances. The link between gut inflammation and microbiota dysbiosis is still poorly [...] Read more.
Cystic fibrosis (CF) is a systemic genetic disease that leads to pulmonary and digestive disorders. In the majority of CF patients, the intestine is the site of chronic inflammation and microbiota disturbances. The link between gut inflammation and microbiota dysbiosis is still poorly understood. The main objective of this study was to assess gut microbiota composition in CF children depending on their intestinal inflammation. We collected fecal samples from 20 children with CF. Fecal calprotectin levels were measured and fecal microbiota was analyzed by 16S rRNA sequencing. We observed intestinal inflammation was associated with microbiota disturbances characterized mainly by increased abundances of Staphylococcus, Streptococcus, and Veillonella dispar, along with decreased abundances of Bacteroides, Bifidobacterium adolescentis, and Faecalibacterium prausnitzii. Those changes exhibited similarities with that of Crohn’s disease (CD), as evidenced by the elevated CD Microbial-Dysbiosis index that we applied for the first time in CF. Furthermore, the significant over-representation of Streptococcus in children with intestinal inflammation appears to be specific to CF and raises the issue of gut–lung axis involvement. Taken together, our results provide new arguments to link gut microbiota and intestinal inflammation in CF and suggest the key role of the gut–lung axis in the CF evolution. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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8 pages, 1303 KiB  
Article
Role of Mucosal Protrusion Angle in Discriminating between True and False Masses of the Small Bowel on Video Capsule Endoscopy
by May Min, Michael G. Noujaim, Jonathan Green, Christopher R. Schlieve, Aditya Vaze, Mitchell A. Cahan and David R. Cave
J. Clin. Med. 2019, 8(4), 418; https://doi.org/10.3390/jcm8040418 - 27 Mar 2019
Cited by 11 | Viewed by 3799
Abstract
The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific presentation, and limitations of traditional endoscopic techniques. In our study, we examined the utility of the mucosal protrusion angle in differentiating between true submucosal masses and bulges of the small [...] Read more.
The diagnosis of small-bowel tumors is challenging due to their low incidence, nonspecific presentation, and limitations of traditional endoscopic techniques. In our study, we examined the utility of the mucosal protrusion angle in differentiating between true submucosal masses and bulges of the small bowel on video capsule endoscopy. We retrospectively reviewed video capsule endoscopies of 34 patients who had suspected small-bowel lesions between 2002 and 2017. Mucosal protrusion angles were defined as the angle between the small-bowel protruding lesion and surrounding mucosa and were measured using a protractor placed on a computer screen. We found that 25 patients were found to have true submucosal masses based on pathology and 9 patients had innocent bulges due to extrinsic compression. True submucosal masses had an average measured protrusion angle of 45.7 degrees ± 20.8 whereas innocent bulges had an average protrusion angle of 108.6 degrees ± 16.3 (p < 0.0001; unpaired t-test). Acute angle of protrusion accurately discriminated between true submucosal masses and extrinsic compression bulges on Fisher’s exact test (p = 0.0001). Our findings suggest that mucosal protrusion angle is a simple and useful tool for differentiating between true masses and innocent bulges of the small bowel. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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28 pages, 4933 KiB  
Article
A Systematic Review, Meta-Analysis, and Meta-Regression Evaluating the Efficacy and Mechanisms of Action of Probiotics and Synbiotics in the Prevention of Surgical Site Infections and Surgery-Related Complications
by Karolina Skonieczna-Żydecka, Mariusz Kaczmarczyk, Igor Łoniewski, Luis F. Lara, Anastasios Koulaouzidis, Agata Misera, Dominika Maciejewska and Wojciech Marlicz
J. Clin. Med. 2018, 7(12), 556; https://doi.org/10.3390/jcm7120556 - 16 Dec 2018
Cited by 46 | Viewed by 7012
Abstract
Intestinal microbiota play an important role in the pathogenesis of surgical site infections (SSIs) and other surgery-related complications (SRCs). Probiotics and synbiotics were found to lower the risk of surgical infections and other surgery-related adverse events. We systematically reviewed the approach based on [...] Read more.
