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Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Endoscopic evaluation including upper endoscopy (for patients who have upper abdominal symptoms suggestive of CD), flexible sigmoidoscopy, and colonoscopy provides direct visualization of the gut’s mucosa. Characteristic findings of ulcerative and Crohn’s colitis include erythema, edema, granularity, ulceration, and friability of the colonic epithelium. Strictures may result from chronic inflammation. However, it is important to emphasize that these findings, while consistent with IBD, are not diagnostic, since they may also be found in a variety of infectious and other colitides. Abnormalities such as aphthous ulcerations and erythema may also be found in the upper gastrointestinal tract in CD. Biopsies taken during endoscopy may show the presence of granulomas or crypt abscesses and may help confirm the clinical impression.
Clinical Outcomes in Children with NEC
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Intestinal stricture(s) affect up to one in four infants who develop NEC (5) and have the potential to cause intestinal obstruction, recurrent sepsis, intestinal perforation, rectal bleeding, metabolic upset (electrolyte imbalance, hypoalbuminemia, cholestasis), and failure to thrive (42). Stricture(s) usually develop between 3 weeks and 3 months after the acute episode but may occur many months later (43–45). The incidence of clinically significant strictures is considerably less than when strictures are diagnosed radiologically by routine contrast studies (46, 47). This is because strictures identified by contrast radiology include acute inflammatory stenoses that may heal spontaneously, especially if the contrast study is done relatively early after the episode of NEC, but it is fibrotic strictures secondary to ischemia that require treatment.
Interventional radiology
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Common causes of esophageal stenosis in children include congenital and surgical strictures, ingestion of corrosive substances, gastroesophageal reflux, achalasia, and dystrophic epidermolysis bullosa. The natural history, response to treatment, and probability of complications all depend strongly on the underlying cause of the stricture. Repeated dilation is often necessary, especially in children with corrosive injury and epidermolysis bullosa. Resection of esophageal strictures (except for congenital stenosis) is now rarely necessary.
The evolving role of JAK inhibitors in the treatment of inflammatory bowel disease
Published in Expert Review of Clinical Immunology, 2023
Nancy Gupta, Sam Papasotiriou, Stephen Hanauer
In the OCTAVE clinical trial, cases of gastrointestinal perforation could not be completely associated with tofacitinib. Factors included worsening of the disease activity, history of NSAID/corticosteroid use, diverticulitis, appendicitis, sheer mechanical stress, post endoscopic procedure complication in the background of active colitis confounded the association [14]. The IR for gastrointestinal perforation in the OCTAVE Open was rare at 0.08 events (95% CI 0.01–0.30) per 100 patient years. In the clinical trial of UC, no cases of gastrointestinal perforation have been noted with upadacitinib [22]. The side effect of perforation seems counter-intuitive since JAK inhibitors heal frail inflamed intestines. Regardless, caution is advised to avoid its use in patients with predisposing risk factors or strictures. Any case of worsening abdominal pain should be followed up with appropriate clinical and diagnostic workup.
Is there still a role of balloon dilatation of benign ureteric strictures in 2019?
Published in Scandinavian Journal of Urology, 2020
Wai Loon Yam, Sey Kiat Terence Lim, Keng Sin Ng, Foo Cheong Ng
After excluding ureteroileal anastomotic strictures and malignant strictures, there are 109 strictures (100 patients) in in our single center retrospective cohort from August 2012 to July 2018. Non-incidental ureteric strictures are diagnosed by imaging such as CT intravenous pyelogram (CT IVP), intravenous urogram (IVU) and/or retrograde/antegrade pyelogram. An incidental stricture is defined as a stricture encountered during ureteroscopy and impassible by a semi-rigid ureteroscopy. A non-incidental stricture is defined as a stricture that can be diagnosed on preoperative imaging. The age of stricture is estimated by the first symptom (e.g. renal colic in a case of ureteric stone causing a stricture formation) or the first imaging (if asymptomatic) to the date of balloon dilatation is performed. Recurrence of stricture is defined as persistence/worsening on follow-up imaging or the need for long term PCN/DJ stent or need for reconstructive surgery.
Sclerosis as a predictive factor for failure after bulbar urethroplasty: a prospective single-centre study
Published in Scandinavian Journal of Urology, 2018
Teresa Olsen Ekerhult, Klas Lindqvist, Lars Grenabo, Christina Kåbjörn Gustafsson, Ralph Peeker
This series comprises 45 patients, prospectively and consecutively recruited, with bulbar urethral strictures subjected to urethroplasty with resection and end-to-end anastomosis during the period December 2011 to December 2014 at Sahlgrenska University Hospital, Gothenburg, Sweden. Out of the initial 71 patients, 26 were excluded for various reasons (Figure 1). The removed diseased urethral segments were analysed by a uropathologist. The majority of the strictures in the present study were single site strictures (in a few cases there were two bulbar strictures in very close proximity to each other and they were, in all cases, resected in one piece) and the ends of the stricture segments were assessable urethroscopically or radiologically. The research protocol was approved by the University of Gothenburg regional ethical review board (permit no. 663-11) and the patients provided informed consent before the urethroplastic surgery.