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Wednesday, 4 December 2013

Enteritis - Diseases associated to Entetitis

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.
Diseases associated to Entetitis
1. Functional gastrointestinal disorders (PI-FGID)
A Giardia outbreak was associated with development of post-infectious functional gastrointestinal disorders (PI-FGID) and chronic fatigue syndrome (PI-CFS). According to the study by the University of Bergen, Patients with PI-CFS and/or PI-FGID 5 years after Giardia lamblia infection showed alterations in NK-cell and CD8-cell populations suggesting a possible immunological abnormality in these conditions(18).

2. Small bowel perforation
There is a report of a  case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(19).

3. Severe intraluminal hemorrhage 
There is a report of 4  9-month-old Simmental male calves were presented with a history of sudden death. The necropsy and microscopic findings allowed a diagnosis of enteritis and severe intraluminal hemorrhage with blood clots in the jejunum, suggestive of jejunal hemorrhage syndrome, according to the study by Institute of Veterinary Medicine Belgrade(20).

4.  Chronic and recurrent occlusion events and multiple small intestinal ulcers
Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel. According to the study by Seoul Paik Hospital, Inje University, College of Medicine Seoul, there is a case of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. 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. Cryptogenic multifocal ulcerous stenosing enteritis should be considered in cases of chronic or recurrent occlusion events and multiple small intestinal ulcers and strictures of unknown origin(21).

5. Hypereosinophilic syndrome
Hypereosinophilic syndrome is a blood disorder characterized by the overproduction of eosinophils in the bone marrow with persistent peripheral eosinophilia, associated with organ damage by the release of eosinophilic mediators. Although HES can involve multiple organ systems, GI tract involvement is very rare. Few cases of HES presenting with gastritis or enteritis have been reported worldwide(21a).

6. Systemic lupus erythematosus
There is a reprot of a  38-year-old Persian Iranian woman admitted with a five-month history of diarrhea and abdominal pain. A physical examination showed nothing abnormal. Initially, she had only lymphopenia and mild eosinophilia. No autoimmune or infectious etiology was detected to justify these abnormalities. A thorough evaluation was not helpful in finding the etiology, until she developed a scalp lesion similar to discoid lupus erythematosus. Computed tomography showed small bowel wall thickening. Briefly, she manifested full-blown SLE, and it was revealed that the diarrhea was caused by eosinophilic enteritis, according to the study by Tehran University of Medical Sciences(21b)
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287
(18) http://www.ncbi.nlm.nih.gov/pubmed/23061432
(19) http://www.ncbi.nlm.nih.gov/pubmed/23379792
(20) http://www.ncbi.nlm.nih.gov/pubmed/22851779
(21) http://www.ncbi.nlm.nih.gov/pubmed/23012673
(21a) http://www.ncbi.nlm.nih.gov/pubmed/22900215
(21b) http://www.ncbi.nlm.nih.gov/pubmed/21702974