Intestinal microbiota play an important role in the pathogenesis of surgical site infections (SSIs) and other surgery-related complications (SRCs). Probiotics and synbiotics were found to lower the risk of surgical infections and other surgery-related adverse events. We systematically reviewed the approach based on the administration of probiotics and synbiotics to diminish SSIs/SRCs rates in patients undergoing various surgical treatments and to determine the mechanisms responsible for their effectiveness. A systematic literature search in PubMed/MEDLINE/Cochrane Central Register of Controlled Trials from the inception of databases to June 2018 for trials in patients undergoing surgery supplemented with pre/pro/synbiotics and randomized to the intervention versus placebo/no treatment and reporting on primarily: (i) putative mechanisms of probiotic/symbiotic action, and secondarily (ii) SSIs and SRCs outcomes. Random-effect model meta-analysis and meta-regression analysis of outcomes was done. Thirty-five trials comprising 3028 adult patients were included; interventions were probiotics (n = 16) and synbiotics (n = 19 trials). We found that C-reactive protein (CRP) and Interleukin-6 (IL-6) were significantly decreased (SMD: −0.40, 95% CI [−0.79, −0.02], p = 0.041; SMD: −0.41, 95% CI [−0.70, −0.02], p = 0.006, respectively) while concentration of acetic, butyric, and propionic acids were elevated in patients supplemented with probiotics (SMD: 1.78, 95% CI [0.80, 2.76], p = 0.0004; SMD: 0.67, 95% CI [0.37, −0.97], p = 0.00001; SMD: 0.46, 95% CI [0.18, 0.73], p = 0.001, respectively). Meta-analysis confirmed that pro- and synbiotics supplementation was associated with significant reduction in the incidence of SRCs including abdominal distention, diarrhea, pneumonia, sepsis, surgery site infection (including superficial incisional), and urinary tract infection, as well as the duration of antibiotic therapy, duration of postoperative pyrexia, time of fluid introduction, solid diet, and duration of hospital stay (p < 0.05). Probiotics and synbiotics administration counteract SSIs/SRCs via modulating gut-immune response and production of short chain fatty acids. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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11 pages, 1093 KiB  
Article
Validity of Capsule Endoscopy in Monitoring Therapeutic Interventions in Patients with Crohn’s Disease
by Masanao Nakamura, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Yasuyuki Mizutani, Takuya Ishikawa, Kazuhiro Furukawa, Eizaburo Ohno, Hiroki Kawashima, Ryoji Miyahara, Anastasios Koulaouzidis, Yoshiki Hirooka and The Nagoya University Crohn’s Disease Study Group
J. Clin. Med. 2018, 7(10), 311; https://doi.org/10.3390/jcm7100311 - 29 Sep 2018
Cited by 14 | Viewed by 2752
Abstract
Mucosal healing in Crohn’s disease (CD) can be evaluated by capsule endoscopy (CE). However, only a few studies have utilized CE to demonstrate the therapeutic effect of medical treatment. We sought to evaluate the validity of using CE to monitor the effect of [...] Read more.
Mucosal healing in Crohn’s disease (CD) can be evaluated by capsule endoscopy (CE). However, only a few studies have utilized CE to demonstrate the therapeutic effect of medical treatment. We sought to evaluate the validity of using CE to monitor the effect of medical treatment in patients with CD. One hundred (n = 100) patients with CD were enrolled. All patients had a gastrointestinal (GI) tract patency check prior to CE. Patients with baseline CE Lewis score (LS) ≤ 135 were included in the non-active CD group and ended the study. In those with LS > 135 (active CD group), additional treatment was administered, regardless of symptoms, as per the treating clinician’s advice. Patients of the active CD group underwent follow-up CE assessment 6 months later. Out of 92 patients with confirmed GI patency who underwent CE, 40 (43.4%) had CE findings of active inflammation. Of 29 patients with LS > 135 who received additional medications and underwent follow-up CE, improvement of the LS was noted in 23 (79.3%) patients. Eleven patients were asymptomatic but received additional medications; 8 (72.7%) had improvement of the LS. This study demonstrated that additional treatment even for patients with CD in clinical remission and active small-bowel inflammation on CE can reduce mucosal damage. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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Review

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17 pages, 273 KiB  
Review
Non-Invasive Biomarkers for Celiac Disease
by Alka Singh, Atreyi Pramanik, Pragyan Acharya and Govind K. Makharia
J. Clin. Med. 2019, 8(6), 885; https://doi.org/10.3390/jcm8060885 - 21 Jun 2019
Cited by 21 | Viewed by 5221
Abstract
Once thought to be uncommon, celiac disease has now become a common disease globally. While avoidance of the gluten-containing diet is the only effective treatment so far, many new targets are being explored for the development of new drugs for its treatment. The [...] Read more.
