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Wednesday, 4 December 2013

Enteritis - The Causes

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Causes
1. Radiation-induced enteritis
Radiation enteritis is a severe problem in patients receiving irradiation of the abdomen or pelvis in the course of cancer treatment. According to the study by Fovárosi Onkormányzat Uzsoki Utcai Kórház Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145, during the radiotherapy of tumors in the minor pelvis and abdomen intestinal inflammation of different degree may occur even if special attention is paid. Irradiation to the minor pelvis causes in half of the cases radiation induced acute enteritis, whereas in 25% chronic enteritis and colitis will develop(6).

2. Virus
Certain virus can induce entertitis including Cytomegalovirus and Norovirus. The Norovirus causes severe gastroenteritis requiring hospitalization especially in children less than five years of age both in developed and developing countries, according to the study to investigate the incidence of norovirus (NoV) in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara, Turkey. Stool samples were obtained from 1000 (413 female, 587 male) children between 0-5 years old with acute gastroenteritis by Gazi University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey, indicated that  NoV detection rate was highest in 2007 (18.4%) and in 2009 (18%), and the difference regarding ELISA positivity among the study years was not statistically significant (p> 0.05). The prevalences of norovirus infection in spring, summer, autumn and winter were 13.8%, 17.7%, 14.7% and 11.2%, respectively. Therefore no seasonal variation was found in the incidence of norovirus infection. However when the monthly prevalence was analyzed, a statistically significant difference was found (p< 0.05) between the rate of norovirus infection in july (24.2%) and december (4.1%)(7).

3. Bacteria
Escherichia coli are ubiquitous bacteria from a wide variety of ecosystems including the gastrointestinal tract of humans and warm-blooded animals. E. coli can play a role as an opportunistic bacteria causing a variety of infectious diseases including, among many others, sepsis, urinary tract infections, meningitis, and wound infections. Moreover, these bacteria can also act as primary pathogens in the intestinal tract, according to the study by Universidad de Barcelona, Barcelona, España(8).

4. Crohn's disease
Crohn's disease is often considered an autoimmune condition, based on the observations of a histopathological inflammatory process in the absence of identifiable causal microorganism(s) and that immune-modulating therapeutics result in diminished host-directed inflammatory pathology(9). Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel, according to the study by, there is a report of a  44-year-old man complained of recurrent colicky abdominal pain and dizziness. Laboratory tests indicated iron-deficiency anemia. There was no evidence of bleeding on esophagogastroduodenoscopic and colonofiberscopic examination. With capsule endoscopy, multiple mucosal ulcers were visualized in the jejunoileal area. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis(10).

5. Medication such as proton pump inhibitors
Gastric acid is a defense mechanism against gastrointestinal infections caused by ingested bacteria. According to the study by Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain, gastric acid suppression induced by proton pump inhibitors (PPIs) but not H2RAs is associated with an increased risk of Campylobacter and Salmonella GE(11).

6. Drugs
There is a report of a 25-year-old woman who was hospitalized repeatedly during a 5-year period due to abdominal pain, change in stool pattern, high CRP and leucocytosis. A thorough interview revealed a recreational use of cocaine, and diary recordings confirmed the association between her abdominal pain and cocaine use(12).
 
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287
(5b) http://www.ncbi.nlm.nih.gov/pubmed/19758501
(6) http://www.ncbi.nlm.nih.gov/pubmed/20739262 
(7) http://www.ncbi.nlm.nih.gov/pubmed/23390907 
(8) http://www.ncbi.nlm.nih.gov/pubmed/22178502 
(9) http://www.ncbi.nlm.nih.gov/pubmed/23256761 
(10) http://www.ncbi.nlm.nih.gov/pubmed/23012673
(11) http://www.ncbi.nlm.nih.gov/pubmed/18054750
(12) http://www.ncbi.nlm.nih.gov/pubmed/19758501