Once thought to be uncommon, celiac disease has now become a common disease globally. While avoidance of the gluten-containing diet is the only effective treatment so far, many new targets are being explored for the development of new drugs for its treatment. The endpoints of therapy include not only reversal of symptoms, normalization of immunological abnormalities and healing of mucosa, but also maintenance of remission of the disease by strict adherence of the gluten-free diet (GFD). There is no single gold standard test for the diagnosis of celiac disease and the diagnosis is based on the presence of a combination of characteristics including the presence of a celiac-specific antibody (anti-tissue transglutaminase antibody, anti-endomysial antibody or anti-deamidated gliadin peptide antibody) and demonstration of villous abnormalities. While the demonstration of enteropathy is an important criterion for a definite diagnosis of celiac disease, it requires endoscopic examination which is perceived as an invasive procedure. The capability of prediction of enteropathy by the presence of the high titer of anti-tissue transglutaminase antibody led to an option of making a diagnosis even without obtaining mucosal biopsies. While present day diagnostic tests are great, they, however, have certain limitations. Therefore, there is a need for biomarkers for screening of patients, prediction of enteropathy, and monitoring of patients for adherence of the gluten-free diet. Efforts are now being made to explore various biomarkers which reflect different changes that occur in the intestinal mucosa using modern day tools including transcriptomics, proteomics, and metabolomics. In the present review, we have discussed comprehensively the pros and cons of available biomarkers and also summarized the current status of emerging biomarkers for the screening, diagnosis, and monitoring of celiac disease. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
21 pages, 3447 KiB  
Review
Use of Hyperspectral/Multispectral Imaging in Gastroenterology. Shedding Some–Different–Light into the Dark
by Samuel Ortega, Himar Fabelo, Dimitris K. Iakovidis, Anastasios Koulaouzidis and Gustavo M. Callico
J. Clin. Med. 2019, 8(1), 36; https://doi.org/10.3390/jcm8010036 - 01 Jan 2019
Cited by 89 | Viewed by 8629
Abstract
Hyperspectral/Multispectral imaging (HSI/MSI) technologies are able to sample from tens to hundreds of spectral channels within the electromagnetic spectrum, exceeding the capabilities of human vision. These spectral techniques are based on the principle that every material has a different response (reflection and absorption) [...] Read more.
Hyperspectral/Multispectral imaging (HSI/MSI) technologies are able to sample from tens to hundreds of spectral channels within the electromagnetic spectrum, exceeding the capabilities of human vision. These spectral techniques are based on the principle that every material has a different response (reflection and absorption) to different wavelengths. Thereby, this technology facilitates the discrimination between different materials. HSI has demonstrated good discrimination capabilities for materials in fields, for instance, remote sensing, pollution monitoring, field surveillance, food quality, agriculture, astronomy, geological mapping, and currently, also in medicine. HSI technology allows tissue observation beyond the limitations of the human eye. Moreover, many researchers are using HSI as a new diagnosis tool to analyze optical properties of tissue. Recently, HSI has shown good performance in identifying human diseases in a non-invasive manner. In this paper, we show the potential use of these technologies in the medical domain, with emphasis in the current advances in gastroenterology. The main aim of this review is to provide an overview of contemporary concepts regarding HSI technology together with state-of-art systems and applications in gastroenterology. Finally, we discuss the current limitations and upcoming trends of HSI in gastroenterology. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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18 pages, 638 KiB  
Review
Microbiome—The Missing Link in the Gut-Brain Axis: Focus on Its Role in Gastrointestinal and Mental Health
by Karolina Skonieczna-Żydecka, Wojciech Marlicz, Agata Misera, Anastasios Koulaouzidis and Igor Łoniewski
J. Clin. Med. 2018, 7(12), 521; https://doi.org/10.3390/jcm7120521 - 07 Dec 2018
Cited by 87 | Viewed by 17702
Abstract
The central nervous system (CNS) and the human gastrointestinal (GI) tract communicate through the gut-brain axis (GBA). Such communication is bi-directional and involves neuronal, endocrine, and immunological mechanisms. There is mounting data that gut microbiota is the source of a number of neuroactive [...] Read more.
The central nervous system (CNS) and the human gastrointestinal (GI) tract communicate through the gut-brain axis (GBA). Such communication is bi-directional and involves neuronal, endocrine, and immunological mechanisms. There is mounting data that gut microbiota is the source of a number of neuroactive and immunocompetent substances, which shape the structure and function of brain regions involved in the control of emotions, cognition, and physical activity. Most GI diseases are associated with altered transmission within the GBA that are influenced by both genetic and environmental factors. Current treatment protocols for GI and non-GI disorders may positively or adversely affect the composition of intestinal microbiota with a diverse impact on therapeutic outcome(s). Alterations of gut microbiota have been associated with mood and depressive disorders. Moreover, mental health is frequently affected in GI and non-GI diseases. Deregulation of the GBA may constitute a grip point for the development of diagnostic tools and personalized microbiota-based therapy. For example, next generation sequencing (NGS) offers detailed analysis of microbiome footprints in patients with mental and GI disorders. Elucidating the role of stem cell–host microbiome cross talks in tissues in GBA disorders might lead to the development of next generation diagnostics and therapeutics. Psychobiotics are a new class of beneficial bacteria with documented efficacy for the treatment of GBA disorders. Novel therapies interfering with small molecules involved in adult stem cell trafficking are on the horizon. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Small Bowel Disorders)
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